Psychosis: A Synthesis of Motivational and Defect Perspectives

Based on the evolution of human intelligence and the tremendous cognitive capacities arising from it, we have an innate tendency for the extreme thought content, thought form, and sensory perceptions of psychosis. During the conscious and awake state, cognitive regulatory control processes block these more extreme variants to facilitate reality congruency necessary for adaptive functioning. While asleep there is no need for reality congruency and the cognitive regulatory control processes are deactivated allowing psychotic equivalents to be expressed in dreams. This paper helps synthesize the two dominant perspectives regarding the etiology of psychosis: the neuroscience defect perspective and the psychoanalytic motivational perspective. Regarding the former, defective cognitive regulation arising from certain conditions, such as the deficit state of schizophrenia, allows extreme cognitive distortions, thought form variants, and sensory perceptual experiences to intrude into the conscious and awake state, thereby producing psychosis. Consistent with the psychoanalytic motivational perspective, defensive processes can motivate extreme cognitive distortions, thought form variants and sensory perceptual experiences, and also facilitate their expression by deactivating the relevant cognitive regulatory control processes.     

Critical Transference in a Case of Severe Epilepsy

In this paper, the author presents a summary of a brief treatment with a young woman, suffering from severe epileptic illness, which describes the mutuality of cross-transferences of deep and intense feelings and the unorthodox way to receive, to take in persons affected with critical phenomena. This treatment was deeply influenced by the traumatic triad, borrowed from Ferenczi: "amnesia, anaesthesia, aboulia," the ways of forgetting (or erasing) the past/the present/the future. The investigation led us to clarify, on the one hand, the incestophilic-or perhaps incestuous-source in the family, and on the other, the burdensome and tragic genealogy and history of each parent. At the end of this short treatment, which took place at a frequency of one session a week (with the patient sitting, standing, lying on the floor; with sometimes severe fits, deliria, threats; bringing of letters, texts, drawings; and a few phone calls), there was an alleviation of the critical phenomena and revival.     

Approaching stimuli bias attention in numerical space

Increasing evidence suggests that common mechanisms underlie the direction of attention in physical space and numerical space, along the mental number line. The small leftward bias (pseudoneglect) found on paper-and-pencil line bisection is also observed when participants 'bisect' number pairs, estimating (without calculating) the number midway between two others. Here we investigated the effect of stimulus motion on attention in numerical space. A two-frame apparent motion paradigm manipulating stimulus size was used to produce the impression that pairs of numbers were approaching (size increase from first to second frame), receding (size decrease), or not moving (no size change). The magnitude of pseudoneglect increased for approaching numbers, even when the final stimulus size was held constant. This result is consistent with previous findings that pseudoneglect in numerical space (as in physical space) increases as stimuli are brought closer to the participant. It also suggests that the perception of stimulus motion modulates attention over the mental number line and provides further support for a connection between the neural representations of physical space and number.     

Empathy Deficit in Antisocial Personality Disorder: A Psychodynamic Formulation

Empathic difficulty is a highly consequential characteristic of antisocial personality structure. The origin, maintenance, and possible resolution of this profound deficit are not very clear. While reconstructing empathic ability is of primary importance in the treatment of antisocial personality, not many proven procedures are in evidence. In this article, the author offers a psychodynamic formulation of the origin, character, and maintenance of the empathic deficiency in antisocial personality. The author discusses some of the treatment implications from this dynamic formulation.     

How Does Neurobiological Research Influence Psychoanalytic Treatments?—Clinical Observations and Reflections From a Study on the Interface of Clinical Psychoanalysis and Neuroscience

One of the counterarguments against empirical research in psychoanalysis is that research negatively influences the treatment situation. In this paper, the impact of a neurobiological study on psychoanalytically oriented treatments is presented from three different perspectives: patients' views, a study group of participating psychoanalysts and a clinical case example. Twenty chronically depressed patients, 20 healthy controls and 16 psychoanalysts participated in the project on research. Results show a clear influence of the neurobiological study on the course of treatments. Patients consistently reported that study participation had a positive impact on their treatment experiences. However, study participation was conflictual for the psychoanalysts and forced them to carefully reflect on their unconscious and conscious involvement to establish a psychoanalytic stance independent from empirical research.     

Rankian Will

Otto Rank (1884–1939) served as Freud's closest partner in the psychoanalytic movement from 1906 to 1926. From 1923 on, Rank, initially with Ferenczi, focused on making analysis more therapeutic, emphasizing current experience in the session over historical exploration and interpretation. Rank settled on will as a missing factor, and wrote extensively about it after the break with Freud in 1926, when he moved to Paris. He emphasized the here-and-now, redefined “resistance” as a positive aspect of counter-will, and suggested a time limit for analysis. Ousted from analytic circles in 1930, he eventually moved to New York, continuing to treat patients and teach until his unexpected death at 55 in 1939. After decades of obscurity, Rank has gained readers and therapists whose orientation is interpersonal, client-centered, relational, humanistic, or existential. His influence on post-Freudian ego-psychology is finally being acknowledged as are his ideas about creativity, will, life-fear and death-fear, guilt, and ethics.     

The Rank–Ferenczi Relationship,as Seen from France

Seen from France, where Rank's “American” work is not well known, the Rank–Ferenczi relationship does not allow to state that the two learned colleagues were the best friends. Rank met Ferenczi in 1908, but their most valuable and fruitful working relationship is limited to the 1922–1924 time period. Their working relationship must be read in light of the unique transference links of each to Freud, and in light of the tormented history of the analytic movement, especially after the First World War. The sensible reader will not forget that after the fast extinction of their short collaboration they continued their own works in their own ways, Otto Rank in Paris and in America and Sándor Ferenczi in Budapest. No more friends, nor enemies, but both, in a different style, brave and creative analysts.