The ‘mad scientists’: Psychoanalysis,dream and virtual reality2

The author explores the concept of reality‐testing as a means of assessing the relationship with reality that prevails in dream and in virtual reality. Based on a model developed by Jean Laplanche, she compares these activities in detail in order to determine their respective independence from the function of reality‐testing. By carefully examining the concept of hallucination in the writings of Freud and Daniel Dennett, the author seeks to pinpoint the specific modalities of interaction between perceptions, ideas, wishes and actions that converge in the ‘belief’ and in the ‘sense of reality’. The paper's main thesis consists of the distinction that it draws between immediacy‐testing and reality‐testing, with the further argument that this distinction not only dissipates the conceptual vagueness that generally surrounds the latter of the two concepts but also that it promotes a more precise analysis of the function of reality in dream and in virtual reality.     

The act of interpretation1

The author understands the interpreting act as an attempt to perceive what happens in the transference/countertransference fi eld and not just what happens in the patient's mind. Interpretation transcends mere intellectual communication. It is also an experience in which analysts’ emotions work as an important instrument in understanding their patients. Interpretation is seen to possess manifest as well as latent content; the latter would contain the analysts’ feelings, emotions and personality. The unconscious content of an interpretation does not inconvenience or preclude the development of the analytic process, but, on the contrary, it allows new associative material to emerge, and it transforms the analytic session into a human relationship. Analysts’ awareness of this content derived from patients’ apperceptions is a signifi cant instrument for understanding what is happening in the analytic relationship, and what transpires in these sessions provides fundamental elements for analysts’ self‐analysis. Some clinical examples demonstrate these occurrences in analytic sessions, and how they can be apprehended and used for a better understanding of the patient. The author also mentions the occurrence of diffi culties during the analytic process. These diffi culties are often the result of lapses in an analyst's perception related to unconscious elements of the relationship.     

Psychotic withdrawal and the overthrow of psychic reality1

The author attempts to distinguish between the world of fantasy and the imagination (which fuels our capacity to ‘dream’) from a withdrawal into fantasy. In this withdrawal, the foundations of which are laid in childhood, a dissociation from psychic reality starts and from it the delusional world arises and constitutes the adult illness. During therapies of adult patients who have experienced a psychotic state, it is often possible to reconstruct the state of infantile withdrawal and understand how their dissociation from reality was ignored or unknowingly encouraged by their parents. Children destined to develop psychosis enter into the dissociated world not just as a defence against anguish or loneliness, but also for the pleasure of experiencing a delusional self‐suffi ciency and a gratifying omnipotence in which anything is possible. Mental workings that take place in the withdrawal do not follow the rules governing normal psychic functioning. Those fantasies cannot be either repressed or ‘dreamed’ in order to be transformed into thoughts. These psychopathological structures, which develop early and autonomously, have to be understood during analytical therapy in their origins and ‘deconstructed’ in order to help the patient to escape from their dominion. By means of clinical examples, the author tries to shed light on the possible ways of reaching patients in their psychotic shelters, thereby helping them to re‐emerge into a psychic reality.     

The crisis of psychoanalysis and psychoanalytical training: The suffering of the candidate on the long road towards qualifi cation1

The author assesses the impact of the so‐called ‘crisis of psychoanalysis’ on the training of candidates, and on those who accompany them through the course. Different causes of the most relevant symptom of the crisis, i.e. the diffi culty of fi nding patients for a four‐sessions‐weekly analysis, are considered. According to the author, analysts themselves must bear some of the responsibility for it. She draws attention to a number of interrelated phenomena, such as: trainees' tension in their encounters with potential analysands, due to awareness of their own needs as trainees; the necessity to accept very disturbed patients whose selection might arouse criticism from the training committee; analyses in which trainees seem to become patients' hostages because of ever‐present fears of interruption; the diffi cult construction of a psychoanalytic identity in trainees who also are in full‐time psychiatric practice; trainees' profound uncertainty about the future both of psychoanalysis in general and their own careers in particular. In agreement with Kernberg, the author stresses the importance of considering the ‘crisis of psychoanalysis’ as a phenomenon whose development may be infl uenced by the analysts themselves.     

