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Finding the Body in the Mind

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Since the 1990s many different scientific disciplines have intensified their interest in the so called 'mind-body-problem': psychoanalysis, philosophy, academic psychology, cognitive science and modern neuroscience. The conceptualization of how the mind works has changed completely, and this has profound implications for clinical psychoanalytical practice as well as for theorizing in contemporary psychoanalysis. The question of how unconscious fantasies and conflicts, as well as traumatic experiences, can be understood and worked through is, and has been, one of the central topics of psychoanalysis. Interdisciplinary studies from the fields of embodied cognitive science, epigenetics, and cognitive neuroscience offer challenging explanations of the functions in the analysts mind which might allow him to create spontaneous associations through which he unconsciously 'understands' the traumatic, embodied experiences of the patient. As the clinical examples presented in this book suggest, it is the continuous observation in clinical situations - as well as the development of a holding and containing analytic relationship in long psychoanalyses - which finally allow the psychoanalyst and his patient to dare to re-experience the trauma (or other threatening infantile conflicts) directly in the transference. These processes open the doors for an increasingly detailed understanding of the traumatic material in the enactments and other forms of "embodied memories" of the analysand in the transference, and to initiate a process of working through. In this book challenging epistemological and methodological questions are connected throughout with the interdisciplinary dialogue between psychoanalysis and modern neurosciences.

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Chapter One - Psychoanalysis as a “Science of the Unconscious” and its Dialogue with the Neurosciences and Embodied Cognitive Science: Some Historical and Epistemological Remarks

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As you know, we have never prided ourselves on the completeness and finality of our knowledge and capacity. We are just as ready now as we were earlier to admit the imperfections of our understanding, to learn new things and to alter our methods in any way that can improve them. (Freud, 1914g, p. 159)

Introduction

What kind of a science is psychoanalysis really? What did Freud mean when he defined psychoanalysis as a special “science of the unconscious”? As a young man Freud was very interested, as is known, in philosophy and in the humanities before he turned with a remarkably strong emotional reaction to the natural sciences. He worked at that time on research in medicine and neurology in the laboratory of Ernst Brücke's Institute of Physiology, where he became acquainted with a strict positivistic understanding of science, that attracted him throughout his whole life. As we know, however, Freud later turned away from the neurology of his time since he recognised the boundaries of the methodological possibilities concerning research of the psyche in this discipline. With The Interpretation of Dreams, the founding work of psychoanalysis, he defined this as “pure psychology” (Grubrich-Simitis, 2009). He further understood himself, however, to be a physician who observed very precisely as a natural scientist. His wish of a precise, “empirical” examination of hypotheses and theories protected Freud, as Joel Whitebook (2010) notes, from his own predilection to wild speculation. Thus, Freud as a “philosophical physician” could establish a new “science of the unconscious”.

 

Chapter Two - Finding the Body in the Mind: Embodiment and Approaching the Non-Represented—a Case Study and Some Theory

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Embodied countertransference responses in the first interview—the key to the un-representable?

Freud wrote in 1914 in “Remembering, repeating and working through”:

Above all, the patient will begin his treatment with a repetition of this kind…What interests us most of all is naturally the relation of this compulsion to repeat to the transference and to resistance…The greater the resistance, the more extensively will acting out (repetition) replace remembering. (Freud, 1914g, p. 150)

Generations of psychoanalysts since Freud have concerned themselves with the way in which repetition in transference can provide a healing process of remembering. This primarily involves symbolically represented and repressed memories or relationship patterns. However, theory and clinical psychoanalysis has focused for quite some time on psychic material present in the analytical relationship in other ways. Levine, Reed, and Scarfone entitled their anthology Unrepresented States and the Construction of Meaning (2013) in honour of André Green, and focused on the question of the search for meaning in the unrepresented from a contemporary perspective. With his widely accepted concept of “dead mother”, Green (2007) described the early identification with an absent mother leading to a withdrawal cathexis and thus to a disappearance of the inner representation that, in the transference relationship, can be perceived by the analyst as an empty, negative hallucination of the object, “a representation of the absence of representation” (Green, p. 196, in Reed, 2013, p. 39). Reed (2013, p. 29 ff.) points out that this negative hallucination of the object leads to an emptiness rather than a representation of the lost object—an empty mirror that, with these patients, is always there, but that is frequently observed in the analysand's extreme reactions to separation from the analyst.

 

Chapter Three - The Relevance of the Embodiment Concept for Psychoanalysis

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But what relevance does this fundamental scientific knowledge have for psychoanalysis?

 

The embodiment concept in psychoanalytic literature

In psychoanalytic literature there are a number of papers that take up the concept of embodiment, though frequently not in the radical sense we postulate here (Leuzinger-Bohleber et al., 2013a; Emde & Leuzinger-Bohleber, 2014). In his historical survey, Sletvold (2011) employs a very broad definition of embodiment in the sense of “work with the body in psychoanalytic therapies”, a tradition that, among other things, goes back to Wilhelm Reich's psychotherapy of the body. Based on the latter therapy, he even develops practical guidelines for the work of the analyst with “unconscious embodied expressions” (Sletvold, 2012; cf., also Bloom, 2006). Similarly, in his work “Fundamentally embodied: the experience of psychological agency”, Frie (2008) points to the works of Lakoff and Johnson (1999) and Damasio (1994/1997), though using the concept of embodiment not in the sense of a new theoretic explanation of specific clinical phenomena, but very generally, as a document of complex processes of reflection “informed by personal history and fundamentally embedded in biological and sociocultural contexts” (p. 374; cf., Langan, 2007; Mizen, 2009). In a similarly global manner, Vivona (2009) argues for an “embodied language” as expression of a modern integration of neurosciences and psychoanalysis.

