Fonagy and Freud. Psychological versus psychic reality

Peter Fonagy and Mary Target present their Playing with reality theory as a developmental theory centred on the concept of psychic reality. This paper compares Fonagy and Target's use of the concept of psychic reality with Freud's original concept. It is argued that the concept of psychic reality has been redefined from delineating a psychic reality stemming from the unconscious to denoting a kind of conscious or preconscious psychological reality characterized by an experience of equality between the internal and the external worlds. The theoretical discussion is illustrated by being applied to eating disorder pathology, which by Fonagy and colleagues is described as associated with thought processes characterized by psychic reality.     

Counter-narratives in context: The role of the organisation and broader culture in psychic splitting among South African survivors of intimate partner violence

Chronic trauma, shame and psychopathology, as well as the association between them, are acutely understudied, both in South African and internationally. The focus of this article is on chronic trauma of a particular kind, intimate partner violence (IPV) and the development of a specific form or shame-related psychopathology, the splitting of self and how this splitting may be further facilitated or exacerbated by the contexts in which people live. The (counter) narratives of three women are presented. These (counter) narratives demonstrate the presence of both a concealed and shameful authentic self, and the socially conforming projected false self, two polarised parts of the psyche. It is argued that the organisational context, a shelter for survivors of IPV, which has a strong ethos centred around advocacy and human rights and which promotes a strong message of personal empowerment and agency, may unintentionally exacerbate the psychic split in women who have been subjugated at a broader (predominantly patriarchal) cultural level their whole lives. Participants’ resistance narratives were often characterised by inconsistencies and contradictions which oscillated between supporting mainstream cultural narratives and organisationally driven, active resistance against the cultural context from which they came. However, resistance narratives often felt thinly veiled and inauthentic, which is one of the problems with interventions in resource constrained settings which are necessarily time-limited. To fully and completely counter the cultural message that has been the focus of participants’ lifelong gendered socialisation, long-term and in depth interventions at organisational level are needed. These ideas are not only relevant to the South African setting, but have wider application internationally.     

Theological and Ethical Reflections on Men and Violence: Toward a New Understanding of Masculinity

Abstract

This paper explores the reasons why men express violence against women, children and other men, suggesting that men's violence represents one of the darkest features of masculinity. The way men are socialized and conditioned requires and produces violent behaviors that are destructive to men themselves as well as to women, children, and the earth. The author proposes the need to re-envision masculinity to enable men and women to create communities in which people are encouraged to participate in ‘adventurous partnering for peace’.     

The Dracula killer: A psychobiographical illustration of the Schahriar syndrome model for serial murder

This psychobiographical study of Richard Trenton Chase (1950–1980), a serial murderer, has the aim to uncover the psychic mechanisms characteristic of his functioning. The study included primary and secondary data sources. All materials collected and analysed, were published and publically available. The Schahriar syndrome model served as the conceptual framework for data framing and interpretation. Findings suggest that Chase exhibited five primitive psychic mechanisms namely: omnipotence, sadistic fantasies, ritualised performance, dehumanisation and symbiotic merger. The Schahriar syndrome model has utility to explain the psychological functioning of a serial murderer.     

平行病历在门诊癌痛患者规范管理中的应用研究

为探索平行病历在门诊癌痛患者规范管理中的作用,选取在疼痛科癌痛门诊就诊的76例患者为研究对象,随机分为对照组37例、观察组39例。所有患者均于首诊、第2周、4周、12周复诊时,完成相关问卷调查。对照组给予常规治疗,用药指导等。观察组除常规治疗和用药指导外,为每位患者建立平行病历及复诊档案。结果显示：观察组疼痛控制情况、生活质量改善、服药依从性及就诊满意度,均优于对照组,差异有统计学意义(P＜0.05)。本研究提示,平行病历有助于改善患者疼痛控制情况和生活质量,提高服药依从性和就诊满意度,改善医疗人文环境,为癌痛患者及家属提供富含共情、关注和尊重的诊疗服务,有利于门诊癌痛患者规范化管理。

     

Processes of change in psychological flexibility in an interdisciplinary group-based treatment for chronic pain based on Acceptance and Commitment Therapy

