Psychoanalysis and schizophrenia: a cautionary tale.

The history of psychoanalysis and schizophrenia is used as an example of psychoanalytic theories of etiology that have not stood the test of time. Those theories pointed to three main factors: very serious inadequacies in the caretaking person; the presence of these inadequacies so early, during the preverbal period, that they led to the impairment of early object relations, the development of psychic structure, and basic ego functions; and the absence of underlying biological abnormalities. Today, many analysts are still reluctant to acknowledge biological etiological factors for other psychiatric conditions.

A psychoanalytic perspective on attention-deficit/hyperactivity disorder.

Psychoanalysts have tended to view the diagnosis of AD/HD either with skepticism or as a contraindication to analytic treatment. The author reviews the history of this puzzling diagnostic entity, which is estimated to account for up to fifty percent of child referrals, and suggests that a psychoanalytic perspective on the underlying disturbance in ego functioning helps to clarify the nature of the symptom picture. Whatever the etiology, which may be compound, she suggests that psychoanalytic treatment, most often in conjunction with psychopharmacological therapy, can address the core disturbance in ego integration that creates the familiar triad of inattention, impulsivity, and hyperactivity.

Psychoanalysts in the public eye: internal resistances.

An attitude against public presentations has been part of the inward looking stance of organized psychoanalysis and has contributed to the often-heard comment that psychoanalysis is a dying profession. Because of the very private nature of clinical psychoanalytic work, this ambivalence to public appearances continues to exist in all psychoanalysts. We have to realize that it is crucial for psychoanalysts to educate the public about psychoanalytic ideas while being aware of possible unintended negative consequences, such as interference in transference issues with patients, ethical and privacy violations, distortion in the press coverage, unfairly biased antipsychoanalytic coverage, and concern about disapproval from prominent and influential members of psychoanalytic organizations about the nature of the press coverage (or even of press coverage at all) leading to criticism of an individual psychoanalyst and interference with his or her progression.

Constant mental change and unknowability in psychoanalysis.

Conflict and compromise formation are central aspects of mental life. They dispose to constant mental change. Limitations of knowability in psychoanalysis are inextricably connected with constant mental change--the latter sometimes diminishing unknowability and sometimes exacerbating it.

Treatment of a boy with atypical ego development.

A multifaceted mode of therapeutic action is delineated as the complex neuropsychological and psychogenic factors in the development and functioning of an unusual four-year-old boy became elucidated. In addition to standard technique, the author developed a variety of psychoanalytically informed ways to facilitate his growth and ameliorate deviational aspects, especially his difficulties in appreciating and responding to the social-emotional world and establishing stable, integrated mental representations of self and other. The evolving treatment process is presented as well as attempts to coordinate and harmonize analytic and developmental goals.

Passions in girls and women: toward a bridge between critical relational theory of gender and modern conflict theory.

This paper considers (1) some aspects of the lack of dialogue among psychoanalytic schools; (2) Brenner's (1982) conception of drives and drive derivatives as inextricably linked to relationships, and some of its less-appreciated implications; (3) the debate over the importance of childhood sexuality in mental life; (4) the attempts by relational theorists to address and reintegrate the role of sexuality and gender, particularly in the study of feminine psychology; (5) the problematic role of aggression in psychoanalytic theories of women; (6) the avoidance by both men and women of women's passions and their anatomical loci, especially the clitoris, whose only function is the provision of pleasure; and (7) the suggestion that an integrated theory, including an understanding of the role of the body as well as of the passions and the defenses against them, results in the most effective clinical psychoanalytic approach. It then suggests that a bridge could be built between a relational point of view that takes into consideration the role of bodily experiences, and a classical point of view in which drive is seen as inextricably linked to relationships from birth on.

Conflict and compromise in gender identity formation. A longitudinal study.

The aims of this paper are twofold. The first aim is to show the complexity of the determinants leading to gender identity formation via the longitudinal study of one female research subject over 33 years. Focus is on the origins, meanings and functions of masculine character traits accrued at each phase of development.

The use of dream analysis in the treatment of a nine-year-old obsessional boy.

In children, as in adults, dreams offer a direct access to the unconscious. The analysis of dreams in the psychoanalytic treatment of children is, however, a neglected area. The work that a 9-year-old boy did with his dreams during the course of his two-and-a-half-year analysis is presented to demonstrate how helpful dream analysis can be in elucidating conflict and defense in the child patient.

A psychoanalytic study of aggression.

Eleven participants carried out a study of aggression by utilizing clinical data from the analyses of patients who manifested significant problems in the management of aggression. The purpose of the study was to increase understanding of the intrapsychic factors that determine the nature and intensity of aggressive tendencies, the place they occupy in the psychic economy, their patterns of expression, and the extrapsychic factors that trigger them. The findings of the study indicate, first, that aggression is multiply determined by developmental, genetic (experiential), and dynamic variables; second, that each cluster of variables affects the nature, intensity, and expression of aggression in a fairly specific way; third, the importance of aggression in the psychic economy is proportional to the extent to which it is overdetermined.

Kohut and Glover. The role of subjectivity in psychoanalytic theory and controversy.

