Loss as a lifelong regenerative learning process

The predisposition to internalize death and loss of crucial attachment objects, subjectively, as a physical attack on the body, is commonly acknowledged in the field of human psychological behaviour (Freud 1915; Parkes 1972). This view is held, essentially, according to psychoanalytic principles of the functioning of the mental processes, to advance the concept of mind and body sensations as psychical consequences, or affects , of loss trauma. It does not, nevertheless, preclude wider social and cultural factors from adding to our understanding of how and why we react to loss in deeply individual ways. In the affective domain of human experience, the relationship between emotional pain and learning may not strike an immediate connection, since emotions are assumed to be subjective psychological affects of the psyche, while learning involves cognitive processes associated with developed responses to external stimuli. From a psychoanalytic perspective, however, it is possible to conceptualize the interconnecting of mind and body ‘states’ associated with pain, through the channelling and regulation of psychic tension in the ego. Importantly, the channelling of impulses into mind and body ‘ideas’ suggests a dynamic process capable of activating the human potential for emotional development and learning through the ego's capacity for adaptation to external change. We can speak, therefore, of affective learning as an integrated regenerative counterpart to emotional devel When death and major life changes are followed by corresponding feelings of loss, the human propensity to search for, and the lost object is generally viewed by therapists to be a normal part of grieving, however paradoxical the demands for integrating thoughts and irrational actions might feel. This illustrates the of a grief process that ultimately demands a degree of emotional development in enabling us to tolerate high levels of anxiety, there is disparity between the inner world of feeling and external reality. In psychodynamic grief work, the therapeutic principle of through' the deeper, inner layers of loss and mourning creates one such model for developing emotional learning and insight. It within this framework that the client can begin to understand his irrational motives, and be freed from the related feelings of alienation in his inner world.

The aim of this paper is to examine the concept of loss and learning in a wider context to include lifelong processes of and growth, which may be a cause for grief. It raises the significance of personal meaning(s) we attach to loss, links this theme to the aetiology of separation anxiety, loss and mourning from a psychoanalytic perspective.     

MOURNING IN THE PSYCHOANALYTIC SITUATION AND IN SHAKESPEARE'S THE TEMPEST

Recognizing that mourning builds psychic structure, the author highlights the ubiquitous and essential nature of mourning in the psychoanalytic situation. Reality testing is intimately connected to mourning and is the warp on which psychic structure is woven in the analytic situation. Reality testing necessarily involves opportunities for mourning and thus will be present in every analytic hour. The confrontation with reality is the basis for all processes of mourning, or for creating defenses against this painful experience. The author views mourning as fundamentally a transformational process, and Shakespeare's The Tempest is used to illustrate this aspect of mourning.     

The missing tombstone: reflections on mourning and creativity

There are differences as well as similarities between mourning occurring after the loss of a single individual under ordinary civilized conditions, and mourning after multiple losses under traumatic conditions. A brief review of the psychoanalytic theory of mourning articulated by Freud in 1917 and modified in the 1960s is followed by an equally brief review of the relationship between artistic creativity and mourning. Because survivors of major disasters who suffer multiple losses need time to recover before they can engage the emotionally demanding task of mourning, the mourning process in these cases is frequently delayed. "Memorial spaces" appear to facilitate delayed mourning because such spaces are responsive to a deeply felt need by survivors of major tragedies to articulate what they experience as unspeakable and unshareable. The memories and the pain associated with them are then welcome because mourning is not about forgetting; mourning is about remembering, a process that may take a lifetime.     

