Strategic self-marginalization: the case of psychoanalysis

Marginality is an important concept in the history of science, though it is often used in a manner that presumes marginality to be a static designation. We contend that the dynamics of marginality are crucial to the history of psychoanalysis, a discipline that has moved between dominant and marginal positions. We address psychoanalytic marginality via three specific "cases": the marginalization among Freud and his followers when psychoanalysis was an emergent discipline; the marginality trope in Erich Fromm's popular psychoanalytic writing when psychoanalysis was orthodoxy in American academic psychiatry; and the rhetorical marginality of psychoanalysis in Sweden as psychoanalysis entered a decline within psychiatry. Our aim is to show that marginalization and self-marginalization serve interpersonal, social, and professional strategies.     

Psychoanalysis and the Catholic Church in Italy: the role of Father Agostino Gemelli, 1925-1953

Agostino Gemelli, a Catholic priest, psychiatrist, administrator, and educator, was an important figure in the early history of psychoanalysis in Italy. He was one of the few establishment figures to grapple with Freud's ideas in Italy during the first half of the twentieth century, a period during which Italy, compared to the rest of Europe and to the United States, was relatively impermeable to psychoanalysis. One of the factors that contributed to this was the opposition of the powerful Catholic Church, which identified in psychoanalysis a challenge to its authority. The author argues that Father Gemelli's shifting positions about psychoanalysis between 1925 and 1953 reflected the exigencies of his historical circumstances. Gemelli was able to identify in psychoanalysis an integrated view of the human condition in stark opposition to the brutal reductionism of psychiatry in Italy at that time, but also encountered in it elements intolerable to the Church. Examining specifically what it is that Gemelli could accept of psychoanalysis, and what needed to be rejected, between 1925 and 1953, illustrates the particular challenge posed by psychoanalysis to Catholicism in Italy.     

Der Weg der Psychoanalyse nach Japan

The establishment of psychoanalysis in Japan was a consequence of opening the country to the influence of the western world by the Meiji restitution of 1868. Thus western psychological thought was also spread to Japan. On this basis, psychoanalysis developed through personal contacts and experiences of individuals and infiltrated into intellectual circles and finally into psychiatry. The establishment of two psychoanalytical societies, one for analysts and one where also lay people had access led to a specific and unique organizational structure. The ??Japanese way?? of psychoanalysis is on the one hand characterized by the confrontation with Buddhism and on the other by specific applications which reflect a certain reserve in the Japanese society to the ??standard procedure?? of psychoanalytic therapy. In this way psychoanalysis in Japan implants a diversity into the international discourse which opposes the current trend towards general homogenization.     

Editorial

The use of drugs during psychoanalysis as well as the psychoanalytical treatment of patients who need psychopharmacological medication raise a whole series of problems that are also the subject of controversial discussion. Nevertheless, the body of literature available on this topic is still quite small. Medication is invariably an outside parameter that is introduced into the psychoanalysis and it can cause a blind spot in the psychoanalytic treatment. On the other hand, as we are treating severely disturbed patients, we are confronted with a growing necessity to introduce medication into the psychoanalytic setting. The paper discusses the related conflicts of the psychoanalyst and shows in a case report how an analytic stance can go hand in hand with adequate medication. The paper argues that we have to accept the state of the art in psychiatry and at the same time continue to talk about medication in terms of psychological processes even though it poses a conflict and is also a threat to our narcissistic equilibrium.     

Day,Night, or Dawn: Commentary on Paper by Steven Stern

It was in the years immediately following World War II and through the 1950s that the psychoanalytic establishment officially defined psychoanalysis as a subspecialty of psychiatry, and it was in that context of the professionalization of American medicine that they codified the distinction between psychoanalysis and (psychoanalytic) psychotherapy. In this commentary on Steven Stern's “Session Frequency and the Definition of Psychoanalysis,” I deconstruct a series of binaries that was built into the analysis/therapy distinction and that has plagued our discipline. It is argued that psychoanalysis identified itself with the culturally “masculine” and heterosexual values of autonomous individuality (the intrapsychic), while it split off all that was relational and social (interpersonal), marked as “feminine,” homosexual, and “primitive,” onto psychotherapy, which it then devalued. The paper then examines the implications for practice and psychoanalytic education.     

