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Psychopathology

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An outstanding collection of papers written by Jungian analysts from different schools of analytical psychology on various aspects of psychopathology. The subjects covered include: depression, anorexia, schizoid personality, narcissistic personality disorder, mania, psychosis, paranoia, masochism, fetishism, transvestisism, perversion, marital dysfunction, survivor syndrome, and old age.The contributors, who include some of the most creative and distinguished clinicians in the Jungian world today, are: Gustav Dreifuss, Alan Edwards, Michael Fordham, C.T. Frey-Wehrlin, Rosemary Gordon, Judith Hubback, Peer Hultberg, Mario Jacoby, Thomas Kirsch, Rushi Ledermann, Fred Plaut, Joseph Redfearn, Nathan Schwartz-Salant, Eva Seligman, Anthony Storr, Mary Williams and Luigi Zoja.The book is intended to appeal beyond the Jungian community, and the editor's introductory remarks which precede each paper highlight (and where necessary explain) concepts and attitudes which seem special to analytical psychology. In this way, psychoanalytically and eclectically orientated practitioners can make full use of this book.

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1. Depressed patients and the coniunctio

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Judith Hubback

Hubback’s paper is of interest because of her express intention of using both ‘archetypal structuralist concepts’and ‘the findings of developmental research; the former is represented in the paper by a tracking of the dynamics of the coniunctio oppositorum, the patterns within a person of integration and unintegration, harmony and dissonance, and the latter by a study of the part played in her patients’ depression by their having had a depressed mother. Where experience of parental imagos of a depressed kind has led to splitting defences, this has injured the innate capacity of the person for coniunctio. What is more, when the parental marriage is experienced as divisive, weak or non-existent, a further injury is done to the prospect of internal marriage within the patient

This is the background for Hubback’s noting a special clinical phenomenon in relation to her group of depressed patients: the necessity of analysing the patient’s ‘phantasies about his mother’s inner life’. The interactive focus naturally falls on the inner life of the analyst in general and on her countertransfer-ence in particular. Thus the analyst’s participation in the patient’s process is explicitly noticedand compared by Hubback to the vital presence of the soror, the alchemist’s assistant, in the alchemical processa Jungian metaphor for analysis itself.

 

2. Success, retreat, panic: over-stimulation and depressive defence

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PeerHultberg

Hultberg’s use of the concept of over-stimulation enables him to throw new light on depression, grandiosity and mania. The secret presence of grandiose phantasies attached to what would otherwise be realistic achievements in the concrete world makes these achievements feel like threats to psychic integration itself. From a personal-historical angle, the patient may have had pressurizing parents, or have been used as a cure for a parent’s narcissistic wound. Then the tension aroused by achievement is unbearable because this is felt by the individualin a sense accuratelyto be against his or her own best interests.

Analysts and therapists will readily recognize Hultberg’s depiction of underachieving patients with their fear of success. His usage of Jung’s idea of degressive restoration of the persona’, in which the individual denies ambition and aspiration, takes on an added dimension when added to the list of neurotic counter-transference possibilities of which we are aware. In particular, the ‘greyness’ of meticulously conducted analyses certainly has to be reframed as a result of Hultberg’s speculations.

 

3. A psychological study of anorexia nervosa: an account of the relationship between psychic factors and bodily functioning

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Eva Seligman

In this chapter on anorexia, Seligman shows that she is aware of the background in family and marital dynamics and how she works this into her analytical approach. The part played by the father and by siblings is therefore fully acknowledged alongside a more internal perspective.

In many respects, the paper serves as an introduction to the treatment of psychosomatic disorders generally. For in many or all of these, we can see what Seligman calls ‘metamorphosis in reverse’—a move from ‘the multi-faceted ostensibly somatic syndrome to its basic, primary emotional constituents in infancy.’

Though Seligman’s use of a teleological approach is implicit rather than explicit, the reader will see how, for her, any understanding of the aetiology of anorexic symptoms is bound up with a consideration of the unconscious purposiveness of the illness: what is the anorexic aiming at, desiring, trying to achieve?

A.S.

Psychosomatic illness constitutes a cry of despair and of hope, and may represent an unsuccessful attempt at a search for wholeness. It points to a division within the individual, and any therapeutic confrontation needs therefore to attempt to encompass all aspects of the patient. When a psychosomatic disorder such as a severe eating disturbance manifests itself, and could threaten the continuance of life, the pressure on the analyst to focus primarily on the symptom may become difficult to resist.

