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PubMed1998

The body in analysis: authentic movement and witnessing in analytic practice.

This paper will describe a form of active imagination called authentic movement, in which attention is given to the somatic unconscious. In authentic movement, patients are encouraged to focus inward and attend to any bodily sensations, images and feelings which may arise. In the process of focusing inward on one's bodily-felt experience, images, somatic memory and the accompanying feelings which arise are then available to be explored as a communication from the patient's unconscious. Authentic movement supports the individual in linking image with affect in that the individual re-experiences the somatic aspect of symbolization. What was previously conserved on the somatic level as unmentalized experience, can now begin to be taken up into the mind, thought about, and made available for analysis. In authentic movement, the analyst acts as a silent witness to the patient's explorations. The quiet focused attention of the witness helps to create a secure containing environment in which the person moving can experience a sense of feeling held and seen. The function of the witness is to hold the patient's experience in his own mind, particularly what is not yet mentalized. The witness utilizes his somatic countertransference, including any images, feelings and bodily responses which are generated by what is being communicated non-verbally, as a means of understanding and responding to the patient's material.

Adult↗
PubMed1999

The relevance of attachment theory to a contemporary Jungian view of the internal world: internal working models, implicit memory and internal objects.

In this paper I examine the various meanings of the term 'internal object' and the differences between various theoretical models for the formation of internal objects. I suggest that the idea in attachment theory of 'internal working models' emphasizes the internal world as one consisting of unconscious internalized patterns of emotional relationships. The term 'internal object' lacks this clarity and the different meanings it carries within differing theoretical frameworks are a source of confusion. I describe the role implicit memory plays in the formation of 'internal working model's and suggest that these offer us an alternative explanation for unconscious fantasy and for object relationships to that of instinctual drives. This model is then brought to bear on contemporary Jungian concepts of the internal world, with a suggestion that, seen in this light, Jung's formulation of the concept of the complex has many features in common with the 'internal working model' of attachment theory.

Drive↗
PubMed2002

Exploring racism.

Whilst the concept of 'race' has no basis in genetics or biology, the dynamics of racism pervade all aspects of modern life--including the consulting room. In this paper the relationship between a white therapist and a black patient is explored through an unbidden thought and a verbal slip that occurred in the course of the therapy. The amplification and examination of these unwanted 'slips' are used to shed light on the subtleties of the effects of difference in colour on the relationship. It is argued here that the interaction reflects and illuminates the asymmetrical relationship between 'black' and 'white' in modern-western society. This is then considered using the concepts of the cultural unconscious and social unconscious as ways of understanding the tenacity of racism in ourselves.

Culture↗
PubMed2005

2. Freud's 'id' and Jung's 'self' as aids in self-analysis.

The id and the self are described as constructs of our unconscious which can be deployed in describing the analytic process. They can be used like the x in mathematics or the joker in a pack of cards as fitting in almost anywhere. But we can call on them as important aids to concentration, when additional room is made for meditating on the past which then comes to life again. They are useful for analysing ourselves and others. In this way the id as well as the self become aide-mémoires. The analysis of the repressed by means of the transference is not the only road to hitherto unconscious memories. This kind of meditation has helped me despite all reservations to undertake self-analysis and to write an autobiography. I maintain that one can have a transference to oneself. It is, of course, narcissistic. But then, no one can write an autobiography without a healthy dose of narcissism.

Ego↗
PubMed1988

A comparison of oxygen therapy devices used in the postoperative recovery period.

Seventy-one patients scheduled to undergo upper or lower abdominal surgical procedures were allocated at random to one of seven treatment groups: in the recovery room they were to receive oxygen via a 40% Ventimask with 10 litres/minute oxygen flow, or via either a Hudson mask or a nasal cannula with 3, 6 or 9 litres/minute oxygen flow. The 40% Ventimask gave the most consistent, satisfactory postoperative values of PaO2 but the much cheaper nasal cannula at 6 or 9 litres/minute was generally adequate in conscious patients. The performance of the intermediately priced Hudson mask was similar to that of the nasal cannula at these flows. The unconscious state was associated with a 45% lower PaO2 than the rousable or awake states. Differences between the treatments with regard to postoperative PaCO2 were small and non-significant. The nasal cannula with 6 litres/minute humidified oxygen flow is recommended for routine treatment, and the Ventimask for unconscious patients.

