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Study of data and findings from clinical and applied psychoanalysis suggests a number of common factors encountered with uncommon frequency and intensity in creativity. In this paper, early childhood experiences, sensorial perceptions, body feelings, loneliness, reactions to loss, and body imagery of several artists are discussed. Problems relating to body image in creativeness are explored.
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Despite the fact that most researchers acknowledge the high prevalence of comorbid substance abuse among schizophrenic patients, there is no common agreement regarding the etiology of this serious public health problem. At the center of this debate though, Khantzian's self-medication hypothesis has captured most of the attention. In the present literature review, the authors evaluate this hypothesis in the light of our current knowledge. Formulated in a clinical context, in reaction to the psychoanalytic interpretation of addiction as a pleasure seeking pathology, Khantzian's hypothesis holds that schizophrenic patients use psychoactive substances to relieve their symptoms. Properly understood, this conjecture presupposes that, with the relief of certain target symptoms, substance use would no more be a necessity. But in reality, the use of psychoactive substances usually leads to a general deterioration of the patients' condition. Pharmacodependent schizophrenic patients relapse more often, they are more frequently hospitalized, they show more violent behaviors, and they are more frequently homeless. In particular, the positive symptoms of these patients are generally exacerbated by the psychoactive drugs--with the possible exception of opiates. This observation is in lign with the fact that psychostimulants (cocaine, amphetamines), anesthesic dissociatives (PCP, ketamine) as well as hallucinogens (cannabis, LSD) are all known to exert psychotomimetic effects. As for negative symptoms, the reality is more complex. Preliminary results certainly suggest that stimulants (minor or major) relieve these symptoms, but in the case of the other psychoactive substances, empirical evidence remains fragmentary. Still, the properties of psychoactive substances invite to pay close attention, among the negative symptoms, to the cognitive deficits, the social inaptitudes and the hedonic deficits of these patients. Unsatisfied with the self-medication hypothesis, an increasing number of researchers hypothesize that schizophrenic patients abuse drugs in hope to relieve the negative affects (stress, depression) that commonly accompany their symptomatology. Interestingly, increasing data link these negative manifestations and substance abuse among schizophrenic patients. But these same data do not elucidate whether these manifestations are primary or secondary to drug abuse. For the moment, these findings must be replicated. Furthermore, it remains to be clarified what negative affect is involved here. Is it stress, anxiety or, as commonly thought, depression? Other paths aim in the direction of personality traits and dissociation. The first path is suggested by recent studies demonstrating that pharmacodependent schizophrenic patients differ from non-abusing schizophrenics in that their personality is characterized by traits such as sensation seeking and impulsivity. As for the second path, it is suggested by a recurrent observation in addictive medicine practice, that is: alcohol, cannabis, ketamine, LSD, opiates, PCP, all these substances can induce dissociative states (depersonalization, derealization, etc.). Surprisingly, most of the hypotheses advanced so far have been formulated without reference to neuroscience. However, from a biological perspective, substance abuse among schizophrenic patients appears paradoxical: while the positive symptoms of schizophrenia might involve an hyperactivity of the reward system, the drugs of abuse all seem to increase dopamine release in that same system. That very paradox further casts some doubt on the self-medication hypothesis. And it opens an alternative: schizophrenic patients might be biologically vulnerable to the rewarding effects of drugs abuse. On the therapeutic level finally, the authors argue that polypharmacy medications such as clozapine and quetiapine, known to act on the reward system preferentially to the extrapyramidal system and known to dissociate fastly from the dopamine-D2 receptor, could simplify clinical intervention.
In young children's dreams the infantile wish appears almost undisguised. Freud used this prototypical expression and representation of the infantile wish in a child's dream to bolster his conviction that the infantile wish was at the genetic root of adults' dreams as well. As development proceeds, a child's dream grows in disguise and complexity. This study of one analysand's dreams at age 5, 13, and 20 addresses the complexity from a longitudinal point of view and attempts to track the infantile wish through all of its developmental vicissitudes and disguises.
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School refusal can be divided into different subgroups, i.e. truancy and school-related fears and Phobias. Psychodynamic psychotherapy is primarily indicated in the treatment of school phobia, which is caused by relationship-based separation anxiety due to fixed dyadic patterns. To avoid further chronification a triangular treatment process should be started. If the child is missing out on school, an in-patient treatment should be considered. Thereby, dysfunctional phantasies can be replaced by age-appropriate ego-functions. With parents projective and identification-processes and libidinous overrepresentations can be worked through. School related fears are not psychoneurotic disorders, but real fears regarding violence or unattainable academic demands. Other forms of therapy and educational interventions are indicated in these cases. Parents can be counselled psychodynamically, if needed. Truancy should be treated by educational means, including interventions by social services if indicated.
