On the Normal and Pathological Middle-age Crisis—Erich Maria Remarque,a Lost Survivor

The case illustration is from a long-term experience of individual psychoanalytic psychotherapy with a male patient, who started therapy when he was 15-years- old. According to DSM-IV criteria, he was diagnosed with a major depressive disorder. A psychological assessment including a Rorschach test showed a poorly integrated but well-adapted Borderline-Narcissistic personality disorder. Various classes of ant-idepressant drugs were used with equivocal or uncertain effects, and the roots and causes of the patient's negative reactions to medication had to be thoroughly investigated and dealt with during psychotherapy. Pharmacotherapy might succeed in targeting the various symptoms of depressive states, but the psychodynamic approach in a psychotherapeutic relationship widens the scope and works introspectively, allowing the patient insights to understanding the symptoms. The use of a psychotropic agent is usually based on trust and belief in its expected effect, but often the effect is not as expected. The psycho- pharmacological drug is also imbued with manifest and latent meanings which can be reached at in the psychoanalytic report. Such meanings and expectancies, and the consequent reactions affect both the patient and the psychotherapist. They have to be dealt with and overcome by psychoanalytic understanding and intervention, as well as experience and skill in use of the medicine concerned.     

Opening Gambits

This study discusses the rôle of destruction and destructive fantasies in forming a relationship to the body and in experiencing the reality of the body. The starting points are Freud’s conception of the nature of the drives and Winnicott’s theory on the use of an object. The central assumption is that the destructive impulses and fantasies directed towards the body create and strengthen the experience of the body as a part of the extrapsychic reality. By improving the trust in the continuity of bodily existence, they help to lessen the experience of the body as a subjective object which improves our relationship to our bodily reality.     

THE FREUDIAN UNCONSCIOUS IN THE CONTEXT OF THE COGNITIVE ORIENTATION

The essence of the story of King Oedipus forms a cornerstone of psychoanalysis since Freud. Oedipality means the painful experience of the child who is left outside the mutual relationship between the parents and the child's wish to kill one parent and marry the other one. The life-long oedipal attitude and relationship develop in dyadic and triadic relationships. An example is given of a boy whose dyadic relationships are threatened by triads, and whose triads are threatened by integrated oedipality. Only after the oedipal situation is worked through does it become possible to live and love in reality, and to maintain manifold relationships. This development is also reflected in thinking, which only slowly develops into multidimensional levels of symbolization and thought. Prior to this development, we continue to “marry dyads” and “kill triads” and remain driven by dyadic and triadic wishes in all fields of our life.     

Contextual Connections to Puns in Tom Swifties

Previous research conducted with short fables was replicated in this study with Swifties in which sentence length and presence of a pun were controlled. Of the 24 one-sentence word plays shown to each participant, half had an enhanced contextual connection that was predicted to increase appropriateness and detection of the incongruity, resulting in heightened perceived cleverness and humor. Results supported predictions, showing especially strong enhancement of perceived cleverness. The authors suggest that this outcome could be generalized to other forms of word play.     

OTR Burnout

When job stress beconies chronic, it can result in the syndrome of burnout. This is characterized by feelings of reduced personal accomplishment, emotional exhaustion, and depersonalizing attitudes towards patients and colleagues. This pilot study explored burnout in a sample of hospital-based registcrcd occupational therapists employed in Virginia. Scores from 129 OTRs on the Maslach Burnout lnventory and a demographic data sheet were analyzed. Burnout scores were compared for OTRs working in physical disabilities, mental health, and developmental disabilitics. Also, the subjects were compared bascd on time spent in direct patient scrvice. The sample rcported moderate levels of burnout. The only statistically significant finding was that the OTRs who spent the least time with patients reported more depersonalization (intensity only) than their peers. Thc results did not replicate those from a previous report that psychiatric occupational therapists arc experiencing more burnout than other occupational therapists. Much further research appears to bc needed on the topic.     

