Unique Eyes and Different Windows of Opportunity

Abstract

The writer discusses her personal experiences of being a consumer of mental health services and, at the same time, working as a mental health professional. She includes the challenges and benefits of this experience, as well as the “sparks, pushes, and bumps” of this dual role. Also included are current and future trends of mental health recovery, suggested to be the key to wellness for consumers.     

Mending the Broken Frame: Self-Narration in a Constructionist Framework

The communal construction of mental illness makes recovery a daunting challenge since society largely perceives the psychiatrically ill as ??deficient??. Not only does one have to deal with the illness itself, one additionally has to deal with the perpetual stigma associated with the labeling, increasing the personal consequences of these illnesses. In my own journey through mental illness, I have repeatedly tried to construct for myself those structures which would help me become stable and empower me from within rather than rob me of my sense of self. This paper is a small expression of that narrative.     

Breakdown in communication: On finding the child in the analysis of an adult

SUMMARY

In this paper a patient is described in whom communication with parts of herself and with her objects, internal and external, had broken down. I suggest that her way of communicating was achieved by projective identification, as described by Klein (1946) and Bion (1962). The only way she could deal with and communicate her own very “bothered” feelings was to “put them” into the analyst. In this way she “bothered” the maternal or analytic mind in such a way as to make the analyst experience feeling like a “bothered” child.

I have tried to show how the analyst holds or contains these feelings, and to show the gradual establishment in the patient of a different way of communicating with the analyst and with the more primitive parts of herself.     

Mentally ill or mentally handicapped? A longitudinal study of severe learning disorder

SUMMARY

In the course of some eighteen months of psychoanalytic psychotherapy, a young woman of twenty-seven once deemed braindamaged at the age of seven years, has shown herself capable of sustaining once weekly psychotherapy. Against all expectations she has taken responsibility for her own attendance, travelling by public transport alone to her sessions. She has also taken initiatives in relation to finding work for herself.

Psychotherapy has disclosed a significant component of autism in the personality which is resorted to regularly and which seems to drag the patient into a passive acceptance of half-life which she tries not to mind. In the course of her sessions the patient has come to take more notice of her predicament and to mind more about the dissatisfactions which she experiences.

The case presented here is considered to have the characteristics of a particular group of adolescents. These are often described as “just slow” and are brought for psychiatric or psychological attention by desperate parents urgently concerned about the working future of their children.

These are individuals of whom the original definition of mental handicap contained in the Mental Health Act 1913 “a state of arrested or incomplete development of mind” would seem to offer as honest, appropriate and meaningful an assessment as the formal I.Q. score introduced in 1959. Unlike the latter, it is an assessment based on a concept of mental development. Assessment by I.Q. score has led to emphasis on training to compensate for the supposed loss of functioning and also to notions like “training for development” and “education from birth”.

In the case described here it was the abandonment of training aims and approaches which produced a dramatic improvement in the well-being of the patient and her family. Treatment is now fostering the potential in this woman to bring her own mind into action and to support in her, her own wish for personal development.     

Occupationally Embedded Exercise Versus Rote Exercise and Psychosocial Response in College-Aged Females

Community integration through occupational engagement is an integral tenet of occupational therapy. However, little is known about how pets may assist this process. This study explores community integration through pet ownership as a meaningful, lifelong, occupation for one person with bipolar illness receiving Assertive Community Treatment. Using a case study approach, eight qualitative interviews, as well as observation and analysis of pet photos, were conducted with the mental health consumer and also with members of her social network. Data were analyzed inductively according to the constant comparative approach. The findings reveal that pet ownership assisted the person to counterbalance and move beyond stigma through pets as enablers of: “continuity,” “belonging,” “action and self-construction,” “acceptance,” and “participation.” This process was influenced by the “severity of illness,” “view of community,” and “supports and resources.” The results contribute to our understanding of pet ownership as a means to community integration. The study indicates that to enable persons with a mental illness to engage in pet ownership, occupational scientists need to examine and understand this occupation in the broader context of recovery, health, and well-being. A perspective of pet ownership as meaningful occupation challenges occupational therapists to develop strategies to actively engage clients and their pets in their community.     

The “Own” and the “Wise”: Does Stigma Status Buffer or Exacerbate Social Rejection of College Students with a Mental Illness?

Applying Goffman’s stigma-status framework and using data from a survey administered to college students (N = 556), we find that respondents who have been diagnosed with a mental illness (the “own”) or who know a family member or friend with a mental illness diagnosis (the “wise”) express lower desired social distance from persons with a mental illness than other respondents (“normals”). Also, informally labeling symptoms as “mental illness” reduced social distance among those similarly diagnosed. However, perceived dangerousness did not vary across stigma status, and the socially-distancing effects of perceived dangerousness were more pronounced among the “own.”     