On the legitimacy of psychiatric power

The author examines the existential, historical, and political roots of psychiatric power, locating them, respectively, in the universality of guilt feelings and the desire to escape them, in psychiatry (replacing religion) as an institution offering surcease from such (and similar disturbing) feelings, and in the alliance, in modern societies, between psychiatry and the state. Clinical psychiatry and psychoanalysis, each in its own distinctive way, have served to legitimize the uses of psychiatric power. Liberty from coercive psychiatry requires destroying the legitimacy, and hence power, of coercive psychiatric principles and practices.     

Approaching the religious patient in forensic psychiatry,with special focus on ethnic minority patients

ABSTRACT

Ethnic minority patients are overrepresented in Danish forensic psychiatry and knowledge is needed on how these patients are approached in relation to religious and cultural issues. The aim of this study was to investigate how psychiatrists in Danish forensic psychiatry approach religious ethnic minority patients. The study revealed positive approach towards religious ethnic minority patients. However, unless religion features as part of the illness, the tendency is to not incorporate the patients’ religiosity in treatment. The study finds that the hospital chaplain is regarded by the psychiatrists as an important part of the ward and expressed the desire for a more formal cooperation with religious specialists to be developed. Finally, the study finds that religious practices such as Ramadan, common prayer, and Islamic edicts on food and unlawful touch are areas where more knowledge is needed, especially in relation to anxiety, potential stress, and conflict situations.     

Sense and nonsense in the social psychiatry concept

The term social psychiatry was justified when coined as a name denoting a psychiatric sub-discipline in order to promote the development of this specific aspect of psychiatric research and practice which, at the time, ran counter to established theory. At present, however, social psychiatry is in danger of becoming isolated, of developing in the boundary regions of psychiatric practice, and thus failing to fulfil its actual role of permeating psychiatry as a whole. The term social psychiatry is regarded as an expression of this isolation and should be avoided.     

精神分析在日本的传播与发展

综述了精神分析在日本的传入与发展。包括:(1)精神传入日本的历史轨迹,如心理学、精神医学、文化学视角的传播;(2)精神分析在日本的发展,如精神分析疗法的推广,精神分析理论的运用;(3)日本对精神分析的评价。     

Towards an anthropological psychiatry

The situation of present day psychiatry is described as being dominated by an empiricist perspective. The limitations of this perspective are analyzed and a rough sketch of the hermeneutical approach in psychiatry is offered. It is argued that a fully developed hermeneutical psychiatry implies a reference towards anthropological themes. Three of them, time, historicity and corporality, are investigated.     

I wish the hour were over: elements of a moral dilemma

In contrast to the viewpoint that sees conflict as deriving from defense against instinctual drives and thus as an intrapsychic phenomenon, this essay presents conflict as sometimes being an external opposition between disparate configurations of the self. These parallel sectors with different goals and ambitions can be seen in a continuum from the dramatic narcissistic behavior disorders to more subtle instances of moral dilemmas. A clinical illustration is offered to demonstrate its occurrence and management in psychoanalysis.     

Psychosynthesis of the brain and mind: Comments on a new intellectual framework in psychiatry and psychotherapy

Abstract

Eric R. Kandel, the Nobel Prize winner of 2000 in physiology and medicine, emphasises five scientific principles of which psychiatrists must be aware and which are presented and critically analysed in this article. Kandel states that professional requirements for future psychiatrists will impose a greater knowledge of the structure and functioning of the brain, and that the rationale for the unique domain that psychiatry occupies within academic medicine is the analysis and understanding of the interaction between the social and biological determinants of behaviour. The work of a psychotherapist is based both on scientific knowledge and, to a large extent, on an empathic understanding of the patient's history as well as his or her verbal and non-verbal expressions – as a consequence, the orientation of hermeneutic philosophy and semiotics should also be included in the intellectual framework. The aim of this paper is to update the channels of communication between modern neurobiology, psychoanalysis, semiotics and philosophy to the best advantage for their multidisciplinary, holistic cooperation.     

Gantt,Pavlov and freud: A comparison

Contrasts between classical Pavlovianism and classical psychoanalysis have been emphasized, but there are also significant similarities of which I write. A recent edition of a textbook of psychiatry which is widely used in the United States (Kaplan and Sadock 1985) indexes neither Pavlov nor Gantt, although it provides extensive coverage of psychoanalysis.     

