Self-images and related autobiographical memories in schizophrenia

Schizophrenia is a severe mental illness, which affects sense of identity. While the ability to have a coherent vision of the self (i.e., self-images) relies partly on its reciprocal relationships with autobiographical memories, little is known about how memories ground "self-images" in schizophrenia. Twenty-five patients with schizophrenia and 25 controls were asked to give six autobiographical memories related to four self-statements they considered essential for defining their identity. Results showed that patients' self-images were more passive than those of controls. Autobiographical memories underlying self-images were less thematically linked to these self-images in patients. We also found evidence of a weakened sense of self and a deficient organization of autobiographical memories grounding the self in schizophrenia. These abnormalities may account for the poor cohesiveness of the self in schizophrenia.     

A Jungian contribution to a dynamic systems understanding of disorganized attachment

This panel emerged from shared clinical concerns when working with adult patients whose presentation style was reminiscent of a disorganized (Type D) infant attachment pattern. Psychotherapeutic work with such patients poses complicated transference and countertransference dilemmas which are addressed by all four panellists via theory and clinical vignettes. In common is an interest in contemporary attachment, neuroscience and trauma theories and their relationship to analytical psychology. Intergenerational trauma seems to be a salient factor in the evolution of fragmented and fragmenting interactions that lead to failures in self-coherence and healthy interpersonal relationships. Such early relational trauma is compounded by further episodes of abuse and neglect leading to failure in a core sense of self. These clinicians share how they have integrated theory and practice in order to help dissociated and disorganized patients to transform their dark and extraordinary suffering through implicit and explicit experiences with the analyst into new, life giving patterns of relationship with self and others. The alchemy of transformation, both positive and negative, is evident in the case material presented.     

A narcissistic defence against affects and the illusion of self-sufficiency.

A narcissistic defence against affects, unlike isolation, is a defence against an object relationship. Object relations are strengthened by the sharing of genuine affects so that the failure to share feelings or the presentation of false feelings creates distance between the self and other objects. The defence is similar to that of denial in that it entails a modification of the ego's own structure. We have suggested that this modification consists of a precocious but fragile establishment of a sense of self. The defence may occupy a sector of the personality or reflect a more massive structural arrest. When there is this structural arrest, we believe that this narcissistic defence forms the basis for the narcissistic character disorder described by Kohut and the false self of Winnicott. This precocious sense of self leading to an illusion of self-sufficiency may also be found in other disorders, including the borderline patient, but the borderline patient, in contrast, suffers from a failure of internalization which leads to object hunger in contrast to the denial of object need of the narcissistic disorder. We suspect that the environmental trauma that may contribute to the narcissistic disorder is less severe as compared to the borderline states and may consist of the mother's failure to accept the child's separateness and autonomy, resulting in a fear of the mother's intrusiveness. The fear of the maternal object's intrusiveness contributes to the relative inability to form a therapeutic alliance in the psychoanalysis of narcissistic character disorders. The analyst's interpretations are experienced as dangerous, not necessarily because of their content but due to the fear of the analyst's intrusive influence. Our understanding of the means of effecting therapeutic change must be modified in patients with narcissistic character disorders for, in contrast to the 'classical' neurotic, analytic progress is not obtained by means of interpreting the transference neurosis in the context of a working or therapeutic alliance. Although we acknowledge that the psychoanalysis of narcissistic disorders can lead to significant therapeutic gains, such analyses may prove to be interminable if the gains do not also result in the establishment of a transference neurosis and therapeutic alliance.     