Developing a Capacity for Bodily Concern: Antonio Damasio and the Psychoanalysis of Body–Mind Relationship

ABSTRACT

The author starts from the assumption that the body is the mind’s primary object. He explores the link between his clinical research about the Body–Mind relationship and neuroscience, by focusing particularly on the contribution by Antonio Damasio who has emphasized the importance of the bodily roots of mental functioning. In many patients nowadays, developing a capacity for “concern for one’s own body” is a stepping stone toward a genuine non-imitative mental functioning. This perspective contrasts with psychoanalytic orientations that give priority to recognition of the other and intersubjective dynamics.     

心理疾病污名内隐测评的类别标签初探

采用单一类型内隐联想测验,考察以往研究中常用的概括化心理疾病词和具体心理疾病词作为心理疾病内隐污名间接测量概念词或类别标签的有效性。结果发现,相较于与积极词配对的任务,两类概念词与消极词（心理疾病态度词）配对的任务反应时更快,正确率更高。研究表明概括化概念和具体疾病与反映人们对心理疾病患者真实态度的消极词存在更紧密的自动联结,是人们头脑中表征心理疾病的概念词或类别标签,可作为内隐测量中的心理疾病概念词用于污名评估。     

Fostering the therapeutic alliance: Recognizing autonomy’s dialogical antecedents

ABSTRACT

This paper presents a reconceptualization of autonomy as the iterative realization of one’s capacity for “effective self-definition,” that is, possessing a sense of clarity and coherence in “who I am,” and exercising the decisional and volitional ownership over my life that this engenders. This process is “Relational,” wherein people’s interpersonal interactions have a deep and pervasive influence on their ability to recognize and exercise their autonomous capacities. This Relational understanding of autonomy is contextualized within the field of addiction rehabilitative practice. Addiction is a pathology that progressively and insidiously undermines autonomy – producing a number of negative consequences that present themselves along a “continuum of pervasiveness.” In order to most fully foster rehabilitation, therapeutic alliances should to be attentive to facilitating autonomy’s dialogical antecedents. Here, interpersonal recognition can help clients to more fully recognize their own autonomous resources – enabling them to embark on their rehabilitative journey and achieve broader autonomous living. This paper concludes by proposing ways that practitioners can manifest their recognition of their clients’ autonomy within the therapeutic encounter.     

Life Experience Is Not a Disease or Why Medicalizing Madness Is Counterproductive to Recovery

Abstract

The author draws on her personal experience as the family member of an individual with mental illness, on her anthropological research and on that of others to argue that medicalizing madness can be counterproductive to recovery. The medical model is sometimes used in a way that strips away the meaning of the illness experience. Analogies drawn to diseases do not help the understanding of mental illness. Psychiatry is a social practice embedded in a social milieu and that renders it less than objective. It is useful to recognize that the experiences called symptoms have meaning and may have positive and pleasurable aspects.     

Therapeutische Teams: Theorie—Empirie—Klinik (Therapeutic Teams: Theory—Research—Clinic)

Abstract

Internalized stigma has been suggested to play a major role in negative changes in identity in severe mental illness. Evidence suggests that roughly one-third of people with severe mental illness show elevated internalized stigma and that it is linked to compromised outcomes in both subjective and objective aspects of recovery. Despite substantial evidence for the impact of internalized stigma, few efforts have been made to develop professionally led treatment to address this issue. In this article, we discuss our development of a new group-based approach to the treatment of internalized stigma which we have termed “narrative enhancement and cognitive therapy (NECT)”. We describe the treatment approach and offer an illustration of it by way of a case vignette.     

Crying wolf? Australian adolescents’ perceptions of the ambiguity of visible indicators of mental health and authenticity of mental illness

Young people’s perspectives about mental health concepts shape both their interactions with sufferers of mental illness and their actions related to their own mental health. The current study employed a cross-sectional qualitative design to explore how adolescents (aged 12–18 years) speak about mental health and illness in order to gain insight into young people’s perceptions and experiences and contribute to shaping approaches to policy and practice. When discussing mental health concepts and appropriate behaviours toward sufferers of mental illness, adolescents conveyed a sense of acceptance and understanding of the potential complexity and severity of mental health problems. In contrast, when discussing mental health in the context of their own lives, a stronger sense of scepticism was conveyed, with students expressing difficulty with the lack of visible markers of mental health and confusion determining authenticity in the mental health states conveyed by their peers. Interestingly, adolescents interviewed commonly conveyed the notion that young people may exaggerate or “fake” a mental illness for personal gain. Adolescent perceptions of mental health and illness hold practical implications for policy and school-based programs aimed at improving mental health knowledge, attitudes and behaviours among youth.     

Maternal intrusion: Its roots and consequences

Abstract

Behind an intrusive mother’s view of her actual child lies a disproportionate, hidden desire to revive an ideal relationship with a perfect mother. The resulting image of an idealized child then becomes a strategic aspect of the mother’s own identity, representing an idealized figure from her own past. As the mother’s idealization is disturbed by the reality of the child, the mother experiences the situation between herself and the baby as “pathological,” that is, disruptive to her. She then attempts to repair the idealization by resisting any change in the status of her relationship to her child, even as the child grows older. Her rigidity in this regard necessarily excludes a paternal presence that could challenge or change the mother–infant idealized dyad. The mother’s orientation is also contradictory to, and acts as a resistance to, psychoanalytic therapeutic interventions, which aim at any “change.”     