Family matters The descendants of Freud and Jung

A brief history of what it has meant to be a Jungian analyst and/or analytical psychologist in the United States and England is portrayed. At first the differences between psychoanalysis and analytical psychology were very great, and there was great animosity between the two schools. The conflict was much stronger in the United States than in England where Jungians developed a much better rapport with psychoanalysis. Recent theoretical developments within psychoanalysis, such as the development of self theory and intersubjectivity, as well as speaking about religious issues in a new way, have brought psychoanalysis closer to analytical psychology. On the other hand, analytical psychology has been enriched by an increased awareness of the importance of developmental issues and transference and countertransference. The implications for both psychoanalysis and analytical psychology are explored.     

The relationship between psychoanalysis and schizophrenia-A response to the commentary by Robert Michels

In this section, the author responds to Dr Michels's commentary. In contrast to the situation in the United States, there are far fewer psychoanalysts in the UK and very few indeed working in general psychiatry to influence its practice. It is argued that psychoanalysis differs from all other psychological approaches with its recognition of the inner world and its unconscious influence on the individual's everyday life. Michels invites one to focus on outcome studies to judge the effectiveness of psychoanalysis in schizophrenia. There is a danger of throwing the baby out with the bathwater in that psychoanalysis helps in understanding presenting clinical material and in risk assessment in everyday general psychiatry.     

Fried and Freud on the Acropolis; on duality in the base of psychoanalytic thinking

Freud was conflicted in relation to his religious background. On the one hand, he was very clear on his adherence to a scientific Weltanschauung. On the other, he was fascinated by the Moses figure and one may see a Judaist structure in his way of thinking. The aim of this paper is to reflect on this conflict and the question of faith in psychoanalysis. After looking at object and method in religion and psychoanalysis, the authors go into the concept of ‘psychic reality’ and its change in the history of psychoanalysis. Through an analysis of Freud’s A Disturbance of Memory on the Acropolis and the function of literature, it is claimed that faith may be seen as a condition for the sense of experiential reality.     

Psychiatry,psychoanalysis and sociology in the work of H.S. Sullivan

Abstract

Conci, M. Psychiatry, Psychoanalysis and Sociology in the Work of H.S. Sullivan. Int Forum Psychoanal 1997;6: 127–135. Stockholm, ISSN 0803-706X.

The author tries to illuminate H.S. Sullivan's complex professional identity. With E. Fromm he shared a basic humanistic orientation, and also the project of creating an interdisciplinary new science of man. This is the perspective he inherited from W.A. White, who tried to make psychoanalysis a major ingredient of psychiatry and social science. Sullivan's pioneer work with schizophrenic patients changed the prognosis of these patients, represented the basis of his interpersonal theory of psychiatry and of his collaboration with Chicago social science. Not only is the epistemological sophistication of his definition of psychiatrywhich includes the biological, intra- psychic, cultural and social dimensions-very relevant today, but so is the work he conducted, through the Washington School of Psychiatry (1936) and the journal Psychiatry (1938), with the aim of creating what he called a “psychiatry of peoples”, leading to world peace and greater social justice. In his view, psychoanalysis was more than a profession: it was a fundamental instrument of personal, cultural and social change.     

Resistance in convergent and in divergent conflicts

Psychoanalytic theory has limited the term conflict to refer only to convergent conflict, whose elements tend to move toward each other, as in repression. Formulations made from the viewpoint of the method of free association have led the author to favor an expansion in the concept of conflict to include also divergent conflict, whose elements tend to move apart, as in regression-progression and in mourning. A broad range of clinical and theoretical phenomena of psychoanalysis can be accounted for by such a revision in the concept of conflict. Focusing on resistance, this paper provides a historical review and discusses the application of an expanded concept of conflict in the field of psychoanalytic technique.     

The role of the symptom in psychopathological states

Abstract.— Four approaches to the role of symptoms in psychopathological states are discussed. These are: Prepsychoanalytic psychiatry, psychoanalysis, family communication theory, and the view that symptoms as a sign of mental illness do not exist. The latter comprises labelling theory and social learning theory. Particular interest is attached to the contentions of symptom substitution and symptomatic treatment. Both are rejected as myths. A theory of action is briefly outlined, and on the basis of this, an alternative interpretationof phenomena ordinarily conceptualized as mental pathology is suggested. The concepts of "psychopathology" and "symptoms" are redefined in accordance with present knowledge, and the importance of formulating human action in an ethical frame of reference is pointed out.