Uses of guilt in the treatment of dehumanization

It is likely that under the impact of impending Nazism, aggression theory in late Freud, as presented in Civilization and its Discontents (1930), left the entirety of guilt to self‐punishment, thus retracting his view that love functions in the superego as remorse and restitution. This change however, essentially withdraws provision for treating victims of abuse, violence and terror. This paper proposes a paradigm shift that reframes Freud's late instinct theory into a theory of dehumanization by recovering reparative and relational components of guilt. This reframe has major implications for the position taken with regard to the role of witnessing and the moral imperative in recovery from dehumanizing experience, which orthodox psychoanalytic theory has essentially bypassed. It is propose that victim treatment, as case examples illustrate, reformulates guilt as drawing on the life instincts to revivify victims’ humanity through analytic witnessing and acknowledgment. Indeed, unless breaches of humanity are confronted by a witness, the life instincts stay merely rhetorical, if not contradictory, by leaving the death instincts to grow unseen and, thus, unopposed. A two‐fold formulation of guilt may better address and redress disorders of dehumanization, whereby ‘death guilt’ (under the sway of aggression) signifies the orthodox, irrevocable guilt of self‐reproach for the bad we may have done, and ‘life guilt’ (under the sway of a moral imperative) the redeemable guilt for the good we have still to do.     

The little obsessional alchemist

Using the psychoanalytic experience with an obsessional child, this paper looks at the moment of insight, that precipitation of coherence which occurs when we say that we suddenly realize something. This is contrasted with the approach of consciously trying to fit theory to the observed facts. Analogies with alchemy are drawn. In addition, the balancing process occurring in obsessional mentality is compared with strangulation by hanging, the opposing forces being comprised of prematurely solidified states of mind such as mania or paranoia which interfere with that fluid state of mind optimal for the precipitation of insight.     

History of a Childhood Neurosis and Its Relation to the Adult Superego

The purpose of this paper is to find meaning for the “presence of conscience” observable in the psychoanalytic setting and corresponding evidence for the origins of such ways of thinking, feeling, and remembering. I apply this perspective to the case study of a man who presented as constricted, inhibited, anxious, and self-critical. He was outwardly successful but internally tormented with what can best be described as an obsessional neurosis. His initial symptomatic neurosis was supplanted by a transference neurosis reflecting a childhood obsessional neurosis. In my theory of mind during this analysis, I often saw the original ideas of Freud at work—unconscious sense of guilt, ego ideal, and conscience. The analysand represented over and over the dynamics of the Oedipus stage of development. I made additional observations about character formation and guilt. The analysand terminated his work with me symptom-free. From this case study, I learned that the presence of conscience (guilt and self-denigration), or of superego structure and function in classical terms, is best approached as to origin by following the development of self in reference to the other.     

The relationship among guilt, dysphoria, anxiety and obsessions in a normal population

Seventy-six college students reported intrusive thoughts and impulses on a checklist. These students also completed questionnaires assessing depression, trait anxiety and perceived guilt. Results indicated for this normal population that intrusive thoughts were more distressful, more difficult to dismiss and occur with a greater variety of content compared to intrusive impulses. Multiple regression analysis showed that guilt was the best predictor of intrusive thoughts and impulses. Self-reported depression and anxiety were not strong predictors with respect to nonclinical obsessions and impulses. Discussion focuses on the utility of assessing guilt with obsessional disorders, the lack of a relationship between self-report trait anxiety and nonclinical obsessions, and the need to examine the relationship between guilt and anxiety with clinically obsessional subjects.     

Prozedurale Faktoren in der psychoanalytischen Behandlung

The traditional concept of acting out was redefined in the context of intersubjective approaches as enactment. When a resistance was previously recognized in the analysis of classical neuroses that had to be resolved for a promising analysis, in enactment the creative preverbal expressions of covert procedural experiences can now be recognized, which become revealed in regressive states and in structural disorders. They create scenes of preverbal communication in which the analyst becomes involved in the inner world of experiences. This has a strong reparative potential. It can be utilized for new experiences and development if the analyst becomes entangled in such scenes as a co-actor, accepts the relationship offer of the patient and contributes to solutions for the entanglement; however, this requires something more comprehensive than the traditional defensive concept of transference. It emphasizes in particular the activity of the analyst and its impact on the formation of the analytical process and recognizes the involvement of the analyst as a constitutive factor in the process of his own transference. Thus, a new definition of abstinence in terms of a selective abstinence is achieved, which is nowadays characteristic of the developmental approach in psychoanalytic treatment.     