Concurrent and Longitudinal Relationships Between Development in Graphic,Language and Symbolic Play Domains from the Fourth to the Fifth Year

This research investigated the developing inter‐relationships between language, graphic symbolism and symbolic play both concurrently and longitudinally from the fourth to the fifth year of childhood. Sixty children (n = 60) aged between 3 and 4 years completed multiple assessments of language and assessments of graphic symbolism, symbolic play and non‐verbal intelligence. A year later, 31 children (n = 31) were re‐tested using the same assessments. The findings revealed that skills within each symbolic domain were inter‐related during the fourth year, appearing to develop in a domain‐general type fashion based upon a common underlying symbolic mechanism. However, between the fourth and the fifth years, only language had predictive validity, suggesting a shift towards the verbal mediation of symbolic play and graphic symbolism as language becomes progressively internalized (Vygotsky, 1962, 1978). Copyright © 2012 John Wiley & Sons, Ltd.     

Book Reviews

Abstract

There are many brief, demanding, aborted cases that no one ever writes about. The typical psychoanalyst or psychoanalytic psychotherapist, however, has many outpatient cases that are shortlived, intense encounters with very disturbed patients. Rather than ignore these encounters as non-analytic or non-instructive, I think these cases add to our knowledge about the mind and its functions. In addition, it is unrealistic to think we can always help a very anxious and disturbed person to enter the treatment process with immediate success. It is more instructive to apply the analytic method and offer the patient what we can and have both analyst and patient learn as much as they can in the time they are able to stay together. Using case material, I show the Kleinian approach to working analytically with these difficult patients. Whether focusing on transference or extra-transference material, the analyst interprets the patient's internal phantasies and anxieties regarding the self and the self's important objects. This analytic stance tends to relieve the immediate anxiety and set the stage for potential self-reflection and the start of basic working-through processes.     

Stumbling along in the Countertransference: Following Up Enactments with Balanced Therapeutic Interpretations

In the course of a psychoanalytic treatment, many clinical situations create countertransference pulls or invitations to participate in enactments of various degrees. In these projective identification-based transferences, the patient is often successful in drawing the analyst into archaic object relational patterns of acting out. During these moments, the analyst must struggle to find a way to stay therapeutically balanced. The urge to rush to judgment with punitive, seductive, rejecting, controlling, or manipulative comments rationalized as interpretations must be managed. If these unavoidable countertransference enactments are managed and studied, they can provide useful information about the patient's internal struggles and can show the way to making more helpful and more therapeutic interpretations. Case material is used for illustration.     

Criticism of the Theory of Motivation

The theory of motivation is a theory which takes the executora＇s motivation as the basis of moral judgment. One presupposition of the theory is that motivation can be a common object of understanding. However, motivation exists only in the heart of the executor, and cannot be known exactly by others, so motivation cannot be perceived like a common object, and thus, logically, cannot be the basis of moral judgment. Even if the executor＇s motivation is accepted by others and turned into a common object, the motivation still cannot become the valid basis of a moral judgment. This is the dilemma of the theory of motivation. In practice, the dilemma appears as follows： if one insists on the theory of motivation, one can be led to the result that people do evil with good intentions. However, just because motivation cannot be the basis of moral judgment does not mean that motivation is of no significance. Good motivation is always better than evil motivation. Therefore, in moral education we should carry out motivation education and teach people to strive to have good motivations for their behavior. This is the value of motivation theory.     

The Passion as ludic practice—understanding public ritual performances in late modern society: a case study from the Netherlands

This article offers the case study of a contemporary mediatized Christian passion event that takes place annually in the public sphere in the Netherlands. Contributing to debates in various studies of religion regarding religious change in late modern societies, the authors propose the concept of ‘play’ that, although not a new concept to the study of religion or ritual, is well suited to investigate religious ritual in a liquid modern world that is characterized by, as scholars state, a global ludification of culture. Play helps to explain that and in what ways a mediatized event like The Passion in a digital media culture opens a ludic space for many people, where their hermeneutical faculty to deal with the sacred is activated. This can resolve the paradox that, in a still secularizing country like the Netherlands, a ritual on the suffering and death of Jesus Christ can be so popular.