Psychoanalytic perspectives on emptiness

A clinical example illustrates the thesis that the experience of feeling empty, like any other mental event, can be understood in terms of the conflicting wishes, prohibitions , compromises, and gratifications that color any experience in ways that clarify its meaning. Theoretical hypotheses which explain mental events and experiences as the result of deficiencies of structures are difficult to translate into therapeutic practices. This is especially true in the case of the experience of emptiness which, in and of itself and often vigorously, asserts an absence of content. The equating of deficiencies of structures, however formulated, with deficiencies in mental content or activity can result in unconsciously joining the empty patient in repudiating important aspects of internal life, maintaining ultimately pathological gratifications , and often contributing to treatment stalemates in which the "absence of content" is often preferred to the presence of frightening wishes, fantasies, and memories.

A psychoanalytic study of migration: its normal and pathological aspects

Without maintaining that it always follows the same steps, we could say that the migratory process passes through several phases. The feelings that prevail are those of intense sorrow for all that has been abandoned or lost, fear of the unknown, and the very profound experiences of loneliness, privation, and helplessness. Paranoid, confusional, and depressive anxieties occupy the scene in turn. This stage may be followed or replaced by a manic state in which the immigrant minimizes the transcendental significance of the change in his life or, on the contrary, magnifies the advantages of the change and overvalues everything in the new situation, disdaining what has been lost. After a variable period of time, nostalgia appears, and sorrow for the lost world. The immigrant begins to recognize feelings previously dissociated or denied and becomes capable of "suffering" his pain ("growing pains") while, at the same time, he becomes more accessible to the slow and progressive incorporation of elements of the new culture. The interaction between his internal and external world becomes more fluid. Recovery of the pleasure of thinking and desiring and of the capacity for making plans for the future, in which the past is regarded as such and not as a "lost paradise" where one constantly longs to return. In this period, it could be considered that mourning for the country of origin has been worked through to the maximum extent possible, facilitating integration of the previous culture into the new culture, without the need to renounce the old. All of this promotes an enrichment of the ego and the consolidation of a more evolved sense of identity.

Psychoanalytic dream theory and recent neurobiological findings about REM sleep

I have reviewed Hobson and McCarley's activation-synthesis hypothesis of dreaming which attempts to show that the instigation and certain formal aspects of dreaming are physiologically determined by a brainstem neuronal mechanism, their reasons for suggesting major revisions in psychoanalytic dream theory, and neurophysiological data that are inconsistent with their hypothesis. I then discussed the concept of mind-body isomorphism pointing out that they use this concept inconsistently, that despite their denials they regularly view physiology as primary and psychological processes as secondary, and that they frequently make the error of mixing the languages of physiology and psychology in their explanatory statements. Finally, in order to evaluate Hobson and McCarley's claim that their findings require revision of psychoanalytic dream theory, I examined their discussions of chase dreams, flying dreams, sexual dreams, the formal characteristics of dreams, the forgetting of dreams, and the instigation of dreams. I concluded that although their fascinating physiological findings may be central to understanding the neurobiology of REM sleep, they do not alter the meaning and interpretation of dreams gleaned through psychoanalytic study.

Pathological narcissism in childhood

Matt's analysis yields a number of theoretical and clinical implications. It demonstrates that narcissistic character pathology can exist in childhood and shows how family dynamics may contribute. The clearly defensive function of Matt's pathology and his later progress through normal infantile narcissism toward further development suggest that the pathogenesis of narcissistic pathology resides neither in regression to an infantile position nor in untamed infantile narcissism. Rather, as the case demonstrates, narcissistic pathology actually reflects a pathological formation of the self used for defensive purposes. Matt's analysis also shows how such pathology in children may be effectively resolved through interpretation. Finally, the analysis demonstrates the peculiarities of the countertransference in such cases and how they may be pivotal in the course of treatment.

