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Cordelia, Lear, and forgiveness.

Painful human interactions are often followed by urges to forgive, be forgiving, or seek forgiveness. The insight analysands develop into their transferences highlights their finding gratification in constantly reenacting painful interactions. Their new understanding can make forgiveness seem irrelevant; waiving the question of forgiveness might then seem the wiser course to follow. Also thrown into question is whether total forgiveness of self and others can ever be achieved. Shakespeare's The Tragedy of King Lear raises these questions. There we encounter, first, the painful interaction of Cordelia and Lear and, finally, Cordelia's response, "No cause, no cause," to a dying Lear's begging her forgiveness for having initially treated her cruelly. Cordelia's response seems to be waiving the question of guilt and forgiveness, but could it be wholehearted? In a search for answers, a reading of Cordelia's and Lear's lines is interwoven with interpretations of unconscious conflict that might be considered were one to encounter clinically a "Cordelia" abused by an aging and failing father at a turning point in her womanly development. Unconsciously, it is concluded, unforgivingness persists alongside the loving, insightful waiving of forgiveness made possible by higher-level ego functioning. Methodological reflections on reading and interpretation are included.

Death↗

Fantasy formation: a child analyst's perspective.

Unconscious fantasy is the principal unit of psychoanalytic investigation. Though individual fantasies, either conscious or unconscious, may emphasize drive, defense, or superego interests, all fantasy life develops from a limited number of themes; these themes concern drive-related issues, experiences of helplessness, or combinations of both. Fantasy formation and fantasy content undergo developmental change. Sensorimotor, behavioral memories occur prior to fantasy and are influential in determining repetitive behavioral enactments. The complexities of infant behavior do not require the postulation of fantasy or representational memory. A complex, innate, instinctual organization of the newborn, similar in many respects to that of other newborn mammals, and distinct from the psychological organization of the older infant, is suggested as an explanation of these phenomena.

Adolescent↗

Aggression and love in the relationship of the couple.

In this paper I examine the interplay of love and aggression in a couple's emotional relationship. I explore the activation of dominant repressed or dissociated object relations with the parental figures, and the unconscious collusion of both partners to enact these past relationships in the present. I then examine the couple's relationship as determined by differences in male and female development, as well as the counterpart of these differences--unconscious moves toward "twinship" and complementarity. Unresolved oedipal conflicts are explored as a major cause of invasion of the couple's sexual boundaries, and a vehicle for the expression of dissociated aggression from many sources. Perversity--the "recruitment of love at the service of aggression"--as a threat to the basic fabric of a couple's love life is one alternative to the normal channels for elaboration of aggression in their relationship. Protective functions of the couple's interaction with their social network are examined in the context of their elaborating and integrating aggression with love.

Aggression↗

Sadomasochism in the neuroses conceived of as a pathological compromise formation.

Masochistic phenomena in adults are discussed as derivatives of conscious and/or unconscious fantasies. These masochistic fantasies are always associated with conscious and/or unconscious narcissistic and sadistic fantasies. These fantasies, like all fantasies in adults, are conceived of as compromise formations. After a selected review of the literature, analytic data are presented to highlight the clinical advantages of a contemporary elaboration of the structural hypothesis for the understanding of sadomasochistic and sadonarcissistic phenomena.

Adult↗

Observing the other: reflections on anthropological fieldwork.

Aspects of anthropological fieldwork are examined from a psychoanalytic viewpoint using two sources: (1) Malinowski's A Diary in the Strict Sense of the Term, a fieldwork journal he kept in New Guinea and the Trobriand Islands "as a means of self-analysis"; (2) the analysis of an anthropologist both before and after she returned from the field. Malinowski's Diary, written in a virtually free-associative form, illustrates how fieldwork stimulates derivatives of significant early infantile conflicts. The patient's analysis revealed the unconscious meaning of, and motivation for, fieldwork for this particular individual. Based on these data, it is postulated that during fieldwork a new, emotionally charged object relationship, with its concomitant transference responses, may be unconsciously established by the anthropologist with the alien society being studied.

Anthropology, Cultural↗

Understanding the patient's use of the method of free association: an ego psychological approach.

