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10: ON THE PSYCHGPATHOLOGY OF NARCISSISM: A CLINICAL APPROACH

Rosenfeld, Herbert A. Karnac Books ePub

FREUD was pessimistic about the psycho-analytic approach to the narcissistic neuroses. He felt that people suffering from these diseases had no capacity for transference, or only insufficient remnants of one. He described the resistance of these patients as a stone wall which cannot be got over, and said that they turn from the physician not in hostility but in indifference. Many analysts have tried to develop methods of analysis which would deal with narcissistic patients-1 am thinking of Waelder (1925), Clark (1933), and later Fromm-Reichmann (1943,1947)5 Bion (1962), Rosenfeld, and others. The majority of analysts who have treated narcissistic patients have disagreed with Freud's view that there was no transference. As the transference is the main vehicle for any analytic investigation, it seems essential for the understanding of narcissism that the behaviour of the narcissist in the analytic transference situation should be minutely observed.

Franz Cohn (1940) suggested that the sharp distinction between transference neurosis and narcissistic neurosis should be disregarded. He felt that the transference in the narcissistic neurosis is of a primitive or rudimentary type-for example, there are often serious difficulties in distinguishing between subject and object-and he stresses the introjection and projection of destructive tendencies in oral and anal terms in relation to the analyst. Stone (1954) described transferences which are ‘literally narcissistic’, where the analyst is confused with the self or is like the self in all respects: the therapist and the patient alternately seem to be parts of each other. He stresses both the primitive destructiveness and the need to experience the analyst as an omnipotent, godlike figure, and suggests that, in the patient's fantasy about the analyst's omnipotence, guilt about primitive destructive aggression plays an important part.

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13: THE PSYGHOPATHOLOGY OF DRUG ADDICTION AND ALCOHOLISM

Rosenfeld, Herbert A. Karnac Books ePub

ALCOHOLISM and drug addiction have always presented a difficult psychiatric and social problem. Psycho-analysts, along with many others, have from early on been interested in the treatment of these disorders, and have attempted to investigate and understand their underlying psychopathology. A large psycho-analytic literature has developed and many analysts have made several contributions to the subject over die years. This paper aims to give a picture of the psycho-analytic literature on alcoholism and drug addiction and to correlate the psychoanalytic findings. An attempt will be made to see whether, on the basis of the ideas on which there is a consensus of opinion among the authors of this literature, one can speak of the psychoanalytic theory of drug addiction or alcoholism,,