Abdomen↗
PubMed2005

Communication with critically ill patients.

AIM: This paper reports a study that investigated the experiences of a group of critical care Jordanian nurses concerning verbal communication with critically ill patients. BACKGROUND: There is evidence that communication in critical care settings is not sufficiently implemented in practice. Inadequate nurse-patient communication results in increased levels of stress and anxiety. Verbal communication can help patients preserve their self-identity and self-esteem, which in turn will enhance their well-being and optimism. METHOD: The study was guided by the phenomenological hermeneutics of Heidegger. Data were generated in 2002 from in-depth interviews and overt participant observation, and analysed qualitatively. FINDINGS: Unconscious patients received less verbal communication and interaction than verbally responsive patients. CONCLUSION: Communication with sedated or unconscious patients in intensive care units should not be viewed as only an interactive process. Rather, it should be perceived as the means to give the information and support that such patients need.

Attitude of Health Personnel↗
PubMed1977

Anaphylactoid reaction to dextran---a report of 133 cases.

From 1968 to 1975, the Swedish Adverse Drug Reaction Committee received 113 reports on anaphylactoid reaction to dextran 70, and 20 reports on the same reaction to dextran 40. For 1975, this would equal a reported incidence of anaphylactoid reaction to dextran 70 of 1:2,500. The median age of patients reacting to dextran 70 was 63 years. Median age increased with increasing severity of the anaphylactoid reaction: from 48 years in patients who died. Symptoms were noticed within 10 min of the start of the infusion, or before 100 ml had been infused in 96 patients (85%) with an anaphylactoid reaction to dextran 70. There was a tendency for severe reactions to be observed earlier than milder ones. Symptoms also tended to be observed earlier in conscious than in unconscious patients. Reactions reported to have occurred in unconscious patients tended to be more severe than those in conscious patients. Patients with anaphylactoid reaction to dextran 40 did not differ from those with reactions to dextran 70 with regard to age, severity of the reaction or time before onset of symptoms. There was one death in this group.

Age Factors↗
PubMed1990

Gnosticism and psychology. Jung's Septem sermones ad mortuos.

In this paper, I have attempted a historical analysis of what Jung might have been thinking when he wrote the 'Seven sermons'. To this end, I tried to ascertain which Gnostic texts Jung may have consulted before writing it. These documents were then compared with the 'Seven sermons', and numerous affinities noted between it and the Gnostic texts. Jung's contemporaneous academic works were then compared with this treatise, and parallels were established between the 'Seven sermons' and Jung's emerging psychology of the unconscious. In the process, an attempt was made to show how Jung made use of Gnostic themes in his emerging psychology. While there is no way of knowing precisely what Jung was thinking when he wrote the 'Seven sermons', it is clear that he was well acquainted not only with the work of Basilides, but also with the work of other Gnostic thinkers. It is not enough to assume that because Jung chose the pseudonym of Basilides, he was necessarily Jung's primary Gnostic influence. At the same time, it is also evident that Jung was developing his own psychology during the writing of the 'Seven sermons'. We recall Jung's observations regarding the 'Seven sermons', which we quoted on page 17: These conversations with the dead formed a kind of prelude to what I had to communicate to the world about the unconscious . . . All my works, all my creative activity, has come from those initial fantasies and dreams which began in 1912, almost fifty years ago. Everything that I accomplished in later life was already contained in them, although at first only in the form of emotions and images (Jung 21, p. 192). On the basis of what has been published, there are enough affinities between his academic work and this treatise to posit that the 'Seven sermons' played an important role in the emergence of Jung's psychology. Given these numerous parallels, I suspect that Jung's unpublished writings, including the Red Book, would only strengthen the arguments put forth in this paper.

Attitude to Death↗
PubMed2006

Discontinuities in the male psyche: waiting, deadness and disembodiment. Archetypal and clinical approaches.

The discontinuities of development in the male psyche that are manifested in some analyses in unconscious experiences of inner disintegration are described. Narcissism and a de-somatized relationship to their own presence are the dominant clinical presentation in these patients. The analyst sometimes experiences these analyses as 'dead', as a result of the projection of a 'dead mother' object. The question of how psychic deadness and impotence can be worked with is examined. Clinical experience with these men shows how notions associated with the puer-senex archetype can illuminate the stark realities of a patient's early experiences, particularly in how mother's presence is felt. A theoretical and clinical bridge is proposed between puer and narcissus to frame how a man may unconsciously strive against psychic fragmentation by clinging to an identification with both--in order to remain intact in the face of being caught in a pre-pubescent state which reflects the insecure attachment to mother. The author describes how patients may find a more grounded embrace of reality via the use of the analyst's empathy and a greater potency through work in the transference/countertransference. These strengthening achievements help men to begin to leave the 'dead mother' behind.