Path analytic examination of a cognitive model of PTSD

Ehlers and Clark (2000) developed a cognitive model of posttraumatic stress disorder (PTSD) symptom maintenance which implicated the role of posttraumatic cognitions and aspects of the trauma memory in maintaining symptoms via an increased sense of current threat. The aim of the current study was to empirically test a variant of this model using path analysis. Participants in the current study were 514 undergraduates at a midwestern university who reported experiencing at least one traumatic event. Path analyses examined various models of the possible relationships between one’s posttraumatic cognitions and the centrality of the traumatic event to the sense of self (considered an aspect of memory integration) in predicting current level of PTSD symptoms. Results indicate that both event centrality and posttraumatic cognitions are unique and independent predictors of current symptom level. Overall, the results of this study support aspects of Ehlers and Clark’s cognitive model of PTSD; cognitive appraisals of the self and centrality of the event were highly related to levels of distress. However, the current study suggests that overly integrated trauma memories may lead to greater distress and not poorly integrated ones as suggested by Ehlers and Clark.     

Linking online self-presentation to identity coherence,identity confusion,and social anxiety in emerging adulthood

The present study examined the role of social media in psychosocial development and adjustment in emerging adulthood. Survey data from a diverse college sample of 220 emerging adults (M age ≈ 23, 175 women) were collected and analysed using a series of multiple regressions. Results revealed that emerging adults high in general identity coherence (indicative of high self-concept clarity) reported presenting the real self and the ideal self on Facebook, suggesting that they were more truthful and positively realistic in their online self-presentation. Emerging adults high in general identity confusion (indicative of less self-concept clarity) reported presenting the ideal self and the false self on Facebook, suggesting that they were less truthful, less realistic, and more socially desirable in their online self-presentation. Moreover, emerging adults who experienced both identity coherence and identity confusion reported presenting the false self on Facebook motivated by self-exploration. Emerging adults experiencing high social anxiety reported presenting the false self on Facebook; they engaged in an extensive self-exploratory and socially desirable online self-presentation. Further, emerging adults experiencing both high identity confusion and high social anxiety reported presenting themselves on Facebook in a less truthful manner. Findings have important implications for identity integration during the emerging adulthood transition in the digital age.     

Happiness,Dispositions and the Self

I argue that happiness is an exclusively categorical mental state. Daniel Haybron’s inclusion of dispositions into his emotional state theory rests of a confusion of constituents of happiness in the narrow psychological sense with objects of prudential concern, to which obviously belong “mood propensities” and other dispositional states. I further argue that while it is probably correct to require of a constituent of happiness that it must in some sense be “deep” and belong to, or directly impact on, a persons’ self, the importance of depth may be overrated by the emotional state theory, which also ignores the possibility that mental states other than moods and emotions can be deep in the relevant sense.     

Transference in Psychotherapy with Schizophrenic Patients

Three current approaches to the group therapy of the cognitively intact, depressed elderly are reviewed. Examination of the strengths and limitations of these three models—self psychology, developmental considerations such as reminiscing and life review, and cognitive—behavioral therapies—points in the direction of the usefulness of an integrated model. The main objectives of an integrated approach include: stabilization of the individual's sense of self, establishment of interpersonal competence, and enhanced mastery over the affects of depression and demoralization. Clinical illustrations are provided to demonstrate the practical considerations in this model of group therapy.     

Mentalization-based therapy with maltreated children living in shelters in southern Brazil: A single case study

This study describes the mentalization-based child therapy of a boy who suffered from early abuse and neglect, who was living in a shelter in southern Brazil. This single case study aimed at assessing whether this kind of psychotherapy contributes to reducing depressive symptoms and developing a greater capacity for reflection on the mental states of self and other, as part of developing a more coherent sense of self. Structured assessments were conducted before therapy and after six months of treatment, and the audio-recorded treatment sessions were analyzed using content analysis, in order to identify key themes in the treatment itself. The results suggested a significant improvement in depressive symptoms and some changes in mentalization with the beginnings of a movement toward a more cohesive and integrated self. We argue that mentalization-based child therapy could be a promising therapeutic approach for children who have experienced severe disruptions of emotional bonds, due to the way it focuses on the capacity to regulate affect and develop a more coherent sense of self.     

The layers of presence: a bio-cultural approach to understanding presence in natural and mediated environments.

