Revisioning Fordham's ‘Defences of the self’ in light of modern relational theory and contemporary neuroscience

This paper explores the evolution of Michael Fordham's ideas concerning ‘defences of the self’, including his application of this concept to a group of ‘difficult’ adult patients in his famous 1974 paper by the same name. After tracing the relevance of Fordham's ideas to my own discovery of a ‘self‐care system’ in the psychological material of early trauma patients (Kalsched 1996 ), I describe how Fordham's seminal notions might be revisioned in light of contemporary relational theory as well as early attachment theory and affective neuroscience. These revisionings involve an awareness that the severe woundings of early unremembered trauma are not transformable through interpretation but will inevitably be repeated in the transference, leading to mutual ‘enactments’ between the analytic partners and, hopefully, to a new outcome. A clinical example of one such mutual enactment between the author and his patient is provided. The paper concludes with reflections on the clinical implications of this difficult case and what it means to become a ‘real person’ to our patients. Finally, Jung's alchemical views on transference are shown to be useful analogies in our understanding of the necessary mutuality in the healing process with these patients.     

Distinguishing Between the Facilitating and the Self-Serving Charismatic Group Leader

Winnicott informed us about the components of the facilitating environment. Kohut warned us to differentiate between the charismatic leader, who looks for enfeebled followers to further his own grandiose ambitions, and the idealizable leader whose actions are based on a sense of values. Findings from attachment theory and neurobiology indicate how specific developmental issues make for a perfect fit between the self-serving charismatic leader and those who have been deprived of attuned interactive regulation and secure attachment in early childhood. This article attempts to integrate the above ideas for application to group dynamics in therapeutic, supervisory, training, and institutional groups.     

Undoing trauma: contemporary neuroscience. A Jungian clinical perspective

This paper uses insights from contemporary neuroscience and attachment theory to explore the profound dissociative defences associated with trauma. I discuss the effects of trauma on the emotional, intellectual and imaginative life of the individual and on the development of the self. Based on work with three patients with very different experiences of trauma, the paper offers clinical illustration of 'right brain to right brain' Jungian analysis. I argue that through repeated transference and countertransference experiences dissociative defences may be undone and change brought about.     

Knowledge of Memory Aging Across the Lifespan

ABSTRACT. The authors examined knowledge of normal and pathological memory aging in a lifespan sample of 198 individuals who ranged in age from 13 to 88 years. Participants completed the Knowledge of Memory Aging Questionnaire (Cherry, Brigman, Hawley, & Reese, 2003). The authors hypothesized that high school students would be less knowledgeable about memory aging issues than college students, middle-aged, and community-dwelling older adults. Consistent with this hypothesis, response accuracy was lower for high school students compared to their older counterparts. Follow-up analyses revealed that high school students’ responses to a subset of questions that tap ageist views of adult cognition were less accurate than the other age groups, implying a response bias toward stereotypical images of memory aging. Implications for research and the design of instructional materials to increase people's knowledge about normative changes in adult cognition are discussed.     

Clarifying the Relationship of Dissociative Experiences to Suicide Ideation and Attempts: A Multimethod Examination in Two Samples

Fears of pain, injury, and death may represent key barriers to acting on suicidal thoughts. Dissociation, which involves a disconnection from one’s body, may reduce fears and sensations of pain associated with harming the body, in turn facilitating suicide attempts. This study examined whether dissociation differentiated individuals with a history of suicide attempts from those with a history of suicide ideation, and investigated whether other relevant constructs explain this relationship. Sample 1 included 754 undergraduates (M_age = 21, 79% female) who completed a battery of self-report measures. Sample 2 included 247 undergraduates (M_age = 19, 74% female) who completed a self-report measure of dissociation, a clinical interview regarding suicide history, and four counterbalanced behavioral pain tolerance tasks. In both samples, dissociation was elevated in lifetime attempters compared to ideators (d = 0.28; d = 0.46; ps = 0.01) and slightly elevated in lifetime ideators compared to nonsuicidal individuals (d = 0.19, p = .02; d = 0.24, p = .47), though this effect was non-significant in the latter sample. In Sample 1, dissociation no longer differentiated attempters from ideators after controlling for clinical covariates. In Sample 2, dissociation was unrelated to behavioral pain tolerance tasks, and these tasks did not account for the association between dissociation and attempts. Overall, dissociation differentiated individuals with a history of suicide attempts from those with ideation alone in both samples. Pain tolerance did not explain this association; instead, it is possible that the relationship of dissociation to suicide attempts is due to “third variables” associated with both phenomena, such as symptoms of borderline personality disorder or posttraumatic stress disorder.     

