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The aim of this paper is to develop a few ideas on the etiology of enuresis nocturna from a systemic point of view. Based on twenty single case studies a typology of the function of enuresis will be described by a detailed analysis of two case studies. The presentation is preceded by a brief summary of the present research situation concerning the etiology of enuresis.
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This paper describes and names as 'enclaves' and 'excursions' two deteriorations of the psychoanalytic situation, which occur when an analyst exceeds the limited, partial acting out inevitable in clinical work. Under pressure from his patient an analyst may unwittingly turn the analysis into a refuge from disturbance, i.e. an enclave. If he succumbs to pressures to move away from, instead of towards, knowing what is psychically urgent, an analyst may turn the analysis into a series of flights, i.e. an excursion. Unrecognized, these deformations interfere with or even halt the therapeutic process, which requires that the analyst find a way of working which accommodates both the patient's communication of, and need for, a refuge or flight with the analyst, while at the same time analysing it.
A 30-year-old single woman came to analysis because of anxiety, guilt and a sense of being bad. After two years of analysis that focused primarily on her relationship with her family members, an unconscious fantasy of having a penis was uncovered. The origin of the fantasy was traced to the narcissistic crisis and the birth of her brother, and as an attempt to regain the loss of mother's love. However, other meanings were added during subsequent developmental stages; namely, the fantasy penis was an umbilical cord that connected her with her mother, it bestowed power and licence to do whatever one wants and was a shield against father's subtle breach of the oedipal fantasies. The resolution of the fantasy passed through a stage of losing the penis and ending up with 'nothing' before a vagina could be experienced as a natural way to be.
This paper results from a research project on the specific characteristics of borderline adolescents and their analysability. An in-depth understanding of the adolescent process is considered essential because it is superimposed on the specific pathology of the borderline subject. Our cases agree in almost all respects with symptomatologies described in the international literature, although pronounced differences emerge in regard to serious acting out and behavioural disturbances. Separation processes, particularly from the mother, are very important in both cases presented. In the authors' view, this research shows that borderline adolescents constitute a definite clinical reality and that strict psychoanalytic technique can be used successfully with them.
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This is the third part of a review and commentary on the psychoanalytic literature on phobias. This section takes up agoraphobia and other phobias of adults, and suggests further avenues for interpenetration of psychoanalytic and psychiatric approaches.
Widespread social crisis phenomena such as unemployment, shortage of housing or lack of prospects are not sufficient to explain aggressive nationalism and the revival of xenophobia in present-day Germany. While from a psychoanalytic viewpoint xenophobia and anti-Semitism have been extensively examined, the same can by no means be said of the phantasm of the "nation". With reference to a case study, the author demonstrates that the adoption of nationalist ideologies (which in Germany specifically are very much bound up with the traditional notion of the nation as a biological organism) can serve both to prevent the outbreak of neurosis at the individual level and to effect what Freud called the "spurious" healing of existing neuroses. Psychologically speaking, the phantasm of the "nation" provides scope for the realization of the desire for pre-ambivalent fusion with an object that has rid itself of everything heterogeneous, alien and autonomous.
This study draws upon both Carlo Ginzburg's procedures for establishing and preserving (historical) evidence and Claude Lévi-Strauss' structuralist approach with its analysis of "primitive" mythologies to demonstrate that binary coding of the social domain is an all-pervasive structural principle. Heim's intention in this is to show that (present-day) xenophobia and racism are the products of a phantasm centering around the division of the world into pure and impure. The author brings into alignment collective fantasies about the homogeneity of the "body politic" with a form of primary narcissism which, if it is to preserve the illusion of original purity, is forced to externalize instinctual urges experienced as heterogeneous and unpleasurable and project them onto "foreigners" and things foreign.
Freud's theory of the antagonism between family and culture provides the point of departure for this study, which sets out to rehabilitate the concepts "ethnic" and "ethnic identity". The family represents the locus of established tradition and familiar ritual and seeks to make each new generation identify with "us and ours". Culture, by contrast, is dependent on contact and confrontation with things alien and foreign. Between these extremes and the potential dangers specific to each of them, ethnicity--which is neither biological nor cultural--represents a mediating factor. In adolescence, a phase of dis- and re-orientation, the individual needs to draw upon his ethnic identity to reconcile the disturbing contradiction between familial and cultural claims, between the native and the alien.
The phenomenon of psychic change has been a subject of interest since the beginning of psychoanalysis. The author presents clinical material from a four-year analysis of a 50-year-old man, including a verbatim session, which illuminates two questions raised about psychic change. (1) What criteria may be used to evaluate psychic change and how do those criteria relate to the concept of 'structural change'? (2) Is it insight or the effects of a new object relationship that is most responsible for the changes that a patient is able to achieve? The search for a single mechanism of psychic change is doomed to frustration. But the author argues that insight is crucial to psychoanalytic change, both for its own sake and for its role in maintaining an understanding relationship.
Change during analysis is here understood as the possibility of elaborating the 'biological bedrock' described by Freud as the repudiation of femininity in both sexes. The analysis of a man with anxiety hysteria permits us to show how temporal regression induced by the analytic setting enables the elaboration of passivity in its fantasy and object-related aspects. The return of this patient seven years after the end of the analysis in a moment of strange coincidence for the analyst, gave rise to a consideration of the difficulties and the issues in topographical and formal regression during analysis: the necessity of working on the dynamics of the narcissistic double and on the anxieties relating to the danger of non-representation and the loss of the capacity for investment. The working through of this primordial passivity, corresponding to active work, concerns analyst as well as analysand in their common work and constitutes the final point which all analyses should reach to achieve a durable change in its topographical, dynamic and economic aspects.
I have not attempted in this paper to discuss psychic change in general, nor the aims of change as such, but rather an approach to achieving psychic change. I discuss the way in which both patient and analyst bring into the analytic relationship their own way of looking at things, their own vertex, and how the converging and separating out of these vertices is part of the movement within the analytic relationship, in the session, where it is experienced by both participants and is basic to the stuff of insight and to psychic change.