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PubMed1984

[Aspects of the preliminary psychotherapeutic phase before analytic treatment of psychosomatically ill patients].

Practical aspects of the treatment of badly affected psychosomatic patients with deficient ego functions are to be presented and discussed here: The presence of the therapist with the patient must be measured in terms of time, space and emotion (not more than 30 minutes; the distance of eye-contact of 1-1,5 m must be kept; kind, dependable devotion). The growth of self-representation and a separate object-representation should be encouraged. This happens a) by enticing the patient to turn his attention from his inner body to the surface of his body and finally to the therapist; b) through the willingness of the therapist to let himself be scrutinized in peace; c) through dialogue between the patient and the therapist. It is of value to attain libidinal cathexis of the body ego of the patient with the help of the therapist and by the patient himself; thereby the old significance can retreat into the background. Overcoming the primary disassociation should be encouraged, namely a) by accepting the limited possibilities of the therapist. b) by showing opposite feelings in the therapist. The present social as well as the previous social situations with the various accompanying inter-personal feelings should make up the content of the discussions between the therapist and the patient in the latter part of the preliminary phase of the treatment. Only after the depicted phase in psychotherapy with badly affected psychosomatic patients attention can be focused on analytical treatment.

Body Image↗
PubMed1983

[The search for meaning--the subject and freedom, a psychoanalytic contribution].

Behaviour or symptoms of neurotic nature are characterized as actions provided we succeed in uncovering their "secret motives" by construction or reconstruction. I. e. we may say insofar we succeed in describing the "whither", the "what for" (S. Freud), to which necessarily belongs "from where" (s. Freud, 1916/17, p. 284, 277) we find sense in nonsense. We also say, that sense already was in existence insofar defense mechanisms were operating preventing its overt expression. But we say sense and rationality have been constituted insofar something, which has never been translated into conscienceness, was raised to the level of language. Both processes take place during the psycho-analytic situation. The following preconditions are apparently necessary for their realization: a) the experience of the acknowledgement of a basic drive-wish by the therapist. This event has the character of evidential nature and as to this is in itself preverbal. Nevertheless we need a verbal phrasing of the corresponding interaction and the accompanying emotion in order that both may be included into the executive power of the ego, i.e. the subject. The strict obedience to the rules of a setting which bind both, patient and therapist at the same time. Because of this a firm basis exists which cannot be doubted. It forms the common background object (J. Grotstein) by which and through which both partners of the dialogue may be "at-one" with one another and to which they may also return insofar further developmental events of their interactional process produce alienations and is pushing them to turn to different external objects. Insofar processes as just alluded to take place, the subject is predicated in a play of argumentated reasoning. And if secret motives and hidden reasons concerning the presented modality of the subject's actions are understood, the subject itself realizes, that it has its origin not in its products but in a negation, in a "zero" position which in itself is a equivalent of freedom. In order that interpretative work in the service of the aims just mentioned may become possible, there are some other preconditions to be fulfilled by the therapist: a) the attitude of "evenly hovering attention" (S. Freud) because it is this attitude which makes the therapist receptive for emotional cathexis, originating in the patient's unconscious.(ABSTRACT TRUNCATED AT 400 WORDS)

Freedom↗
PubMed1984

On the universal nature of primal scene fantasies.