While most of our methods of listening have been geared toward unearthing unconscious fantasies, those directed toward the ego's all-inclusive role in effecting the associative process have lagged far behind. It is the thesis of this paper that listening from the perspective of the ego allows the analyst to work more closely with what the patient is ready to understand. Clinical technique, using an ego psychological view, is elaborated, demonstrated, and compared to technique dependent on the reading of signs and symbols of the unconscious.

Adult↗

On the scientific standing of psychoanalysis.

This paper speaks for the claim that psychoanalysis qualifies as a scientific enterprise. It will derive from the conceptual and evidential structure of psychoanalysis a causal empirical hypothesis that admits of scientific intraclinical testing. Relevant topics from the philosophy of science (especially the nature of causal explanation and the work of Grünbaum) and the psychoanalytic theories of pathogenesis and therapeutic action are discussed in a preliminary way to create a framework for the demonstration. The dynamic unconscious is examined as the core causal concept of psychoanalysis. Taken together with an account of the structure of the mental apparatus, a coherent picture of mental causation (the propagation of an unconscious impulse) comes into view. This leads to the formulation of a set of clinical propositions that unite to generate a causal empirical hypothesis based solely on data from the analytic setting--namely, that the transferences and symptoms that appear in free association in the analytic situation possess an interrelational structure that is theoretically implied and can be statistically confirmed.

Cognition↗

Cisternal MHPG level inversely correlates with Glasgow coma scale after aneurysmal subarachnoid hemorrhage.

We measured the concentrations of monoamines and amino acids in the cisternal cerebrospinal fluid obtained from 15 patients after aneurysmal subarachnoid hemorrhage. Based on the Glasgow Coma Scale (GCS), the patients were divided into two conscious (GCS always 14 or better from the third post-operative day to Day 12; n = 8) and unconscious groups (n = 7). We examined the concentrations of monoamines and amino acids between the two groups and evaluated the correlation between the concentrations and the GCS at CSF sampling. The concentration of MHPG was significantly higher in the unconscious than in the conscious group from Days 4 to 12. A significant inverse correlation was observed between the MHPG concentration and the GCS (r = approximately 0.635, p < 0.0001). Measuring the cisternal MHPG concentration may be useful for estimating convalescence after subarachnoid hemorrhage.

Aged↗

The self: clues from the brain.

Can we find a way of thinking about the self that is compatible with modern neuroscience? I think we can. First of all, we have to recognize that "the self" is not the same as "the conscious self," since much of who we are as individuals takes place out of conscious awareness. Second, we have to accept that some aspects of the self, especially the unconscious aspects, occur in and can be studied in other species, allowing us to relate these aspects of the self to detailed brain mechanisms. Finally, it also helps to think of the self in terms of memory. Obviously, much of who we are is based on memories learned through personal experience, including both conscious or explicit memories and unconscious or implicit memories. This is particularly important since much progress has been made in relating memory to the cells and synapses of the brain. By viewing the self as a network of memories the effort to relate the self to the brain can build on this progress. Emphasizing memory and experience does not take away from the fact that our genetic history also contributes to who we are. In fact, genes and experience, or nature and nurture, are, in the end, not different things, but different ways of doing the same thing-wiring the synapses of our brain. In many ways, the self is synaptic. This synaptic view of the self is not meant as a challenge to other views, such as spiritual, cultural, or psychological views. It is instead, just a way of understanding how these other aspects of who we are relate, deep down, to the brain.

Animals↗

Individual effect-site concentrations of propofol are similar at loss of consciousness and at awakening.

Reported effect-site concentrations of propofol at loss of consciousness and recovery of consciousness vary widely. Thus, no single concentration based on a population average will prove optimal for individual patients. We therefore tested the hypothesis that individual propofol effect-site concentrations at loss and return of consciousness are similar. Propofol effect-site concentrations at loss and recovery of consciousness were estimated with a target-control infusion system in 20 adults. Propofol effect-site concentrations were gradually increased until the volunteers lost consciousness (no response to verbal stimuli); unconsciousness was maintained for 15 min, and the volunteers were then awakened. This protocol was repeated three times in each volunteer. Our major outcomes were the concentration producing unconsciousness and the relationship between the estimated effect-site concentrations at loss and recovery of consciousness. The target effect-site propofol concentration was 2.0 +/- 0.9 at loss of consciousness and 1.8 +/- 0.7 at return of consciousness (P <0.001). The average difference between individual effect-site concentrations at return and loss of consciousness was only 0.17 +/- 0.32 microg/mL (95% confidence interval for the difference 0.09-0.25 microg/mL). Our results thus suggest that individual titration to loss of consciousness is an alternative to dosing propofol on the basis of average population requirements.

