The anatomy of a symptom: concept development and symptom formation in a four-year-old boy

The case of a four-year-old boy with a postural symptom that resolved rapidly in the course of play therapy is presented. Various unconscious fantasies appeared to underlie the symptom. In particular, this case illustrates a young child's sophisticated capacity to abstract a complex relational feature from a set of unconscious fantasies that then became the basis of his symptom. The structure of the boy's symptom is relevant to (1) the question of what constitutes a symptom, (2) the relationship between concept development and symptom formation, and (3) the status of certain primary process mechanisms as they relate to concept development. Proposals are presented to help situate the contributions of psychoanalytic theory with respect to the domain of cognitive psychology, and to illustrate the unique contributions of each domain toward their mutual enrichment.     

The scenic function of the ego and its role in symptom and character formation1

The author argues that the scenic function of the ego permits the situationally appropriate representation of an unconscious, infantile configuration – that is, of a relatively stable, personality‐based drive scene having the same status as latent dream thoughts. The products of conflict elaboration (symptoms, etc.) are manifested in different ways in accordance with the conditions of the relevant situation. The contents of the drive scene are created by the psychical apparatus on the basis of infantile perceptions and are revealed in screen memories. The capacity for situationally appropriate representation is apparently bound up with the mobile drive, including its narcissistic transformations. Desexualization (in the sense of neutralization) renders scenic elaboration impossible. The drive derivatives withdrawn from the scenic configuration contribute to ego organization and the formation of character traits, which no longer vary according to the situation, but can only be modified by a change in personality structure itself. It is as yet unclear whether a process of resexualization can make them amenable once more to analytic work. The form of narcissistic libido that can assume a scenic configuration is closely related to primary narcissism. Its manifestations, which may likewise emerge in situation‐dependent symptom formations, appear accessible to analysis.     

Posttraumatic stress symptoms in refugees: assessments with the Harvard Trauma Questionnaire and the Hopkins symptom Checklist-25 in different languages

The original versions of the Harvard Trauma Questionnaire and Hopkins Symptoms Checklist-25 were written and subsequently validated in the Cambodian, Laotian, and Vietnamese languages. For use in a Dutch treatment center, with refugee patients mostly speaking other languages, additional translations were made. The objective of this study was examination of the psychometric properties of some of these new translations, i.e., the Arabic, Farsi, Serbo-Croatian, Russian, and English bilingual adaptations. It is concluded that the psychometric properties of both tests are adequate across those different cultures and are, in general, applicable to measure symptoms of depression, anxiety, and posttraumatic stress disorder.     

Trauma and Religiousness

Victims of traumatic events who experience re-traumatization often develop a highly ambivalent relationship to God and all religiosity as extremely conflictual. On the one hand, they may choose to blame God for not having protected them, for having left them to feel so alone, for having been indifferent to them or they may even turn their wrath upon God, as the source of cruelty. Often though, the traumas experienced by individuals prompt them to turn to God and religion in search of help. This gives reason for the need of new and up-to-date research that can help elucidate why some people choose to seek help in religion and others turn away from it.     

Childhood and Trauma

In this paper, I follow the evolution of the concept of trauma within psychoanalytic theory, and some of the effects of this evolution. Starting out from the point where Freud gives up the theory of trauma as the cause of neurosis in 1897, and the alleged reasons for such a change, I analyze the theoretical and clinical consequences of this change within psychoanalysis. I proceed to develop Ferenczi's ideas on trauma, their relevance to present-day psychoanalytic theorizing and practice, as well as for the understanding of the psychic processes in children, tracing the development of some of these ideas in contemporary psychoanalytic thinking.     

Psychoanalysis and Trauma

This article articulates some of the problems that surround the use of the term trauma in psychoanalytic theory and suggests that the key element for a theory of pathogenesis and mental functioning is not the either/or of external versus internal causation or trauma versus drive. Rather, it is an understanding of whether, or to what extent, the raw data of existential experience is or is not transformed into psychological experience. From this perspective, trauma is whatever outstrips and disrupts the psyche’s capacity for representation or mentalization. Absent the potential for mental representation, these events and phenomena are historical only from an external, third-person perspective. Until they are mentalized, they remain locked within an ahistorical, repetitive process as potentials for action, somatization, and projection.     

Trauma and Gender

The meaning of trauma within psychology has for a long time been viewed mostly from a ‘pathologising’ standpoint. Viewed as pathology, people's trauma may become understood using a singular lens thereby leaving out broader contextual (social, environmental, political, historical, economical etc.) aspects that have been shown to play a role in the subjective experience of various forms of suffering. Psychology has for a long time been quick to diagnose victims of traumatic experiences from an individualistic perspective, almost always positioning the ‘problem’ within the person. As a result of the Vietnam War, World Wars I and II and the Holocaust, the rise in the diagnosing of PTSD gave way to the labelling of trauma. Within psychology, post‐traumatic stress disorder has become the way to operationalise suffering, and I would like to argue that this occludes how suffering lives in a family, a community and in gendered bodies. The gendering of trauma continues to be a silenced space. There is a need to highlight and acknowledge the gendered nature of suffering which begs for trauma to be understood in context and not as an isolated act or occurrence affecting the individual. Women have remained, and in many ways continue to remain, silenced with minimal opportunities to name the world for themselves. This paper seeks to provide a critical analysis of the notion of trauma (and its intersection with gender) that arises from conflict and post‐conflict situations.     

The contribution of Hartmann's adaptational theory to psychoanalysis, with special reference to regression and symptom formation

My experience of clinical work is consistent with the conclusion that both practice and theory are improved by applying the contributions of Heinz Hartmann. His work provides an important conceptual bridge to understanding the adaptive and pathologic changes that appear in the course of human development. The specific details of those changes are just as much an issue demanding the analyst's attention as is the tracing of patterns of childhood instinctual life. In this paper, I will point to some areas of controversy where renewed attention to Hartmann's ideas might be useful, and I will attempt to illustrate the clinical utility of his theoretical contributions.     

Defensiveness and symptom reporting

This investigation examined whether high levels of defensiveness were associated with lower levels of reporting symptoms of ill health. Participants completed questionnaires measuring defensiveness, trait anxiety (neuroticism), and health. Analyses revealed that overall high defensiveness was significantly associated with lower levels of symptom reporting, and that among individuals high in neuroticism (a trait normally associated with high levels of symptom reporting), those individuals also high in defensiveness reported significantly lower levels of symptoms. The results suggest that defensiveness may act as a buffer against the perception and reporting of the symptoms of illness.     

Transference symptom

Transference symptom is a hazy notion in Freud's writings. The notion is presented here as a particular moment in the crystallization of the transference neurosis. It results from a double cathexis of the analytic frame and the analyst resulting in a symbolic distortion that is represented plastically within the session, as occurs in dreams. The transference symptom proceeds from two different preconscious cathexes, one attached to the reality of the frame, the other to the drive linked to the analyst. A psychic space is thereby opened up for interpreting both the resistance and the unconscious derivatives of infantile conflict. The transference symptom is a compromise formation that includes the analyst and questions the countertransference stance. Three different analytic situations give rise to transference symptoms according to the relative balance between frame and process in the analytic encounter. The concept is compared with enactment.