[Clinical consequences of modernity]

When they receive patients in their treatment centre, clinicians witness symptoms which are sometimes very closely related to the inclusion within hypermodernity of hyperbole and instantaneousness. A study of the question of contemporary violence through an analytical explanation of the relationship between the subject and the object.

Dreams, katharsis and anxiety

Over the centuries, the importance and the nature of the relationship of "inside" and "outside" in human experience have shifted, with consequences for notions of mind and body. This paper begins with dreams and healing in the Asklepian tradition. It continues with Aristotle's notions of psuche and how these influenced his conception of katharsis and tragedy. Jumping then to the 17th century, we will consider Descartes' focus on dreams in his theories of thinking. Finally, we will turn explicitly to Freud's use of dreams in relation to his theories of anxiety, of psychic processes and of the Oedipus Complex.

Freud's occupational choice and the unconscious: reverberations of Goethe's "On Nature"

The story of the young Freud's search for a brilliant career, familiar from his autobiography and standard sources, and of other relevant aspects of his adolescence, is reviewed in light of hypotheses about his unconscious fantasies. His plan to become a lawyer underwent a gradual change into a wish to make a great contribution to knowledge, like Darwin. But how did hearing the essay "On Nature" read tip the balance toward medicine? The author argues that an answer requires treating that text much the way an analyst interprets a dream or a set of free associations, and proceeds to do so. "On Nature" also foreshadows numerous themes in Freud's mature writings and in his professional practice. The paper concludes with reflections on activity and passivity in Freud's personality and professional work, and with a discussion of ways in which Darwin's theories and those of his followers revived interest in Nature-philosophy, themes from which, rather than the furor sanandi, drew Freud finally to medicine.

Scenic memory of the Shoah--"the adventuresome life of Alfred Silbermann"

This paper addresses the late psychosocial sequelae of extreme trauma and its impact on the Second Generation in Germany. The example of the short-term analysis of a Shoah survivor and his relationship to his son conducted in his home environment shows how psychic consequences of extreme traumatization and more particularly their unconscious transgenerational transmission to the Second Generation mainly take place as part of unconscious "scenes". The concept of "scenic memory of the Shoah" goes beyond the classical type of transference.

[The Dying Horse: the contradictoriness of the Self in a dream of Raskolnikov and in the breakdown of Nietzsche]

The author deals with the curious and uncanny parallel between a dream recounted in Dostoevsky's Crime and Punishment and the famous Turin incident from Nietzsche's life shortly before his psychotic breakdown. The psychoanalytic interpretation focuses on the articulation of the contradictoriness and multiplicity of the Self.

The psychological study of anxiety in the era of the Second World War

The mid-twentieth century in Britain ushered in a new age of anxiety with the development of total war and the aerial bombing of civilians. Rather than trying to chart and quantify levels of anxiety and fear on the British home front during the Blitz, this article's goal is to examine how these emotions were conceptualized by psychological experts immediately prior to and during the war. The essay follows the rising problematization of anxiety and fear as new concepts calling for professional knowledge and management. It emphasizes the contribution of psychoanalysts to this development while pointing to gradual change between the two world wars.

Zombies, vampires, werewolves: an adolescent's developmental system for the undead and their ambivalent dependence on the living, and technical implications

While vampires haunt contemporary American pop culture, the undead have populated psychoanalytic literature from Abraham's March 15, 1915 letter to Freud to today. PEP lists 439 psychoanalytic references to the undead (99 on zombies; 288 on vampires; 52 on werewolves). A selection of papers are cited, focusing on clinical cases, ethnography media and literature, even breast-feeding fantasized as blood sucking, associated with primitive dynamics. Previous works' libidinal, object relations, and dynamic perspectives on various "undeads" are summarized. This paper's contribution to the psychoanalytic literature is to examine the relationship of the three categories of undead both among each other and in their relation to the living. This paper presents a young adolescent's extensive play and fantasies about the undead, and his sophisticated intrapsychic model for the undead, developed prior to treatment, that kept him in psychical equilibrium, yet also kept him from feeling alive. This model has developmental implications for handling three types of transferences. Also, we may shed light on both contemporary preoccupation with the undead in contemporary American popular culture, and its endurance over time in Western culture.