Adult↗

The contrecoup injury in a cat case of traffic accident: MRI findings.

The clinical application of MRI of a cat case of traffic accident was examined. On admission, the animal was unconscious and remained so for 2 days. Radiographs disclosed a fracture in the parietal bone. From the temporary unconscious status and the fracture, cerebral damage was suspected and an MRI examination was performed. The contrecoup injury in the cat case of traffic accident which could not be diagnosed by radiography was diagnosed by MRI examination.

Accidents, Traffic↗

Supervision: a container-contained approach.

The authors illustrate an approach to the supervisory process as a learning experience for both supervisee and supervisor built on the containment of unconscious anxieties. It is argued that a core function of psychoanalytic supervision is to help contain the emotional turbulence and the unconscious anxieties arising and evolving in the two interacting domains of the analytic and the supervisory sessions. From this perspective, the analyst-patient interaction and that of the supervisee and supervisor can be understood as twin, tiered transformational arenas, the supervisory one being at the service of holding and grasping the roles the supervisee/analyst goes through as part of the analytic process. On the basis of detailed clinical material from a disturbed 7-year-old girl, the authors explore the interrelated issues and difficulties in containing anxieties and turbulence in both the analytic and the supervisory situation. When emotional containment is adequately handled, the supervision helps the understanding and development of the supervisee's use of his/her own personality as a treatment instrument, as advocated by Fleming and Benedek decades ago. The supervisory session thus furthers the resolution of clinical issues through symbol-formation, clinical sessions and supervision being twin domains for recording and understanding emotional evolution.

Child↗

Affect in psychoanalytic theory: discussion of André Green's 'on discriminating and not discriminating between affect and representation'.

André Green's 1999 programmatic essay on affect and representation, an attempt to extend Freud's model of the neuroses (where affect and representation have different vicissitudes) to non-neurotic cases is submitted to critical reading. Green wishes to restore the importance of representation; to use the second topographical theory, where id, psychical impulse and object-cathexis replace the unconscious and the ideational representation in order to conceptualize borderline disturbance, and to show how ultimately the 'non-discrimination' affect-representation obtains in non-neurotic cases as well. The author, interested in the question posed in Green's essay as to what we have to sell our borderline patients, addresses the various reasons why this project fails. Among the problematic points are the paradox of Green's model of unconscious affect, that does not allow the analyst to generate meaning with borderline patients, the view of 'representation' as replacing presence and perception of the object that does not allow the analyst to be a non-absent object, and the inability to conceptualize affect-representatives and to work out the definition of affect as 'the anticipation of a meeting with the other's body' which does not allow the analyst to function as an 'anticipatory object' or 'an object of affect'.

Affect↗

Who killed Laius?: On Sophocles' enigmatic message.

Using Laplanche's basic conceptualisation of the role of the other in unconscious processes, the author proposes a reading of Sophocles' tragedy, Oedipus the King, according to basic principles of dream interpretation. This reading corroborates contemporary literary perspectives suggesting that Sophocles' tragedy may not only convey the myth but also provide a critical analysis of how myths work. Important textual inconsistencies and incoherence, which have been noted through the centuries, suggest the existence of another, repressed story. Moreover, the action of the play points to enigmatic parental messages of infanticide and the silencing of Oedipus's story, as well as their translation into primordial guilt, as the origins of the tragic denouement. Oedipus's self-condemnation of parricide follows these enigmatic codes and is unrelated to, and may even contradict, the evidence offered in the tragedy as to the identity of Laius's murderers. Moreover, Sophocles' text provides a complex intertwining of hermeneutic and deterministic perspectives. Through the use of the mythical deterministic content, the formal characteristics of Sophocles' text, mainly its complex time perspective and extensive use of double meaning, dramatise in the act of reading an acute awareness of interpretation. This reading underscores the fundamental role of the other in the constitution of unconscious processes.

