Early Development and its Disturbances: Clinical, Conceptual and Empirical Research on ADHD and other Psychopathologies and its Epistemological Reflec

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In this volume internationally well known experts discuss whether psychoanalysis - with its rich mix of clinical experiences and conceptualizations of early development and symptoms - has something unique to offer through deepening the understanding of children suffering from this and similar developmental disturbances. The contributors consider therapeutic strategies as well as possibilities of early prevention.Surprisingly, psychoanalysts have only during the past few years actively engaged in the on-going and very important controversial discussions on attention deficit hyperactivity disorder (ADHD). There may be many reasons for the increasing interest in this topic over the past few years - for example the dialogue between psychoanalysis and contemporary neurobiology/brain research which opens a fascinating window on an old problem in European culture: the mind-body problem. This exchange also promises to enlarge the understanding of psychic problems probably connected with some neurobiologically-based pathologies, widely assumed to include ADHD.Another area covered in this work shows that it might be that it is only during the last years that epigenetic researchers have been able empirically to demonstrate that early traumatization might strongly influence the 'triggering' of gene disposition, for example the genetic disposition to develop ADHD. This gives some reassurance that it may be relevant to treat children with ADHD psychoanalytically: psychoanalysts have expertise in understanding and treating children affected by early trauma, independent of their genetic disposition.

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CHAPTER-1

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PART I

INTRODUCTION

CHAPTER ONE

Controversies on different approaches in psychoanalytic research on early development and ADHD

Marianne Leuzinger-Bohleber, Jorge Canestri
and Mary Target

1 Introductory remarks

Surprisingly, psychoanalysts have only during the past few years actively engaged in the on-going and very important controversial discussions on attention deficit hyperactivity disorder (ADHD) (for example, the casebook on learning disabilities by Rothstein and Glenn, 1999; the special volume of Psychoanalytic Inquiry, 2002; and the panel on ADHD and trauma at the IPA Congress in Rio 2005 reported by Sugarman, 2006 and at the IPA Congress in Chicago, 2009, summarized by Sugarman, 2010).1 Carney (2002: 301) writes in his prologue to this volume: ‘Not so long ago, some practitioners both inside and outside psychoanalysis discouraged the use of psychodynamic treatment for patients with AD/HD.’ Salomonsson (2004: 132) agrees, writing: ‘Psychoanalysis is an often-neglected treatment method for children with neuropsychiatric disorders.’

 

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PART II

EARLY DEVELOPMENT AND ITS DISTURBANCES

CHAPTER TWO

Attachment, trauma,
and psychoanalysis: where
psychoanalysis meets neuroscience

Peter Fonagy

Why do we do this to each other?

Trauma is puzzling: a couple of deeply puzzling vignettes to start us off. James is currently in prison for armed robbery. His father was frequently violent towards James, in the name of punishment. On one occasion, at the age of nine, James was punished for stealing. This is how James later described that incident:

he put the gas cooker on, right, and um—I will always remember this, he put a hand on top of the gas cooker, and roasted our hands (your hand) yeah, my hand, and uhm—the next day I went to school with gloves on, because they [were] really, really bad …

James’ reactions to these and dozens of similar experiences is telling: ‘I used to have a drink and sleep and when I wake up I was a different person.’ When asked to describe if he ever felt upset, James is completely unable to understand the question. ‘When I was young I never really got upset because I had everything I wanted really and when you get everything that you want you don’t really get upset.’ When asked how his childhood experiences might have affected his adult personality, he responds totally without insight: ‘I cannot explain, I can’t, it’s not even up there for me to explain.’

 

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CHAPTER THREE

Coping with children’s temperament

William B. Carey, M.D.

Introduction

The main focus of this volume is ‘Early Development and its Disturbances’ with special emphasis on the ‘psychoanalytic perspective on the development of Attention deficit/Hyperactivity Disorder (ADHD) and other psychopathologies’. My assignment is to discuss ‘Coping with Children’s Temperament’ (Carey and McDevitt, 1995) as part of this complicated area. The main observation I would like to make is this: the current neglect of normal temperament differences has resulted in an overdiagnosis of CNS-based (central nervous system based) psychopathology and an overuse of medication. I shall propose that we must do better at recognizing children’s temperaments and other normal behaviours and must help parents to cope with them appropriately rather than ignoring or pathologizing them.

Current status of overdiagnosis of ADHD, bipolar disorder,
and other psychopathologies

 

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CHAPTER FOUR

Motion and meaning: psychoanalytic inquiry of so-called ADHD children

Heidi Staufenberg

Introduction

In the title of my paper, with the word ‘meaning’ I am citing a central concept in the history and theory of psychoanalysis. The object of our word is to uncover meaning. Allow me to refer here to Freud who once said that, ‘Interpreting means finding a hidden meaning.’ And we all know that ‘finding’ is meant quite ambiguously here: finding something hidden, something that of course exists, but also finding in the sense of inventing, of something after the fact. I can not, and do not, wish to enter into the debate on the construction and reconstruction of meaning here, but I believe it is important to be aware of this set of issues. After all, in our work with children we encounter a danger inherent in psychoanalytical interpretation in an especially acute manner. By which I mean the danger of not addressing the subject, and with our interpretation imposing an outside meaning on the subject, namely the ‘patient’. In other words, in psychoanalytical practice the focus must always also be on enduring the fact that there are things we do not know. Bion’s (1963) famous statement that ‘no memory, no desire’ is reminiscent of the stance I call for here, namely inner openness toward the patient, that is, be cautious of ‘knowing’ and understanding in that ‘understanding’ is all too easily only an ostensible matter and can lead to conclusions that go straight past the subject. This admonishment to be cautious should really be taken to heart when working with children as the child does not speak to us with the same level of intellectual abstraction and self-reflection.

 

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CHAPTER FIVE

Further comments on Sophia’s mimetic autism, with special reference to Bion’s theory of thinking

Jorge L. Ahumada and Luisa C. Busch de Ahumada

Sophia’s clinical narrative has had an eventful journey, meeting different psychoanalytic outlooks and cultures. What follows is our attempt at a second look at some topics raised by our paper ‘From Mimesis to Agency: Steps in the Development of Psychic Two-ness’ (Busch de Ahumada and Ahumada, 2005), depicting the first eighteen months of treatment of a case of mimetic autism. Of the many valuable suggestions received we shall take special heed of Antonino’s Ferro’s comments to its Spanish version, putting forward a dialogue with a Bionian, and partly Meltzerian, conceptual frame. Given the current upsurge of autistic spectrum psychopathologies, our argument concerns the conceptual and technical tensions between the autism-derived Tustinian conceptual frame we put to work and the Kleinian and Bionian ones which in goodly part we share; but before going into such issues some historical notes seem necessary.

 

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CHAPTER SIX

Early affect regulations and its disturbances: Approaching ADHD
in a psychoanalysis with a child
and an adult

Marianne Leuzinger-Bohleber

1 Approaching affect regulation and its disorders through psychoanalysis in times of theoretical pluralism

For all of the theoretical and conceptual differences, most psychoanalytic authors agree that disturbances in early affect regulation are one of the main factors in the genesis of ADHD and other developmental pathologies. In times of theoretical pluralism in psychoanalysis, however, there are differences in the approaches used to explain the source and effects of an early disturbance in affect regulation. This rich diversity in contemporary psychoanalytic theory allows us, on the one hand, as if looking through a kaleidoscope, to perceive ever new information patterns in the complex clinical material and make use of them for the joint process of acquiring knowledge with our patients, as I would like to illustrate with examples from two cases. On the other hand, epistemologically and methodologically, as Charles Hanly will elaborate for us in his paper, the pluralism in psychoanalysis today puts us before demanding problems which, however, I cannot discuss in this context (cf. Leuzinger-Bohleber and Bürgin, 2003; Leuzinger-Bohleber, in press). To stay with the metaphor: the view through the kaleidoscope may very well give us access to the abundance and multiplicity of clinical observation, but, as Hanly explains, this does not relieve us of the need to recognize irreconcilable contradictions in the theoretical explanations of clinical phenomena and make them the subject of an intrapsychoanalytic, interdisciplinary, dialogue devoted to research and unification of the psychoanalytic base knowledge. In this process, as I see it, a form of psychoanalytic conceptual research has a central role to play, which stays close to the clinical research in psychoanalysis while taking the results of empirical and interdisciplinary research into account in its critical reflections on psychoanalytic concepts. Therefore, in my paper I’d like to try to make use of the view through the plural kaleidoscope to search for common features as well as contradictions in explaining the genesis of ADHD, and—together with clinical observations—integrate them into a current understanding of this syndrome.

 

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PART III

PSYCHOANALYTIC RESEARCH:
HOPES, VIEWS, CONTROVERSIAL
DISCUSSION

CHAPTER SEVEN

Logic, meaning, and truth
in psychoanalytic research

Charles Hanly

On unity and verifiability in psychoanalytic theory

It has been hoped that psychoanalysis would evolve toward the unity of a mainstream, integrated theory based on amendments of, and additions to, the persisting elements of Freud’s theory (Rangell, 1997; Hanly, 1997). In my opinion, there is little evidence of this tendency occurring spontaneously. For example, there is evidence of an abundance of pluralism, and a poverty of unification, in the last issue of The Psychoanalytic Quarterly devoted to theories of therapeutic action. The eight authors stated their own theories in more or less splendid isolation, leaving it to the commentators to identify any similarities or differences that there might be. It suggests that the flame of hope for a unified mainstream psychoanalytic theory is burning low.

 

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CHAPTER EIGHT

Trauma or drive—drive and trauma: Revisited

Ilse Grubrich-Simitis

Preliminary note

The paper reproduced below was presented at the 44th Congress of the International Psychoanalytical Association in Rio de Janeiro on 29 July 2005. The Congress theme was ‘Trauma: New Developments in Psychoanalysis’ and my paper formed part of a Conceptual Research Committee Panel on ‘What does Conceptual Research on Trauma Really Mean?’, chaired by Marianne Leuzinger-Bohleber and including Ricardo Bernardi, Jorge Canestri, and Sverre Varvin.

I had not originally intended my paper for publication, as it is substantially based on my essay ‘Trauma or drive—drive and Trauma’, published in The Psychoanalytic Study of the Child in 1988; some of the formulations of the new text take up those of the original contribution, and certain passages are even reproduced verbatim from it, because I could not today express many of the ideas in question better or differently after a lapse of some twenty years. My paper was well received in Rio and many members of the audience stated that they would like to be able to see it in print. There are other arguments in favour of publication too: on the one hand, a new generation of psychoanalysts has since grown up, and, on the other, the subject matter of the earlier essay has manifestly remained relevant today and is considered, in the last quarter of the present paper, in the light of modern psychoanalytic trauma research. Finally, for the purposes of the oral presentation I had summarized the thoroughly elaborated ideas put forward in the essay, making them easier to absorb in the time available.

 

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CHAPTER NINE

Pluralism in theory and in
research—and what now?1
A plea for connectionism

Anna Ursula Dreher

Abstract

For a long time now there has been an analytic discussion about the pluralism of theories; the author proposes that there is a second pluralism we must pay attention to, namely the one in the analytic research field. Introductory remarks on the development of conceptual research serve as reference to highlight the two pluralisms—relating to the Green-Wallerstein-debate about the common ground in psychoanalysis; and relating to considerations about the scientific status of psychoanalysis and about some current understandings of analytic research.

Psychoanalysis as a science ‘between nature and culture’ (in Green’s and Wallerstein’s words) would have to take both nature and culture into account, not only in its theoretical concepts but also in research and methodology. In doing so it would be desirable not only to lament those two pluralisms, but to understand both positively as resources in the search for the best problem solutions.

 

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CHAPTER TEN

New orleans congress panel:
what does conceptual research
have to offer?

Jorge L. Ahumada and Roberto Doria-Medina

To the question, ‘What does conceptual research have to offer?’ the short answer is: everything. Shorn of it, psychoanalysis dissolves as a discipline. However, it speaks of its intricacies that we write this paper as a dialogue, to keep to our distinct stances.

J.L.A.: Freud was immersed in a lifelong conceptual struggle with what emerged from his clinical findings. Empirical work—gathering the relevant evidences—and conceptual work go hand in hand, this being valid for each and every observational discipline. Thus, the Galapagos Islands as a natural experiment lent Darwin the evidential path to his theory of the evolution of species, providing him the exemplars needed for accessing what went on, and to do so from multiple perspectives. When they expound on what the scientific method purportedly is, philosophers of science studiously skip such prime exemplars of knowledge buildup coming from the observational sciences.

 

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