The quality of the transference resistances is to a great extent deepened on the quantity of other resistances. Resistances have the tendency to accumulate wherever there is a favourable opportunity to withstand the analysis. In most cases the transference offers the best opportunity, for example, we see the resistance coming from the conscious repetition, from the unconscious feeling of guilt and from the resistance by repression, takes part of building up the transference resistance. Freud speaks of the transference of resistance into a negative, hostile transference: It is on account of this transformation that the dissolution that transference resistances so often because the chief task of the therapeutics work. In the case of our patient the analysis finally showed the development of anxiety in the transference to be castration anxiety that had arisen from infantile masturbation with accompanying incestuous wishes toward the mother and the hared and castration wishes toward the father. In the analysis, if the resistance resulting factors in the development of anxiety in the analysis. If the resistance result from this anxiety is analysis the addition of other resistances, then the final resistance in the analysis cannot be considered as an index to the amount of the genuine infantile anxiety for the anxiety resulting from infantile masturbation, on account of the genuine infantile anxiety: For the anxiety resulting from infantile masturbation on account of its anxiety resulting from infantile masturbation, on account of its particular capacity for being used as a resistance in analysis, becomes the nucleus of crystallisation or the basis for the addition of all the other resistances. In a footnote to his paper ‘The Dynamics of th Transference,’ this idea was alluded to by Freud, that, ‘Over and over again, when one draws near to a pathogenic complex, that part of it that is first thrust forward into consciousness will be some aspect of it that can be transferred, having been so, it will then be defended with the utmost obstinacy by the patient’. The footnote says: ‘From which however one need not infer in general any very particular pathogenic importance in the point selected for resistance by transference. In warfare, when a bitter fight is raging over the possession of some little chapel or a single farmhouse, we do not necessarily assume that the church is a national monument, or that the barns contain the military funds. Their value may be merely tactical; in the next onslaught they will very likely be of no importance’.
The dissolution of the transference resistance means then not only the dissolution of the resistance resulting from the genuine infantile castration anxiety but a liberation of the supporting resistance that often can only later be separately dissolved, because during the phase of the violent acting-out in the transference these resistances are not accessible to interpretation and dissolution.
For what is said about the psychology of metaphor is analogous to the transformational aspects of developed transferences and steadfast interpretations that both facilitate and organize them as transferences. Allowing that these transferences and ‘remembered’ experiences come into existence over a period of time, nothing that is identical with them has ever before been enacted, and nothing identical with them will ever be enacted again. They are creations that may be fully achieved only under specific analytic conditions. For example, at the time of his childhood scene with his father, the young man of the clinical example, could not have had the specific experience as recounted. strictly speaking, he was not reliving that moment. As a bo y, he must have experienced some of the main precursors and constituents of his present mode of experience, but he could not have done so in the present articulated and integrated manner. That present manner was the basis of his anguished outcry. words like re-creating, but re-experiencing and reliving simply do not do justice to the phenomena. In the way he was doing it, he was living that moment for the first time.
By making this claim, there is no constricting some of our well-established ideas about interpretation and insight, for example, disputing point that insight refers to more than the recovery of lost memories, and takes in, as well, a new grasp of the significance and interrelations of events one has always remembered. The latter connections that the analysand will say, as Freud pointed out, ‘As a matter of fact I’ve always known it, only I’ve never thought of’ (1914). In fact, it is to develop that points further to say that the young child simply does not have the means of fully defining what we later regard as its own life experiences. It takes an adult to do that, especially with the help of an analyst. It was, after all, Freud’s analysis that made it possible to define infantile psychosexuality. in this respect, but without disrespect, child analysis retains a quality of applied psychoanalysis. The adult definition of infantile psychosexuality is ‘artificial’ in the same way that the interpreting transference neurosis is: Both are ways of describing as true something that was not truer in quite that way as, at the time of its greatest development significance. this apparent paradox about ‘remembering’ as a form of creating goes a long was, that saying, what it is this distinctive about psychoanalytic interpretation.
In steadfastly and perspicaciously making transference interpretation, the analyst helps constitute new modes of experience and new experiences. This newness characterizes the experience of analytic transference in them. Unlike extra-analytic transference, they can no longer be sheerly repetitive or merely new editions. Instead, they become repetitively new editions understood as such because defined as such by the simplification and steadfast transference interpretation, instead of responding to the analysand in kind, Which would actualize the repetition, the analyst makes an interpretation. This interpretation does not necessarily or regularly match something the analysand does often seem to have always represented often, but he does not seem to have done so at all. To think otherwise about this would, in effect, to claim that, unconsciously, every analysand is Freud or a fully insightful Freudian analyst. And that claim is totally absurd.
It would be closer to the truth to say this: Unconsciously, the analysand already knows or has experienced fragmentary, amorphous, uncoordinated constituents of many of the transference interpretations. Alternatively, one may say that, implicitly, the analysand has been insisting on some as yet unspecified certainties and, in keeping with this, following some set of as yet unspecified rules in his actions, these the transference interpretations now organize explicitly. Each transference interpretation thus refers to many things that have already been defined by the analysand, and it does so in a way that transforms them. That’s why one may call it interpretation. Otherwise, it would be mere repeating or sterile paraphrasing. Interpretation is a creative redescription that implicitly has the structure of a simile. It says, ‘This is like it,’ Each interpretation does, therefore, add new actions to the life the analysand has already lived.
Technically, redescription in the terms of transference-repetition is necessary. This is so because, up to the time of interpretation and working through, the analysand has been, in one sense unable and, in another sense, unconsciously and desperately unwilling, to conduct his life differently, in and of them, the repetitions cannot after the symptoms, the subjective distress, the wasting of one’s possibilities rather they can only perpetuate a static situation by repeatedly confirming its necessity. They prove once again, the unconsciously maintained damaging certainties. But once they get to be viewed as historically grounded actions and subjectively defined situations. As they do upon being interpreted and worked through, they appear as having always been, in crucial respects, inventions of the analysand’s making and, so, as his responsibility. in being seen as versions one’ past life, they may be changed in significant and beneficial ways. Less of all, are they presented as purely inevitable happenings, as a fixed fate or as the well-established way of the world. However, we encounter a second paradox that goes to the heart of psychoanalysis interpretation, namely, that responsible, insightful change is possible through psychoanalysis just because, as a child the analysand mistakenly assumes and then denied responsibility for much that he encountered in the early formative environment and during maturation.
One major point remains to be made about the logic of viewing transference interpretation as simplifying yet innovative redescription. This point is that the interpretations bring about a coordination of the terms in which to state both the analysand’s current problems and their life-historical background. The analysand’s symptoms and distress are described as actions and modes of action, with due regard for the principle of multiple function or multiple meaning: In coordination with that description, the decisive developmental situation and conflicts are stated as actions and modes of action. Continuity is established between the childhood constructions of relationships and the self and the present constructions of these interpretations of transference shows who both are part of the same set of practices, that is, how they follow the same set of rules. Past and present are coordinated to show continuity rather than arranged in a definite sequence.
In the same way, the form of analytic behaviour and the content of association are given co-ordinated descriptions, say, as being defiant, devouring, or reparative. Or, in the case of depression, the depressive symptoms, the depressive analytic transference, the themes of present and past loss, destructiveness and helplessness, all will be redecribed under the aspect of one continuously developing self-presentation. And this coordination will be worked out in that hermeneutically circular fashion in which the analyst defines both th facts to be explained and the explanations to be applied to these facts. In the end, as is well known, both the paramount issues of the analysis and the leading explanatory account of them are likely to be significantly different from the provisional versions of them used at the beginning of the analysis.
The increasing influence of the modernist version of transference and its interpretation represents an adaptation to several long-term philosophical, scientific, and cultural shifts we can now recognize. this changing view of transference is also the most visible emblem of the deep changes in psychoanalytic theory that are now quietly taking place, and of their theoretical pluralism that is so prevalent today (Cooper, 1985).
One of these long-term changes in the climate in which psychoanalysis dwells results from a large philosophical debate concerning the nature of history, veridicality, and narrative. Kermode (1985) has written of the change during this century in our modes of understanding and interpreting the past and the present, ‘Once upon a time it seemed obvious that you could best understand how things are by asking how they got to be that way. Now attention [is] directed to how things are in their immediate plexuities. There is a switch to use the linguistic expressions, from the diachronic to the synchronic view. Diachrony, roughly speaking, studies things in their synchrony to be as they are, synchrony concerns itself with things as they are and ignores the question, how they got that way. This distinction, put forth by de Sasussure (1915), has achieved philosophical dominance today and is the clear source of the hermeneutic view so prevalent in psychoanalysis, proposed by Ricoeur (1970). From here, it is a short distance to Schafer (1981), and Gill (1982), or Spence (1982) who in varying ways adopt the synchronic view. In this view, the analytic task is interpretation, with the patient, of the events of the analytic situation - usually broadly labelled transference - with a construction rather than a reconstruction of the past. In effect, while there is a past of ‘there and then’ it is knowable only through the filter of the present, of ‘here and now’. There is no other past than the one as we construct, and there is no way of understanding the past but through its relation to the present.
Psychoanalysis, like history but unlike fiction, does have anchoring points, for history’s anchoring points are the evidences that events really did occur, There was a Roman empire, it did have dates, actual persons lived and died. These ‘facts’ place a limitation for the narratives an interpretations that may seriously be entertained. Psychoanalysis is anchored in its scientific developmental psychology and in the biology of attachment and affects. Biology confers regularities and limits on possible histories, and our constructions of the past must accord with this scientific knowledge. constructions of childhood that are incompatible with what we know of developmental possibilities may open our eye’s to new concepts of development, but more likely they alert us to maimed childhoods that have led our patients to usual narrative constructions in the effort to maintain self-esteem and internal coherence. A second, far less secure, anchorage is the enormous amount of convergent data that accumulate during the course of an analysis, which are likely to give the analyst the impression that he is reconstructing rather than constructing the figures and the circumstances of his patient’s past. While a diachronic view may no longer suffice, it may also not be fully dispensable if our patient’s histories are to maintain psychoanalytic coherence, rooted in bodily experience, and the loving, hating and terrifying affects accompanying the fantastic world of infantile psychic reality. Not all analysis are yet as ready as Spence, for example, to give up all claim to the truth value explanatory power of the understanding of the past, even if it is limited to knowing past constructions of the past. Nevertheless, the change in philosophical outlook during our century is profound and contributes to our changing view of the analytic process is exemplified in the transference and its interpretation.
Approaching the same issue from an entirely different vantage point, Emde (1981) speaking for the ‘baby-watchers’ and discussing changing models of infancy and early development, details a second source of the major change of climate to which he writes, The models suggest that what we reconstruct, and what may be extraordinarily helpful to the patient in making a biography, may never have happened. The human being, infant child, is understood to be fundamentally active in constructing his experience. Reality is neither given nor is it necessarily registered in an unmodified form. Perhaps it makes sense for the psychoanalysis to place renewed emphasis on recent and current experiences - first, as a context for interpreting early experience - first, as a context for interpreting the potential amelioration, . . . Psychoanalysts are specialists in dealing with the intrapsychic world not only particular with the dynamic unconscious, but we need to pay attention not only to the intrapsychic realm. conflicting-laden and conflict-free, but also to the interpersonal realm. He concludes, . . . we have probably placed far to much an emphasis on early experience itself as opposed to the process by which it is modified or made use of by subsequent experience.
This view of psychic developments, discarding the timeless unconscious and so powerful at odds with the views that were held by psychoanalysts during the time when most of our ideas of transference interpretation were formed, clearly suggests the modernist model of transference interpretation.
A change in the cultural environment of psychoanalysis provides a third source for the changing model of transference interpretation. Valenstein describes oscillations in psychoanalytic outlook between an emphasis on cognition at one end, and on affect at the other. One might see these as differences between old-fashioned scientific and romantic world views. Surely the period of ego psychology, perhaps reflected in the English translation of Freud, and certainly reflected in the effect to insist on the libidinal energetic point of view, represented the attempt to see psychoanalysis as Freud usually did, as an objective science in the nineteenth century style, with hypotheses created out of naïve observations. It accorded with that view to see the transference as an objective reflection of history. We are currently in one of our more romantic periods. It is consonant with that view to see transference as an activity - stormy, romantic, active, affective - a kind of adventure from which the two individuals emerge changed and renewed. In this romantic view, interpretation of the transference are intended to remove obstacles interfering with the heightening and intimacy of the experience, with the implication that self-knowledge and change will result from their encounter. A romantic figure, the patient and analyst set forth on a quest into the unknown, and whether or not one of them returns with a Holy Grail, they return with many new stories to tell and a new life experience - the analysis. Gardner’s (1983) book, ‘Self Inquiry’ epitomizes this romantic view of analyst and patient as a poet-pair engaged in mutual self-inquiry. It is clear that many analysis would rather be artistic than scientist. By contrast, the older, cognitive view of the transference is of an intellectual journey, emotionally loaded of course, but basically a trip back in history, seeking truth and insight.
Finally, our newer ideas of transference interpretation come from the rereading and reinterpretations of Freud that necessarily accompany the changes in outlook in the corresponding pendulum of analytic techniques from Freud’s actual technique, as reconstructed from his notes and the report s of his patients, to the so-called ‘classical’ technique that held sway after Freud’s death, and again, to the currently changing technical scene. Lipton (1977) has insisted that in the 1940s andv1950s the so-called classical technique replaced Freud’s own more personal and relaxed technique, probably in reaction to Alexander’s suggestion of the corrective emotional experience. It was Lipton’s view that the misnamed ‘classical’ technique, in contrast to Freud’s, emphasized rules for the analyst’s behaviour and sacrificed the purpose of the analysis. Eissler’s 1953 description of analysis as an activity that ideally uses only interpretations became the paradigm for ‘classical’ analysis. It was, Lipton, says, a serious and severe distortion of the mature analytic technique developed by Freud. Freud regarded the analyst ‘s personal behaviour, the personality of the analyst exemplified for Lipton in the case of the Rat Man. The so-called ’classical’ (and in his view non-Freudian) techniques attempted to include every aspect of the analytic situation as part of technique and led to the model of the silent, restrained psychoanalyst. Lipton’s argument is persuasive.
These two different models of technique have obvious implications concerning the transference and its interpretation. Unless we believe in an extreme version of the historical model, we must expect that the silent, restraint, nonparticipatory psychoanalyst will elicit different responses from his patient than will the vivid, less-hidden, more responsive analyst. The range of personal behaviours available to the analyst before we need be concerned that the analyst is engaging in activities that are excessively self-revelatory or that force the patient into a social relationship is probably much broader than we thought a few years ago. But we also know that almost any behaviour of the analyst, including restraint or silence, immediately influences the patient’s responses. In these newer views of the analytic situation it is not easy to know that intrapsychically derived patient behaviours.
It is evident today that psychoanalyst’s under the sway of their theories and personalities, differ greatly concerning matters to which they are sensitive, and, of course, we can interpret only the transferences we perceive. Despite this limitation, a review of the literature reveals, along with the usual rigidities, a laudable tendency to describe one’s experience as fully as possible, without heed to how it contradicts belief, often blurring over when experience and theory do not match. However, we have always been better at what we do than at what we say we do. This is exemplified in Heimann’s (1956) paper. Speaking from a modified Kleinian perspective, and holding the historical theory of transference interpretation, Heimann managed 30 years ago to describe vividly and to support passionately much of what today is under discussion as the modernist version. That her position were contradictory bothered her not at all. While many of us prefer to think we are following our theories, like all good scientists, good psychoanalysts, beginning with Freud, have always seen and responded to far more than our theories admit. when we have seen too much, we change our theories.
Overall, during the last half of this century, these trends, as well as our ever-increasing knowledge of our increasing distance from Freud’s authority have led to specific theoretical developments (Cooper, 1984, 1985), many of them inferred in the newer transference model. Our current pluralistic theoretical world, in which almost all analysts are working, wittingly or not, with individual amalgams of Freud’s drive theory, ego psychology, interpersonal Sullivanian psychoanalysis, object-relationship theory, Bowlbyan or Mahlerian attachment theory, and usually smuggled-in versions of self-psychology, lies at the base of the newer ideas and disagreements concerning transference interpretation.
Although the historical definitions of transference and transference interpretation have the merit of seeming precision and limited scope, they are based on a psychoanalytical theory that no longer stands alone and has lost ground in at least, subsumed, by modernist conceptions that are more attuned to the theories that abound today.
Asa prefatory remark about Freud and transference, the observations can be offered that Freud wrote briefly about transference and did so, in the main, before 1917. Another observation which can rarely be made about Freud’s work, what he did write on transference and did not reach the high level of analytical thought which has come to be regarded as standard for him. Some indication of what his contribution consist of is given by the editors of the Standard Edition, who list them in several places. One of the longer lists, in a footnote includes six reference ‘Studies on Hysteria’, with Breuer (1895),the Dora paper (1905), The Dynamics of Transference’ (1912), Observations on Transference-Love’ (1915), the chapter on transference in the Introductory Lectures (1917), and Analysis Terminable and Interminable (1937). Although the editors in no sense suggest that these six papers include everything Freud wrote on the subject that these six papers include everything Freud wrote on the subject, it does seem evident that, considering the essential importance of transference to analysis, he wrote little. moreover, the three papers in which transference is the specific theme. `The Dynamics of Transference,`Transference-Love ; and the transference chapter in the Introductory Lectures, come across as perhaps his least significant contributions.
Freud’s first direct mention of transference occurs in ‘Studies on Hysteria’ (1895), His first significant reference to it, however, did not appear until five years later when, in a lecture to Fliess on April 16, 1900, he said (Freud 1887-1902) he was ‘beginning to see that the apparent endlessness of the treatment is something of an inherent feature and is connected with transference. In a footnote to his letter the editors state that, ‘this is the first insight into the role of transference in psychoanalytic therapy’.
Despite these early references, it seems correct to say that yet another five yea s was to go by before the phenomenon of transference was actually introduced. Even then the introduction was far from prominent, for it was tacked like an afterthought as a four-page portion of a postscript to what was perhaps Freud’s most fascinating case history to date, the case of Dora (1905).
Using data from Dora’s three-month-long, unexpected terminated analysis, and especially from her dramatic transference reactions which had taken him quite unaware. Freud now gave to transference its first distinct psychological entity for th first time indicated its essential role in the analytic process. His account, although in general more than adequate - in fact elegant and remarkable ‘finished’ - was brief, almost Iaconic, and perhaps not an entirely worthy introduction to such a truly great discovery. What was uniquely great was his recognizing the usefulness of transference. In his analysis of Dora h e had noted not only that transference feelings existed and were powerful, but much to his dismay, he had realized that as serious, perhaps, even insurmountable, obstacle they could be,. Then, in what seems like a creative leap, Freud made the almost und unbelievable discovery that transference was in fact the key to analysis, that by properly taking the patient’s transference into account, an entirely new, essential and immensely effective heuristic and therapeutic force was added to the analytic method.
A neuron is a long cell that has a thick central area containing the nucleus; it also has one long process called an ‘axon’ and one or more short, bushy processes called ‘dendrites’. Dendrites receive impulses from other neurons. (The exceptions are sensory neurons, such as those that transmit information about temperature or touch, in which the signal is generated by specialized receptors in the skin.) These impulses are propagated electrically along the cell membrane to the end of the axon. At the tip of the axon the signal is chemically transmitted to an adjacent neuron or muscle cell.
Like all other cells, neurons contain charged ions, potassium and sodium (positively charged) and chlorine (negatively charged). Neurons differ from other cells in that they are able to produce a nerve impulse. A neuron is polarized - that is, it has an overall negative charge inside the cell membrane because of the high concentration of chlorine ions and low concentration of potassium and sodium ions. The concentration of these same ions is exactly reversed outside the cell. This charge differential represents stored electrical energy, sometimes referred to as ‘membrane potential’ or ‘resting potential’. The negative charge inside the cell is maintained by two features. The first is the selective permeability of the cell membrane, which is more permeable to potassium than sodium. The second feature is sodium pumps within the cell membrane that actively pump sodium out of the cell. When depolarization occurs, this charge differential across the membrane is reversed, and a nerve impulse is produced.
Depolarization is a rapid change in the permeability of the cell membrane. When sensory input or any other kind of stimulating current is received by the neuron, the membrane permeability is changed, allowing a sudden influx of sodium ions into the cell. The high concentration of sodium, or action potential, changes the overall charges within the cell from negative too irrefutable positivity, and charged to ion concentrations, for triggering similar reactions along the membrane, propagating the nerve impulse. After a brief period called the ‘refractory period’, during which the ionic concentration returned to resting potential, the neuron can repeat this process.
Nerve impulses travel at different speeds, depending on the cellular composition of a neuron. Where speed of impulse is important, as in the nervous system, axons are insulated with a membranous substance called ‘myelin’. The insulation provided by myelin maintains the ionic charge over long distances. Nerve impulses are propagated at specific points along the myelin sheath; these points are called the ‘Nodes of Ranvier’. Examples of myelinated axons are those in sensory nerve fibres and nerves connected to skeletal muscles. In non-myelinated cells, the nerve impulse is propagated more diffusely.
When the electrical signal reaches the tip of an axon, it stimulates small presynaptic vesicles in the cell. These vesicles contain chemicals called neurotransmitters, which are released into the microscopic space between neurons (the synaptic cleft). The neurotransmitters subjoin of abounding deliberations to particularly specific receptors on the surface of the adjacent neuron their adherence of fastening or affix by a state of being firmly attached to the receptor or something that causes the adjacent cell to depolarize and propagate an action potential of its own. The duration of a stimulus from a neurotransmitter is limited by the breakdown of the chemicals in the synaptic cleft and the ‘reuptake’ by the neuron that produced them. Formerly, each neuron was thought to make only one transmitter, but recent studies have shown that some cells progress of two or more.
The signals conveying everything that human beings sense and think, and every motion they make, follows nerve pathways in the human body as waves of ions (atoms or groups of atoms that carries electric charges). Australian physiologist Sir John Eccles discovered many of the intricacies of this electrochemical signalling process, particularly the pivotal step in which a signal is conveyed from one nerve cell to another. He shared the 1963 Nobel Prize in physiology or medicine for this work, which he described in the 1965 Scientific American article.
A neuron is a long cell that has a thick central area containing the nucleus, it also has one long process called an axon and one or more short, bushy processes called ‘dendrites’. Dendrites receive impulses from other neurons. (The exceptions are sensory neurons, such as those that transmit information about temperature or touch, in which the signal is generated by specialized receptors in the skin.) These impulses are propagated electrically along the cell membrane to the end of the axon. At the tip of the axon the signal is chemically transmitted to an adjacent neuron or muscle cell.
Depolarization is a rapid change in the permeability of the cell membrane. When sensory input or any other kind of stimulating current is received by the neuron, the membrane permeability is changed, allowing a sudden influx of sodium ions into the cell. The high concentration of sodium, or action potential, changes the overall charges within the cell from negative too positively in finding the local change in ion concentration, which triggers similar reactions along the membrane, propagating the nerve impulse. After a brief period called the ‘refractory period’, during which the ionic concentration returned to resting potential, the neuron can repeat this process.
When the electrical signal reaches the tip of an axon, it stimulates small presynaptic vesicles in the cell. These vesicles contain chemicals called neurotransmitters, which are released into the microscopic space between the synaptic cleft. The neurotransmitters attach to specialized or specific receptors on the surface of the adjacent neuron. This stimulus causes the adjacent cell to depolarize and propagate an action potential of its own. The duration of a stimulus from a neurotransmitter is limited by the breakdown of the chemicals in the synaptic cleft and the reuptake by the neuron that produced them.
If to say, that Roderick MacKinnon, born in 1956, is the American biomedical researcher and co-winner of the 2003 Nobel Prize in chemistry for his discoveries involving ion channels. The pores that govern the passage of molecules into and out of cells, in that of every second in each of the billions of cells in the human body, millions of ions, such as potassium and sodium, shuttles back and forth through these special portals in the cellular membrane. This action underlies a range of physiological processes, including muscle contraction and the communication of impulses between nerve cells. MacKinnon and his colleagues were the first to show the detailed structure of one type of ion channel.
Born in 1956, MacKinnon grew up in Burlington, Massachusetts, outside Boston. He earned his bachelor’s degree in biochemistry from Brandeis University in Waltham, Massachusetts, in 1978, and his medical degree from Tufts University School of Medicine in Boston in 1982. After beginning a career in medicine, MacKinnon turned to biomedical research. Postdoctoral fellowships at Harvard University in Cambridge, Massachusetts, and Brandeis ultimately led to a professorship in the Department of Neurobiology at Harvard Medical School in 1989. In 1996 MacKinnon moved to Rockefeller University in New York City, where he became a professor of molecular Neurobiology and biophysics.
To study an ion channel - in this case, a particular cellular protein involved in the transport of potassium - MacKinnon chose a difficult method known as X-ray crystallography. This method involves forming the protein into a crystal and then using X rays to determine the protein’s structure. Many scientists doubted that the approach would work, but in 1998 MacKinnon and his team achieved success, presenting a detailed three-dimensional picture of the potassium channel.
In subsequent research, MacKinnon and his colleagues discovered more about the chemical workings of ion channels. This work helped to explain, for example, how such a pore permits the passage of millions of potassium ions per second while largely blocking the passage of sodium ions. Increased knowledge of these protein pores will be important for the design of future drugs because the malfunctioning of ion channels has been linked to heart disease and cystic fibrosis, among other illnesses.
In addition to the Nobel Prize, MacKinnon has been honoured with the 1999 Albert Lasker Basic Medical Research Award. He shared the Nobel Prize with American biologist Peter Agre, who, in separate research, discovered the molecular channel through which cells transport water.
When a neuron is in its resting state, its voltage is about -70 millivolts. An excitatory neurotransmitter alters the membrane of the postsynaptic neuron, making it possible for ions (electrically charged molecules) to move back and forth across the neuron’s membranes. This flow of ions makes the neuron’s voltage rise toward zero. If enough excitatory receptors have been activated, the postsynaptic neuron responds by firing, generating a nerve impulse that causes its own neurotransmitter to be released into the next synapse. An inhibitory neurotransmitter causes different ions to pass back and forth across the postsynaptic neuron’s membrane, lowering the nerve cell’s voltage to -80 or -90 millivolts. The drop in voltage makes it less likely that the postsynaptic cell will fire.
If the postsynaptic cell is a muscle cell rather than a neuron, an excitatory neurotransmitter will cause the muscle to contract. If the postsynaptic cell is a gland cell, an excitatory neurotransmitter will cause the cell to secrete its contents.
While most neurotransmitters interact with their receptors to create new electrical nerve impulses that energize or inhibit the adjoining cell, some neurotransmitter interactions do not generate or suppress nerve impulses. Instead, they interact with a second type of receptor that changes the internal chemistry of the postsynaptic cell by either causing or blocking the formation of chemicals called second messenger molecules. These second messengers regulate the postsynaptic cell’s biochemical processes and enable it to conduct the maintenance necessary to continue synthesizing neurotransmitters and conducting nerve impulses. Examples of second messengers, which are formed and entirely contained within the postsynaptic cell, include cyclic adenosine monophosphate, diacylglycerol, and inositol phosphates.
Once neurotransmitters have been secreted into synapses and have passed on their chemical signals, the presynaptic neuron clears the synapse of neurotransmitter molecules. For example, acetylcholine is broken down by the enzyme acetylcholinesterase into choline and acetate. Neurotransmitters like dopamine, serotonin, and GABA is removed by a physical process called reuptake. In reuptake, a protein in the presynaptic membrane acts as a sort of sponge, causing the neurotransmitters to reenter the presynaptic neuron, where they can be broken down by enzymes or repackaged for reuse.
Neurotransmitters are known to be involved in a number of disorders, including Alzheimer’s disease. Victims of Alzheimer’s disease suffer from loss of intellectual capacity, disintegration of personality, mental confusion, hallucinations, and aggressive - even violent - behaviour. These symptoms are the result of progressive degeneration in many types of neurons in the brain. Forgetfulness, one of the earliest symptoms of Alzheimer’s disease, is partly caused by the destruction of neurons that normally release the neurotransmitter acetylcholine. Medications that increase brain levels of acetylcholine have helped restore short-term memory and reduce mood swings in some Alzheimer’s patients.
Neurotransmitters also play a role in Parkinson disease, which slowly attacks the nervous system, causing symptoms that worsen over time. Fatigue, mental confusion, a mask-like facial expression, stooping posture, shuffling gait, and problems with and speaking is among the difficulties suffered by Parkinson victims. These symptoms have been partly linked to the deterioration and eventual death of neurons that run from the base of the brain to the basal ganglia, a collection of nerve cells that manufacture the neurotransmitter dopamine. The reasons why such neurons die are yet to be understood, but the related symptoms can be alleviated. L-dopa, or levodopa, widely used to treat Parkinson disease, acts as a supplementary precursor for dopamine. It causes the surviving neurons in the basal ganglia to increase their production of dopamine, thereby compensating to some extent for the disabled neurons.
Many other effective drugs have been shown to act by influencing neurotransmitter behaviour. Some drugs work by interfering with the interactions between neurotransmitters and intestinal receptors. For example, belladonna decreases intestinal cramps in such disorders as irritable bowel syndrome by blocking acetylcholine from combining with receptors. This process reduces nerve signals to the bowel wall, which prevents painful spasms.
Other drugs block the reuptake process. One well-known example is the drug fluoxetine (Prozac), which blocks the reuptake of serotonin. Serotonin then remains in the synapse for a longer time, and its ability to act as a signal is prolonged, which contributes to the relief of depression and the control of obsessive-compulsive behaviours.
Neurotransmitters are released into a microscopic gap, called a synapse, that separates the transmitting neuron from the cell receiving the chemical signal. The cell that generates the signal is called the presynaptic cell, while the receiving cell is termed the postsynaptic cell.
After their release into the synapse, neurotransmitters combine chemically with highly specific protein molecules, termed receptors, that are embedded in the surface membranes of the postsynaptic cell. When this combination occurs, the voltage, or electrical force, of the postsynaptic cell is either increased (excited) or decreased (inhibited).
When a neuron is in its resting state, its voltage is about -70 millivolts. An excitatory neurotransmitter alters the membrane of the postsynaptic neuron, making it possible for ions (electrically charged molecules) to move back and forth across the neuron’s membranes. This flow of ions makes the neuron’s voltage rise toward zero. If enough excitatory receptors have been activated, the postsynaptic neuron responds by firing, generating a nerve impulse that causes its own neurotransmitter to be released into the next synapse. An inhibitory neurotransmitter causes different ions to pass back and forth across the postsynaptic neuron’s membrane, lowering the nerve cell’s voltage to -80 or -90 millivolts. The drop in voltage makes it less likely that the postsynaptic cell will fire.
If the postsynaptic cell is a muscle cell rather than a neuron, an excitatory neurotransmitter will cause the muscle to contract. If the postsynaptic cell is a gland cell, an excitatory neurotransmitter will cause the cell to secrete its contents.
While most neurotransmitters interact with their receptors to create new electrical nerve impulses that energize or inhibit the adjoining cell, some neurotransmitter interactions do not generate or suppress nerve impulses. Instead, they interact with a second type of receptor that changes the internal chemistry of the postsynaptic cell by either causing or blocking the formation of chemicals called second messenger molecules. These second messengers regulate the postsynaptic cell’s biochemical processes and enable it to conduct the maintenance necessary to continue synthesizing neurotransmitters and conducting nerve impulses. Examples of second messengers, which are formed and entirely contained within the postsynaptic cell, include cyclic adenosine monophosphate, diacylglycerol, and inositol phosphates.
Once neurotransmitters have been secreted into synapses and have passed on their chemical signals, the presynaptic neuron clears the synapse of neurotransmitter molecules. For example, acetylcholine is broken down by the enzyme acetylcholinesterase into choline and acetate. Neurotransmitters like dopamine, serotonin, and GABA is removed by a physical process called reuptake. In reuptake, a protein in the presynaptic membrane acts as a sort of sponge, causing the neurotransmitters to reenter the presynaptic neuron, where they can be broken down by enzymes or repackaged for reuse.
Severe mental illness almost always alters a person’s life dramatically. People with severe mental illnesses experience disturbing symptoms that can make it difficult in holding down a job, or go to school, relate to others, or cope with ordinary life demands. Some individuals require hospitalization because they become unable to care for themselves or because they are at risk of committing suicide.
The symptoms of mental illness can be very distressing. People who develop schizophrenia may hear voices inside their head that say nasty things about them or command them to act in strange or unpredictable ways. Or they may be paralysed by paranoia - the deep conviction that everyone, including their closest family members, wants to injure or destroy them. People with major depression may feel that nothing brings pleasure and that life is so dreary and unhappy that it is better to be dead. People with panic disorder may experience heart palpitations, rapid breathing, and anxiety so extreme that they may not be able to leave home. People whom experience episodes of mania may engage in reckless sexual behaviour or may spend money indiscriminately, acts that later cause them to feel guilt, shame, and desperation.
Other mental illnesses, while not always debilitating, create certain problems in living. People with personality disorders may experience loneliness and isolation because their personality style interferes with social relations. People with an eating disorder may become so preoccupied with their weight and appearance that they force themselves to vomit or refuse to eat. Individuals who develop post-traumatic stress disorder may become angry easily, experience disturbing memories, and have trouble concentrating.
Experiences of mental illness often differ to be unlike or distinct in nature as it depends on one’s culture or social group, sometimes greatly so. For example, in most of the non-Western world, people with depression complain principally of physical ailments, such as lack of energy, poor sleep, loss of appetite, and various kinds of physical pain. And yet, even in North America these complaints are commonplace. But in the United States and other Western societies, depressed people and mental health professionals who treat them tend to emphasize psychological problems, such as feelings of sadness, worthlessness, and despair. The experience of schizophrenia also differs by culture. In India, one-third of the new cases of schizophrenia involve catatonia, a behavioural condition in which a person maintains a bizarre statue-like posture for hours or days. This condition is rare in Europe and North America.
