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Medium 9781780491172

Chapter Four - Tolerable and Intolerable Regret: Clinical Transformation of the Intolerable into the Tolerable

Kavaler-Adler, Susan Karnac Books ePub


Tolerable and intolerable regret: clinical transformation of the intolerable into the tolerable

Intolerable regret in the mother and validation for the daughter

In classical psychoanalysis, we have been taught to not reassure patients. What does this mean? Why this caution? My understanding of this caution has been that the patient needs to struggle with his/her conflicts over his own impulses, to find his/her own resolutions by consciously confronting impulses that formerly were unconscious or out of control. The analysand needs to have this process without any interference in it. Whatever the patient's struggle, he/she needs room for it. The patient needs the psychic space, analytic space, and transitional space to struggle with his/her own dilemmas. To not offer reassurance is thought of as allowing such space. Refraining from offering reassurance also allows patients to experience that the analyst is not afraid of their experience. When a psychoanalyst does reassure a patient (and this happens probably more often than we admit), it is mostly our countertransference enactment of a rescue fantasy. Perhaps, getting the patient off the hook is a way of gratifying our own wish to restore our own inner harmony, through a gesture that seems kind and compassionate at the time. Perhaps in this way, we attempt to create reparation for ourselves; reparation with our internal parent, through projecting that parental other on to the patient.

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Medium 9781855750876

2. Freud’s Importance for the Mental Hygiene Movement 18 (1926)

Sandor Ferenczi Karnac Books ePub

Written on the Occasion of his Seventieth Birthday

IT is with great pleasure that I accede to the kind request of Dr. Frankwood Williams to say something about the possible relations between the mental-hygiene movement and the psychological and therapeutical method originated and developed by Freud and called psycho-analysis. For a long time I have been convinced that the importance of those relations has, generally speaking, been too little appreciated. The literature of psychoanalysis has been concerned chiefly with the investigation of neuroses, from which it obtained all its new knowledge. Although this knowledge has at times been applied to the psychoses also, the analysis of the psychoses has remained only applied psychoanalysis, as it were; it has not developed into an independent source of knowledge.

It may nevertheless be asserted that psychiatric science has profited much by the analytic point of view. Before Freud’s time psychiatry was not based on psychology. Attempts were made to ascribe the symptoms of mental disease to anatomical changes in the brain. But such attempts were only half successful, and then only in connexion with certain deficiencies in severe organic lesions of the brain(psychotic disturbances in cases of brain tumours, multiple sclerosis, after repeated paralytic strokes, after inflammation of the brain, and in cases of progressive paralysis and senile dementia). All the so-called functional psychoses— mania, melancholia, paranoia, dementia praecox, and hysterical psychosis—remained inexplicable from an anatomical point of view, however much one tried to prove that specific microscopical changes took place in those disorders. The expression ‘functional’ served merely to veil our ignorance. How could we be able to give the slightest explanation of the pathological change in the functioning of the psyche when we did not know anything about its normal functioning? Instead of remembering that fact, the authors of psychiatric manuals indulged in fancies about invisible cellular and even molecular changes, which were supposed to be at the bottom of the psychoses. Not one psychiatrist thought of looking for psychological explanations of the psychotic symptoms.

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Medium 9781855756281

Part 6. Blessings and Humiliations (1966–1970)

Hopkins, Linda Karnac Books ePub



[1966] was a year of sustained terror, violence, confusion and humiliation and fervid chaos in my life. I lost and willfully chose to lose all the habitual anchorages that had sustained me for twenty years in England.
Masud Khan1

Ten great years [Svetlana and I] had together, 1956–1966.
Masud Khan2

Amsterdam, 1965, is a marker for the ending of Khan's divine years because the overall lack of understanding of his letter changed him. In his private world, it was perfectly acceptable to make a point using stories that were not exact truths and there was nothing wrong with the letter that had so incensed Frances Gitelson. Khan's preferred communication was through exaggeration, distortion, and even lying, with the goal of expressing the essence of a truth. In contrast to Robert Stoller, Khan did not value a straightforward account of events. In fact, he did not even care about external truth; he told Stoller, speaking seriously, “My realities are psychic realities.”3 In the West, he often quoted Oscar Wilde, who shared this way of thinking: “Nothing that actually occurs is of the smallest importance.”4 People who were willing to “play” with him did not object to this manner of communication and indeed they were regularly inspired by it.

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Medium 9781782202974

Chapter Five - Sensual Experience, Defensive Second Skin, and the Eclipse of the Body: Some Thoughts on Tustin and Ferrari

Karnac Books ePub

Riccardo Lombardi

Tustin underscored the fact that children with psychogenic autism have no sense of self-identity, and she favored a working through based on their need for primary self-definition. For her, the absence of a working through of an early developmental phase in which identity is built up leads to the construction of an autistic shell that makes it possible to circumvent this dark zone of failed early development. Tustin later extended her discoveries to adult patients with autistic characteristics who feel unreal and perceive life as a sort of dream. This is not, of course, a creative dream, but, instead, the condition Bion indicated in which one is neither awake nor asleep.

Tustin sensed how central recognition of the body is to helping these patients define an identity of their own. An interest in the importance of the body in primitive development is a point of contact between Tustin's perspective of infantile autism and my own clinical research, conducted primarily on adolescent and adult patients with serious forms of psychosis containing very often clear autistic components. In fact, in my writing, I have tried in various ways to show how “the perception of the body is the decisive element of differentiation and a first principle of reality which can stimulate awareness of the body-self and of the other” (Lombardi, 2005). Following Ferrari's (2004) hypothesis of the eclipse of the body, I consider two parallel relationships within the analytic relationship: the “horizontal” analysand–analyst relationship and the “vertical” body–mind relationship. In primitive mental states, I attribute a central role to the working through of the “vertical” body–mind relationship: my approach involves deliberately not giving priority to the aspect of transference interpretation, while bearing in mind that the most urgent clinical need is to establish a “transference to the patient's body”, together with the rudiments of a functioning mental metabolism and of representation and consciousness of self in the patient.

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Medium 9781855752009

Chapter 4. The Sense of a Core Self: I. Self versus Other

Stern, Daniel N. Karnac Books ePub

AT THE AGE of two to three months, infants begin to give the impression of being quite different persons. When engaged in social interaction, they appear to be more wholly integrated. It is as if their actions, plans, affects, perceptions, and cognitions can now all be brought into play and focused, for a while, on an interpersonal situation. They are not simply more social, or more regulated, or more attentive, or smarter. They seem to approach interpersonal relatedness with an organizing perspective that makes it feel as if there is now an integrated sense of themselves as distinct and coherent bodies, with control over their own actions, ownership of their own affectivity, a sense of continuity, and a sense of other people as distinct and separate interactants. And the world now begins to treat them as if they are complete persons and do possess an integrated sense of themselves.

In spite of this very distinctive impression, the prevailing views of clinical developmental theory do not reflect the image of an infant with an integrated sense of self. Instead, it is widely held that infants go through an extended period of self/other undifferentiation and that only very slowly, sometime towards the end of the first year of life, do they differentiate a sense of self and other. Some psychoanalytic developmental theories, of which Mahler provides the most influential example, propose that during the undifferentiated phase infants experience a state of fusion or “dual-unity” with mother. This is the phase of “normal symbiosis,” lasting roughly from the second to the seventh or ninth month. This state of dual-unity is proposed as the background from which the infant gradually separates and individuates to arrive at a sense of self and of other. Academic theories have not differed basically from the psychoanalytic theories in the sense that both propose a slow emergence of self after a long period of undifferentiation.

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