Object loss, renewed mourning, and psychic change in Jane Austen's Persuasion

Austen's extraordinary realism in depicting the dynamic internal processes which follow on the heroine's loss in Persuasion becomes clear in the light of a psychoanalytic understanding of mourning. Persuasion dramatizes the effects of a mother's death in adolescence as these come into play at the time of the heroine's separation from her fiancée and her later mourning. The thesis of this paper is that, despite falling in love with the brilliant hero, an unfinished mourning and an unconscious identification with her dead mother helped to persuade the heroine Anne Elliot to break her engagement, to create a 'final parting' as her mother had done to her in dying. The heroine's internal monologues show that she has projected some of the darker feelings of mourning, her anger and resentment, on to the hero and that she reopens a complex mourning process, partly through the displacement of affect, showing how traumatic effects of loss can be worked through in deferred action, effecting positive psychic change.     

Parenting a damaged child: mourning, regression, and disappointment

This paper is an examination of the long-term parenting experiences of parents who have given birth to CNS damaged infants. In particular, the focus is on the mourning, regression, rage, and depression that frequently attend these parents throughout their lives and can become pathological and pathogenic interferences with the provision of good-enough parenting. Several clinical vignettes were presented, each of which illustrated the usefulness of different psychoanalytic clinical theories about normality and pathology of parenting and parent-child interaction. The now-classical contribution of Solnit and Stark (Mourning and the Birth of a Defective Child, 1962) is reviewed along with Benedek's and others' psychoanalytic theories about normal parenting. The thinking of these writers is within the framework of structural/libidinal theory and seems to be useful in describing certain parenting problems that concern the mourning and regressive aspects of parenting. However, it was proposed that some of the adaptive coping and pathology encompassed by Solnit and Stark's explanations is not comfortably illuminated by the structural clinical theory of conflict and drives. Freud's discussion (1917) compares mourning and melancholia, which he differentiated as related but dynamically distinct clinical phenomena. This work is briefly recalled as an earlier point in theory building where structural theory was not sufficient to explain clinical depression and rage that exceeds normal mourning (as in Freud's melancholia). It is felt that an additional theoretical perspective on parenting provided by self psychology can fill in some of the gaps left by structural theory explanations. The self psychology perspective is particularly helpful with understanding the rage, ambivalence, and chronic depression often experienced by parents of damaged children. According to this perspective, the damaged child is a disappointing selfobject for the parent, and the parent's self organization will give him the resources to cope adaptively or to develop narcissistic pathology. Three types of intrapsychic problems for a parent are described: mourning the lost object, the fantasied perfect child; experiencing and recovering from regression to early identifications with his own parents; withstanding tension and regulating one's self (experiencing chronic depression and rage) when confronted with a great disappointment in a selfobject (represented by the damaged child). It is important when designing intervention strategies in a hospital or pediatric clinic setting to clarify which type of problem is the major focus of the parent's struggle.(ABSTRACT TRUNCATED AT 400 WORDS)     

A Dialogue on Racial Melancholia

As Freud's privileged theory of unresolved grief, melancholia presents a compelling framework to conceptualize registers of loss and depression attendant to both psychic and material processes of Asian American immigration, assimilation, and racialization. Freud initially formulates melancholia as a pathological form of individual mourning for lost objects, places, or ideals. However, we propose a concept of melancholia as a depathologized structure of everyday group experience for Asian Americans. We analyze a number of Asian American cultural productions (literature and film) as well as two case histories of university students involving intergenerational conflicts and lost ideals of whiteness, Asianness, home, and language. Exploring these analyses against Klein's notions of lost objects, we propose a more refined theory of good and bad racialized objects. This theory raises the psychic and political difficulties of reinstatement and the mediation of the depressive position for Asian Americans. In addition, this theory suggests that processes of immigration, assimilation, and racialization are neither pathological nor permanent but involve the fluid negotiation between mourning and melancholia. Throughout this essay, we consider methods by which a more speculative approach to psychoanalytic theory and clinical practice might offer a deeper understanding of Asian American mental health issues.     