Dreams↗
PubMed1998

Epilepsy and recursive consciousness with special attention to Jackson's theory of consciousness.

John Hughlings Jackson's theory of consciousness has been reconsidered. The author stressed that his uniqueness as a neuroscientist lay in his keen interest in the recursive nature of human consciousness. Two clinical symptoms of interest to Jackson were discussed: recurrent utterances and mental diplopia. Recurrent utterances were believed to represent an exceptional state, in which the unconscious process in speech production, otherwise destined to be swept away automatically, became manifest and observable. Jackson regarded mental diplopia as a revelation of otherwise inaccessible duality of all healthy mental actions. Therefore, he supposed that the essence of recursive consciousness resided in a transformation of multiple, multidirectional, unconscious processes into a linear, unidirectional process.

Cognition↗
PubMed1991

Ownership: a pathography of the self.

With this essay I intend to base a theory of psychodynamics on the concept of ownership. I begin with the crucial but negative notion, unconsciousness, exploring certain ways in which this notion is necessary to any psychodynamic theory. Following Havens (1986), I take the concept of self as supraordinate to the elements of psychoanalytic structural theory. Building upon a unique relationship between the self and the unconscious, I then show that variations in self-ownership suffice to generate the gamut of psychopathological situations. I critique the economic aspect of Freudian psychodynamic theory, suggesting a way to improve upon it. In light of the theory thus elaborated, I examine the problem of deliberate suffering. Finally, I suggest a place of special importance for the present theory in psychoanalysis and psychiatry.

Ego↗
PubMed2006

On making the right choice: the deliberation-without-attention effect.

Contrary to conventional wisdom, it is not always advantageous to engage in thorough conscious deliberation before choosing. On the basis of recent insights into the characteristics of conscious and unconscious thought, we tested the hypothesis that simple choices (such as between different towels or different sets of oven mitts) indeed produce better results after conscious thought, but that choices in complex matters (such as between different houses or different cars) should be left to unconscious thought. Named the "deliberation-without-attention" hypothesis, it was confirmed in four studies on consumer choice, both in the laboratory as well as among actual shoppers, that purchases of complex products were viewed more favorably when decisions had been made in the absence of attentive deliberation.

Attention↗
PubMed1978

Changing pattern of drugs used for self-poisoning.

In 1967-76 the annual number of admissions to a poisoning treatment centre rose from 964 to 2134. The proportion of admissions caused by taking barbiturate hypnotics and methaqualone fell considerably while that caused by taking benzodiazepines and tricyclic antidepressants increased. As a result the proportion of patients admitted unconscious fell from 23% to 15%. The declining contributions of barbiturates and methaqualone and increased importance of tricyclic antidepressants were significant in all grades of coma. The change in drugs taken, however, has not yet reduced the percentage of unconscious patients needing endotracheal intubation or assisted ventilation, and hypothermia remains as common. Only hypotension has become less frequent as antidepressants replace barbiturates as the main cause of drug-induced coma. The use of salicylates for self-poisoning is declining slowly, and paracetamol poisoning is now as common.

Acetaminophen↗
PubMed1979

Long-term outcome after severe head injury.

From a consecutive series of 7000 patients with head injuries admitted to the regional accident service, Radcliffe Infirmary, Oxford between 10 and 24 years earlier, every patient was taken who had been amnesic or unconscious for one week or longer. Of these 479 patients, all but ten were traced, and either the cause of death was established or the survivors examined. Ten years after injury 4% were totally disabled, and 14% severely disabled to a degree precluding normal occupational or social life. Of the remainder, 49% had recovered, and the rest were dead. Additionally, a selected series of 64 patients whose unconsciousness had been prolonged for a month or more were studied. Forty of these had survived between three and 25 years after injury and were re-examined. On the basis of age at injury, the worst state of neurological responsiveness, and the duration of posttraumatic amnesia, the outcome of head injury can be predicted reliably in most cases. Patients and relatives need more reassurance and simple psychotherapeutic support, especially in the first few months after injury. Extrapolation from our figures suggests that each year in England and Wales 210 patients survive totally disabled and another 1500 are severely disabled.

