Food and violence: Childhood violence and emotional abuse as complicating factors in the inpatient treatment of eating disorders

SUMMARY

This paper considers the treatment, on an inpatient eating disorders ward, of patients who have suffered violence and emotional abuse during childhood. The complex web of relationships surrounding these patients is discussed, and it is suggested that there are multiple transferences — to the institution, to various members of staff, and to other patients — and that splitting of these transferences is inevitable. Staff experience powerful countertransference feelings, related to the patient's violent history. A central task for the staff team as a whole is to understand and contain the patient's disturbance — taking on, tolerating, and processing the projections. This demands the close working-together of the members of the multidisciplinary team, so that staff can together openly examine the patient's interaction with them and their own emotional responses to the patient and to other members of staff. If these responses are not understood by the ward staff, they can lead to conflict and inappropriate decisions. On the other hand, if the staff team together can build up a picture of the patient's relationships on the ward, and their meaning for the patient, this picture, like a particular projection of the world in an atlas, provides a ‘map’ of the patient's inner world. This ‘map’ can be used by the staff team in navigating their interactions with the patient. It can also assist the psychotherapist in her work to help the patient recognise and, eventually, own the split-off parts of herself.     

You Can Lead An Ape To A Tool But...: A Review Of Povinelli’s Folk Physics For Apes: The Chimpanzee’s Theory Of How The World Works.

We reviewed Daniel Povinelli's book, Folk physics for apes: The chimpanzee's theory of how the world works. After a summary of the book's contents, we analyzed two sets of experiments on chimpanzees' folk psychology: one that explored whether chimpanzees understand that others see (i.e., that apes have internal visual experiences) and another that examined whether chimpanzees can distinguish intended from unintended actions. The conceptual scaffolding on which these studies were conceived was sufficiently faulty that their outcomes were virtually assured a priori. We then analyzed two sets of experiments on chimpanzees' folk physics, reinforcing our view that conceptual confusion guaranteed that certain key predictions about the outcome of these studies could not be supported. A unifying reason for this conceptual confusion is that the author devalues understanding that results from programmatic conditioning. We closed the review by relating Povinelli's findings and conclusions to behavior analysis and by explaining why behavior analysts should read this book     

THE TRIPLISM OF PRACTICAL REASON

There can be reasons for belief, for action, and for feeling. In each case, knowledge of such reasons requires non‐empirical knowledge of some truths about them: these will be truths about what there is reason to believe, to feel, or to do – either outright or on condition of certain facts obtaining. Call these a priori truths about reasons, ‘norms’. Norms are a priori true propositions about reasons. It's an epistemic norm that if something's a good explanation that's a reason to believe it. It's an evaluative norm that if someone's cheated you that's a reason to be annoyed with them. There are many evaluative norms, relating to a variety of feelings. Equally, there may be various epistemic norms, even though in this case they all relate to belief. My concern here, however, is with practical norms: a priori truths about what there is reason to do. I have a suggestion about what fundamental practical norms there are, which I would like to describe and explain. It is that there are just three distinct kinds of practical norm governing what there is reason to do – three categories or generic sources of practical normativity, one may say. I call them the Bridge principle, the principle of Good, and the Demand principle – Bridge, Good and Demand for short. I have said more about them in my book, The Domain of Reasons; 1 here my aim is simply to set them out and sketch some questions to which this ‘triplism of practical reason’ 2 gives rise. In particular, since these norms are about practical reasons, not about morality, a question I'll touch on is how moral obligation comes onto the scene.     