There are now numerous studies of Acceptance and Commitment Therapy (ACT) for chronic pain. These studies provide growing support for the efficacy and effectiveness of ACT in this context as well as for the role of ACT-specific therapeutic processes, particularly those underlying psychological flexibility. The purpose of the present study was to continue to build on this work with a broader focus on these processes, including acceptance of pain, general psychological acceptance, mindfulness, and values-based action. Participants included 168 patients who completed an ACT-based treatment for chronic pain and a three-month follow-up. Following treatment and at follow-up, participants reported significantly reduced levels of depression, pain-related anxiety, physical and psychosocial disability, medical visits, and pain intensity in comparison to the start of treatment. They also showed significant increases in each of the processes of psychological flexibility. Most uncontrolled effect sizes were medium or large at the follow-up. In correlation analyses changes in the four processes measures generally were significantly related to changes in the measures of depression, anxiety, and disability. In regression analyses the combined processes were related to changes in outcomes above and beyond change in pain intensity. Although in some ways preliminary, these results specifically support the unique role of general psychological acceptance in relation to improvements achieved by treatment participants. The current study clarifies potential processes of change in treatment for chronic pain, particularly those aiming to enhance psychological flexibility.     

Narcissism, hypochondria and the problem of alternative theories

This paper is an experiment in conceptual integration and clinical theory testing. Its argument is that narcissism and sexual object love develop from a single source and continue to interact during childhood development and adult life (Freud) and that drives in their oedipal and other formations are not merely disintegration products of narcissism (Kohut). Material from two analyses, supplemented by material from two others, indicate that narcissistic injury was a significant factor in the neuroses of these patients but that aggressive and libidinal conflicts were also decisive such that their hypochondriac symptoms were compositions of their interacting causality. As a result these neuroses are negative instances of Kohut's theory of narcissism. The hypochondriac symptoms as they emerged could not have had the structure and dynamics they actually had nor could the analytic process these patients underwent have achieved the far-reaching and durable amelioration of these symptoms that occurred. On the positive side, these analyses are but two inductive instances that support Freud's theory. However, one major difficulty of the faddishness of psychoanalytic theorizing is that much of worth is lost from general theories that turn out not to be supportable. The clinical material from these two cases which disprove basic elements of self-psychology metapsychology also require adjustments to classical theory that integrate the contributions of self-psychology to psychoanalytic clinical theory.     

Psychotic withdrawal and the overthrow of psychic reality1

The author attempts to distinguish between the world of fantasy and the imagination (which fuels our capacity to ‘dream’) from a withdrawal into fantasy. In this withdrawal, the foundations of which are laid in childhood, a dissociation from psychic reality starts and from it the delusional world arises and constitutes the adult illness. During therapies of adult patients who have experienced a psychotic state, it is often possible to reconstruct the state of infantile withdrawal and understand how their dissociation from reality was ignored or unknowingly encouraged by their parents. Children destined to develop psychosis enter into the dissociated world not just as a defence against anguish or loneliness, but also for the pleasure of experiencing a delusional self‐suffi ciency and a gratifying omnipotence in which anything is possible. Mental workings that take place in the withdrawal do not follow the rules governing normal psychic functioning. Those fantasies cannot be either repressed or ‘dreamed’ in order to be transformed into thoughts. These psychopathological structures, which develop early and autonomously, have to be understood during analytical therapy in their origins and ‘deconstructed’ in order to help the patient to escape from their dominion. By means of clinical examples, the author tries to shed light on the possible ways of reaching patients in their psychotic shelters, thereby helping them to re‐emerge into a psychic reality.     

麻醉科医师在晚期癌痛治疗中的作用

1986年WHO推出的“三阶梯”癌痛镇痛用药方案目前在临床工作中存在误区。麻醉科医师必须明确在晚期癌痛治疗转变中的责任和义务:具有专业能力、保健与防病能力,消除使用阿片类药物成瘾恐惧症;团队协作能力、新技术的评估能力,实行跨学科综合姑息保健;遵循生物心理社会医学模式,对晚期癌痛患者实施人文关怀。不仅会运用药物和医疗技术手段,还需配合心理和社会方面进行全面的诊疗,更好地为患者服务。     

MMPI-2 Content Scale Validity Within a Sample of Chronic Pain Patients

The concurrent, criterion-related and discriminant validity of four of the MMPI-2 content scales were examined within a population of 309 patients being evaluated for the treatment of chronic pain. Utilizing both self-report and therapist-derived criteria, the MMPI-2 content scales designed to assess symptoms of anxiety (ANX), depression (DEP), low self-esteem (LSE), and anger (ANG) demonstrated the ability to provide valid information beyond that provided by the traditional MMPI-2 clinical and validity indices. Further, a multi-trait/multi-method analytic approach revealed; (1) strong discriminant validity for the ANG content scale and (2) substantial variance overlap among all the self-report measures of subjective distress, compromising our efforts to evaluate the discriminant validity of the ANX, DEP, and LSE content scales.