Introduction: The role of shame in psychoanalytic theory and practice

Introducing three papers by Leon Wurmser, Claude Janin and John Steiner the author gives an overview of the development of the concept of shame in psychoanalytic theory and practice. Different aspects of the phenomenon of shame are being discussed including its relation to guilt, object relations and identity as well as the role of gaze when emerging from a psychic retreat.     

Verdi's Rigoletto: The dialectic interplay of the psychic positions in seemingly 'mindless' violence

In this paper the author demonstrates the interplay of the psychic positions (paranoid-schizoid and depressive, alongside more primitive mental states) as they may appear in experiences of overwhelming anxieties relating to fragmentation and disintegration. These are examined in relation to the appearance of what has been described in the literature as 'mindless' violence. The vehicle for this demonstration is Verdi's opera Rigoletto , which the author examines using Fonagy and Target's model for the understanding of mindless violence. The opera is 'read' as a case study of the protagonist, using the drama as a reflection of Rigoletto's internal object representations. The author attempts to extend Fonagy and Target's model to include primitive mental states, in order to understand 'mindless' violence as a result of collapse of the dialectical relationship of the psychic positions, leading to the violent act as a desperate attempt at re-establishing a sense of self. From this perspective, the moment of the violent act may be seen as use of an autistic object and as supplying of autistic shape. The violence is ultimately directed against the already fragmenting self, especially cherished parts of it, however it may enable acknowledgement of repudiated, unmentalised emotions previously experienced as a void.     

A place within the heart: finding a home with parental objects

For adopted and Looked After children with compromised early experiences, there can be troubling phantasies and anxieties associated with parental objects. These internal object relations can seriously restrict the development of secure intimate relationships with new parental figures. Adoptive parents and foster carers bear the brunt of the associated difficulties. Clinical work with the child, parents/carers, family, or network, may help processes of containment, differentiation, working through, mourning, and integration. This paper is based on thinking derived from clinical work with children who are adopted or Looked After, and with adoptive parental couples, carers, and networks. The primary focus is on how the child needs to find a ‘psychic home’ in the minds of others for their damaged internal parental objects, and the emotional capacities required in adoptive parents to provide this. I describe some of the complexities for adoptive parents and others in providing what is needed to enable the child to experience their internal parental objects in a fuller way. This process can allow the child to introject, identify with, and re-imagine their internal parental objects, and through this develop a more realistic relationship to their adoptive parents and to their birth parents. It promotes trust, freedom, and emotional depth in the relationship with parental figures.     

Metaphor and the violent

During the treatment of violent individuals who were, incidentally, highly verbal, the authors noticed that physical assaults were often preceded by the perpetrator s use of metaphors. It was observed that the linguistic metaphors failed to function as ordinary as if devices and became concretised. When this occurred, the perpetrators resorted to a physical attack. In this paper, the authors argue that the capacity to interconnect (which is considered to be the essence of psychic work) is dependent upon what can be conceptualised as a primary mental frame or warp. Distortion of the warp will, in turn, weaken the weaving, or interconnecting function of the ego, which is considered analogous to the interconnecting in linguistic metaphors. Clinical material from the treatment of three violent men (two in psychotherapy and one in analysis) is used to illustrate the hypothesis that the concretised use of metaphor represents a restitutive, but failed attempt to maintain a psychic coherence in the face of an imminent breakdown.     

Mental health and mediumship: an interpretative phenomenological analysis

There is a lack of research examining the mental health of practicing mediums, yet the nature of mediumship work inherently presents a number of challenges to the mental health of practitioners. In this study, we aimed to gain an understanding of how mediums experience their mental health in relation to their mediumistic practice and how they recognise and respond to psychological difficulties experienced by their clients. Fourteen mediums from the North West of England took part in one-to-one interviews, which were transcribed and subject to interpretative phenomenological analysis. Four themes were identified: from past traumas to mediumistic identity; spirit makes sense, mental illness is chaos; being resilient but vulnerable; and ethical mediumistic practice. The research highlights the value of not dismissing or attempting to change appraisals of valued aspects of mediums’ anomalous experiences. However, the findings do indicate that support for exposure to clients’ difficulties might be helpful.     

