The psychoanalytic dictionary: a position paper on diversity and its unifiers

An attempt is made to create a conceptual housing for an increasingly common stance among clinicians who willingly draw from diverse theories as they seem applicable to the immediate clinical moment. The working clinician generally does this without regard to questions of eclectic contradiction or of whether concepts can be extricated from the theories in which they are embedded. The metaphor of a psychoanalytic dictionary is used to create this conceptual housing. Within this metaphor, a psychoanalytic alphabet, vocabulary, and grammar are defined, as well as a set of core assumptions that gives some shape to the boundaries of the psychoanalytic language. Diversity is located in the preferred alphabets and vocabularies of varied psychoanalysts, and unifiers are found in the grammar and core assumptions of the language. Questions regarding internally inconsistent eclecticism and extricability are discussed. The integrative concepts chosen here (among the many that are possible)--concepts defining a shared view of how mind works--are found in such familiar ideas as displacement, condensation, over-determination, and multiple function.     

Freud's "Project" and its relationship to psychoanalytic theory

Sigmund Freud wrote the "Project for a Scientific Psychology" in 1895. Although the "Project" is essential a neurological model of mind, it will be shown that major concepts in psychoanalytic theory can be traced to this work. These include libido, primary process and the pleasure principle, secondary process and the reality principle, wish fulfillment, the ego, consciousness, and repression. The "Project" signifies a transition in Freud's thinking from a neurological to a psychological realm of discourse.     

Early developmental issues reconsidered: commentary on Pine's ideas on symbiosis

The concept of symbiosis is a powerful one expressing a significant emotional experience for many individuals. However, the concept needs to be differentiated from infant-stage symbiosis, Margaret Mahler's second stage of normal development. The latter idea, according to Pine (2004), was of "central" importance to Mahler. Although Pine acknowledges the influence of research findings and some critical challenges to this idea, he maintains nonetheless that it "remains quite valuable" and reports what he suggests are manifestations of symbiotic experiences in the infant-mother relationship. His recognition of infant observational data has led him to feature the idea of "moments" of merger between mother and infant. Empirical data, however, challenge both the idea of a more broadly defined stage of infantile symbiosis and the more narrowly conceived "moments." A different understanding of development in the presence of early-stage symbiosis is provided.     

Commentary on "Sedation before ventilator withdrawal

In any important article in the field of clinical ethics, the focus should not be on the specific case example, but rather on the issues it presents for thought and discussion. Barbara Springer Edwards and Winston M. Ueno achieve this end admirably. They present a terminally ill patient who requested termination of ventilator support, despite the overwhelming odds that he would die as a result. The authors ask whether or not the physician acted appropriately in accommodating the patient's wish and in sedating him to decrease suffering in his last moments. They present compelling arguments that sedation was warranted in this case. They also note correctly that competent patients have the right to refuse treatment. However, in addition to the question of sedation, this case raises other important issues, specifically those related to pain management and depression in the terminally ill....     

Commentary on "Being on time for appointments

In "Being on time for appointments," Sharon Schwarze addresses an important issue -- the tendency for doctors to keep patients waiting for their appointments. Let me state categorically that I agree that this is a deplorable situation that warrants discussion and warrants a serious attempt to correct the practice. I do believe, however, that this is an issue more appropriately considered under the rubric of etiquette rather than ethics, though clearly it is subsumed in the category of respect for persons....