In search of psychoanalytic pluralism: an inquiry into time, money, and love

This essay examines religious studies scholarship that has relied heavily upon the work of Sigmund Freud and attempts to show its weakness by offering a self psychological reading to complement each text. In doing this, I inquire into the scholarly tendency to avoid pluralistic use of meta-psychologies, arguing that the well-being of the field is weakened by such scholarly fixations. The essay draws its concluding observations largely on trends in scholarly literature, inquiring into the nature and quality of the use of multiple meta-psychologies in scholarly monographs.

Bearing the unbearable: ancestral transmission through dreams and moving metaphors in the analtyic field

This paper explores how untold and unresolved intergenerational trauma may be transmitted through unconscious channels of communication, manifesting in the dreams of descendants. Unwitting carriers for that which was too horrific for their ancestors to bear, descendants may enter analysis through an unconscious need to uncover past secrets, piece together ancestral histories before the keys to comprehending their terrible inheritance die with their forebears. They seek the relational containment of the analytic relationship to provide psychological conditions to bear the unbearable, know the unknowable, speak the unspeakable and redeem the unredeemable. In the case of 'Rachael', initial dreams gave rise to what Hobson (1984) called 'moving metaphors of self' in the analytic field. Dream imagery, projective and introjective processes in the transference-countertransference dynamics gradually revealed an unknown ancestral history. I clarify the back and forth process from dream to waking dream thoughts to moving metaphors and differentiate the moving metaphor from a living symbol. I argue that the containment of the analytic relationship nested within the security of the analytic space is a necessary precondition for such healing processes to occur.

Is acute and transient psychotic disorder (ATPD) mini schizophrenia? The evidence from phenomenology and epidemiology

Acute and transient psychotic disorders (ATPD) first appeared in ICD-10 but classification of acute psychosis has a long historical tradition. The prevalence rate of these disorders varies from 3.9 to 9.6 per 100,000 populations. Systematic clinical information that would provide definitive guidance on the classification of acute psychotic disorders is not yet available. Moreover there is no evidence available to guide the treatment of these disorders. In absence of the reliable epidemiological information the ATPD is treated as a form of 'mini schizophrenia' as if the disorder is an attenuated form of schizophrenia. A systematic review of the literature on acute and transient psychosis was conducted and all studies on epidemiology and treatment of acute and transient psychosis were identified. The existing evidence suggested that ATPD has little relationship with schizophrenia. ATPD is diagnostically unstable over time. Various estimates suggest that about 1/3 of patients with baseline ATPD retained their diagnosis over 3-12 years, the most frequent re-diagnosis being bipolar disorder and not schizophrenia. There are important differences in the epidemiology of this disorder from schizophrenia. These include gender distribution (ATPD has preponderance of females while equal gender distribution is one of the most established finding in epidemiology of schizophrenia) and much better premorbid level of functioning and social interactions. Other distinguishing features include the age at onset (onset throughout adult life, but usually between the 30- 50 years), development, and duration of symptoms (ATPD have an acute or even abrupt onset and the onset is only rarely precipitated by acute severe stress) and usually a favourable outcome, in spite of the fact that they are frequently recurrent. Literature on the subject is scanty and has serious methodological limitations. Treating ATPD has serious long term implications for the care of those suffering from ATPD. Long term treatments with antipsychotics which can induce metabolic disorders and reduce life expectancy, amongst many other side effects mean that we have to reconsider our approach to the diagnosis of ATPD seriously. Treating the acute and transient psychosis as a mini schizophrenia is seriously hindering research and clinical practice. I will review the epidemiology and phenomenology of acute and transient psychotic disorder, the current gaps in knowledge and its effects on our clinical practice in the light of systematic review of the evidence.

A psychoanalytic grave walk--Scenic memory of the Shoah. On the transgenerational transmission of extreme trauma in Germany

In this article we describe a phase of a long-term psychoanalysis of a daughter of Shoah Survivors. The article is part of a research project conducted at the Sigmund Freud-Institute in Frankfurt/Main. The focus of the study is on the transmission of extreme trauma from the First to the Second Generation, with special reference to Germany. "Scenic memory of the Shoah" is presented as a concept that stresses the non-verbal, unconscious communication between the generations. The so-called "concretistic" behavior of the Second Generation, which has been described in the literature, is conceptualized here as scenic memory of the traumatic experiences during Nazi persecution, that is, a highly symbolic and metaphorical expression of the extreme trauma handed down to the patient by the parents.

