The mental pain of the psychoanalyst: A personal view

Abstract

Mental pain is a common concern of psychoanalysts in their professional life. Combining her clinical experience with previous contributions by others, the author presents a personal overview of the patient-triggered mental pain of the analyst. Countertransference is considered to be the major source of the analyst's work-derived mental pain. This type of mental pain is not to be avoided or discarded by the analyst. Rather, the analyst will benefit from tolerating and even welcoming professional mental pain: in most cases, mental pain will bring with it rich clinical material that, upon interpretation, will help him or her to offer previously intolerable contents back to the patient in a transformed version that now becomes acceptable. The analyst's mental pain may emerge in his dreams; clinical examples of this phenomenon are presented. It is suggested that there is an increased chance of the analyst undergoing mental pain when treating patients suffering from severe psychopathology, and a clinical case is reported to illustrate this assertion. The author proposes that a lifelong effort is to be expected from analysts in terms of enhancing their threshold of tolerance to professional mental pain. In situations of mental pain, analysts must be particularly aware of the need to modulate their interpretations before transmitting them to the patient. The capacity of analysts to transform their mental pain (Ta, according to Bion) will depend on the plasticity of their container functions, the quality of their transformation abilities and, in particular, their threshold of tolerance to mental pain.     

Distinction between mental pain and psychic suffering as separate entities in the patient's experience

Abstract

Mental pain and psychic suffering are herein defined as two separate concepts in psychoanalysis. The concept of mental pain lies at the core of psychoanalysis; it was introduced by Freud and was further elaborated by a number of investigators, mostly by Bion. Mental pain refers to a pain that the patient reports as being impossible to describe in words, and lacking any associations, whereas psychic suffering can be both named and described by the patient. Mental pain is derived from non-tolerance on the part of the psychic apparatus when it is harmed by very painful emotions. In contrast to psychic suffering, mental pain resists elaboration and transformation by dream-work. How to address and transform the patient's mental pain is a major challenge facing the analyst in his clinical work because mental pain may halt or slow the progression of the analytical process. To overcome this hindrance, the work of the analyst is focused on helping patients to modify their mental pain into psychic suffering, that is, to reactivate in the patient the chain of transformations that generates thought. The analyst is also challanged with the mental pain of the patients because he has himself to tolerate the mental patient induced by counter transference. Suggestions for the analyst on how to deal with the mental pain of the patient during psychoanalytic therapy are proposed.     

Twist Structures and Nelson Conuclei

Studia Logica - Motivated by Kalman residuated lattices, Nelson residuated lattices and Nelson paraconsistent residuated lattices, we provide a natural common generalization of them. Nelson...     

Is interoceptive awareness really altered in somatoform disorders? Testing competing theories with two paradigms of heartbeat perception

Alterations in the perception of body signals (i.e., interoceptive awareness [IA]) are considered crucial for the development and maintenance of somatoform disorders (SFDs). However, competing theories come to different conclusions about whether IA is increased or decreased in SFDs. The present study investigated IA in 23 patients with SFDs (as defined by the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) and in 27 healthy controls. IA was reliably assessed with two well-established heartbeat perception paradigms (heartbeat discrimination task and mental tracking task). The results of both paradigms showed no evidence for increased IA in patients with SFDs. Correlational analyses revealed that having a higher number of somatoform symptoms was significantly linked to lower (rather than higher) IA in SFDs. These findings are in line with recent cognitive approaches to SFDs that stress the importance of biased schema-guided processing of interoceptive information. (PsycINFO Database Record (c) 2012 APA, all rights reserved).     

Neural correlates of perceptual narrowing in cross‐species face‐voice matching

Integrating the multisensory features of talking faces is critical to learning and extracting coherent meaning from social signals. While we know much about the development of these capacities at the behavioral level, we know very little about the underlying neural processes. One prominent behavioral milestone of these capacities is the perceptual narrowing of face–voice matching, whereby young infants match faces and voices across species, but older infants do not. In the present study, we provide neurophysiological evidence for developmental decline in cross‐species face–voice matching. We measured event‐related brain potentials (ERPs) while 4‐ and 8‐month‐old infants watched and listened to congruent and incongruent audio‐visual presentations of monkey vocalizations and humans mimicking monkey vocalizations. The ERP results indicated that younger infants distinguished between the congruent and the incongruent faces and voices regardless of species, whereas in older infants, the sensitivity to multisensory congruency was limited to the human face and voice. Furthermore, with development, visual and frontal brain processes and their functional connectivity became more sensitive to the congruence of human faces and voices relative to monkey faces and voices. Our data show the neural correlates of perceptual narrowing in face–voice matching and support the notion that postnatal experience with species identity is associated with neural changes in multisensory processing ( Lewkowicz & Ghazanfar, 2009 ).     

The update of semantic memories in amnestic mild cognitive impairment

It is still controversial to what extent neocortical consolidated memories are susceptible of change by processes of reconsolidation and transformation throughout experience, and whether the medial temporal lobes are necessary for this update of semantic consolidated memories, as they are for episodic remembering. We hypothesize that patients with amnestic mild cognitive impairment (aMCI) who have deficits in episodic memory may also have difficulties in updating information on added new features of objects. Sixteen participants with aMCI and 20 healthy control participants performed a semantic word-to-picture task, in which they were asked to identify as belonging to a given semantic category NEW objects, that have incorporated novel features, as well as OLD items, semantically and visually SIMILAR items and UNRELATED items. Patients with aMCI made a greater percentage of errors than healthy controls. Participants globally made greater percentages of errors in difficult types of items, namely NEW and SIMILAR, as compared to easier ones, OLD and UNRELATED. Importantly, an item by diagnostic group interaction effect was observed, and post hoc analysis showed that patients with aMCI made a higher percentage of errors than controls in NEW items only. In conclusion, patients with aMCI had a particular difficulty in identifying the NEW items of the word-to-picture task as compared to the control participants, supporting the concept of a flexible and dynamic conceptual knowledge system, involving the update of semantic memories and the integration of new attributes in a constant transformation process, which is impaired in these patients.     

The Psychosomatic Relationship As A Symbolic Circular Communication: Subjective And Transgenerational Dreams

The human being can be divided into body and mind, two inextricably linked aspects influencing each other. From birth, the body is the site of emotional experiences thanks to cellular memory. The transgenerational and the oneiric imaginary are two themes closely related to the body. Many families express their emotional experiences through bodily symptoms and, in dreams, body icons are used to “talk” about the subject’s identity. The body expresses itself and “speaks” through dreams, which can even become predictors of diseases.     

Accessing source information in analogical problem-solving

Several studies showed that people presented with source information fail to apply it to an analogous target problem unless they are instructed to use the source. Seven experiments were carried out to assess whether such a lack of spontaneous transfer occurs because individuals do not activate the source during the target task or because they do not realize the source-target relationship. Experiment 1 compared a condition in which the source was activated with no cue about the source-target connection to conditions in which subjects were informed about this connection. Results suggested that the lack of spontaneous transfer does not depend on failure in activating source information. Experiments 2, 3, and 4 were devised to falsify this finding by activating the source closer and closer to the target and by focusing participants' attention toward the relevant aspects of the source. Experiments 5, 6, and 7 were aimed at stressing source-target correspondences by introducing surface similarities. All experiments showed that the mere activation of the source does not facilitate analogical transfer. Results suggested that two processes should be distinguished in the access phase of analogical problem-solving: Source retrieval and identification of the source-target connection.