Schizophrenia, is a very severe mental illness characterized by a variety of symptoms, including loss of contact with reality, bizarre behaviour, disorganized thinking and speech, decreased emotional expressiveness, and social withdrawal. Usually only some of these symptoms occur in any one person. The term schizophrenia comes from Greek words meaning ‘split mind.’ However, contrary to common belief, schizophrenia does not refer to a person with a split personality or multiple personality. For a description of a mental illness in which a person has multiple personalities, to observers, schizophrenia may seem like madness or insanity, but persons with schizophrenia have disturbed, frightening thoughts and may have trouble telling the difference between real and unreal experiences.
Perhaps more than any other mental illness, schizophrenia has a debilitating effect on the lives of the people who suffer from it. A person with schizophrenia may have difficulty telling the difference between real and unreal experiences, logical and illogical thoughts, or appropriate and inappropriate behavioural interactions whose appropriations are to express of the objectifying descriptions upon the cases to act of having or having to carry of a definite direction, resisting upon those forms that exploit the contribution in weights of others, or sustain without the adequate issues for which exists or going together without conflict or incongruity, which are accorded to the agreeing conditions, that are disinherently limited. Schizophrenia seriously impairs a person’s ability to work, go to school, enjoy relationships with others, or take care of oneself. In addition, people with schizophrenia frequently require hospitalization because they pose a danger to themselves. About 10 percent of people with schizophrenia commit suicide, and many others attempt suicide. Once people develop schizophrenia, they usually suffer from the illness for the rest of their lives. Although there is no cure, treatment can help many people with schizophrenia lead productive lives.
Schizophrenia also carries an enormous cost to society. People with schizophrenia occupy about one-third of all beds in psychiatric hospitals in the United States. In addition, people with schizophrenia account for at least 10 percent of the homeless population in the United States. The National Institute of Mental Health has estimated that schizophrenia costs the United States tens of billions of dollars each year in direct treatment, social services, and lost productivity.
Approximately 1 percent of people develop schizophrenia at some time during their lives. Experts estimate that about 1.8 million people in the United States have schizophrenia. The prevalence of schizophrenia is rather being one than another or more, regardless of sex, race, and culture. Although women are just as likely as men to develop schizophrenia, women tend to experience the illness to a lesser extent than is severely, with fewer hospitalizations and better social functioning in the community.
Schizophrenia usually develops in late adolescence or early adulthood, between the ages of 15 and 30. Much less common, schizophrenia develops later in life. The illness may begin abruptly, but it usually develops slowly over months or years. Mental health professionals diagnose schizophrenia based on an interview with the patient in which they determine whether the person has experienced specific symptoms of the illness.
Symptoms and functioning in people with schizophrenia tend to vary over time, sometimes worsening and other times improving. For many patients the symptoms gradually become less severe as they grow older. About 25 percent of people with schizophrenia become symptom-free later in their lives.
A variety of symptoms characterize schizophrenia. The most prominent include symptoms of psychosis - such as delusions and hallucinations - as well as bizarre behaviour, strange movements, and disorganized thinking and speech. Many people with schizophrenia do not recognize that their mental functioning is disturbed.
Delusions are false beliefs that appear obviously untrue to other people. For example, a person with schizophrenia may believe that he is the king of England when he is not. People with schizophrenia may have delusions that others, such as the local police are plotting against them or spying on them. They may believe that aliens are controlling their thoughts or that their own thoughts are being broadcast to the world so that other people can hear them.
People with schizophrenia may also experience hallucinations (false sensory perceptions). People with hallucinations see, hear, smell, feel, or taste things that are not really there. Auditory hallucinations, such as hearing voices when no one else is around, are especially common in schizophrenia. These hallucinations may include, in and around two or more voices conversing with other, voices that continually comment on the person’s life, or voices that command the person to do something.
People with schizophrenia often behave bizarrely. They may talk to themselves, walk backward, laugh suddenly without explanation, make funny faces, or masturbate in public. In rare cases, they maintain a rigid, bizarre pose for hours on end. Alternately, they may engage in constant random or repetitive movement, such that the actions justified, the dynamical situation has proven current to the motional services in moderation that include the primary presence of its operateness.
People with schizophrenia sometimes talk in incoherent or nonsensical ways, which may commonly suggest of an impounding distinction the impact to cause confused or disorganized thinking? In conversation they may eradicably jump from subject to subject or string together loosely associated phrases. They may combine words and phrases in meaningless ways or make up new words. In addition, they may show poverty of speech, in which they talk less and more slowly than other people, fail to answer questions or reply only briefly, or suddenly stop talking in the middle of speech.
Another common characteristic of schizophrenia is social withdrawal. People with schizophrenia may avoid others or act as though others do not exist. They often show decreased emotional expressiveness. For example, they may talk in a low, monotonous voice, avoid eye contact with others, and display a blank facial expression. They may also have difficulties experiencing pleasure and may lack interest in participating in activities.
Other symptoms of schizophrenia include difficulties with memory, attention span, abstract thinking, and planning ahead. People with schizophrenia commonly have problems with anxiety, depression, and suicidal thoughts. In addition, people with schizophrenia are much more likely to abuse or become dependent upon drugs or alcohol than other people. The use of alcohol and drugs often worsens the symptoms of schizophrenia, resulting in relapses and hospitalizations.
Schizophrenia appears to result not from a single cause, but from a variety of factors. Most scientists believe that schizophrenia is a biological disease caused by genetic factors, an imbalance of chemicals in the brain, structural brain abnormalities, or abnormalities in the prenatal environment. In addition, stressful life events may contribute to the development of schizophrenia in those who are predisposed to the illness.
Some evidence suggests that schizophrenia may result from an imbalance of chemicals in the brain called ‘neurotransmitters’. These chemicals enable neurons (brain cells) to communicate with other. Some scientists suggest that schizophrenia result from excess activity of the neurotransmitter dopamine in certain parts of the brain or from an abnormal sensitivity to dopamine. Support for this hypothesis comes from Antipsychotic drugs, which reduce psychotic symptoms in schizophrenia by blocking brain receptors for dopamine. In addition, amphetamines, which increase dopamine activity, intensify psychotic symptoms in people with schizophrenia. Despite these findings, many experts believe that excess dopamine activity alone cannot account for schizophrenia. Other neurotransmitters, such as serotonin and norepinephrine, may play important roles as well.
Brain imaging techniques, such as ‘magnetic resonance’ imaging and ‘positron-emission tomography’, have led researchers to discover specific structural abnormalities in the brains of people with schizophrenia. For example, people with chronic schizophrenia tend to have enlarged brain ventricles (cavities in the brain that contains cerebrospinal fluid). They also have a smaller overall volume of brain tissue compared to mentally healthy people. Other people with schizophrenia show abnormally low activity in the frontal lobe of the brain, which governs abstract thought, planning, and judgment. Research has identified possible abnormalities in many other parts of the brain, including the temporal lobes, basal ganglia, thalamus, hippocampus, and superior temporal gyrus. These defects may partially explain the abnormal thoughts, perceptions, and behaviours that characterize schizophrenia.
Evidence suggests those factors in the prenatal environment and during birth can increase the risk of a person later developing schizophrenia. These events are believed to affect the brain development of the fetus during a critical period. For example, pregnant women who have been exposed to the influenza virus or who have poor nutrition have a slightly increased chance of giving birth to a child who later develops schizophrenia. In addition, obstetric complications during the birth of a child - for example, delivery with forceps - can slightly increase the chances of the child later developing schizophrenia.
Although scientists favour a biological cause of schizophrenia, stress in the environment may affect the onset and course of the illness. Stressful life circumstances - such as growing up and living in poverty, the death of a loved one, an important change in jobs or relationships, or chronic tension and hostility at home - can increase the chances of schizophrenia in a person biologically predisposed to the disease. In addition, stressful events can trigger a relapse of symptoms in a person who already has the illness. Individuals who have effective skills for managing stress may be less susceptible to its negative effects. Psychological and social rehabilitation can help patients develop more effective skills for dealing with stress.
Although there is no cure for schizophrenia, effective treatment exists that can improve the long-term course of the illness. With many years of treatment and rehabilitation, significant numbers of people with schizophrenia experience partial or full remission of their symptoms.
Treatment of schizophrenia usually involves a combination of medication, rehabilitation, and treatment of other problems the person may have. Antipsychotic drugs (also called ‘neuroleptics’) are the most frequently used medications for treatment of schizophrenia. Psychological and social rehabilitation programs may help people with schizophrenia function in the community and reduce stress related to their symptoms. Treatment of secondary problems, such as substance abuse and infectious diseases, is also an important part of an overall treatment program.
Serotonin, neurotransmitter, or chemical that transmits messages across the synapses, or gaps, between adjacent cells, in among the many functions, serotonin is released from blood cells called platelets to activate blood vessel constriction and blood clotting. In the gastrointestinal tract, serotonin inhibits gastric acid production and stimulates muscle contraction in the intestinal wall. Its functions in the central nervous system and effects on human behaviour - including mood, memory, and appetite control - have been the subject of a great deal of research. This intensive study of serotonin has revealed important knowledge about the serotonin-related cause and treatment of many illnesses.
Serotonin is produced in the brain from the amino acid tryptophan, which is derived from foods high in protein, such as meat and dairy products. Tryptophan is transported to the brain, where it is broken down by enzymes to produce serotonin. In the process of neurotransmission, serotonin is transferred from one nerve cell, or neuron, to another, triggering an electrical impulse that stimulates or inhibits cell activity as needed. Serotonin is then reabsorbed by the first neuron, in a process known as reuptake, where it is recycled and used again or converted into an inactive chemical form and excreted.
While the complete picture of serotonin’s function in the body is still being investigated, many disorders are known to be associated with an imbalance of serotonin in the brain. Drugs that manipulate serotonin levels have been used to alleviate the symptoms of serotonin imbalances. Some of these drugs, known as selective serotonin reuptake inhibitors (SSRIs), block or inhibit the reuptake of serotonin into neurons, enabling serotonin to remain active in the synapses for a longer period of time. These medications are used to treat such psychiatric disorders as depression; obsessive-compulsive disorder, in which repetitive and disturbing thoughts trigger bizarre, ritualistic behaviours; and impulsive aggressive behaviours. Fluoxetine (more commonly known by the brand name Prozac), is a widely prescribed SSRI used to treat depression, and more recently, obsessive-compulsive disorder.
Drugs that affect serotonin levels may prove beneficial in the treatment of nonpsychiatric disorders as well, including diabetic neuropathy (degeneration of nerves outside the central nervous system in diabetics) and premenstrual syndrome. Recently the serotonin-releasing agent dexfenfluramine has been approved for patients who are 30 percent or more over their ideal body weight. By preventing serotonin reuptake, dexfenfluramine promotes satiety, or fullness, after eating less food.
Other drugs serve as agonists that react with neurons to produce effects similar to those of serotonin. Serotonin agonists have been used to treat migraine headaches, in which low levels of serotonin cause arteries in the brain to swell, resulting in a headache. Sumatriptan is an agonist drug that mimics the effects of serotonin in the brain, constricting blood vessels and alleviating pain.
Drugs known as ‘antagonists’ bind with neurons to prevent serotonin neurotransmission. Some antagonists have been found effective in treating the nausea that typically accompanies radiation and chemotherapy in cancer treatment. Antagonists are also being tested to treat high blood pressure and other cardiovascular disorders by blocking serotonin’s ability to constrict blood vessels. Other antagonists may produce an effect on learning and memory in age-associated memory impairment.
Antipsychotic medications, developed in the mid-1950's, can dramatically improve the quality of life for people with schizophrenia. The drugs reduce or eliminate psychotic symptoms such as hallucinations and delusions. The medications can also help prevent these symptoms from returning. Common Antipsychotic drugs include risperidone (Risperdal), olanzapine (Zyprexa), clozapine (Clozaril), quetiapine (Seroquel), haloperidol (Haldol), thioridazine (Mellaril), chlorpromazine (Thorazine), fluphenazine (Prolixin), and trifluoperazine (Stelazine). People with schizophrenia usually must take medication for the rest of their lives to control psychotic symptoms. Antipsychotic medications appear to be less effective at treating other symptoms of schizophrenia, such as social withdrawal and apathy.
Mood disorders, also called ‘affective disorders’, create disturbances in a person’s emotional life. Depression, mania, and bipolar disorder are examples of mood disorders. Symptoms of depression may include feelings of sadness, hopelessness, and worthlessness, as well as complaints of physical pain and changes in appetite, sleep patterns, and energy level. In mania, on the other hand, an individual experiences an abnormally elevated mood, often marked by exaggerated self-importance, irritability, agitation, and a decreased need for sleep. In bipolar disorder, also called manic-depressive illness, a person’s mood alternates between extremes of mania and depression.
Bipolar disorder is a mental illness that causes mood swings. In the manic phase, a person might feel ecstatic, self-important, and energetic. But when the person becomes depressed, the mood shifts to extreme sadness, negative thinking, and apathy. Some studies indicate that the disease occurs at unusually high rates in creative people, such as artists, writers, and musicians. But some researchers contend that the methodology of these studies was flawed and their results were misleading. In the October 1996 Discover Magazine article, anthropologist Jo Ann C. Gutin presents the results of several studies that explore the link between creativity and mental illness.
Freud created an entirely new approach to the understanding of human personality by his demonstration of the existence and force of the unconscious. In addition, he founded a new medical discipline and formulated basic therapeutic procedures that in modified form are applied widely in the present-day treatment of neuroses and psychoses. Although never accorded full recognition during his lifetime, Freud is generally acknowledged as one of the great creative minds of modern times.
Among his other works are Totem and Taboo (1913), Ego and the Id (1923), New Introductory Lectures on Psychoanalysis (1933), and Moses and Monotheism (1939).
The ego, the term occurring in psychoanalysis, that designates its term as denoting the central part of the personality structure that deals with reality and is influenced by social forces. According to the psychoanalytic theories developed by Sigmund Freud, the ego constitutes one of the three basic provinces of the mind, the other two, being the id and the superego. Formation of the ego begins at birth in the first encounters with the external world of people and things. The ego learns to modify behaviour by controlling those impulses that are socially unacceptable. Its role is that of a mediator between unconscious impulses and acquired social and personal standards.
In philosophy, ego means the conscious self or ‘I.’ It was viewed by some philosophers, notably the 17th-century Frenchman René Descartes and the 18th-century German Johann Gottlieb Fichte, as the sole basis of reality; they saw the universe as existing only in the individual's knowledge and experience of it. Other philosophers, such as the 18th-century German Immanuel Kant, proposed two forms of the ego, one perceiving and the other thinking.
As well, the term Id was oriented into psychoanalytic theory, one of the three basic elements of personality, the others being the ego and the superego. The id can be equated with the unconscious of common usage, which is the reservoir of the instinctual drives of the individual, including biological urges, wishes, and affective motives. The id is dominated by the pleasure principle, through which the individual is pressed for immediate gratification of his or her desires. In strict Freudian theory the energy behind the instinctual drives of the id is known as the libido, a generalized force, basically sexual in nature, through which the sexual and psychosexual nature of the individual finds expression.
Also, the Superego, in psychoanalytic theory is one of the three basic and most fundamental constituents of the mind, the others being the id and the ego. As postulated by Sigmund Freud, the term designates the element of the mind that, in normal personalities, automatically modifies and inhibits those instinctual impulses or drives of the id that tend to produce antisocial actions and thoughts.
According to psychoanalytic theory, the superego develops as the child gradually and unconsciously adopts the values and standards, first of his or her parents, and later of the social environment. According to modern Freudian psychoanalysts, the superego includes the positive ego, or conscious self-image, or ego ideal, that each individual develops.
Psychoanalysis, is the name applied to a specific method of investigating unconscious mental processes and to a form of psychotherapy. The term refers, as well, to the systematic structure of psychoanalytic theory, which is based on the relation of conscious and unconscious psychological processes.
The techniques of psychoanalysis and much of the psychoanalytic theory based on its application were developed by Sigmund Freud. His work concerning the structure and the functioning of the human mind had influential significance, both practically and scientifically, and it continues to influence contemporary thought.
Of Freud’s three basic personality structures - id, ego, and superego - only the id is totally unconscious. The first of Freud's innovations was his recognition of unconscious psychiatric processes that follow laws different from those that govern conscious experience. Under the influence of the unconscious, thoughts and feelings that belong together may be shifted or displaced out of context; two disparate ideas or images may be condensed into one; thoughts may be dramatized in the form of images rather than expressed as abstract concepts; and certain objects may be represented symbolically by images of other objects, although the resemblance between the symbol and the original object may be vague or farfetched. The laws of logic, indispensable for conscious thinking, do not apply to these unconscious mental productions.
Recognition of these modes of operation in unconscious mental processes made possibly the understanding of such previously incomprehensible psychological phenomena as dreaming. Through analysis of unconscious processes, Freud saw dreams as serving to protect sleep against disturbing impulses arising from within and related to early life experiences. Thus, unacceptable impulses and thoughts, called the latent dream content, are transformed into a conscious, although no longer immediately comprehensible, experience called the manifest dream. Knowledge of these unconscious mechanisms permits the analyst to reverse the so-called dream work, that is, the process by which the latent dream is transformed into the manifest dream, and through dream interpretation, to recognize its underlying meaning.
A basic assumption of Freudian theory is that the unconscious conflicts involve instinctual impulses, or drives, that originate in childhood. As these unconscious conflicts are recognized by the patient through analysis, his or her adult mind can find solutions that were unattainable to the immature mind of the child. This depiction of the role of instinctual drives in human life is a unique feature of Freudian theory.
According to Freud's doctrine of infantile sexuality, adult sexuality is an end-product of a complex process of development, beginning in childhood, involving a variety of body functions or areas (oral, anal, and genital zones), and corresponding to various stages in the relation of the child to adults, especially to parents. This distinguishes the oedipus Complex, in psychoanalysis, a son’s largely unconscious sexual attraction toward his mother accompanied by jealousy toward his father. The terminological distinction of the oedipus complex, derived from the Greek legend of Oedipus, was first used in the late 1800's by Austrian psychiatrist Sigmund Freud, the founder of psychoanalysis. Freud thought that the Oedipus complex was the most important event of a boy’s childhood and had a great effect on his subsequent adult life. Freud claimed that in nearly all cases the boy represses the desire for his mother and the jealousy toward his father. As a result of this unconscious experience, Freud believed, a boy with an Oedipus complex feels guilt and experiences strong emotional conflicts. Freud thought that young women went through a similar experience, in which they are attracted to their father and surmount the disconfirming antagonistic attitude toward their mother. He called this the Electra complex. According to Freud, if a woman remains under the influence of the Electra complex, she is likely to choose a husband with characteristics similar to those of her father.
Of crucial importance is the so-called Oedipal period, occurring at about four to six years of age, because at this stage of development the child for the first time becomes capable of an emotional attachment to the parent of the opposite sex that is similar to the adult's relationship to a mate; the child simultaneously reacts as a rival to the parent of the same sex. Physical immaturity dooms the child's desires to frustration and his or her first step toward adulthood to failure. Intellectual immaturity further complicates the situation because it makes children afraid of their own fantasies. The extent to which the child overcomes these emotional upheavals and to which these attachments, fears, and fantasies continue to live on in the unconscious greatly influences later life, especially ‘loves’ relationships.
The conflicts occurring in the earlier developmental stages are no less significant as a formative influence, because these problems represent the earliest prototypes of such basic human situations as dependency on others and relationship to authority. Also, basic in moulding the personality of the individual is the behaviour of the parents toward the child during these stages of development. The fact that the child reacts, not only to objective reality, but also to fantasy distortions of reality, however, greatly complicates even the best-intentioned educational efforts.
The effort to clarify the bewildering number of interrelated observations uncovered by psychoanalytic exploration led to the development of a model of the structure of the psychic system. Three functional systems are distinguished that are conveniently designated as the id, ego, and superego.
The first system refers to the sexual and aggressive tendencies that arise from the body, as distinguished from the mind. Freud called these tendencies ‘Triebe’, which literally means ‘drives,’ but which is often inaccurately translated as ‘instincts’ to indicate their innate character. These inherent drives claim immediate satisfaction, which is experienced as pleasurable; the id thus is dominated by the pleasure principle. In his later writings, Freud tended more toward psychological rather than biological conceptualization of the drives.
How the conditions for satisfaction are to be brought about is the task of the second system, the ego, which is the domain of such functions as perception, thinking, and motor control that can accurately assess environmental conditions. In order to fulfill its function of adaptation, or reality testing, the ego must be capable of enforcing the postponement of satisfaction of the instinctual impulses originating in the id. To defend itself against unacceptable impulses, the ego develops specific psychic means, known as defence mechanisms. These include repression, the exclusion of impulses from conscious awareness; projection, the process of ascribing to others one's own unacknowledged desires; and reaction formation, the establishments of a pattern of behaviour directly opposed to a strong unconscious imperative necessarily in need for or required to employ of its relief. Such defence mechanisms are put into operation whenever anxiety signals a danger that the original unacceptable impulses may reemerge.
An id impulse becomes unacceptable, not only as a result of a temporary need for postponing its satisfaction until suitable reality conditions can be found, but more often because of a prohibition imposed on the individual by others, originally the parents. The totality of these demands and prohibitions constitutes the major content of the third system, the superego, the function of which is to control the ego in accordance with the internalized standards of parental figures. If the demands of the superego are not fulfilled, the person may feel shame or guilt. Because the superego, in Freudian theory, originates in the struggle to overcome the Oedipal conflict, it has a power akin to an instinctual drive, is in part unconscious, and can give rise to feelings of guilt not justified by any conscious transgression. The ego, having to mediate among the demands of the id, the superego, and the outside world, may not be strong enough to reconcile these conflicting forces. The more the ego is impeded in its development because of being enmeshed in its earlier conflicts, called fixations or complexes, or the more it reverts to earlier satisfactions and archaic modes of functioning, known as regression, the greater is the likelihood of succumbing to these pressures. Unable to function normally, it can maintain its limited control and integrity only at the price of symptom formation, in which the tensions are expressed in neurotic symptoms.
A cornerstone of modern psychoanalytic theory and practice is the concept of anxiety, which institutes appropriate mechanisms of defence against certain danger situations. These danger situations, as described by Freud, are the fear of abandonment by or the loss of the loved one (the object), the risk of losing the object's love, the danger of retaliation and punishment, and, finally, the hazard of reproach by the superego. Thus, symptom formation, character and impulse disorders, and perversions, as well as sublimations, represent compromise formations - different forms of an adaptive integration that the ego tries to achieve through more or less successfully reconciling the different conflicting forces in the mind.
Various psychoanalytic schools have adopted other names for their doctrines to indicate deviations from Freudian theory.
Swiss psychiatrist Carl Jung began his studies of human motivation in the early 1900's and created the school of psychoanalysis known as analytical psychology. A contemporary of Austrian psychoanalyst Sigmund Freud, Jung at first collaborated closely with Freud but eventually moved on to pursue his own theories, including the exploration of personality types. According to Jung, there are two basic personality types, extroverted and introverted, which alternate equally in the completely normal individual. Jung also believed that the unconscious mind is formed by the personal unconscious (the repressed feelings and thoughts developed during an individual’s life) and the collective unconscious (those feelings, thoughts, and memories shared by all humanity).
Carl Gustav Jung, one of the earliest pupils of Freud, eventually created a school that he preferred to call analytical psychology. Like Freud, Jung used the concept of the libido; however, to him it meant not only sexual drives, but a composite of all creative instincts and impulses and the entire motivating force of human conduct. According to his theories, the unconscious is composed of two parts, as the personal unconscious, which contains the results of the individual's entire experience, and the collective unconscious, the reservoir of the experience of the human race. In the collective unconscious exist a number of primordial images, or archetypes, common to all individuals of a given country or historical era. Archetypes take the form of bits of intuitive knowledge or apprehension and normally exist only in the collective unconscious of the individual. When the conscious mind contains no images, however, as in sleep, or when the consciousness is caught off guard, the archetypes commence to function. Archetypes are primitive modes of thought and tend to personify natural processes in terms of such mythological concepts as good and evil spirits, fairies, and dragons. The mother and the father also serve as prominent archetypes.
An important concept in Jung's theory is the existence of two basically different types of personality, mental attitude, and function. When the libido and the individual's general interest are turned outward toward people and objects of the external world, he or she is said to be extroverted. When the reverse is true, and libido and interest are centred on the individual, he or she is said to be introverted. In a completely normal individual these two tendencies alternate, dominating, but usually the libido is directed mainly neither in one direction nor of the other; as a result, two personality types are recognizable.
The Jungian concepts in the term ‘complex’, was an acceptable group of repressed ideas that shape an individual’s response to think, feel, and act in a certain habitual pattern. Swiss psychiatrist Carl Jung, who originally coined the term complex, derived it from the Latin word complexus, meaning interweaving or braiding. Jung stated that a complex is a ‘grouping of psychic elements about emotionally toned contents,’ adding that it ‘consists of a nuclear element and a great number of secondarily constellated associations.’ The components of a complex may be present in consciousness or in the unconscious. Conflicts, frustrations, and threats to personal security encountered during infancy are then repressed into the unconscious, where they remain dormant, but not forgotten. These unconscious memories will govern an individual’s response to emotional conflict even into adult life, as the original trauma and its associated effect patterns thinking and behaviour to meet the new conflict.
The Oedipus and Electra complexes as described by Sigmund Freud, and the inferiority complex as described by Alfred Adler, have been influential concepts within the context of psychoanalytic theory
Jung rejected Freud's distinction between the ego and superego and recognized a portion of the personality, somewhat similar to the superego, that he called the persona. The persona consists of what a person appears to be to others, in contrast to what he or she actually is. The persona is the role the individual chooses to play in life, the total impression he or she wishes to make on the outside world.
Austrian psychologist and psychiatrist Alfred Adler, after leaving the university he studied and was associated with Sigmund Freud, the founder of psychoanalysis. In 1911 Adler left the orthodox psychoanalytic school to found a neo-Freudian school of psychoanalysis. After 1926 he was a visiting professor at Columbia University, and in 1935 he and his family moved to the United States.
In his analysis of individual development, Adler stressed the sense of inferiority, rather than sexual drives, as the motivating force in human life. According to Adler, conscious or subconscious feelings of inferiority (to which he gave the name inferiority complex), combined with compensatory defence mechanisms, is the basic cause of psychopathological behaviour. The function of the psychoanalyst, furthermore, is to discover and rationalize such feelings and break down the compensatory, neurotic will for power that they engender in the patient. Adler's works include ‘The Theory and Practice of Individual Psychology’ (1918) and ‘The Pattern of Life’ (1930).
Adler’s analysis of individual development stressed the sense of inferiority, rather than sexual drives, as the motivating force in human life. According to Adler, conscious or subconscious feelings of inferiority (to which he gave the name inferiority complex), combined with compensatory defence mechanisms, is the basic cause of psychopathological behaviour. The function of the psychoanalyst, furthermore, is to discover and rationalize such feelings and break down the compensatory, neurotic will for power that they engender in the patient. Adler's works include ‘The Theory and Practice of Individual Psychology’ (1918) and ‘The Pattern of Life’ (1930).
Alfred Adler, another of Freud's pupils, differed from both Freud and Jung in stressing that the motivating force in human life is the sense of inferiority, which begins as soon as an infant is able to comprehend the existence of other people who are better able to care for themselves and cope with their environment. From the moment the feeling of inferiority is established, the child strives to overcome it. Because inferiority is intolerable, the compensatory mechanisms set up by the mind may get out of hand, resulting in self-centred neurotic attitudes, overcompensations, and a retreat from the real world and its problems.
Adler laid particular stress on inferiority feelings arising from what he regarded as the three most important relationships: those between the individual and work, friends, and loved ones. The avoidance of inferiority feelings in these relationships leads the individual to adopt a life goal that is often not realistic and is frequently expressed as an unreasoning will to power and to all others are influenced by the dominant ascendancy leading to every type of antisocial behaviour from bullying and boasting to political tyranny. Adler believed that analysis can foster a sane and rational ‘community feeling’ that is constructive rather than destructive.
Austrian psychologist and psychotherapist Otto Rank worked with Sigmund Freud, the founder of psychoanalysis, before developing his own theories about mental and emotional disorders. Rank believed that an individual’s neurotic tendencies could be linked to the traumatic experience of birth.
Another student of Freud, Dr. Otto Rank, introduced a new theory of neurosis, attributing all neurotic disturbances to the primary trauma of birth. In his later writings he described individual development as a progression from complete dependence on the mother and family, to a physical independence coupled with intellectual dependence on society, and finally to complete intellectual and psychological emancipation. Rank also laid great importance on the will, defined as ‘a positive guiding organization and integration of self, implementing its use in the constant critical creativites as well as that it inhabits and controls the instinctual drives.’
American psychoanalyst and social philosopher Erich Fromm stressed the importance of social and economic factors on human behaviour. His focus was a departure from a traditional psychoanalysis, which emphasized the role of the subconscious. In the 1969 essay for Collier’s Year Book, Fromm presents various explanations for human violence. He argues that violence cannot be controlled by imposing stronger legal penalties, but rather by creating a more just society in which people connect with other as humans and are able to control their own lives.
Later noteworthy modifications of psychoanalytic theory include those of the American psychoanalyst’s Erich Fromm, Karen Horney, and Harry Stack Sullivan. The theories of Fromm lay particular emphasis on the concept that society and the individual is not separate and opposing forces, that the nature of society is determined by its historic background, and that the needs and desires of individuals are largely formed by their society. As a result, Fromm believed, the fundamental problem of psychoanalysis and psychology is not to resolve conflicts between fixed and unchanging instinctive drives in the individual and the fixed demands and laws of society, but to bring about harmony and an understanding of the relationship between the individual and society. Fromm also stressed the importance to the individual of developing the ability to fully use his or her mental, emotional, and sensory powers.
Horney worked primarily in the field of therapy and the nature of neuroses, which she defined as of two types: situation neuroses and character neuroses. Situation neuroses arise from the anxiety attendant on a single conflict, such for being faced with a difficult decision. Although they may paralyse the individual temporarily, making it impossible to think or act efficiently, such neuroses are not deeply rooted. Character neuroses are characterized by a basic anxiety and a basic hostility resulting from a lack of love and affection in childhood.
Sullivan believed that all development can be described exclusively in terms of interpersonal relations. Character types as well as neurotic symptoms are explained as results of the struggle against anxiety arising from the individual's relations with others, including security measures of which a system is maintained for the purpose of allaying anxiety.
An important school of thought is based on the teachings of the British psychoanalyst Melanie Klein. Because most of Klein's followers worked with her in England, this has come to be known as the English school. Its influence, nevertheless, is very strong throughout the European continent and in South America. Its principal theories were derived from observations made in the psychoanalysis of children. Klein posited the existence of complex unconscious fantasies in children under the age of six months. The principal source of anxiety arises from the threat to existence posed by the death instinct. Depending on how concrete representations of the destructive forces are dealt within the unconscious fantasy life of the child, two basic early mental attitudes result that Klein characterized as a ‘depressive position’ and a ‘paranoid position.’ In the paranoid position, the ego's defence consists of projecting the dangerous internal object onto some external representative, which is treated as a genuine threat emanating from the external world. In the depressive position, the threatening object is introjected and treated in fantasy as concretely retained within the person. Depressive and hypochondriacal symptoms result. Although considerable doubt exists that such complex unconscious fantasies operate in the minds of infants, these observations have been of the utmost importance to the psychology of unconscious fantasies, paranoid delusions, and theory concerning early object relations.
Scottish physician William Cullen coined the term neurosis near the end of the 18th century to describe a wide variety of nervous behaviours with no apparent physical cause. Austrian psychoanalyst Sigmund Freud and his followers popularized the word in the late 19th and early 20th centuries. Freud defined neurosis as one class of mental illnesses. In his view, people became neurotic when their conscious mind repressed inappropriate fantasies of the unconscious mind.
Until 1980 neuroses appeared as a specific diagnostic category in the Diagnostic and Statistical Manual of Mental Disorders, a handbook for mental health professionals. Neurosis encompassed a variety of mental illnesses, including Dissociative disorders, anxiety disorders, and phobias.
In the psychoanalytic model, neurosis differs from a psychosis, another general term used to describe mental illnesses. Individuals with neuroses can function at work and in social situations, whereas people with psychoses find it quite difficult to function adequately. People with neuroses do not grossly distort or misinterpret reality as those with psychoses do. In addition, neurotic individuals recognize that their mental functioning is disturbed while psychotic individuals usually do not. Most mental health professionals now use the term psychosis to refer to symptoms such as hallucinations, delusions, and bizarre behaviour.
Psychosis, the mental illness in which a person loses contact with reality and has difficulty functioning in daily life. Psychotic symptoms can indicate severe mental illnesses, such as schizophrenia and bipolar disorder (manic-depressive illness). Unlike people with fewer severe psychological problems, psychotic individuals do not usually recognize that their mental functioning is disturbed.
Once, again, a psychosis, is categorized as a mental illness in which a person loses contact with reality and has difficulty functioning in daily life. Psychotic symptoms can indicate severe mental illnesses, such as schizophrenia and bipolar disorder (manic-depressive illness). Unlike people with fewer severe psychological problems, psychotic individuals do not usually recognize that their mental functioning is disturbed.
Mental health professionals generally divide psychotic symptoms into three broad types: hallucinations, delusions, and bizarre behaviour. Hallucinations refer to hearing, seeing, smelling, feeling, or tasting something when nothing in the environment actually caused that sensation. For example, a person experiencing an auditory hallucination might hear a voice calling their name even though no one else is actually present. A delusion is a false belief held by a person that appears obviously untrue to other people in that person’s culture. For example, a man may believe that Martians have implanted a microchip in his brain that controls his thoughts. Bizarre behaviour refers to behaviour in a person that is strange or incomprehensible to others who know the person. For example, hoarding unused scraps of tin because of their ‘magical properties’ would be a type of bizarre behaviour.
In philosophy, ego means the conscious self or ‘I.’ It was viewed by some philosophers, notably the 17th-century Frenchman René Descartes and the 18th-century German Johann Gottlieb Fichte, as the sole basis of reality; they saw the universe as existing only in the individual's knowledge and experience of it. Other philosophers, such as the 18th-century German Immanuel Kant, proposed two forms of the ego, one perceiving and the other thinking.