On decoding and rewriting genomes: a psychoanalytical reading of a scientific revolution

In various documents the view emerges that contemporary biotechnosciences are currently experiencing a scientific revolution: a massive increase of pace, scale and scope. A significant part of the research endeavours involved in this scientific upheaval is devoted to understanding and, if possible, ameliorating humankind: from our genomes up to our bodies and brains. New developments in contemporary technosciences, such as synthetic biology and other genomics and "post-genomics" fields, tend to blur the distinctions between prevention, therapy and enhancement. An important dimension of this development is "biomimesis": i.e. the tendency of novel technologies and materials to mimic or plagiarize nature on a molecular and microscopic level in order to optimise prospects for the embedding of technological artefacts in natural systems such as human bodies and brains. In this paper, these developments are read and assessed from a psychoanalytical perspective. Three key concepts from psychoanalysis are used to come to terms with what is happening in research laboratories today. After assessing the general profile of the current revolution in this manner, I will focus on a particular case study, a line of research that may serve as exemplification of the vicissitudes of contemporary technosciences, namely viral biomaterials. Viral life forms can be genetically modified (their genomes can be rewritten) in such a manner that they may be inserted in human bodies in order to produce substances at specific sites such as hormones (testosterone), neurotransmitters (dopamine), enzymes (insulin) or bone and muscle tissue. Notably, certain target groups such as top athletes, soldiers or patients suffering from degenerative diseases may become the pioneers serving as research subjects for novel applications. The same technologies can be used for various purposes ranging from therapy up to prevention and enhancement.

Working with the relational unconscious: an integration of intrapsychic and relational analysis

From its inception, psychoanalysis has tended to idealize the curative value of insight while devaluing the mutative significance of the analytic relationship. This paper argues that applying the construct of the "relational unconscious" in clinical practice offers a possible resolution of this "mind-relationship" rift. From this perspective, transference and countertransference provoke a continual intersubjective/interpersonal enactment of a co-created infantile drama emanating from the internal worlds of analyst and analysand in which a vital form of parental and/or self loving is at stake. Case vignettes demonstrate how to apply the relational unconscious in clinical practice.

Pathological organizations and psychic retreats in eating disorders

A set of characteristic symptoms allow for the relatively straightforward diagnosis of eating disorders. Simultaneously and paradoxically, underlying the eating disorders are a wide variety of personality organizations/disorders, stretching from the neurotic to the borderline and narcissistic, and even to conditions approaching psychosis. This paper will argue that the inherent commonalities can be ascribed to pathological organizations of a similar nature and quality, operational across the spectrum of eating disorders and functioning in a particular, sadomasochistic way. The typical forms that eating disorders take are based on the specific ways that food and the body are used, that is, symptom manifestation. These distinctive symptom manifestations appear to be related to Steiner's (1982, 1993) notion of a psychic retreat. Pathological organizations and psychic retreats are latent until called upon either sporadically or continuously. When activated, these defensive structures operate like a complex psychic skeleton around which the unique psychodynamics of each patient become rearranged and thereby transformed.

Seeing through The Bell Jar: investigating linguistic patterns of psychological disorder

As a means of conveying difficult personal experiences, illness narratives and their analysis have the potential to increase awareness of patients' lives and circumstances. Becoming sensitised to the linguistic texture of narrative offers readers a means of increasing narrative understanding. Using the fictional narrative of The Bell Jar, this paper outlines a novel method for exploring the language of illness narratives. Corpus stylistics provides new insights into narrative texture and demonstrates the importance of recurrent linguistic features in shaping meaning. The paper concludes by proposing the application of a similar methodology to non-fictional illness narratives in therapeutic contexts.

'To Paint the Portrait of a Bird': analytic work from the perspective of a 'developmental' Jungian

Jungians who are trained in the so-called 'Developmental School' straddle the two worlds of psychoanalysis and classical Jungian thinking. This is not always an easy position in which to be, but if the tensions can be held it is potentially a rich and creative way of working. In this paper I attempt to explore this position using the poem, 'To Paint the Portrait of a Bird' by Jacques Prévert as a metaphor for the analytic endeavour. From this perspective I hope to illustrate the importance of being able on the one hand to hold and maintain a clear frame for the careful and detailed exploration of the transference within which the more malign aspects of the psyche might be expressed, and, on the other, to allow the alchemical process of mutual transformation that lies outside the conscious understanding of the analytic couple.

