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Chapter Five - Inspiration of the Clinical Psychoanalytical Practice by the Dialogue with the Neurosciences and Embodied Cognitive Science: Some Examples

Leuzinger-Bohleber, Marianne Karnac Books ePub

Facing the pain in psychoanalyses with severely traumatised chronically depressed analysands—new ways in conceptualisation and treatment*

Introduction

Night after night Mr P wakes up bathed in sweat and in shock from a nightmare following a mere few hours of sleep: for the last twenty-five years he has been suffering from severe depressions accompanied by extreme sleeping disorders, unbearable, chronic widespread pain, suicidal thoughts, panic attacks, and a series of psychosomatic symptoms, among others, acute neurodermatitis.

Mr P is one among many suffering from severe depression. As already mentioned in Chapter Three: according to the World Health Organization (WHO), today over 300 million people suffer from major depression, which, according to the organisation's prognosis, is destined to become the second most frequent illness worldwide by 2020. This enormous increase in severely depressive sicknesses is the object of interesting historical, sociological, and economic analyses, which I am unfortunately unable to address in present context (cf., Chapter Three; Bahrke, 2010; Ehrenberg, 1998; Gammelgaard, 2010; Haubl, 2013; Illouz, 2006; Sennett, 1998). In keeping with psychoanalytic concept research, I will instead be focusing on clinical and extra-clinical results relating to the intimate and frequently unrecognised link between trauma and depression. Mr P's nightmares also point to this connection. Thus, for instance, following six months of psychoanalysis, he reports the following dream:

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Chapter Three - The Relevance of the Embodiment Concept for Psychoanalysis

Leuzinger-Bohleber, Marianne Karnac Books ePub

But what relevance does this fundamental scientific knowledge have for psychoanalysis?

 

The embodiment concept in psychoanalytic literature

In psychoanalytic literature there are a number of papers that take up the concept of embodiment, though frequently not in the radical sense we postulate here (Leuzinger-Bohleber et al., 2013a; Emde & Leuzinger-Bohleber, 2014). In his historical survey, Sletvold (2011) employs a very broad definition of embodiment in the sense of “work with the body in psychoanalytic therapies”, a tradition that, among other things, goes back to Wilhelm Reich's psychotherapy of the body. Based on the latter therapy, he even develops practical guidelines for the work of the analyst with “unconscious embodied expressions” (Sletvold, 2012; cf., also Bloom, 2006). Similarly, in his work “Fundamentally embodied: the experience of psychological agency”, Frie (2008) points to the works of Lakoff and Johnson (1999) and Damasio (1994/1997), though using the concept of embodiment not in the sense of a new theoretic explanation of specific clinical phenomena, but very generally, as a document of complex processes of reflection “informed by personal history and fundamentally embedded in biological and sociocultural contexts” (p. 374; cf., Langan, 2007; Mizen, 2009). In a similarly global manner, Vivona (2009) argues for an “embodied language” as expression of a modern integration of neurosciences and psychoanalysis.

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Chapter Six - How to Investigate Transformations in Psychoanalysis? Contrasting Clinical and Extra-Clinical Findings on Changes of Dreams in Psychoanalysis with a Severely Traumatised, Chronically Depressed Analysand: Tamara Fischmann, Marianne Leuzinger-

Leuzinger-Bohleber, Marianne Karnac Books ePub

Tamara Fischmann, Marianne Leuzinger-Bohleber, Margerete Schoett, and Michael Russ

Introduction *

As mentioned in the introduction of the present volume, a growing number of research groups throughout the world have apparently begun to realise that the neurosciences and psychoanalysis could benefit from each other in interesting ways. The neurosciences are now equipped with objective, precise methods for verifying hypotheses on human behaviour, while psychoanalysis, based on its rich experience with patients and its unique method of field research, has developed a variety of different models in order to conceptualise the multi-layered and complex observations that derive from the psychoanalytic situation and to test them by means of its specific form of empirical research, namely, clinical psychoanalytical research. The explanatory models and insights developed by psychoanalysis can also be of interest to neuroscientists and raise specific research questions.

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Chapter Seven - “Finding the Body in the Mind…” and Some Consequences for Early Prevention: The Concept “Outreaching Psychoanalysis” and Some Realisations

Leuzinger-Bohleber, Marianne Karnac Books ePub

As mentioned in the introduction, the last chapter of this volume is given over to some of the consequences of the contemporary dialogue between psychoanalysis and the Neurosciences in the field of early prevention. If one takes Freud's thesis seriously, namely, that all psychic and psychosocial experiences are retained by the body and determine future problem-solving, then emotions, fantasies, and object relations could prompt many psychoanalysts to engage in another form of “outreaching psychoanalysis” in early prevention (see, e.g., Emde & Leuzinger-Bohleber, 2014). In all these projects we see the enormous plasticity of the brain and the psyche in the first months of life as a great opportunity to reach out to children suffering from severe traumas and their families and, through this, to implement alternative, progressive developmental paths by way of alternative relationship experiences. As has been impressively documented by psychoanalytic research on resiliency, when compared to the primary object relationships, for these children alternative relationship experiences have often proven life-saving decades later—even though it may have been possible to only partially offer such alternative experiences (cf., also, among others, Hauser et al., 2006). For some of these children, inwardly, they seemed to be like a “principle of hope” (Ernst Bloch) and, in the best of cases, to contribute to the avoidance of psychic resignation among children, or their attempt to overcome their suffered traumatisation by violent and self-destructive means. In this sense, in the attempt to make psychoanalytic knowledge available to children and their families living on the periphery of our society as traumatised refugees, as migrants forced into exile by war and persecution, or as losers in a modern society chiefly determined by speed and competition, we see ourselves in the tradition of Alexander Mitscherlich and his vision of a psychoanalytic, cultural-critical research (Mitscherlich & Mitscherlich, 1967).

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Chapter Four - “I still don’t know who I Really am…” Depression and Trauma: A Transgenerational Psychoanalytical Perspective

Leuzinger-Bohleber, Marianne Karnac Books ePub

Introduction: depression—the most frequent psychic disorder with the danger of chronification

Mrs M had a depressive break down in her early fifties. She was not able to work anymore as a social worker with delinquent adolescents. She was highly suicidal and suffered from severe sleeping and eating disorders. In the initial interview she told that her boy-friend, married to another woman, had moved to another town. Another reason for her breakdown were the daily quarrels between her adolescent daughter and her grandmother, all living in the same house. She always told her daughter: Be nice to the old woman and respect her although she realised that the strange behavior of her mother was quite pathological. (see Chapters Two and Three)

Psychoanalysts all over the world currently have many patients like Mrs M in treatment. Severe depression, often in combination with personality disorders, is one of the most frequent diagnoses of patients in psychoanalytic long-term-therapies and psychoanalysis today, and often has, as in the example of Mrs M, an obviously trans-generational dimension.

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