As well, the term id was oriented into psychoanalytic theory, one of the three basic elements of personality, the others being the ego and the super-ego. The id can be equated with the unconscious of common usage, which is the reservoir of the instinctual drives of the individual, including biological urges, wishes, and affective motives. The id is dominated by the pleasure principle, through which the individual is pressed for immediate gratification of his or her desires. In strict Freudian theory the energy behind the instinctual drives of the id is known as the libido, a generalized force, basically sexual in nature, through which the sexual and psychosexual nature of the individual finds expression.
Also, the Super-ego, in psychoanalytic theory is one of the three basic and most fundamental constituents of the mind, the others being the id and the ego. As postulated by Sigmund Freud, the term designates the element of the mind that, in normal personalities, automatically modifies and inhibits those instinctual impulses or drives of the id that tend to produce antisocial actions and thoughts.
According to psychoanalytic theory, the super-ego develops as the child gradually and unconsciously adopts the values and standards, first of his or her parents, and later of the social environment. According to modern Freudian psychoanalysts, the super-ego includes the positive ego, or conscious self-image, or ego ideal, that each individual develops.
Psychoanalysis, is the name applied to a specific method of investigating unconscious mental processes and to a form of psychotherapy. The term refers, as well, to the systematic structure of psychoanalytic theory, which is based on the relation of conscious and unconscious psychological processes.
The techniques of psychoanalysis and much of the psychoanalytic theory based on its application were developed by Sigmund Freud. His work concerning the structure and the functioning of the human mind had far-reaching significance, both practically and scientifically, and it continues to influence contemporary thought.
Of Freud’s three basic personality structures - id, ego, and super-ego - only the id is totally unconscious. The first of Freud's innovations was his recognition of unconscious psychiatric processes that follow laws different from those that govern conscious experience. Under the influence of the unconscious, thoughts and feelings that belong together may be shifted or displaced out of context; two disparate ideas or images may be condensed into one; thoughts may be dramatized in the form of images rather than expressed as abstract concepts; and certain objects may be represented symbolically by images of other objects, although the resemblance between the symbol and the original object may be vague or farfetched. The laws of logic, indispensable for conscious thinking, do not apply to these unconscious mental productions.
Recognition of these modes of operation in unconscious mental processes made possibly the understanding of such previously incomprehensible psychological phenomena as dreaming. Through analysis of unconscious processes, Freud saw dreams as serving to protect sleep against disturbing impulses arising from within and related to early life experiences. Thus, unacceptable impulses and thoughts, called the latent dream content, are transformed into a conscious, although no longer immediately comprehensible, experience called the manifest dream. Knowledge of these unconscious mechanisms permits the analyst to reverse the so-called dream work, that is, the process by which the latent dream is transformed into the manifest dream, and through dream interpretation, to recognize its underlying meaning.
A basic assumption of Freudian theory is that the unconscious conflicts involve instinctual impulses, or drives, that originate in childhood. As these unconscious conflicts are recognized by the patient through analysis, his or her adult mind can find solutions that were unattainable to the immature mind of the child. This depiction of the role of instinctual drives in human life is a unique feature of Freudian theory.
According to Freudian doctrine of infantile sexuality, adult sexuality is an end-product of a complex process of development, beginning in childhood, involving a variety of body functions or areas (oral, anal, and genital zones), and corresponding to various stages in the relation of the child to adults, especially to parents. This distinguishes the oedipus Complex, in psychoanalysis, a son’s largely unconscious sexual attraction toward his mother accompanied by jealousy toward his father. The terminological distinction of the oedipus complex, derived from the Greek legend of Oedipus, was first used in the late 1800's by Austrian psychiatrist Sigmund Freud, the founder of psychoanalysis. Freud thought that the Oedipus complex was the most important event of a boy’s childhood and had a great effect on his subsequent adult life. Freud claimed that in nearly all cases the boy represses the desire for his mother and the jealousy toward his father. As a result of this unconscious experience, Freud believed, a boy with an Oedipus complex feels guilt and experiences strong emotional conflicts. Freud thought that girls go through a similar experience, in which they are attracted to their father and surmount the disconfirming antagonistic attitude toward their mother. He called this the Electra complex. According to Freud, if a woman remains under the influence of the Electra complex, she is likely to choose a husband with characteristics similar to those of her father.
Of crucial importance is the so-called Oedipal period, occurring at about four to six years of age, because at this stage of development the child for the first time becomes capable of an emotional attachment to the parent of the opposite sex that is similar to the adult's relationship to a mate; the child simultaneously reacts as a rival to the parent of the same sex. Physical immaturity dooms the child's desires to frustration and his or her first step toward adulthood to failure. Intellectual immaturity further complicates the situation because it makes children afraid of their own fantasies. The extent to which the child overcomes these emotional upheavals and to which these attachments, fears, and fantasies continue to live on in the unconscious greatly influences later life, especially ‘loves’ relationships.
The conflicts occurring in the earlier developmental stages are no less significant as a formative influence, because these problems represent the earliest prototypes of such basic human situations as dependency on others and relationship to authority. Also, basic in moulding the personality of the individual is the behaviour of the parents toward the child during these stages of development. The fact that the child reacts, not only to objective reality, but also to fantasy distortions of reality, however, greatly complicates even the best-intentioned educational efforts.
The effort to clarify the bewildering number of interrelated observations uncovered by psychoanalytic exploration led to the development of a model of the structure of the psychic system. Three functional systems are distinguished that are conveniently designated as the id, ego, and super-ego.
The first system refers to the sexual and aggressive tendencies that arise from the body, as distinguished from the mind. Freud called these tendencies ‘Triebe’ which literally means ‘drives,’ but which is often inaccurately translated as ‘instincts’ to indicate their innate character. These inherent drives claim immediate satisfaction, which is experienced as pleasurable; the id thus is dominated by the pleasure principle. In his later writings, Freud tended more toward psychological rather than biological conceptualization of the drives.
How the conditions for satisfaction are to be brought about is the task of the second system, the ego, which is the domain of such functions as perception, thinking, and motor control that can accurately assess environmental conditions. In order to fulfill its function of adaptation, or reality testing, the ego must be capable of enforcing the postponement of satisfaction of the instinctual impulses originating in the id. To defend itself against unacceptable impulses, the ego develops specific psychic means, known as defence mechanisms. These include repression, the exclusion of impulses from conscious awareness; projection, the process of ascribing to others one's own unacknowledged desires; and reaction formation, the establishments of a pattern of behaviour directly opposed to a strong unconscious imperative necessarily in need for or required to employ of its relief. Such defence mechanisms are put into operation whenever anxiety signals a danger that the original unacceptable impulses may reemerge.
An id impulse becomes unacceptable, not only as a result of a temporary need for postponing its satisfaction until suitable reality conditions can be found, but more often because of a prohibition imposed on the individual by others, originally the parents. The totality of these demands and prohibitions constitutes the major content of the third system, the super-ego, the function of which is to control the ego in accordance with the internalized standards of parental figures. If the demands of the super-ego are not fulfilled, the person may feel shame or guilt. Because the super-ego, in Freudian theory, originates in the struggle to overcome the Oedipal conflict, it has a power akin to an instinctual drive, is in part unconscious, and can give rise to feelings of guilt not justified by any conscious transgression. The ego, having to mediate among the demands of the id, the super-ego, and the outside world, may not be strong enough to reconcile these conflicting forces. The more the ego is impeded in its development because of being enmeshed in its earlier conflicts, called fixations or complexes, or the more it reverts to earlier satisfactions and archaic modes of functioning, known as regression, the greater is the likelihood of succumbing to these pressures. Unable to function normally, it can maintain its limited control and integrity only at the price of symptom formation, in which the tensions are expressed in neurotic symptoms.
A cornerstone of modern psychoanalytic theory and practice is the concept of anxiety, which institutes appropriate mechanisms of defence against certain danger situations. These danger situations, as described by Freud, are the fear of abandonment by or the loss of the loved one (the object), the risk of losing the object's love, the danger of retaliation and punishment, and, finally, the hazard of reproach by the super-ego. Thus, symptom formation, character and impulse disorders, and perversions, as well as sublimations, represent compromise formations - different forms of an adaptive integration that the ego tries to achieve through more or less successfully reconciling the different conflicting forces in the mind.
Various psychoanalytic schools have adopted other names for their doctrines to indicate deviations from Freudian theory.
Swiss psychiatrist Carl Jung began his studies of human motivation in the early 1900's and created the school of psychoanalysis known as analytical psychology. A contemporary of Austrian psychoanalyst Sigmund Freud, Jung at first collaborated closely with Freud but eventually moved on to pursue his own theories, including the exploration of personality types. According to Jung, there are two basic personality types, extroverted and introverted, which alternate equally in the completely normal individual. Jung also believed that the unconscious mind is formed by the personal unconscious (the repressed feelings and thoughts developed during an individual’s life) and the collective unconscious (those feelings, thoughts, and memories shared by all humanity).
Carl Gustav Jung, one of the earliest pupils of Freud, eventually created a school that he preferred to call analytical psychology. Like Freud, Jung used the concept of the libido; however, to him it meant not only sexual drives, but a composite of all creative instincts and impulses and the entire motivating force of human conduct. According to his theories, the unconscious is composed of two parts, as the personal unconscious, which contains the results of the individual's entire experience, and the collective unconscious, the reservoir of the experience of the human race. In the collective unconscious exist a number of primordial images, or archetypes, common to all individuals of a given country or historical era. Archetypes take the form of bits of intuitive knowledge or apprehension and normally exist only in the collective unconscious of the individual. When the conscious mind contains no images, however, as in sleep, or when the consciousness is caught off guard, the archetypes commence to function. Archetypes are primitive modes of thought and tend to personify natural processes in terms of such mythological concepts as good and evil spirits, fairies, and dragons. The mother and the father also serve as prominent archetypes.
An important concept in Jung's theory is the existence of two basically different types of personality, mental attitude, and function. When the libido and the individual's general interest are turned outward toward people and objects of the external world, he or she is said to be extroverted. When the reverse is true, and libido and interest are centred on the individual, he or she is said to be introverted. In a completely normal individual these two tendencies alternate, dominating, but usually the libido is directed mainly neither in one direction nor of the other; as a result, two personality types are recognizable.
The Jungian concepts in the term ‘complex’, was an acceptable group of repressed ideas that shape an individual’s response to think, feel, and act in a certain habitual pattern. Swiss psychiatrist Carl Jung, who originally coined the term complex, derived it from the Latin word complexus, meaning interweaving or braiding. Jung stated that a complex is a ‘grouping of psychic elements about emotionally toned contents,’ adding that it ‘consists of a nuclear element and a great number of secondarily constellated associations.’ The components of a complex may be present in consciousness or in the unconscious. Conflicts, frustrations, and threats to personal security encountered during infancy are then repressed into the unconscious, where they remain dormant, but not forgotten. These unconscious memories will govern an individual’s response to emotional conflict even into adult life, as the original trauma and its associated effect patterns thinking and behaviour to meet the new conflict.
The Oedipus and Electra complexes as described by Sigmund Freud, and the inferiority complex as described by Alfred Adler, have been influential concepts within the context of psychoanalytic theory
Jung rejected Freud's distinction between the ego and super-ego and recognized a portion of the personality, somewhat similar to the super-ego, that he called the persona. The persona consists of what a person appears to be to others, in contrast to what he or she actually is. The persona is the role the individual chooses to play in life, the total impression he or she wishes to make on the outside world.
Austrian psychologist and psychiatrist Alfred Adler, after leaving the university he studied and was associated with Sigmund Freud, the founder of psychoanalysis. In 1911 Adler left the orthodox psychoanalytic school to found a neo-Freudian school of psychoanalysis. After 1926 he was a visiting professor at Columbia University, and in 1935 he and his family moved to the United States.
In his analysis of individual development, Adler stressed the sense of inferiority, rather than sexual drives, as the motivating force in human life. According to Adler, conscious or subconscious feelings of inferiority (to which he gave the name inferiority complex), combined with compensatory defence mechanisms, is the basic cause of psychopathological behaviour. The function of the psychoanalyst, furthermore, is to discover and rationalize such feelings and break down the compensatory, neurotic will for power that they engender in the patient. Adler's works include ‘The Theory and Practice of Individual Psychology’ (1918) and ‘The Pattern of Life’ (1930).
Adler’s analysis of individual development stressed the sense of inferiority, rather than sexual drives, as the motivating force in human life. According to Adler, conscious or subconscious feelings of inferiority (to which he gave the name inferiority complex), combined with compensatory defence mechanisms, is the basic cause of psychopathological behaviour. The function of the psychoanalyst, furthermore, is to discover and rationalize such feelings and break down the compensatory, neurotic will for power that they engender in the patient. Adler's works include ‘The Theory and Practice of Individual Psychology’ (1918) and ‘The Pattern of Life’ (1930).
Alfred Adler, another of Freud's pupils, differed from both Freud and Jung in stressing that the motivating force in human life is the sense of inferiority, which begins as soon as an infant is able to comprehend the existence of other people who are better able to care for themselves and cope with their environment. From the moment the feeling of inferiority is established, the child strives to overcome it. Because inferiority is intolerable, the compensatory mechanisms set up by the mind may get out of hand, resulting in self-centred neurotic attitudes, overcompensations, and a retreat from the real world and its problems.
Adler laid particular stress on inferiority feelings arising from what he regarded as the three most important relationships: those between the individual and work, friends, and loved ones. The avoidance of inferiority feelings in these relationships leads the individual to adopt a life goal that is often not realistic and frequently is expressed as an unreasoning will to power and to all others are influenced by the dominant ascendancy leading to every type of antisocial behaviour from bullying and boasting to political tyranny. Adler believed that analysis can foster a sane and rational ‘community feeling’ that is constructive rather than destructive.
Austrian psychologist and psychotherapist Otto Rank worked with Sigmund Freud, the founder of psychoanalysis, before developing his own theories about mental and emotional disorders. Rank believed that an individual’s neurotic tendencies could be linked to the traumatic experience of birth.
Another student of Freud, Dr. Otto Rank, introduced a new theory of neurosis, attributing all neurotic disturbances to the primary trauma of birth. In his later writings he described individual development as a progression from complete dependence on the mother and family, to a physical independence coupled with intellectual dependence on society, and finally to complete intellectual and psychological emancipation. Rank also laid great importance on the will, defined as ‘a positive guiding organization and integration of self, implementing its use in the constant critical creativites as well as that it inhabits and controls the instinctual drives.’
American psychoanalyst and social philosopher Erich Fromm stressed the importance of social and economic factors on human behaviour. His focus was a departure from a traditional psychoanalysis, which emphasized the role of the subconscious. In the 1969 essay for Collier’s Year Book, Fromm presents various explanations for human violence. He argues that violence cannot be controlled by imposing stronger legal penalties, but rather by creating a more just society in which people connect with other as humans and are able to control their own lives.
Later noteworthy modifications of psychoanalytic theory include those of the American psychoanalyst’s Erich Fromm, Karen Horney, and Harry Stack Sullivan. The theories of Fromm lay particular emphasis on the concept that society and the individual is not separate and opposing forces, that the nature of society is determined by its historic background, and that the needs and desires of individuals are largely formed by their society. As a result, Fromm believed, the fundamental problem of psychoanalysis and psychology is not to resolve conflicts between fixed and unchanging instinctive drives in the individual and the fixed demands and laws of society, but to bring about harmony and an understanding of the relationship between the individual and society. Fromm also stressed the importance to the individual of developing the ability to fully use his or her mental, emotional, and sensory powers.
Horney worked primarily in the field of therapy and the nature of neuroses, which she defined as of two types: situation neuroses and character neuroses. Situation neuroses arise from the anxiety attendant on a single conflict, such for being faced with a difficult decision. Although they may paralyse the individual temporarily, making it impossible to think or act efficiently, such neuroses are not deeply rooted. Character neuroses are characterized by a basic anxiety and a basic hostility resulting from a lack of love and affection in childhood.
Sullivan believed that all development can be described exclusively in terms of interpersonal relations. Character types as well as neurotic symptoms are explained as results of the struggle against anxiety arising from the individual's relations with others, including security measures of which a system is maintained for the purpose of allaying anxiety.
An important school of thought is based on the teachings of the British psychoanalyst Melanie Klein. Because most of Klein's followers worked with her in England, this has come to be known as the English school. Its influence, nevertheless, is very strong throughout the European continent and in South America. Its principal theories were derived from observations made in the psychoanalysis of children. Klein posited the existence of complex unconscious fantasies in children under the age of six months. The principal source of anxiety arises from the threat to existence posed by the death instinct. Depending on how concrete representations of the destructive forces are dealt within the unconscious fantasy life of the child, two basic early mental attitudes result that Klein characterized as a ‘depressive position’ and a ‘paranoid position.’ In the paranoid position, the ego's defence consists of projecting the dangerous internal object onto some external representative, which is treated as a genuine threat emanating from the external world. In the depressive position, the threatening object is introjected and treated in fantasy as concretely retained within the person. Depressive and hypochondriacal symptoms result. Although considerable doubt exists that such complex unconscious fantasies operate in the minds of infants, these observations have been of the utmost importance to the psychology of unconscious fantasies, paranoid delusions, and theory concerning early object relations.
Mental health professionals generally divide psychotic symptoms into three broad types: hallucinations, delusions, and bizarre behaviour. Hallucinations refer to hearing, seeing, smelling, feeling, or tasting something when nothing in the environment actually caused that sensation. For example, a person experiencing an auditory hallucination might hear a voice calling their name even though no one else is actually present. A delusion is a false belief held by a person that appears obviously untrue to other people in that person’s culture. For example, a man may believe that Martians have implanted a microchip in his brain that controls his thoughts. Bizarre behaviour refers to behaviour in a person that is strange or incomprehensible to others who know the person. For example, hoarding unused scraps of tin because of their ‘magical properties’ would be a type of bizarre behaviour.
Psychosis can occur in a number of mental illnesses. These include schizophrenia and schizophrenia-related disorders, bipolar disorder, paranoid personality disorder, and delusional disorder. Less common, psychotic symptoms occur in major depression Dissociative disorders, and post-traumatic stress disorder.
Psychotic symptoms can also result from substance abuse. Stimulants, such as cocaine and amphetamines, can cause psychotic symptoms, especially if taken in high doses or over long periods of time. Hallucinogenic substances, such as lysergic acid diethylamide (LSD), mescaline and phencyclidine (PCP), can cause psychosis. Alcohol and marijuana can occasionally cause psychotic symptoms as well. Individuals with alcoholism may experience psychotic symptoms, especially hallucinations, as they withdraw from alcohol use. Alcohol dependence over a long period of time can result in Korsakoff’s psychosis, a syndrome that may include psychotic symptoms and an inability to form new memories. Certain medical conditions can also cause psychosis. Syphilis, especially if untreated for many years, can lead to psychosis. Brain tumours can also lead to psychotic symptoms.
Treatment of psychotic symptoms usually involved taking antipsychotic drugs, and called neuroleptics. Common Antipsychotic drugs include chlorpromazine (Thorazine), fluphenazine (Prolixin), thioridazine (Mellaril), trifluoperazine (Stelazine), clozapine (Clozaril), haloperidol (Haldol), olanzapine (Zyprexa), and risperidone (Risperdal). These medications can help reduce psychotic symptoms and prevent symptoms from returning. However, they can also cause severe side effects, such as muscle spasms, tremors, and tardive dyskinesia - a permanent condition marked by uncontrollable lip smacking, grimacing, and tongue movements. Psychotic symptoms in individuals with bipolar disorder may respond to other types of medication, including lithium, carbamazepine (Tegretol), and valproate (Depakene).
Psychotic symptoms that occur as a result of substance abuse usually disappear gradually after the person stops using the substances. Physicians sometimes use Antipsychotic medications temporarily to treat these individuals. Physicians have not discovered any effective treatments for Korsakoff’s psychosis. Psychotic symptoms resulting from medical conditions often disappear after treatment of the underlying medical problem.
The Sociocultural perspective regards mental illness as the result of social, economic, and cultural factors. Evidence for this view comes from research that has demonstrated an increased risk of mental illness among people living in poverty. In addition, the incidence of mental illness rises in times of high unemployment. The shift in the world population from rural areas to cities - with their crowding, noise, pollution, decay, and social isolation - and, has also, been implicated in causing relatively high rates of mental illness. Furthermore, rapid social change, which has particularly affected indigenous peoples throughout the world, brings about high rates of suicide and alcoholism. Refugees and victims of social disasters - warfare, displacement, genocide, violence - have a higher risk of mental illness, especially depression, anxiety, and post-traumatic stress disorder.
Social scientists emphasize that the link between social ills and mental illness is correlational rather than causal. For example, although societies undergoing rapid social change often have high rates of suicide the specific causes have not been identified. Social and cultural factors may create relative risks for a population or class of people, but it is unclear how such factors raise the risk of mental illness for an individual.
There are no blood tests, imaging techniques, or other laboratory procedures that can reliably diagnose a mental illness. Thus, the diagnosis of mental illness is always a judgment or an interpretation by an observer based on the spoken exchange, ideas, behaviours, and experiences of the patient.
In the late 19th century Viennese neurologist Sigmund Freud developed a theory of personality and a system of psychotherapy known as psychoanalysis. According to this theory, people are strongly influenced by unconscious forces, including innate sexual and aggressive drives.
The Psychodynamic perspective views mental illness as caused by unconscious and unresolved conflicts in the mind. As stated by Freud, these conflicts arise in early childhood and may cause mental illness by impeding the balanced development of the three systems that constitute the human psyche: the id, which comprises innate sexual and aggressive drives; the ego, the conscious portion of the mind that mediates between the unconscious and reality; and the super-ego, which controls the primitive impulses of the id and represents moral ideals. In this view, generalized anxiety disorder stems from a signal of unconscious danger whose source can only be identified through a thorough analysis of the person’s personality and life experiences. Modern Psychodynamic theorists tend to emphasize sexuality less than Freud did and focus more on problems in the individual’s relationships with others.
Both the humanistic and existential perspectives view abnormal behaviour as resulting from a person’s failure to find meaning in life and fulfill his or her potential. The humanistic school of psychology, as represented in the work of American psychologist Carl Rogers, views mental health and personal growth as the natural conditions of human life. In Rogers’s view, every person possesses a drive toward self-actualization, the fulfilment of one’s greatest potential. Mental illness develops when a person’s condition by some circumstantial environment interferes with this drive. The existential perspective sees emotional disturbances as the result of a person’s failure to act authentically - that is, to behave in accordance with one’s own goals and values, rather than the goals and values of others.
The pioneers of behaviourism, American psychologist’s John B. Watson and B. F. Skinner, maintained that psychology should confine itself to the study of observable behaviour, rather than explore a person’s unconscious feelings. The behavioural perspective explains mental illness, as well as all of human behaviour, as a learned response to, malaria, and infection’s stimuli. In this view, rewards and punishments in a person’s environment shape that person’s behaviour, for example, a person involved in a serious car accident may develop a phobia of cars or the generalized fear to all forms of transportation.
The cognitive perspective holds that mental illness result from problems in cognition - that is, problems in how a person reasons, perceives events, and solves problems. American psychiatrist Aaron Beck proposed that some mental illnesses - such as depression, anxiety disorders, and personality disorders - result from a way of thinking learned in childhood that is not consistent with reality. For example, people with depression tend to see themselves in a negative light, exaggerate the importance of minor flaws or failures, and misinterpret the behaviour of others in negative ways. It remains unclear, however, whether these kinds of cognitive problems actually cause mental illness or merely represent symptoms of the illnesses themselves.
People have tried to understand the causes of mental illness for thousands of years. The modern era of psychiatry, which began in the late 19th and early 20th centuries, has witnessed a sharp debate between biological and psychological perspectives of mental illness. The biological perspective views mental illness in terms of bodily processes, whereas psychological perspectives emphasize the roles of a person’s upbringing and environment.
These two perspectives are exemplified in the work of German psychiatrist Emil Kraepelin and Austrian psychoanalyst Sigmund Freud. Kraepelin, influenced by the work in the mid-1800's of German psychiatrist Wilhelm Griesinger, believed that psychiatric disorders were disease entities that could be classified like physical illnesses. That is, Kraepelin believed that the fundamental causes of mental illness lay in the physiology and biochemistry of the human brain. His classification system of mental disorders, first published in 1883, formed the basis for later diagnostic systems. Freud, on the other hand, argued that the source of mental illness lay in unconscious conflicts originating in early childhood experiences. Freud found evidence for this idea through the analysis of dreams, free association, and slips of speech.
This debate has continued into the late 20th century. Beginning in the 1960's, the biological perspective became dominant, supported by numerous breakthroughs in psychopharmacology, genetics, neurophysiology, and brain research. For example, scientists discovered many medications that helped to relieve symptoms of certain mental illnesses and demonstrated that people can inherit a vulnerability to some mental illnesses. Psychological perspectives also remain influential, including the Psychodynamic perspective, the humanistic and existential perspectives, the behavioural perspective, the cognitive perspective, and the Sociocultural perspective.
Psychiatry has increasingly emphasized a biological basis for the causes of mental illness. Studies suggest a genetic influence in some mental illnesses, such as schizophrenia and bipolar disorder, although the evidence is not conclusive.
Clinical depression is one of the most common forms of mental illness. Although depression can be treated with psychotherapy, many scientists believe there are biological causes for the disease. In the June 1998 Scientific American article, neurobiologist Charles B. Nemeroff reports upon the connection between biochemical changes in the brain and depression.
Scientists have identified a number of neurotransmitters, or chemical substances that enable brain cells to communicate with other, that appears important in regulating a person’s emotions and behaviour. These include dopamine, serotonin, norepinephrine, gamma-amino butyric acid (GABA), and acetylcholine. Excesses and deficiencies in levels of these neurotransmitters have been associated with depression, anxiety, and schizophrenia, but scientists have yet to determine the exact mechanisms involved.
Research shows that the more genetically related a person is to someone with schizophrenia, the greater the risk that person has of developing the illness. For example, children of one parent with schizophrenia have a 13 percent chance of developing the illness, whereas children of two parents with schizophrenia have a 46 percent chance of developing the disorder.
Advances in brain imaging techniques, such as magnetic resonance imaging (MRI) and positron emission tomography (PET), have enabled scientists to study the role of brain structure in mental illness. Some studies have revealed structural brain abnormalities in certain mental illnesses. For example, some people with schizophrenia have enlarged brain ventricles (cavities in the brain that contains cerebrospinal fluid). However, this may be a result of schizophrenia rather than a cause, and not all people with schizophrenia show this abnormality.
Are a person’s characteristics primarily shaped by early influences, remaining relatively stable thereafter throughout life? Or does change spontaneously occur continuously throughout life? Many people believe that early experiences are formative, providing a strong or weak foundation for later psychological growth. This view is expressed in the popular saying ‘As the twig is bent, so grows the tree.’ From this perspective, it is crucial to ensure that young children have a good start in life. But many developmental scientists believe that later experiences can modify or even reverse early influences; studies show that even when early experiences are traumatic or abusive, considerable recovery can occur. From this vantage point, early experiences influence, but rarely determine, later characteristics.
Traumatic experiences in this early period of life will damage a personality more seriously than those occurring in later childhood such as are found in the history of psychoneurotics. The infant’s mind is more vulnerable the younger and less used it has been, further, the trauma has quickened the infant ‘s egocentricity. In addition early traumatic experiences shortens the only period in life in which an individual ordinarily enjoys the most security, thus endangering the ability to store up as it were a reasonable supplies of assurance and self-reliance for the individual’s later struggles through life. Thus, as such, a child sensitized considerably more toward the frustrations of later like than by later traumatic experiences. hence many experiences in later life which would mean little to a ‘healthy’ person and not much to a psychoneurotic, mean a great deal of pain and suffering to the schizophrenic. His resistance against frustration is easily exhausted.
Once he reaches his limit of endurance, he escapes the unbearable reality of his present life by attempting to reestablish the autistic, delusional world of the infant, but this is impossible because the content of his delusions and hallucinations are naturally coloured by the experiences of his whole lifetime.
How do these developments influence the patient’s attitude toward the analyst and the analyst’s approach to him?
Due to the very damage and the succeeding chain of frustrations which the schizophrenic undergoes before finally giving in to illness, he feels extremely suspicious and distrustful of everyone, particularly of the psychotherapist ho approaches him with the intent of intruding into his isolated world and personal life. To him the physician’s approach means the threat of being compelled to return to the frustrations of real life and to reveal his inadequacy to meet them or, - still worse – a repetition of the aggressive interference with his initial symptoms and peculiarities which he has encountered in his previous environment.
The difficulty that the patient’s dilemma through his frustrations is the product through which is called ‘delusion’: Delusion itself is a false belief which is firmly held by a person even though other people recognize the belief as obviously untrue. For example, a person who truly believes he is Napoleon Bonaparte is delusional. Religious beliefs or popular conceptions, such as the belief that people have been abducted by aliens, are not delusions because they are widely held beliefs. Delusions are a type of psychotic symptom that indicate a person has lost contact with reality.
There are many different types of delusions. A person with a paranoid delusion believes that others - such as the FBI, or the CIA, even the Mafia as trying to harm or plot against him. A person with a delusion of reference believes that events or people refer specifically to him or her when they do not. For example, a woman with schizophrenia may believe that a television news broadcaster is talking personally to her rather than to the entire viewing audience. A grandiose delusion is a belief that one is extremely famous or that one has special powers, such as the ability to magically heal people.
A delusion of control is a belief that others are able to control one’s thoughts, feelings, or actions. For example, a man with this type of delusion may believe that someone has implanted a microchip in his brain that enables other people to control his thoughts. A somatic delusion is a belief that something is wrong with one’s body - for example, that one’s brain is rotting away - even though no medical evidence supports this belief. A person with an erotic delusion believes that someone is in love with him or her despite a lack of evidence for this belief. In a delusion of jealousy, a person believes that his or her spouse or lover is unfaithful despite evidence to the contrary.
Delusions commonly occur in certain severe mental illnesses, such as schizophrenia, bipolar disorder (also called manic-depressive illness), some cases of major depression, Dissociative disorders, post-traumatic stress disorder, and paranoid personality disorder. In addition, delusions may result from abuse of certain drugs, including alcohol, cocaine, amphetamines, and hallucinogens such as lysergic acid diethylamide (LSD), phencyclidine (PCP), and mescaline. Medical conditions affecting the brain, such as syphilis and brain tumours, may also cause delusions.
Delusional disorder is a relatively uncommon mental illness characterized by delusions. People with this disorder have one or more delusions that persist for at least one month. In addition, they do not suffer from other symptoms of schizophrenia, such as disorganized speech and bizarre behaviour. Usually their delusions are less bizarre than those that occur in schizophrenia and seem merely odd or unsupported by facts. Examples of nonbizarre delusions include beliefs that one is being followed, loved by someone famous, or deceived by one’s spouse. Because delusional disorder is relatively rare, little research has systematically examined its treatment. However, doctors most often use Antipsychotic drugs (also called neuroleptics) to treat this disorder. These drugs help reduce or eliminate delusions, hallucinations, and other psychotic symptoms.
In spite of his narcissistic retreat, every schizophrenic has some underlying notion of the unreality and loneliness of his substitute delusionary world. He longs for human contact and understanding, yet is afraid to admit of himself, or his therapist for fear of further frustration.
That is why the patient may take weeks and months to test the analyst before being willing to accept him, however, once he has accepted him. His dependence on the analyst is greater and he is more sensitive about it than is the psychoneurotic because of the schizophrenic’s deeply rooted insecurity, the narcissistic seemingly self-righteous attitude is but a defence.
Whenever the analyst fails the patient from reasons to be discussed later - one cannot at times avoid failing one’s schizophrenic patients - it will be severe disappointment and a repetition of the chain of frustrations the schizophrenic has previously endured.
The instinctually primitive part of the schizophrenic’s mind that does not discriminate between himself and the environment, it may mean the withdrawal of the impersonal supporting forces of his infancy. Severe anxiety will follow this vital deprivation.
In the light of his personal relationship with the analyst it means that the therapist seduced the patient to use him as a bridge over which he might possibly be led from the utter loneliness of his own world to reality and human warmth, only to have him discover that this bridge is not reliable. if so, he will respond helplessly with an outburst of hostility or with renewed withdrawal as may be seen most impressively in catatonic stupor.
The symptoms of mental illness can be very distressing. People who develop schizophrenia may hear voices inside their head that say nasty things about them or command them to act in strange or unpredictable ways. Or they may be paralysed by paranoia—the deep conviction that everyone, including their closest family members, wants to injure or destroy them. People with major depression may feel that nothing brings pleasure and that life is so dreary and unhappy that it is better to be dead. People with panic disorder may experience heart palpitations, rapid breathing, and anxiety so extreme that they may not be able to leave home. People whom experience episodes of mania may engage in reckless sexual behaviour or may spend money indiscriminately, acts that later cause them to feel guilt, shame, and desperation.
Other mental illnesses, while not always debilitating, create certain problems in living. People with personality disorders may experience loneliness and isolation because their personality style interferes with social relations. People with an eating disorder may become so preoccupied with their weight and appearance that they force themselves to vomit or refuse to eat. Individuals who develop post-traumatic stress disorder may become angry easily, experience disturbing memories, and have trouble concentrating.
Experiences of mental illness often interact differently but depends on one’s culture or social group, sometimes greatly so. For example, in most of the non-Western world, people with depression complain principally of physical ailments, such as lack of energy, poor sleep, loss of appetite, and various kinds of physical pain. Indeed, even in North America these complaints are commonplace. But in the United States and other Western societies, depressed people and mental health professionals who treat them tend to emphasize psychological problems, such as feelings of sadness, worthlessness, and despair. The experience of schizophrenia also differs by culture. In India, one-third of the new cases of schizophrenia involve catatonia, a behavioural condition in which a person maintains a bizarre statue like pose for hours or days. This condition is rare in Europe and North America.
With appropriate treatment, most people can recover from mental illness and return to normal life. Even those with persistent, long-term mental illnesses can usually learn to manage their symptoms and live productive lives.