TERMINATION OF A FE/MALE TRANSSEXUAL PATIENT'S ANALYSIS: AN EXAMPLE OF GENERAL VALIDITY

The author describes the termination of an analysis, which, while relating to the particular case of a male-to-female transsexual patient, may be relevant to all analysts, particularly those whose patients need to integrate disavowed and split-off parts of themselves. The patient had undergone sex-change surgery at the age of 20. Having lived as a woman thereafter, she had asked for analysis some twenty years later. The author, who discussed the first three years of that analysis in an earlier paper, as well as her hesitation about undertaking it, considers that its termination after seven years illustrates not only the specific problems posed by transsexuals but also the general ones presented by 'heterogeneous patients'. To the best of her knowledge, this is the first published case history of a transsexual patient who has undergone surgery. In the author's view, the patient has acquired a new sense of internal unity based on a notion of sex differentiation in which mutual respect between the sexes has replaced confusion and mutual hate, and her quality of life has improved. On the general level, this termination shows how the reduction of paranoid-schizoid anxieties and the reintegration of split-off parts of the personality lead, as the depressive position is worked through, to a better toleration of internal contradictions, a new sense of cohesion of the self and a diminution of the fear of madness.     

Temporality in Psychosis: Loss of Lived Time in an Alien World

This article presents a model of the temporal structure of psychic life. Time is a rule-guided process. A person's psychic life, too, yields to an examination of necessary and regulated operations. To outline both the regular and the modified perception of time within psychic life, Sigmund Freud's model of the drive interaction is brought to bear on Jacques Marie Émile Lacan's understanding of psychosis. Both Freud's and Lacan's findings are explained with an eye on the temporal dimension of the psyche, temporal modifications manifested in states of psychotic delusion, and the role of time for one's meaningful engagement with the world. Psychic time is nonlinear. The future, the past, and the present must be engaged simultaneously, albeit not in the same way, to yield the sense of temporal fullness. For Freud, the cooperative functioning of the drives accounts for the sustainment of the lucid psychic life, whereas modifications in the drives’ interactions signal psychic disturbances. Lacan (1955/1993) stresses the atemporal character of the nonexistent, negated, or lost reality that pressures an individual to enter a psychotic delusion. This article makes the assumption that the psychological states in which the reckoning with time is lost are the consequences of an unsuccessful incorporation of traumatic stimuli that are caused both by outside phenomena and by the actions of an individual's inner drives. The findings of this article support the view that psychic traumas necessitate modifications to the sense of time. The findings also offer an understanding of the kinds of temporal modifications that occur in an individual's psychic life and the way in which these temporal changes lead to the experience of radical otherness that is present in some cases of psychological disturbances.     

The 'black hole' in the inner universe

Summary The metaphor of the 'black hole' has been borrowed from astronomy in order to describe certain phenomena occurring in work with autistic and psychotic children. This metaphor is different from Tustin's concept of the 'black hole'. I shall attempt to describe another phenomenon: not that of the hole in the self, resulting from premature separation, but the hole in the object that the autistic or psychotic child is relating to - or, rather, turning away from. I describe an autistic boy's need to protect himself against the catastrophic experience of relating to an object with such a hole in its mind. That is a particular kind of a depressed object which emits deadness, instead of the lively, responsive affect that the child should get in communication. It is not an intrusive object, but it sucks in and drowns energy. If the experience of relating to the 'black hole' in the object happens early and in such a powerful way that the child's energy feels insufficient to defend against it in any way, then the fear of annihilation becomes so strong that it may lead to the wiping out of the whole internal universe in order to escape its deadly gravitational pull. Only when a different kind of relationship gets internalized, through therapy, with an object that contains and returns life and energy, can the mind grow enough to be able to communicate the other, darker side of the relationship from which it has closed itself away.     

The Capgras delusion: an integrated approach

Delusions are studied in two philosophical traditions: the continental or phenomenological tradition and the Anglo-American or analytic tradition. Each has its own view of delusions. Broadly stated, phenomenologists view delusions as a disturbed experience whilst most analytic researchers view them as beliefs. It is my contention that the most plausible account of delusions must ultimately incorporate valuable insights from both traditions. To illustrate the potential value of integration I provide a novel model of the Capgras delusion which describes how an analytic, cognitive neuropsychological two-factor account of the Capgras delusion and the phenomenological view of delusions might be integrated.     