The scope of this paper is limited to inspecting primal scene fantasies, their meaning and function, as part of the primary organizing fantasies in the psychosexual development of the human being. The aim is to examine how primal scene fantasies, throughout life, reflect the shaping of oedipal sexuality. An infant cannot cathect the use of genital functions or their psychic contents by practising them with his more knowledgeable parents or caring persons. In order to alleviate this deprivation the child creates fantasy self objects, proto fantasies of his sexual parents with whom, in the form of primal scene fantasies, he then tries to work out his sexual libido. In our opinion, the formless, psychically non-structuralized impulses of genital-oedipal sexuality tend to awaken an inner state of mind at any stage of life in which the infantile primitive dynamics, helplessness and readiness to destroy, are again repeated. Not only oral desire and the breast alone are 'good' or 'bad'. The same dynamics apply to every impulse for which the actual capacity for psychic work is insufficient. The new inner impulses brought along with progressing psychosexual development can create such a situation. The unstable cathexis of genital-oedipal sexuality is the universal fate of a human being. The child cannot participate in the sexual activities of adulthood, and is unable to cathect his genital functions under real conditions and with real partners. The cathectic wound thus inflicted on the self and the exclusion experienced are essentially bound together. The theme of inclusion or exclusion, so intertwined with the primal scene fantasies, concerns not only object relations, but self-esteem as well.

Adult↗
PubMedDate not supplied

Obesity: locus of control, body image, weight loss, and age-at-onset.

In a retrospective investigation designed to measure locus of control, body image, and weight loss in Overeaters Anonymous members who had childhood, adolescence, or adulthood onset of obesity, 116 subjects were grouped according to age at onset of obesity and the year they joined OA. A convenience, volunteer sample of OA members completed a demographic data questionnaire, Rotter's Social Reaction. Inventory, and Secord and Jourard's Body Cathexis Scale. Significant overweight percentage differences were not found when the three age-at-onset groups were compared. Significant differences emerged, however, for adolescent-onset group persons who were categorized as "old" members; they had a larger weight loss and were more satisfied with their body image. A positive linear relationship between greater perception of internal control and a good body image was found in the entire adulthood-onset group. Weight loss and good body image of the oldest adolescent-onset group probably was the outcome of their association with a self-help group i.e., OA. Assessment of developmental issues related to the time of initial weight gain may indicate which treatment regime would be most effective.

Adolescent↗
PubMed1982

Female masturbation in adolescence and the development of the relationship to the body.

The significance of the role played by masturbation in the female is examined from a developmental point of view in order to question the assumption, often made, that female masturbation has the same normal significance as masturbation for the male. In order to do so, the difference between attitudes to male and female masturbation is defined as a difference in attitude to the use of the hand for masturbatory activity and is related to the observation that it is that activity that female children give up post-oedipally and again in post-puberty. The unconscious meaning of the hand, as identified with the mother's active handling of the child's body, is examined to show that masturbation is needed by the child to internalize a positive narcissistic cathexis of the body as well as a means of separating from the mother's body. The continued use of the hand during adolescence and adulthood by the girl or woman is then seen as a defensive means of maintaining a positive relationship to her own sexual body once the girl's body has become identified with that of her mother. The failure of this defence when used by the girl as a means to maintain a positive relationship to her own sexual body is seen as leading to the unconsciously determined need to attack her body, as can be observed clinically in those adolescents who physically attack their body.

Adolescent↗
PubMed1982

Strachey's influence: a preliminary report.

James Strachey stands between his reader and Freud precisely because he translated and organized Freud's life work. Therefore we need to know what Strachey took for granted and how he made his choices in order to begin to disentangle Strachey's views from Freud's. Freud had no fear of sounding disorderly when describing what he could not see and did not understand. In fact, he was trying to reveal the faults in his own ideas by putting them as clearly as he could. Freud also began to develop intricate and nonspatial conceptions, but even these more abstract ways of thinking about unconscious activity are usually laid out in plain German. In his translation 'A Child is Being Beaten' Strachey always chose simple clarity. Because he believed that Freud was describing facts and forces which accounted for them, Strachey usually chose the most authoritative tone or quantitative term. This was a serious mistake. Strachey shifted Freud's focused questions and flexible approximations into artificial words which have the ring of set explanations. I have shown that much of what Freud wrote about ideas which are now called mental representation, drive and instinct, mental object relationships, developmental differentiation, ego-id-superego, regression, repression and cathexis is missing in Strachey's wording. By condensing some of Freud's descriptions of his own ideas, Strachey composed a premature technical language which isolated Freud's work from the science of his time, as well as ours, and may have hindered the development of psychoanalytic theory.