Primal negation as a primitive agony: reflections on the absence of a place-for-becoming

The fundamental existential question for the borderline/ hysteric patient is not 'who am I?' but 'where am I?' or perhaps 'where can I be?'. This paper(1) explores this statement with reference to a pivotal clinical experience which changed the author's thinking and theorizing about this state. Case material is presented which focuses on an experience of what the author describes as 'primal negation' which gives rise to primitive displacement anxiety and this is proposed as a specific form of primitive mental agony. There is an elaboration of a borderline defence against an unthinkable experience of formless dread which the author conceives as an attempt to construct a sense of a liveable shape. There is a description of an aspect of the analyst's 'dreaming on behalf of the patient' and an elaboration of what this came to mean for both analyst and patient.

"Operation Pied Piper": a psychoanalytic narrative of authority in a time of war

The evacuation of British children during World War II is read alongside the legend of the "Pied Piper" after which the mass migration was officially named. While virtually every British account of World War II makes mention of the evacuation, most are silent on the question of its ominous title: "Operation Pied Piper." This paper traces the legend's key theme - on influencing and being influenced - as it surfaces in the writing of one child analyst and one social worker charged with the responsibility of leading a family of five hostels for British youth. At a time when Hitler's deadly regime reached unprecedented heights across the Channel, the legend of the "Pied Piper" becomes a highly suggestive metaphor for thinking about D. W. Winnicott and Clare Britton's writing on what authority could mean in the face of leadership gone terribly wrong. Quite another, profoundly intimate loss of leadership haunts their words as well: Sigmund Freud, in exile from Hitler's Europe and leader of the psychoanalytic movement, died in London just weeks after the first wave of Blitz evacuations. It is in this context that Winnicott and Britton articulated a theory of authority that could address the losses of history without at the same time demanding the loss of the mind.

[Figures of anima in the Odyssey]

Feminine characters in the Odyssey show different aspects of the archetype: Mother and Anima (C.G. Jung). From an Analytical Psychology perspective the encounters of Odysseus with goddesses: Circe, Calypso, Ino are looked at as different and successive stages of the hero's way into the inconscious, who shows himself in feminine figures, being masculine the consciousness of the hero. Nausicaa is a new, nearly-human figure of Anima who appears after the symbolic death of Odysseus and leads him to the royal couple Alcinous-Arete: in front of them all he finds his new, reborn, personality by creating and narrating his own myth.

Interpreting psychoanalytic interpretation: a fourfold perspective

Following an overview of psychoanalytic interpretation in theory, practice, and historical context, as well as the question of whether interpretations have scientific validity, the author holds that hermeneutics, the philosophical and psychological study of interpretation, provides a rich understanding of recent developments in self psychology, inter-subjective and relational perspectives, attachment theory, and psycho-spiritual views on psychoanalytic process. He then offers four distinct hermeneutical vantage points regarding interpretation in the psychoanalytic context, including (1) Freud's adaptation of the Aristotelian view of interpretation as the uncovering of a set of predetermined meanings and structures; (2) the phenomenological view of interpretation as the laying bare of "the things themselves," that is, removing the coverings of objectification and concretization imposed by social norms and the conscious ego; (3) the dialogical existential view of interpretation as an ongoing relational process; and (4) the transformational understanding in which interpretation evokes a "presence" that transforms both patient and analyst. He concludes by contending that these perspectives are not mutually exclusive ways of conducting an analysis, but rather that all occur within the analyst's suspended attention, the caregiving and holding essential to good therapeutic outcomes, and the mutuality of the psychoanalytic dialogue.

Resurrecting the buried self: fairy tales and the analytic encounter

The author uses the lens of myth and fairy tales to examine the narratives generated by the analytic experience. Fairy tales are understood as representing fundamental developmental conflicts, accounting for their enduring power over time. The analytic encounter is seen as an analogue of the fairy tale in which the hidden self, damaged by loss and abandonment, reemerges only through the redemptive power of [an] other's love. Clinical material is presented in which hidden parts of the patient's self are projected into the analyst for safekeeping; these hidden parts resonate with the analyst's own lost, unrealized potential and form an intersubjective experience which the author believes is transformative. The patient's dormant powers emerge in a newly experienced atmosphere of recognition, and in this way, the analytic encounter resembles the fairy tale in providing an identificatory bond and a protective space for the patient's hidden vitality.

Narcissism, mania and analysts' envy

Character traits like narcissism, mania and grandiosity are routinely discussed in the psychoanalytic literature as aspects of psychopathology only. However, many individuals who have both achieved and contributed to society in the most profound ways often have such characteristics. Psychoanalysts, sometimes envious of patients who possess considerable wealth and/or power, may be inclined to overly pathologize such qualities, denying their own desires for the perks of power and material success. Mad Men is discussed largely in this context.