Some hazards to neutrality in the psychoanalysis of candidates

The author looks at the challenges confronting psychoanalysts as they attempt to approach a desirable goal of neutrality in the treatment of psychoanalytic candidates and others who will become or are professional colleagues. Many such hazards are embedded in the interlocking relationships that inevitably exist between the analytic institute and its personnel, its training analysts, and its candidate-analysands. The author considers difficulties in the crucial analysis of aggression in training analyses. The analysis of aggression plays a determinative role in the personal and professional lives of analysands, and vitally affects the health and creativity of analytic institutions and the future of psychoanalysis.     

What happens before and after acute enactments? An exercise in clinical validation and the broadening of hypotheses

This paper seeks to validate clinical facts and theoretical hypotheses that have been discussed before and that address configurations involving chronic and acute enactments. Its validation process compares clinical material from psychoanalytic work in different psychoanalytic cultures - work from South America-Uruguay (Yardino), Europe-Spain (Sapisochin), South Africa (Ivey), Europe-UK (Bateman). It documents clinical facts described in four articles and confirms that during chronic enactments the analytic dyad gets caught up in a dual relationship that veils and congeals the triangular situation because acknowledging it would be traumatic. The lack of triangular space impedes the formation of symbols as well as dreaming and creates non-dreams-for-two. During chronic enactments analysts use their implicit alpha-function to assemble traumatic areas. These areas emerge as a mix of discharges and non-dreams that are dreamed through acute enactments. Acute enactments occur when chronic enactments dissolve and patients experience an abrupt contact with reality. The attenuated trauma is then dreamed alive. The linking of new symbols develops a network of symbolic thought and creates dreams-for-two and broadens the patient's mental universe. The validation process has deepened our vision concerning clinical facts, especially in relation to: (1) the wavering between acute and chronic enactments, (2) analysts' inhibitions and feelings of guilt, and (3) the influence of analysts' personalities on the configurations they describe. These theoretical hypotheses have been confirmed and broadened not only in relation to the vicissitudes of dream work in traumatic areas, but also in relation to defenses such as thin or thick skin, and in relation to listening in countertransferential detours.     

Destruction and guilt: Splitting and reintegration in the analysis of a traumatised patient

The author traces in detail how, in the analytic relationship, she was slowly able to read aspects of the trauma as 'quotations' and gradually, through transference, transform them into a symbolic language. Split-off aggression and guilt feelings became progressively accessible to interpretation through transferential projective identifi cations. During his analysis, the patient discovered he was the child of Nazi criminals: on his mother's side they were the third generation; on his father's side, the second.     

The construction, reconstruction, and deconstruction of memory in the light of social cognition.

Psychic trauma results when the ego is overwhelmed by intolerable affect. Some childhood experiences are directly traumatic, requiring no intervening interpretive process to render them traumatic. Troublesome affect that falls short of being truly traumatic, in the strict sense of the term, may nevertheless exert a psychopathogenic effect on the child's psychic development. Whether a child is troubled by an experience depends on what that experience meant to the child. Accordingly, the psychopathogenic effects of childhood experience are a function of the child's general level of cognitive sophistication and specific ability to appreciate the subtle nuances of social interactions. If a child's cognitive capabilities are not up to the task of providing the necessary explanations for a given social interaction, the child is left to fall back on fantasy to fill in the gaps. The field of "social cognition" proves particularly helpful in understanding what a child is capable of gleaning from an experience. Research in this area helps psychoanalysts understand how experience becomes constructed and reconstructed in the form of memories. Social cognition also helps psychoanalysts understand when and how a lived experience ends up being psychopathogenic or, alternatively, ceases any longer to exert an ongoing psychopathogenic effect on an individual's psyche. A review of social cognition research leads to a reconsideration of such psychoanalytic concepts as repression, dissociation, reconstruction, and resistance. It also directs attention to the concept of developmental (as opposed to psychoanalytic) reconstruction and deconstruction.     

Confronting Bluebeard: totalitarian regimes in childhood and in the collective psyche

Beginning with the story of Bluebeard, the author considers how traumatic overwhelm can occur in everyday childhood situations of a psychically murderous quality; for example, a nanny’s totalitarian regime may be invisible to parents ruled by collective social and cultural norms. A child who is remote from mother and idealises a father embodying a powerful patriarchal system may remain naïvely dependent in marriage and unable to cope with the realities of human aggression. The paper describes analytic work with a woman who had suffered repeated breakdowns and needed to relinquish a fragile, socially constructed identity in order to establish her own true orientation.     