This paper proposes a bio-cultural theory of presence based on four different positions related to the role and structure of presence, as follows. First, presence is a defining feature of self and it is related to the evolution of a key feature of any central nervous system: the embedding of sensory-referred properties into an internal functional space. Without the emergence of the sense of presence it is impossible for the nervous system to experience distal attribution: the referencing of our perception to an external space beyond the limits of the sensory organs themselves. Second, even if the experience of the sense of presence is a unitary feeling, conceptually it can be divided in three different layers, phylogenetically different and strictly related to the three levels of self identified by Damasio. In particular we can make conceptual distinctions between proto presence (self vs. non self), core presence (self vs. present external world), and extended presence (self relative to present external world). Third, given that each layer of presence solves a particular facet of the internal/external world separation, it is characterized by specific properties. Finally, in humans the sense of presence is a direct function of these three layers: the more they are integrated, the more we are present. In the experience of optimal presence, biologically and culturally determined cognitive processes are working in harmony--to focus all levels of the self on a significant situation in the external world, whether this is real or virtual.     

Community based cognitive therapy in the treatment of posttraumatic stress disorder following the Omagh bomb

Studies in academic research centres with selected patients have shown that several cognitive behaviour therapies are effective in the treatment of PTSD following traumas affecting individuals or small groups. Little information is available on the extent to which these positive findings will generalize to more routine clinical settings with less selected patients or to a trauma that affects a whole community. The present study addresses these generalization issues. A consecutive series of 91 patients with PTSD resulting from a car bomb which exploded in the centre of Omagh, Northern Ireland in August 1998 were treated with cognitive therapy, along lines advocated by Ehlers and Clark (2000). There were no major exclusion criteria and 53% of patients had an additional axis I disorder (comorbidity). Therapists were NHS staff with heavy caseloads and modest prior training in CBT for PTSD. A brief training in specialist procedures for PTSD was provided. Patients received an average of eight treatment sessions. Significant and substantial improvements in PTSD were observed. Degree of improvement was comparable to that in previously reported research trials. Comorbidity was not associated with poorer outcome, perhaps because comorbid patients were given more sessions of treatment (average 10 vs 5 sessions). Patients who were physically injured improved less than those who were not physically injured. Overall, the results indicate that the positive findings obtained in research settings generalize well to a frontline, non-selective service.     

Towards an integrated model of group psychotherapy with the elderly

Three current approaches to the group therapy of the cognitively intact, depressed elderly are reviewed. Examination of the strengths and limitations of these three models--self psychology, developmental considerations such as reminiscing and life review, and cognitive-behavioral therapies--points in the direction of the usefulness of an integrated model. The main objectives of an integrated approach include: stabilization of the individual's sense of self, establishment of interpersonal competence, and enhanced mastery over the affects of depression and demoralization. Clinical illustrations are provided to demonstrate the practical considerations in this model of group therapy.     

Self-concept integration and differentiation in subclinical individuals with dissociation proneness

Dissociative pathology is characterized by an altered sense of self. Still, it remains unclear (a) whether the altered sense of self is also associated with non-pathological dissociation as well and (b) whether this potential association is an intrinsic connection or a consequence of other related constructs, including childhood trauma. This study addresses this question by examining how self-concept organization may differ among individuals with different levels of dissociation proneness. The structure of self-concept was operationalized by various indexes of self-concept integration and differentiation. Results showed that individuals high in dissociation proneness have lower self-concept clarity and compartmentalize self-aspects with more polarized evaluations. Notably, the association between dissociation proneness and evaluative self-compartmentalization held after controlling for childhood trauma, anxiety, and depression. This characteristic self-concept organization can be an attribute of non-pathological dissociation.     

Visual and phonetic codes and the process of generation in letter matching

Physically identical letter pairs are matched more quickly than are nominally identical or nonidentical pairs, which is an effect usually interpreted as resulting from the use of a visual memory code versus a phonetic or name code. However, prior manipulations of phonetic confusion and visual-field lateralization have provided little evidence consistent with this notion. Here, three reaction time experiments suggest through converging confusion and visual-field manipulations that a phonetic code is not used in either simultaneous or successive letter matching. Two additional experiments yield confusion evidence consistent with a rapid visual generation process underlying nominally identical and nonidentical matches, emphasizing the role of visual memory processes in all of the commonly used same-different letter-matching tasks. Implications for coding and hemispheric theories are discussed.     