Freud never wrote a detailed essay on alcoholism or drug addiction, but there are many isolated remarks or suggestions in his writings which throw some light on the psychopathology of addiction. In 1897 in a letter to Fliess (Freud, 1950) he suggests that masturbation is the primary addiction and that the other addictions, such as alcohol, morphine, tobacco, etc., only enter into life as substitutes or replacements for it. In another letter to Fliess he discusses the relation of dipsomania to repressed sexuality and thinks that in this condition there is a substitution of one impulse for an associated sexual one. In the Three Essays on Sexuality (1905) he says that there is in some children a constitutional intensification of the erotogenic significance of the labial region. If that significance persists, these same children when they are grown up —will have a powerful motive for drinking and smoking.’ In Jokes and Their Relation to the Umon seimss (2904) he writes: A cheerful mood, whether it is produced endogenously or toxically, reduces the inhibiting forces, criticism among them, and makes accessible once again sources of pleasure which were under the weight of suppression. Under the influence of alcohol the grown man once more becomes a child who finds pleasure in having the course of his thoughts freely at his disposal without paying regard to the compulsion of logic.’ In his ‘Contributions to the Psychology of Love (1910) Freud contrasted the relation of the lover to the sexual object with that of the wine drinker to wine. Whereas the lover may pursue an endless series of substitute objects, none of which ever gives full satisfaction, the drinker is more or less bound to his favourite drink and the repeated gratification does not affect the recurrence of his strong desire. The great lovers of alcohol describe their attitude to wine as the most perfect harmony, a model of a happy marriage. In 1911 he refers to the part played by alcohol in alcoholic delusions of jealousy and suggests that drink removes inhibitions and undoes the work of sublimation. As the result of this, homosexual libido is freed and the drinker suspects the woman he is jealous of in relationship to all the men whom he himself is tempted to love. In 1917 he compares toxic hallucinations, such as alcoholic delusions, with the wishful psychosis of'amentia’ (Freud, 1917a). He believes that alcoholic delirium arises when alcohol is withdrawn, which implies that it is a reaction to the loss of alcohol which is experienced as unbearable. In ‘Mourning and Melancholia’ (1917b) he expresses the view that alcoholic intoxication, in so far as it consists in a state of elation, belongs to the manic group of mental conditions. In mania there is a relaxation in the expenditure of energy on repression. In alcoholism the freeing of impulses from repression is made possible by the toxin. In 1928 in a paper on ‘Humour’, Freud (1927) again refers to intoxication. He compares humour with elation and suggests that it signifies the triumph not only of the ego but also of the pleasure principle. He writes ‘(The) rejection of the claims of reality and the putting through of the pleasure principle bring humour near to the regressive or reactionary processes which engage our attention so extensively in psychopathology. Its fending off of the possibility of suffering places it among the great series of methods which the human mind has constructed in order to evade the compulsion to suffer-a series which begins with neurosis and culminates in madness and which includes intoxication, self-absorption and ecstasy/ From these quotations of Freud's views it is clear that he realized that the root of addiction goes back to the oral phase of development, but he also saw that there was a connexion between addiction and infantile masturbation. He also makes it clear that he believes that the drinker often regards alcohol as an ideal object, which would explain why the drinker becomes so deeply attached to alcohol-representing this object By connecting the psychopathology of mania and humour with alcoholism and intoxication Freud laid the foundation for a deeper understanding of the addictions.

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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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7. Persecutory anxiety

Rosenfeld, Herbert A. Karnac Books ePub

The patient presented in this seminar initially appears to be a mysterious geometric object During the course of the presentation the patient frees himself from the nebulous atmosphere in which he has enveloped himself to reveal a way of mental functioning that may be understood, reached, and touched. But being touched can represent a danger, a source of persecution. Rosenfeld shows how one may handle this delicate situation in such a way as to access the relationship. This requires great wisdom and the ability to wait: wait for the patient to perceive the value that the analyst figure takes on for him and, above all, wait for the patient to achieve the ability to keep things together when he connects with his emotions and with people, moving away from his world of geometric figures.

This case presents additional interest in its illustration of the difficulties of tackling the particular depressive anxiety that emerges from analytic insight, associated with the painful and intolerable perception of how much life has been wasted in the psychotic state. Drawing upon prophetic words from Pirandello’s Henry IV, the patient describes this pervasive anxiety in a touching manner; this is something that often appears during the course of improvement in the analysis of psychotic cases.

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2: REMARKS ON THE RELATION OF MALE HOMOSEXUALITY TO PARANOIA, PARANOID ANXIETY AND NARCISSISM

Rosenfeld, Herbert A. Karnac Books ePub

Psycho-analytical Theories of Paranoia

THE problems I wish to discuss concern the interrelations between homosexuality and paranoia, paranoid anxiety and narcissism. As early as 1908, Freud discussed with some prominent analysts of that time, particularly Ferenczi and Jung, the intimate relationship which he felt invariably existed between paranoia and latent homosexuality; and since then many papers on paranoia have appeared in the analytic literature. Most of the earlier and some of the later authors think that the projection of latent homosexuality is the most important factor in this disease. Ferenczi (1911a) went so far as to suggest that paranoia may be simply a distorted form of homosexuality. Freud (1911) stated his views on paranoia in his Schreber case, There he put forward his famous formula for paranoia, of how the consciously unbearable homosexual feelings are changed into hostile ones for defensive purposes, and then projected. At the same time he demonstrated that the projective mechanism could be used for other purposes: ‘In the beginning of the disease (dementia paranoides), all object cathexis is withdrawn from the objects of the environment and regression to narcissism takes place. In the process of recovery, the libido is brought back to the people it had abandoned. In paranoia, this process is carried out by the method of projection.'

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