Manic depression and religious experience: The use of religion in therapy

In the article, I explore the use of spiritual strategies in the treatment of manic depression in religiously oriented psychiatric inpatients. Manic depression, a disorder primarily of mood, is characterized by bouts of mania alternating with depression. Religious themes and mystical experiences pervade the language of manic depressive illness, e.g., sensing one is God, being given a divine mission, receiving divine messages, having ecstatic experiences, and so on. Debate exists concerning the effectiveness of spiritual interventions in manic patients. I suggest that a trained religious leader may be able to work therapeutically with such patients, provided that two goals are kept in mind: emphasizing beliefs that facilitate positive coping and challenging irrational religious beliefs (i.e., beliefs that lead to negative coping). When examined psychoanalytically, patients’ religious symbols and beliefs reveal deeply held beliefs about themselves. In particular, splitting and idealization and devaluation can be seen in their religious belief system. The role of culture in promoting maladaptive belief systems must not be overlooked. In employing spiritual interventions in patients diagnosed with manic depression, potential dangers are imposing one's values on patients and overstating the importance of spirituality.     

The Representation of the Shoah in Maus: History as Psychology

The contemporary tendency in United States culture to substitute a discourse of psychology for political and social analysis is especially evident in treatments of the Shoah. Drawing on postmodernist techniques, Art Spiegelman's“Holocaust commix”, Maus, dramatizes not historical reality but the effort of representing the memory of trauma. In the absence of symbolic authority, suffering from rivalry with his father and haunted by the real of the father's voice, the son becomes the subject of the narration. Like Maus, the Holocaust Museum in Washington, D.C. and the criticism of Dominick LaCapra focus on the psychological processes of the private individual. This revised version was published online in August 2006 with corrections to the Cover Date.     

An Attachment Perspective on Reunions in Couple Psychoanalytic Psychotherapy

Psychoanalysis has been slow to acknowledge attachment theory as one of its own. Yet traditions of observational and representational research associated with it have much to offer in shedding light on intrapsychic as well as interpersonal phenomena. This paper explores these traditions and their potential clinical utility for couple psychoanalytic psychotherapy. In particular, attention is drawn to behaviour and representations associated with the experience of reunion in therapy sessions.     

Family Dynamics and AIDS Phobia: A Case Study

The author introduces and defines AIDS phobia. He illustrates the hypochondria type of AIDS phobia from a combined individual, couple, and family treatment perspective. He describes the treatment process and outcome after an effective countertransference-based intervention, connects the individual manifestations of the index patient's illness to the family dynamics, and concludes with an analysis of the multigenerational contributions to the individual's psychopathology.     

Rejoinder to Harold Blum2

The author's main disagreement with Harold Blum is over Blum's contention that symptomatic improvement is directly linked to the recovery of memories. The idea that memories are laid down in childhood and preserved until the time of their later recovery flies in the face of what we now understand as the creation of memories by the neurobiological systems underpinning this aspect of mental function. No evidence directly links symptomatic improvement to reconstruction and thus to outcome; care should be taken to avoid confusing co‐occurrence with causality. While reconstruction of how things actually were in childhood can significantly contribute to therapeutic action, it is the process rather than the outcome of this reconstruction that is therapeutic, due to the opportunity thus afforded to rework current experiences in the context of other perspectives. The author clarifies his definition of transference to show some areas of agreement between his position and Blum's. He disusses contemporary neuroscientific views on memory and identifies a number of psychoanalytic writers who have used these productively.     

Reaction to Mortality: An Interdisciplinary Organizing Principle for the Human Sciences

Ernest Becker's theory about death denial is one example of depth psychological theory. Because very important features of Becker's theory have now successfully and singularly met the rigorous empirical testing of Terror Management Theory (TMT), it must be concluded that the theory of death denial stands apart from and above alternative depth psychological theories in explaining human behavioral and attitudinal motivation. Nevertheless, TMT only touches the surface of Becker's theory in the round. This essay looks at how Becker's wider theories of death denial are applied to (1) personal psychological, (2) social psychological, (3) political, and (4) spiritual aspects of human experience and suggests that what Becker has given us is an organizing principle, a theory of considerable integrative, explanatory, and interpretive power, for a broadly interdisciplinary social science of human behavior.     

Further considerations of theory,technique, and affect in child psychoanalysis: Two prelatency cases

The analyses of two young boys, 4½ and 5 years old, are presented. One child was severely inhibited and nearly mute; the other was disorganized, frenetic, and violent. In the context of these treatments, the author raises several questions related to clinical theory and technique, including the use of early interpretation of affect with such children; the possible benefit of verbalizing primary affects in this early interpretive work; and the roles of verbalization and affect in work with caregivers and adult patients.     

Don’t tell me I’m normal: inpatient psychotherapy of a severely abused patient at the Cassel Hospital

This paper is a case study of a patient with severe personality disorder undergoing treatment at the Cassel Hospital. It looks at a phase of her individual psychoanalytic psychotherapy and how that sits within an institutional model of treatment that can be understood as applied psychoanalysis, in which Tom Main’s concept of a ‘culture of enquiry’ aims to observe and bring together splitting and projective processes operating at all levels of the organisation. The patient, who had been sexually abused and then suffered a prolonged suicidal breakdown, exerted intense pressure on the institution through her experience of herself as both a victim of abuse and a participant in it. A working through is described, in which different parts of the patient that had been projected into different parts of the institution are brought together, and her primitive demand for a two-person world gives way to an acceptance of triangulation. Themes from her individual sessions are enacted in the milieu-based treatment, and conversely struggles in the patient community appear in her sessions. It is from drawing these parts of the patient together as a whole institution that the treatment derives its power and effectiveness.