By a variety of symptoms, including loss of contact with reality, bizarre behaviour, disorganized thinking and speech, decreased emotional expressiveness, and social withdrawal. Usually only some of these symptoms occur in any one person. The term schizophrenia comes from Greek words meaning ‘split mind.’ However, contrary to common belief, schizophrenia does not refer to a person with a split personality or multiple personality. For a description of a mental illness in which a person has multiple personalities. To observers, schizophrenia may seem or appear for being as some sorted kind of madness or a manufacturing insanity.
Perhaps more than any other mental illness, schizophrenia has a debilitating effect on the lives of the people who suffer from it. A person with schizophrenia may have difficulty telling the difference between real and unreal experiences, logical and illogical thoughts, or appropriate and inappropriate behaviour. Schizophrenia seriously impairs a person’s ability to work, go to school, enjoy relationships with others, or take care of oneself. In addition, people with schizophrenia frequently require hospitalization because they pose a danger to themselves. About 10 percent of people with schizophrenia commit suicide, and many others attempt suicide. Once people develop schizophrenia, they usually suffer from the illness for the rest of their lives. Although there is no cure, treatment can help many people with schizophrenia lead productive lives.
Schizophrenia also carries an enormous cost to society. People with schizophrenia occupy about one-third of all beds in psychiatric hospitals in the United States. In addition, people with schizophrenia account for at least 10 percent of the homeless population in the United States. The National Institute of Mental Health has estimated that schizophrenia costs the United States tens of billions of dollars each year in direct treatment, social services, and lost productivity.
Approximately 1 percent of people develop schizophrenia at some time during their lives. Experts estimate that about 1.8 million people in the United States have schizophrenia. The prevalence of schizophrenia is the same regardless of sex, race, and culture. Although women are just as likely as men to develop schizophrenia, women tend to experience the illness less severely, with fewer hospitalizations and better social functioning in the community.
Schizophrenia usually develops in late adolescence or early adulthood, between the ages of 15 and 30. Much less commonly, schizophrenia develops later in life. The illness may begin abruptly, but it usually develops slowly over months or years. Mental health professionals diagnose schizophrenia based on an interview with the patient in which they determine whether the person has experienced specific symptoms of the illness.
Symptoms and functioning in people with schizophrenia tend to vary over time, sometimes worsening and other times improving. For many patients the symptoms gradually become less severe as they grow older. About 25 percent of people with schizophrenia become symptom-free later in their lives.
A variety of symptoms characterize schizophrenia. The most prominent include symptoms of psychosis—such as delusions and hallucinations - as well as bizarre behaviour, strange movements, and disorganized thinking and speech. Many people with schizophrenia do not recognize that their mental functioning is disturbed.
Delusions are false beliefs that appear obviously untrue to other people. For example, a person with schizophrenia may believe that he is the king of England when he is not. People with schizophrenia may have delusions that others, such as the police or the FBI, are plotting against them or spying on them. They may believe that aliens are controlling their thoughts or that their own thoughts are being broadcast to the world so that other people can hear them.
Research suggests that the genes one inherits strongly influence one’s risk of developing schizophrenia. Studies of families have shown that the more close one is related to someone with schizophrenia, the greater the risk one has of developing the illness. For example, the children of one parent with schizophrenia have about a 13 percent chance of developing the illness, and children of two parents with schizophrenia have about a 46 percent chance of eventually developing schizophrenia. This increased risk occurs even when such children are adopted and raised by mentally healthy parents. In comparison, children in the general population have only about a 1 percent chance of developing schizophrenia.
Some evidence suggests that schizophrenia may result from an imbalance of chemicals in the brain called neurotransmitters. These chemicals enable neurons (brain cells) to communicate with each other. Some scientists suggest that schizophrenia results from excess activity of the neurotransmitter dopamine in certain parts of the brain or from an abnormal sensitivity to dopamine. Support for this hypothesis comes from Antipsychotic drugs, which reduce psychotic symptoms in schizophrenia by blocking brain receptors for dopamine. In addition, amphetamines, which increase dopamine activity, intensify psychotic symptoms in people with schizophrenia. Despite these findings, many experts believe that excess dopamine activity alone cannot account for schizophrenia. Other neurotransmitters, such as serotonin and norepinephrine, may play important roles as well.
Although scientists favour a biological cause of schizophrenia, stress in the environment may affect the onset and course of the illness. Stressful life circumstances - such as maturing in age and character as for living in poverty, the death of a loved one, an important change in jobs or relationships, or chronic tension and hostility at home—can increase the chances of schizophrenia in a person biologically predisposed to the disease. In addition, stressful events can trigger a relapse of symptoms in a person who already has the illness. Individuals who have effective skills for managing stress may be less susceptible to its negative effects. Psychological and social rehabilitation can help patients develop more effective skills for dealing with stress.
Although there is no cure for schizophrenia, effective treatment exists that can improve the long-term course of the illness. With many years of treatment and rehabilitation, significant numbers of people with schizophrenia experience partial or full remission of their symptoms.
Treatment of schizophrenia usually involves a combination of medication, rehabilitation, and treatment of other problems the person may have. Antipsychotic drugs (also called neuroleptics) are the most frequently used medications for treatment of schizophrenia. Psychological and social rehabilitation programs may help people with schizophrenia function in the community and reduce stress related to their symptoms. Treatment of secondary problems, such as substance abuse and infectious diseases, is also an important part of an overall treatment program.
Antipsychotic medications, developed in the mid-1950s, can dramatically improve the quality of life for people with schizophrenia. The drugs reduce or eliminate psychotic symptoms such as hallucinations and delusions. The medications can also help prevent these symptoms from returning. Common Antipsychotic drugs include risperidone (Risperdal), olanzapine (Zyprexa), clozapine (Clozaril), quetiapine (Seroquel), haloperidol (Haldol), thioridazine (Mellaril), chlorpromazine (Thorazine), fluphenazine (Prolixin), and trifluoperazine (Stelazine). People with schizophrenia usually must take medication for the rest of their lives to control psychotic symptoms. Antipsychotic medications appear to be less effective at treating other symptoms of schizophrenia, such as social withdrawal and apathy.
Because many patients with schizophrenia continue to experience difficulties despite taking medication, psychological and social rehabilitation is often necessary. A variety of methods can be effective. Social skills training helps people with schizophrenia learn specific behaviours for functioning in society, such as making friends, purchasing items at a store, or initiating conversations. Behavioural training methods can also help them learn self-care skills such as personal hygiene, money management, and proper nutrition. In addition, cognitive-behavioural therapy, a type of psychotherapy, can help reduce persistent symptoms such as hallucinations, delusions, and social withdrawal.
Because many patients have difficulty obtaining or keeping jobs, supported employment programs that help patients find and maintain jobs are a helpful part of rehabilitation. In these programs, the patient works alongside people without disabilities and earns competitive wages. An employment specialist (or vocational specialist) helps the person maintain their job by, for example, training the person in specific skills, helping the employer accommodate the person, arranging transportation, and monitoring performance. These programs are most effective when the supported employment is closely integrated with other aspects of treatment, such as medication and monitoring of symptoms.
Some people with schizophrenia are vulnerable to frequent crises because they do not regularly go to mental health centres to receive the treatment they need. These individuals often relapse and face rehospitalization. To ensure that such patients take their medication and receive appropriate psychological and social rehabilitation, assertive community treatment (ACT) programs have been developed that deliver treatment to patients in natural settings, such as in their homes, in restaurants, or on the street.
People with schizophrenia often have other medical problems, so an effective treatment program must attend to these as well. One of the most generally shared in or participated in things conforming to a type without noteworthy excellence or faults just as common a rule, by ordinary, frequent and ordinarily as an idea or expression deficient in originality or freshness, yet, only of its exchanging the commonplace of the common associated problems is vehemently and usually coarsely expressed condemnation or disapproved, as the interpretative category of an unequalled vocabulary is itself a genuine abuse. Successful treatment of substance abuse inpatients with schizophrenia requires careful coordination with their mental health care, so that the same clinicians are treating both disorders at the same time.
The high rate of substance abuse in patients with schizophrenia contributes to a high prevalence of infectious diseases, including hepatitis B and C and the human immunodeficiency virus (HIV). Assessment, education, and treatment or management of these illnesses is critical for the long-term health of patients.
Other problems frequently associated with schizophrenia include housing instability and homelessness, legal problems, violence, trauma and post-traumatic stress disorder, anxiety, depression, and suicide attempts. Close monitoring and psychotherapeutic interventions are often helpful in addressing these problems.
Several other psychiatric disorders are closely related to schizophrenia. In schizoaffective disorder, a person shows symptoms of schizophrenia combined with either mania or severe depression. Schizophreniform disorder refers to an illness in which a person experiences schizophrenic symptoms for more than one month but fewer than six months. In schizotypal personality disorder, a person engages in odd thinking, speech, and behaviour, but usually does not lose contact with reality. Sometimes mental health professionals refer to these disorders together as schizophrenia-spectrum disorders.
Severe mental illness almost always alters a person’s life dramatically. People with severe mental illnesses experience disturbing symptoms that can cause of such difficulties and holding to a job, or go to school, relate to others, or cope with ordinary life demands. Some individuals require hospitalization because they become unable to care for themselves or because they are at risk of committing suicide.
The symptoms of mental illness can be very distressing. People who develop schizophrenia may hear voices inside their head that say nasty things about them or command them to act in strange or unpredictable ways. Or they may be paralysed by paranoia - the deep conviction that everyone, including their closest family members, wants to injure or destroy them. People with major depression may feel that nothing brings pleasure and that life is so dreary and unhappy that it is better to be dead. People with panic disorder may experience heart palpitations, rapid breathing, and anxiety so extreme that they may not be able to leave home. People whom experience episodes of mania may engage in reckless sexual behaviour or may spend money indiscriminately, acts that later cause them to feel guilt, shame, and desperation.
Other mental illnesses, while not always debilitating, create certain problems in living. People with personality disorders may experience loneliness and isolation because their personality style interferes with social relations. People with an eating disorder may become so preoccupied with their weight and appearance that they force themselves to vomit or refuse to eat. Individuals who develop post-traumatic stress disorder may become angry easily, experience disturbing memories, and have trouble concentrating.
Experiences of mental illness often take issue upon its stability for depending on one’s culture or social group, sometimes greatly so. For example, in most of the non-Western world, people with depression complain principally of physical ailments, such as lack of energy, poor sleep, loss of appetite, and various kinds of physical pain. Indeed, even in North America these complaints are commonplace. But in the United States and other Western societies, depressed people and mental health professionals who treat them tend to emphasize psychological problems, such as feelings of sadness, worthlessness, and despair. The experience of schizophrenia also differs by culture. In India, one-third of the new cases of schizophrenia involve catatonia, a behavioural condition in which a person maintains a bizarre statue like pose for hours or days. This condition is rare in Europe and North America.
Of furthering issues regarding depersonalization disorder, meaning, in effect, that it is a categorised illness based within its intendment for being an illness, of mind, in which people experience an unwelcome sense of detachment from their own bodies. They may feel as though they are floating above the ground, outside observers of their own mental or physical processes. Other symptoms may include a feeling that they or other people are mechanical or unreal, a feeling of being in a dream, a feeling that their hands or feet are larger or smaller than usual, and a deadening of emotional responses. These symptoms are chronic and severe enough to impede normal functioning in a social, school, or work environment.
Depersonalization disorder is a relatively rare syndrome thought to result from severe psychological stress. It may occur as part of other mental illnesses, especially anxiety disorders. For example, some people with panic disorder feel nervous, have a sense of doom about their future and health, and have a troubling sense of detachment form the lose in the attemptive use in making or doing or achieving a useful regularity as might be expected of the control over their bodies. Depersonalization disorder may also be a component of more severe mental illness, such as schizophrenia. Treatment may include training in relaxation techniques that enhance body perception and control, hypnosis to modify symptoms, and psychotherapy to explore possible stress-related components of the disorder.
Psychiatrists classify depersonalization disorder as one of the Dissociative disorders. Such disorders involve a disruption of consciousness, memory, identity, or perception.
All the while, the schizophrenic responds to altercations in the analyst’s defections and understanding by corresponding stormy and dramatic changes from love to hatred, from willingness to leave his delusional world to resistance and renewed withdrawal.
As understandable as these changes are, nevertheless may come as a surprise to the analyst who frequently has not observed their source, this is quite in contrast to his experience with psychoneurosis whose emotional reactions during an interview he can usually predict. These unpredictable changes seem to be the reason for the conception of the unreliability of the schizophrenic’s transference reaction, yet they follow the same dynamic rules as the psychoneurotic’s oscillations between positive and negative transference and resistance, however, if the schizophrenic’s reactions are stormy and seemingly more unpredictable than those of the psychoneurotic, that instances suggested to be due to the inevitable errors in the analyst’s approach to the schizophrenic, of which he himself may be unaware, rather than to the unreliability of the patient‘s emotional response?
Why is it inevitable that the psychoanalyst disappoint his schizophrenic patient time and again?
The schizophrenic withdraws from painful reality and retires to what resembles the early speechless phase of development where consciousness is not yet crystalized. As the expression of his feelings is not hindered by the convention that he has eliminated, as his thinking, feelings, behaviour and speech - when present - obey the working rules of the archaic unconscious. His thinking is magical and does not follow logical rules. It does not admit to every last ‘no’, and likewise the no to ‘yes’: There is no recognition of space and time, I, you, and they, are interchangeable expression through which of symbols and often by movement and gestures rather than by words.
As the schizophrenic is suspicious, he will distrust the words of his analyst. He will interpret them and incidental gestures and attitudes of the analyst according to his own delusional experience. The analyst may not even be aware of these involuntary manifestations of his attitudes, yet they mean much to the hypersensitive schizophrenic who uses them as a means of orienting himself to the therapist‘s personality and intentions toward him.
In other words, the schizophrenic patient and the therapist are people living in different worlds and no different levels of personal development with different means of expressing and of orienting themselves. We know little about the language of the unconscious that belongs to the schizophrenic, and our access to it is blocked by the very process of our own adjustment to a world the schizophrenic has relinquished, so, we should not be surprised that errors and misunderstandings occur when we under take to communicate and strive for a rapport with him.
Another source of the schizophrenic’s disappointment arises form which the analyser accepts and does not interfere with the behaviour of the schizophrenic, his attitude may lead the patient to expect that the analyst will assist in carrying out all the patient’s wishes, even though they may not seem to be in his interest to the analyser‘s and the hospital’s in their relationship to society. This attitude of acceptance so different from the patient’s previous experiences readily fosters the anticipation that the analyst will try to carry out the patient’s suggestion and take his part, even against conventional society with which it should occasionally arise. Frequently it will be wise for the analyst to agree with the patient‘s wish to remain unbattled and untidy until he is ready to talk about the reasons for his behaviour or to change spontaneously. At other times, he will unfortunately be unable to take the patient’s part without being able to make the patient understand and accept the reasons for the analyst’s position.
If the analyst is not able to accept the possibility of misunderstanding the reaction of the schizophrenic patient and in turn of being misunderstood by him, it may shake his security with his patient.
That is to say, that, among other things, the schizophrenic, once he accepts the analyst’s insecurity. being helpless and open to himself - in spite of his pretended grandiose isolation - he will feel utterly defeated by the insecurity of his would-be helper. Such disappointment may furnish reasons for outbursts of hatred and are comparable to the negative transference reactions of psychoneurosis, yet more intense than these, since they are not limited by the restrictions of the actual world - that is, it exists in or based on fact, its only problem is a sure-enough externalization for which things are existing in the act of being external in something that has existence, ss if it were an actualization as received in the obtainable enactment for being externalized, such that its problem of in some actual life that proves obtainable achieved, in that of doing something that has an existence for having absolute actuality.
These outbursts are accompanied by anxiety, feelings of guilt, and fear of retaliations which in turn lead to increased hostility. Yet this established a vicious circle: We disappoint the patient, he is afraid that we hate him for his hatred and therefore continues to hate us. If in addition he senses that the analyst is afraid of his aggressiveness, it confirms his fear that he is actually considered as some dangerous and unacceptable, and this augments his hatred.
This establishes that the schizophrenics capable of developing strong relationships of love and hatred toward the analyst. After all, one could not be so hostile if it were not for the background of a very close relationship. In addition, the schizophrenic develops transference reactions on the narrower sense which he can differentiate from the actual interpersonal relationship. For which the schizophrenic’s emotional reactions toward the analyst have to be met with extreme care and caution. The love which the sensitive schizophrenic feels as he first emerges, and his cautions acceptance of the analyst’s warmth of interest are really most delicate and tender things. If the analyst deals with the transference reactions of a psychoneurotic is bad enough, though as a reparable rule, but if he fails with a schizophrenic in meeting positive feelings by pointing it out for instance before the patient indicates that he is ready to discuss it, he may easily freeze to death what has just begun to grow and so destroy any further possibility of therapy.
Some analysts may feel that the atmosphere of complete acceptance and of strict avoidance of any arbitrary denials which we recommend as a basic rule for the treatment of schizophrenics may not avoid our wish to guide of reacceptance of reality, nevertheless, Freud says that every science and therapy which accepts his teachings about unconscious, about transference and resistance and about infantile sexuality, may be called psychoanalysis. According in this definition we believe we are practising psychoanalysis with our schizophrenic patients.
Whether we call it analysis or not, it is clear that successful treatment does not depend on technical rules of any special psychiatric school but rather on the basic attitude of individual therapist toward psychologic persons. If he meets them as strangle creatures of another world whose productions are not comprehensible to ‘normal’ beings, he cannot treat them, if he realizes, however, that the difference between himself and the psychologic is only of degree, and not of kind, he will know better how to meet him. He will not be able to identify himself sufficiently with the patient to understand and accept his emotional reactions without becoming involved in them.
The process of constant and perpetual change is examined and closely matched within the study of philosophical speculations and pointed of a world view which asserts that basic reality is constantly in a process of flux and change. Indeed, reality is identified with pure process. Concepts such as creativity, freedom, novelty, emergence, and growth are fundamental explanatory categories for process philosophy. This metaphysical perspective is to be contrasted with a philosophy of substance, the view that a fixed and permanent reality underlies the changing or fluctuating world of ordinary experience. Whereas substance philosophy emphasizes static being, process philosophy emphasizes dynamically becoming.
Although process philosophy is as old as the 6th-century Bc Greek philosopher, Heraclitus, renewed interest in it was stimulated in the 19th century by the theory of evolution. Key figures in the development of modern process philosophy were the British philosophers Herbert Spencer, Samuel Alexander, and Alfred North Whitehead, the American philosophers Charles S. Peirce and William James, and the French philosophers Henri Bergson and Pierre Teilhard de Chardin. Whitehead's Process and Reality: An Essay in Cosmology (1929) is generally considered the most important systematic expression of process philosophy.
Contemporary theology has been strongly influenced by process philosophy. The American theologian Charles Hartshorne, for instance, rather than interpreting God as an unchanging absolute, emphasizes God's sensitive and caring relationship with the world. A personal God enters into relationships in such a way that he is affected by the relationships, and to be affected by relationships is to change. So too is in the process of growth and development. Important contributions to process theology have also been made by such theologians as William Temple, Daniel Day Williams, Schubert Ogden, and John Cobb, Jr.
‘Reality’ is a difficult word to use to every one’s satisfaction or even to one’s own satisfaction. In this instance the word reality is used arbitrarily to designate the direct, here-and-now impact of the analyst upon the patient. Reality. In this sense, contrasts with the impact the analyst has through his representation in the patient’s fantasy life, neurosis, and transference, since both kinds of impact seem always to coexist and since the former - the analyst’s real impact - may be the worst enemy of the transference, the matter of their differentiation is possibly the most challenging aspect of analysis.
The analytic situation, which is set up to shut out ordinary reality intrusions, that cannot nor should not exclude all, but to say, that in the beginning months, for instance, reality inevitably has the upper hand. The analyst, the office, the procedure, are all overwhelmingly real. Everything is strange, frightening and exciting, gratifying and frustrating. Unlike the patient can test it and orient himself to it, the impact of this reality is usually so great that even an ordinary useful transference relationship cannot be expected to develop.
Perhaps the most confusing aspect of this beginning period is the frequent appearance in it of what can be regarded as a false transference relationship. With great intensity and clarity, the patient may reveal, through transference-like references about the analyst, some of the deepest secrets only of his neurosis but of its genesis. The pseudotransference, too good to be true, is almost sure to be nothing more than the patient’s attempt to deal with the person of the analyst, the entire spectrum of his various patterns of behaviour. If, it is easy to do, the analyst overlooks the likelihood that the patient’s relationship with at this time is really about that almost everything said about it is related, analysis may get off to a very bad start. And if, as is even earlier to do, the analyst’s interests the genetic meaning of the openly exposed material, a good transference relationship may be seriously delayed and a workable transference neurosis may never appear. even after initial reality has had time to fade, reality may continue to intrude in ways that are very hard to detect and that are very troublesome.
One of the most serious problems of analysis is the very substantial help which the patient receives directly from the analyst and the analytic situation. For many a patient, the analyst in the analytic situation is in fact the most stable, reasonable, wise and understanding person he has ever met, and the setting in which they meet may actually be the most honest, open, direct and regular relationship he has ever experienced. Added to this is the considerable helpfulness to him of being able to clarify his life storey. confess his guilt, express his ambitions, and explore his confusions. Further real help comes from the learning-about-life accruing from the analyst’s skilled questions, observations and interpretations. Taken together, the total real value to the patient of the analytic situation can easily be immense. The trouble with this kind of help is that it goes on and on, it may have such a real, direct and continuing impact upon the patient that he can never get deeply enough involved in transference situation to allow him to resolve or even to become acquainted with his most crippling internal difficulties. The trouble is far too good, the trouble also is that we as analysts apparently cannot resist the seductiveness of being directly helpful, and this, when combined with the compelling assumption that helpfulness is bound to be good, permits us top credit patient improvements to ‘analysis’ when more properly it should often be recognized for being the amounting result for the patient’s using the analytic situation, as the model, for being the preceptors and supporter in the dealing practically within the immediate distractions as holding to some problem.
Perhaps, we can now refer to something in a clear unmistakable manner, and it would be to mention, for being, that one more difficult-to-handle intrusion of reality into the analysis, that by saying, that this is the definitive and final interruption of the transference neurosis by the reality of termination; in the sense, the situation is reversed and the intrusion is analytically desirable, since ideally the impact of reality of impending and certain termination is used to facilitate the resolution of the transference. As with the resolution of earlier episodes of transference neurosis, this final one is brought about principally by the analyst’s interpretations and reconstructions. As these take effect, the transference neurosis and, hopefully, along with it the original neurosis is resolved. This final resolution, however, which is much more comprehensive, is usually very different and may not come about at all without the help of the reality of termination. Accordingly, any attenuation of the ending, such as tapering off or causal or tentative stopping, should be expected to stand in the way of an effective resolution of the transference. Yet, it seems that this is what most commonly happens to an ending, and because of this a great many patients may lose the potentially great benefit of a thorough resolution and are forever after left suspended in the net of unresolved transference.
Yet, utter indistinctly rigorous termination seems understandable, as difficult as transference neurosis may be in the analyst at other times, this ending period, if rigorously carried out, simply has to be the period of his greatest emotional strain. There can surely be no more likely time for an analyst to surrender his analytic position and, responding to his own transference, become personally involved with his patient than during the process of separating from a long and self-restrained relationship. Accordingly, it may be better to slur over the ending lightly than to mishandle it in an attempt to be rigorous.
In considering more broadly the function of the transference in the psychoanalytic process, one is confronted by the apparent naïve, but, nonetheless important questions of the role of the actual (current) object as compared with that of the object representation of the original personage in the past. We recall Freud’s paradoxical, somewhat gloomy, but portentous concluding passage in ‘The Dynamics of Transference.’ This struggle between the doctor and the patient, between intellect and instinctual life, between understanding and seeking to act, is played out almost exclusively in the phenomena of transference. It is on that field that the victory must be won - the victory whose expression is on that field that the victory must be won - the victory whose expression is the permanent cure of the neuroses. It cannot be disputed that controlling the phenomena of transference presents the psychoanalysis with the greatest difficultly, but it should not be forgotten that they do us the inestimable service of making the patient ‘s hidden and forgotten erotic impulses of showing their immediate and manifested impossibilities, for when all is said and done, it is impossible to destroy anyone in absentia or in effigies.
Both object and representation are made necessary by the basic phenomenon of original separation. The existence of an image of the object, which persist in the absence of the object, is one of the important beginnings of psychic life in general, certainly an indispensable prerequisite for object relationship. As generally construed. Whether this is viewed as (or a times demonstrably is) something unstable for allotting introjection, s always subject to alternative projection, or an intrapsychic object representation clearly distinguished from the self-representation, or firm identification in the super-ego, or in the ego itself, these phenomena are in various ways components of the system of mastery of the fact of separation, or separateness, from the original absolutely necessarily anaclitic (in the earliest period) symbiotic ‘object’. In the light of clinical observation, it would appear to be that the relative stability (parental) object representation. At which time of varying degree, are to a greater extent for the archaic phenomena. Even in nonpsychotic patients, overwhelmed by them, sometimes resembles the restoration from oedipal identification, which provides the preponderant basis for most demonstrable analytic transferences. That within the necrotic patients, the transference is effectively established when this representation invests the analyst to a degree - depending on intensity of drive and most of ego participation - which ranges in all the, wishing and strivings to remake and analyst to biasses judgements and misinterpretation of data, finally are the actual perceptual distortions.
However, the old object representations as such may be invested, however rigidly established the libidinal or aggressive cathexis of the image may be, this as such can become the actual and exclusive focus of instinctual discharge, or of complicated and intense instinct-defence solutions, only and general energy-sparing quality of strictly intrapsychic processes. For the vast majority of persons, visible to any degree, including those with severe neurosis, character distortions, addictions and certain psychoses, the striving is toward the living and actual object, even at the cost of intense suffering. In a sense, this returns us to the state in which the psychological ‘object-to-be’. Has a critical importance never again to be duplicated, except in certain acute life emergencies, even if the object is not firmly perceived as such, in the sense of later object relations? And it does seem that trance impressions from the earliest contacts in the service of life preservation, and the associated instinctual gratifications, and innumerable secondarily associated sensory impressions. Are activated by the specific inborn urges of sexual maturation? These propel the individual to renew many of the earliest modes of actual bodily contact, in connection with seeking for specific instinctual gratification. Or, to look away from clear-cut instinctual matters to the more remote elaborations of human contact: Few regard loneliness as other than a source of suffering, even self-imposed, as an apparent matter of choice, and the forcible imposition of ‘solitary confinement ‘ is surely one of the most cruel of punishments.
In taking to question, we are entering an area of life in which things are other then themselves, where meaning is multifaceted, and where the line between the old and the new is blurred. It should, by, its immediate measure, help develop our recognition or meaning of the pertinent applicability as to the relevance of interrelated aspects of the psychology of ‘metaphor’. In the psychology of metaphor we will find a useful analogy to the psychology of transference interpretation. Our’s will be newly encountered as good metaphors, those it response to which we say, ‘That’s it exactly’ or ‘That really captures it‘ or ‘That says it all’.
Some literary and linguistic analysis, (e.g., Lewis, 1936 and Snell, 1953) and also people in everyday life, believe that there are experiences that can only be expressed metaphorically. And it is for this achievement that these metaphors, which may be entire poem or as lines or even words highly valued. But how can this be so? Just what in th e ‘it’ that the metaphor ‘is’ or ‘captures’ or ‘says’? If this ‘is’ or this ‘experience’ can only be rendered metaphorically, when we can know it only as such, that is, as the metaphor itself. Of the position out of which are put forward by, T.S, Eliot (1933) and E.W. Harding (1963) in their discussion of poetry, for in these instances we are granted that there is no known and logically independent version of the experience that can serve to validate the metaphor. Whatever the metaphor makes available to us depends on it and it and so cannot be used to prove its correctness.
It seems justifiable to conclude that the metaphor is a new experience rather than a mere paraphrase of an already fully constituted expedience. The metaphor creates an experience that one has never had before. It is an experience one has not realized by oneself. The metaphor does, of course, suggest certain constituent experiences of which one may have been more or less dimly aware. One may say, therefore, that the metaphor speaks for those constituents, on the existence of which much of its appeal depends. But in its organizing and implicit ly rendering these constituents in its new way, it is a creation rather than a mere paraphrase or anew edition. Paraphrasing and new editions never speak as forcefully as good new metaphors, nor could they facilitate further new experience. One analytically familiar feature of these creations is that they make it safe and pleasing to experience something that otherwise would be considered too threatening and so would be kept in fragmented obscurity through defensive measures.
Thus, when one says, ‘That’s it exactly’ one is implicitly recognizing and announcing that one has found and accepted a new mode of experiencing oneself and one’s world, which is to say, asserting a transformation of one’s own subjectivity. Something is now said to be true, and in a sense it is true, but it is true for the first time. Where this quality or state of being, is that there is nothing just like it, or can ever happen again, for the second time cannot be the same as the first. One can’ t step into a stream of the same watering point and then step once again into the same spot. A revelatory metaphor re-encountered or repeated later may lose some of its force, alternatively, it may gain some significance, but it cannot remain exactly the same metaphor or mobilize an experience identical with the first. The point applies as well as to new metaphors that are similar to familiar ones: They have to be judged or experienced through their conventionalized predecessors, as through methods of knowing or already proved instrumentally of perceiving. The audience and the performer, who may be one person, as such that may not have, as yet.
What is to be said about the psychology of metaphor is analogous to the transformational aspects of developed transference and the steadfast interpretation that both facilitate and organize them as transference. Allowing that these transferences and ‘remembered’ experiences come into existence over a period of time, nothing that is identical with them has ever before been enacted, and nothing will ever be enacted again. They are creations that may be fully achieved only under specific analytic conditions. Such that living was not reliving that moment, words like re-living, re-experiencing and reliving simply do not do justice to the phenomena, that in making this claim. A seeming contradiction over-writes some of our well-establish ideas. - in offering, - I am not contradicting some of our well-established ideas about interpretation and insight, I am, however, disputing the point that insight refers to much than the recovery of lost memories, and takes in as well, a new grasp of the significance and interpretations of events one has always remembered. In point, as, Freud pointed out, ‘As a matter of fact I’ve always known it, only that I’ve never thought of it; (1914), In fact, it is to develop that point in furthering to say that it takes an adult to do that, especially with the help of an analyst. It was, after all, Freud’s analysis of adults that make it possible to define infantile psychosexuality. In this respect, but without disregard, child analysis retains a quality of applied psychoanalysis’ in the same way that the interpreted transference neurosis is: Both are always of describing as true something that was not true in quite that way at the time of its greatest developmental significance. This apparent paradox about ‘remembering’ as a form of creating goes a long way, probably that what it is, is distinctive about psychoanalytic interpretation.
In steadfastly and perspicaciously making transference interpretation. This newness characterizes the experience of analytic transference themselves. Unlike extra-analytic transferences, they can no longer be sheerly repetitive or merely new editions. Instead, they become repetitive new editions understood as such because defined as such by the simplifying and steadfast transference interpretations. Instead of responding to the analysand in kind, which would actualize the repetition, the analyst makes an interpretation. This interpretation does not necessarily or regularly match something the analysand already knows or has experienced unconsciously. Although, the analysand does often seem to have already represented some things unconsciously in the very terms of the interpretation. Equally often he does not seem to have done so at all. To think otherwise about this would be, in effect, to claim that, unconsciously, every analysand is Freud or a fully insightful Freudian. And that claim is absurd.
It would be closer to the truth to say this: Unconsciously, the analysand already knows or has experienced fragmentary, amorphous, uncoordinated constituents of many of the transference interpretations. Alternatively, one may say that, implicitly, the analysand has been insisting on some as yet unspecified certainties and, in keeping with this, following some set of as yet unspecified rules in his actions, these transference interpretations now organize explicitly. Each transference interpretation refers to many things that have already been defined by the analysand, and it does so in a way that transforms them. That’s why one may call it interpretation, but it would be mere repeating or sterile paraphrasing. Interpretation is a creative redescription that implicitly has the structure of a simile. It says, ‘This is like that’, Each interpretation does, therefore, add new actions to the life and analysand had already lived.
Technically, redescription in the terms of transference-repetition is necessary. This is so because, up to the time of interpretation and working through, the analysand has been, in one sense, unable and, in another sense, unconsciously and desperately unwilling, to conduct his life differently. in and of themselves, the repetitions cannot alter the symptoms, the subjective distress, and wasting of one’s possibilities, rather, they can only perpetuate state situation by repeatedly confirming its necessity. They prove once again, the unconsciously maintained, damaging certainties. But once they get to be viewed as historically grounded actions and subjectively defined situations, as they do upon being interpreted and worked through, they appear as having always been, in crucial respects, inventions of the analysand’s making and, so, as his responsibility. in being seen as versions of one’s past life. As they may be significantly different, as the subject of change in favouring - as something that is desirable or beneficial - within the common ability to make intelligent choices and to reach intelligent conclusions or decisions in understanding ways. Less and less are they presented as purely inevitable happenings, as a fixed state or as the well-established way of the world. As, here, we encounter a second paradox that goes to the heart of psychoanalytic interpretation, namely, that responsible, insightful change is possible thorough psychoanalysis just because, as a child, the analysand mistakenly assumed and then denied responsibility for much that he encountered in the early formative environment and during maturation.
One major point remains to be made about the logic of viewing transference interpretation as simplifying yet innovative redescription. This point is that the interpretation bring about a coordination of the terms in which to state both the analysand’s current problems and their life-historical background. The analysand’s symptoms and desires are described as actions and, modes of action, with due regard for the principle of multiple function or multiple meaning, in coordination with that description, the decisive developmental situations and conflicts are stated as actions and modes of action. Continuity is established between the childhood constructions of relationships and self and the present constructions of these. Interpretation of transferences shows how both are part of the same set of practice, that is, how they follow the same set of rules. Past and present are coordinated to show continuity rather than arranged in a definite causal sequence.