Conceptualizing splitting: On the different meanings of splitting and their implications for the understanding of the person and the analytic process

While “splitting” is a familiar concept, its meaning is not as self‐evident as is commonly assumed. In different contexts, it refers to different phenomena and is supported by different understandings of psychic dynamics. In this paper, the author presents four different conceptualizations of splitting, which capture the essential aspects of contemporary psychoanalytic discourse on the concept. There is a dissociative kind of splitting, which involves splitting off, in the face of trauma, whole personalities, which to some extent remain accessible to consciousness; there is a disavowal kind of splitting that splits off our awareness of disturbing realities or their meanings in our efforts to avoid the inner restraints imposed by repression; and there are two forms of splitting of the object into good and bad—one focusing on the splitting of representations of the object due to ego weakness and environmental determinants, and the other on the splitting of the mind itself in a primarily destructive act aimed at sparing the good from the destructiveness of our death instinct. All four conceptualizations have their origins in Freud's writing and then are further developed in the work of later analysts. The author argues that understanding the nature of these various conceptualizations of splitting can contribute to analytic theory and practice. It also sheds light on the essential nature of analytic approaches and how they offer different perspectives on the unity and disunity of man's basic nature.     

Thinking about and working with depressed mothers in the early months of their infant's life

This paper illustrates how my work has developed over the years and informed my thinking about, and work with, depressed mothers. It also describes the work of the Parent Infant Foundation in Sydney where pregnant women and mothers with infants and toddlers are seen in groups and individually through home visits. The relevance of the support of a peer group when doing such difficult work is described. The paper draws on a central theme: the depressed mother, returning to her own infant beginnings through pregnancy and birth, confronts a dead mother-dead infant dyad. Trauma from the mother's own infancy is seen to have created an internal, autistic, deadened, psychic space. It is argued that behind this deadness lies the primeval pain of abandonment and loss. The associated rage, previously repressed but now awakened by her alive infant and his powerful primitive demands, invade the mother's psyche. The internal deadness freezes her alive processes as mother to her baby. Unbearable pain is awakened - and she may be in terror and unable to move, or she may experience herself as drowning in something catastrophic. SUMMARY This paper illustrates how my work has developed over the     

Learning the Church: ecclesiological thought and ecclesial practice

This article illustrates how the ecclesiological ideas developed by Professor Daniel Hardy (1930–2007) have been received and used in the life of the Church of England's Diocese of Coventry. It highlights the importance of theological engagement for those in a position of oversight and leadership in the Church, and goes on to connect Hardy's language of intensity and extensity with the story, structure and ethos of Coventry Cathedral in general, and with the iconic Stalingrad Madonna in particular, illustrating the rich synthesis that can be achieved between systematic ecclesiology and the central ethos of a church. The article goes on to argue that certain practices in the Church of England in general, and Coventry Diocese in particular, resonate well with Hardy's idea of ‘socio-poiesis’. These include the nurture of virtuous ecclesial practice and use of measurement in parish life (notably through ‘Natural Church Development)’, the new form taken by ecumenism in British cities and the role of the Bishop within it, as well as the embeddedness of the Church of England in many of the nation's schools. In relating Hardy's key themes to these concrete practices, this article challenges the stale division between Church and Academy, advocating fruitful and animating dialogue between the two as the best response to the challenges faced by each today.     

A Contemporary View of Some of Joseph Sandler's Key Concepts

Three of Sandler's seminal papers—“The Background of Safety” (1960a), “The Concept of the Representational World” (1962), and “Countertransference and Role Responsiveness” (1976)—are scrutinized and discussed to explore the evolution of his thinking over some 40 years. His early insistence on the importance of feeling states and intrapsychic mechanisms and processes, especially those relating to internal objects and internal object relationships, are emphasized as well as the interactions and complementary relationship between theoretical formulations and clinical findings, as exemplified in his research activities in the Index Department of the Anna Freud Centre in London and in his paper on countertransference and role responsiveness. Interrelationships with other concepts, both clinical and theoretical, show up in Sandler's work as well as that of other eminent authors up to the present time, and similarities in conceptualizations are highlighted. Sandler's continuous efforts to clarify psychoanalytic concepts and to integrate differing psychoanalytic conceptualizations and models are illustrated by references to and quotations from the salient papers.     