Playing with reality

The authors explore the interpersonal aspects of the early development of an experience of external reality and the roots of this experience in primary intersubjectivity. They suggest some implications that this has for psychoanalytic work with the patient's experience of external reality. They argue that the external world is not an independently existing 'given', for the infant to discover, as is sometimes implicitly assumed. Infants acquire knowledge about the world not just through their own explorations of it but by using other minds as teachers. The experience of external reality is invariably shaped through subjectivities. The authors argue that at first the infant assumes that his knowledge is knowledge held by all, that what he knows is known by others and that what is known by others is accessible to him. Only slowly does the uniqueness of his own perspective differentiate so that a sense of mental self can develop. In clinical work we frequently observe the undoing of this process of differentiation, and understanding the underlying mechanisms can be helpful in managing the transference and countertransference consequences when the process has been derailed.     

On psychic reality and neutrality: Empathy and the work of construction in countertransference

Abstract

The clinical challenges faced in encountering patients who do not fit the standard treatment of Oedipus conflicts clearly show the limitations of the interpretative method, thus making indispensable the study of clinical concepts and techniques as a way to broaden the psychoanalytic horizons. In order to analyse the different psychopathological problems resistant to traditional clinical approaches, it is necessary to reorganise the technique on the basis of a better understanding of the ways in which subjectivity is rooted in early psychic constitution. In this way, empathy becomes important as a clinical tool. The use of empathy must be understood as a decisive factor in handling clinical cases and situations in which the treatment encounters obstacles that restrict the power of the analyst's verbal interventions.In this case, can we say that the use of empathy interferes directly with and changes the position of the concept of psychic reality? Moreover, as we use empathy, can we also say that the concept of neutrality is transformed, without being abandoned? The intention of this paper is to discuss these questions using clinical material taken from the analysis of borderline clinical cases and situations.     

Medicine's symbolic reality

Modern socio‐cultural studies of medicine demonstrate the symbolic character of much of medical reality. This symbolic reality can be appreciated as mediating the traditional division of medicine into biophysical and human sciences. Comparative studies of medical systems offer a general model for medicine as a human science. These studies document that medicine, from an historical and cross‐cultural perspective, is constituted as a cultural system in which symbolic meanings take an active part in disease formation, the classification and cognitive management of illness, and in therapy. Medicine's symbolic reality also forms a bridge between cultural and psychophysiological phenomena; the basis for psychosomatic and socioso‐matic pathology and therapy. This in turn becomes a central problem for medical theory and for a philosophical reinvestigation of medicine.     

虚拟现实暴露疗法在社交焦虑中的应用:效果、机制及展望

由于传统干预方法的诸多局限,虚拟现实暴露疗法(virtual reality exposure therapy,VRET)逐渐应用于对社交焦虑的干预,VRET是将虚拟现实技术与传统行为暴露治疗相结合而形成的一种新的干预方法。文章总结了VRET的三个发展阶段及其研究范式,述评了在VRET过程中的作用机制。未来研究可致力于设计更加自然的人机交互技术,实现技术与社交焦虑治疗的深度融合以及关注第三人称视角应用的作用及机制。     

Virtual reality and the psyche. Some psychoanalytic approaches to media addiction

This paper explores the ramifications of excessive use of media on personality development, the development of symbolic and thinking functions and on psychic reality. In doing so, the questions of whether there are specific media objects possessing an intrinsic symbolic quality, and which attachments in the inner world of a child/adolescent can be mobilized or destroyed are discussed. By selecting specific material, computer gamers use their game to activate the field of a personal psychic reality. Hereby, they attempt some kind of self‐healing. However, after leaving the game, conflicts and traumata re‐enacted but unresolved in the game disappear from their temporary representation without generating any resonance in the gamer's psychic experience. Consequently, although states of mind and affects are activated in the computer game, their processing and integration fail; the game results in a compulsive repetition. The construction and consolidation of retrievable maturation and structural development, the representation of the unrepresentable, succeed in the context of the triangulating analytic relationship, initially through a jointly performed symbolic and narrative re‐experience or the recreation of the game. Theoretical considerations are illustrated by means of clinical vignettes.     