Adult↗

Between the frontier and the network: notes for a metapsychology of freedom.

The author examines the paradigm of the frontier and encounters the establishment of the paradigm of the network, a tendency that currently runs through diverse fields of thought. The network is not proposed as a globalising structure that would neutralise what is different, but as integration based on preservation of what is plural and its transformations. The author moves between these two paradigms in psychoanalytic metapsychology and clinical practice. The concept of frontier is intrinsic to the entire theory: repression, which separates the unconscious from the preconscious, the barrier against stimuli, the delimitation of spaces and agencies. But psychoanalysis is also a precursor of the paradigm of the network, with its concepts of unconscious, free association and evenly suspended attention. She points out that it is psychoanalysis that, in the area of scientific thought, subverts the radical split between subjects and their objects of observation, through the concepts of transference and countertransference, thus inaugurating a revolutionary theory of knowledge. This perspective can later be seen as a forerunner of changes in other disciplines. This text legitimises the contribution of psychoanalysis to thinking and knowledge, as well as the potential of a therapeutic method that provides the tools for crossing frontiers, unknotting and weaving networks, operating in the face of risks of pathological consolidations, thus holding to its unavoidable commitment to freedom.

Attention↗

On not being able to dream.

In this paper, the author explores the phenomenon of not being able to dream (as opposed to not being able to remember one's dreams) from three different vantage points. First, from the point of view of psychoanalytic theory, he discusses Bion's idea that the work of dreaming creates the conscious and unconscious mind (and not the other way around). A person who cannot dream is unable to generate differentiable conscious and unconscious experience and, consequently, lives in a psychic state in which he is unable to differentiate waking from sleeping, dreaming from perceiving. The author then approaches the problem of the inability to dream from the perspective achieved by a literary work. He discusses a Borges fiction that creates, in a singularly artful way, the experience of not being able to dream. Finally, the author utilises the vantage point of a detailed account of a clinical experience to explore what it means not to be able to dream. He describes an initial state characterised by the patient's proliferation of unutilisable 'psychic noise' which, over a period of years, led to the analyst's experiencing 'reverie-deprivation' and brief periods of countertransference psychosis. Two analytic sessions are presented and discussed in which psychological work was done that contributed to an enhanced capacity on the part of both patient and analyst for genuine dreaming - both in sleep and in analytic reverie states.

Countertransference↗

Repression, transference and reconstruction.

Whereas Peter Fonagy almost dismisses the importance of repression and the recovery of repressed and suppressed memory, the author believes that the analysis of repression retains importance in clinical psychoanalysis. Transference is a return of the repressed, with repressed memories embedded within a fundamental unconscious fantasy constellation. Moreover, transference is an essential, but not the only, route to the understanding and analysis of the patient. Nor should transference be confused with the real or new analytic relationship. The author does not regard the dynamic unconscious as definitely registered and retrieved in procedural memory, awaiting further research. A focus on the present 'self with other' model of therapeutic action neglects pathogenesis and the importance of childhood and its psychoanalytic reconstruction.

Adult↗

What's true and whose idea was it?

In this paper, the author explores the idea that psychoanalysis at its core involves an effort on the part of patient and analyst to articulate what is true to an emotional experience in a form that is utilizable by the analytic pair for purposes of psychological change. Building upon the work of Bion, what is true to human emotional experience is seen as independent of the analyst's formulation of it. In this sense, we, as psychoanalysts, are not inventors of emotional truths, but participant observers and scribes. And yet, in the very act of thinking and giving verbally symbolic 'shape' to what we intuit to be true to an emotional experience, we alter that truth. This understanding of what is true underlies the analytic conception of the therapeutic action of interpretation: in interpreting, the analyst verbally symbolizes what he feels is true to the patient's unconscious experience and, in so doing, alters what is true and contributes to the creation of a potentially new experience with which the analytic pair may do psychological work. These ideas are illustrated in a detailed discussion of an analytic session. The analyst makes use of his reverie experience--for which both and neither of the members of the analytic pair may claim authorship--in his effort to arrive at tentative understandings of what is true to the patient's unconscious emotional experience at several junctures in the session.

Expressed Emotion↗