[Phenomenology of dreams]

A phenomenology of dreams searches for meaning, with the aim not only of explaining but also of understanding the experience. What and who is it for? And what about the nearly forgotten dream among the moderns, the banal returning to the nightmare, sleepiness, or dreamlike reverie. Nostalgia for the dream, where we saw a very early state of light, not a ordinaire qu duel. Regret for the dreamlike splendor exceeded by the modeling power of modern aesthetics--film and the explosion of virtual imaging technologies. Disappointment at the discovery of a cognitive permanence throughout sleep and a unique fit with the real upon awaking? An excess of methodological rigor where we validate the logic of the dream, correlating the clinical improvement in psychotherapy and the ability to interpret one's own dreams. The dangerous psychological access when the dream primarily is mine, viewed as a veiled expression of an unspoken desire, or when the dream reveals to me, in an existential conception of man, through time and space, my daily life, my freedom beyond my needs. Might its ultimate sense also mean its abolition? From the story of a famous forgotten dream, based on unexpected scientific data emerges the question: do we dream to forget? The main thing would not be consciousness but confidence, when " the sleeping man, his regard extinguished, dead to himself seizes the light in the night " (Heraclitus).

Seduction and revenge in Virginia Woolf's Orlando

Virginia Woolf's Orlando was characterized by Nigel Nicolson as a "charming love letter" to his mother, Vita Sackville-West. The fictional biography was actually an attempt by Woolf to organize herself after the unbearable humiliation of Vita's abandoning her for another woman. In imagining, writing, and publishing Orlando, Woolf turns her despair about Vita's betrayal into a monument of revenge, defending against disorganizing feelings of humiliation, powerlessness, rage, and loss by creating her own scathing portrait of Vita. In the novel, Woolf also intermittently merges herself with Orlando/Vita to create a permanent tie to the woman who--like her mother and sister--excited and rejected her.

Good communication in psychiatry--a conceptual review

BACKGROUND

The communication between clinician and patient is the basis of psychiatric treatment. However, there has been little practical attention to training in it, and no specific theory of what constitutes good communication in psychiatry has been developed. This review aims to identify principles that guide good communication.

METHODS

A conceptual review of guiding principles for how clinicians should communicate with patients to achieve clinical objectives in psychiatry.

RESULTS

Five guiding principles for clinicians were identified: a focus on the patient's concerns; positive regard and personal respect; appropriate involvement of patients in decision making; genuineness with a personal touch; and the use of a psychological treatment model.

CONCLUSIONS

The principles are mostly generic, but their implementation can be particularly challenging in psychiatry. They may guide further empirical research on effective communication in psychiatry and be utilised using different personal skills of clinicians.

Silent cries, dancing tears: the metapsychology of art revisited/revised

Against the backdrop of a broad survey of the literature on applied psychoanalysis, a number of concepts underpinning the metapsychology of art are revisited and revised: sublimation; interrelationships between primary and secondary processes; symbolization; "fantasy"; and "cathexis." Concepts embedded in dichotomous or drive/energic contexts are examined and reformulated in terms of a continuum of semiotic processes. Freudian dream structure is viewed as a biological/natural template for nonrepressive artistic forms of sublimation. The synthesis presented proposes a model of continuous rather than discontinuous processes, in a nonenergic, biosemiotic metatheoretical framework.

[The first interview: taking into consideration countertransference-phenomena and interpretation]

During history-taking the patient induces feelings and fantasies in his physician. They may be related to unconscious conflicts of the patient, contributing to his illness. Their verbalization by the physician, who clarifies their possible connection with the unconscious motivations of the patient can reach his emotions and foster his insight, thereby relieving his suffering. Not all patients benefit from the confrontation, clarification and interpretation by their physician.

[The unbearable reality of the child: Münchhausen's syndrome by proxy]

The hypothesis of Münchhausen's syndrome arises through a clinical situation. The patient is unable to consider the question of "being a mother". The child takes the place of a real, unbearable object, which she evacuates or which can disappear. This maternal suffering requires psychotherapeutic care.

[Can therapeutic education enrich psychiatric care?]

There are different ways of approaching therapeutic education in psychiatry. While the behavioural approach is based on acquisition and success, psychoanalysis focuses more on the patient's self-knowledge. The systemic approach is interested in social interaction and collective potential.