The role of conflictual elements in the genesis of a new theory and in relation to the use of theory in a psychoanalytic controversy will be explored in two "case" studies. In the first, a close reading of Kohut's "The Two Analyses of Mr. Z" and in the second, a detailed examination of Glover's shifting allegiances toward Kleinian theory will reflect the role of transference and of idealization as powerful motivating elements.

Interracial psychotherapy: a report of the treatment of an inner-city adolescent.

This report demonstrates the effectiveness of long-term psychodynamic psychotherapy between a patient and therapist of different races. The patient's experience as a member of a minority was recognized, as were the psychodynamic meanings that race possessed in reference to identification, transference, resistance, and countertransference.

Freud and feminine subjectivity.

I have delineated a factor, subjectivity, to account for the difficulty in the psychoanalytic understanding of feminine sexuality, particularly the nature of feminine sexual pleasure. This factor has been unappreciated hitherto by psychoanalysts. Subjectivity is a notion that refers to the capacity of a person to posit him- or herself as an independent agent who determines or controls his or her own thoughts and actions.

Gender identity disorder in a girl: insights from adoption.

Gender identity disorder in girls is reported far less frequently than in boys. The analysis of a six-year-old adopted girl with gender identity disorder is presented to show the importance of the mother-infant relationship and of parental, especially maternal, attitudes toward gender in the normal development of gender identity and gender role definition. This child's unusual history included a late adoption, with clear evidence of separation trauma, and the ongoing influence of maternal infertility.

Nonverbal communications: some reflections on their role in the psychoanalytic process and psychoanalytic education.

This paper focuses on the phenomenon of nonverbal behavior and its role in analytic practice and in the teaching of technique. The idea is presented that data arising from the nonverbal realm are underutilized both in the clinical situation and in supervision. Some possible reasons for the development of this situation are presented, illustrated by several clinical examples drawn from the author's experiences as a candidate.

The legend of the European vampire. Object loss and corporeal preservation.

This paper reconsiders the manifold European legends of the vampire in a clinical context. The study of clinical psychoanalytic material that is homologous with these legends reveals that in both myth and clinical work, vampire legends and fantasies may signal experiences of object loss. Vampires are, after all, persons who have died but who are nonetheless immortal or "undead.

After the analysis: analyst as both old and new object.

In the course of followup study of satisfactorily analyzed former patients, there are observed two sets of phenomena: (1) recurrence of the analytic transference neurosis, and (2) rapid recovery from this transference neurosis. These phenomena are telescoped repetitions of the analysis and reflect the ongoing mental representation of the analyst as a displacement from the objects of the past, organized into the transference neurosis. The spontaneous and rapid recovery from the transference neurosis in followup study repeats the "cure" of the analysis and the new ongoing representation of the analyst as a nonconflicted object.

An inquiry into the fate of the transference in psychoanalysis.

Despite universal agreement about the importance of transference, there is no single, comprehensive, generally accepted explanation for the place transference occupies in clinical psychoanalytic theory. In this presentation, I trace the origins of some major trends prominent in theoretical controversy to their antecedents. Some seminal contributions which introduced important issues into the evolving theory of transference are highlighted; this is followed by a brief outline of the ideas of a representative sample of current theorists.

The deficit syndrome in schizophrenia: psychoanalytic and neurobiological perspectives.

The author summarizes recent advances in neurobiological research which appear to offer compelling evidence that the most pathognomonic feature of schizophrenia, the deficit or negative syndrome, is associated with functional abnormalities in the frontal lobe of the brain. These brain abnormalities are correlated with those conceptualized by psychoanalytic theories of withdrawal of libido and loss of mental representation. In the light of this data, the author expresses serious reservations about three psychoanalytic formulations concerning the causes of the deficit syndrome: (1) the syndrome represents, in a primary rather than a secondary way, a psychological defense; (2) it is caused by severe conflicts or neglect during early childhood which lead to impairments in the building up of psychic structure and mental representation; (3) difficulties with the aggressive drive play a primary etiological role.

On the clinical utility of the concept of depressive affect as signal affect.

The author reviews the scant literature relating to the concept of depressive affect as an affect parallel to anxiety. Then, through the presentation of detailed clinical psychoanalytic data, in particular the patient's associations to interpretation, he demonstrates the value to the conduct of a psychoanalysis of an awareness of the role of depressive affect as a signal affect that triggers defense.

Hierarchies, boundaries, and representation in a Freudian model of mental organization.

Freud used a spatial model of mental organization, derived from his explanation of aphasia, as an organizing framework for psychoanalytic theory. He introduced the ideas of representation and overdetermination to describe relations of the contents of systems that were joined to form, first, a hierarchical nervous system, then, mental systems. Freud used his basic model to organize aspects of mental function and phenomena, of interpersonal and social phenomena, and some kinds of biological phenomena.

A psychoanalytic perspective on depression.

A correct understanding of the role of depressive affect in triggering psychic conflict leads to a reformulation of the origins and the psychodynamics of depression as a feature of mental illness. It also raises serious question about the validity of the diagnosis of depressive illness.

The relevance of the analyst's character and attitudes to his work.

This paper is intended to sensitize analysts to the role of their character in analytic technique. The relation of character to countertransference, its role in analytic style, in the introduction of parameters, and in transference neurosis, will be elaborated. The problem of matching and of accounting for our failures will illustrate the complex meshing of character with more traditional factors.