Rational versus anagogic interpretation: xenophon's dream and others

Freud's insistence that "a dream is a (disguised) fulfillment of a (suppressed or repressed) wish" has come under attack repeatedly. This principle, while never widely accepted, was nevertheless expressed, explicitly or otherwise, in the works of Homer, Herodotus, Plato, and other writers of the classical world. A detailed account of a dream of Xenophon's is employed to illustrate the capacity of a psychologically naïve Athenian writer to reject anagogic interpretation in favor of a more soundly based understanding of his own dreams. This is followed with a discussion of "dreams from above," which are most likely to raise this particular issue, one of considerable clinical and theoretical importance.

An example of self-analysis

The literature on self-analysis indicates that it is a desirable process to cultivate postanalytically for continued self-growth, analyzing countertransference problems, and dealing with symptoms or problems of living that might arise after formal analysis is completed. A number of techniques are described, the choice of which is probably dependent on the personality of the individual who wishes to pursue self-analysis. I describe an episode of self-analysis occurring near the end of the analysis of a woman who aroused in me an unusual degree of positive feeling, at least part of which can be considered countertransference. After she had aroused negative feelings in me, she was able to deal in an affectful way with strongly repressed impulses, actually acted out in early childhood, to steal from her mother. This stimulated dreams in me that allowed me to work out guilt for hostility to my mother. A dream representing stealing her purse altered long-standing compulsive thoughts I had known meant guilt to my mother. The self-analysis was not undertaken to deal with a countertransference problem, but arose out of it to deal with a symptom, or old conflict, 25 years after the completion of formal analysis.

Psychic trauma and masochism

Three analyses are presented in which acute trauma (overwhelming internal or external stimulation so great as to preclude the patient's utilizing his usual defenses adequately) in childhood contributed to the development of masochism. The patients later attempted mastery through repetition, reversal, and erotization , and employed regression as a defense against feared oedipal wishes.

Termination in the Dora case

Freud's insistence on interpreting Dora's second dream after she had announced that this would be her last analytic session illustrates his preoccupation with dreams as well as his failure to understand what Dora wanted from the analysis. Freud remained concerned with the relationship between Dora's symptoms (dreams) and her psychic reality; she was more interested in the external realities of her life, e.g., leaving analysis. Although the theme of termination was noted in Freud's interpretation of Dora's first dream, it was neglected during the final two weeks of the analysis. Freud's interpretations of Dora's dreams became the subject of the analysis, and Dora felt excluded. Several aspects of Freud's negative countertransference have been noted above: the analytic situation in many ways paralleled Dora's relationship with her mother; negative maternal elements in the transference destroyed any hopes Dora might have had of finding a suitable parent in Freud. The analysis ended with both Freud and Dora feeling betrayed.

Deconstructing the manifest dream

A major part of the analyst's task is to discover the basis for the patient's misidentification of his present life situation with significant but threatening events of his earlier life, now repressed and inaccessible to conscious recall. Reconstructing the patient's history is a crucial step in this process of discovery, but the dynamic relation between the present and the past must be reconstructed as well. The structure of the manifest dream contains the key to this relation. The imagery of the dream is a composite of experimental materials drawn from important drive-related events of the present and the past. The complex formed by the manifest dream and the patient's associations provides the analyst with data about both of these distinct sets of drive-related experiences. As Freud's discussion of his M elusine dream illustrates, one associative thread can be traced to an experience that incorporates a conflicted current wish. Another thread will lead to an experience in which a repressed wish of childhood has been expressed. Where the two associative threads converge, in the composite imagery of the dream, the basis for the identification between the wishes of the present and the past will be exposed. An understanding of the structure of the manifest dream helps to clarify some of the important theoretical issues left unresolved in Freud's writings. These include: the function of the day residue and the mechanism through which it is formed, the relation of the screen memory to the associative process, and the differing roles of condensation and displacement in dream construction and free association. A simple procedure is described for enhancing the recovery of the significant childhood memories whose details have been incorporated into the composite imagery of the manifest dream.

On antithetic and metathetic words in the analytic situation

Freud's view of primal words emphasized their origins in the vocal acquisition of language and their similarity to primary process behavior in young children. Our English vernacular is rich in word play of reversals and antitheses, some words being truly ancient, others originating in the subversions of slang and in the child's penchant for mirror imaging and other primary process play. In the regression of analytic work the uttered word can combine with dream imagery and behavioral enactment to convey the antitheses abounding in the oral, anal, and early phallic concerns of the individuating child acquiring language.

