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5. Other Manifestations of die Deadi Constellation

Williams, Arthur Hyatt Karnac Books ePub

In one family, Caribbean in origin, that I treated there was a tough stall holder at a street market father in his late fifties, a mother a few years his junior, three sons, and a daughter. The mother could just about read and write, but was not of subnormal intelligence. The eldest son, in his mid-thirties, was a successful solicitor, entirely interested in young women. The second son, two years younger, was a carpenter, skilled at his work, but with a tendency to become depressed and inactive. The third son was a slick, clever businessman, a wheeler-dealer. Both younger sons lived with women many years older than themselves, clearly representing mother. The youngest sibling was a girl, attractive and wayward, who had caused her parents much anxiety by her unamenable, undisciplined behavior over which they had little influence. The family had been affluent, but times had changed and their standard of living had fallen dramatically.

The impression I got, through treating the oldest brother in as near to psychoanalytical therapy as possible, was that father was bright but operated at the frontier of criminality. He was kind, rough, quick to avenge grievances, proud, resourceful, and with a smoldering, explosive temper. Mother had bouts of depression, including some severe ones for which she had been given several courses of electroconvulsive therapy. She had made suicidal attempts from time to time, one or two having necessitated treatment in an intensive care unit. The second son had also made two suicidal attempts, or at least gestures, toward suicide.

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CHAPTER FIVE: The fiend that sleeps but does not die: Toward a psychoanalytic treatment of the addictions

Karnac Books ePub

The fiend that sleeps but does not
die: Toward a psychoanalytic treatment
of the addictions

Stephen M. Sonnenberg

In this essay the author describes his views on the psychoanalytic treatment of the addictions. He describes addiction as a serious mental disorder, which is appropriately included as a topic in this conference. Next, he conveys the scope of this major public health problem, and discusses the reasons why psychoanalysis has made so small a contribution to its understanding. This essay discusses addiction in high functioning analytic patients, and offers a definition of what constitutes high functioning individuals. Case examples from thirty years ago, and from the present, illustrate how today, with more advanced knowledge, more successful analytic treatment of addiction is possible. The author describes modifications in standard analytic technique which are helpful, and which result in analysands who remain abstinent indefinitely.

At first blush one might wonder whether the treatment of the addictions belongs in this conference where we are exploring such difficult clinical situations as the treatment of schizophrenia, borderline personality disorder, and suicidality. I contend that it very much fits, because addicted analysands often behave in suicidal ways, in some cases might well qualify diagnostically as schizophrenics or borderlines, and in general fundamentally challenge the treating psychoanalyst to work effectively.

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1. Leslie Sohn. Psychosis and violence

Williams, Paul Karnac Books ePub

Leslie Sohn

Previously, in another place, I presented a paper on unprovoked assaults, and discussed some patients, one of whom will appear in this paper. From that I wrote a paper which appeared in the International Journal of Psychoanalysis (Sohn 1995).

I want to take a further look at the patient I described in order to emphasise the relationship of his psychotic state to the events of violence which brought him to our attention. And then, in contrast, I want to talk about a young psychotic woman who never resorted to physical violence, although she had had delusional ideas of having murdered - or somebody having been murdered, or somebody having murdered somebody - and she felt that she’d seen the dead body. Then I want to talk about two other men; one a borderline case with almost delusional belief in his sanity, whose violence was solely directed unwittingly to his own mind and its contents, and to the mind of others who were exposed to him, and we were expected to believe implicitly in his conclusions. To do so, and to believe that, would mean that the listener’s mind would have totally given up its own scepticism and independent thinking. In other words, that the listener’s mind would have felt murdered, or dead. This man deigned physical assault; he was above it, and I think he even deigned physical contact as well.

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18. Victims and Victimology (I)

Williams, Arthur Hyatt Karnac Books ePub

There are individuals who evacuate seemingly unbearable states of mind into other people or into another person and then attack that person. In so doing they attack the part of themselves that has been evacuated, the part they have been unable to digest and metabolize as part of their impulse or fantasy life. After offloading it they feel relief, but this is a temporary respite, as they then feel they will be attacked by the person into whom they have evacuated the dangerous, unmanageable part of themselves. The counterattack may be by the person in receipt of the projection, or by the part which is in the projector himself or herself. This part is felt to be angry at having been gotten rid of.

Some potential victims who have been treated this way retaliate violently on their own behalf. Some, however, seem to be born victims who unconsciously, or consciously and perversely, welcome ill-treatment, even to the point of becoming murder victims. There is a distinction between the perverse masochism of finding pleasure in pain and/or the threat of pain and serious damage—in other words, a more and a less serious category. An example of the latter is the young man who persuaded some youths to crucify him in a public park. Fortunately, he was freed; only much later was it revealed that he had asked to be crucified. Some expressions of masochism, and indeed of sadism, are extremely complicated. What is happening cannot be understood until the unconscious fantasy constellation is pieced together. Usually the individual addicted to a particular kind of action knows only a part of the constellation, most of which is going on below the surface in the unconscious mind. Whenever in a repetitive sequence of action there is a dividend of pleasure, it takes a lot of therapy and a good deal of understanding in depth before that dividend can be renounced.

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19. Victims and Victimology (II)

Williams, Arthur Hyatt Karnac Books ePub

Someone said to Oscar Wilde, “Each man tries to kill the thing he hates.” Wilde replied, “No, each man kills the thing he loves.” Both these statements express an aspect of the truth. The hated aspect poses a threat, is experienced as a persecutor, and is a conscience arouser. It is an enemy of one’s own peace of mind and of success in life. In extreme examples in literature and in history, one finds that the categories into which the activities of a nonmitigator of murderous impulses fall are few in number. Oedipus Rex, Cain and Abel, Clytemnestra and Agamemnon, followed by Orestes and Clytemnestra, all exhibit patterns that one can discern in repeated murderous actions over millennia. Roughly, they can be matched with the states of mind of the respective villains—envy, jealousy, greed, suspicion, retaliation, revenge, or, more psychologically, paranoia. In addition, there is the confusion between a hunting approach and an amorous, courtship one, as if the two currents of human endeavor had not been sufficiendy differentiated. At base, the problem in Shakespeare’s Othello demonstrates the military dilemma: how to proceed, from within a warm, “homosexual” pattern of military comradeship, to a quite different kind of pat-tern, that of family relations and development. Under “attack”—a military kind of attack by Iago—Othello resorts to a military ruth-lessness in his attempt to settle his domestic problems, but is tactically outmaneuvered by Iago.

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