The concept of change by psychoanalysis has undergone an historical process related to the course and development of psychoanalytic theory. Change has changed from an effect on symptoms, to underlying etiologic conflicts, to background character, to the functioning of psychic structural systems. The psychoanalytic process does not overlap with the process of change. The former may be present without the latter. The will to recover is accompanied by the unconscious need to cover. The methodology of change is examined with regard to process, agent(s), and intrapsychic results. Every analysis is a training and supervised analysis. With increasing autonomy of the ego, the patient, identifying with the analysing functioning of the analyst, becomes his own analyst. The theory of change is related to the psychoanalytic theory of neurosis of which it is part, and differs in alternative theories extant today. The dynamic occurrences I have described as bringing about change rest upon my view of 'total composite psychoanalytic theory' as evolved to the present.
This paper presents an explanation and illustration of the behavioural phenomenon of concretization through acting out. The phenomenon refers to the realization of fantasies and psychic conflicts pertaining to the traumatic past of Holocaust survivor parents, which might have been transmitted to the next generation narratively or beyond words. I have illustrated this phenomenon by material taken from the first stages of the analysis of a young man who shot and wounded his father during the latter's attempt to save him from suicide. The analytic experience facilitated the stabilization of ego boundaries and the emergence of a more secure sense of self.
This paper deals with male impotence in relation to love. A detailed clinical presentation attempts to show how the symptom was embedded in faulty processes of separation-individuation, whereby regression in the service of intercourse, passion and love is hindered by the fears and fantasies underlying merging experiences. These problems are examined as they appear interwoven in transference and counter-transference phenomena. The clinical case presentation is followed by a discussion of different forms of male impotence from a more general viewpoint; its relation not only to castration and phallic anxiety, but also to earlier developmental aspects. Finally, some reflections about male and female gender differences in relation to symbiotic experience.
The development of this clinical case, that of a young mother who was a painter, illustrates the link between motherhood and sublimated creativity. The importance of male identifications, the difficulties of identification with the mother and the guilt connected with penis envy are emphasized. Castration anxiety is attached to the child, experienced as a penis equivalent. Anal fixation also plays a crucial part, aggravating the refusal of an excessively guilt-ridden genital sexuality. The vicissitudes and conditions of female sublimation are discussed.
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.
This paper highlights features of the work on autism of Tustin and others pertaining to the analysis of adult patients. Several clinical illustrations from the analysis of neurotic, borderline and psychotic patients emphasizing the survival function of autistic shapes, objects and delusions are presented. The need for further discrimination between autistic states of mind and other primitive mental states is recommended.
The author inquires whether dreams related in psychoanalysis can be indicator of curative change, and if so what affective conditions go to making this possible. To answer this question convincingly, he puts forward a new model of dream generation. It proceeds from the relation between cognitive elements, regulatory affective processes and species of interaction represented in individual dream situations. Such a model requires a new theory of mental representation, affective processes and memory. For precise analysis of change processes, Moser has recourse to a coding system for dream content. Finally he compares change processes in dreams with those in the psychoanalytic situation and suggests hypotheses on the extent to which changes in dreams can be indicators of changes in the psychoanalytic process.
The author discusses the old question about an exceptional position of the dream in psychoanalysis in a new way: he postulates the exceptional position of the dream in relation to the transference. Case material is given to illustrate how the dream report goes beyond the level of information insofar it is in itself equivalent to a specific ongoing of the transference process. In conclusion the relations between dream and transference are discussed in regard to a hypothetic functional unit.
With a conceptual approach to the Rorschach, there is a strong tie between this test and a theory of personality that lies outside the test itself. Shifts in that personality theory can provide new concepts and formulations for understanding Rorschach data. Such shifts can also promote new and different ways of conceptualizing and using the test. The author contends that changes in psychoanalytic theory are currently facilitating a more experiential view of the Rorschach. He reviews the relationship between personality theory and Rorschach testing, discusses changes in psychoanalytic theory that are leading to a more experiential Rorschach psychology, and describes the meaning of an experiential approach to the Rorschach.
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