Child↗
PubMed1981

Developmental aspects of the interaction between narcissism, self-esteem and object relations.

This paper reviews the history, within psycho-analysis, of narcissism and shows that it cannot be understood as a unitary concept. This is reflected in much of the extensive literature on the topic. The definition of narcissism solely in terms of the libidinal drive cathexis of the self representation is rejected. Instead, narcissism is defined as the sum of the positively-coloured feeling states attached to the self-representation. By pursuing a developmental investigation of narcissistic and opposing phenomena, the multiple sources which contribute to or detract from the overall level of self-esteem are demonstrated. Such an investigation clarifies the close relationship between the concepts of self-esteem, well-being and narcissism, and differentiating definitions are put forward. The term 'counter-narcissistic' is introduced to denote the negative contributions to self-esteem which detract from the narcissistic input. The interplay between the contributions to the overall quality of self-esteem, deriving on the one hand from somatic and instinctual drive sources, and on the other from object relationships, exemplifies the multiple origins of its qualities at any one time. This interplay is pursued through the sequential developmental phases from infancy to the oedipal level in order to show the complex epigenesis of narcissism, counter-narcissism and self-esteem.

Ego↗
PubMedDate not supplied

Some clinical manifestations of structural defects in a borderline personality.

A case is presented that illustrates specific clinical manifestations of structural deficits and psychopathological complexes characteristic of borderline patients. Following an overview of the patient's presenting problems and history, the patient's personality organization is conceptualized metapsychologically. Then the clinical manifestations of three core problem areas in the patient are explored: (1) deficits in narcissistic cathexis leading to clinically apparent, primitive, self-confirming character traits, (2) fear of helplessness and pathological attempts to establish a sense of control, and (3) arrest of drive development coupled with limited ego capacity for sublimation.

Adult↗
PubMed1995

Chronic psychological effects of exercise and exercise plus cognitive strategies.

Psychological changes associated with 16-wk moderate and low intensity exercise training programs, two of which possessed a cognitive component, were evaluated. Subjects were healthy, sedentary adults, 69 women (mean age = 54.8 +/- 8.3 yr) and 66 men (mean age = 50.6 +/- 8.0 yr). Participants were randomly assigned to a control group (C), moderate intensity walking group (MW), low intensity walking group (LW), low intensity walking plus relaxation response group (LWR), or mindful exercise (ME) group-a Tai Chi type program. Women in the ME group experienced reductions in mood disturbance (tension, P < 0.01; depression, P < 0.05; anger, P < 0.008; confusion, P < 0.02; and total mood disturbance, P < 0.006) and an improvement in general mood (P < 0.04). Women in the MW group noted greater satisfaction with physical attributes (body cathexis, P < 0.03), and men in MW reported increased positive affect (P < 0.006). No other differences were observed between groups on measures of mood, self-esteem, personality, or life satisfaction. Equivocal support is provided for the hypothesis that exercise plus cognitive strategy training programs are more effective than exercise programs lacking a structured cognitive component in promoting psychological benefits.

Adaptation, Psychological↗
PubMed1995

[The painful body of the psychotic. A balance between psychiatric symptoms and somatic diseases in somatic patients].

This paper revises the medical and psychoanalytical studies approaching the relationship between physical and psychiatric symptoms in the psychotic patient, with special attention to P. Marty, A. Andréoli and C. Dejours works. The authors report two patients suffering from mood disorders whose psychiatric symptoms disappeared when a pneumonia appeared. They also present two psychotic patients who has been treated for several years with description of the oscillation between psychiatric and physical symptoms. Psychiatric symptoms in psychosis permit a discharge way of the psychic excitement that provides a protective effect against somatic disorders. The effectiveness of ancient or modern psychiatric therapeutics is partially based on their body effect (like hypoglicemics in Sakel therapy, seizures in E.C.T., fever in malaria therapy, iatrogenic parkinsonism in neuroleptic treatment). Human physical illness allows body cathexis and reorganization of the psychic life.

