A perspective on the patterns of loss, lack, disappointment and shame encountered in the treatment of six women with severe and chronic anorexia nervosa

Abstract :  This paper explores how the aggressive fantasies and energies expressed in anorexic self-hatred can be recycled to become the basis of psychological growth and recovery. This shift is made possible by focusing on the telos of the analysand's psychological system as it expresses itself through her illness, and using Clark's idea that sanity is a form of recycled madness. It also draws on Jung's view of the unconscious as an active and purposive agent, and libido as a neutral psychic energy which can serve different purposes.
I discuss a number of clinical vignettes, focusing on the hard, ruthless, defiant and hateful aspects of (what might appear to be) 'monstrous' anorexic behaviour, and the kinds of countertransference reactions these behaviours can provoke. I also explore what these kinds of behaviours might represent in terms of multi-generational family dynamics, as well as mother-daughter dynamics.
At the core of the paper is the idea that the capacity to use aggression in clear ways, but within the limits of conscience, is essential for the protection of one's physical and psychological boundaries. Without the capacity to defend oneself, and the ability to decide quickly and clearly when it is right to risk hurting the other in order to do so, one cannot take any level of risk in life, or draw close to the other. I suggest that for recovery from anorexia to occur, the aggressive, self-hateful, destructive energies which are so central to the illness need to be recycled into these kinds of awarenesses and life-skills.     

Autonomy,Sanity and Moral Theory

The concept of autonomy plays atleast two roles in moral theory. First, itprovides a source of constraints upon action:because I am autonomous you may not interferewith me, even for my own good. Second, itprovides a foundation for moral theory: humanautonomy has been thought by some to producemoral principles of a more general kind.This paper seeks to understand what autonomyis, and whether the autonomy of which we arecapable is able to serve these roles. We wouldnaturally hope for a concept of autonomy thatis value-neutral rather than value-laden. Thatis to say, we would want the judgement that Iam autonomous to depend wholly on, say,structural features of my psychology, and in noway to require us to make ethical judgements, orother value judgements. Being value-neutral isperhaps desirable in a concept of autonomyserving the first role, and plausiblyindispensible in one playing the second. Ishall argue, however, that value-neutral conceptionsof autonomy are impoverished and out of linewith our intuitions; set out and defendan explicitly value-laden conception ofautonomy; and explore the implications of such a view for theability of autonomy to play the rolesmentioned above.     

Through a glass darkly Some reflections on psychiatric nursing

Abstract

This paper is about ways of understanding some of the behaviour and events that occur in psychiatric wards. It is argued that a psychodynamic understanding of these events would help both staff and patients see some ‘meaning in madness’.     

Concerning Madness and Human Suffering

Pastoral Psychology - Few behavioral scientists have attempted a penetrating examination of the problem of suffering. Eschewing its etiology as a moral issue, they have left it to philosophers and...     

Agency and pain: An exploration

The notion of agency has become particularly prominent in social‐science writing. This article identifies some of the weaknesses in the ways it has been employed in contemporary anthropology. It criticises the assumptions of self‐empowerment, responsibility, and constructivism that are held to be essential to moral agency in much of that usage. Present‐day conceptions of agency in this literature introduce—whether intentionally or not—a triumphalist vision of history. Drawing on recent neuro‐physiological research, religious history and ethnography, it focuses on pain in order to think about agency in other than triumphalist terms. Triumphalist versions of agency, the article argues, are not only inherently questionable, they also distract our attention away from the need to understand how different traditions articulate the idea of living sanely in a world that is inevitably painful.     

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.     

理想与癫狂——王莽改制的思想史意义与政治史意义

王莽改制作为儒家理想主义运动的产物,其历史意义是双重的。从思想史的角度看,改制事件彰显了儒家政治思想中的癫狂性格;从政治史的角度看,事件向人们提供了观察中国古代政治生活之本性的契机。     

What implications does The Red Book have for my clinical practice?

The Red Book takes us to the heart of Jung's project, exposing the fundamentally religious nature of his work. Jungian analysts who heed the religious imperative will find themselves caught - as Jung was - between the 'spirit of this time' and the 'spirit of the depths', which raises significant questions for our clinical work.     

Fischer and Ravizza on Moral Sanity and Weakness of Will

This essay evaluates John Martin Fischer and Mark Ravizza'smature semi-compatibilist account of moral responsibility, focusingon their new theory of moderate reasons-responsiveness as a model of``moral sanity.' This theory, presented in Responsibility andControl, solves many of the problems with Fischer's earlier weakreasons-responsiveness model, such as its unwanted implication thatagents who are only erratically responsive to bizarre reasons can beresponsible for their acts. But I argue that the new model still facesseveral problems. It does not allow sufficiently for non-psychoticagents (who are largely reasons-responsive) with localized beliefsand desires incompatible with full responsibility. Nor does it take intoaccount that practical ``fragmentation of the self' over time may alsoreduce competence, since moral sanity requires some minimum level ofnarrative unity in our plans and projects. Finally, I argue that actual-sequenceaccounts cannot adequately explain sane but weak-willed agency. This isbecause without libertarian freedom, such accounts have no way to modelthe perverse agent's determination to be irrational or weak.     

The agony of integration and the blessings of finitude – facing ‘extinction points’ and moments of madness

This paper explores the inevitable pain that integration requires in our individuation process. The unspeakable agony we defended against in order to survive we now experience consciously, including moments of going out of existence at the core of our madness. Clinical examples are given of these ‘extinction points’ and the abject helplessness analysand and analyst suffer in the face of this destructiveness. The first and second witness to this process (usually the analyst and the psyche itself) and the primordial creative life force are recognized in the process of recovery, a recovery that recoups the blessings of our finite human living.