Coniunctio—in bodily and psychic modes: dissociation, devitalization and integration in a case of chronic fatigue syndrome

Three years of analytical psychotherapy with a professional woman in mid-life, suffering from chronic fatigue syndrome (CFS), is described. Gradual recovery merged into mid-life changes; marriage, along with a new balance of maternal and paternal imagos, enabled her to trust enough to become pregnant— coniunctio in the most primal bodily and psychic modes.
Her life-long, schizoid type pattern, 'the pendulum of closeness and isolation', with its extreme of psycho-physical collapse and devitalization, was replayed in therapy. The analyst's symbolic attitude is emphasized, containing the patient's initial affective explosion and validating the physicality of her condition. Mirroring and steady rhythmic attunement became a new, pre-verbal, source of trust—vitalization; differentiation and separation replaced defensive splitting and dissociation. Then the overwhelmingly powerful bodily/maternal could be counterbalanced by the masculine, and a transitional space emerged for symbolic work.
Both the regressive and the dynamic aspects of CFS are located in the earliest undifferentiated, archetypal, bodily/psychic modes, when the frustration of primary needs evokes the defences of the self. It is argued that our psychodynamic understanding can contribute to the stalemate in seeing chronic fatigue syndrome as either an organic illness or depression, and that a new linking of the somatic and psychic calls for a new professional collaboration.     

Unlawful Entry: Male Fears of Psychic Penetration

In this paper, it is argued that males as well as females have an early experience in relation to the nursing mother of being receptive to bodily and psychic penetration. Males tend to lose access to this experience and may come to fear penetration as a threat such that a masculine sense of self is felt to be dependent on an impermeable psychic boundary that is not to be penetrated. Instead, phallicism as a fortress of emotional self-sufficiency—which the author labels the citadel complex—becomes the matrix of a subjective sense of masculinity. The multiple and combined forces of bodily development, the establishment of gender identity, and the process of separation-individuation are examined for their role in this process.

A critique of the Lacanian concept of paternal law suggests that the “law of the father” can be interpreted as a law regulating penetration. Paternal law can be viewed as a code for the establishment of an impenetrable masculinity whereby entry into an adult male psyche becomes unthinkable, “unlawful.” An impermeable bodily and psychic boundary—the ability to penetrate without the ability to be penetrated—collapses a necessary dialectical tension that may affect men's experience of sex and of love and that may shape and limit their desire.     

Words that touch2

In this paper the author examines her own use of language as a psychoanalyst and asks: what is the best way to help analysands to find the words to express not only what they are thinking but also what they are feeling and experiencing? In common with other psychoanalysts, the author has observed that each of us simultaneously utilises both advanced psychic mechanisms that are accessible to symbolism and more archaic ones, which are less so. However, she draws a distinction between people who are able to tolerate the perception of their own heterogeneity, even if it is sometimes a source of suffering, and those whom she terms ‘heterogeneous patients’. Patients in the latter category, whose lack of internal cohesion causes them anxiety, are afraid of losing their sense of identity. The author asks how we can understand their language and how we should speak to them. She uses several clinical examples to demonstrate that ‘heterogeneous patients’ need to be touched with a language that does not confine itself to imparting thoughts verbally but also conveys feelings and the sensations that accompany those feelings. It is also an ‘incarnated’ language because the words pronounced by the analyst can awaken, or reawaken, bodily fantasies in the patient. These words may enable him to find an emotional meaning in forgotten sensory or bodily experiences, which may then become a starting point for his work of thinking and of symbolisation.     

Libido und psychische Energie

The authors investigate different definitions of “psychic energy” and “libido” as well as their critique. With regard to “psychic energy” it is shown that the critique relates in particular to the perspective of Brenner and others and not to Freud's definition. They argue that Freud uses the term “psychic energy” as a synonym for “libido” and not “libido” as a synonym for “psychic energy”. It is assumed that until 1914, Freud related “libido” to manifestations of bodily sexual tensions and afterwards to manifestations of sexual energy in the psychic field. The authors reject this change for epistemological reasons as well as Freud's attempt to use dynamic, economic considerations as an explanatory device. Freud's energy concept is inconsistent with the definition of energy in natural sciences, and, whereas the meta-psychological topographical, dynamic and structural viewpoints have a solid foundation in the representational world to which the psychoanalytic process affords unique access, this is not true of the economic viewpoint. It is claimed that bodily tensions exist in the representational world only in the form of affects, so that the economic viewpoint should, in the authors' opinion, be abandoned in favour of an affective one. In the context of the endeavour to obtain pleasure and avoid unpleasure as adduced by Freud, this viewpoint concentrates on the relationships between affects and the different elements of the representational world, thereby serving as the topoi of meta-psychological investigation dimensions.     