Reflections of a Midlife Lesbian Feminist Therapist

In this paper the author evaluated her own work as a lesbian feminist psychotherapist form a critical perspective. Using the work of Kitzinger and Perkins, Carter Heyward and Samuel Sandweiss, she suggests that psychotherapy, as constructed today, has become primarily behavioral, cognitive, apolitical and disconnected from its original purposes. After describing her own midlife spiritual crisis she details, through journal entries, a journey toward a deeper and more absorbed state of mental health. The author then questions how a therapist might utilize techniques drawn from spiritual and body work practices that might help a client find a place inside that is more soul healing, rather than just of the mind.     

No Turning Back

ABSTRACT

It has been 16 years since the publication of my article, “Infertility in the age of technology: From frozen sperm to egg donation.” Today I would title it simply “Fertility in the age of technology.” In that article, I presented Diana, an analytic patient in her middle forties, who became a mother through implantation of a donor egg. Her journey to parenthood was fraught with physical and emotional trauma partly as a result of ever more high-tech and invasive treatments. The purpose of my 2000 article was to discuss the anxieties that the then new biotech treatments caused for both patient and analyst. I stated, “What makes this unique for the analytic process is that we analysts must confront our own anxieties and the underlying fantasies stimulated by the new procedures at the same time as we are helping our patients analyze theirs. Patient and analyst alike become inextricably linked in an exploration that will ultimately have a profound impact on both participants. Regardless of theoretical position, we become a part of the process, willingly or not” (Blum, 2000, p. 1543). Now, in this article, I look beyond the consulting room. I reflect upon the relationship between societal influences and technological advances and their integration into psychoanalytic theory.     

Longing for the Feminine: Reflections on Love,Sexual Orientation,Individuation, and the Soul

This article is a collaboration that represents several years of dialogue about our topic, alongside the individual depth work done by each of us to overcome the negativities that often poison collaborations and feeling connections: envy, enmeshment, and passivity. It is the unique expression of two women working together in a co-creative process pulsed by feminine principles. Diane is a Jungian analyst and has spent her life close to the unconscious. Fran is a writer, educator, and lifelong student of mystical paths. The article gives an account of Diane's longing for the divine feminine and the particular meaning it has for her as a lesbian in this time of global upheaval. In particular, her story highlights the psychic suffering that individuals go through when their same-sex attractions and love orientation are judged as psychologically “immature” or religiously “sinful.” Neither Christian-based “conversion therapy” nor Jungian analysis turned Diane into a heterosexual woman. Her story reveals the benefit of Jung's depth psychology even as it underscores the singularity of every person's individuation process. The article's unusual format is a tandem of Diane's first-person sharing of her soul's journey and Fran's witnessing of the journey's profound significance. We found that both voices were needed. Truth requires not only the one who lives a journey with courage but also the one who witnesses it with a loving heart. Ultimately, we see the personal journeys of gays and lesbians as significant to the larger context of the evolution of human consciousness.     

From psychic holes to psychic representations

Abstract

In this essay, I will explore the term “psychic hole,” and compare it to similar terms from the world of astrophysics and terms used in the psychoanalytic literature. I will then present my own conception of the “psychic hole” in cases of Holocaust survivors' offspring. I will explain how this “hole” is created, and describe a particular aspect of the “psychic hole” that is unique to Holocaust survivors' offspring, namely the enactments (termed “concretization” by Bergman) generated by the negated traumatic themes that reside in it. I will illustrate these enactments using clinical material taken from case studies of Holocaust survivors' offspring that I have previously published. The clinical vignettes reveal the transgenerational impact of the memory hole resulting from negation of survivor parents on the lives of their offspring, up to the third generation. They also show the painful journey from enactments to psychic representations, a journey which exposes the traumatic events that have been denied or repressed, and facilitates the work of mourning and the eventual achievement of a better integrated self. Finally, I will offer technical suggestions for analysts to help patients transform psychic holes into psychic representations.     

Measuring Stigma Toward Mental Illness: Development and Application of the Mental Illness Stigma Scale1

Guided by theory on stigma, a Likert‐type scale was developed to measure 7 factors of attitudes toward people with mental illness: interpersonal anxiety, relationship disruption, poor hygiene, visibility, treatability, professional efficacy, and recovery. The scale was validated among college students and community members, measuring attitudes toward people with mental illness, depression, bipolar disorder, and schizophrenia. In a second application, college students completed the scale from their own perspective, then from an imagined perspective of someone with mental illness, while psychiatric patients completed the scale from their own perspective, then from an imagined viewpoint of someone without mental illness. Psychiatric patients assumed that they were stigmatized to a greater extent than was admitted by the student sample.