Nostalgia and lost identity

Nostalgia for the Soviet Union is a major social phenomenon in Russia today due to the irrevocable losses of the recent past in which Soviet citizens involuntarily became immigrants in their own country. With reference to discussions of nostalgia in philosophical and psychoanalytic literature, I suggest that nostalgia may represent either a defensive regression to the past or a progressive striving for wholeness through re‐connecting with what has been lost in the service of a greater integration. I compare this with the processes of adaptation seen in immigrants and provide a clinical illustration of a young man coming to terms with loss and change in the post‐Soviet era. When nostalgia is recognized as a legitimate emotional experience it may facilitate mourning and enable the integration of the past with the present and the development of a new identity.     

Teaching Psychiatric Patients: A Psychoanalytic Study

This paper attempts to describe some of the challenges of teaching psychiatric patients within a hospital environment. It uses post-Kleinian ideas to look at the unconscious processes at work within the learning/teaching dynamic and observes the psychotic mind's unique approach to learning. The central hypothesis of the paper is that psychoanalytic reflection of educational processes within a psychiatric institution is of clear benefit to both teacher and learner, and can also forestall several of the more problematic or even harmful outcomes of the increasing trend to ‘educate’ the patient.     

Letting go: some thoughts about termination

Termination of analysis is discussed from three perspectives. First, considered as a vicissitude of the analytic relationship, termination contains essential elements of the psychoanalytic process itself. Cycles of attachment, loss, mourning, and internalization mark moments in, as well as overviews of, every analysis from its beginning to well past its termination. Second, Freud's approach to the subject of termination is explored and widened, with an emphasis on its relation to mourning and on the depth and permanence of analytic transference--two dimensions relatively neglected by Freud, perhaps for personal reasons. Finally, clinical issues are presented that are meaningful to the author in his work with analysands, including his work as a training analyst.     

Reminiscence,Ritual, and Beyond Working Through: Commentary on Papers by Joyce Slochower and by Laura Impert and Margaret Rubin

The author examines, contextualizes, and elaborates upon Slochower's psychoanalytic exploration of commemorative rituals and, more specifically, the Jewish tradition of Yitzor as well as upon Impert and Rubin's understanding of embodied nostalgic reminiscences, considering them within a therapeutic context for the mourner entering into the clinical situation. Slochower's experience with commemorative rituals as facilitating environments for the restoration or support of potential space and memorial activity suggests that they can aid in the re-construction and re-shaping of emotional memory, going beyond a notion of “working through.” Impert and Rubin suggest that generative nostalgic reminisces, a soma-sensory based form of memory that holds the potential for activating arrested mourning, may be clinically usefully in awakening dormant or dissociated grief so that patients can access mourning. Extending upon these contributions, the author further considers the possibility that mourning might be more usefully conceived as processes of transformational work for which a fixed resolution or outcome is neither proscribed nor prescribed. This transformational work may be seen, in part, as ongoing cycles of self-surrender to the mourner's swirling constructions of attachments lost, re-found, re-remembered, and re-conceived.     

Toward developing a scale to empirically measure psychotic defense mechanisms

In recent years, research on psychological processes has greatly advanced our understanding of various psychopathologies. Defense mechanisms, for example, have been described as observable phenomena, and studies have shown meaningful relationships among these processes and other measurable dimensions of health and illness. Despite some notable exceptions, one area that has been overlooked is the empirical study of defenses in psychotic disorders. This is in part due to the lack of valid instruments measuring psychotic-level defenses. Propadeutic to creating an empirical scale for measuring psychotic defenses, the psychoanalytic and empirical literature on psychotic defenses is reviewed, after which the concept of psychotic defenses as measured by the P-DMRS (Psychotic-Defense Mechanism Rating Scales)--which can be used independently or in combination with the current DMRS (Defense Mechanism Rating Scales)--is operationalized. Finally, current research directions applying the P-DMRS to the clinical setting are presented, as well as its implications for guiding current clinical practice.     