Adolescent↗
PubMed1975

Variations in clinical presentation of Fallot's tetralogy in infancy. Angiographic and pathogenetic implications.

Striking variability has been observed in the presenting features in infancy of patients subsequently shown to have tetralogy of Fallot. Some patients presented with severe cyanosis in the neonatal period while others had a systolic murmur and cyanosis only on crying. In these latter patients cyanosis became present at rest over the subsequent months. Yet others presented with episodic attacks of unconsciousness, and a final group presented with dyspnoea and heart failure, accompanying a left-to-right shunt. Angiography demonstrates corresponding variations in the anatomy of the ventricular outflow tracts. In the severely cyanosed patients, the conus septum was deviated so as to obstruct the pulmonary outflow tract, and was best visualized in the lateral projection. In the patients with increasing cyanosis or episodic attacks of unconsciousness, the conus septum again obstructed the pulmonary infundibulum, but was obliquely orientated, not being seen clearly on either lateral or frontal projections. The episodic attacks were considered to be related to infundibular spasm, as previously shown to occur in Fallot's tetralogy. In contrast, increasing cyanosis was believed to be related to hypertrophy of infundibular musculature. In the patients with an initial left-to-right shunt, the arteries were orientated side-by-side so that the conus septum was observed in the frontal projection. Again, subsequent cyanosis was related to ventricular hypertrophy producing outflow tract obstruction. These findings are interpreted in the setting of a recent study, indicating that Fallot's tetralogy is produced by rotation of the embryonic conus together with sinistro-anterior deviation of the conus septum.

Angiocardiography↗
PubMed2001

Hearing voices: the fate of the analyst's identifications.

Using detailed clinical examples, the author illustrates the function of conscious and unconscious identifications with former training analysts, supervisors, teachers, and theorists in the mind of the working analyst. As compromise formations, analytic identifications are the product of loving and aggressive wishes, defenses against those wishes, and self-punitive trends that accompany the analyst in the work. The analyst's stance at any given moment has an identificatory history that may become conscious at certain times with certain patients. While the analyst's identifications modify over time, following a predictable developmental path, they are never fully given up, but consciously and unconsciously remain an active part of the analyst's inner life. During the clinical hour they are responsive to both the analyst's and the patient's conflicts, and they coexist in a dynamic reciprocal relationship with the patient's inner life.

Conflict, Psychological↗
PubMed2003

Psychic trauma and traumatic object loss.

Psychoanalysis began with the concept of psychic trauma, which was subsequently not clearly differentiated from traumatic object loss or from unconscious conflict and fantasy. Psychic trauma is investigated in relation to unconscious conflict, with and without concurrent object loss. The syndromes of PTSD, uncomplicated by object loss, of traumatic bereavement, and of relatively nontraumatic bereavement, though often interwoven and inseparable, are all different. The significance of the loss, sociocultural factors, and group process influence individual responses to trauma and traumatic bereavement. There are specific neurobiological and psychological sequelae of traumatic experience. Clinical applications are noted.

Bereavement↗
PubMed2004

The psychoanalytic assumption of the primary process: extrapsychoanalytic evidence and findings.

No evidence for an assumption of a theory can be gained by data derived from methods dependent on that theory. Three experiments, using methods independent of psychoanalysis, test the psychoanalytic posit that primary process exists as a formal mental mode distinct from secondary process. The three experiments, using a nonpsychoanalytic index for primary process, test for a preponderance of primary process organization in three areas in which Freud observed primary process: (1) in unconscious mental states and during implicit tasks; (2) in the mental productions of preschool children; and (3) in anxiety states, as these are typically associated with unconscious conflict. All three experiments show significant results in favor of the primary process. Further, the three experiments taken together, because they account for seemingly disparate data, lend further credence to the original assumption. These positive results suggest that primary process may be more important than even Freud suspected. Perhaps it is the basic mental organization in many nonhuman mammals and some birds. Primary process organization may also underlie aspects of such basic psychological operations as generalizations in conditioning and assessments-in-action, as opposed to judgments proper, about how one would act. Finally, primary process may play a key role in drive activity. Three types of experiments are proposed to test these far-reaching applications of the primary process concept.

Anxiety↗