The Jewish Cultural Complex

Although 70 years have passed since the Nazi Holocaust, the aftereffects resulting from it and centuries of Jewish oppression persist in Jewish tribal identity and in the mechanisms for its survival. In much the same way that PTSD affects individuals who have suffered life-threatening situations, a history of collective trauma has produced within Jewish psyches symptoms such as hypervigilance, reactivity, and a sense of profound danger in the world. The author proposes that such sedimented responses form a Jewish cultural complex with a hypermuscular defense system armed against further psychic attacks. Healing involves a restoration of the feeling function and a return to the rich body of Jewish ethical principles that balance personal security with compassion for self and other.     

Family narrative interaction and children's sense of self

Family narratives about the shared past may be a particularly significant site for preadolescents' emerging sense of self both as an individual and as a member of a unified family. We examined the relations between family narrative interaction style when reminiscing and preadolescents' sense of self. Results indicated three narrative interaction styles that describe the extent to which families discuss or fail to discuss their past in integrated and validating ways. Specifically, conversations with a coordinated perspective incorporated information from all members and were related to higher self-esteem, especially in girls. Conversations with an individual perspective, in which family members took turns telling their thoughts and feelings about the event without integration among the perspectives, were associated with a more external locus of control, especially in boys. Conversations with an imposed perspective, in which one family member was in charge of the conversation or in which unpleasant exchanges between members occurred, were not associated with either self-esteem or locus of control. Implications of these narrative interaction styles for children's developing sense of self are discussed.     

On being, knowing and having a self

This paper(1) takes the distinction between being conscious ('core consciousness') and knowing that one is conscious (self-reflexive consciousness) as a starting point for differentiating between three different aspects of the self: 1) the overall process of psychosomatic being which we share with all living creatures and which expresses itself through action (self as totality), 2) the conscious awareness of knowing the self that is a peculiarly human phenomenon consequent on the development of symbolic imagination (sense of self including numinous experiences of the self) and 3) having a self (or soul) as an essential attribute of being human that can only be achieved through being endowed with a self in the mind of others (self-identity leading to the self as the centre of the personality). Some clinical implications of these distinctions are considered including the role of interpretation as fostering integration through the provision of alternative self-images, the loss of self-reflexive consciousness in states of overwhelming affect and the attack on the spontaneous psychosomatic being of the self in states of self-hatred and self-division.     

„Affektlose Zustände?“

In clinical work psychoanalysts are confronted with phenomena that are marked by affectless states and an apparent non-existence of affects. The author refers to patients who are addicted to near-death, dwell in states of confusion and inhibition in which affects are not found to be attached to thoughts, where splitting dominates and containment for fragmentation is sought. Instead of the latter it comes to pulverization and atomization and therefore to the annihilation of affects: affects seem to be unperceivable. Such phenomena allow considerations concerning the concept of the death drive. The questions are considered whether the apparent non-existence of affects is an expression of a silent death drive, what the function of these affectless states is and what the object relationship, which is expressed and communicated within these states looks like. Three concepts are taken into consideration: whether these affectless states are manifestations of a developmental state in which splitting is yet not an issue (Fairbairn), or must they be seen under a defensive aspect as a protection against persecutory tantalizing affects (Klein), or are these states the pure manifestations of the death drive (Green). By means of a clinical vignette of a patient suffering from an inhibition of thought processes, an inability to work on the basis of a borderline pathology and treated with high-frequency psychoanalysis, the phenomenon of ?affectless states“ is elaborated on the basis of the three aforementioned theoretical concepts and the dynamic unconscious fantasy associated with these seemingly affectless states is discussed.     