Trauma,resilience and healthy and unhealthy forms of dissociation

This paper outlines the difference between healthy and unhealthy forms of dissociation following, and in response to, traumatic experience, in particular the experience of refugees, calling on 30 years’ experience in working with refugees in voluntary and public sectors, including 20 years at the Refugee Therapy Centre, London. It differentiates dissociation from repression, and looks at some of the specific traumatic experiences associated with refugees’ displacement and situation, particularly relating to loss. Four key characteristics of resilience are described: ‘psychic space’, ‘sense of self’, and the use of a ‘listening other’ and ‘healthy dissociation/resiliency’. Two vignettes are given to illustrate the difference between healthy and unhealthy dissociation.     

Testimonies in the Treatment of Genocidal Trauma

This article describes an approach to the treatment of genocide survivors that addresses both the personal and communal/historical dimensions of their experiences. I begin by outlining the characteristics of massive psychic trauma as background for using video testimonies in the treatment of Holocaust survivors. I then discuss videotaped interviews with perpetrators as an illustrative contrast to survivors' testimonies. The third section explains my position as a psychoanalyst encountering historical trauma and its relationship to my own experiences as a survivor. Following a brief history of videotaping as a medium for recording testimonies, I conclude by demonstrating the ways in which active listening can lead to the revelation of new dimensions of historical as well as personal truth.     

Theatres of the psyche

Fragments of the analytic voyage of a forty year old patient, haunted by the idea of her death since infancy when confronted with the anguish that accompanies the discovery of a potentially death dealing illness. In three years of intensive analytic work, her way of functioning psychically changed dramatically (her flight from imaginative life, total disaffectation of her emotional life, psychic deafness regarding her body and its messages ≡). These discoveries led to my analysand's resuming her psychoanalytic voyage in these words: 'Even if I am destined to die of this cancer, at least I shall have lived'.     

Psychic reality and the nature of consciousness

In this paper we make the case for a psychoanalytically informed reconsideration of the phenomena of consciousness. Classically, following Freud, who viewed consciousness as merely a reflection or perception of unconscious mental activity, psychoanalysts have tended to regard a focus on conscious experience as potentially reductionistic and at risk of overlooking the mind's deeper structures. We describe the case of Mr K, a patient who experienced disturbances of consciousness that forced us to consider the possibility that the capacity to experience ourselves as conscious, intentional agents in a coherent world of objects is not merely a modality of perception but rather a maturational and developmental achievement that to some degree depends on adequate experiences of caregiving and is vital in ensuring the possibility of human communication. As such, it is a capacity that is vulnerable to experiences of neglect and maltreatment. We suggest that as well as compromising the capacity to think about one's own and other people's feelings, such experiences may have the further adverse consequence of leading the individual to experience and risk becoming conscious of certain dangerously maladaptive, destructive states of mind which in normal development remain inaccessible to conscious experience. Phenomenologically, such states of mind are experienced as fragmentation and disturbances of consciousness. We discuss the clinical implications of these reflections and the limitations they place on psychoanalytic work in the context of their impact on the work with Mr K.     

The Oedipus complex: A confrontation at the central cross‐roads of psychoanalysis

The theory of the Oedipus complex as Freud formulated it rests on the following pillars: the child's characteristic sexual and aggressive impulses concerning the parents, phallic monism, and the castration complex. This paper reviews the context in which Freud discovered the Oedipus complex, as well as Freud's theory. It then examines the proposals of later authors whose general Oedipal theories differ from Freud's in an attempt to point out both their possible correlations and confrontations with Freud. It includes Klein's pre‐genital Oedipal theory, Lacan's structuralist reinterpretation, Bion's reconception of the complex under the knowledge vertex, Green's generalized triangulation theory, Meltzer's notions of the aesthetic object and sexual mental states, and Chasseguet‐Smirgel's archaic Oedipal matrix