Adult↗
PubMed1993

Body image of achondroplastic children before and after leg elongation.

Body image disturbance was studied in 6 achondroplastic children before and after surgical leg elongation (Wagner's procedure) using Fisher's Draw-a-Person Test and the Body Cathexis Test, as well as on another group of 6 achondroplastic children who had undergone the same procedure several years earlier. These groups were compared with 12 healthy control children. Gross disturbance of body image was present before the operation with a substantial improvement after the procedure. However, even years after the surgical procedure there still exists a difference in body image between the control-normal group and achondroplastic adolescents.

Achondroplasia↗
PubMed1993

[The future of a nation. Political and psychoanalytic reflections on German re-unification].

Taking a lead from Alexander and Margarete Mitscherlich's psychogram of post-war German society in The Inability to Mourn and Heinz Kohut's remarks on a theory of narcissism, the authors interpret the over-hasty reunification process and the liquidation of the GDR as an attempt to remedy the precarious nature of the collective narcissistic equilibrium. As in the post-war period, when concern with the immediate past was stifled by "reconstruction" and the "economic miracle", so the advent of "deutschmark nationalism" after 1989/90 was marked by the central role played by money. In the emotional cathexis centering around money the authors identify a collective tendency to restore a lost self-object and revive an archaic megalo-self that was thought to have been abandoned for good with the downfall of Hitler.

Democracy↗
PubMed1995

Countertransference as instrument and obstacle: a comprehensive and descriptive framework.

A comprehensive and descriptive approach to counter-transference phenomena is proposed. Three types of mental activity are distinguished: the objective-rational attitude is an adaptive, relatively nondefensive mode of observation; the reactive mental state corresponds to the classical notion of unconscious counter-transference as an obstacle and a defense; by contrast the reflective attitudes involve preconscious and conscious psychical activity. Reflective activity involves four phases: (1) during emergence, an inner reaction appears; (2) immersion, through a regressive exploration, leads to introjective identification; (3) integrative elaboration involves a shift in cathexis, more distance, and an organization of the regressed contents, while (4) an interpretation is forming in mind. Three case examples from the literature serve to illustrate.

Countertransference↗
PubMed1997

Hypochondria versus the relation to the object.

In the context of ideas of Freud, Klein, Bion, Rosenfeld and others on hypochondria, psychic development and object relations, the author presents the case history of a female patient who anxiously takes flight from the analyst's interpretations into somatic pains. The experience of separateness and of the 'facts of life' is so unbearable to her that she prefers a dialogue with her body to one with the analyst. Cathexis is withdrawn from the frustrating external object and transferred to an organ of the body, which, however, also proves inadequate and is hated, because, as the author shows, the processes of projection and introjection are inescapable. Clinical material is given to demonstrate how the patient uses hypochondriacal states to ward off a psychotic breakdown. Progress ensues when the analyst realizes that the patient's hypochondria is a form of communication in body language. In a particularly telling sequence, the patient physically averts her eyes from the unbearable reality of a rose in the consulting room because it stands for the separateness of the analyst. But interpretation gradually ushers in processes of symbolization, whereby the concrete physical injury felt by the patient to have been inflicted on her by the sight of the rose is turned into a symbolic 'allergic' reaction and the allergy becomes metaphorical.

Female↗
PubMed1997

[Therapeutic effects of the Feldenkrais method "awareness through movement" in patients with eating disorders].

