8 Chapters
Medium 9781855758926

CHAPTER THREE. Hysteria and mourning-a psychosomatic case

Sklar, Jonathan Karnac Books ePub

Of course missing a mistress and the jealousy that lingers on afterwards are physical illnesses just as much as tuberculosis or leukaemia. Ye t we need to distinguish among the physical maladies between those that are caused by a purely physical agency and those that act on the body only through the media of the intellect. Above all, if part of our intellect that serves as a medium of transmission is memory—that is if the cause is annulled or removed—however cruel our suffering is, however deep seems the disturbance wrought on our organism, it is extremely rare, given the power of thought to renew itself or rather its inability to remain unchanged, unlike bodily tissues, for the prognosis to be unfavourable.

—Marcel Proust, The Fugitive (1925, p. 608)

In Studies on Hysteria, Freud and Breuer write about tracing “the most various symptoms which are ostensibly spontaneous and as one might say, idiopathic products of hysteria are just as strictly related to the precipitating trauma” (Breuer & Freud 1893–1895, p. 4). They go on to describe various illnesses, including disorders in the nature of tic. There have, however, been very few case reports in the recent literature on the treatment of such cases.

See All Chapters
Medium 9781855758926

CHAPTER SIX. Psychosomatics and technique

Sklar, Jonathan Karnac Books ePub

It is generally well known that out of the crews of Whaling vessels few ever return in the ships on board of which they departed.

—Theodore Foster, A Cruise in a Whale Boat, and Adventures
in the Pacific Ocean (1979, p. xv)

At the age of eight, the writer Aharon Appelfeld witnessed the pogrom in his hometown of Czernowitz. He saw the murder of his mother and, separated from the rest of family, survived by scavenging in the forests. Remembrance was complicated, he thought, by his having been too young a child to process much of what he saw. The past remains entirely physical for him: “etched inside my body but not in my memory” (Appelfeld 2005). More than half a century later, his feet still cause tension in his legs and this pain instantly transfers him back to his years in hiding. The very act of sitting or standing can conjure up hellish visions of packed railway stations; rotting straw or the call of a bird trigger visceral memories deep within his body.

The capacity for free association is both protected and inhibited by the movement of affect into the body, which acts as a container and can deflect away from the mind with its complexity of thoughts and associative strands. A particular part of the body with its physicality, such as a feeling of body rigidity or a certain sequence of movements, can contain that which must not be felt and integrated in the mind.

See All Chapters
Medium 9781855758926

CHAPTER TWO. Formulation of interpretations in clinical practice

Sklar, Jonathan Karnac Books ePub

Lear: Who is it that can tell me who I am.
Fool: Lear’s Shadow.

William Shakespeare, King Lear

Analysis is an interaction between two people. The patient brings his own highly individual difficulties and sufferings to the analyses, which are the affects and intellectual thoughts referring to his unconscious object relationships. The analyst brings what he hopes is a sound and adequate technique, which also must be highly individual. We know this from the diversity of points from which an analyst can set off in one of several directions, especially if we can agree no single way is correct on the analytic journey. The analyst has to make an interpretation in such a way as to lower the patient’s resistance, through an understanding of the conflict in the patient’s mind. Yet this seemingly simple idea can be undertaken in different ways.

A great deal of the analytic work is expected, by both parties, to be accomplished in words—the patient telling his story through free association and the analyst speaking heris interpretation to make the unconscious conscious. What the patient cannot say, he brings by way of enactment, in what he does during his life in analysis, in the analytic hour, as well as the enactment of the dream in the session. Congruently, the analyst also brings to the session much that is not said, but can be thought of as a particularity called “the holding environment”.

See All Chapters
Medium 9781855758926

CHAPTER FIVE. Daydreams, dreams, and trauma

Sklar, Jonathan Karnac Books ePub

When they were building the walls, how could I not have Noticed! But I never heard the builders, not a sound. Imperceptibly they’ve closed me off from the outside world.

—C. V. Cavafy, Walls (1896, p. 3)

This paper will examine the damage that early trauma can inflict on dream states. For some severely traumatized patients, there can be an ongoing failure of dream work. The affect from both the past and the present can fail to even be mobilized and, as such, psychic energy is withdrawn from the dream machine. So the same dream whirrs round again and again repetitively, but devoid of the possibility of a creative drive.

The repetitious nature of such dreams is often unnoticed by the patient. The analyst may regard them as familiar yet flat and unyielding to further knowledge or exploration, as if they contain a resistance to dream interpretation itself. Attempting to understand and make connections beneath the surface structure of the repetitious manifest content can lead to change in the patient. Identity organized around trauma but with unconscious control exercised against any felt emotional life can often be noticed in the countertransference. If changes can occur in the affect system of the patient, the emergence of closer contact with reality can result.

See All Chapters
Medium 9781855758926

CHAPTER ONE. The rebirth of history and trauma in psychoanalysis

Sklar, Jonathan Karnac Books ePub

She gathered up all the fragments
But could not make them fit.

Anna Akhmatova (1912, p. 100)

The papers contained in this volume span some twenty-five years’ practice in psychoanalysis. They are written from the point of view of a psychoanalyst nurtured within the British Society and, in particular, the Independent tradition that stretches back to the clinical and theoretical dialogues of Freud and Ferenczi through Winnicott and Michael and Enid Balint towards the twenty-first century. During this time, the British Psychoanalytical Society has moved from being a Society of three theoretical strands comprising the Independent, Contemporary Freudian, and Kleinian groups to one that has given up the “gentleman’s agreement” in order to be one group in one Society. Presently, education in the Institute is suffused with a surfeit of “here and now” analysis with a considerable loss of analytic interest in free association and history. The atmosphere is now one in which a senior analyst in the Society can state, “I have come to bury Free Association not to praise it” (McDermott 2003, pp. 1349–1356) without inhibition or concern for the historical part played by that concept in the development of psychoanalysis. Often, the main focus is on the manifest content of clinical material rather than what lies behind the surface—the depth of the latent unconscious meanings of the dream and the meanderings of free association in the clinical work. The papers in this volume highlight the value and everyday use of history in order to retrieve analytic traditions which, like that of free association, have been pushed aside.

See All Chapters

See All Chapters