Maternal Role Confusion: Relations to Maternal Attachment and Mother–Child Interaction from Infancy to Adolescence

Self‐reports of role confusion with the parent in childhood are associated with a variety of adverse outcomes. However, role‐confusion has been studied primarily from the point of view of the child. The current study evaluated an instrument for assessing role confusion from maternal interviews rather than from child observations or self‐reports in adulthood. Fifty‐one mothers participating in a longitudinal study since their own child's infancy were administered the Experiences of Caregiving Interview (C. George & J. Solomon, 1996) when the child was age 20. Interviews were coded using the newly developed Parental Assessment of Role Confusion (PARC; L. Vulliez‐Coady & K. Lyons‐Ruth, 2009). Maternal PARC scores were related to observational measures of role‐confusion in interaction with the child both in infancy and late adolescence. PARC scores also were related to mothers’ hostile‐helpless states of mind on the Adult Attachment Interview (C. George, N. Kaplan, & M. Main, 1984, 1985, 1986) and to the extent of Unresolved loss, but not Unresolved Trauma. PARC scores also were related to mothers’ self‐reports of helplessness experienced in the parenting role. Discriminant validity of the PARC was demonstrated in that role confusion on the PARC was not related to hostile or disoriented forms of parent–child interaction. Implications for clinical assessment of role confusion are discussed.     

Psychological and physiological responses to stress: The right hemisphere and the hypothalamo-pituitary-adrenal axis,an inquiry into problems of human bonding

In addition to repeated reexperiencing of the event, the delayed effects of severe psychological trauma, i.e., post traumatic stress disorder (PTSD), present a paradoxical mix of symptoms. There is enhancement of the self-preservative catecholamine states; anger and fear with a contrasting sense of meaninglessness and a blunting of the emotional responses of the attachment behavior so critical for species preservation. Hormonally, there is a striking separation of the catecholamine response, which stays elevated and that of the hypothalamo-pituitary-adrenal (HPA) axis, which may remain at normal levels. Pathophysiologically, the reexperiencing of the trauma and the arousal may be associated with dysfunction of the locus coeruleus, amygdala and hippocampal systems. This article explores the consequences of an additional dysfunction: a dissociation of the hemispheres that appears to be responsible for the alexithymic avoidance and failure of the cortisol response that so often follow severe psychological trauma. There is neurophysiological evidence that the left and right hemispheres subserve different emotional sets that correspond to “control” and “appraisal,” i.e., very approximately to the self and species preservative behavioral complexes, respectively. Several studies point to physiological dissociation of hemispheric functions during alexithymia. This raises the question: What has been lost if in this condition the right side no longer fully contributes to integrated cerebral function? Right hemispheric damaged children lose critical social skills and in adults the related sense of familiarity critical for bonding is lost. Such losses of social sensibilities may account for the lack of empathy and difficulties with bonding found in sociopathy and borderline personality: conditions now believed to result from repeated psychological trauma during development. On the other hand, systems that promote right hemispheric contributions provide solacing access to a “Higher Power.” They also appear to protect against socially disordered behavior, substance abuse, the failure of the HPA axis and some aspects of the pathophysiology of chronic disease.     

Bodily self and schizophrenia: The loss of implicit self-body knowledge

Schizophrenia spectrum has been associated with a disruption of the basic sense of self, which pertains, among others, the representation of one's own body. We investigated the impact of either implicit or explicit access to the representation of one's own body-effectors on bodily self-awareness, in first-episode schizophrenia (FES) patients and healthy controls (HCs). We contrasted their performance in an implicit self-recognition task (visual matching) and in an explicit self/other discrimination task. Both tasks employed participant's own and others' body-effectors. Concerning the implicit task, HCs were more accurate with their own than with others' body-effectors, whereas patients did not show such self-advantage. Regarding the explicit task, both groups did not exhibit a self-advantage, and patients showed a higher percentage of self-misattribution errors. Neither self/other nor implicit/explicit effects were found in both groups when processing inanimate-objects. We propose that FES patients suffer of a disturbed implicit sense of bodily self.