 

4. Object constancy or constant object?

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Fred Plaut

In this iconoclastic chapter, Plaut challenges the mental health values of both psychoanalysis and analytical psychologyobject constancy and individuation, respectively. He feels that there has been an idealization of both of these concepts which excludes other paths to psychological fulfilment, less sanctioned by psychotherapeutic criteria.

Actually, Plaut points out, in analytical psychology a place has been made for a valuing of the less than whole, less than perfect, less than fully object-relating. Provided there is a cultural context (often of a religious nature), then the shared dimension brings in a qualitative change so that graffiti-like imagery has to be understood as having an unconsciously sacral intent.

Plaut challenges the illusion that we ever ‘master’ our objects. To some extent, then, he disputes the very idea of psychopathol ogy. On the other hand, I do not think he wishes to be heard as arguing for the mental health value of all schizoid phenomena.

A.S.

Psychoanalytic theories of child development employ the useful concept of object constancy, which forms a milestone in the relations between the developing ego and its images, technically referred to as objects. When for one reason or another this milestone, which is also a formidable hurdle, has not been passed, the crucial question arises whether the person can nevertheless make progress towards a viable mode of living, including stable relations with others. Some of the differences between psychoanalytic theory and analytical psychology may be semantic rather than fundamental: when it comes to the application and aims of therapy, the similarities may well outweigh the differences and incompatibilities of theory. Therefore a mutually acceptable model of child development may well emerge.

 

5. Narcissistic disorder and its treatment

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Rushi Ledermann

This chapter is one of a series by Ledermann on the aetiology, phenomenology and treatment of pathological narcissism. It exemplifies the way in which sensitive application of psycho-pathological understanding serves, rather than injures, an approach to the patient as an individual For, as Ledermann points out, the manifestation of apparent ego strength could easily convince the clinician that she or he was confronted with neurosis rather than with a serious personality disorder. If that were to happen, then the well-thought-out understanding of the analytic needs of such patients, as described by Ledermann, would not take place.

Ledermann combines insights from psychoanalysis with the developmental theories of Michael Fordham. From Jung, she takes the notion of the inevitable presence in the unconscious of something opposite to what is presented on the surface. It is this conviction that enables her to hold on to hope in a fraught situation, such hope being available for the patient to draw on when he or she is ready.

 

6. Reflections on introversion and/or schizoid personality

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Thomas Kirsch

Kirsch’s chapter is noteworthy for several reasons. First, he is attempting to clarify differences and similarities between the terminology of analytical psychology and psychoanalysis. He notes that what may be conventionally pathologized as ‘schizoid overlaps with what Jung termed ‘introversion’ (see below). But he has also formulated ways in which the two states are different Second, what he has to say about the matching of types in analysis speaks to the issue posed by Edwards (and mentioned in my Introduction): the whole question of a fit between patient and analyst Here, as elsewhere in the chapter, Kirsch is quite open about his changing views. Third, Kirsch shows how the personality of the analyst influences his interpretive stanceand does so with a wealth of clinical detail

For some readers, typology may be an unfamiliar subject It is a system developed by Jung to demonstrate and ascertain different modes of psychological functioning in terms of psycho-logical types. Some individuals are more excited or energized by the internal world and others by the external world: these are introverts and extraverts, respectively. But, in addition to these basic attitudes to the world, there are also certain properties or functions of mental life. Jung identified these as thinking—by which he meant knowing what a thing is, naming it and linking it to other things; feeling—which for Jung means something other than affect or emotion: a consideration of the value of something or having a viewpoint or perspective on something; sensation—which represents all facts available to the senses, telling us that something is, but not what it is; and, finally, intuition, winch Jung uses to mean a sense of where something is going, of what the possibilities are. A person will have a primary or superior function: this will be the most developed and refined of the four. The other three functions fall into a typical pattern. One will be only slightly less developed than the superior function, and this is called the auxiliary function. One will be the least developed of all. Because this is the most unconscious, least accessible and most problematic function, it is referred to as the inferior function.

 

7. Reflections on Heinz Kohut’s concept of narcissism

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Mario Jacoby

Jacobys aim is not to stress that many contemporary ideas in psychoanalysis concerning narcissism and self-psychology have been anticipated byJungians. Rather, he is exploring similarities and differences between two major strands of theorizing. As he says, he is, if anything, looking at analytical psychology through the eyes of Kohutian self psychology.