Values and Beliefs of Vegetarians and Omnivores

Abstract

Following the claim by some anthropologists and sociologists that 1 symbolic meaning of meat is a preference for hierarchical domination (C. J. Adams, 1990; N. Fiddes, 1989; D. D. Heisley, 1990; J. Twigg, 1983), the authors compared the values and beliefs of vegetarians and omnivores in 2 studies conducted in New Zealand. They compared the full range of vegetarians and omnivores on right-wing authoritarianism, social dominance orientation, human values, and consumption values. The participants tending toward omnivorism differed from those leaning toward veganism and vegetarianism in 2 principal ways: The omnivores (a) were more likely to endorse hierarchical domination and (b) placed less importance on emotional states. Accordingly, the acceptance or rejection of meat co-varied with the acceptance or rejection of the values associated with meat; that finding suggests that individuals consume meat and embrace its symbolism in ways consistent with their self-definitions.     

Towards a relational framework for pathological gambling (Part I): Five circuits

Relationship patterns before and after pathological gambling were investigated qualitatively using eight in‐depth clinical case studies in which one partner met Diagnostic and Statistical Manual of Mental Disorders‐IV pathological gambling criteria. Five circuits of couple interactions are described: (i) fault‐lines; (ii) pressure points; (iii) escalation; (iv) relapse and (v) congruence. The exploration of these circuits is developed in two complementary articles. This first article delineates the first four circuits as recursive self‐perpetuating cycles of couple distress in systemic interaction with pathological gambling development and relapse. The second article delineates how a couple can be helped to extricate themselves from these recursive circuits through ‘congruence’. Implications of this relational formulation of pathological gambling for conceptualization, assessment and treatment are discussed.     

宫腔镜检查在诊断子宫内膜息肉中的价值分析

通过比较超声、宫腔镜检查与病理诊断子宫内膜息肉的结果,以及超声诊断结果阴性的病例中,宫腔镜与病理诊断的差异检出率,探讨宫腔镜检查对正确诊断子宫内膜息肉的重要性.回顾性收集连续在我院妇科行宫腔镜检查且证实子宫内膜息肉诊断的住院患者共730例.总结各病例超声诊断、宫腔镜检查及病理诊断的结果.统计分析显示,三者诊断子宫内膜息肉的检出率分别为82.7％、93.4％、90.8％.其中,由超声检查漏诊的子宫内膜息肉患者共126例,宫腔镜及病理检出率分别为96.8％、88.1％,且两者的阴性结果互不重叠,这种诊断差异在超声诊断结果示内膜增厚/内膜厚薄不均病例中尤为显著.因此,子宫内膜息肉的诊断方式中,宫腔镜诊断检出率最高,但仍有漏诊的病例由病理确诊,研究认为宫腔镜检查是确诊子宫内膜息肉的重要诊断方法.     

Controlling,Avoiding, or Protecting the Object: Three Reactions to the Breakdown of Psychic Retreats

In working psychoanalytically, it is common to encounter patients who need to carefully manage their immediate objects. This is evident in their stories about external life at home, at work, and with friends as well as in how it emerges within the transference. While a frequent theme in many analytic cases, the motives behind this need are varied.

Case material is used to show how these reactions emerge when psychic retreats fail. When unable to find refuge in pathological organizations or psychic retreats, patients are exposed to the worst of paranoid and depressive anxieties with only a fragile foxhole to withdraw into or defend from. In such a precarious psychological state, fantasies of unbearable self and object danger emerge, leading to various forms of acting out, overreliance on projective identification, and perverted images of giving and receiving. These fantasies result in the desire for idealized objects, the drive to resurrect fallen objects, and the need to avoid cruel and attacking objects that have taken over and replaced the sought out ideal.     

From “It's Not Me” to “It Was Me,After All”: A Case Presentation of a Patient Diagnosed with Dissociative Identity Disorder

In cases of extreme childhood trauma associated with abuse and neglect, one's sense of self is seriously compromised. Attachment patterns, symptoms, defensive operations, and character formation will differ depending upon the level of interference and impingement. When repeated trauma occurs in early childhood, the dissociative response may become the first line of defense for the person to rely upon. In its most severe form, patients are diagnosed with Dissociative Identity Disorder (DID). This paper addresses the case of a woman diagnosed with DID. It describes the restoration of a cohesive sense of self from the eight parts of a dissociated and fragmented self in the course of therapy. The clinical case material presented is that of the child part of her, known as Lucy. Her treatment resulted in the integration of the “it's not me!” self to the patient's knowledge that “it was me, after all.”