Psychoanalysis Traumatized: The Legacy of the Holocaust

Psychoanalysis is a survivor of the Holocaust. It was founded and flourished in central European centers that would be destroyed by the Nazis. A core group of refugees who lived through persecution and exile were instrumental in rebuilding their movement on alien shores. They had no opportunity to mourn the loss of their culture or their leader, Freud, whose death was overshadowed by the cataclysmic upheaval around them. Though its trauma has been dissociated, it is represented in psychoanalytic ideas and enacted in institutions within the context of delayed or incomplete mourning. For example, authoritarianism in psychoanalytic institutions will be explored as a reliving of the trauma of both fascism and exile, and not merely typical group psychology. Further evidence of the impact of dissociated trauma includes the astonishing scotoma for actual events in treatment of Holocaust survivors; the extreme privileging of infantile fantasy over reality, and attention to childhood neurosis at the expense of adult catastrophic events.     

From neurotic guilt to existential guilt as grief: the road to interiority, agency, and compassion through mourning. part I

This study proposes through a case illustration that psychoanalytic patients who can process both aggression and loss through a mourning process are able to free themselves from pathological self attack when the object relations work of attachment, psychic holding, and separation transpires. In the case of Helen discussed here, transformation through a “developmental mourning process” results in the evolution of powerful psychological capacities for interiority, self agency, and interpersonal compassion. This developmental mourning process is endowed with the assimilation and psychic fantasy symbolization of aggression.Susan Kavaler-Adler, Ph.D., ABPP, is Founder and Executive Director, Training Analyst, Faculty Member, and Supervisor at the Object Relations Institute for Psychotherapy and Psychoanalysis, New York.     

Fragmentation,persecution and primitive guilt

The clinical and theoretical approaches of Melanie Klein and her followers provide valuable direction in the psychoanalytic treatment of psychotic patients. This paper looks at Klein's work as well as the goals of psychoanalytic work. The clinical issues of primitive guilt and paranoia are discussed with regard to more primitive patients who experience internal fragmentation and psychic chaos. Finally, a case is explored in which a psychotic patient struggled with experiences of primitive guilt and intense persecutory phantasies.     

RECRIMINATION IN THE ANALYTIC SITUATION: A HYPOTHESIS ABOUT ITS INFLUENCE ON PSYCHOANALYTICAL GROUPS

This paper deals with certain distortions in communication generated by mutual recrimination that is the result of disturbances in the ideal agencies of both parties. Although the ideal ego, superego and ego ideal participate equally in reproach, it is the latter which is the most decisive. In clinical experience, recrimination may easily colour the analytic dialogue. In such cases, interpretation loses its sense of clarification and another type of dialogue replaces it. There, words are used to take possession of the other, for its autonomy is a threat to the static character of the pathology of mourning. The problem of recrimination has also tainted the development of psychoanalysis, to the point of disrupting the process of discovery itself. This paper deals with repercussions in the psychoanalytic movement and also in the elements that constitute its structure. Finally, different variations and disturbances in the psychoanalytic ideal are considered, as well as the involvement of the psychoanalytic institution in preserving or transforming the ideal. Here the importance of institutions and institutional ideals is emphasised. Finally, we suggest that ideals either encourage or hinder the working through of individual and collective mourning.     

Author biographies

This paper describes how an application of psychodynamic principles and techniques in a school setting can open up perspectives and insights into aspects of loss and mourning, which result in the personal and professional growth of individuals. It discusses applied psychoanalytic work in relation to its clinical base in the consulting room, in particular family work, and exemplifies this with a variety of cases.     

Winnicott's children: The holding environment and therapeutic communication in brief and non-intensive work

This paper discusses brief and non-intensive work using a Winnicottian framework for understanding the processes involved. The importance of play, communication and interpretation are considered within the careful establishment of a unique holding environment for each patient. Parallels are drawn with ordinary development and care of the infant and young child. Two clinical examples are given to illustrate these concepts. The first describes the treatment of parents and children following the accidental death of the youngest child, and the second describes time-limited work with a sexually abused and abusing teenage boy. The value of providing a range of psychoanalytic treatments to meet the range of needs of patients is discussed. The importance of conceptualizing such treatments in ways that do not imply that they are ‘diluted’ psychoanalysis is also stressed, particularly with a view to the increasing pressure on therapists to offer help to as many children as possible within limited treatment time.     

