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11 From denial to self-awareness : a 20 years’ study of childhood delinquency evolving into adult neurosis

Limentani, Adam Karnac Books ePub

TWENTY YEARS AGO two children, a girl aged ten-and-a-half and her brother a year older, were referred for psychotherapy to the Portman Clinic, London, with a long history of behaviour disorder, delinquency and severely disturbed family background. In the case of the boy, analytical psychotherapy was terminated after two years with good results, whilst the girl’s treatment, having been brought to an end after three years, was resumed shortly afterwards and continued at intervals until 1979. Although it is possible that this report may stimulate a discussion on the value and limitation of psychotherapy in the management of delinquent children, my main concern is in showing the evolution of the delinquency into a neurosis, a development which could only be dealt with by prolonged psychotherapy. To make the presentation easier, I have adopted the artificial method of dividing it into three phases, though in reality the development was gradual and contact was almost uninterrupted throughout the period.

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6 Object choice and bisexuality

Limentani, Adam Karnac Books ePub

INTRODUCTION

PSYCHOANALYSIS HAS THROWN much light on the factors which enable some people to retain their homosexuality in a latent state, while others can successfully satisfy the needs of the male and female parts of their personality without being compelled to act out their id experiences in a fully fledged perversion. The capacity of certain individuals to engage in sexual activities with members of both sexes continues to present a challenge to our theoretical understanding of human sexuality and of the perversion as such. In general, theoretical and clinical discussions tend to concentrate our attention on the homosexual aspect of the dichotomy, neglecting Freud’s reminder that even heterosexuality requires justification (Freud, 1905a, p. 146).

In this context defence is understood to be directed not only at protecting the ego against anxiety aroused by instinctual drives, the superego, or external dangers, but also and preferably at including all the techniques used by the ego to dominate control and channel forces which might lead to neurosis or psychosis. In those bisexual cases where homosexuality is predominant, the heterosexuality may well assume a defensive role, which does not become apparent until one outlet is suddenly unavailable.

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9 The significance of transsexualism in relation to some basic psychoanalytic concepts

Limentani, Adam Karnac Books ePub

I INTRODUCTION

TRANSSEXUALISM HAS HITHERTO been largely ignored by psychoanalysts as being a defence against homosexuality or a bizarre and rare disorder of gender identity. In recent years a serious problem has arisen as a result of the publicity afforded to sex change operations and the unwelcome glamorization of such operations. The accumulation of clinical reports and information has not been accompanied by a substantial advancement in our theoretical understanding of the condition. When theory fails to develop at the same pace as clinical practice there will inevitably be adverse repercussions often leading to dangerous generalization and reflecting on the handling of, and approach to, each individual case.

The aim of this paper is to deal with those aspects of transsexualism which seem to challenge basic psychoanalytic concepts, and in particular castration anxiety, the oedipal complex and the role of conflict especially in relation to gender identity formation.

A further purpose is to stimulate amongst psychoanalysts the formation and expression of the psychoanalytic point of view. One recalls the time when prefrontal leucotomy was being hailed as a great advancement in the treatment of the mentally ill, neurotic and psychotic alike. This treatment is seldom used now and if lessons from the past are to be of value then a repetition of the indifference and laissez-faire attitude which was prevalent in the profession at that time should be avoided.

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3 A re-evaluation of acting out in relation to working through

Limentani, Adam Karnac Books ePub

IT SEEMS LOGICAL that any discussion on acting out, in order to be meaningful, would have to be related to the concept of ‘working through’. There are few aspects of our daily analytical work which are more challenging than acting out and more directly pointing to the necessity and arduousness of working through the patient’s resistances, as Freud (1914) has warned us. The problem is not only that the tendency to act out needs constant attention by the analyst but also that disturbing episodes of acting out may well occur in the course of working through anxieties and conflicts under apparently quite satisfactory circumstances. I am referring to those optimal conditions where analyst and patient work well together and, of course, where the analyst has in no way contributed to force the patient to act out as a result of his own incompetence or because of the persistence of unresolved conflicts in himself. However, it would be fair to say that there are many instances when the analyst may unwittingly play a part. The experienced analyst is not only disappointed at seeing years of insightful working through wasted but may even come to the conclusion that the patient’s resistances are intractable to the point of abandoning analysis.

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2 The Orpheus myth as reflected in problems of ambivalence and reparation in the oedipal situation

Limentani, Adam Karnac Books ePub

I ORPHEUS OBSERVED

MANY YEARS AGO I had a patient who was identified with Orpheus. The identification with the Poet-Hero of classical antiquity came to light suddenly and unexpectedly at the end of the fourth year of a psychoanalysis which my patient, whom I shall call Mr A, had requested on account of deep depression, inability to use his intellectual resources and a tendency to find himself rejected by men and women.

Mr A believed, with some justification, that all his problems were due to the fact that, owing to the war, he had been separated from his parents for long periods from the age of two and a half onwards. His state of mind during those early years could be reconstructed in the analysis when, during the first three years, Mr A would often phone the analyst late at night, ‘just to hear [his] voice’. In due course this was understood as an attempt to resuscitate the analyst who was felt as having died during the unbearable twenty-three hours’ separation. The only improvement at the time of the session I wish to report was shown by the abandonment of a search for a homosexual solution to his problems and the development of a well defined heterosexual disposition. Just as he was beginning to feel more secure in his dealings with women, Mr A suffered one more rejection as a result of his unwillingness to commit himself. The young woman with whom he had been in love for some time had finally married someone else. Mr A came to his session after attending the wedding ceremony, looking depressed but unusually willing to talk about his feelings, claiming that this time he had really lost everything. Admitting that he felt extremely jealous of the newly wedded couple, he insisted he was fully justified in feeling sadistic and murderous.

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