In the same way, the form of analytic behaviour and the content of associations are given coordinate descriptions, say, for being defiant, devouring, or reparative. Or, in the case of depression, the depressive symptoms, the depressive analytic transference, the themes of present and past loss destructiveness and helplessness, all will be redecribed under the aspect of one continuously developing self-presentation. And this coordination will be worked out in the hermeneutically circular fashion in which the analyst defines both the facts to be explained and the explanations to be applied to these facts. In the end, as is well known, Both the paramount issues of the analysis and the leading explanatory account of them are likely to be significantly different from the provisional versions of them used at the beginning of the analysis.
This is the sophisticated cognitive simplification that promotes the convincing development and recognition of transference and the emotional experiencing of the past as it is now remembered. The coordination of terms is the only way to break into the vicious circle of the neurosis disturbance and reduce its unconsciously self-confirming character. New meaning is established by steadfast interpretation of transference and the condition for loving of which they are enactments.
That this kind of analytic work is not simply intellectual but shown in the analytic presentations that analysand was now operating according to rules which, through previous transference interpretations and coordination of terms, had changed. The changed rules were implicit in this hitherto-avoided experiencing of the past. It was not re-experiencing, or not mainly that: In its special way, it was experiencing that past for the first time.
It should take to be marked and noted, and, if not only to mention of two implications of which (1) The transference phenomena that finally constitute the transference e neurosis and to be taken as regressive in only some of their aspects. This is so because, viewed as achievements of the analysis, they have never existed before as such, rather, they constitute a creation achieved through a novel relationship into which one has entered by conscious and rational design. The analytic definition of the conditions for loving has never been arrived at before: They have never been simplified, organized, intensified, and transparent as they get to be in the analytically circumscribed and identified transference neurosis. It seems a more adequate or balanced view of transference neurosis. It seems a more adequate or balanced view of transference phenomena to regard them as multidirectional in meaning rather than as simply regressive or repetitive. This would be to look at them in as ways that are analogous to the way we look at creative works of art. We would see the transference as creating the past in the present, in a special analytic way and under favourable conditions. Essentially, they represent movement forward, and not backward.
And, (2) It is wrong to think that interpretation deals only in what is concealed or disguised or, what is its correlate, that ‘the unconscious’ is omniscient. In particular, it cannot be the case that ‘the unconscious’ knows all about transference and repetition, By establishing new connections, comprehensive context, and coordinated perspectives on familiar actions, interpretation creates new meanings or new actions. Not everything that has yet been organized has been actively kept apart by defensive measures, not everything that has not yet been recognized has been denied. This point is obvious, but it is often obscured by formulation, some of Freud’s among them, which suggest that interpretation is only just uncovering (Fingarette, 1963).
What, then, is interpretation? And how does it work? Extremely little seems to be known about it, but this does not prevent an almost universal belief in its remarkable efficacy as a weapon. Interpretation has, it must be confessed, many of the qualities of a magic weapon. It is, of course, felt as such by many patients. Some of them spend hours at a time in providing interpretations of their own - often ingenious, illuminating, correct. others, again, derive a direct libidinal gratification from being given interpretations and may even circulate interpretation is usually either scoffed at as something indicated or develop something parallel to a drug-addition to them. In some non-analytical circles interpretation is usually either scoffed at as something ludicrous or dreaded as a frightful danger. This last attitude is shared, as more than is often realized, by a certain number of analysts. This was particularly revealed by the reactions shown in many quarters when the idea of giving interpretations to small children was first mooted by MeIanie Klein. However, it is believed that it would be true in general to say, that analysts are incline to feel interpretation as something extremely powerful whether for good or ill. And there might seem to be a good many grounds for thinking that our feelings on the subject tend to distort our beliefs, at all events, many of these beliefs seem superficially to be contradictory, and the contradictions do not always spring from different schools of though, but are apparently sometimes held simultaneously by one individual. Thus, we are told that if we interpret too soon or too rashly, we hazardously risk of losing a patient: That interpretation may give rise to intolerable and unmanageable outbreaks of anxiety by ‘liberating’ it. That interpretation is the only way of enabling a patient to cope with an unmanageable outbreak of anxiety by ‘resolving’ it. That interpretation must always refer to material on the very point of emerging into consciousness, that the most useful interpretations are rally deep ones. Be cautious with your interpretations; , says one voice, ‘When in doubt, interpret’ says another. Nevertheless, although there is enviably a good deal of confusion in all of this. Do not think these views are necessarily incompatible: The various pieces of advice may turn out to refer to different circumstances and different cases and to imply unlike moderations of differently more or less kinds of applicable character uses of the word ‘interpretation’.
For the word is evidently used in more than on sense. It is, after all, perhaps, only a synonym for the old phrase we have already come across - ‘making what unconscious conscious and it shares all of the phrase’s ambiguities. For in one sense, if you give a German-English dictionary to someone who knows no German, you will be giving him a collection of interpretations, what is more, is the kind of sense in which the nature of interpretation has been discussed in a recent paper by Bernfield. Such descriptive interpretations have no relevance to our present topic, nonetheless, in proceeding, the actuality as dispensed among the ultimate instrumentations of psycho-analytic therapy and to which for convenience the name ‘mutative’ interpretation is so that is, given a schematized outline of what is understood by a view to clarify of expositional instances for which the interpretation of hostile impulses are by virtue of this power (his strictly limited power) as auxiliary super-ego, that the analyst gives permission for a certain small quantity of the patient’s id-energy (in our instance, in the form of an aggressive impulse), the object of the patient’s id-impulses, the quality of these impulses which is now released into consciousness will become consciously directed toward the analyst. This is the critical point. If all goes well, the patient’s ego will become aware of the contrast between the aggressive character of his feelings and the real nature of the analyst, who does not behave like the patient’s ‘good’ or ‘bad’ archaic objects. The patient, which is to say, will become aware of a distinction between his archaic phantasy object and the dimensionality of an actualized external object. The interpretation has now become a mutative one, since it has produced a breach in the neurotic vicious circle. For the patient, having become aware of the lack of aggressiveness of actuality that is potentially realized of the existing external object, will be able to diminish his own aggressiveness; the new object which he introjects will be less aggressive, and consequently, the aggressiveness of his super-ego will also diminish, as, too, the further corollary of these events. And with them the patient will obtain access to the infantile material which is being re-experienced by him in his relation to the analyst.
Something as taken or advanced as fact, which is in having the quality of becoming actual and not confuted in being of such a comparison with an expressed or implied standard or absolute, that we are now found to embark upon a description of the successive phases of therapy with the chronically schizophrenic adult patient. The ‘Out-of-contact’ phase’, is not properly or sufficiently attended to or in progress of any measurable extent over which of something exists, however, the term is phraseologically accessible to meaning, such that I do not term this the ‘autistic phase’, for the reason that the word ‘autistic’ has come to have a certain connotation, in psychodynamic theory, which is regarded as invalid and therefore do not advocate. Specifically, the term ‘autistic’, as generally used, conjures up Freud’s (1911) psychodynamic formulation of schizophrenia as involving withdrawal of libido from the outer world and its subsequent investment in the self-as involving of a regression into narcissism. Instead, however, is that there occurs in schizophrenia, a regressive dedifferentiation toward an early level of ego-development which has its prototype in the experience of a young infant for whom the inner and outer worlds have not yet become clearly distinguishable, as an amount of anxiety which is related to the unfamiliarity as found to be the major sources of anxiety in individuals suffering from [paranoid] schizophrenia. Where the sources of such anxiety is variously ego-defensive by phenomena. We well know that to any psychiatric patient himself, the threatening affects present themselves not undistortedly, but in forms modified by ego-defences which, although intently protective, at the same time distortions that may appear as something experiential in a strange and frightening way.
He finds himself unable to renounce any concern with that of the other patients. Exceptions are those patients whose projections attach not to any real-life figure at all, but to quite pure-culture alter-ego. And reach their of peace about the matter. For in actuality this would be tantamount to repudiating important components of himself, moreover, the other person is necessary to him as the bearer of these externalized (e.g., projected) emotions. Bu t, cannot find peace through a friendly acceptance of the prosecutory figure, for this would be unsurmountable to accept, however, his own picture of himself, various qualities abhorrent to him. So an uneasy equilibrium is maintained, with his experiencing a gnawing, threatened, absorbing concern with the prosecutory figure whom he cannot rid from his mind (this is in line with the formulation of Werner (1940) and Loewald (1960)).
Such that the therapist, operating from this basic-orientation can meet usefully a wide variety of typical problem-situations, that which is in response to the patient‘s manifestation of delusional thinking, he will be aware that, for the patient, the delusions represent years of arduous and subjectively constructive thought, and are therefore most deeply cherished. He will not forget that obscured that obscures them is an indispensable nucleus of reality-perception. Likewise, when a patient is having vigorously to disavow any feeling about a clearly affect -laden matter, the therapist will remain in tune with the patient‘s own feeling experience, by remarking, ‘I gather you don’ t find yourself having any particular feeling about this’ - or. Better, will make no mention of feeling - rather than try to overcome the unconscious denial by asserting: But ‘ surely this must make you very angry (or hurt, or whatever). Similarly, in response to the expressions of an archaic, harsh, super-ego in the patient, rather than set himself up as the spokesman, the personification, of the repressed id-impulses, he will realize that it is in the super-ego that the patient’s conscious self-his personal identity-mainly resides: Thus, he will seldom urge the patient to recognize sexual or aggressive feelings within, and will more often acknowledge how strong a sense of protest or outrage the patient feels upon perceiving these in others.
To the extent that the therapist is free from a compulsion to rescue the suffering patient, he can remain sufficiently extricated from that suffering to be able to note significant sequence in the appearance of such symptoms as hallucinations, verbalized delusions, and so forth, and thus be in a position to be genuinely helpful. Even when on a car ride with a patient, or grappling with the latter’s physical assault, the therapist may on occasion be able to allow himself enough detachment to help the patient situations from earlier life, such ‘action interpretations’ may be especially important to the patient whose memory and whose capacity for abstract thinking are severely impaired.
Thus, one places in the long run a minimum of pressure on the patient who is already paralysed with pressure, and keeps oneself in a comparatively unanxious and receptive state which, better than anything else, helps eventually to relieve the patient’s anxiety and unlock his tongue. Sooner or later, like a bright dawn pushing back a long night, the patient will put his rusty vocalization capacities to work in venting reproach, contempt, and fury upon the therapist for doing, as the patient sees it, nothing to help him.
The therapist learns to take fewer and fewer things for grantee in his work, to question more and more of his long-held assumptions and discard many of them. He learns that one does not set a ceiling upon human beings’ potential growth. He finds recurrent delight in the creative spontaneity with which the schizophrenic patient pierces the sober and constructing wrapping of our culture’s conventions, and he discovers that humour is present in his work in rich abundance, leaving the genuine tragedy and helping to make it supportable. While developing a deep confidence in his intuitive ability, when working with the severely fragmented or differentiated patient he will not jump too quickly to attempted communicated ‘closure’ (in the Gestalt sense), but will leave it in the patient’s hands to do, no matter how slowly and painfully, the parts of the communicational work which only he can do. Meanwhile, he will not need no shield himself, through the maintenance of an urgently and actively ‘helpful’ or ‘rescuing’ attitude, from feeling at a deep level the impact of the fragmented and differentiated world, with its attendment feelings, in which the patient exists. The unfolding of such feeling experiences, the therapist of the next phase of the therapy, the ‘urgently helpful’ therapist attitude is unconsciously designed to avert, comparable to the defensive function. In the patient, of the latter’s schizophrenic delusions.
From a purely descriptive viewpoint, schizophrenia an be seen to consist essentially in an impairment of both ‘integration’ and ‘differentiation’ - which are but opposite faces of a unitary growth process. From a psychodynamic viewpoint as well, this malfunctioning of integration-and-differentiation seems basic to all the bewilderingly complex and varied manifestations of schizophrenia.
Taking first the matter of integration: When we assess the schizophrenic individual in terms of the classically structural areas of the personality - id, ego, and super-ego - we discover these to be poorly integrated with one another. The id is experienced by the ego as a Pandora’s box, the contents of which will overwhelm one if it is opened. The ego is, as many writers have stated, severely split, sometimes into innumerable islands which are not linked discernibly with one another. And the super-ego unintegrated ego are, if anything, even more destructive to it than are the accessions of the threatening id-impulses, as Szalita-Pemow (1951), Hill (1955) and others have emphasized. Moreover, the super-ego is, like the ego, even in itself not well integrated, its utterances contain the most glaring inconsistencies from one moment to the next. Jacobson (1954) has shown that there is actually a dissolution of the super-ego, as an integral structure - a regressive transformation back into the threatening parental images whose conglomeration originally formed it.
Differentiation is a process which is essentially to integration, and vice versa, for personality structure-functions or psychic contents to become integrated, they must first have emerged as partially differentiated or separated from one another, and differentiation in turn can emerge only out of a foundation of more or less integrated function or contents.
When we look at this process of differentiation in the schizophrenic person, we find it to be, similarly, severely impaired. It is difficult or impossible for him to differentiate between himself and the outer world. He often cannot distinguish between memories and present perceptions, memories experienced with hallucinatory vividness and immediacy are sensed as perceptions of present events. And perceptions of present events may be experienced as memories from the past. He may be unable to distinguish between emotions and somatic sensations, feelings from the emotional sphere often come through to him as somatic sensations, or even variations in his somatic structure (changes in the size, colour and so forth, of bodily parts).
He cannot distinguish between thoughts and feelings on the one hand, and action on the other: Thus, if the therapist encourages him to explore thoughts and feelings of a sexual or murderous nature, for example, he feels that the therapist is trying to invite him into sexual activity, or incite him to murder. He may be unable to differentiate, perceptually, one person from another, so that he is prone to misidentify them.
In the conduct of his daily life and in his communicating with other persons, he is unable, as Bateson et al. has reported, to distinguish between the symbolic and the concrete. If his therapist uses symbolic language, he may experience this in literal terms, and, on the other hand, the affairs of daily life (eating, dressing, sleeping and so on) which we think of as literal and concrete, he may react to as possessing a unique symbolic significance which completely obscures their ‘practical’ importance in his life for being part of the untold story for being human.
However, in the schizophrenic these two processes, that is to say, that of integration and differentiation, that tend to be out of step with one another, so that at one moment a patient’s more urgent need may be for increased integration, whereas at another he may more urgently need increased differentiation. And there are some patients who show for months on end a more urgent need in one of these areas, before the alternate growth-phase comes on the scene. Thus, there is a modicum of validity in speaking of two different ‘types’ of schizophrenic patients. This distinction is largely artificial, but it is useful for purposes of serving to explain of something that makes clear what is obscure bu t not readily understood or grasped from the main centres of human activity.
One comes to realize, how premature have been one’s efforts to find out what feelings the patient is experiencing or what thoughts he is having: One comes to realize that much of the time he has neither feelings nor thoughts differentiated as such and communicable to us.
Such differentiation as the patient possess tends to crumble when intense emotion enters his awareness. A paranoid man, for example, may find that when his hatred toward another person reaches a certain degree of intensity, he is flooded with anxiety because he no longer knows whether he hates, or instead, ‘really loves’ the other individual. This is not based, as primarily upon the mechanism which Freud (1911) outlined in his classical description of the nature of paranoid delusions of persecution, a description in which repressed homosexual love played the central role. the central difficulty is rather that the ego is too poorly differentiated to maintain its structure in the face of such powerful affects, and the patient becomes overwhelmed with what can only be described as ‘undifferentiated passion’, precisely as one finds an infant to be overwhelmed at times with affect which the observer cannot specifically identify as any one kind of emotion.
As for the feelings which the therapist himself experiences in working with the ‘non-differentiated type’ of patient, we fund, again, a persistent threat of the therapist’s sense of identity. But whereas, in the instance the threat was felt predominantly as a disturbance of one’s personal integration, it is felt predominantly as a weakening of one’s sense of differentiation. In this instance, the ‘therapeutic symbiosis’ which a necessary development, tends to occur earlier, for this patient’s predominant mode of relatedness with other persons, at the developmental level at which point we find him at the very beginning of a symbiotic relatedness among others, that is to say, with its subjective absence of ego-boundaries, involves not only special gratification but anxiety-provoking disturbances of one’s sense of personal identity.
The comparatively rapid development of symbiotic relatedness is facilitated by the patient’s characteristically non-verbal, therapeutic sessions. In response, the therapist’s own behaviour becomes more and more similar, so that each participant is now offering to the other, the intermittence over which of times are silent, impassive screen which facilitates abundant mutual projecting and introjecting. Thus a symbiotic state is likely to be reached earlier than in one’s work with the typically much more verbal type of patient whom, for instance, that the patient’s and the therapist’s more abundant verbalizations tend persistently to stress the ego-boundaries separating the two persons from one another.
With the predominantly non-differentiated patient, the therapist’s sense of identity as a complexly differentiated individual entity becomes further eroded, or undermined, as he finds the patient persistently operating on the unwavering conviction, that, time after time, that the therapist is but an undifferentiated aspect of the whole vague mass of which his own poorly differentiated hostility, but which in the patient’s tenaciously held view, is the way the world around him really is.
Further, since the patient typically verbalized little but a few maddeningly monotonous stereotypes, the therapist tends to feel over the course of time, with so little of his own intellectual content being explicitly tapped in the relationship, that his richness of intellect is progressively rusting away - becoming less differentiated, more stereotyped and rudimentary. Moreover, the patient presents but one of two emotional wavelengths to which the therapist can himself tune in. Rather than a rich spectrum of emotion which calls into resource a similarly wide range of feelings from the therapist himself. Thus not only the therapist’s intellectual resources, but his emotional capacities too, become subjectively narrowed down and impoverished, as he finds that his patient evokes in him neither any wide range of ideas, nor any emotion except, for example, rage, or contempt, or dull hopelessness.
This feeling experience on his part, anxiety-provoking and discouraging though he finds it, is a necessary therapeutic development. it is necessary, that is, for him thus to experience at first hand something of the patient’s own lack of differentiation, for, as in the therapy with the non-integrated patient, that, again, the healing process occurs external to the patient, as it were, at an intrapsychic level in the therapist, before it becomes established in the patient himself. That is, the therapist’s coming to view the patient, his relationship with the patient, and himself in this relationship, all for being largely non-differentiated, is a development which sets the stage for the patient’s gradually increasing differentiation. Now the therapist comes too sense, time after time, newly emerging tendrils of differentiation in the patient, before the latter is himself conscious of them. In responding to these with spontaneity as they show themselves, time and again, that the therapist helps the patient to become aware that they are a part of him. But there are times when a therapist can only say that he feels a new response in himself in reaction to behaviour which objectively seems as stereotyped as ever.
Thus a heavy reliance upon one’s intuition is a technical point, although a second point concerns the relatively sparing use of transference interpretation - perhaps, more sparing than in one’s work with the predominantly non-integrated, or fragmented, patient. in the instance of that first ‘type’ of patient, such that transference interpretations may have a specific value in fostering the patient’s wholeness, his integration, by focussing his disparate personality fragments into the context of the patient-therapist relationship. But the predominantly non-differentiated patient, who is, above all trying to branch out, in his interpersonal relationships and in his intrapsychic content, beyond the immediate, symbiotic situation with the therapist, premature transference interpretations which tend to bring it all back to the relationship with his therapist - which tend, that is, to reduce divergent ramifications of meaning to this one idea that something conveys to the mind as the one purpose to accomplish or do, as such is the intention of meaning.
The last technical point is, like the others, a function of the growth process of a process which involves both patient and the therapist. The patient’s differentiation is fostered not only by the therapist’s sensing, and responding to, an increasingly differentiated person in him, but also by the therapist’s permitting his own personality differentiation, his own complex individuality which was to a greater extent, already firmly established before beginning work with this patient, to come more and more freely into play in the therapeutic relationship. At a crucial point is, for example, he must have the courage to act upon the course that his own intuition directs, in deferring sharply from the patient - to be the person he knows himself to be and to address the person he knows to inhabit the patient’s body, no matter how sharply this conflicts with the patient’s own image of himself and of his therapist. Whereas, it was essential earlier to allow the anxiety-arousing symbiosis to develop, now the therapist must find similar courage to help determinedly in its resolution. In asserting increasingly his own complex individuality, he provides the patient with an increasingly clearly differentiated person with whom to identify and over against whom to become conscious of his own separate self.
That the states of what are called non-integration and non-differentiation should be thought of as not merely rather fixed levels of maturation or regression at which a patient exists over a long period of time, but as flexible defences of the ego against overwhelming anxiety. Thus, from noticing at what moments in the theopathic session, or at what junctures over the long course of treatment, a patient’s characteristic non-integration or non-differentiation notably increases or notably lessons, we can tell when areas of particularity severe anxiety have been encountered in his personality investigation, and chart the resolution of this anxiety as growth proceeds.
In the role of regression in the transference situation is subject to wide differences of opinion. It was, of course, one of Freud’s earliest discoveries that regression had of its earliest points of fixation, and is a cardinal feature, not only in the development of neurosis and psychosis, but also in the revival of earlier conflicts in the transference situation. With the development of psychoanalysis and its application to an ever increasing range of received increased attention. The significance of the analytic situation as a means of fostering regression as a prerequisite for the therapeutic work has been emphasized by Ida Macapline in a recent paper. Differing opinions as to the significance, value, and technical handling of regressive manifestoes from the basis of important modifications of analytic technique, which will be considered, however, in respect to the transference neurosis, the view recently expressed by Phyllis Greenacre, that regression, and indispensable features would be generally accepted. It is also a matter of generally based agreement that a prerequisite for successful analysis is revival and repetition in the analytic situation of the struggle of primitive stages of development. Those who emphasize defence analysis, however, tend to view regression as a manifestation of resistance, as a primitive mechanism of defence employed by the growth sets of the transference neurosis. Analysis of these regressive manifestations with their potential dangers depends on the existing and continued functioning of adequate ego strength to maintain therapeutic alliance at an adult level. Those, in contrast, who stress the significance of transference as a revival of the early mother-child relationship does not emphasize regression as an indication of resistance or defence, the revival of these primitive experiences in the transference situation is, in fact, regarded as can essential prerequisite for satisfactory psychological maturation and true geniality. The Kleinian school, as already indicated features the continued activity of primitive conflicts in determining essential features of the transference at every stage of analysis. Their increasing overt revival in the analytic situation, therefore, signifies a reopening of the analysis, and in general, is regarded as an indication of diminuation rather than increase of resistance. The dangers involved according to this point of view and are determined more but to the failure to mitigate anxiety by suitable transference interpretation. By this failure to obtainably achieve, in the early phases of analysis, a sound and stabling therapeutic alliance is based on the maturity of the patient’s essential ego characteristics.
In considering, briefly, the terminal phases of analysis, many unresolved problems concerning the goal of the therapy and definition of a completed psychoanalysis must be kept in mind. Distinction must also be made between the technical problems of the terminal phase and evaluation of transference after the analysis has been terminated, there is widespread agreement as to the frequent revival in the terminal phases of primitive transference manifestations apparently resolved during the early phases of primitive transference manifestation, apparently resolved during the early phase of analysis has been terminated. Balint, and those who accept Ferenczi’s concept of primary passive love, suggest that some gratification of primitive passive needs may be essential for successful termination. To Klein, the terminal phases of analysis also represent a repetition of important features of the early mother-child relationship. According to her point of view, this period represents, in essence, a revival of the early weaning situation. Completion depends on a mastery of early depressive struggles culminating in successful introjection of the analysis as a good object. Although, in this connection, emphasis differs considerably, it should be noted that those who stress the importance of identification with the analyst as a basis for therapeutic alliance, also accept the inevitability of some permanent modifications of a similar nature. Those, however, who make a definite differentiation between transference of the transference neurosis as a main prerequisite for successful termination. The identification based on therapeutic alliance must be interpreted and understood, particularly with reference to the reality aspects of the analyst’s personality. In spite, therefore, of significant important differences there are, as already indicated in connection with the earlier papers of Sterba and Strachey, important points of agreement in respect to the goal of psychoanalysis.
The differences already considered indicate some basic current problems of transference. So far, however, discussion has been limited to variations within the framework of a traditional technique. We must consider problems related to overt modifications, so as the essential expanding context of use between variations introduced in respect to certain clinical conditions. Often as a preliminary to classical psychoanalysis, and modifications based on changes on basic approach which lead to significant alterations with regard both to the method and to the aim of therapy. It is generally agreed that some neurosis, borderline patients and the psychosis. The nature and meaning of such changes are, however, viewed differently according to the relative emphasis placed on the ego and its defences, on underlying unconscious conflicts, and on the significance and handling of regression in the therapeutic situation.
In ‘Analysis Terminable and Interminable’, Freud suggested that certainly inaccessible to psychoanalytic procedure. Hartmann has suggested that in addition to these primary attributes, other ego characteristics, originally develop for defensive purposes, and the related neutralized instinctual energy at the disposal of the ego, may be relatively or absolutely divorced from unconscious fantasy. This not only explains the relative inefficacy of early transference interpretation, but also hints of possible limitations in the potentialities of analysis attributable to secondary autonomy of the ego which is considered to be relatively irreversible. In certain cases, moreover, it is suggested that analysis of precarious or seriously pathological defences - particularly those concerned of aggressive impulses - may be not only ineffective, but dangerous. The relative failure of ego development in such cases not only precludes the development of a genuine therapeutic alliance, but also raises the risk of a serious regressive, often predominantly hostile transference situation. In certain cases, therefore, preliminary period of psychotherapy is recommended in order to explore the capacities of the patient to tolerate traditional psychoanalysis. In others, as Robert Knight in his paper on borderline states, and as many analysts’ working with psychotic patients have suggested, psychoanalytic procedure is not considered applicable. Instead, a therapeutic approach based on analytic understanding which, in essence, utilizes an essentially implicit positive transference as a means of reinforcing, rather than analysing the precarious defences of the individual, is advocated. In contrast, Herbert Rosenfeld approached even severely disturbed psychotic patients with minimal modifications of psychoanalytic techniques. Only changes which the severity of the patient’s condition enforces are introduced. The dangers of regression in therapy are not emphasized since primitive fantasy is considered to be active under all circumstances. The most primitive period is viewed in terms of early object relations with special stress on prosecutory anxiety related to the death instinct. Interpretation of this primitive fantasy in the transference situation, is best offered the opportunity of strengthening the severity-threatened psychosis mainly to serve traumatic experiences, particularly of deprivation in early infancy. According to this point of view, profound regression offers an opportunity to fulfil, in the transference situation, primitive needs which had not been met at the appropriate level of development. Similar suggestions have been proposed by Margolin and others, in the concept of anaclitic treatment. Serious psychosomatic diseases, that approach the premise that the inevitable regression is shown by certain patients and should be utilized in therapy, as a means for gratifying, in their extremely permissive transference situation. Having distinctive or certain limits in the burdensome instant for demanding to that which has not been met in infancy, as this must, in the connection of being taken to understand that the gratifications recommended in the treatment of severely disturbed patients are determined by their conviction. Of these patients are incapable of developing transference as we understand it, in the connection with neurosis and must therefore be handled by a modified technique.
The opinions so far considered, however, much of them, as mine differ in certain respects, are, nonetheless, all based on the fundamental premise that an essential difference between analysis and other methods of therapy depends on whether or not interpretation of transference is an integral feature of technical procedure. Results based on the effects of suggestions are to be avoided, as far as possible, whenever traditional technique is employed. This goal has, however, tp establish a point by appropriate objective means, that corroborated evidence that proved the need for better a state of being even more difficult to achieve than Freud expected when he first discerned the significance of symptomatic recovery based on positive transference. The importance of suggestion, even in the most strict analytic methods, has been repeatedly stressed by Edward Glover and others. Widespread and increasing emphasis as to the part played by the analyst’s personality in determining the nature of the individual transference also implies recognition of unavoidable suggestive tendencies in the therapeutic process. Many analysts today believe that the classical conception of analytic objectivity and anonymity cannot be maintained. Instead, thorough analysis of reality aspects of the therapist’s personality and point of view is advocated as an essential feature of transference analysis and an indispensable prerequisite for the dynamic changes already discussed in relation to the termination of analysis. It thus remains the ultimate goal of psychoanalyst’s whenever their theoretical orientation, to avoid, as far as is humanly possible, results based on the unrecognized or unanalysed action of suggestion, and to maintain, as a primary goal, the resolution of such results through consistent and careful interpretation.
There are, however, a number of therapists, both within and outside the field of psychoanalysis, who consider that the transference situation should not be handled only or mainly as a setting for interpretation even in the treatment or analysis of neurotic patients. Instead, they advocate utilization of the transference relationship for the manipulation of corrective emotional experience. The theoretical orientation of those utilizing this concept of transference may be closer to, or more distant form, a Freudian point of view according to the degree to which current relationships are seen as determined by past events. At one extreme, current aspects and cultural factors are considered of predominant importance, at the other, mental development is viewed in essentially Freudian terms and modifications of technique are ascribed to inherent limitations of the analytic method rather than to essentially changed conceptions of the early phases of mental development. Of this group, Alexander is perhaps the best example. It is thirty years since, in his Salzburg paper, he indicated the tendency for patients to regress, even after apparently successful transference analysis of the oedipus situation to narcissistic dependent pregenital levels which prove stubborn and refractory to transference interpretation. In his more recent work, the role of regression in the transference situation has been increasingly stressed. The emergence and persistence of dependent, pregenital commands for something as or is if one’s right or due requirements are challenged in measuring moderations of a wide range of clinical conditions. It is argued, that its indications that the encouragement of a regressive transference situation is undesirable and therapeutically ineffective. The analyst, therefore, should when this threatens adopt a definite role explicitly differing from the behaviour of the parents in early childhood in order to bring about therapeutic results through a corrective emotional experience in the transference situation. This, it is suggested, will obviate the tendency to regression, thus curtailing the length of treatment and improving therapeutic results. Limitations of regressive manifestations by active steps modifying traditional analytic procedure in a variety of ways are also frequently indicated, according to this point of view.
It will be clear that to those who maintain the conviction that interpretation of all transference manifestations remain an essential feature of psychoanalysis, the type of manifestation as described, even though based on a Freudian reconstruction of the early phases of mental developments, and represent a major modification. It is determined by a conviction that psychoanalysis, as a therapeutic method, has limitations related to the tendency to regression, which cannot be resolved by traditional technique. Moreover, the fundamental premises on which, and the conception of corrective emotional experience is based minimizing the significance of insight and recall. It is essentially, suggested that corrective emotional experience alone may bring about qualitative dynamic alterations in mental structure, which can lead to a satisfactory therapeutic goal. This implies a definite modification on the analytic hypothesis whose current problems are determined by their defences against the direct opposition to the instinctual impulses and the intentional object, to which had been set up during the decisive periods of early development. An analytic result therefore depends on the revival, repetition and mastery of earlier conflict in the current experience of the transference situation with insight an indispensable feature of an analytic goal.
Since certain important modifications are related to the concept of regression in the transference situation, it should be considered that this concept is in relation to the repetition compulsion, that transference, essentially is a revival of earlier emotional experience, must be regarded as a manifestation of the repetition compulsion is generally accepted. It is, however, necessarily to distinguish between repetition compulsion as an attempt to master traumatic experience and repetition compulsion as an attempt to return to a real or fantasized earlier state of rest or gratification. Lagache, in a recent paper, has connected by or as if by the affirming relatedness as associated to the corresponding divergence in the repetition compulsion to an inherent need to appear in the problems that had previously been left unsolved. From this point of view, the regressive aspects of the transference situation are to be regarded as a necessary preliminary to the mastery of unresolved conflict, as too, the regressive aspects of transference are mainly attributed to a wish to return to an earlier state of rest or narcissistic gratification, to the maintenance of the status quo in preference to any progressive action, to which Freud’s original conception of the death instinct. There is a good deal to suggest that both aspects of the repetition compulsion may bee seen in self-destructive forces tend to be stronger that progressive libidinal impulses, the potentialities of the analytic approach will inevitably appear to be limited. In those, in contrast, in whom that regard the reappearance in the transference situation of earlier conflicts as an indication of tendencies to master and progress will continue to feel that the classical analytic method remains the optimal approach to psychological illness wherever it is applicable.
Clarifications maintain the position or peculiar state as occupying a spatial point in temporal conditions, with a significant relevance to the amplitude larger in extent or a greater capacity that the average infinitive period has of time. Whereas in absence or termination must reflect on or upon the fearing analysis if the transference, as compelling of a generally acknowledged focal point, this itself may debase the appropriate factor that generates, in every degree. The exemplifying analytic technique that would react upon the discipline needed to utilize the new values, whereby, they can be ascribed as the commonality in holding the services to a suspicious self-direction and comprehensive understanding, in that of whatever is humanly affiliated to the best as can be, and yet, the advocacy to the analysis of the transference is generally acknowledged as the central feature of analytic technique? Freud regarded transference and resistance as facts in the observational conceptuality for which of representing the state of inventions. He writes, . . . that the theory of psychoanalysis in an attempt to account for two striking and unexpected facts of observation which emerge whenever an attempt is made. Evidently the symptoms of a neurotic source, may in his past life, inhabit the sources of experiential recall to the past or the introspective reflections. In the state of affairs, in that for being the latent characterizations announced as the factoring responsibility for the transference and of resistance . . . one which takes the other side of the problem, while accepting as such, to the latencies and the hidden values non-accepting for new interactions as brought through a hypothesis that will hardly escape the charge of misappropriation of properties by attempting endeavour to re-associate the essentially established personalization, that if the pursuit in calling them a psychoanalyst’. Rapaport (1967) argued, in his posthumously published paper on the methodology of psychoanalysis, that transference and resistance inevitably follow from the fact that the analytic situation is interpersonal.
Despite this general agreement on the centrality of transference and resistance in technique, in that, the analysis of transference is not pursued as systematically and comprehensively affirmed, however, it could be and should be. The relative privacy for which psychoanalytic work makes it impossible for one or of that of any-other, to skilfully improve upon the attemptive conceptual representation as comprehended of issues, its assumption to state this view as anything more that impressions, involving on that of what in the analysis of the transference and to states awareness in the number of reasons that an important aspect in the analysis of the transference of the transference, namely in the resistance, by the awareness of the transference is especially, and often adhering to the analytic procedures that interact among cultural inhibitors, but that will be distinguished as such, that its ranging manifold of distancing non-localities as founded of the analyst’s.
