Medium 9780946439966

The Psychotic

Views: 1304
Ratings: (0)

The Psychotic: Aspects of the Personality presents the results of Dr David Rosenfeld's many years of experience as an analyst working with deeply disturbed or psychotic patients, and demonstrates how the deeply resulting clinical and theoretical formulations may additionally be applied to less disturbed patients.Part One, dealing with the theory and clinical treatment of the psychotic aspects of the personality, includes a review of the literature and a rich array of clinical material to illustrate Dr Rosenfeld's technical approach. A chapter devoted to the survivors of concentration camps shows how the concept of encapsulated autistic nuclei leads to new diagnostic and technical procedures, while a further paper discusses the psychotic difficulties attending heart-transplant surgery. Further essays illuminate the importance of the accurate detection and the use of the countertransference and the significance of the supervisor's supportive role in severe cases.Part Two develops Dr Rosenfeld's notion of the primitive psychotic body image (PPBI), and shows how the model has proved its effectiveness in such areas as somatic delusion and drug-addiction.

List price: $37.99

Your Price: $30.39

You Save: 20%

Remix
Remove
 

11 Chapters

Format Buy Remix

1. Psychosis and psychotic part: a clinical approach

ePub

O, throw away the worser part of it and live the purer with the other half.

[Shakespeare, Hamlet, Act III, Scene 4]

In this chapter I present clinical material corresponding to two patients, Samuel and Pierre, in order to illustrate some views on the psychoses. As defined by Freud, by psychosis we understand the denial of reality and non-adjustment to it. It is a narcissistic disturbance, a damaged psychic apparatus. In addition, I develop some concepts about the psychotic part, psychosis, transference, transference in the psychosis, projected insight—expelled and then attacked outside—and the models and theories that might be used to explain the emergence of violence in the psychoanalytic treatment of the psychotic patient (Samuel). I discuss the usefulness of research into psychosis in order to create new models and hypotheses—for instance, the primitive psychotic body image model. Pierre’s case, likewise, shows the alternation between a psychotic part and a neurotic part, even within the same session.

 

2. Identification and its vicissitudes in relation to the Nazi phenomenon

ePub

Introduction

We can write about identification from different points of view: theoretical, developmental, genetic, or clinical. But when we attempt to write about identification disturbances in connection with Nazism, things become complicated. What am I supposed to do as the author of a paper of this kind? Methodologically, the approach includes two poles to be developed: Nazism, on the one hand, and identification, on the other. So I ask myself: Is it possible to describe the Nazi phenomenon? Is it possible to remain within the boundaries of cold scientificism? Is it possible to bring together and develop the two poles of this proposal?

In connection with the first question, I considered making a study of inanimate or non-human bonds of Nazism and its psychosocial effects, and defending man’s dignity and human rights. Also, I thought of describing some of the patients and others who had fled from an extermination camp.

Thus, after brooding for several months over the subject of this chapter, I concluded that there are certain phenomena of Nazism where the mere fact of putting them into words would seem to minimize their horror.

 

3. Psychosis and cardiac transplant

ePub

with Natalio Cvik

HAMLET: Angels and ministers of grace defend us! Be thou a spirit of health or goblin damned, bring with thee airs from heaven or blasts from hell, be thy intents wicked or charitable, thou com’st in such a questionable shape that I will speak to thee. I’ll call thee Hamlet, King, father; royal Dane, O answer me! Let me not burst in ignorance, but tell why thy canoniz’d bones, hearsed in death, have burst their cerements; why the sepulchre, wherein we saw thee quietly inurned, hath op’d his ponderous and marble jaws, to cast thee up again. What may this mean, that thou, dead cor’se, again in complete steel revisits thus the glimpses of the moon, making night hideous, and we fools of nature so horridly to shake our disposition with thoughts beyond the reaches of our souls? Say, why is this? Wherefore?

[Shakespeare, Hamlet, Act I, Scene 5]

Introduction

We would like to establish clearly two aspects that are evident in the following clinical case: the transference psychosis and the delusions (expressed in the transference-countertransference interplay), and the role of the father in the evolution of this patient. These two elements, within the framework of the sessions, allow the therapist to detect the rejection of the transplanted organ.

 

4. Counter-transference and the psychotic part of the personality

ePub

Definition of resistances

From the standpoint of the field of analytical transference, resistances should not be defined as facts attributed only to the patient. The definition of the term ‘resistance’ depends on a detection and a definition made by the therapist. Resistances only exist once the therapist has defined them as such. They are therefore dependent on the therapist, who alone can perceive them and define their sphere (Lagache, 1968).