 

Chapter Four - “I still don’t know who I Really am…” Depression and Trauma: A Transgenerational Psychoanalytical Perspective

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Introduction: depression—the most frequent psychic disorder with the danger of chronification

Mrs M had a depressive break down in her early fifties. She was not able to work anymore as a social worker with delinquent adolescents. She was highly suicidal and suffered from severe sleeping and eating disorders. In the initial interview she told that her boy-friend, married to another woman, had moved to another town. Another reason for her breakdown were the daily quarrels between her adolescent daughter and her grandmother, all living in the same house. She always told her daughter: Be nice to the old woman and respect her although she realised that the strange behavior of her mother was quite pathological. (see Chapters Two and Three)

Psychoanalysts all over the world currently have many patients like Mrs M in treatment. Severe depression, often in combination with personality disorders, is one of the most frequent diagnoses of patients in psychoanalytic long-term-therapies and psychoanalysis today, and often has, as in the example of Mrs M, an obviously trans-generational dimension.

 

Chapter Five - Inspiration of the Clinical Psychoanalytical Practice by the Dialogue with the Neurosciences and Embodied Cognitive Science: Some Examples

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Facing the pain in psychoanalyses with severely traumatised chronically depressed analysands—new ways in conceptualisation and treatment*

Introduction

Night after night Mr P wakes up bathed in sweat and in shock from a nightmare following a mere few hours of sleep: for the last twenty-five years he has been suffering from severe depressions accompanied by extreme sleeping disorders, unbearable, chronic widespread pain, suicidal thoughts, panic attacks, and a series of psychosomatic symptoms, among others, acute neurodermatitis.

Mr P is one among many suffering from severe depression. As already mentioned in Chapter Three: according to the World Health Organization (WHO), today over 300 million people suffer from major depression, which, according to the organisation's prognosis, is destined to become the second most frequent illness worldwide by 2020. This enormous increase in severely depressive sicknesses is the object of interesting historical, sociological, and economic analyses, which I am unfortunately unable to address in present context (cf., Chapter Three; Bahrke, 2010; Ehrenberg, 1998; Gammelgaard, 2010; Haubl, 2013; Illouz, 2006; Sennett, 1998). In keeping with psychoanalytic concept research, I will instead be focusing on clinical and extra-clinical results relating to the intimate and frequently unrecognised link between trauma and depression. Mr P's nightmares also point to this connection. Thus, for instance, following six months of psychoanalysis, he reports the following dream:

 

Chapter Six - How to Investigate Transformations in Psychoanalysis? Contrasting Clinical and Extra-Clinical Findings on Changes of Dreams in Psychoanalysis with a Severely Traumatised, Chronically Depressed Analysand: Tamara Fischmann, Marianne Leuzinger-

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Tamara Fischmann, Marianne Leuzinger-Bohleber, Margerete Schoett, and Michael Russ

Introduction *

As mentioned in the introduction of the present volume, a growing number of research groups throughout the world have apparently begun to realise that the neurosciences and psychoanalysis could benefit from each other in interesting ways. The neurosciences are now equipped with objective, precise methods for verifying hypotheses on human behaviour, while psychoanalysis, based on its rich experience with patients and its unique method of field research, has developed a variety of different models in order to conceptualise the multi-layered and complex observations that derive from the psychoanalytic situation and to test them by means of its specific form of empirical research, namely, clinical psychoanalytical research. The explanatory models and insights developed by psychoanalysis can also be of interest to neuroscientists and raise specific research questions.

 

Chapter Seven - “Finding the Body in the Mind…” and Some Consequences for Early Prevention: The Concept “Outreaching Psychoanalysis” and Some Realisations

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As mentioned in the introduction, the last chapter of this volume is given over to some of the consequences of the contemporary dialogue between psychoanalysis and the Neurosciences in the field of early prevention. If one takes Freud's thesis seriously, namely, that all psychic and psychosocial experiences are retained by the body and determine future problem-solving, then emotions, fantasies, and object relations could prompt many psychoanalysts to engage in another form of “outreaching psychoanalysis” in early prevention (see, e.g., Emde & Leuzinger-Bohleber, 2014). In all these projects we see the enormous plasticity of the brain and the psyche in the first months of life as a great opportunity to reach out to children suffering from severe traumas and their families and, through this, to implement alternative, progressive developmental paths by way of alternative relationship experiences. As has been impressively documented by psychoanalytic research on resiliency, when compared to the primary object relationships, for these children alternative relationship experiences have often proven life-saving decades later—even though it may have been possible to only partially offer such alternative experiences (cf., also, among others, Hauser et al., 2006). For some of these children, inwardly, they seemed to be like a “principle of hope” (Ernst Bloch) and, in the best of cases, to contribute to the avoidance of psychic resignation among children, or their attempt to overcome their suffered traumatisation by violent and self-destructive means. In this sense, in the attempt to make psychoanalytic knowledge available to children and their families living on the periphery of our society as traumatised refugees, as migrants forced into exile by war and persecution, or as losers in a modern society chiefly determined by speed and competition, we see ourselves in the tradition of Alexander Mitscherlich and his vision of a psychoanalytic, cultural-critical research (Mitscherlich & Mitscherlich, 1967).

 

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