The testing of reality from the standpoint of the body self

Traditionally, the body self has been regarded as involved in reality testing principally in the determination of the distinction between the source of a stimulus being internal or external. The body has been closely related to instinctual drives, to urgency, and thus to conflicts that are crucial to normal and pathological development. However, the concept of the body self comprising all the psychic experiencing of body sensation, body functioning, and body image is broader than the body's connection to inner-outer reality testing and id pressures. The findings from childhood observations and from clinical research indicate that at each stage of the child's life, from earliest infancy on, the maturation and development of the body self becomes integrated with the whole group of psychic regulatory activities that contribute to the individual's sense of reality. The development of the body self at each period involves criteria by which some aspect of reality is tested. The subject of this paper has been the developmental pattern of experiences that contribute to the individual's sense of his body in particular and to the sense of reality of the self in general.     

Enrique Pichon Rivière's conception of reality in psychoanalysis

The author places the subject of his paper in the context of the original views of a school of Argentinian psychoanalysts that differed from traditional conceptions of man and his 1 relationship with the sociocultural context – that is, with reality. These were the analysts who followed Enrique Pichon Rivière and further developed his ideas – namely, Madeleine and Willy Baranger, José Bleger, and David Liberman. The author begins his exposition with a discussion of Pichon Rivière and culture. He then offers an outline of Pichon Rivière's particular conception of man, followed by a section on the Internal Group as the nexus between the psyche and reality. Further sections address the idea of reality in the analytic situation as a dynamic field and the operative definition of the transference; the distinction between perceptual reality and the reading of reality, with a consideration of the notion of ‘critical judgement’; and lastly the issue of health and illness in terms of adaptation to reality. In addition, on the basis of a quotation from Antonio Damasio, the author draws a parallel between these psychoanalytic thinkers’ ‘psychosocial’ approach to man and the findings of contemporary neuroscience as presented by one of its paradigmatic protagonists.     

Fire at the theatre: (Un)reality of/in the transference and interpretation1

Only in Bion's extended idea of ‘waking dream thought’ is the oneiric paradigm of the cure (already an obvious Freudian principle) completely applicable. The author's basic hypothesis is that, by adopting this paradigm thoroughly, one can combine the radical antirealism which is expressed in the postulate by which all the patient's communications are transference‐connected (here meaning ‘false connection’‐i.e. as projection/displacement of elements of the patient's inner psychic world) with the ‘reality’ of the transference, that is to say with the conviction that the facts of the analysis are co‐determined by the patient‐analyst dyad and actually rooted in how they interact. The Freudian metaphor of the fi re at the theatre is reintroduced here to suggest the crisis of the therapist's internal setting and capacity for reverie, which occurs when the irreducible ambiguity of the transference is resolved defensively, either in the patient's external reality or in his unconscious fantasy constellation. The author gives three clinical examples. The fi rst shows some of the not necessarily negative effects of this temporary crisis. The other two vignettes show a way of listening to the traumatic events of the patient's life from a perspective (that of the ‘analytic fi eld’) which is thought to be potentially the most transformative and vital to the analytical relationship.     

Triadic reality and the capacity to love

The author describes the concept of triadic reality, which he sees as a necessary prerequisite to healthy negotiation of the oedipal phase. Without positive representations of both parents individually-and, significantly, of both parents together in relation to the child-the child is hampered in her efforts to achieve a sense of triadic reality, resulting in difficulties in self representation and in object choice, as well as a limited capacity to love. A detailed case report is presented, highlighting relevant aspects of the author's work with a patient named Marielena.     

Consultation in adolescence: Hurried,terminable, interminable1

The physiological ambivalence displayed by adolescents towards dependence on adults is an obstacle, at least initially, to a course of psychotherapy. A consultation is often the only thing that can be offered to start with, and constitutes an essential stage even for those teenagers who go on to prove themselves able to benefi t from therapy or analysis. The way this fi rst meeting is handled is therefore crucial. The author investigates the diffi culties and paradoxes of this consultation, the particular nature of the ‘time’ of the consultation compared to that of therapy, and the different internal attitude this requires of the analyst. She thus identifi es two separate confi gurations‐a hurried consultation and an interminable consultation‐which can result when the consultation fails in its primary objectives. Both are connected with possible collusive elements in the professional linked to specifi c adolescent angst. The very detailed account of a consultation shows the ‘journey’ made by a 14 year‐old starting from her urgent request to be freed from a symptom experienced as an incomprehensible obstacle, to her gradual development of curiosity towards herself and towards her own mental and emotional make‐up, resulting in her acceptance of therapeutic treatment, which would initially have been impossible.     