A further interest of the author’s is to consider the implications for technique. It can be seen that Jacoby, a training analyst in Zurich, is quite clear that attention to transference-counter-transference processes is a central feature of analysis. When first reading the paper, I was struck by the sensitive and self-aware way in which Jacoby dealt with his patient’s idealizationnot in a manner that dismissed it as ‘defence’, but somehow managing to allow for growth inherent in such a transference (along the lines of Kohut’s model).

Finally, what Jacoby says about the ‘Jungian self repays study.

A.S.

There is much diversity in current psychoanalytic literature, but for many years now my attention has been particularly drawn to Heinz Kohut’s works on narcissism (1966,1971,1972,1977). Kohut has struck me in many ways as a kindred spirit, his views being akin to my own on psychology and his therapeutic approach similar to mine, which, in itself, is closely related to C. G. Jung’s analytical psychology. While reading Kohut’s often microscopically subtle, descriptions and interpretations, traits of various analysands, including the analysand I am for myself, would immediately come to mind. I was also struck again and again by how close Kohut seemed to analytical psychology, even in the way he sees the basic problem of psychological theorizing. Because he firmly believes that ‘all worthwhile theorizing is tentative, probing, provisional—contains an element of playfulness’ (Kohut, 1977, p. 206), Kohut is tolerant about possible inconsistencies in psychological theory. As he writes, ‘I am using the word playfulness advisedly to contrast the basic attitude of creative science with that of dogmatic religion’ (ibid., p. 207). Here we have a striking parallel with Jung, who, in his memoirs, complains about Freud’s dogmatism with the following words, ‘As I saw it, scientific truth was a hypothesis which might be adequate for the moment but was not to be preserved as an article of faith for all time’ (Jung, 1963, p. 148).

 

8. The borderline personality: vision and healing

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Nathan Schwartz-Salant

Herein, with a wealth of clinical material, Schwartz-Salant demonstrates the use of the concept of the ‘unconscious dyad’ in analysis. This leads to a sophisticated refraining of the coniunctio to suggest the multi-leveled dynamics of an interactive field. Such dynamics are specifically stated by Schwartz-Salant to go beyond the personal realm.

A further technical innovation is the idea of ‘imaginal sight’. This way of relating to the patient and the clinical material makes explicit what many analysts probably dobut they do so implicitly, hence at a lower level of conscious awareness.

Schwartz-Salant’s twinning of the ‘logic’ of the borderline patient with a particular mystical tradition serves to prevent any simplistic pathologizing. The borderline patient is presented, to a degree, as Everyman or Everywoman.

The many references to the Rosarium or the Rosarium Philosophorum refer to Jung’s commentary on an illustrated alchemical tract of the sixteenth century. The pictures of the Rosarium are numbered, and the whole work, entitled The Psychology of the Transference, is found in Volume 16 of Jung’s Collected Works. Jung thought that alchemy, looked at with a symbolic and not a scientific eye, could be regarded as one of the precursors of modern study of the unconscious and, in particular, of analytical interest in the transformation of personality.

 

9. The treatment of chronic psychoses

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C. T. Frey-Wehrlin, R. Bosnak, F. Langegger, Ch. Robinson

Though said to be a report, this short paper by Dr. Frey and his colleagues from the Ziirichberg Clinic in Zurich is in fact a thought-provoking disquisition on the subject of chronicity in psychological illness. As such, it contains a wealth of ideas for the workaday clinician, some of them tending to the optimistic, some to the pessimistic. The authors propose that our concern for the chronic patient is truly a concern for something chronic in ourselves’the shadow of our individuality.

A.S.

As it is now more than thirteen years since the Ziirichberg Clinic opened, we welcome the opportunity to report on our experiences with psychotic patients and to follow it up with some reflections based on these experiences.

To begin with, a brief description of the setting: the Ziirichberg Clinic is a State-accredited, closed psychiatric clinic. It houses 35 patients in two buildings. Although in the annexe boarders are free to come and go, the main building is run as a closed nursing home, the centre of which is a closely supervised eleven-bedded ward.

 

10. The energy of warring and combining opposites; problems for the psychotic patient and the therapist in achieving the symbolic situation

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Joseph Redfearn

As Editor, I should like to pick out the ideas in Redfearn’s paper that have strongly influenced me since I first heard it in 1977.