The return of the erased: Memory and forgetfulness in Eternal sunshine of the spotless mind (2004)

Eternal sunshine of the spotless mind is a film about remembering and forgetting loss. This essay reads the film as an examination of mourning and melancholia, which are distinct ways of remembering and forgetting both a love object and its loss. Freud distinguished mourning from its pathological counterpart, melancholia, claiming that there is a normal way to grieve, mourning, and its degeneration into an abnormal pattern, melancholia. The author aims to make two points: firstly, that both processes are characterized by ambivalence and identification and therefore have some commonalities; secondly, that there is a difference between the two processes that is less apparent than the ones discussed by Freud. This is the difference between remembering a good and a bad object. Following Klein the author argues that this is a crucial qualitative difference between mourning and melancholia. She concludes that a central issue in grieving is not forgetting but remembering well.     

Mourning’s dissonance; who am I who mourns and whom do I mourn?

In this article I explore how a relational psychoanalytic and phenomenological perspective can open out new possibilities for interpretations of experiences of bereavement. I critically discuss Freud’s acclaimed paper, ‘Mourning and melancholia’ in the light of work by philosophers Merleau-Ponty (a phenomenologist) and Judith Butler (a contemporary post-modern feminist philosopher). I reflect on how questions of identity, language, and embodiment, crucial themes in Merleau-Ponty’s and Butler’s theorising of human subjectivities, emerge in two literary/autobiographical accounts of mourning: Nora Webster, by the contemporary Irish writer, Colm Tóibín, and Mourning Diary by the French philosopher, Roland Barthes. Through my discussion of these philosophical and literary texts I argue for a psychoanalytic perspective which is attuned to the conscious and unconscious subtleties and complexities of mourning and engages with the ways in which the identities of the mourner and the mourned and the relations between them are, for the mourner, constantly in flux. I emphasize the importance of attending in the psychoanalytic relationship to the specificity and uniqueness of individuals’ languages of mourning and to the effects on experiences of bereavement of gender, race, class, sexuality, age, and physical ability within particular socio-historical and cultural contexts.     

A beam of "chimeric" darkness: presence, interconnectedness, and transformation in the psychoanalytic treatment of a patient convicted of sex offenses

The paper puts forward the dimension created by analytic presence and the ensuing patient-analyst interconnectedness in the process of psychoanalytic treatment and change, particularly with more disturbed patients. Working within this dimension, at a fundamental level of contact and impact, opens up new possibilities of extending the reach of psychoanalytic treatment. The analyst's "presencing" and interconnectedness with the patient forge a living therapeutic entity that is not a one-person or two-person psychology, but an emergent two-in-one new entity that goes beyond the confines of the separate subjectivities of patient and analyst and the simple summation of the two. The paper describes the kind of knowledge, experience, and powerful therapeutic potential that comes into being through analytic "presencing" and patient-analyst interconnectedness, and particularly focuses on the chimeric element, or quality, of this interconnectedness. The term "chimera/chimerism"-chosen here for its wealth of mythological, genetic, biological, biomedicinal (chimeric proteins), and psychoanalytical associations-is used in this paper to highlight the complex quality of patient-analyst interconnectedness, especially in difficult, psychotic, psychically foreclosed, dissociative and perverse states. The author offers an extensive clinical account of psychoanalytic treatment of a patient convicted of sex offenses in order to illustrate "presencing," interconnectedness, and the extent and intricate emotional meaning of the extreme chimerism that this kind of (difficult) treatment entailed.