Self-Disclosure and Vulnerability

Abstract

Based on the theoretical assumption and clinical observation that projective identification is a natural, constant element in human psychology, clinical material is used to illustrate how projective identification centered transference states create situations where acting out of the patient's phantasies and conflicts by both patient and therapist is both common and unavoidable. Because they are more obvious, some forms of projective identification encountered in clinical practice are easier for the analyst to notice and interpret. Other forms are more subtle and therefore difficult to figure out. Finally, some forms, whether subtle or obvious, seem to create a stronger pull on the analyst to blindly act out.

In some psychoanalytic treatments, one form of projective identification might embody the core transference. In other cases, the patient might shift or evolve from one level of this mechanism to another. Some patients attempt to permanently discharge their projective anxiety, phantasy, or conflict into the analyst. There is a patent resistance to re-own, examine, or recognize this projection. Some of these patients are narcissistic in functioning, others are borderline, and many attempt to find refuge behind a psychic barricade or retreat (Steiner 1993). In other forms of projective identification, the patient enlists the analyst to master their internal struggles for them. This occurs through the combination of interpersonal and intra-psychic object relational dynamics. This “do my dirty work for me” approach within the transference can evoke various degrees of counter-transference enactments and transference/counter-transference acting out.

Another form of projective identification, common in the clinical setting, is when a patient wants to expand the way of relating internally, but is convinced the analyst needs to validate or coach the patient along. This is why such a patient may stimulate transference/counter-transference tests and conduct practice runs of new object relational phantasies within the therapeutic relationship. Over and over, the patient may gently engage the analyst in a test, to see if it is ok to change their core view of reality. Depending on how the analyst reacts or interprets, the patient may feel encouraged to or discouraged from continuing the new method of relating to self and object. The patient's view of the analyst's reactions is, of course, distorted by transference phantasies, so the analyst must be careful to investigate the patient's reasoning and feelings about the so-called encouragement or discouragement. This does not negate the possible counter-transference by the analyst in which he or she may indeed be seduced into becoming a discouraging or encouraging parental figure who actually voices suggestions and judgment.

All these forms of projective identification surface with patients across the diagnostic spectrum, from higher functioning depressive persons to those who are more disturbed paranoid-schizoid cases. Whether immediately obvious or more submerged in the therapeutic relationship, projective identification almost always leads to some degree of acting out on the part of the analyst. Therefore, it is critical to monitor or use the analyst's counter-transference as a map towards understanding the patient's phantasies and conflicts that push them to engage in a particular form of projective identification.     

The Meaningfulness of Helping Others: Loren Eiseley's “The Star Thrower”

Freud and Klein describe projective processes—projection, projective identification, and the repetition compulsion—that cause interpersonal distortions not only in the psychotherapy relationship but in adult intimate relationships as well. Winnicott's theory of the use of an object describes a way of relating that is free of the distortions of projection, opening up the possibility of differentiation between intimate partners. Two case examples illustrate how addressing projective processes assisted one patient in extricating herself from a psychologically abusive relationship and helped a couple in treatment to move from object relating to object use. It is argued that the use of these psychoanalytic theories has an important role within a modern relational social work practice.     