Based on the movement-pedagogical concept of Feldenkrais and the findings-of disturbed body perception by eating disordered patients this research aimed at studying the therapeutical effects of the Feldenkrais Method "Awareness through Movement" with eating disorder patients, 15 eating disordered patients treated at the Roseneck hospital for behavioural medicine rated-by means of a questionnaire consisting of scales of the Body Cathexis Scale (BCS), the Body Parts Satisfaction Scale (BPSS), the questionnaire for body perception (Fragebogen zum Körpererleben; FKE), the Emotion inventory (Emotionalitätsinventar; EMI-B), the Anorexia-Nervosa-Inventory for Self-rating (ANIS) and the Eating Disorder Inventory-2 (EDI)-various aspects of their eating disorder before and after participating in a nine hour course of the Feldenkrais Method. The data of these patients were compared to those of the members of a control group, also consisting of 15 eating disordered patients who did not participate in a Feldenkrais course. The participants of the Feldenkrais-course showed increasing contentment with regard to problematic zones of their body and their own health as well as concerning acceptance and familiarity with their own body. Other results were a more spontaneous, open and self-confident behaviour, the decrease of feelings of helplessness and decrease of the wish to return to the security of the early childhood, which indicates the development of felt sense of self, self-confidence and a general process of maturation of the whole personality. The outcome points to the therapeutical effectiveness of the Feldenkrais Method with eating-disorder patients within a multimodal treatment program.

Adolescent↗
PubMedDate not supplied

[Difficulties of describing human relationships with the help of psychoanalytic descriptive models: a critique of ego-psychology].

Progress of psychotherapy and of related behaviour sciences makes evident the importance of a better understanding of human relations. But psychoanalysis finds it hard to describe interpersonal processes without transference. In order to remain within the conceptional frame of metapsychology it has to see interaction between individuals as the oral, aggressive or sexual cathexis of an object or as satisfaction or denial of the subject by the object. The structure of the "ego", which--in analogy to medical thinking--is conceived as an organ with its functions, is considered to have no interpersonal activities. The "ego" of the classic psychoanalytic theory is chiefly occupied with itself. It has to care for its egoistical interests and to guarantee its self-preservation. As an auxiliary and meanwhile popular concept the "self" has been introduced to describe object-relations. This concept is not sharply defined. Due to its metapsychological implications it produces additional theoretical difficulties. Linguistic studies show that every inventory of words implies a certain insight into reality. For this reason the metapsychological machine-like concept of psychic structures does not permit new ideas about interpersonal relations. If we leave metapsychology and base on colloquial speech we see that the experience of "I" is much more related to persons than the rather autistic concept of the "ego" shows. Further we learn that self-preservation cannot be an egoistical interest; it depends on the attachment to others. All feelings of self-esteem depend much more on interpersonal relations than on "narcissistic regulations". From these experiences three conclusions are derived: a) One of the main qualities of the ego is the relatedness to persons. b) The concept of narcissistic regulation as a successor of primary narcissism is no longer useful. Narcissistic traits develop as the secundary compensations if the individual failed to build up satisfactory interpersonal relations. c) The revision of (a) ego-psychology and (b) theory of narcissism asks for modifications of the therapeutic technique, where now the interest is especially concentrated on interpersonal problems instead on the pathology of the ego.

Drive↗
PubMedDate not supplied

[Psychodynamics of psychogenic fever].

In this study we aimed to formulate a psychological framework on the origins of vegetative fever. Our sample comprised 13 patients. Concerning the structure of personality we found, that all the patients came from broken homes, that they showed pronounced disturbances in their inter-personal relationships, that they had developed an extremely exigeant ideal ego and that they strongly suppressed their aggressiveness. We were able to define two characteristic situations which can trigger vegetative fever; the break-down of the ideal ego due to external traumatic circumstances and the threat of the disolution of a symbiotic relationship. Beside the vegetative fever all our patients showed a great number of other psychological or functional disturbances. Only a few of the psychologically severely affected patients could be treated with psychotherapy. The pronounced tendency to somatize with a strong libidinal cathexis of the whole organism can be interpreted as an attempt to restore the feeling of coherence of the ego in order to avoid it's psychotic break-down (Meng).

Adolescent↗