1. Psychosis involves a distortion in the relation to the Other who tends to get used as a dumping ground.

2. The self always contains a body-self But in psychosis, particularly, the physical pole of the psyche-soma spectrum is activated (or suppressed). This needs to be taken into account in therapy.

3. When considering who or what might function as a transforming container for psychotic process, one should not be too idealistic; many improvised solutions can do this.

4. At the level of the primal relationship, simple and straightforward affect is translated into something far more primitive and explosive.

5. ‘Affective psychoses represent premature attempts to attain whole-person feelings.’ This preserves a prospective or teleolo-gical function for psychosis.

6. There is something that can be called ‘pseudo-health’. This is based on an unrelated projection of bad stuff rather than achieved via ‘suffering and transformation’. Though noticeable in psychotics, this can also be seen in non-psychotic persons.

 

11. Schreber’s delusional transference: a disorder of the self

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Alan Edwards

Edwards puts forward what can be described as a ‘post-Jungian’ viewpoint concerning the case of Schreber. To Jung’s idea of an anima inflation, he adds the possibility that there may have been a ‘disorder of the deintegrative-reintegrative processes’ of the self (without ruling out some inborn defect). Professor Fleschig, Schreber’s doctor, functioned as a paternal self object, felt to be hostile and dangerous. Schreber identified himself with a maternal self-object, hence his gradual ‘unmanning’.

From the prospective or teleological point of view, Schreber could be seen as trying, via the agency of the self, to heal the pathological splits between the maternal and paternal self-objects’.

A.S.

Introduction

It was in 1907 that Jung published ‘The psychology of dementia praecox’ (CW 3), and for him, and also for analytical psychology, the study of disorders of the self has always been of major interest. Now, with the presentation by Fordham of his clinical work and theoretical views on autism (1976), it seems possible to begin to extend his approach and insight into other clinical areas, and to look again at the schizophrenias, borderline states, narcissistic personality disorders, and homosexuality.

 

12. Masochism: the shadow side of the archetypal need to venerate and worship

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Rosemary Gordon

Non-Jungian clinicians may well feel at home with Gordon’s description of her actual clinical work with patients, because it is close to and exemplifies general psychoanalytic method and practice.

However, her vision is rooted in analytical psychology, and this has led her to explore the possible origin, meaning and function of the psychopathological syndrome of masochism in some of her patients. As with Freud, Klein and some other analysts, this search has led Gordon back to the thesis that there exists an original death drivealso interpreted by Erich Neumann, for example, as a ‘wish for a weak ego to dissolve in the self, or by the Kleinian analyst Betty Joseph’s suggestion that masochism may be based on the infant’s belief that the price to be paid for the love of the parents is the surrender of personal separateness and individuality. But, unlike most psychoanalysts, her Jungian understanding leads her to link the death drive to themes like ‘death and rebirth’ and the symbolic meanings of death.

 

13. The psychopathology of fetishism and transvestism Anthony Storr

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Anthony Storr

This early work of Storr’s has stood the test of time remarkably well. Indeed, its concerns are as relevant now as they were over 30 years ago. For instance, Storr’s intention of showing that the teleological viewpoint can add something to the conventional psychoanalytic one, and his criticisms of Freud’s interpretation of the Medusa mythologem, are directly relevant to the project of a book such as this.

Then there is Storr’s use of a phrase like ‘subjective masculinity’ (to depict what it is that some perverts and fetishists lack). This is anticipatory of the approach of Robert Stoller, who argued that gender identity, looked at from a psychoanalytic standpoint, is an internal matter, not a behavioural one.

The third theme that I would like to highlight concerns the way Storr conceptualizes the interplay of masculine and feminine, male and female factors in psychopathology. On the personal-historical level he is referring to the relationship with the parents, as individuals and as a couple. On a more impersonal, archetypal level, he is touching on something of great complexity and importance: the struggle to wrest phallic power from the Great Mother and the unforeseen problems for the individual when that is attempted by means of identification. Finally, Storr’s reflections on what Western societies demand of men and how that affects their gendered self-conception show that, in this area at least, not a lot has changed since 1957.