Post-traumatic accelerated cohesion: Its recognition and management in group treatment of Vietnam veterans

Post-traumatic accelerated cohesion (p-TAC) is the name given to a frequently observed group phenomenon in the treatment of Vietnam veterans who suffer traumatic war neuroses. It is critical that this group dynamic be discussed, especially since group is widely regarded as the modality of choice in treating these veterans. Post-traumatic accelerated cohesion is the rapid, premature development of cohesion in a group of virtual strangers, and is here presented in terms of its harmful impact on the group and the impasses it creates. Suggestions are given to resolve p-TAC and move the group toward fulfilling its goals. Placed within the self psychology and object relations theoretical frameworks, the discussion addresses issues pertaining to developmental arrests and post-traumatic self disorders and their relationship to p-TAC dynamics.The views in this paper are the author's sole responsibility and do not necessarily reflect those of the Veterans Administration.     

A confusion of tongues or whose reality is it?

In a 1933 paper Ferenczi implied that conflict between the adult's and the child's construction of reality is traumatic for the child. As all individuals construct their own view of reality, it is inevitable that there will be conflicting constructions between child and adult--and between analyst and analysand. This may be biologically rooted; recent ethological studies suggest that parent-child conflict is ubiquitous because of a divergence of needs. When a child perceives a marked divergence between his or her construction of reality and that of the caretaker, the child may tend to reject the information proffered by the caretaker. This may appear later as a resistance to learning from the analyst. The divergence of needs between child and caretaker may have a profound influence on the child's cognitive development. The capacity to share other constructions of reality is a developmental achievement which may be facilitated by the psychoanalytic process.     

Mind the baby: The role of the nanny in infant observation

The influence of nannies and other significant caregivers on a child's psychological and emotional development may be profound and if unrecognized may contribute to psychopathology in adulthood. However, the significance of the nanny has been relatively neglected within the psychoanalytic literature. In this paper I will discuss the impact of early caregivers other than the biological mother on the psychic development of the child, and the role of the nanny within the family dynamics as a figure attracting powerful unconscious phantasies and unwanted projections. These ideas will be illustrated by a detailed account of a year‐long observation of an infant who had a succession of several different nannies in her first three months before her parents employed a more permanent nanny. It is proposed that the baby's emerging attachments to her two primary caregivers, mother and nanny, developed in parallel and influenced each other, with observable impact on her behaviour and developing personality. The paper concludes with a review of the place of infant observation within psychoanalytic training and how the experience of witnessing the earliest infant‐caregiver relationships in an extra‐analytic setting both refines understanding of developmental theory and builds a foundation for psychoanalytic practice.     

Helping patients by analyzing self-criticism

This paper is addressed to patients' need for help with punitive self-critical attitudes. Such help has not always been sufficiently provided by psychoanalysts, owing to an unrecognized failure of neutrality. Historically, a gradual overemphasis on the concept of an unconscious sense of guilt has acted as a barrier to the appreciation of shame. An alternative concept, punitive unconscious self-criticism, which stands in contrast to constructive self-criticism and is common to the painful affects of guilt, shame, humiliation, and depression, can facilitate helpful analytic treatment. Heinz Kohut's contributions are examined. His analytic stance is differentiated from his theories of development. In the former, characterized by an affirmative attitude, he takes a position of functional neutrality toward shame and pays consistent though unstated attention to the effects of punitive unconscious self-criticism. The affirmative attitude can be employed without adoption of Kohut's self psychology, i.e., without abandoning the basic psychoanalytic approach to mental conflict and development. The concept of punitive unconscious self-criticism and the concept of divergent conflict, provide sufficient explanatory power. Clinical examples are used to illustrate these ideas.     

Guilt about being born and debt concerning the gift of life

A very powerful form of preoedipal guilt stems from a sense of having damaged the life-giving parent with one's most basic needs. A related phenomenon is the child's sense that another subjectivity has deliberately chosen to give and sustain the child's life. This experience gives rise to a compelling mixture of awe, reverence, and obligation, a sense of guilt about being born, of debt concerning the gift of life. This sense of guilt and debt are part of every child's development. Depending on how conflicts surrounding them are negotiated, the child can come to feel either an appetite for living or a crushing sense of selfishness and unworthiness. Such forms of guilt and debt may lead not only to masochism generally, but to a particularly pernicious form of negative therapeutic reaction that can sabotage psychoanalytic work. A patient may feel, for instance, that a successful psychoanalysis is a selfish indulgence and an immoral betrayal of a sacred duty to rescue his or her parents from their misery. Guilt about being born and the sense of debt concerning the gift of life are linked to various developmental, psychodynamic, interpersonal, and cultural phenomena.     