But the therapist may be led to believe that the therapeutic process is satisfactory because the patient responds in a way the therapist considers ‘good’ or ‘well adapted’ to his interpretations. It may happen that the patient’s semantic sense of his psychoanalytical cure is reversed. He will then ascribe to it a distorted meaning. Occasionally, the patient gives grossly formal responses, which mask an additional disguised way of manipulating the therapist. Sometimes we suspect that something is wrong with the treatment when we start getting consistently ‘good’ answers, which are obviously stereotyped and simulated (Liberman, 1970-72).

 

5. Child analysis: technique and psychotic aspects of the personality

ePub

with Alicia D. de Lisondo

Fillet of a fenny snake,
In the cauldron boil and bake;
Eye of newt, and toe of frog,
Wool of bat, and tongue of dog,
Adder’s fork and blind-worm’s sting,
Lizard’s leg and howlet’s wing,

Scale of dragon, tooth of wolf,
Witches’ mummy, maw and gulf
Of the ravin’d salt-sea shark …

[Shakespeare, Macbeth, Act IV, Scene 1]

A dragon, a monster, teeth, hands,
a skeleton, monsters, spears, arrows,
heads… .

[A drawing by the patient, Aty]

This study seeks to highlight the importance of supervision in clinical work- In support of our argument, we discuss material from the case of a patient whose behaviour suggested a psychotic condition. There were, however, certain areas where he preserved parts of his ‘self, and we refer to these as ‘encapsulated nodes’. The patient’s childhood was unusual in the extreme, rooted in events that read like a true adventure story. An infant from an Indian tribe was about to be sacrificed when he was rescued in the nick of time by two anthropologists. They were able to get him away and eventually found a couple willing to adopt him. And so the story began.

 

6. Technique, acting out, and psychosomatics

ePub

By ‘acting out’ we mean any external behaviour or act motivated by the transference relationship with the analyst (Freud, 1914g).

As Freud (1914g) pointed out, it is a way of remembering by repeating acts instead of recalling them and communicating them in verbal and symbolic language. It is a past that never ceased to be the past. On many occasions, acting out implies recalling, in a continuous present, something that was never a part of the past at all: it is to present the same story, over and over again, on a stage where a drama of the past is unfolding.

As Herbert Rosenfeld (1965) and David Liberman (1978) have pointed out, it is often usual in the course of psychoanalytic treatment to employ a communication style of repertoire including acting.

The difference between using acting as a form of communication or as an attack on the bond depends mainly on the analyst’s decoding ability at that moment.

Herbert Rosenfeld (1965) describes and clarifies the difference between normal or neurotic acting out and psychotic acting out, and he relates them to different stages of early development: ‘Acting out is a defence against confusional anxieties. Besides, in the case of chronic schizophrenics, there is an additional problem which increases their tendency to act out: the acute state of confusion from which they are constantly trying to defend themselves. If progress is made in analysis and the emotions deriving from the state of confusion emerge in the transference, the patient resorts to excessive acting out as a defence.’

 

7. The handling of resistances in adult patients

ePub

I

Among the factors which influence the prospects of analytic treatment and add to its difficulties in the same manner as the resistances, must be reckoned not only the nature of the patient’s ego but the individuality of the analyst.

[Freud, 1937c]

Compliance with the requirements of the setting—that is, being punctual, associating freely or pretending to—does not mean that many of the patients we are going to discuss here may not put the psychoanalytic setting and language to the service of secret resistances and hidden pregenital pleasures. Perhaps it would be more adequate to say that this is a certain type of resistance.

From that point of view of the analytic transference, resistances should not be attributed only to the patient. The definition of the term ‘resistance’ depends on its being detected and defined by the therapist. It exists only when the latter defines it as such (Lagache, 1961). In other words, it depends on the therapist perceiving and defining it in his field.

There is another, new problem: a therapist may think that the therapeutic process is getting on well because the patient appears to respond to what he considers ‘good’ or adequate answers to his interpretations. But it might happen that this patient has a distorted notion of the meaning of the psychoanalytic cure (semantic distortion). Sometimes it is an apparently formal response, which hides another secret level of using the therapist. At other times, faced with a stereotype of constant ‘good’ responses and lack of transference conflicts, we must suspect that there is something wrong with the treatment (Liber-man, 1970-72).

 

8. Hypochondria, somatic delusion, and body image

ePub

Knowledge in the psychological field is different from that in the physical sciences, in that it does not consist of discovering physical objects and processes that are already in existence to be uncovered. Rather, it is made of detailed observation of, combined with empathic responsiveness to, another person’s states, so that a construction which has sufficient consonance with the nature of those states can be formed, making it possible to describe them to other people who have had something like the same experiences. Thus, those readers who have not had deep experiences with psychotic children may have found this a somewhat incomprehensible book, for we have been immersed in states which are not part of everyday experience.