However, it must first be to distinguish between two types of interpretation of the transference. That one is an interpretation of resistance to the awareness of transference, the other, is an interpretation of resistance to the resolution of transference. The distinction has clearly been best spelled out in the form from which copies or reproductions can be produced, as to cause to make its awareness and yielding values as grounded in the cognisance to Greenson (1967) and Stone (1967). The first kind of resistance may be called decence transference, although this term emphases the terminological characterization by its term is mainly employed to refer to a phrase of analysis and carried within the general resistance to the transference of wishes, it can also be used for a more isolated instance of transference of defence. With some oversimplification, one might say that in resistance to the awareness of transference, the transference, the transference is what does the resisting.
Another connected description of stating this distinction between resistance and the awareness of transference and resistance to the resolution of transference is between implicit and indirect references to the transference and explicitly or directly referential to the transference. The interpretation of resistance to awareness of the transference is intended to make the implicit transference explicit. While the interpretation of resistance to the resolution of transference is intended to make the patient realize that the already explicit transference does indeed include a determinant from the past.
It is also important to distinguish between the general concept of an interpretation of resistance to the resolution of transference and a particular variety of such an interpretation, namely, a genetic transference interpretation - that is, an interpretation of how an attitude in the present is an inappropriate carry-over from the past. While there is a tendency among analysts to deal explicit references to the transference primarily among analyses to deal explicitly the references to the transference as primarily by a genetic transference interpretation, there are other ways of working toward a revolution of the transference. However, this argument does so implicate that not only is not enough emphasis being given to interpretation of the transference in the here and now, that is, to the interpretation of implicit manifestations of the transference, but also that interpretations intended to resolve the transference as manifested in explicit references to the transference should be primarily in the here and now, rather than genetic transference interpretations.
A patient’s statement that he feels the analyst is harsh, for example, is, at least to begin with, likely best dealt with not by interpreting that this is a displacement from the patient’s feeling that his father was harsh, but by as elucidation of some other aspect of this here and now attitude, such as what has gone on in the analytic situation that seems to the patient to justify his feeling or what was the anxiety that made it so difficult for him to express his feelings. How the patient experiences the actual situation is an example of the role of the actual situation in a manifestation of transference, which will be a major point of relevant significance.
Of course, both interpretations of the transference in the here and now and genetic transference interpretations are valid and constitute a sequence. We presume that a resistance to the transference ultimately rests on the displacement onto the analysts of attitudes from the past.
Because Freud’s case histories focus much more on the yield of analysis than on the details of the process, they are readily but perhaps incorrectly construed as emphasizing work outside the transference much more than work within the transference, and, even within the transference, emphasizing genetic transference interpretations much more than work with the transference in the here and now (Muslin and Gill, 1978). The example of Freud’s case reports may have played a role in what is to be considered as the common maldistribution of emphasis in these two respects - not enough on the transference and, within the transference, not enough on the here and now.
Transference interpretations in the here and now and genetic transference interpretations are, of course, exemplified in Freud’s writings and are in the repertoire of every analyst, but they are not distinguished sharply enough.
Both participants in the analytic situation are motivated to avoid these interactions. Flight away from the transference and to the past can be a relief to both the patient and the analyst.
These aligning measures have been divided into five categorical divisions and placed into the following parts: (1) The principle that the transference should be encouraged to expand as much as possible within the analytic situation because the analytic work is best done within the transference. (2) the interpretation of disguised allusion to the transference as a main technique for encouraging the expansion of the transference within the analytic situation, (3) the principle that all transference has a connection with something in the present actual analysis situation, (4) how the connection between transference and the actual analytic situation is used in interpreting resistance to the awareness of transference, and (5) the resolution of transference within the here and now and the role of genetic transference interpretation.
The importance of transference interpretations will surely be agreeing to by all analysts, the greater effectiveness of transference interpretations than interpretations outside the transference will be agreeing to by many, but what of the relative roles of interpretation of the transference and interpretation outside the transference?
Freud can be interpreted as either of saying that the analysis of the transference in auxiliary to the analysis of the neurosis or that the analysis of the transference is equivalent to the analysis of the neurosis. The first position is stated in his saying (1913) that the disturbance of the transference has to be overcome by the analysis of transference resistance in order to get on with the work of analysing the neurosis. It is also implied in his reiteration that the ultimate task of analysis is to remember the past, to fill in the gap in memory. The second position is stated in his saying that the victory must be won on the field of the transference (1912) and that the mastery of the transference neurosis ‘coincides with getting rid of the illness which was originally brought to the neurosis (1917). In this second view, he says that after the resistance is overcome, memories appear relatively without difficulty.
These two different positions also find expression in the two different ways in which Freud speaks of the transference. In `Dynamics of Transference` he refers to the transference, on the one hand, as `the most powerful resistance to the treatment`(1912) but, on the other hand, as doing us the inestimable service of making the patient’s . . . , immediate impulses and manifests, when all is said and done, it is impossible to destroy anyone in absentia or in effigie (1912).
It can be agreed that his principal emphasis fails on the second position. He wrote once, in summary, ‘Thus our therapeutic work falls into two phases in the first, all the libido is forced from the symptoms into the transference and concentrated there, in the second, the struggle is waged around this new object and the libido is liberated from it`(1912).
The detailed demonstration that he advocated that the transference should be encouraged to expand as much as possible within the analytic situation lies in clarification that resistance is primarily expressed by repetition, and repetition takes place both within and outside the analytic situation, but that the analyst seeks to deal with it primarily within the analytic situation, that repetition can be not only in the motor sphere (acting) but also in the psychical sphere, and that the psychical sphere is not confined to remembering but includes the present, too.
Freud`s emphasis that the purpose of resistance is to prevent remembering can obscure his point that resistance shows itself primarily by repetition, whether inside or outside the analytic situation. `The greater the resistance, the more extensively, and will act out (repetition)replace remembering`. Similarly in `The Dynamics of Transference` Freud said that the main reason that the transference is so well suited to serve the resistance is that the unconscious implies does not want to be remembered . . . but endeavour to reproduce themselves . . . (1918), the transference is a resistance primarily insofar as it is a repetition.
The point can be restated in terms of the relation between transference and resistance. The resistance expresses itself in repetition, that is, in transference both inside and outside the analytic situation. To deal with the transference. Therefore, is equivalent to dealing with the resistance. Freud emphasized transference within the analytic situation so strongly that it has come to mean only repetition within the analytic situation, even though, conceptually speaking, repetition outside the analytic situation is transference too, and Freud once used the term that way. `We soon perceive that the transference is itself only a piece of repetition and that the repetition is a transference of the forgotten past not only onto the analyst but also onto all the other aspects of the current situation. We . . . find . . . the compulsion to repeat, which now replaces the impulsion to remember, not only in his personal attitude to his analyst but also in every other activity and relationship which may occupy his life at the time . . . (1914).
It is important to realize that the expansion of the repetition inside the analytic situation, whether or not in a reciprocal relationship to repetition outside the analytic situation, is the avenue to control the repetition: `The main instrument . . . for curbing the patients compulsion to repeat and for turning it into a motive for remembering lies in the handling of the transference. We render the compulsion harmless, and indeed useful, by giving it the right to assert itself in a definite field`(1914).
Kanzer has discussed this issue well in his paper on ‘The Motor Sphere of the Transference’ (1966). He writes of a ‘double-pronged stick-and-carrot’ technique by which the transference is fostered within the analytic situation and discouraged outside the analytic situation. The ‘stick’ is the principle of abstinence as exemplified in the admonition against making important decisions during treatment, and the ‘carrot’ is the opportunity afforded the transference to expand within the treatment, ‘in almost complete freedom’ as in a ‘playground’ (Freud, 1914). As Freud put it, ‘Provided only that the patient shows compliance enough to respect the necessary conditions of the analysis, we regularly succeed in giving all the symptoms of the illness a new transference meaning, and in replacing his ordinary neurosis by a ‘transference neurosis’ of which he can be cured by the therapeutic work’ (1914).
The reason it is desirable for the transference to be expressed within the treatment is that there, it `is at every point accessible to our intervention`(1914). In a later statement he made the same point this way. `We have followed this new edition - the transference-neurosis - of the old disorder from its start, we have observed its origin and growth, and we are especially well able to find our way about in it since, as its object, we are situated at it’s very centre, (1917), it is not that the transference is forced into the treatment, but that it is spontaneously but implicitly present and is encouraged to expand there and become explicit
Freud emphasized acting in the transference so strongly that one can overlook the repetition in the transference, but does not of necessity for its enactment or recognition that gives validity to acts of a subordinate conformation as ratified in support of explicit authoritative permission. Repetition need not go as far as motor behaviour, it can also be expressed in attitudes, feelings, and intentions, and, indeed, the repetition often does take such form rather than motor action. The importance of making this clear is that Freud can be mistakenly read to mean that repetition in the psychical sphere can only mean remembering the past, is when he writes that the analyst as prepared for a perpetual struggle with his patient to keep in the psychical sphere all the impulses which the patient would like to direct into the motor sphere, and he celebrates it as a triumph for the treatment if he can bring it about that something the patient wishes to discharge in action are disposed if through the work of remembering (1914).
It is true that the analyst’s efforts are to convert acting in the motor sphere into awareness in the psychical sphere, but transference may be in the psychical sphere to begin with, albeit disguised. The psychical sphere includes awareness in the transference as well as remembering.
One of the objections one hears, from both analysts and patient, to a heavy emphasis on interpretation of associations about the patients real life primarily in terms of the transference is that it means the analyst is disregarding the importance of what goes on in the patients real life. The criticism is not judiciable. To emphasize the transference meaning is not to deny or belittle other meanings, but to focus on the one of several meanings of the content that is the most important for the analytic process, for the reasons of positing the addition for one coming to any falsifiable conclusion.
Another way in which interpretations of resistance to the transference can be, or at lease appear to the patient to be, a belittling of the importance of the patients outside life is to make the interpretation as though the outside behaviour is primarily an acting out of the transference. The patient may undertake some actions in the outside world as an expression of and resistance to the transference, that is, acting out. But the interpretation of associations about actions in the outside world as having implications for the transference needs mean only that the choice of outside action to figure in the associations is co-determined by the need to express a transference indirectly. It is because of the resistance to awareness of the transference that the transference to be disguised. When the disguise is unmasked by interpretation, it becomes clear that, despite the inevitable differences between the outside situation and the transference situation, the content is the same for the analysis of the necrosis that coincides (Freud wrote that the mastering of the transference neurosis only coincides with getting rid of the illness which was originally brought to the treatment (1917)).
The analytic situation itself fosters the development of attitudes with primary determinants in the past, i.e., transference. The analyst’s reserve provides the patient with few and equivocal cues. The purpose of the analytic situation fosters the development of strong emotional responses, and the very fact that the patient has a neurosis means, as Freud said, that’ . . . it is a perfectly normal and intelligible thing that the libidinal cathexis [we would now add negative feelings] of someone who is partly unsatisfied, a cathexes which are held ready in anticipation, should be directly as well to the figure of the analyst (1912).
While the analytic setup itself fosters the expansion of the transference within the analytic situation, the interpretation of resistance to the awareness of transference will further this expansion.
There are important resistances on the part of both patient and analyst to awareness of the transference. On the patient’s part, this is because of the difficulty in recognizing erotic and hostile impulses toward the very person to whom they have to be disclosed. On the analyst’s part, this is because the patient is likely to attitude the very attitudes to him which are most likely to cause him discomfort. The attitudes the patient believes the analysts have toward him are often the ones the patient is least likely to voice, in a general sense because of a feeling that it is impertinent for him to concern himself with the analyst’s feelings, and in a more specific sense because the aptitudes as held by the analyst are often attitudes the patient feels the analyst will be comfortable about having ascribed to him. It is for this reason that the analyst must be especially alert to the attitudes the patient believes he has, not only to the attitudes the patient does have toward him. If the analyst is able to see himself as a participant in an interaction, as he will become much more attuned to this important area of transference, which might otherwise escape him.
The investigations of attitudes are ascribed to the analyst makes easier the subsequent investigation of the intrinsic factors in the patient that played a role in such ascription. For example, the exposure of the fact that the patient ascribes sexual interests in him to the analyst, and generally to the patient, alternatively the subsequent exploration of the patient’s sexual wish toward the analyst, and genetically the parent.
The resistance to the awareness of these attitudes is responsible for their appearing in various disguises in the patient’s manifested associations and for the analyst’s reluctance to unmask the disguise. The most commonly recognized disguise is by displacement, but identification is an equally important one. In displacement, the patient’s attitudes are narrated for being toward a third party. In identification, the patient attitudes to himself attitudes he believes the analyst has toward him.
To encourage the expansion of the transference within the analytic situation, the disguises in which the transference appears have to be interpreted in the case of displacement the interpretation will be of allusions to the transference in association not manifestly about the transference. This is a kind of interpretation every analyst often makes. In the case of identifications, the analyst interprets the attitudes that the patient ascribes to himself the identification with which an attitude and subsequently attributed to the analyst. Lipton (1977) has recently described this form of disguise allusion in the transference with illuminating illustration.
In his autobiography, Freud wrote, ‘The patient remains under the influence of the analytic situation as hopefully of a latter position or a period of decline, as though he is not directing responsibly for the mental activities onto a particular subject. Justly in assuming that nothing will occur, as not of some reference to the situation (1925). Since associations are obviously often not directed about the analytic situation, the interpretation of Freud’s remark rests on what he meant by the ‘analytic situation’.
It is believed that Freud’s meaning can be clarified by reference to a statement he made in, ‘The Interpretation of Dreams’. He said that when the patient is told to say whatever comes into his mind, his associations become directed by the ‘purposive ideas inherent in the treatment’ and that there are two such inherent regressive themes, one relating to the illness and the other - concerning which, Freud said, the patient has ‘no suspicion’; - relating to other analyst’s relating to the patient has ‘no suspicions’ - relating to the analyst (1900). If the patient has ‘no suspicions’ of the theme relating to the analyst, such that the theme appears only in disguise, the patient ‘s associations, it is contended that Freud’s remark not only specifies the themes inherent in the patient ‘s identifications’, but means that the associations are simultaneously directed by these two purposive ideas, not something by one and sometimes by the other.
One important reason that the early and continuing presence of the transference is not always recognized in that it is considered to be absent in the patient who is talking recognized is that it is considered to be absent in the patient who is talking freely and apparently without resistance. As (Muslin and Gill, 1976) pointed out in a paper on the early interpretation of transference resistance, to the transference is probably present from the beginning, even if the patient is talking apparently freely. The patient may well be talking about issues not manifestingly about the transference which are nevertheless, also allusions to the transference, but the analyst has to be alert to the pervasiveness of such allusory discernment about them.
The analyst should progress on the working assumption, that the patient’s associations have transference implications pervasively, that with which this assumption is not to be confused with denial or neglect of the current aspects of the analytic situation. It is theoretically always possible to give precedence to a transference interpretation if one can only discern it through its disguise by resistance. This is not to dispute the desirability of learning as much as one can about the patient, if only to be a position to make more correct interpretations of the transference. One therefore, does not interfere with an apparently free flow of associations, especially early, unless the transference threatens the analytic situation to the point where its interpretation is mandatory rather than optional.
With the recognition that evens apparently freely associating patient may also be showing resistance to awareness of the transference, this formulation should not interfere as long a useful information being gathered should relace Freud’s dictum that the transference should not be interpreted until it becomes a resistance (1913).
It can be argued that every transference has some connection to some aspect of the current analytic situation, in the sense that the past can exert an influence only insofar as it exists in the present. Of course, all the determinants of a transference are current in the sense that what I am distinguishing is the current reality of the analytic situation, that is, what actually goes on between patient and analyst in the situation from how the patient is currently constituted as a result of his past.
All analysts would dubiously agree that there are both current and transferential determinants of the analytic situation, and probably no analyst would argue that a transference of the analytic situation, and probably no analyst would argue that a transference idea can be expressed without contamination, as it was, that is, without any connection to anything current in the patient-analyst relationship. Nevertheless, the implications of this fact for technique are often neglected in practice, as my next point is only to argue for the connection.
Several authors, e.g., Kohut 1959 and Loewald 1960, have pointed out that Freud`s early application by the act or practice of using something or the state of being used, this, however, employ of the quality of being appropriate or valuable to some end as to accommodate the accountable or warrant the use of the term transference. In `The Interpretation of Dreams, in a connection not immediately recognizable as related to the present day use of the term, reveals the fallacy of considering that transference can be expressed free of any connection to the present. That early use was to refer to the fact that an unconscious idea cannot be expressed as such, but only as it becomes connected to a preconscious o r conscious content. In the phenomenon with which Freud was then concerned, the dream transference took place from an unconscious wish to a day residue. In `The Interpretation of Dreams, `Freud used the term transference both for the general rule that an unconscious content is expressible only as it becomes transferred to a preconscious or conscious content and for the specific application of this rule to a transference to the analyst. Just as the day residue is the point of attachment of the dream wish, so must there be an analytic-situation residue, though Freud did not use that term, as the point of attachment of the transference.
Analysts have always limited their behaviour, both in variety and intensity, to increase the extent to which the patient‘s behaviour is determined by his idiosyncratic interpretation of the analyst’s behaviour. In fact, analysts unfortunately sometimes limit the behaviour so much as to compare with such an expression or unpiled standard or absolute approximation, that the entire relationship with the patient matter of technique, with no nontechnical personal relation, as Liptop (1977) has pointed out.
But no matter how far the analyst attempts to carry this limitation of his behaviour, the very existence of the analytic situation provides the patient with innumerable cues which can enviably become his rationale for his transference responses. In other words, the current situation cannot be made to disappear - that is, the analytic situation is real. It is easy to forget this truism in one’s zeal to diminish the role of the current situation in determining the patient ‘s responses. One can try to keep past and present determinants relatively perceptible from one another, but one cannot obtain either ‘pure culture‘. Freud wrote: ‘I insist on this procedure [the couch], however, for its purpose and result are to prevent the transference from mingling with the patient’s associations imperceptibly, to isolate the transference and to allow it to come forward in due course sharply defined as a resistance’ (1913). Even ‘isolate’ is too strong a word in the light of the inevitable intertwining of the transference with the current situation.
If the analyst remains under the illusion that the current cues he provides to the patient can be reduced to the vanishing point, he may be led into a silent withdrawal, which is not too distant from the caricature of an analyst as someone who does refuse to have any personal relationship with the patient. What happens then is that silence has become a technique rather than merely an indication that the analyst is listening. The patient’s responses under such conditions can be mistaken for uncontaminated transference when they are in fact transference adaptions to the actuality of the silence.
The recognition, from which it takes its point of departure, as it was, has a crucial implications for the technique of interpreting resistance to the awareness of transference, in that, if, the analyst becomes persuaded of the centrality of transference and the importance of encouraging the transference to expand within the analytic situation, he has to find the presenting and plausible interpretation of resistance to the awareness of transference he should make. Is that, his most reliable guide is the cues offered by what is actually going on in the analytic situation? : On the one hand, the events of the situation, such as change in time of session, or an interpretation made by the analyst, and, on the other hand, how the patient is experiencing the situation as reflected in explicit remarks about it, however, fleeting these may be. This is the primary yield for technique of the recognition that any transference must have a link to the actuality of the analytic situation. The cue points to the nature of the transference, just as the day residue for a dream may be a quick pointer of the latent dream thoughts. Attention to the current situation for a transference elaboration will keep the analyst from making mechanical transference interpretation, in which he interprets that there are allusions to the transference in association not manifestly about the transference, but without offering any plausible bias for the interpretation. Attention to the current stimulation offers some degree of protection against the analyst’s inevitability whose tendency to project his own views onto the patient, either because of countertransference or because of a preconceived theoretical bias about the content and hierarchical relationships in psychodynamics.
The analyst may be very surprised at what in his behaviour the patient finds important or unimportant, for the patient’s responses will be idiosyncratically determined by the transference, the patient’s responses may seem to be something the patient as well as the analysts consider trivial, because, as in displacement to a trivial aspect of the day residue of a dream, displacement can better serve resistance when it is to something trivial. Because it is connected to conflict-laden material, the stimulus to the transference may be difficult to find. It may be quickly disavowed, so that its presence in awareness is only transitory. With the discovery of the disavowed, the patient may also gain insight into how it repeats as disavowed earlier in his life. In his search for the present stimuli which the patient is responding transferentially, as the analyst must therefore remain alert to both fleeting and apparently trivial manifested reference to himself as well as in the events of the analytic situation.
If the analyst interprets the patient’s attitudes in a spirit of seeing their possible plausibility in the light of what information the patient does have, rather than in the spirit of either affirming or denying the patient’s views, the way is open for their further expression and elucidation. The analyst will be respecting the effort to be plausible and realistic, rather than manufacturing his transference attitudes out of whole bodied material.
Importantly, is to make a transference interpretation plausible to the patient in terms of as current stimulus that, if the analyst is persuaded that the manifest content has important implications for the transference but he is unable to see a current stimulus for the attitude, he should explicitly say so if he decides to make the transference interpretation anyway. The patient himself may then be able to say what the current stimulus is.
It is sometimes argued that the analyst’s attention to his own behaviour is a precipitant for the transference, will increase the patient’s resistance to recognizing the transference. That, on the contrary, that because of the inevitable interrelationship of the current and transferential determinants, it is only through interpretation that they can be disentangled.
It is also argued that one must wait until the transference has reached optimal intensity before it can be advantageously interpreted. It is true that too hasty and interpretation of the transference can serve as a defensive function for the analyst and deny him the information he needs to make a more appropriate transference interpretation. But it is true that delay in interpreting transference interpretation, but it is also true that delay in interpreting runs the risk of allowing an unmanageable transference to develop. It is also true that deliberate delay can be a manipulation in the service of abreaction rather than analysis, and, like silence, can lead to a response to the actual situation which is mistaken for uncontaminated transference. Obviously important, is assumed in the issues of timing are involved, whereas an important clue to when a transference interpretation is apt and which one to makes lies in whether the interpretation can be made plausibly in terms of the determinant, namely, as something in the current analytic situation. Such as, in the approaching transference in the spirit of seeing how it appears plausibly realistic to the patient, it paves the way toward its further elucidation and expression.
Freud’s emphasis on remembering as the goal of the analytic work implies that remembering is the principal avenue to the resolution of the transference. But the delineation of the successive steps in the development of the analytic technique (1920) makes clear that he saw this development as a change from an effort to reach memories directly to the utilization of the transference as the necessary intermediacy to reaching the memories.
In contrast to remembering as the way the transference is resolved, Freud also described resistance for beings primarily overcome in the transference, with remembering following relatively easily afterwards, ‘From the repetitive reactions which are exhibited in the transference we are led along the familiar paths to the awakening of the memories, which appear without difficulty, as it was, after the resistance has been overcome’ (1914), and ‘This revision of the process of repetition can be accomplished only in part in connection with the memory traces of the process which led to repression. The decisive part of the work’s achieved by creating in the patient’s relation to the analyst - in the ‘transference‘ new editions of the old conflicts . . . Thus, the transference becomes the battlefield on which all the mutually struggling forces should meet one another’ (1917). This is the primary indication for which Strachey (1934) classified in his seminal paper on the therapeutic action of psychoanalysis.
There are two main ways in which resolution of the transference can take place through work with the transference in the here and now. The first lies in the clarification of what are the clues in the current situation which are the patient‘s point of departure force a transference elaboration. The exposure of the current point of departure at once raises the question of whether it is adequate to the conclusion drawn from it. The relating of the transference to a current stimulus is, after all, parts of the patient‘s effort to make, the transference attitude plausibly determined by the present. The reverse and ambiguity of the analyst’s behaviour are what increases the ranges of apparently plausible conclusions the patient may draw. If an examination of the basis for the conclusion makes clear that the actual situation to which the patient responds is subject to other meanings than the one the patient has reached, he will more reality consider his pre-existing bias, that is to say, in that of transference.
Critically, it is suggested that, in speaking of the current relationship and the relation between the patient’s conclusion and the information on which they seem plausibly based, such in some absolute conception of what is real in the analytic situation, of which the analyst is the final arbiter. That is not the case, that what the patient must come to see is that the information he has is subject to other possible interpretations implies the very contrary to an absolute conception of reality. In fact, analyst and patient engage in a dialogue in a spirit of attempting to arrive at a consensus about reality, not about some factious absolute reality.
The second way in which resolution of the transference can take place within the work with the transference in the here and now is that in the very interpretation of the transference the patient had a new experience. He is being treated differently from how he expected to be. Analysts seem reluctant to emphasize his new experience, as though it endangers the role of insight and argue for interpersonal influence as the significant factor in change. Strachey’s emphasis on the new experience in the mutative transference interpretation has unfortunately been overshadowed by his views on introjection, which have been mistaken to advocate manipulating the transference. Strachey meant introjection of the more benign super-ego of the analyst only as a temporary strep on the road toward insight. Not only is the new experience not to be confused with the interpersonal influence of a transference gratification, but the new experience occurs together with insight into both the patient’s biassed expectation and the new experience. As Strachey points out, what is unique about the transference interpretation is that insight and the new experience take place in relation to the very person who was expected to behave differently, and it is this which gives the work in the transference, its immediacy and effectiveness. While Freud did stress the effective immediacy of the transference, he did not make the new experience explicit.
It is important to recognize that transference interpretation is not a matter of experience, in contrast to insight, but a joining of the two together, both are needed to bring about and maintain the desired changes in the patient. It is also important to recognize that no new techniques of intervention are required to provide the new experience. It is an inevitable accompaniment of interpretation of the transference in the here and now. It is often overlooked that, although Strachey said that only transference interpretations are outside the transference.
Rosenfeld (1972) has pointed out that clarification of material outside the transference is often necessary to know what is the appropriate transference interpretation, and that both genetic transference interpretations and extratransference interpretation taking to consider an inclination as marked by or indication of notable worth or simply the consequence based upon the role in working through. Strachey said relatively little about working through, but surely nothing against the necessary provision with which every thing needfully is explicitly recognized as the role for the recovery of the past in the resolving dissection of the purposiveness determined by the transference.
In taking positions, as to emphasis the role of the analysis of the transference in the here and now, both in interpreting resistance to the awareness of transference and in working toward its resolution by relating to the actuality of the situation. In that of opinion or purpose with the evidence that extratransference and genetic transference interpretation and, of course, working through is important too, that the matter is one of emphasis. Also, interpretation of resistance to awareness of the transference should figure in the majority of sessions, and that if this is done by relating the transference to the actual analytic situation, the very same interpretation is a beginning of work to the resolution of the transference. To justify this view more persuasively would require detailed case material.
The concern and considerations that the Kleinian annalists whom, many analysts feel, are in error in giving the analysis of the transference too great if not even as exclusive role in the analytic process. It is true that Kleinians emphasize the analysis of the transference more, in their writing at least, than does the general run of analysts. As, Anna Freud (1968) complained that the concept of transference has become overexpanded seems to be directed against the Kleinians. One of the reasons the Kleinians consider themselves the true followers of Freud in technique are precisely because of the emphasis they put on the analysis of the transference. Hanna Segal (1967), for example, writes, `Too say that all communications are seen as communications about the patents phantasy as well as current external life is equivalent to saying that all communications contain something relevant to the transference situation. In Kleinian technique, the interpretation of the transference is often more central than in the classical technique.
Affirmly held point of view or way of regarding that Freud and transference had accedingly connected by simulating observations that we can only offer, that Freud wrote briefly about transference, and did so, to sustain the way in which, is, as a whole, that his actions were justly taken in and around 1917. Another observation which can rarely be made about Freud’s works, and which everyone may not agree with, is that, with one or two exceptions, what he did write on transference did not reach the high level of analytical thought which has come to be regarded as standard for him. Some indication of what his contribution consists of is given by the editors of the Standard Edition, who list them in several places. One of the longer lists, in a footnote on page 431 of Volume 16, includes six references: ‘Studies of Hysteria’ with Breuer (1895), the Dora paper (1905), ‘The Dynamics of Transference’ (1912), ‘Observations on Transference-Love’ (1915), the chapter on transference in the Introductory Lectures (1917), and ‘Analysis Terminable and Interminable’ (1937). Although the editors, in no sense suggest that these six papers include everything Freud wrote on the subject. It does seem evident that, considering the essential importance of transference to analysis, he wrote, ‘The Dynamics of Transference’, ‘Transference-Love’, and the transference chapter in the Introductory Lectures, came across, as, perhaps, his least significant contribution.
Freud’s first direct mention of transference comes upon the pages ascribed within the ’Studies of Hysteria’ (1895), his first significant reference to it, however did not appear until five years later, when, in a letter to Fliess on April 16, 1900, he said (Freud, 1887-1902) he was ‘beginning to see that the apparent endlessness of the treatment is something of an inherent feature and is connected with the transference’. In a footnote to this letter the editors said that, ‘This is the first insight into the role of transference in psychotherapy.’
Despite these early references, it seems correct to say that yet another five years were to go by before the phenomenon of transference was actually introduced. Even so, the introduction was far from prominent, for it was tacked on like an afterthought as a four-page portion of a postscript to what was perhaps Freud’s most fascinating case history to date, the case of Dora (1905).
Using data from Dora’s three-month-long, unexpectedly terminated analysis, and especially from her dramatic transference reaction which had taken him quite unawares, Freud now gave to transference its first distinct psychological entity and for the first time indicated its essential role in the analytic process. His account, although in general more than adequate - in the elegant fact and unmistakably ‘finished’ - was brief, and almost to the point, and perhaps not an entirely worthy introduction so much more a truly great discovery. What was uniquely great was his recognizing the usefulness of transference. In his analysis of Dora he had noted not only that transference feelings existed and were powerful, but, much to his dismay, he had realized what a serious, perhaps, even insurmountable obstacles that objectively would be. Then, in what seems like a creative leap, Freud made the almost unbelievable discoveries that transference was in fact, the key to analysis, that by properly taking the patient’s transference and therapeutic force was added to the analytic method.
The impact on analysis of this startling discovery was actually much greater and much more significant than most people seem to appreciate. Although the role of transference as the sine quo non of analysis and is widely accepted, and was stated by Freud from the first, it has almost never been acclaimed for having brought about an entire change in the nature of analysis. The introduction of free association to analysis, a much lesser change, receives and still receives much more recognition.
One of the reasons for the relatively unheralded entry of transference into analysis may have been for circumstances of its discovery. Although Freud’s new ideas were recorded as if they arose as sudden inspiration during the Dora analysis, they may in fact have developed somewhat later. In the paper‘s precatory remarks, for instance, Freud said he had not discussed transference with Dora at all, and in the postscript, he said he had been unaware of her transference feelings. Also, pointing to a later discovery date is the extraordinary delay in the paper’s publication. According to the editor’s note, the paper had been completed and accepted for publication by late January 1901, but this date was then actually set back more than four and a half years until October 1905. The editors said, ‘We have no information as to how it happened that Freud, . . . deferred publication.’ It readily seems that for reasons to have been that only during those four and a half years, as a consequence to his own self-analysis, that he came to a better understanding of the relevantly significant as the applicable reason to posit of the transference. Only then may it have been possible for him to turn again to the Dora case, to apply to it of what he had learned in himself, to write this essay as part of the postscript, and at last to release the paper for publication.
Freud’s self-analysis has been considered from many angles, but not significantly, as can be of valuing measure, in at least from the standpoint of transference. Opponents of the idea that there is such a thing as definite self-analysis, some of whom say it is impossible, generally an object on grounds that without any analyst there can be no transference neurosis. Freud clearly demonstrated, as, perhaps, that the situation that may be necessary to fill this need: Self-analysis may require that, at least a halfway satisfactory transference object. In Freud`s case, the main transference object at this time seems to have been Fliess, who filled the role rather well. As with any analysis, the authenticity as known in the unfeigned design as if existing or having no illusions and facing reality squarely, by which the ‘real’ impact on Freud was slight, he was essentially a neutral figure, relatively anonymous and physically separates. All of this, and Fliess`s own reciprocal transference reactions, made it possible for Freud to endow Fliess with whatever qualities and whatever feelings were essential to the development of Freud`s transference, and, it should be added, his transference neurosis. In the end, of course, the transference was in part resolved. Freud`s eventual awakening of its self realization in its presence within him of such strange and powerful psychological forces must have come to the conclusion as a stupefied disilluionary dejection toward Fliess, however, his subsequent working out of some of these transference attachments must have been both an intellectual triumph and an immensely healing and releasing of actions, operations or motions involved in the accomplishment of an ending that makes from its process.
In the years following this revolutionary discovery, the central role of transference in analysis increased in remarkable acceptance, and it has easily held this central position ever since. What the substance of this central position distinctfully composes in having or be capable of having within the constructs to which is something of a mystery, for, it seems as nothing about analysis and is, of least to be, the well known than how individual analysis actually uses transference in their day-to-day work with patients. As a guess, as, perhaps of each analysts concept of transference derives variably but significantly from his own inner experience, transference probably means many and varying differentiations to things as to different analysts.
In the same differentiated individuals, as that Freud’s own pupils must have differed on this issue, not only from him but from each other. Although some of their differences may have been slight, others, my have contributed significantly to later analytic developments. A question could be raised, for instance, whether differences in handling the transference which at first were the property of one analyst gradually develop into formal clinical methods used by many, and whether these clinical methods, after having been conceptualized, serve as the beginning of variously divergent schools of analysis. Such occurrences, consistent with certain beliefs that analytic ideas do arise in this way, primarily out of transference experiences in the analytic situation, would lead to the question whether the history of the ideological differences in what was actually said and done in response to transference reactions that to any other factor. Whatever the case, many differences and divergencies did occur among the early analysts, and all of that is supposed to have had to do in some major way with differences in the handling of the transference.
Strangely, Freud himself seems to have taken little part in influencing this rapid and divergent period of growth. Usually accused of being too dominating in such matters, Freud seems to have done just the opposite during the development of this most critical aspect of analysis, the process itself, and, for reasons unknown, detached himself from it.