Actual neurosis as the underlying psychic structure of panic disorder, somatization, and somatoform disorder: an integration of Freudian and attachment perspectives

Starting from a contemporary critique of the DSM-IV, this paper argues that the diagnostic categories of panic disorder somatization, and undifferentiated somatoform disorders can be understood as belonging to a common type of psychopathology--i.e., the Freudian actual neuroses. In addition to their strong clinical similarity, these disorders share an etiological similarity; and the authors propose a combination of Freud's focus on this type of patient's inability to represent an endogenous drive arousal with the post-Freudian focus on separation anxiety. An etiological hypothesis is put forward based on contemporary psychoanalytic attachment theory, highlighting mentalization. Concrete implications for a psychoanalytically based treatment are proposed.     

Narcissism, hypochondria and the problem of alternative theories

This paper is an experiment in conceptual integration and clinical theory testing. Its argument is that narcissism and sexual object love develop from a single source and continue to interact during childhood development and adult life (Freud) and that drives in their oedipal and other formations are not merely disintegration products of narcissism (Kohut). Material from two analyses, supplemented by material from two others, indicate that narcissistic injury was a significant factor in the neuroses of these patients but that aggressive and libidinal conflicts were also decisive such that their hypochondriac symptoms were compositions of their interacting causality. As a result these neuroses are negative instances of Kohut's theory of narcissism. The hypochondriac symptoms as they emerged could not have had the structure and dynamics they actually had nor could the analytic process these patients underwent have achieved the far-reaching and durable amelioration of these symptoms that occurred. On the positive side, these analyses are but two inductive instances that support Freud's theory. However, one major difficulty of the faddishness of psychoanalytic theorizing is that much of worth is lost from general theories that turn out not to be supportable. The clinical material from these two cases which disprove basic elements of self-psychology metapsychology also require adjustments to classical theory that integrate the contributions of self-psychology to psychoanalytic clinical theory.     

The adult-child relationship in breastfeeding and development: a Merleau-Pontian perspective on the existential and social conflicts in childrearing

This paper discusses Merleau-Ponty’s use of idea of ambivalence and its role in psychological conflicts. Merleau-Ponty affirms ambivalent conflicts as lived and social rather than biologically determined, as one might have in some developmental accounts, or hidden, as in some psychoanalytic accounts. With this concept, the paper takes up feminist considerations of the conflicts experienced by mothers in breastfeeding. It argues that the Merleau-Pontian and feminist approach to considering breastfeeding provides a nuanced model for thinking about development that is better suited to cases where both the child and the parent are co-evolving.     

Lines of advance in psychoanalytic psychotherapy

Freud's 1919 paper is taken as a starting-point to review how far we have advanced towards fulfilment of his prophetic remarks about the need to develop psychoanalytic psychotherapy for the masses. A glance is taken back to some of the circumstances and characters involved in Budapest where the paper was given at the 1918 congress, where there was much talk about the need to do something about the war neuroses. Similar pressures led to the founding of the Tavistock Clinic and Cassel Hospital in the UK, long before the start of the NHS. The pressures of both world wars advanced the applications of psychoanalysis; the next wave of pressures may come from NHS changes and entry into Europe. The history of psychoanalytic psychotherapy in the UK is also considered via looking briefly at the history and development of psychoanalytic publications, of the Tavistock Clinic, of psychoanalytic training, of child psychotherapy and the emergence of adult (non-medical) psychotherapy. There have always been tensions between exponents of the pure gold of analysis and the needs of its wider applications. More flexible arrangements and boundaries are necessary if we are to spread psychoanalysis beyond London and to fulfil Freud's own hopes about the large-scale application of psychoanalytic therapy.     

Social neuroscience of child and adolescent depression

The social neuroscience of child and adolescent depression is inherently multidisciplinary. Depressive disorders beginning early in life can have serious developmental and functional consequences. Psychopathology research has described depression's defining clinical and contextual features, and intervention research has characterized its response to treatment and prevention programs. Neuroendocrine, electrophysiological, and neuroimaging studies have identified core neurobiological aspects of early-onset mood disorders. These areas are reviewed using a developmental social neuroscience perspective for integrating disparate observations. The paper introduces a dynamic adaptive systems framework, and it discusses hedonic capacity, stress sensitivity, ruminative self-focus, and attentional impairments as fundamental components of mood disorders.