The generalization of shared reality: When communication about one target shapes evaluations of other targets

Communicators often tune their message about a target to the audience's attitude toward that target. This tuning can shape a communicator's own evaluation of the target, which reflects the creation of a shared reality with the audience. So far, evidence for shared‐reality creation has been confined to one specific target. In two experiments, we examined whether and when a shared reality would generalize to other targets. In Experiment 1, shared‐reality creation about an ambiguous sexist target generalized to the evaluation of a new ambiguous sexist target for which no audience attitude was provided. However, this happened only when there was high (vs. low) commonality with the audience regarding previous judgments. In Experiment 2, we investigated conditions for the temporal persistence of generalization. One week after message tuning to a high‐commonality audience, a shared reality generalized to a new ambiguous sexist target when participants recalled the shared‐reality creation about the initial target, but it did not generalize in conditions without such recall. Also, no generalization occurred for non‐ambiguous or non‐sexist targets. Results suggest that shared reality generalization depends on perceived commonality with the audience, recollection of shared reality at time of judgment, and similarity between new and initial targets.     

Weaving with the world: Winnicott's re-imagining of reality

For Winnicott, at the root of psychic life is primary creativity from which meaningfulness emerges spontaneously. One non-psychoanalytic source of Winnicott's view can be found in the work of the English romantic poets Wordsworth and Coleridge. Winnicott discovered in these poets kindred spirits who deepened his appreciation of the delicate area between what is perceived and what conceived. The author suggests one way to read Winnicott's theory of primary creativity is as a re-imagining of what it means to have contact with reality. For Winnicott, the emphasis is less on conflict between pleasure and reality and more on contrast between two different kinds of relationship with reality as it becomes increasingly external.     

The latency complex: the dead hand of anti‐development

It is common knowledge that the same phenomena can be viewed in a variety of ways. This paper considers the implications of a constellation observed in some adult patients who have increasingly reminded the author of some of the children of latency age with whom he has also worked. In the literature these patients may also have been thought about in terms of ‘defences of the self’ (Fordham), patients who are ‘difficult to reach’ (Joseph), ‘psychic retreats’ (Steiner), and those who make ‘attacks on linking’ (Bion). They may equally be considered in terms of schizoid, narcissistic or borderline personalities, or as showing features on the autistic spectrum, such as mindlessness and extreme obsessionality. Writers such as Helene Deutsch with her concept of an ‘as‐if personality’, Winnicott with his ‘false self’, and Rosenfeld, discussing the split‐off parts of the personality in narcissistic patients, have also offered much to think about in their consideration of some of these phenomena. This paper proposes yet another vertex – the author's own imaginative conjecture – that is by no means mutually exclusive of any of these others.     

Manipulating body representations with virtual reality: Clinical implications for anorexia nervosa

Anorexia nervosa patients exhibit distorted body-representations. Specifically, they represent their bodies as larger than reality. Given that this distortion likely exacerbates the condition, there is an obligation to further understand and, if possible, rectify it. In pursuit of this, experimental paradigms are needed which manipulate the spatial content of these representations. In this essay, I discuss how virtual reality technology that implements full-body variants of the rubber-hand illusion may prove useful in this regard, and I discuss some issues related to the clinical application of this method.     

Psychic reality in the psychoanalytic process.

The case is made for regarding psychic reality as synonymous with subjective (conscious) experience, which is inherently open to, but not reducible to, unconscious determinants. Both analyst and analysand engage in the analytic relation and interaction from the perspective of their respective psychic realities. Thus, components of the analytic relation--transference/countertransference, alliance, and real relation--are forms of psychic reality. The tensions of subjectivity and objectivity are discussed in relation to the analytic situation, especially with regard to whether the patient's or the analyst's psychic reality is to be given priority or preference. The same reality, situation, or relationship can be viewed from different perspectives and subjected to varying interpretations without any one being exclusively true or false-each may be partially true and/or partially false. The patient's recounting of his history is a part of the patient's psychic reality that intersects with a necessarily divergent account constructed by the analyst. The ensuing dialogue seeks a form of real coherence that is mutually realistic and makes realistic sense for both parties. Reliance on subjective psychic reality becomes a possible, but precarious and potentially misleading, basis for analytic understanding without other observational (verbal and behavioral) or objective data.