 

14. The androgyne: some inconclusive reflections on sexual perversions

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Michael Fordham

Fqrdham observes that Jungian analysts have neglected the perversions. He also suggests that Jungian interest in imagination and phantasy can go on in an excessively disembodied way. For these reasons, Fordham’s approach to perversion makes use of terms and concepts of his own and those of psychoanalytic writers (Freud, Klein, Bion and Meltzer).

This enables Fordham to point out parallels between Bion’s theory of beta elements, alpha elements, and alpha function and Jung’s idea of the archetype, with its instinctual and spiritual poles. The androgyne, itself an archetypal image, acts as an organizer for polymorphous and physical sexual activities. In his use of the image of the androgyne, Fordham is emphasizing the part played in internal life by images of which the individual may not be aware.

Fordham makes a further suggestion about why it is that perverse mental process leads or does not lead to actual perversion: could this have something to do with psychological type? He concludes that, though interesting, this is not sufficient as an explanation.

 

15. The archetypes in marriage

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Mary Williams

This paper, which has not been published before, has enjoyed a vogue amongst trainees at the Society of Analytical Psychology, probably because of the way in which Williams makes use of animus/anima theory to enlarge the more recent clinical concept of unconscious collusion within a couple. She shows how the parental images, themselves a blend of the personal and the typical, influence partner choice and also the on-going vicissitudes of marriage. Finally, her summary of Jung’s idea of there being a container and a contained in marriage leads on to further discussion of the impact in marriage of projected parental imagery, containing, as it does, infantile wishes and desires.

Thus, classical Jungian theory is intertwined with a more developmental approach.

A.S.

In this chapter I discuss anima and animus figures and their spell-binding power in marriage. I also give an account of clinical research in which I took part at the Tavistock Clinic under the aegis of Henry Dicks, in which he looked anew at the phenomena unfolding before our eyes. Only those working hypotheses developed and tried out over the years that confirm and elaborate Jung’s findings are discussed.

 

16. The analyst and the damaged victims of Nazi persecution

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Gustav Dreifuss

The Holocaust was an event without parallel in human history. It was perhaps the greatest collective disaster we have ever known. Dreifuss shows that the analyst of a patient who has suffered during the Holocaust has to be aware of certain clinical consequences of the patient’s pro found psychic injuriessuch as a tendency to disclaim the capacity to make use of analysis (on account of having been damaged in the first place). What is true of the Holocaust may be relevant to any collective trauma, and the sense of guilt at having survived, well known in connection with Holocaust victims, may also be found in other situations. What Dreifuss says about the meaninglessness of the Holocaust experience, and how this is taken up by the commentators, is also of great interest. For the question ‘why was I born the person I am’ is one that crops up in the analysis of nearly everyone at some time or other.

The theme of the relationship between Judaism and Christianity is important for at least two reasons. First, because here, as elsewhere, we can see that analytical psychology has developed Jung’s ideas on Jewish psychology’. Second, because the figure of the Jew often crops up in the analytical material of non-Jewsthese days, representing someone to envy as often as the traditional shadow personification.

 

17. Working against Dorian Gray: analysis and the old

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LuigiZoja

The project ofZoja’s paper is far wider than its title implies. In addition, there is a salient critique of Freudian theory, in which the psychoanalytic contribution is linked with several problematic features of our culture. Then there is an analysis of the culture’s main problem: ignorance and fear of death. This, in its turn, is connected to a radical undercutting of the authentic patterns of life so that all of us, not just the old, suffer from anomie and ontological anxiety,

One other feature of the paper to which I should like to draw attention concerns Zoja’s use of puer and senex. These terms, which may be unfamiliar to some readers, refer to differing psychological and emotional outlooks (and are not intended to be restricted to males). They are not developmental concepts, though they can be employed in that veinfor even old women and men can be seen to have puer or puella characteristics; similarly, the senex can be seen in the character of babies. Clearly, each of us will have both puer and senex in her or his make-up. The puer suggests the possibility of a new beginning, revolution, renewal, and creativity generally. The senex refers us to qualities such as wisdom, balance, steadiness, generosity towards others, farsightedness. Each ‘position’ can become pathological: unmitigated puer is redolent of impatience, overspiritualization, lack of realism, naive idealism, tendencies ever to start anew, being untouched by age, and given to flights of imagination. Pure senex is excessively cautious and conservative, authoritarian, obsessional, overgrounded, melancholic, and lacking imagination. The injury that our culture has done us concerns the forcible splitting of an archetypal interplay between puer and senex.

 

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