What was needed, one might be inclined to say, was not leadership in the form of domination, but leadership in trying to provide what was lacking, and still lacking, namely an analytical rationale for transference phenomena. The question must be asked, of course, whether in fact this would have been a good thing at that particular time in psychoanalytic history. Perhaps not. The exercise of closure, which Freud’s structuring might have amounted to. But although adding to understanding and stability at ceratin theoretical levels, could at another level, so such closures have often done, have placed many obstacles in the way of further analytical developments. Thus, his leaving the matter of transference wide open, even though it led to confusion and uncertainty, may have been just as well.
In many ways the closest Freud ever came to establishing a formal analytical rationale for transference was his first attempt, in the postscript to the case of hysteria (1905). These few pages are and among the most important of all Freud’s writings, outweighing by far the paper to which they are appended. Yet, in the case of Dora has always been taught as an entity rather than the ancillary to the essay on transference. In that essay Freud was clear: His ideas revealed tremendous insights and promised more to come, and that, the powers of the neurosis are occupied in creating a new edition of the same disease. Just think of the analytic implications of his saying that this new edition consists of a special class of mental structures, for the most part unconscious, having the peculiar characteristic of being able to replace earlier persons with that of the person of the analyst, and in the fashion applying all components of the original neurosis to the person of the analytical at the present time. Surely as profound a statement as any he ever made.
He then goes on to say that there is no way to avoid transference, that this ‘latest creation of the desire must be combatted like all the earlier ones’, and that, although this is by far the hardest part of analysis, only after the transference has been resolved can a patient arrive at a sense of conviction of the validity of the connection which have been constructed during analysis.
He concludes by saying, ‘In psychoanalysis . . . all the patients’ tendencies, including hostile ones, are aroused, they are then turned to account for reasons to explain or the internalization of justification, and by the same measure was to purposively give a sensible reason for the proposed change in the analysis by which of being made conscious. That, in this way, the transference is constantly being put-down, however, transference, which seems ordained to be the greatest obstacle to psychoanalysis, becomes its most powerfully . . .
These remarkable observations, in conveying a sense of deep conviction that could arise, one feels, only from Freud’s own hard-won inner experience, that nowhere is there a suggestion that transference is a mere technical matter. Far from it, as Freud announces that he has come upon as new and exciting kind of mental function, or, as it is to believe, that a new and exciting kind of ego function.
Very quickly, however, Freud’s conviction sees to have failed him. Nothing he wrote afterwards about transference was at this level, and most of his later references were a retreat from it, for instance, he never did develop the promising idea that the mind constantly creates new editions of the original neurosis and meaningfully inclines the minded inclusion in them, an ever-changing series of persons. Instead, he tended to become less specific, even referring to transference at times in a broad terms as if it were no more than rapport between patient and analysts, or as if it was an interpersonal or psychosocial relationship, concepts which, of course, a great many analysts have since adopted, but which were not part of Freud’s original ideas.
Perhaps his most persistent deviation was an on-and-off tendency to regard transference merely as a technical matter, often writing of it as an asset to analysis when positive and a liability when negative.
Significantly, because it indicated that an active struggle was still going on within him, Freud occasionally expressed once again, even though briefly his earlier insights, particularly his ideas that transference is an essential although unexplored part of mental life. An example of this appears in his alternative obtainments such that is gainfully to appear of as quality of being pleasant or agreeable to a feature that makes for pleasantness or ease, among the amenities of the central geniality, otherwise, the prevailing indifference account for the transference in ‘An Autobiographical Study’ (1925). Transference, he says, ‘is a universal phenomenon of the human mind. And in fact dominated the whole of each person’s relations to his human environment. In these few words’ Freud again made the point, and in declarative fashion, that transference is a mental structure of the greatest magnitude, but he never really followed it up.
Rather extensive evidence of his departure from the original concept and his continuing struggle with that concept is seen most clearly, wherein, the ‘Analysis Terminable and Interminable’ is much more than a courageous, brilliant, and pessimistic, appraisal of the difficulties and limitations of analysis, although transference is briefly mentioned in its content, yet a great deal about it comes through, some quite directly, some by easy inference. When looked at in this way, two themes stand out: Freud’s personal frustration with the enigmas of transference and his tacit placing of transference in the centre of success and failure in analysis, both as a therapy and as a developing science. What also comes through, is the perplexing realization of how far Freud had, by now, seemingly moved away from his original concepts. Or had he?
All the same, even if it is insufficient for exclusive reliance in relations to the complicated neurosis, for which it would be fallacious to assign to the recall and reconstruction of the past an exclusively explanatory value (in the intellectual sense), important though that functions be, and difficult as its full-blown emotional correlate may be to come by. There is no doubt that, even in complicated neurosis, equivalently complicated transference neurosis, the genuine complex and complicated transference neurosis, the genuinely experienced linking of the past and present can have, at times, a certain uniquely specific dynamic effect of its own, a type of telescoping or merging of common elements in experience, which must be connected with the meaninglessness of time in unconscious life, compared with its stern authority in the life of consciousness and adaptation to everyday reality. Contributing decisively to such experiences as to whatever degree it occurs, is of course, the vivid currency of the transference neurosis, and central in this, the reincarnations of old objects in an actual person, the analyst.
Thus, an allied problem in the general sphere of transference is the fascination and often enigmatic interplay of past and present. If one wishes to view this interplay in terms of a stereotyped formulation, the matter can remain relatively uncomplicated - as a formulation. Unfortunately. , This is too often the case. The phenomenon, however, retains some important obscurities, which cannot thoroughly dispel, but to which I would like to call attention. To concentrate on the dimension of time, it seems in reference to the complication and immediate aspects of technique, nonetheless, essential. For example, we can assume that the transference neurosis re-enacts the essential conflicts of the infantile neurosis in a current setting. If a reasonable degree of awareness of transference is established, the next problem is the genetic reduction of the neurosis to its elements in the past, through analysis of the transference resistance and allied intrapsychic resistances, ultimately genetic interpretations, recollections and reconstructions and working through. Such that the transference is related to its genetic origins, the analyst thereby emerges in his true, i.e., real, identity to the patient, the transference is putatively ‘resolved’. To the extent that one follows the traditional view that all resistances, including the transference itself, is ultimately directed against the restoration of early memories as, this is a convincing formulation. Is that, only to say, that in his own right as such as having to a certain tightly logical quality? However, we know that it this is not so readily accomplished, apart from the special intrapsychic considerations described afterward by Freud in ‘Analysis Terminable and Interminable’. Although in a favourable case, much of the cognitive interpretative work can be accomplished, there remains the fact that cognition responsibility, in its bare sense, does not necessarily lead to the subsidence of powerful dynamism, to the withdrawal of ‘cathexes’ from importantly real objects. For, as mentioned, a short while ago, the analyst is a real and living object, apart from the representations with which the transference invests him, and which are interpretable as such, for which there is no, at any time a seldom, a confusing interrelations and commonly of the emergent responses, due to the same old seeking, and this is directed toward a new individual in his own right, both are important, furthermore, there are large and important ones of overlapping. Apart from such considerations, even the explicitly incestuous transference is currently experienced (as, at least in good part) by a full-grown adult (like the original oedipus), instead of a totally and actually helpless child. To be sure, the latter state is reflected in the emergent transference elements of instinctual striving, but it is subject to analysis, and the residual is something significant, if not totally different. It is these residual sexual wish, presumably directed toward the person of the analyst, as such, which must be displaced to others, if, as generally agreed, the revival of infantile fantasies and strivings in the biologically mature adolescent presents a new and special problem, one must assume distinctiveness of experience for the adult, although it is true that in the majority of instances, adequate solution is favoured by the adult state. There is, in any case, a residual relationship between persons who have worked together in a prolonged, arduous and intimate relationship, which, strictly speaking, are reversibly disconnected or divorced of services, in that the transference merely ushers out the retirement for which its rendering retreat of that state of mind or feeling by an inner avoidance of something usually felt as unpleasant or pronounced for it’s adverse but mutual colouration. Blending to some confusion between the two spheres of feeling. The general tendency is that both components are fully gratified to some degree. But, there is the ubiquitous power of the residual primordial transference, yet, argue to cling to an omnipotent partisan to resist the displacement of its ‘sublimated’ anaclitic aspects, even if the various representation of the wishes for bodily intimacy has been thoroughly analysed and successfully displaced. The outcome is largely the transference of the transference, as mentioned earlier, in a different context. For everyday reality can provide no actual answer to such cravings. In this connection, note, Freud’s genial envy of Pfister. If the man of faith finds this gratification in revealing religion, others in a wide range of secular beliefs and ‘leaders’ the modern rational and sceptical intellectual is less fortunate in this respect. Presumably free, he is prone to invest even intellectual disciplines or the proponents with inappropriate expectations and partisan passions, but, least of mention, that within these fields of analytical and theoretical thought, is not to provide exceptions to this tendency.
Though if one is to maintain and beneficially confine its bothering of reservations about the clarity of conceptualization, the explanatory discussion of Kohut and Seitz, is a very useful contribution to the direct complication or which by some understanding the awkwardness of oneself. Both Loewald and Kohut have deliberately associated a special but the different use of one of Freud’s three conceptions of transference, i.e., the transference from the unconscious to the preconscious.
Yet, to furthering comments on primordial transference, at least potentially, are largely psychological (mental) component, the concept of ‘transference of the transference’ would be applicable to this component. For it does appear that certain aspect of the search for the omnipotent and omniscient caretaking parents are implicitly practical as virtually capable for being turned to use or account for its functional practicability for something of a process or the procedure for being all but the essential purpose to come to or tend toward a common point, for which are the knowledgeable information or ideas, is nothing but causative effectuality. As suggested earlier, there are important qualitative and quantitative distinctions in the mode of persistence and such strivings, however, even to the extent that they are detached from the analyst and carried into some reasonably appropriate expression in everyday life, they retain at least a subtle quality which contravenes reality, one which derives from earliest infancy, and remains - to this extent - a transference. ‘Santa Claus’ lives on, where one might least expect to meet him, whether as a donor of miracle drug or of far more complex panaceas.
If one prescribes to this parasymbiotic transference drive, a true primordial origin, it is necessary to take cognizance of certain important concepts dealing with the earliest period of life. If we assume a powerful original organismic drive toward an original ‘object’, a striving to nullify separation from the beginning, how does this make something legally valid or operative usually by formal approval or sanctioned with concepts such as ‘primary narcissism’ or the ‘objectless phase’ or ‘the primary psycho physiological self’ (We note in passing that there are those who do not accept these as usually construed in the technique of Balint), for example, or Fairbairn or - conspicuously - Melanie Klein. These are states, variously defined or conceived, which apply to the earliest neonatal period, in which life, to state more simply, exists only as the potential in physiological processes. Since there is (we postulate) no clear awareness of self-withdrawal from the mother, there can be no ‘mentally’ represented or experienced drive to obliterate the separation (concerning oneself and object, conceivers of as separate, in a continuing sense). There are, of course, discharge phenomena, the precursors of purposive activity, and there are urgent physiological needs, directed toward fulfilment or relief, rather than toward an object as such. However, in relation to these physiological needs as archaistic precursors of object relationships, it must be noted that in all, except respiration and spontaneous sphincter relief (even in these instances, not without exception or reservation), the need fulfilment must be mediated by the primordial object (or her surrogate). There is also, of course, the uniquely important requirement for ‘holding’, in a literal expression, from the outset. The material partner in human symbiosis which supplies what the neonate cannot seek by ‘clinging’, as for Bowlty and Murphy, in the sense that must be experienced to the physiological ebb and flow of tension, even if restricted to the kinaesthetic, connected with a peripheral sensory registration, which is the protophase of the recognition of separation from the object or nonpresence of the object, as a painful instance of, her presence in apposition the converse? That the general context may be only in which the sense of unity is preponderant, or, more accurately, that there is no general awareness of ‘separation’ as such, means that the drive for union does not exist in a general psychological sense. It is, so to speak, satisfied. That object constancy, with its cognate ‘longing’, is quite a different experience from the urgencies of primitive need fulfilment is true, however, regardless of what may be added by maturational and developmental considerations, instinctual and perceptual, there is no reason to assume other than a core of developmental continuity from the earliest needs and their fulfilment to the later state, and some continuing degree of contingency based on them.
There is a very rough parallel in the way certain analytic patients, before a firm relationship with the analyst is established, signal certain primitive experiences and tendencies in special reactions to the end of the hour, to the nonvisibility of the analyst, to interruption of their association, to failure of the analyst to talk, and similar matters. We must note that in the basic formation of the ego is evident amongst the primitive reactions and beyond to separations, in the form of very early identifications as based on care taking functions. Certainly in the very development of autonomous ego of the mother’s investment in the, have a decisive role in the character of the their development. And in the case of object constancy, in its connotation of libidinal cathexis, where is no need whatsoever (emotional or otherwise) is needed for prolonged periods. The importance of the object is, to put it mildly, liable to deteriorate, or to differ complicating aggressive change. Probably the characteristic feature of later developing relations to the object (love and the wish for love), as separate if not always separated from demonstrable primitivity, in the need fulfilment, have a special relationship to those ‘ancillary’ aspects of neonatal nurture, whose lack has been shown to be an actual threat to life in some instances, not to speak of sound emotional development. So that from the first, regardless of the assumed state of libidinal (and aggressive) economy, or the assumed state of psychological nondifferentiation between self and potential object, there are critical percussive phenomena, objectively observed, and probably prototypic subjective experiences of separation, which are the forerunners of all subsequent experiences of the kind. One may generalize to the effect that, with maturation and development, secondary identifications, and the various other processes of ‘internalization’ in its broadest sense, the problem of separation and its mastery becomes correspondingly more complex, and changes with the successive phase of life, but never entirely disappears.
In the view of the psychoanalytic situation described earlier, the latent mobilization of experiences of separation stimulated by the situational structure awakens the driving primordial urge to undo or to master the painful separations which it represents, usually embodied in the various forms of clinical transference that which we are familiar. One legitimate gratification which tends to mitigate superfluous transference regression is the transmission of understanding that at times, are thought that by the ‘mature transference’, in effect, the ‘therapeutic alliance’ or a group of mature ego functions which enter into such an alliance. Now, there are one blurring and overlapping at the conceptual edges in both instances, but the concept as such is largely distinct from either one, as it is from the primitive transference, which we have been discussing. Whether the concept is thought by others to comprehend a demonstrable actuality, which is a further question. This question, of course, can only follow on conceptual clarity. This in saying, of a nonrational urge, not directly dependent on the perception of immediate clinical purposes, a true transference in the sense that it is displaced (in currently relevant form) from the parent of early childhood to the analyst. Its content is not anti-sensational, but largely non-sensual of sometimes transitional, as the child’s pleasure in the assemblages of ‘dirty words’ and encompasses a special and not minuscule sphere of the object relationship: The wish to understand, and to be understood, the wish to be given understanding, i.e., teaching, specifically by the parent (or later surrogate); the wish to be taught to use ingenuity in making or doing o r achieving an end through the actions in a nonpunitive way, corresponding to the growing perception of hazard and conflict and very likely the implicit wish to be provided with and taught channels of substitutional drive discharge. With this, there may well be a wish, corresponding to that element in Loewald’s description of therapeutic process, to be seen in terms of one’s developmental potentialities by the analyst. No doubt, the list could be extended into many subtleties, details, and variations. However, one should not omit to specify that, in its peak development, it would include the wish for increasingly accurate interpretations and the wish to facilitate such interpretations by providing adequate material ultimately, of course, by identification, to participate in, or even be the author of the interpretations. The childhood system of wishes which underlie the transference is a correlate of biological maturation, and the latent (i.e., teachable) autonomous ego function, appearing with it, however, there is a drive-like quality in the participation phenomena, which disqualifies any conception of the urge’s identical with the functions. No one who has ever watched a child importunes a parent with questions, or experiment with new words, or solicit her interests in a new game, or demand a storytelling or reading, can doubt this. That this powerful support and integration in the ego identification with a loved parent are undoubtedly true, just as it is true of the identification with an analyst toward whom a positive relationship has been established. That ‘functional pleasure ‘ inscribes the part, where certain specific ego energies, perhaps very likely the ego’s own urge to extend its hegemony in the personality. However, it can be stressed in the derive element, even the special phase configurations and colourations, and with its importance of object relations, libidinal and aggressive, for a specific reason. For just as the primordial transference seeks to undo separation, in a sense to obviate object relationships as we know them, the ‘mature transference’, tends toward separation and individuation, and increasing contact with the environment, optimally with a large affirmative (increasing neutralized) relationship toward the original object toward whom (or her surrogates) a different dynamic of demands is now increasingly directed. The further considerations which have led to the emphasis that the drive-like elements in these attitudes are integrated phenomena, as example of ‘multiple functional’ rather than the discrete exorcise of function or functions, is the conviction that there is a continuing dynamic relation of relative interchangeability between the two series, at least based on the response to gratifications in a significant zone of complicated energetic overlap, possibly including the phenomenon of neutralization. That the empirical ‘interchangeability’ is limited, and that goes without saying, that in no way diminishes its decisive importance. The linguistic communications as in mention, that the excessive transference neurosis regression, which can seriously vitiate the affirmative psychoanalytic process, finds a prototype in the regressive behaviour and demands of certain children, who do not receive their share of teaching, ‘attention’, play, nonseductive, affectionate demonstration, as to use the quality of being appropriate or valuable to some end, even the act or practice of using something or the state of being used to which of responsible interests in development, and similar matters, from their parents. In the psychnalytic situation, both the gratifications offered by the analyst and the freedom of expression by the patient, are diversely limited and concentrated, practically entirely (in the every day demonstrable sense) in the sphere of linguistic expression, on the analyst’s side, further, in the transmission of understanding.
Whereas, the primordial transference exploits the primitive aspects of linguistic communication, by expressing the mature transference as to advocate the seeking mastery of the outer and inner environments, a mastery to which the mature elements in speech contribute importantly, for which these are stressed upon the clear-cut genetic prototype for the free associating its interpretative dialogue is the original learning and teaching of speech, the dialogue between child and mother. It is interesting to note that just as the profundities of interests between people who often include - in the service of the ego - transitory introjection and identifications, of the very word ‘communication’, representing the central ego function of speech, from which are a closely intimate relation to the etymologically certain, in actual usages, to the word chosen for that major of religious sacrament for that which is the physical ingestion of the body and blood of the Deity. Perhaps, this is just another suggestion that the oldest of individual problems does, after all, continue to seek its solution, in its own terms if only in a minimal sense, and in channels so remote as to be unrecognizable.
The mature transference is a dynamic and integral part of the therapeutic alliance, alone with the tender aspect of the erotic transference, evens more attenuated (and more dependable) friendly feeling of adult type, and the ego identification with the analyst. Indispensable, of course, are the genuine adult need for help, the crystallizing rational and intuitive appraisal of the analyst, the adult sense of confidence in him, and innumerable other nuances of adult thought and feeling. With these, giving a driving momentum and power to the analytic process, but always, by its very nature, a potential source of resistance, and always requiring analysis, is the primordial transference and its various appearances in the specific therapeutic transference. That it is, if well managed, not only a reflection of the repetition compulsion in its menacing sense, but a living presentation from the id, seeking new solutions, and trying again, so to speak, to find a place in the patient’s conscious and effective life, has important affirmative potentialities. This has been specifically emphasized by Nunberg, Lagache and Loewald among others. Loewald has recently elaborated very effectively the idea of ‘ghosts’ seeking to become ‘ancestors’ based on an early figure of speech of Freud. The mature transference, in its own infantile right, provides some of the unique qualities of propulsive force, which comes from the world of feeling, rather than the world of thought. If one views it in a purely figurative sense, that fraction of the mature transference which derives from ‘conversion’ is somewhat like propulsive fraction as the wind in a boats sailing to windward currents into motion, the strong headwind, the ultimate source of both resistance and propulsion, is the primordial transference. This view, however, should not displace the original and independent, if cognate, a favourable tide or current would also be required. It is not that the mature transference is itself entirely exempt from analytic clarification and interpretation. For one thing, in common with other childhood spheres of experience, there may have been traumas in this sphere, punishments, serious defects or lacks of parental communication, Listening, attention or interest. In general, this is probably far more important than has hitherto appeared in our prevalent paradigmatic approach to adult analysis, even taking into account the considerable changes due to the growing interest in ego psychology. ‘Learning’ in the analysis can, of course, be a troublesome intellectualizing resistance. Furthermore, both the patient’s communications and his receptions and utilization of interpretations may exhibit only too clearly, as sometimes in the case of other ego mechanisms, their origin in and tenacious relation to instinctual or anaclitic dynamism; the longing implement out of silence for which the analyst is to override the uncritical acceptance (or rejection) of interpretations, in that the patient revealingly is to mention the unmindful assimilation, fluently, rich, endlessly detailed associations without spontaneous reflection or integration. In the direct demands for solution of moral and practical probability for an entirely intellectual scope, and a variety of others. It may and always be easy to discriminate between the utilization of speech by an essentially instinctual demand, and an intellectual or linguistic trait or having to be determined by specific factors in their own developmental sphere, however, the underlying and essentially genuine dynamism which have to continue to be placed for a notable time interval or remain arbitrary or the conventional character most favoured to the purposes of processes of analysis, as it was to the original processes of maturational development, communication, and benign separation. Lagache, on the desirability of separating the current unqualified usage, ‘positive’ and ’negative’ transference, as based on the patient‘s immediate state of feeling, from a classification based on the essential effect on analytic processes. Yet, the later of mature transference is, in general, a ‘positive transference’.
Concerning considerations in the transference neurosis, and the problem of transference interpretation, may be offered at this point. The whole situational structure of analysis (in contrast with other personal relationships), its dialogue of free association and interpretation, and its deprivations as to most ordinary cognitive and emotional interpersonal drives that tend toward the separation of discrete transferences from their synthesis with one another and with defences in character or symptoms, and with deepening regression, toward a contuative enactment of the essential of the infantile neurosis, in the transference neurosis. In other relationships, the ‘give and take’ aspects - gratifying aggressive, punitive or otherwise actively responsive, and the open mobility of searching for alternative or greater satisfaction - exert a profound dynamic and economic influence, so that only extraordinary situations, or transference of pathological character, or both, occasion to comparable regression.
It is a curious fact, whereas the dynamic meaning to the importance of the transference neurosis has been well established since Freud gave this the phenomenon a central position in his clinical thinking, the clinical reference, when the term is used, remains variable and somewhat ambiguous. For example, Greenson, in his excellent recent paper, speaks of it as appearing, ‘when the analyst and the analysis become the central concern in the patient’s life’. However, previous remarks in this connection, for which it is worthwhile to specify certain aspects of Greenson’s definition, for the term ‘central’ is somewhat ambiguous, as to its specific reference. Certainly, the term could apply to the symbolic position of the analyst in relation to the patient’s experiencing ego and the symbolically decisive position which he correspondingly assumes in the relation to the other important figures in the patient’s current life. However, while the analysis is in any case, and for multiple reasons, exceedingly important the seriously involved patient, there is a free observing portion of is ego, also involved, not in the same sense as that involved in the transference regression and revived in infantile conflicts. And here is here being, of course, always the integrated adult personalty, however diluted in may seem at times, of its rarity, although certainly does occur, that the analysis actually exceeds the quality or state of being of notable worth or influence that the other major concerns, attachments, and responsibilities of the patient’s life, nor is it desirable that his should occur, on the other hand, if construed with proper attention to the economic considerations as mentioned, the concept is important, both theoretically and clinically. In the theoretical direction to the assumption that there is a continuing system of object relationships and conflict situations, most important in the unconscious representations, but participating to some degree in all others, deriving in a successive series of transference from the experiences of separation from the original object, the mother. In this sense, the analyst’s applicability to a uniquely important portion of the patient‘s personality, the portion that ‘never grew up’, to maintain a central figure. In the clinical sense, to call or direct attention especially to a supposed cause, source, or to refer to the importance of the transference neurosis as outlining for the essential and central analytic task, providing by its very currency and demonstrability a relatively secure cognitive base for procedural duties. By its inclusion of the patient’s essential psychopathological processes and tendencies, in their original functional connection, it offers, in its resolution or marked reduction, the most formidable lever for analytic cure. Nonetheless, transference neurosis must be seen in its interweaving with the patient’s extra-analytic system of personal contacts. The relationship to the analyst may influence the course of relationships to others, in the same sense that the clinical neurosis did, except that the former is alloplastic, relatively exposed, and subject to constant interpretation. It is also an important fact that, except in those rare instances where the original dyadic relationship appears to turn, the analyst, even in the strict transference sphere, cannot be assigned all the transference role simultaneously. Other actors are required. He may at times oscillate with confusing rapidity between the status of mother and father, but he is usually predominantly in one of the roles for long periods, someone else representing the other. Furthermore, apart from ‘acting out’, complicated and mutually inconsistent attitudes of the anterior apprehensions for realizing often about something not generally realized in the verbalization, may require the seeking of other transference objects, i.e., The husband or wife, friend, another analyst and so forth. Children, even the patient’s own children, may be invested with strivings of the patient, displaced from the analysis, even experience the impulses which they would wish to call forth in the analyst. The range is extensive, varied, and complicated, requiring constant alertness. Transference interpretation therefore often has a necessarily paradoxical inclusiveness, which is an important reality of technique. There is another aspect, and that is the dynamic and economic impact of the intimate and actual dramatist personate of the transference neurosis in the progress of the analysis as such, and on the patient ‘s motivation, as well as his real lifer avenues for recovery. For the persons in his milieu may fulfill their ‘positive’ or ‘negative ‘ roles in transference drama, which may facilitate or impede interpretative effectiveness, they provide the substantial and dependable real life gratifications which ultimately facilitate the analysis of the residual analytic transference, or their capacities or attitudes may occasion overload of the anaclitic and instinctual needs in the transference which renders the same process far more difficultly. In the most unhappy instances, there can be a serious undercounting of the motivation for basic change.
There is also the fundamental question of the role of the transference interpretation. At the Marienbad Symposium most of Strachey’s colleagues appeared to accept the essential import of his contribution and thus unique significance of the transference interpretations, despite the various reservations as to detail and emphasis on other important aspects of the therapeutic process. Nevertheless, there are still many who, if not in doubt regarding the great value of transference interpretations are inclined to doubt their uniqueness, and to stress the importance of economic considerations in determining the choice as to whether transference or extratransference interpretations may be indicated. Now, apart from the realistic considerations mentioned in the preceding passage (in a sense the necessarily ‘distributed’ character of a variable fraction of transference interpretation). There is in fact that the extra-analytic life of the patent often provides indispensable data fo the understanding of detailed complexities of his psychic functioning, because of the sheer variety of its references, some of which cannot be reproduced in the relationship to the analyst. For example, there is no repartee (in the ordinary sense ) in the analysis. The way the patient handles the dialogue with an angry employee may be importantly revealing. The same may be true of the quality of his reaction to a real danger of dismissal. There are not only the realities, but the ‘formal’ aspects of this responses. These expressions of personality remain important, even though his ‘acting out‘ of the transference (assuming this was this was the case) may have been more important, and, of course, requiring transference interpretation. Furthermore, they remain useful, if discriminatingly and conservatively treated, even if they are inevitably always subject that epistemological reservations, which haunts so much of analytic data. Of course, the ‘positive’ transference has a role in the utilization of such interpretations that what enables the patent to listen to them and them seriously.
In an operational sense, it would seem that extratransference interpretations cannot set aside, or underestimated in importance, but the unique effectiveness of transference interpretations is not thereby disestablished. No other interpretation is free, within reason, of the doubt introduced by not really knowing the ‘other person’s’ participation in love, or quarrel or criticism or whatever the issue. And no other situation provides the patient the combined sense of cognitive acquisition, with the experience of complete personal tolerance and acceptance, that is implicit in an interpretation by an individual who is an object of the emotion, drive, or even defences, which are active at the time. There is no doubt that such interpretations must not only (in common with all others) include personal tact, but must be offered with special care as to their intellectual reasonability, in relation to the immediate context, lest they defeat their essential purpose. It is not too often likely that a patient who has just been jilted in a long-standing love affair, and suffering exceedingly, will find an immediate interpretation that his suffering is due to the fact that the analyst does not reciprocate his love, even though a dynamism in this general sphere may be ultimately demonstrable, and acceptable to the patient. On the other hand, once the transference neurosis is established, with accompanying subtle (sometime gross) colouration of the patient’s life, th n more far-reaching anticipatory, transference interpretations are indicated, for, if all of the patient’s libidinal and aggression are not, in fact, invested in the analyst, he has at least an unconscious role in all important emotional transactions, and, if the assumption is correct that the regressive drive, mobilized by the analytic situation, is in the direction of restoration of a single all-encompassing relationship, specified pragmatically in the individual case by the actually attained level of development, then there is a dynamic factor at work, importantly meriting interpretation as such, to the extent that available material supports it. This would be the immediate clinical application on the material regarding the ‘cognitive lag’ or ‘cognitive fall-back’.
Post-Traumatic Stress Disorder, resides in a mental illness that some people develop after experiencing traumatic or life-threatening events. Such events include warfare, rape and other sexual assaults, violent physical attacks, torture, child abuse, natural disasters such as earthquakes and floods, and automobile or aeroplane crashes. People who attest of the traumatic events may also develop the disorder.
Post-traumatic stress disorder in war veterans is sometimes called shell shock or combat fatigue. In victims of sexual or physical abuse, the disorder has been called rape trauma or battered woman syndrome. The American Psychiatric Association (APA) adopted the current name of the disorder in 1980.
In the late 1960's and early 1970's, mass demonstrations erupted throughout the United States protesting US involvement in the Vietnam War (1959-1975). Thousands of veterans joined together in a national organization, Vietnam Veterans Against the War, that supported and influenced the antiwar movement. In this transcript from an April 22, 1971, hearing before the Senate Committee on Foreign Relations, committee chairman Senator J. William Fulbright indicated his sympathy for the antiwar movement. Fulbright’s comments were followed by the testimony of Vietnam veteran John Kerry, who called for an end to the war. Kerry also detailed what he believed to be the war’s negative effect in both Vietnam and the United States. Kerry became a Democratic senator from Massachusetts in 1985.
People with this disorder relive the traumatic event again and again through nightmares and disturbing memories during the day. They sometimes have flashbacks, in which they suddenly lose touch with reality and relive images, sounds, and other sensations from the trauma. Because of their extreme anxiety and disruptive opposition to events, they try to avoid anything that reminds them of it. They may seem emotionally numb, detached, irritable, and easily startled. They may feel guilty about surviving a traumatic event that killed other people. Other symptoms include trouble concentrating, depression, and sleep difficulties. Symptoms of the disorder usually begin shortly after the traumatic event, although some people may not show symptoms for several years. If left untreated, the disorder can last for years.
Post-traumatic stress disorder can severely disrupt one’s life. Besides the emotional pain of reliving the trauma, the symptoms of the disorder may cause a person to think that he or she is ‘going crazy.’ In addition, people with this disorder may have unpredictable, angry outbursts at family members. At other times, they may seem to have no affection for their loved ones. Some people try to mask their symptoms by abusing alcohol or drugs. Others work very long hours to prevent any ‘down’ periods when they might relive the trauma. Such actions may delay the onset of the disorder until these individuals retire or become sober.
Studies have set or to bring into a new found control from 1 to 14 percent of people that suffer from post-traumatic stress disorder at some point during their lives. The findings vary widely due to differences in the populations studied and the research methods used. Among people who have survived traumatic events, the prevalence appears to be much higher. The disorder may be particularly prevalent among people who have served in combat. For example, one study of veterans of the Vietnam War (1959-1975) found that veterans exposed to a high level of combat were nine times more likely to have post-traumatic stress disorder than military personnel who did not serve in the war zone of Southeast Asia.
Post-traumatic stress disorder is an extreme reaction to extreme stress. In moments of crisis, people respond in ways that allow them to endure and survive the trauma. Afterward those responses, such as emotional numbing, may persist even though they are no longer necessary.
Not everyone who experiences a traumatic event develops post-traumatic stress disorder. Several factors influence whether people develop the disorder. Those who experience severe and prolonged traumas are more likely to develop the disorder than people who experience less severe trauma. Additionally, those who directly witness or experience death, injury, or attacks are more likely to develop symptoms.
People may also have been existing biological and psychological vulnerabilities that make them more likely to develop the disorder. Those with histories of anxiety disorders in their families may have inherited a genetic predisposition to react more severely to stress and trauma than other people. In addition, people’s life experiences, especially in childhood, can affect their psychological vulnerability to the disorder. For example, people whose early childhood experiences made them feel that events are unpredictable and uncontrollable have a greater likelihood than others of developing the disorder. Individuals with a strong, supportive social network of friends and family members seem somewhat protected from developing post-traumatic stress disorder.
Treatment of post-traumatic stress disorder may involve psychotherapy, psychoactive drugs, or both. Psychotherapists help individuals confront the traumatic experience, work through their strong negative emotions, and overcome their symptoms. Many people with post-traumatic stress disorder benefit from group therapy with other individuals suffering from the disorder. Physicians may prescribe antidepressants or anxiety-reducing drugs to treat the mood disturbances that sometimes accompany the disorder.
At the arriving considerations that are marked and noted, through which the essence of functional dynamics as based of the transference in the psychoanalytic process or the basic underlying the most basic of beliefs that in politics there is neither good nor evil, however, in that something that forms part of the minimal body, character or structure of that thing predetermines the properties to the good life. Nonetheless, most psychoanalysts maintain that schizophrenic patients cannot be treated psychoanalytically because they are too narcissistic to develop with the psychotherapist as interpersonal relationship that is sufficiently reliable and consistent for psychoanalytic work. Freud, Fenichel and others have recognized that a new technique of approaching patients psychoanalytically must be found if analysts are to work with psychotics. Among those who have worked successfully in recent years with schizophrenics, Sullivan, Hill, and Karl Menninger and his staffs have made various modifications of their analytic approach. The techniques that are in use with psychotics are different from our approach to psychoneurotics. This is not a result of the schizophrenic’s inability to build up a consistent personal relationship with the therapist but due to his extremely intense and sensitive transference reactions.
Let us see first what the essences of the schizophrenic’s transference reactions are and how we try to meet these reactions.