[Frances Tustin, 1981]

Introduction

I

n this chapter I attempt to describe the various clinical ways in which hypochondriac pictures become manifest in psychoanalytic practice. It is not my purpose to create new entities or abstract terminology, but rather to offer a description that is mainly based on the clinical experience of the variations a hypochondriac picture may present; the realization that different dynamics prevail in each of them may prove useful for their technical and therapeutic handling in psychoanalytic practice. The mechanisms underlying hypochondria are predominant modes of functioning, which does not imply they never change: they may change, become altered, and alternate with others. What I want to stress is that there is a prevailing dynamics, as well as its relationship with generic-developmental levels. Likewise, I discuss the conceptions of body scheme predominant in each type of hypochondria.

 

9. Drug abuse and inanimate objects

ePub

In this chapter I describe the psychoanalytic study of the psychopathological changes that can be detected in the treatment of drug addicts, based on the clinical evolution of several such patients. In this evolution, I have found a number of characteristics that, in my experience, can be generalized. I attempt, then, to show the evolutional steps detectable in the course of the clinical treatment of these patients, the approach being similar to that previously used in my study of successive stages in a therapeutic group (D. Rosenfeld, 1988). I also advance new concepts explained on the basis of the theory of the primitive psychotic body image (p. 235), as well as the idea that addicts are in a continuous search for primitive autistic sensations (p. 256), and I develop new ideas related to life, death, and suicide in addicted patients (p. 247). I also propose a new classification of three different types of these patients.

The management of the patient who is addicted to drugs is particularly difficult because the analyst is dealing not only with a specific set of symptoms, but also at the same time with the combination of a mental state and the intoxication and confusion derived from drug use. In view of the length, difficulties, and vicissitudes of the treatment of drug addicts, I found it important to be able to establish milestones in order to find my way along the evolutionary course of transference neurosis and psychosis, which is of basic importance in the treatment of these cases. ‘The understanding of the specific psychopathology of drug addiction must result from the study of the transference neurosis and psychosis, always within the psychoanalytic setting’ (Bleger, 1967).

 

10. Psychoanalysis of the impulsive character: a linguistic-communicative study

ePub

Psychoanalysis started with the investigation of neurotic symptoms—that is, with phenomena that are ego-alien, ego-dystonic, and that do not syntonically fit the character. Character is the ordinary, habitual ways of behaviour, and Freud’s insight concerning anal character made it possible to study the habitual behaviour modes as motivated by unconscious tendencies.

In his work on Dostoyevsky, Freud (1928b) wrote of the compromises of the superego’s morality as an organized mode that is used not to purify guilt, but to permit new murders. Freud presented the example of Ivan the Terrible. In Dostoyevsky there coincide contradictory and opposing features: selfishness, violence, gambling, raping, epilepsy on the one hand and, on the other, his immense capacity for love and manifestations of exaggerated kindness. However, a large part of this conflict could be sublimated, enabling him to live in society. ‘Dostoyevsky’s very strong destructive instinct, which might easily have made him a criminal, was in his actual life directed mainly against his own person (inward instead of outward) and thus found expression as masochism and a sense of guilt’ (p. 178).

 

11. Linguistics and psychosis

ePub

Alba

In this chapter, I present the clinical history of a patient suffering a psychotic episode, which was characterized by delusions, cenesthetic hallucinations, and a particular way of speaking: very fast, without pauses or silences.

I present the beginning of her treatment, as well as her family and historical data. I also describe the clinical material, and I comment in detail on a session showing the transformations in the patient’s language.

The patient was treated with medication from the beginning of her therapy, which began at a rate of four sessions a week; she then had three sessions per week during the last years of therapy. The treatment lasted for a total of nine and one-half years, and I supervised the case for part of that time.

I go on in my presentation to develop some hypotheses regarding the origin of the delusions, and I stress the importance of using countertransference with psychotic or very regressed patients. I also discuss how linguistics allows us to study the alterations of thought, detectable through the alterations of language.

 

Details

Print Book
E-Books
Chapters

Format name
ePub
Encrypted
No
Sku
B000000020856
Isbn
9781780498775
File size
748 KB
Printing
Allowed
Copying
Allowed
Read aloud
Allowed
Format name
ePub
Encrypted
No
Printing
Allowed
Copying
Allowed
Read aloud
Allowed
Sku
In metadata
Isbn
In metadata
File size
In metadata