Further reflections on Freud and his writing

As we broaden our frames of reference, Freud's genius looms larger. An adequate appreciation of Freud accordingly necessitates an examination of how he read and wrote and how Strachey translated him. Despite the enormous amount of psychoanalytic commentary, the subject of his writing qua writing still remains untapped to a considerable extent. By deepening our awareness of the nuances and implications of the manner in which Freud wrote, we correspondingly increase our knowledge of his original mind and the way he understood psychoanalysis.

[Psychopathologic aspects of tetanic seizures]

In that work, the tetanic's depresses are taken out from the sphere of spasmophilie , concept that the authors take as no pertinent. Those depresses find again the sphere of the nevrosis . It is an answer to the anguish and to the oedipus-problematic of the subject. The authors, by making clear their remarks with several observations, circle the clinic constants escorting the birth of depresses, the bodily expression of the anguish, the psycho-motive peculiarity of the tetanic and the phenomenon of repetition. The authors conclude with a thought over the sense of the symptoms, and over a psycho-somatic medicine that essentially refers to the relation between the doctor and the patient.

The value of written communications in dynamic psychotherapy

The literature on the use of written communication in interpretive psychotherapy is reviewed, and a range of possible uses of writing by patients and therapists is described, with some illustration. It is suggested that greater use of writing at some stages of some psychotherapies could be valuable.

The genius of the dream

In Act V of A Midsummer Night's Dream, Theseus and Hippolyta exchange views on the dreamlike adventures reported by the young lovers. Theseus dismisses their stories as fantasies of wish fulfillment, but Hippolyta points out that despite their strangeness, the tales reflect an adaptive change in the psychic reality of the lovers. The dramatic action of the play supports Hippolyta's view. The release of Demetrius from his transferential infatuation with Hermia comes at the moment of awakening from a dream in which he has matched his current feelings for Hermia with a repressed libidinal fantasy of childhood. This example of a correction dream illustrates how condensation in dreams functions adaptively in matching a new experience with previously stored representations of related events in the past. It also illustrates the ability of the matching process to go beyond the narrow logical categories of waking thought to reach deeper levels of experience otherwise inaccessible to the dreamer. This ability accounts for the important role played by dreaming in the creative process generally and in the day-to-day working-through process of psychoanalytic therapy. The adaptive function of dreaming is subject at many points to interference from the censorship mechanisms discovered and emphasized by Freud. A theory of dreaming combining these antagonistic processes is more consistent with the data of the sleep laboratory than the traditional psychoanalytic theory alone. It also provides a better fit with the introspective date more familiar to the analyst as illustrated by Freud's well-documented analysis of his own dreams.

The racially different psychiatrist--implications for psychotherapy

The race of the therapist can play a significant role in the manifestation of transference and counter-transference phenomena in inter-racial psychotherapy. References to the race of therapist may be the first sign of a developing transference relationship. Failure to appreciate the impact of racial difference can impede therapeutic progress while sensitive confrontation may be a valuable tool in the recognition and communication of emotionally charged feelings in therapy. Dream material is influenced by the race of the therapist who may be less easy to disguise in dreams, and the therapist may avoid certain dream interpretations because of unacknowledged discomfort about race. These observations have implications for the supervisory process in training and for the general issue of the influence of the person of the therapist on the process of psychotherapy.

Poetry as therapy

In the practice of general psychiatry, art therapy in the form of painting is widely employed. Music and drama similarly provide regular treatment occasions. The use of poetry is less familiar and is little discussed in the literature. This paper reviews a therapeutic liaison, happening largely by chance, which depended almost exclusively upon an exchange of verse. The relationship between the processes of psychotherapy, on the one hand, and the writing and reading of poetry, on the other, is suggested and illustrated by the patient's writings. It may be that good poetry, like successful psychotherapy, arises from disturbed emotions only when they are given resolution and form. Exceptionally the two go hand-in-hand.

[Essay on madness and the novel: an author in search of psychiatrists]

The authors present the psychiatric comment on a French contemporary writer who has been a well-known figure. Delinquent she expressed herself by ravings of megalomania and persecution.