Christer Sjödin interviews Jan Stensson

Abstract

The author examines different definitions and applications of the terms “psychic energy” and “libido.” With regard to the “psychic energy” terminology, he shows that its application and usage relate in particular to the perspective of Brenner and not to Freud's definition. He argues that Freud uses the term “psychic energy” as a synonym for “libido,” and not “libido” as a synonym for “psychic energy.” It is demonstrated that in Freud's view, up until 1914, “libido” relates to manifestations of bodily sexual tensions, and subsequently this term applies to the manifestations of sexual energy in the psychic field. The author rejects this change in terminology and also challenges Freud's attempt to use dynamic-economic considerations as an explanatory device for epistemological reasons. Freud's concept of energy is inconsistent with the meaning of energy as defined in the physical sciences, and whereas the metapsychological topographical, dynamic, and structural viewpoints have a solid foundation in the representational world to which the psychoanalytic process affords unique access, this is not true of the economic viewpoint. It is claimed that bodily tensions only exist in the representational world in the form of affects, so that, in the author's opinion, the economic viewpoint should be abandoned in favour of an affective one. In the context of the endeavour to obtain pleasure and avoid unpleasure adduced by Freud, this viewpoint focuses on the relationships between affects and the different elements of the representational world, thereby serving as the subject of metapsychological investigation.     

To Know Another Inside and Out: Linking Psychic and Somatic Experience in Eating Disorders

ABSTRACT

This article explores the role of the body in the psychoanalytic treatment of eating disorders from a relational and developmental perspective. Many who struggle with eating disorders and related issues have had early experiences that adversely affected the development of flexible, adaptive self-regulation, including the ability to experience affects as psychic states that can be safely shared in the context of a relationship. Because of their difficulty symbolizing and expressing feelings, patients with eating disorders often experience affects as somatic problems, for which they seek somatic solutions. Tuning in to patients’ bodily experience can open up pathways for accessing and, eventually, verbalizing and reflecting on internal states in the therapeutic relationship. As shown through a detailed case illustration, the therapist can discover and engage aspects of the intersubjective matrix that may not meet the eye by attending to his or her own bodily experiences and associations in and out of sessions.     

Oedipus complex and development of self

The emergence of oedipal object relations is a crucial stage in the development toward individuated adult mentation, distinguished from early stages of psychic life which are transindividual (as in Kohut's "selfobject transference"). The latter continue to function as deep layers of individual psychic life; but the development of oedipal/postoedipal object relations, and advanced psychic structure and functioning based on it, represents a norm in psychoanalytic psychology and therapy. The poet John Keats's ideas about the formation of the individual "soul" (identity as an individual) by the intervention of "circumstances" are cited to illustrate this aspect of the oedipus complex.     

On receiving what has gone astray, on finding what has got lost

Disturbing emotions that act as bodily cryptograms waiting to be deciphered are currently understood as intra-psychic trauma. The author briefly discusses Fordham's concepts of deintegration and primitive identity, as well as early patterns of mother-infant attunement to describe how the empathic capacity of the analyst is dramatically challenged in helping patients to give birth to unbearable emotions that remain an undifferentiated entity. Referring to Ogden's understanding of the mechanism of projective identification, the author will explore how unconscious mental processes in the analyst and the patient can work at re-activating failures in the deintegrative process. Clinical material is presented to show how unconscious psychic events that affect the patient but cannot be known consciously can be born into mind by the analytic couple.     

Tacit assumptions,countertransference and psychoanalytic technique. Part two: The influence of countertransference on theory and technique

In this article, the author examines bodily symptoms attributed to psychic mediating factors in the light of a psychoanalytic model of affect and sym- bolization. He uses clinical material from a consultation-liaison setting and a psychoanalytic treatment to illustrate how the model might help to understand different bodily symptoms as manifestations of different degrees of failure in the psychic elaboration of affect. On a more personal note, this could be seen as an attempt to understand, using a newly acquired conceptual tool, what went on in his 20 years of experience in the general hospital psychiatry setting.     

抑郁性神经症患者精神创伤的临床调查与分析

通过调查与分析。希望进一步了解导致抑郁性神经症的精神创伤的性质和易感人群的年龄、教育程度和性别等方面的特点。为此类疾病的病因分析及其防治提供客观的依据。结果表明：1．不同的年龄、教育程度和性别均有各自敏感的生活事件,部分生活事件在任何年龄阶段、教育程度、性别的人群中都可构成精神创伤;2．家庭矛盾、个人发展、疾病、失去亲人等生活事件容易构成精神创伤,其中家庭矛盾尤为突出;3．不可控的生活事件是构成抑郁性神经症近、远期精神创伤的重要基础。可见,抑郁性神经症的发病与精神创伤关系密切;不同教育程度、年龄、性别对生活事件的体验及其导致精神创伤的程度不同。     

More of myself: Manipulating interoceptive awareness by heightened attention to bodily and narrative aspects of the self

Psychology distinguishes between a bodily and a narrative self. Within neuroscience, models of the bodily self are based on exteroceptive sensorimotor processes or on the integration of interoceptive sensations. Recent research has revealed interactions between interoceptive and exteroceptive processing of self-related information, for example that mirror self-observation can improve interoceptive awareness. Using heartbeat perception, we measured the effect on interoceptive awareness of two experimental manipulations, designed to heighten attention to bodily and narrative aspects of the self. Participants gazed at a photograph of their own face or at self-relevant words. In both experimental conditions interoceptive awareness was significantly increased, compared to baseline. Results show that attention to narrative aspects of self, previously regarded as relying on higher-order processes, has an effect similar to self-face stimuli in improving interoceptive awareness. Our findings extend the previously observed interaction between the bodily self and interoception to more abstract amodal representations of the self.     

THE PSYCHOANALYST OF THE FUTURE: WISE ENOUGH TO DARE TO BE MAD AT TIMES3

What sort of patients do we have in psychoanalysis now, at the beginning of the third millennium, and what sort will we have in the future? In the author's clinical experience, the patients who are currently seeking help from the psychoanalyst use primitive defence mechanisms alongside neurotic ones. Most of them do not explicitly request psychoanalytic treatment, but this does not mean that they would not want it if they knew what it was. She argues that is the psychoanalyst's task to identify the latent request behind the ‘non‐request’. To conduct a psychoanalysis with such patients, the psychoanalyst has to identify and interpret both primitive and neurotic psychic mechanisms; moreover, he has to use not only language that speaks to patients but also language that ‘touches’ them, because these patients are difficult to reach through verbal symbolism. This implies that the psychoanalyst must be attentive to the bodily manifestations and bodily phantasies accompanying his countertransference feelings. The author shows through clinical examples what she means by ‘language that can touch patients’. The psychoanalyst gradually builds up this language while, at the same time, daring to discover in himself his own mad aspects and giving himself enough psychical freedom to accept them.     

PERSONS AND RELICS

We describe a number of puzzling phenomena and use them as evidence for a hypothesis about why bodily continuity matters for personal identity. The phenomena all belong to a particular kind of symbolisation: each of them illustrates how an entity (object or person) sometimes acquires symbolic significance in virtue of a material link with the symbolised entity. Relics are the most obvious example of what happens here: they are cherished, desired or respected, not because of their intrinsic features, but because of their material link with some significant individual person. Crucial for the hypothesis we wish to defend, is the fact that a human being can in some cases and for some others function as a relic of what she used to be; in these cases a human individual has a specific significance in virtue of a material link (bodily continuity) with her own past. We argue that this phenomenon can be extended and that the importance of bodily continuity for personal identity is constituted by the kind of symbolisation upon which the existence of relics is based. 1     

Identit?t, Identit?tsdiffusion, Identit?tsst?rung

Identity takes place in the transitional space between the individual and society. It means that the individual has the feeling to be a unique being with past and future, to be different from others but also to be similar to them in many aspects and share a great deal with them. This sense of coherence and continuity in the context of social relatedness shapes life. A differentiation is made between primary identity, personal identity and current identity. The development is essentially determined by preverbal interpersonal processes. If the balance which sustains the feeling of identity becomes lost then disturbances of the identity occur, which compromise the sense of identity especially in social contexts. An identity diffusion arises. Depending on the fixation, a differentiation is made between phase-specific identity crisis, developmental disorder and reactive identity disturbance.     

Psychoanalysis: the transformation of the subject by the spoken word

Psychoanalysis recruits the power of the spoken word to modify the subject's relationship with his or her own unconscious psychic processes. It helps the analysand to reclaim for his or her words the psychic integrity that was lost or never achieved due to the power of defensive dissociation and repression. The psychoanalytic dialogue and the working through mediated by it lead to the elaboration of self-narratives and interpretive understandings, which contribute to the transformation of the subject's self-experience. Such transformation is conditioned by earlier integration of experiences of satisfaction in the context of bodily dialogues and speech with primary objects.     

Dis-Identity: New Forms of Identity and Psychopathology—Socioanthropological Changes and Self-Development

The passage from modernity to postmodernity deeply upset the group dimension, and, consequently, personal identity itself. Transformations involving the entire planet, socioanthropological changes our society had to cope with, are producing a change in the dynamics of identity formation and the appearance of new psychopathological figures. The loss of cohesion of the sense of belonging and the weak internalization process of the elements that form the individual identity (cultural, linguistic, religious traditions, etc.) draw an essentially uncertain and temporary existence. Drawing on some themes of subjectual group analysis theory of personality, the article proposes the concept of dis-identity as key to read ongoing psychic changes.     

Dreaming as a primordial state of the mind: The clinical relevance of structural faults in the body ego as revealed in dreaming1

Thetherapeuticactionofpsychoanalysis, attributedformanyyearstotheinterpretation of the repressed libido, has shifted its focus to object relationships. Some modern analysts maintain that the primary factor of psychic change is the new model of object relationship provided by analysis, and do not consider signifi cant the knowledge of episodes comprising implicit memories, whose irrecoverable nature is demonstrated by neuroscience. Nevertheless, the author proposes that the knowledge of specifi c archaic events, useless as their interpretation may be, offers a glimpse of the make‐up of the mind, contributing to the improvement of the empathy indispensable for inducing changes in the patient. Episodes linked to absolute narcissism, in the beginnings of the body ego, which do not appear either in associations or in transference, emerge in dreams. Neuroscience has made possible the understanding of aspects of dreaming capable of providing a glimpse of the genesis of the ego, whose development from the bodily phase of absolute narcissism to the psychic object phase can thus be traced. The unearthing of the genesis of primary structural faults in dreaming furnishes the analyst with an estimate of the possibilities for development of the ego, and this knowledge provides fi ne tuning capable of guiding the analyst's conduct. A clinical case illustrates how these phenomena occur, showing the intersubjective relationship as the silent primary generator of psychic changes, consolidated and developed secondarily by means of the analytical dialogue.     

Structural differentiation of psychological performances in epilepsy patients

Investigating the specific of psychic performance disorders in epileptics structural aspects in addition to quantitative performance differences are considerable. We compared psychometrically obtained performance structures of epileptic children and adults and of parallelised healthy control persons. It became evident, that the performance differentiation hypothesis is to corroborate also in epileptic patients. The psychic performance structure of epileptics is characterized by a lower differentiation level of the basis functions underlining the performances. Our factor analytic investigations emphasize the importance of deceleration of psychic/psychomotoric speed in epileptics as primary basic disorder.     

Emptiness as defense in severe regressive states

This paper examines the empty states experienced by severely ill borderline patients. At times of stressful regression, these patients use complaints of emptiness to describe profound disturbances of affect, cognition, object relations, and bodily experience. Empty states may be seen as complex defensive configurations which protect a borderline level of psychic structure from the impact of aggressively charged object relations, and ward off further regression to states of fragmentation or fusion. Severely ill borderline patients consolidate an empty screen by means of a characteristic repertoire of primitive defenses consisting of various forms of projective identification, including bitriangulation and projective identification of psychic agencies, somatization, acting out, and specific alterations in cognition. The author describes the highly deviant organizations of the object world seen in empty states, and the complex and disturbing countertransferences which these states evoke.     

PARADOXES EN MIROIR ET SIGNES

The authors inquire to which degree the different levels of the bodily, psychological, and cultural alienation of mental patients reflect a psychologically and/or socially primary regression. By drawing on Arabo-islamic science and philosophy, and their own clinical practice, as well as by integrating various psychoanalytic and psychiatric theories, and psycho-physiological research, the authors develop a socio-analytic theory and methodology. By applying their approach on a psychological, intra-, inter-, and meta-cultural level the authors try to explain the psychic and socio-cultural mechanisms and paradoxes which nowadays turn many individuals into strangers to their own culture, their own body and into strangers to their own filiation and its bodily mark.