22 Chapters
Medium 9780950714684

5: TRANSFERENCE-PHENOMENA AND TRANSFERENCE-ANALYSIS IN AN ACUTE CATATONIC SCHIZOPHRENIC PATIENT

Rosenfeld, Herbert A. Karnac Books ePub

MOST analysts have until recently refrained from treating schizophrenic patients, in the belief that the schizophrenic is incapable of forming a transference. My own experience has shown me that we are dealing here not with an absence of transference, but with the difficult problem of recognizing and interpreting schizophrenic transference-phenomena. It may be valuable to examine first the findings of other analysts,

Both Freud (1911 and 1914b) and Abraham (1908a) made it quite clear that in their opinion the schizophrenic is incapable of forming a transference, owing to his regression to the auto-erotic level of development. They explained this by stating that on the earliest infantile level, which they called the auto-erotic phase, there was as yet no awareness of an object. But there are several statements of Freud's which seem to contradict the concept of an auto-erotic phase, in which there is no relation to an object, such as that in The Ego and the Id (1923) where Freud says: tfAt the very beginning, in the individual's primitive oral phase, object cathexis and identification are no doubt indistinguishable from each other/ From this later opinion of his we may conclude that he recognized the existence of object cathexis in earliest infancy. Freud however never gave any indication that he changed his view about the lack of transference in schizophrenia (perhaps because he had no later experience with such patients).

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12: AN INVESTIGATION INTO THE NEED OF NEUROTIC AND PSYCHOTIC PATIENTS TO ACT OUT DURING ANALYSIS (1964)

Rosenfeld, Herbert A. Karnac Books ePub

Iw investigating the need of patients to act out during analysis, I have come to understand that some acting out occurs in every analysis, and that one might well be justified in saying that partial acting out is not only inevitable but is in fact an essential part of an effective analysis. It is only when this partial acting out increases and becomes excessive, that both the analysis and the patient are endangered.

As far back as 1914 Freud discussed the question of acting out. In explaining the process of analysis he says: We may say that the patient does not remember anything of what he has forgotten and repressed but acts it out (Freud, 1914a). Freud then relates the acting to the repetition compulsion and continues: As long as the patient is in the treatment he cannot escape from this compulsion to repeat; at last one understands that it is his way of remembering/ Later on he says: ‘We soon perceive that the transference is itself only a piece of repetition and that the repetition is a transference of the forgotten past not only on to the doctor, but also on to all the other aspects of the current situation. We must be prepared to find, therefore, that the patient abandons himself to the compulsion to repeat, which now replaces the impulsion to remember, not only in his personal attitude to his doctor but also in every other activity and relationship which may occupy his life at the time/

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9: NOTES ON THE PSYGHOPATHOLOGY AND PSYCHO-ANALYTIC TREATMENT OF SCHIZOPHRENIA

Rosenfeld, Herbert A. Karnac Books ePub

MY interest in the psychological approach to schizophrenia goes back more than twenty-five years. At that time I had the opportunity of interviewing a large number of schizophrenic patients in the Maudsley Hospital and I noticed that some of them regarded psychological problems as the cause of their illness. I remember a young catatonic schizophrenic girl of sixteen who explained to me that she became ill after she had discovered the facts of life. She found it unbearable to think about the details of her birth from the inside of her mother. She explained that this was the reason why she did not want to have anything to do with her mother or anybody else. She did not want to read any more because she was afraid of having to visualize again something which was similarly unbearable. In fact it seemed as if this girl had, as a result of this experience, turned away from the outer world and from all her interests which were related to it. My observations at that time had the effect of making me increasingly doubtful about the prevalent contemporary teaching, which suggested that schizophrenia should be regarded as an endogenous problem which became manifest completely uninfluenced by external circumstances. At a later time I had the opportunity of trying some psychotherapy with schizophrenics in various hospitals and was astonished that I succeeded in making good contact with some very ill schizophrenic patients and that they could be helped by simple psychotherapeutic talks. In other cases, however, I felt completely helpless, especially when I realized that, after some initial improvement, the patients became very much worse.

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11: THE PSYGHOPATHOLOGY OF HYPOCHONDRIASIS (1964)

Rosenfeld, Herbert A. Karnac Books ePub

KNOWLEDGE about a disease called ‘Hypochondriasis’ dates from the time of Hippocrates, and ever since then it appears to have been a common illness, judging from the literature throughout the ages. At the time of Boswell, who himself suffered from it, hypochondriasis in England was so common as to be called the ‘English Malady’. There is a large psychiatric literature on the question as to whether hypochondriasis ever existed as a separate disease entity. Bleuler thought that all patients suffering from chronic hypochondriasis were schizophrenics. Raeke, Westphal, Sommer, Wolfsohn and later Schilder were all in favour of regarding severe chronic hypochondriasis as a ‘psychotic disease entity. Bleuler defined hypochondriasis as a condition consisting in ‘continuous attention to one's own state of health, with a tendency to ascribe disease to oneself from insignificant signs and even without such’. The severity of hypochondriasis varies a great deal and it may be valuable to differentiate the disease entity ‘hypochondriasis’, which is a very chronic psychosis, generally believed to be of bad prognosis, from ‘hypochrondriacal states’, which are more temporary: they may be psychotic or neurotic in origin. Hypochondriacal states are found in the neuroses and psychoses, as in hysteria and obsessional neurosis; in depressive and neurasthenic conditions; in schizophrenia; and also in the initial states of organic psychosis. They are common in adolescence and in middle age. Temporary hypochondriacal anxieties, for example, may arise when early infantile psychotic, particularly paranoid, anxieties are stimulated and have to be worked over again by the individual. This would explain why hypochondriacal anxieties frequently arise in phases of readjustment, for example at puberty or in middle age. The meaning of these hypochondriacal phases would be similar to the function which Melanie Klein attributes to the infantile neurosis, which she connects with the working over again of early psychotic anxieties.

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9. Crisis situations

Rosenfeld, Herbert A. Karnac Books ePub

This clinical situation here regards a young man who has his first psychotic breakdown three weeks after beginning analytic work, and who then makes a horrific suicide attempt

The analytic events covered go up to the sixth year of analysis, including material from two sessions.

These sessions are followed by a dream the analyst had which— we later find out—occurs at the same time as a manic explosion by the patient, who is taken into a psychiatric hospital.

Rosenfeld emphasizes how useful it is for the analyst to build up a preliminary picture in his mind, which can then be modified as analysis proceeds, to serve as a fallback when a hard-to-manage crisis situation occurs.

An example for similar situations may be found in the analysis of this patient, revealing the need to rapidly become aware of the existence of a serious risk of suicide or of a psychotic crisis, fed by omnipotent guilt and identification with a destructive mother.

A great deal of caution must be used in the treatment of manic conditions. If handled precipitately, the patient’s depressive state may worsen and push him to suicide.

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