Using hypnosis to model Fregoli delusion and the impact of challenges on belief revision

Fregoli delusion involves the belief that strangers are known people in disguise. We aimed to model aspects of this delusion for the first time using hypnosis. We informed hypnotised subjects that someone would enter the room (a confederate) and they would believe this person was someone they knew in disguise. After testing their reaction to the confederate, we challenged their delusion by directly contradicting their belief and then asking them to focus on the confederate’s voice and gait. Finally, we indexed whether they could identify photographs of the confederate. We found that just over half of our high hypnotisable subjects identified the confederate as someone they knew in disguise. Although many highs abandoned their belief in response to challenges, some maintained strong, unwavering conviction that the confederate was a known person. We discuss these findings in terms of how evidence might be evaluated during both hypnotic and clinical delusions.     

What Mistakes Disclose: A Process Dissociation Approach to Automatic and Controlled Processes in Social Psychology

Process dissociation is a model for separating automatic and controlled contributions to responses in a single task. Although it was developed to separate conscious and unconscious uses of memory, researchers have increasingly found the model useful to answer questions in social psychology. This article reviews process dissociation studies with a focus on social psychology. It emphasizes the model's conceptual definitions of automatic and controlled processing and how those relate to procedures for estimating them. Process dissociation is contrasted with task dissociation, in which automatic and controlled processes are identified with implicit and explicit tasks. Current trends and future directions are identified, including the use of model testing procedures to compare competing theories of how automatic and controlled processes interact.     

Becoming and Being an Analyst in the British Psychoanalytical Society

The articles of Elizabeth Spillius and Jennifer Johns exemplify contrasting ways in which an analyst may form her psychoanalytic identity. She may recognize and accept a particular theoretical standpoint as valid, and form an analytic identity around that position. Or she may engage with a variety of viewpoints, and form an analytic identity through the interaction between these and her own internal self-experience. These approaches coexist in the British Psychoanalytical Society. There has been the potential for creative discussion between them, especially as regards their implications for analytic training. These six articles together, however, reveal how hard it has been for such discussion to take place. Spillius describes the disparity between the Society's three groups in relation to candidates' choice of supervisors, and I discuss this further. It seems to reflect an underlying difference in approach to psychoanalytic training, based on these different views of how an analyst's identity is formed. I suggest that the difficulty in debating this freely reflects a fear that opening up the issue might lead the Society to split. In 2005 the so-called Gentlemen's Agreement, which for 60 years governed group balance in the British Society, was formally abolished. In the light of this, I consider what is needed for a Society creatively to contain divergent philosophies of training.     

A Bayesian Model of Biases in Artificial Language Learning: The Case of a Word‐Order Universal

In this article, we develop a hierarchical Bayesian model of learning in a general type of artificial language‐learning experiment in which learners are exposed to a mixture of grammars representing the variation present in real learners’ input, particularly at times of language change. The modeling goal is to formalize and quantify hypothesized learning biases. The test case is an experiment ( Culbertson, Smolensky, & Legendre, 2012 ) targeting the learning of word‐order patterns in the nominal domain. The model identifies internal biases of the experimental participants, providing evidence that learners impose (possibly arbitrary) properties on the grammars they learn, potentially resulting in the cross‐linguistic regularities known as typological universals. Learners exposed to mixtures of artificial grammars tended to shift those mixtures in certain ways rather than others; the model reveals how learners’ inferences are systematically affected by specific prior biases. These biases are in line with a typological generalization—Greenberg's Universal 18—which bans a particular word‐order pattern relating nouns, adjectives, and numerals.     

Homoerotic Countertransference The Love That Dare Not Speak Its Name?

Despite the recent interest in erotic countertransference and self-disclosure, little has been written about these phenomena when both analyst and patient are the same gender. Since homoerotic feelings can surface in any treatment, regardless of the participants' sexual orientation, this may well be a phobic avoidance that restricts many treatments, as well as our profession. I propose that the analyst's awareness of homoerotic feelings in the countertransference—including struggling with ways to express them—ultimately can create an atmosphere of safety. I offer an extended case example of one man with whom I colluded to ignore frightening aspects of his sexual fantasies. It was only by using my erotic countertransference, especially at a charged and pivotal moment, that I was able to help the patient begin to integrate split-off aspects of his sexuality.