We think of a schizophrenic as a person who has had serious traumatic experiences in early infancy at a time when his ego and its ability to examine reality were not yet developed. These early traumatic experiences seem to furnish the psychological basis for the pathogenic influence of the flustrations of later years. At this early time the infant lives grandiosely in a narcissistic world of his own. His needs and desires seem to be taken care of by something vague and indefinite which he does not yet differentiate. As Ferenczi noted, they are expressed by gestures and movements since speech is as yet undeveloped. Frequently the child’s desires are fulfilled without any expression of them, a result that seems to him a product of his magical thinking.
Are a person’s characteristics primarily shaped by early influences, remaining relatively stable thereafter throughout life? Or does change spontaneously occur continuously throughout life? Many people believe that early experiences are formative, providing a strong or weak foundation for later psychological growth. This view is expressed in the popular saying ‘As the twig is bent, so grows the tree.’ From this perspective, it is crucial to ensure that young children have a good start in life. But many developmental scientists believe that later experiences can modify or even reverse early influences; studies show that even when early experiences are traumatic or abusive, considerable recovery can occur. From this vantage point, early experiences influence, but rarely determine, later characteristics.
Traumatic experiences in this early period of life will damage a personality more seriously than those occurring in later childhood such as are found in the history of psychoneurotics. The infant’s mind is more vulnerable the younger and less used it has been, furthers, the trauma has quickened the infant ‘s egocentricity. In addition early traumatic experiences shorten the only period in life in which an individual ordinarily enjoys the most security, thus endangering the ability to store up as it was a reasonable supplies of assurance and self-reliance for the individual’s later struggles through life. Thus, as such, a child sensitized considerably more toward the frustrations of later like than by later traumatic experiences. hence many experiences in later life which would mean little to a ‘healthy’ person and not much to a psychoneurotic, mean a great deal of pain and suffering to the schizophrenic. His resistance against frustration is easily exhausted.
Once he reaches his limit of endurance, he escapes the unbearable reality of his present life by attempting to reestablish the autistic, delusional world of the infant, but this is impossible because the content of his delusions and hallucinations are naturally coloured by the experiences of his whole lifetime.
How do these developments influence the patient’s attitude toward the analyst and the analyst’s approach to him?
Due to the very damage and the succeeding chain of frustrations which the schizophrenic undergoes before finally giving in to illness, he feels extremely suspicious and distrustful of everyone, particularly of the psychotherapist ho approaches him with the intent of intruding into his isolated world and personal life. To him the physician’s approach means the threat of being compelled to return to the frustrations of real life and to reveal his inadequacy to meet them or, - still worse – a repetition of the aggressive interference with his initial symptoms and peculiarities which he has encountered in his previous environment.
The difficulty that the patient’s dilemma through his frustrations is the product through which is called ‘delusion’: Delusion itself is a false belief which is firmly held by a person even though other people recognize the belief as obviously untrue. For example, a person who truly believes he is Napoleon Bonaparte is delusional. Religious beliefs or popular conceptions, such as the beliefs that people have been abducted by aliens, are not delusions because they are widely held beliefs. Delusions are a type of psychotic symptom that indicate a person has lost contact with reality.
There are many different types of delusions. A person with a paranoid delusion believes that others - such as the FBI, or the CIA, even the Mafia as trying to harm or plot against him. A person with a delusion of reference believes that events or people refer specifically to him or her when they do not. For example, a woman with schizophrenia may believe that a television news broadcaster is talking personally to her rather than to the entire viewing audience. A grandiose delusion is a belief that one is extremely famous or that one has special powers, such as the ability to magically heal people.
A delusion of control is a belief that others are able to control one’s thoughts, feelings, or actions. For example, a man with this type of delusion may believe that someone has implanted a microchip in his brain that enables other people to control his thoughts. A somatic delusion is a belief that something is wrong with one’s body - for example, that one’s brain is rotting away - even though no medical evidence supports this belief. A person with an erotic delusion believes that someone is in love with him or her despite a lack of evidence for this belief. In a delusion of jealousy, a person believes that his or her spouse or lover is unfaithful despite evidence to the contrary.
Delusions commonly occur in certain severe mental illnesses, such as schizophrenia, bipolar disorder (also called manic-depressive illness), some cases of major depression, Dissociative disorders, post-traumatic stress disorder, and paranoid personality disorder. In addition, delusions may result from abuse of certain drugs, including alcohol, cocaine, amphetamines, and hallucinogens such as lysergic acid diethylamide (LSD), phencyclidine (PCP), and mescaline. Medical conditions affecting the brain, such as syphilis and brain tumours, may also cause delusions.
Delusional disorder is a relatively uncommon mental illness characterized by delusions. People with this disorder have one or more delusions that persist for at least one month. In addition, they do not suffer from other symptoms of schizophrenia, such as disorganized speech and bizarre behaviour. Usually their delusions are less bizarre than those that occur in schizophrenia and seem merely odd or unsupported by facts. Examples of nonbizarre delusions include beliefs that one is being followed, loved by someone famous, or deceived by one’s spouse. Because delusional disorder is relatively rare, little research has systematically examined its treatment. However, doctors most often use Antipsychotic drugs (also called neuroleptics) to treat this disorder. These drugs help reduce or eliminate delusions, hallucinations, and other psychotic symptoms.
In spite of his narcissistic retreat, every schizophrenic has some underlying notion of the unreality and loneliness of his substitute delusionary world. He longs for human contact and understanding, yet is afraid to admit of himself, or his therapist for fear of further frustration.
That is why the patient may take weeks and months to test the analyst before being willing to accept him, however, once he has accepted him. His dependence on the analyst is greater and he is more sensitive about it than is the psychoneurotic because of the schizophrenic’s deeply rooted insecurity, the narcissistic seemingly self-righteous attitude is but a defence.
Whenever the analyst fails the patient from reasons to be discussed later - one cannot at times avoid failing one’s schizophrenic patients - it will be severe disappointment and a repetition of the chain of frustrations the schizophrenic has previously endured.
The instinctually primitive part of the schizophrenic’s mind that does not discriminate between himself and the environment, it may mean the withdrawal of the impersonal supporting forces of his infancy. Severe anxiety will follow this vital deprivation.
In the light of his personal relationship with the analyst it means that the therapist seduced the patient to use him as a bridge over which he might possibly be led from the utter loneliness of his own world to reality and human warmth, only to have him discover that this bridge is not reliable. if so, he will respond helplessly with an outburst of hostility or with renewed withdrawal as may be seen most impressively in catatonic stupor.
The symptoms of mental illness can be very distressing. People who develop schizophrenia may hear voices inside their head that say nasty things about them or command them to act in strange or unpredictable ways. Or they may be paralysed by paranoia—the deep conviction that everyone, including their closest family members, wants to injure or destroy them. People with major depression may feel that nothing brings pleasure and that life is so dreary and unhappy that it is better to be dead. People with panic disorder may experience heart palpitations, rapid breathing, and anxiety so extreme that they may not be able to leave home. People whom experience episodes of mania may engage in reckless sexual behaviour or may spend money indiscriminately, acts that later cause them to feel guilt, shame, and desperation.
Other mental illnesses, while not always debilitating, create certain problems in living. People with personality disorders may experience loneliness and isolation because their personality style interferes with social relations. People with an eating disorder may become so preoccupied with their weight and appearance that they force themselves to vomit or refuse to eat. Individuals who develop post-traumatic stress disorder may become angry easily, experience disturbing memories, and have trouble concentrating.
Experiences of mental illness often interact differently but depend on one’s culture or social group, sometimes greatly so. For example, in most of the non-Western world, people with depression complain principally of physical ailments, such as lack of energy, poor sleep, loss of appetite, and various kinds of physical pain. Indeed, even in North America these complaints are commonplace. But in the United States and other Western societies, depressed people and mental health professionals who treat them tend to emphasize psychological problems, such as feelings of sadness, worthlessness, and despair. The experience of schizophrenia also differs by culture. In India, one-third of the new cases of schizophrenia involve catatonia, a behavioural condition in which a person maintains a bizarre statue like pose for hours or days. This condition is rare in Europe and North America.
With appropriate treatment, most people can recover from mental illness and return to normal life. Even those with persistent, long-term mental illnesses can usually learn to manage their symptoms and live productive lives.
By a variety of symptoms, including loss of contact with reality, bizarre behaviour, disorganized thinking and speech, decreased emotional expressiveness, and social withdrawal. Usually only some of these symptoms occur in any one person. The term schizophrenia comes from Greek words meaning ‘split mind.’ However, contrary to common belief, schizophrenia does not refer to a person with a split personality or multiple personality. For a description of a mental illness in which a person has multiple personalities. To observers, schizophrenia may seem or appear for being as some sorted kind of madness or a manufacturing insanity.
Perhaps more than any other mental illness, schizophrenia has a debilitating effect on the lives of the people who suffer from it. A person with schizophrenia may have difficulty telling the difference between real and unreal experiences, logical and illogical thoughts, or appropriate and inappropriate behaviour. Schizophrenia seriously impairs a person’s ability to work, go to school, enjoy relationships with others, or take care of oneself. In addition, people with schizophrenia frequently require hospitalization because they pose a danger to themselves. About 10 percent of people with schizophrenia commit suicide, and many others attempt suicide. Once people develop schizophrenia, they usually suffer from the illness for the rest of their lives. Although there is no cure, treatment can help many people with schizophrenia lead productive lives.
Schizophrenia also carries an enormous cost to society. People with schizophrenia occupy about one-third of all beds in psychiatric hospitals in the United States. In addition, people with schizophrenia account for at least 10 percent of the homeless population in the United States. The National Institute of Mental Health has estimated that schizophrenia costs the United States tens of billions of dollars each year in direct treatment, social services, and lost productivity.
Approximately 1 percent of people develop schizophrenia at some time during their lives. Experts estimate that about 1.8 million people in the United States have schizophrenia. The prevalence of schizophrenia is the same regardless of sex, race, and culture. Although women are just as likely as men to develop schizophrenia, women tend to experience the illness less severely, with fewer hospitalizations and better social functioning in the community.
Schizophrenia usually develops in late adolescence or early adulthood, between the ages of 15 and 30. Much less commonly, schizophrenia develops later in life. The illness may begin abruptly, but it usually develops slowly over months or years. Mental health professionals diagnose schizophrenia based on an interview with the patient in which they determine whether the person has experienced specific symptoms of the illness.
Symptoms and functioning in people with schizophrenia tend to vary over time, sometimes worsening and other times improving. For many patients the symptoms gradually become less severe as they grow older. About 25 percent of people with schizophrenia become symptom-free later in their lives.
A variety of symptoms characterize schizophrenia. The most prominent include symptoms of psychosis—such as delusions and hallucinations - as well as bizarre behaviour, strange movements, and disorganized thinking and speech. Many people with schizophrenia do not recognize that their mental functioning is disturbed.
Delusions are false beliefs that appear obviously untrue to other people. For example, a person with schizophrenia may believe that he is the king of England when he is not. People with schizophrenia may have delusions that others, such as the police or the FBI, are plotting against them or spying on them. They may believe that aliens are controlling their thoughts or that their own thoughts are being broadcast to the world so that other people can hear them.
Research suggests that the genes one inherits strongly influence one’s risk of developing schizophrenia. Studies of families have shown that the more close one is related to someone with schizophrenia, the greater the risk one has of developing the illness. For example, the children of one parent with schizophrenia have about a 13 percent chance of developing the illness, and children of two parents with schizophrenia have about a 46 percent chance of eventually developing schizophrenia. This increased risk occurs even when such children are adopted and raised by mentally healthy parents. In comparison, children in the general population have only about a 1 percent chance of developing schizophrenia.
Some evidence suggests that schizophrenia may result from an imbalance of chemicals in the brain called neurotransmitters. These chemicals enable neurons (brain cells) to communicate with each other. Some scientists suggest that schizophrenia results from excess activity of the neurotransmitter dopamine in certain parts of the brain or from an abnormal sensitivity to dopamine. Support for this hypothesis comes from Antipsychotic drugs, which reduce psychotic symptoms in schizophrenia by blocking brain receptors for dopamine. In addition, amphetamines, which increase dopamine activity, intensify psychotic symptoms in people with schizophrenia. Despite these findings, many experts believe that excess dopamine activity alone cannot account for schizophrenia. Other neurotransmitters, such as serotonin and norepinephrine, may play important roles as well.
Although scientists favour a biological cause of schizophrenia, stress in the environment may affect the onset and course of the illness. Stressful life circumstances - such as maturing in age and character as for living in poverty, the death of a loved one, an important change in jobs or relationships, or chronic tension and hostility at home—can increase the chances of schizophrenia in a person biologically predisposed to the disease. In addition, stressful events can trigger a relapse of symptoms in a person who already has the illness. Individuals who have effective skills for managing stress may be less susceptible to its negative effects. Psychological and social rehabilitation can help patients develop more effective skills for dealing with stress.
Although there is no cure for schizophrenia, effective treatment exists that can improve the long-term course of the illness. With many years of treatment and rehabilitation, significant numbers of people with schizophrenia experience partial or full remission of their symptoms.
Treatment of schizophrenia usually involves a combination of medication, rehabilitation, and treatment of other problems the person may have. Antipsychotic drugs (also called neuroleptics) are the most frequently used medications for treatment of schizophrenia. Psychological and social rehabilitation programs may help people with schizophrenia function in the community and reduce stress related to their symptoms. Treatment of secondary problems, such as substance abuse and infectious diseases, is also an important part of an overall treatment program.
Antipsychotic medications, developed in the mid-1950s, can dramatically improve the quality of life for people with schizophrenia. The drugs reduce or eliminate psychotic symptoms such as hallucinations and delusions. The medications can also help prevent these symptoms from returning. Common Antipsychotic drugs include risperidone (Risperdal), olanzapine (Zyprexa), clozapine (Clozaril), quetiapine (Seroquel), haloperidol (Haldol), thioridazine (Mellaril), chlorpromazine (Thorazine), fluphenazine (Prolixin), and trifluoperazine (Stelazine). People with schizophrenia usually must take medication for the rest of their lives to control psychotic symptoms. Antipsychotic medications appear to be less effective at treating other symptoms of schizophrenia, such as social withdrawal and apathy.
Because many patients with schizophrenia continue to experience difficulties despite taking medication, psychological and social rehabilitation is often necessary. A variety of methods can be effective. Social skills training help people with schizophrenia learn specific behaviours for functioning in society, such as making friends, purchasing items at a store, or initiating conversations. Behavioural training methods can also help them learn self-care skills such as personal hygiene, money management, and proper nutrition. In addition, cognitive-behavioural therapy, a type of psychotherapy, can help reduce persistent symptoms such as hallucinations, delusions, and social withdrawal.
Because many patients have difficulty obtaining or keeping jobs, supported employment programs that help patients find and maintain jobs are a helpful part of rehabilitation. In these programs, the patient works alongside people without disabilities and earns competitive wages. An employment specialist (or vocational specialist) helps the person maintain their job by, for example, training the person in specific skills, helping the employer accommodate the person, arranging transportation, and monitoring performance. These programs are most effective when the supported employment is closely integrated with other aspects of treatment, such as medication and monitoring of symptoms.
Some people with schizophrenia are vulnerable to frequent crises because they do not regularly go to mental health centres to receive the treatment they need. These individuals often relapse and face rehospitalization. To ensure that such patients take their medication and receive appropriate psychological and social rehabilitation, assertive community treatment (ACT) programs have been developed that deliver treatment to patients in natural settings, such as in their homes, in restaurants, or on the street.
People with schizophrenia often have other medical problems, so an effective treatment program must attend to these as well. One of the most generally shared in or participated in things conforming to a type without noteworthy excellence or faults just as common a rule, by ordinary, frequent and ordinarily as an idea or expression deficient in originality or freshness, yet, only of its exchanging the commonplace of the common associated problems is vehemently and usually coarsely expressed condemnation or disapproved, as the interpretative category of an unequalled vocabulary is itself a genuine abuse. Successful treatment of substance abuse inpatients with schizophrenia requires careful coordination with their mental health care, so that the same clinicians are treating both disorders at the same time.
The high rate of substance abuse in patients with schizophrenia contributes to a high prevalence of infectious diseases, including hepatitis B and C and the human immunodeficiency virus (HIV). Assessment, education, and treatment or management of these illnesses is critical for the long-term health of patients.
Other problems frequently associated with schizophrenia include housing instability and homelessness, legal problems, violence, trauma and post-traumatic stress disorder, anxiety, depression, and suicide attempts. Close monitoring and psychotherapeutic interventions are often helpful in addressing these problems.
Several other psychiatric disorders are closely related to schizophrenia. In schizoaffective disorder, a person shows symptoms of schizophrenia combined with either mania or severe depression. Schizophreniform disorder refers to an illness in which a person experiences schizophrenic symptoms for more than one month but fewer than six months. In schizotypal personality disorder, a person engages in odd thinking, speech, and behaviour, but usually does not lose contact with reality. Sometimes mental health professionals refer to these disorders together as schizophrenia-spectrum disorders.
Severe mental illness almost always alters a person’s life dramatically. People with severe mental illnesses experience disturbing symptoms that can cause of such difficulties and holding to a job, or go to school, relate to others, or cope with ordinary life demands. Some individuals require hospitalization because they become unable to care for themselves or because they are at risk of committing suicide.
The symptoms of mental illness can be very distressing. People who develop schizophrenia may hear voices inside their head that say nasty things about them or command them to act in strange or unpredictable ways. Or they may be paralysed by paranoia - the deep conviction that everyone, including their closest family members, wants to injure or destroy them. People with major depression may feel that nothing brings pleasure and that life is so dreary and unhappy that it is better to be dead. People with panic disorder may experience heart palpitations, rapid breathing, and anxiety so extreme that they may not be able to leave home. People whom experience episodes of mania may engage in reckless sexual behaviour or may spend money indiscriminately, acts that later cause them to feel guilt, shame, and desperation.
Other mental illnesses, while not always debilitating, create certain problems in living. People with personality disorders may experience loneliness and isolation because their personality style interferes with social relations. People with an eating disorder may become so preoccupied with their weight and appearance that they force themselves to vomit or refuse to eat. Individuals who develop post-traumatic stress disorder may become angry easily, experience disturbing memories, and have trouble concentrating.
Experiences of mental illness often take issue upon its stability for depending on one’s culture or social group, sometimes greatly so. For example, in most of the non-Western world, people with depression complain principally of physical ailments, such as lack of energy, poor sleep, loss of appetite, and various kinds of physical pain. Indeed, even in North America these complaints are commonplace. But in the United States and other Western societies, depressed people and mental health professionals who treat them tend to emphasize psychological problems, such as feelings of sadness, worthlessness, and despair. The experience of schizophrenia also differs by culture. In India, one-third of the new cases of schizophrenia involve catatonia, a behavioural condition in which a person maintains a bizarre statue like pose for hours or days. This condition is rare in Europe and North America.
Of furthering issues regarding depersonalization disorder, meaning, in effect, that it is a categorised illness based within its intendment for being an illness, of mind, in which people experience an unwelcome sense of detachment from their own bodies. They may feel as though they are floating above the ground, outside observers of their own mental or physical processes. Other symptoms may include a feeling that they or other people are mechanical or unreal, a feeling of being in a dream, a feeling that their hands or feet are larger or smaller than usual, and a deadening of emotional responses. These symptoms are chronic and severe enough to impede normal functioning in a social, school, or work environment.
Depersonalization disorder is a relatively rare syndrome thought to result from severe psychological stress. It may occur as part of other mental illnesses, especially anxiety disorders. For example, some people with panic disorder feel nervous, have a sense of doom about their future and health, and have a troubling sense of detachment form the lose in the attemptive use in making or doing or achieving a useful regularity as might beg to ask for something equally expected of the control over their bodies. Depersonalization disorder may also be a component of more severe mental illness, such as schizophrenia. Treatment may include training in relaxation techniques that enhance body perception and control, hypnosis to modify symptoms, and psychotherapy to explore possible stress-related components of the disorder.
Psychiatrists classify depersonalization disorder as one of the Dissociative disorders. Such disorders involve a disruption of consciousness, memory, identity, or perception.
All the while, the schizophrenic responds to altercations in the analyst’s defections and understanding by corresponding stormy and dramatic changes from love to hatred, from willingness to leave his delusional world to resistance and renewed withdrawal.
As understandable as these changes are, nevertheless may come as a surprise to the analyst who frequently has not observed their source, this is quite in contrast to his experience with psychoneurosis whose emotional reactions during an interview he can usually predict. These unpredictable changes seem to be the reason for the conception of the unreliability of the schizophrenic’s transference reaction, yet they follow the same dynamic rules as the psychoneurotic’s oscillations between positive and negative transference and resistance, however, if the schizophrenic’s reactions are stormy and seemingly more unpredictable than those of the psychoneurotic, that instances suggested to be due to the inevitable errors in the analyst’s approach to the schizophrenic, of which he himself may be unaware, rather than to the unreliability of the patient‘s emotional response?
Why is it inevitable that the psychoanalysts disappoint his schizophrenic patient time and again?
The schizophrenic withdraws from painful reality and retires to what resembles the early speechless phase of development where consciousness is not yet crystalized. As the expression of his feelings is not hindered by the convention that he has eliminated, as his thinking, feelings, behaviour and speech - when present - obey the working rules of the archaic unconscious. His thinking is magical and does not follow logical rules. It does not admit to every last saying of ‘no’, but likewise nor the positive expression in the no to ‘yes’: There is no recognition of space and time, I, you, and they, are interchangeable expression through which of symbols and often by movement and gestures rather than by words.
As the schizophrenic is suspicious, he will distrust the words of his analyst. He will interpret them and incidental gestures and attitudes of the according to his own delusional experience. The analyst may not even be aware of these involuntary manifestations of his attitudes, yet they mean much to the hypersensitive schizophrenic who uses them as a means of orienting himself to the therapist‘s personality and intentions toward him.
In other words, the schizophrenic patient and the therapist are people living in different worlds and no different levels of personal development with different means of expressing and of orienting themselves. We know little about the language of the unconscious that belongs to the schizophrenic, and our access to it is blocked by the very process of our own adjustment to a world the schizophrenic has relinquished, so, we should not be surprised that errors and misunderstandings occur when we under take to communicate and strive for a rapport with him.
Another source of the schizophrenic’s disappointment arises form which the analyser accepts and does not interfere with the behaviour of the schizophrenic, his attitude may lead the patient to expect that the analyst will assist in carrying out all the patient’s wishes, even though they may not seem to be in his interest to the analyser‘s and the hospital’s in their relationship to society. This attitude of acceptance so different from the patient’s previous experiences readily fosters the anticipation that the analyst will try to carry out the patient’s suggestion and take his part, even against conventional society with which it should occasionally arise. Frequently it will be wise for the analyst to agree with the patient‘s wish to remain unbattled and untidy until he is ready to talk about the reasons for his behaviour or to change spontaneously. At other times, he will unfortunately be unable to take the patient’s part without being able to make the patient understand and accept the reasons for the analyst’s position.
If the analyst is not able to accept the possibility of misunderstanding the reaction of the schizophrenic patient and in turn of being misunderstood by him, it may shake his security with his patient.
That is to say, that, among other things, the schizophrenic, once he accepts the analyst’s insecurity. being helpless and open to himself - in spite of his pretended grandiose isolation - he will feel utterly defeated by the insecurity of his would-be helper. Such disappointment may furnish reasons for outbursts of hatred and are comparable to the negative transference reactions of psychoneurosis, yet more intense than these, since they are not limited by the restrictions of the actual world - that is, it exists in or based on fact, its only problem is a sure-enough externalization for which things are existing in the act of being external in something that has existence, ss if it were an actualization as received in the obtainable enactment for being externalized, such that its problem of in some actual life that proves obtainable achieved, in that of doing something that has an existence for having absolute actuality.
These outbursts are accompanied by anxiety, feelings of guilt, and fear of retaliations which in turn lead to increased hostility. Yet this established a vicious circle: We disappoint the patient, he is afraid that we hate him for his hatred and therefore continues to hate us. If in addition he senses that the analyst is afraid of his aggressiveness, it confirms his fear that he is actually considered as some dangerous and unacceptable, and this augments his hatred.
This establishes that the schizophrenics capable of developing strong relationships of love and hatred toward the analyst. After all, one could not be so hostile if it were not for the background of a very close relationship. In addition, the schizophrenic develops transference reactions on the narrower sense which he can differentiate from the actual interpersonal relationship. For which the schizophrenic’s emotional reactions toward the analyst have to be met with extreme care and caution. The love which the sensitive schizophrenic feels as he first emerges, and his cautions acceptances of the analyst’s warmth of interest are really most delicate and tender things. If the analyst deals with the transference reactions of a psychoneurotic is bad enough, though as a reparable rule, but if he fails with a schizophrenic in meeting positive feelings by pointing it out for instance before the patient indicates that he is ready to discuss it, he may easily freeze to death what has just begun to grow and so destroy any further possibility of therapy.
Some analysts may feel that the atmosphere of complete acceptance and of strict avoidance of any arbitrary denials which we recommend as a basic rule for the treatment of schizophrenics may not avoid our wish to guide of reacceptance of reality, nevertheless, Freud says that every science and therapy which accept his teachings about unconscious, about transference and resistance and about infantile sexuality, may be called psychoanalysis. According in this definition we believe we are practising psychoanalysis with our schizophrenic patients.
Whether we call it analysis or not, it is clear that successful treatment does not depend on technical rules of any special psychiatric school but rather on the basic attitude of individual therapist toward psychologic persons. If he meets them as strangle creatures of another world whose productions are not comprehensible to ‘normal’ beings, he cannot treat them, if he realizes, however, that the difference between himself and the psychologic is only of degree, and not of kind, he will know better how to meet him. He will not be able to identify himself sufficiently with the patient to understand and accept his emotional reactions without becoming involved in them.
The process of constant and perpetual change is examined and closely matched within the study of philosophical speculations and pointed of a world view which asserts that basic reality is constantly in a process of flux and change. Indeed, reality is identified with pure process. Concepts such as creativity, freedom, novelty, emergence, and growth are fundamental explanatory categories for process philosophy. This metaphysical perspective is to be contrasted with a philosophy of substance, the view that a fixed and permanent reality underlies the changing or fluctuating world of ordinary experience. Whereas substance philosophy emphasizes static being, process philosophy emphasizes dynamically becoming.
Although process philosophy is as old as the 6th-century Bc Greek philosopher, Heraclitus, renewed interest in it was stimulated in the 19th century by the theory of evolution. Key figures in the development of modern process philosophy were the British philosophers Herbert Spencer, Samuel Alexander, and Alfred North Whitehead, the American philosophers Charles S. Peirce and William James, and the French philosophers Henri Bergson and Pierre Teilhard de Chardin. Whitehead's Process and Reality: An Essay in Cosmology (1929) is generally considered the most important systematic expression of process philosophy.
Contemporary theology has been strongly influenced by process philosophy. The American theologian Charles Hartshorne, for instance, rather than interpreting God as an unchanging absolute, emphasizes God's sensitive and caring relationship with the world. A personal God enters into relationships in such a way that he is affected by the relationships, and to be affected by relationships is to change. So too is in the process of growth and development. Important contributions to process theology have also been made by such theologians as William Temple, Daniel Day Williams, Schubert Ogden, and John Cobb, Jr.
‘Reality’ is a difficult word to use to every one’s satisfaction or even to one’s own satisfaction. In this instance the word reality is used arbitrarily to designate the direct, here-and-now impact of the analyst upon the patient. Reality. In this sense, contrasts with the impact the analyst has through his representation in the patient’s fantasy life, neurosis, and transference, since both kinds of impact seem always to coexist and since the former - the analyst’s real impact - may be the worst enemy of the transference, the matter of their differentiation is possibly the most challenging aspect of analysis.
The analytic situation, which is set up to shut out ordinary reality intrusions, that cannot, . . . neither should not exclude all, but to say, that in the beginning months, for instance, reality inevitably has the upper hand. The analyst, the office, the procedure, are all overwhelmingly real. Everything is strange, frightening and exciting, gratifying and frustrating. Unlike the patient can test it and orient himself to it, the impact of this reality is usually so great that even an ordinary useful transference relationship cannot be expected to develop.
Perhaps the most confusing aspect of this beginning period is the frequent appearance in it of what can be regarded as a false transference relationship. With great intensity and clarity, the patient may reveal, through transference-like references about the analyst, some of the deepest secrets only of his neurosis but of its genesis. The pseudotransference, too good to be true, is almost sure to be nothing more than the patient’s attempt to deal with the person of the analyst, the entire spectrum of his various patterns of behaviour. If, it is easy to do, the analyst overlooks the likelihood that the patient’s relationship with at this time is really about that almost everything said about it is related, analysis may get off to a very bad start. And if, as is even earlier to do, the analyst’s interests the genetic meaning of the openly exposed material, a good transference relationship may be seriously delayed and a workable transference neurosis may never appear. even after initial reality has had time to fade, reality may continue to intrude in ways that are very hard to detect and that is very troublesome.
One of the most serious problems of analysis is the very substantial help which the patient receives directly from the analyst and the analytic situation. For many a patient, the analyst in the analytic situation is in fact the most stable, reasonable, wise and understanding person he has ever met, and the setting in which they meet may actually be the most honest, open, direct and regular relationship he has ever experienced. Added to this is the considerable helpfulness to him of being able to clarify his life storey. confess his guilt, express his ambitions, and explore his confusions. Further real help comes from the learning-about-life accruing from the analyst’s skilled questions, observations and interpretations. Taken together, the total real value to the patient of the analytic situation can easily be immense. The trouble with this kind of help is that it goes on and on, it may have such a real, direct and continuing impact upon the patient that he can never get deeply enough involved in transference situation to allow him to resolve or even to become acquainted with his most crippling internal difficulties. The trouble is far too good, the trouble also is that we as analysts apparently cannot resist the seductiveness of being directly helpful, and this, when combined with the compelling assumption that helpfulness is bound to be good, permits us top credit patient improvements to ‘analysis’ when more properly it should often be recognized for being the amounting result for the patient’s using the analytic situation, as the model, for being the preceptors and supporter in the dealing practically within the immediate distractions as holding to some problem.
Perhaps, we can now refer to something in a clear unmistakable manner, and it would be to mention, for being, that one more difficult-to-handle intrusion of reality into the analysis, that by saying, that this is the definitive and final interruption of the transference neurosis by the reality of termination; in the sense, the situation is reversed and the intrusion is analytically desirable, since ideally the impact of reality of impending and certain termination is used to facilitate the resolution of the transference. As with the resolution of earlier episodes of transference neurosis, this final one is brought about principally by the analyst’s interpretations and reconstructions. As these take effect, the transference neurosis and, hopefully, along with it the original neurosis is resolved. This final resolution, however, which is much more comprehensive, is usually very different and may not come about at all without the help of the reality of termination. Accordingly, any attenuation of the ending, such as tapering off or causal or tentative stopping, should be expected to stand in the way of an effective resolution of the transference. Yet, it seems that this is what most commonly happens to an ending, and because of this a great many patients may lose the potentially great benefit of a thorough resolution and are forever after left suspended in the net of unresolved transference.
Yet, utter indistinctly rigorous termination seems understandable, as difficult as transference neurosis may be in the analyst at other times, this ending period, if rigorously carried out, simply has to be the period of his greatest emotional strain. There can surely be no more likely time for an analyst to surrender his analytic position and, responding to his own transference, become personally involved with his patient than during the process of separating from a long and self-restrained relationship. Accordingly, it may be better to slur over the ending lightly than to mishandle it in an attempt to be rigorous.
In considering more broadly the function of the transference in the psychoanalytic process, one is confronted by the apparent naïve, but, nonetheless important questions of the role of the actual (current) object as compared with that of the object representation of the original personage in the past. We recall Freud’s paradoxical, somewhat gloomy, but portentous concluding passage in ‘The Dynamics of Transference.’ This struggle between the doctor and the patient, between intellect and instinctual life, between understanding and seeking to act, is played out almost exclusively in the phenomena of transference. It is on that field that the victory must be won - the victory whose expression is on that field that the victory must be won - the victory whose expression is the permanent cure of the neuroses. It cannot be disputed that controlling the phenomena of transference presents the psychoanalysis with the greatest difficultly, but it should not be forgotten that they do us the inestimable service of making the patient ‘s hidden and forgotten erotic impulses of showing their immediate and manifested impossibilities, for when all is said and done, it is impossible to destroy anyone in absentia or in effigies.
Both object and representations are made necessary by the basic phenomenon of original separation. The existence of an image of the object, which persist in the absence of the object, is one of the important beginnings of psychic life in general, certainly an indispensable prerequisite for object relationship. As generally construed. Whether this is viewed as (or a times demonstrably is) something unstable for allotting introjection, s always subject to alternative projection, or an intrapsychic object representation clearly distinguished from the self-representation, or firm identification in the super-ego, or in the ego itself, these phenomena are in various ways components of the system of mastery of the fact of separation, or separateness, from the original absolutely necessarily anaclitic (in the earliest period) symbiotic ‘object’. In the light of clinical observation, it would appear to be that the relative stabilities (parental) object representation. At which time of varying degree, are to a greater extent for the archaic phenomena. Even in nonpsychotic patients, overwhelmed by them, sometimes resembles the restoration from oedipal identification, which provides the preponderant basis for most demonstrable analytic transferences. That within the necrotic patients, the transference is effectively established when this representation invests the analyst to a degree - depending on intensity of drive and most of ego participation - which ranges in all the, wishing and strivings to remake and analyst to biasses judgements and misinterpretation of data, finally are the actual perceptual distortions.
However, the old object representations may be invested, however rigidly established the libidinal or aggressive cathexis of the image may be, this as such can become the actual and exclusive focus of instinctual discharge, or of complicated and intense instinct-defence solutions, only and general energy-sparing quality of strictly intrapsychic processes. For the vast majority of persons, visible to any degree, including those with severe neurosis, character distortions, addictions and certain psychoses, the striving is toward the living and actual object, even at the cost of intense suffering. In a sense, this returns us to the state in which the psychological ‘object-to-be’. