Witnessing and Passing. Discussion of Prince's “The Self in Pain: The Paradox of Memory. The Paradox of Testimony”

The author indicates that she has two voices. One voice speaks to the patient's loneliness and detachment and her expectation to not be seen, believed, or acknowledged. This voice, housing the knowledge that events that remain unprocessed continue to have an impact, wants Dr. Prince to risk intrusion and preemption. This voice believes that it is worth it. The author's other voice considers bottomless wounds and speaks to the patient's need to build up healthy aspects of personality that is necessary to do the holocaust work. This voice holds that this is not the time for Dr. Prince to witness what happened to the patient, what the perpetrators of massive crimes did to her or what the onlookers saw and chose not to do. This voice says that the patients lead should be followed. The author elaborates on her two voices and indicates what she would have done had she been working with the patient.     

Idiodynamics in re Personality Theory and Psychoarchaeology

Idiodynamics is the science of the idioverse. The idioverse consists of the population of events experienced by a single unique individual. This conception supersedes that of personality because the idioverse purports to be a more direct and objective formulation. The idioverse is understood, in large measure, by markers that are peculiar to the individual and are discovered through a study of the totality of the individual's expressed experience. Three types of norms afford these data for observation: the nomothetic, the demographic, and the idiodynamic. All are essential for an understanding of how the individual participates in the experience of the self and of others. A biogenic medium and a sociogenic medium overlap in the formulation of the idioverse, and these media overlap and converge to constitute a matrix that provides idiodynamic norms. Comprehension of the idioverse reveals the individual as a self-creative and dynamic process. Idiodynamics should be distinguished from the earlier idiographic approach to individuality. Psychoarchaeology is the reconstruction of biographical identities and/or sources. This methodology is well illustrated in Morton Prince's classic case of dissociation (Sally Beauchamp).     

Multiple personality and hypnosis: the first one hundred years

The Enlightenment brought with it a greater scientific interest in and attention to a wider range of human behavior. In 1789, there emerged during the French Revolution a case of what would be today called multiple personality disorder which came under the care of a local physician, Dr. Eberhard Gmelin. Gmelin had only recently become interested in mesmerism and tried this procedure with this patient. So started an ongoing and gradually increasing exploration of the role of hypnosis in multiple personalities. This paper contributes to the historical background of such psychodynamic concepts as dissociation, splitting, repression, consciousness, subconscious, and unconscious.     

Who was Morton Prince?

Morton Prince, a Boston neurologist, founded the Journal of Abnormal Psychology in 1906 as an outlet especially for those who took a psychogenic view of neurotic disorders. Through experiments with hypnotism, he added appreciably to knowledge of subconscious and coconscious mental processes; The Dissociation of a Personality (Prince, 1905) still ranks as a classic. He early saw that studying normal people in the depth and detail with which one studied patients could make significant contributions to our whole understanding of human nature. Before his death he established and briefly directed the Harvard Psychological Clinic, devising the research environment out of which presently sprang major contributions to the study of personality.     

“I Fired My Last Doctor for Not Taking Me Seriously”: Collaborating With a Difficult Medical Patient in a Multidisciplinary Primary Care Facility

We present the case of a multidisciplinary primary care assessment of a 32-year-old woman with multiple medical and psychological complaints. Following the collaborative care model, this assessment was conducted by a team consisting of a clinical health psychologist, Dr. J. L. Skillings, and a family physician, Dr. W. J. Murdoch. We describe the primary care environment in which this referral was made including the methods that were utilized to insure a successful professional collaboration. We report the results and recommendations from a comprehensive biopsychosocial assessment; we place emphasis on the psychological diagnosis and pain symptoms. We also describe the feedback session in which the assessment results were provided to the patient and her spouse by both physician and psychologist. Multiperspective commentary about the assessment is offered by the patient and her husband as well as the physician and psychologist assessors.     

Toni Wolff-James Kirsch correspondence

This paper draws on the letters between Toni Wolff and James Kirsch from 1929-1933 and from 1949-1953 to highlight some aspects of Toni Wolff's relationship with her superviser and former analysand, James Kirsch. Her personality, her approach to her work as analyst, and her relationship with Jung and with colleagues are illustrated with selected quotes from the correspondence.     

"I fired my last doctor for not taking me seriously": collaborating with a difficult medical patient in a multidisciplinary primary care facility

We present the case of a multidisciplinary primary care assessment of a 32-year-old woman with multiple medical and psychological complaints. Following the collaborative care model, this assessment was conducted by a team consisting of a clinical health psychologist, Dr. J. L. Skillings, and a family physician, Dr. W. J. Murdoch. We describe the primary care environment in which this referral was made including the methods that were utilized to insure a successful professional collaboration. We report the results and recommendations from a comprehensive biopsychosocial assessment; we place emphasis on the psychological diagnosis and pain symptoms. We also describe the feedback session in which the assessment results were provided to the patient and her spouse by both physician and psychologist. Multiperspective commentary about the assessment is offered by the patient and her husband as well as the physician and psychologist assessors.     

一例中学生转学适应问题咨询案例报告

本文对一中学生由于转学导致的心理问题的案例进行了详细报告,来访者的主要问题为生活事件引起的心理压力导致焦虑等情绪产生。在该案例的咨询过程中,主要通过排解负性情绪、纠正认知偏差等过程让来访者的心理问题得到解决,同时,通过咨询使来访者的个性得到完善和发展。     

BOOK REVIEWS

Book reviews in this article:
C linical P sychology . By C. M. Louttit.
C linical and E xperimental S tudies in P ersonality . By Morton Prince.
A S ource B ook of G estalt P sychology. By W. D. Ellis.
A B iological A pproach to T he P roblems of A bnormal B ehavior. By Milton Harrington.
R ecent E xperiments in P sychology. By Leland W. Crafts, Theodore C. Schneirla, Elsa E. Robinson, and Ralph W. Gilbert.
S cientists A re H uman . (No. 6, Library of Science and Culture .) By Dr. David Lindsay Watson.     

Incomplete mourning,betrayal, and revenge in The Prince of Tides: Erotic countertransference in the cinema

The Prince of Tidesis the characterological study of and interaction between two families, that of Savannah, the patient and Dr. Susan Lowenstein, the psychiatrist. In order to treat Savannah, recovering from a suicide attempt, fraternal twin Tom (Savannah's memory) comes to New York to assist in his sister's treatment. Tom becomes the patient relating the family dynamics in six cinematic flashbacks. These show the parental disharmony, Tom's strong Oedipal attachment, maternal betrayal and Tom's wish for revenge, his incomplete mourning for his older brother Luke, and its effects on his life. The relationship between Susan, her husband and son, Bernard, and how each interacts with Tom is also described. Susan's erotic countertransference is analyzed, and the role of the woman therapist in the cinema discussed.     

Case presentation: Jean

This symposium was devoted to the consideration of Dr. Mary Libbey's treatment of a 22-year-old woman. The unfolding of the analysand's symbiotic attachment to her mother, the devastating sequelae of her having been the stable center of a pathological family that devoted itself to the care of a severely handicapped sibling, and her immersion in unresolved mourning form the center of this richly detailed and carefully reported case study. In addition, four verbatim sessions are reported, one from each year of the first two years of treatment, and two from the third year of treatment. Dr. Epstein's discussion, praising Dr. Libbey's therapeutic skill, makes note of the issues in the patient's family of origin that served to prepare her to feel endangered in the treatment. Dr. Epstein's view is that the analyst has created an analytic situation that, because it is minimally impinging, allows the patient to become increasingly aware of her unmet needs in a way that is tolerable and minimally "destabilizing to the symbiotically based organization of her internal self and object world." In the climate of safety created in the treatment, the patient can begin to complete the work of mourning for her sister, friend, and aunt, a process of mourning that would be impossible in the context of her nuclear family, centered as it is on a mother who cannot tolerate separation. Limit-setting in the treatment is seen to be reassuring to the patient, facilitating as it does the analyst's commitment to maintaining the integrity of the analytic situation. Dr. Schafer's discussion, while in agreement with Dr. Epstein in recognizing the excellence of the presentation and the sensitivity and hard work that had gone into both the treatment and the clinical presentation, included some specific and focused observations about the transference and countertransference situations prevailing in this treatment and also some suggestions for creating a more consistently safe analytic atmosphere for this particular patient and others like her. Dr. Schafer proposes that the therapist acknowledge to herself and accept as well as possible the inevitable feeling of helplessness such patients provoke. In a more concrete vein, he advocates talking in the first person declarative as much as possible, preferring "I don't understand" to the more standard "What do you mean?" or "Why?" The therapist is encouraged to eschew interpreting what the patient says about the therapeutic relationship for a long time, and, further, he suggests not quickly connecting or easily reducing the therapeutic relationship to childhood prototypes.(ABSTRACT TRUNCATED AT 400 WORDS)     

Male and female internal images in a case of frigidity

Abstract

This is the case of a young woman suffering from a narcissistic personality disturbance with Oedipal aspects. The development of the analytic treatment is stressed through the analysis of her dreams. The analytic setting provided an appropriate mirroring Self-object. Thereby the patient has had the opportunity to express her own defective female grandiose Self, which was at the base of her disturbances.     

‘Making Room for the Other(s)’: A consideration of psychodynamic counselling with women with Asperger’s Syndrome

This paper explores psychodynamic therapy with young women with Aspergers Syndrome through the use of a composite case study. It seeks to make sense of a female patient’s obsession with a figure from celebrity culture – ‘Tom’ from ‘Britain’s Got Talent’. The potential use of ‘Tom’ by the patient as an idealised object, an autistic object, a transitional object and a transformative object is considered. Drawing on Rosenfeld’s concept of pathological narcissism and Meltzer’s concept of ‘aesthetic reciprocity’, the paper seeks to make sense of both the defences that the patient utilises and the impact of the deficits she has experienced. Attention is given to the development of the therapy through the use of play and work in the transference. Gradually, the patient becomes more able to tolerate separateness and in doing so becomes more connected to her own internal world and the feelings of others. In so doing, she becomes more aware of her actual social marginalisation and gains a greater sense of awareness of her diagnosis.     

Anaïs Nin: A case study of personality disorder and creativity

Anaïs Nin, diarist and author of autobiographical novellas and erotica, and gregarious socialite, was known for her exotic persona and stormy personal life. The concept of personality disorder and the underlying assumption of the buffering capacity that personality affords to stressors are discussed. Against this background, evidence drawn from Nin’s diaries, short stories and two biographies suggests that she conformed to the diagnostic criteria of histrionic personality disorder (HPD), with comorbid borderline and narcissistic features, and numerous Axis I symptoms. The proposed origin of the overall dysfunctional histrionic pattern is attributed to her early developmental history, and the maladaptive cognitive mechanisms of dissociation and repression inferred from her writings and shown to conform to the HPD pattern. Finally, it is argued that while Nin may not have displayed the classic divergent cognitive style thought to underlie the association between schizotypy and creativity, her HPD psychopathology was pivotal in shaping her creative products, most famous of which is her diary.     

An integrated approach to psychotherapy techniques for patients with personality disorder

Personality disordered patients present with multiple problem areas and potential targets of change. This complex clinical situation can be addressed by an integrated approach to the treatment by using treatment strategies and techniques from the various schools of therapy, sequenced and adapted to the individual patient. An optimal choice and sequencing of treatment techniques is organized around general treatment strategies (assessment and case formulation, treatment structuring, observing the therapeutic relationship, addressing problematic personality organization, and addressing sequential goals) with the severity of the personality disturbance in mind. The biggest threat to successful integration of the treatment is the reaction of severe personality disordered patients who lack an integrated sense of self and suffer from intense, fluctuating emotions that challenge an inexperienced, reactive therapist.     

Seeking double personality: Nakamura Kokyō's work in abnormal psychology in early 20th-century Japan

This paper examines Nakamura Kokyō's study of a woman with a split personality who lived in his home as a maid from 1917 until her death in 1940. She was his indispensable muse and assistant in his efforts to promote abnormal psychology and psychotherapy. This paper first explores the central position of multiple personality in Nakamura's theory of the subconscious, which was largely based on the model of dissociation. It then examines how it became a central issue in Nakamura's disputes with religions including the element of spirit possession, which invoked Western psychical research to modernize their doctrines. While both were concerned with the subconscious and alterations in personality, Nakamura's psychological view was distinguished from those spiritual understandings by his emphasis on individual memories, particularly those that were traumatic, and hysteria. The remaining sections of the paper will examine Nakamura's views on memory and hysteria, which conflicted with both the academic mainstream and the established cultural beliefs. This conflict may partly explain the limited success of Nakamura's academic and social campaigns.     

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.     

A Career Plundered

Dr. Margaret Bean-Bayog, a Boston psychiatrist, was sued by the Lozano family after a former patient, Paul Lozano, committed suicide. The case was widely and sensationally publicized in the newspapers and other media. A combination of inaccurate reporting, inept proceedings by the Massachusetts Board of Registration in Medicine, and the threat of ruinous legal fees led Dr. Bean-Bayog to surrender her license to practice medicine. Facts that were not reported in the press were described in Dr. Maltsberger's address, delivered on April 15, 1992, at the annual AAS meeting in San Francisco. The implications for therapists attempting to treat seriously suicidal patients in the current hostile forensic climate were further discussed. The text of the address is presented here.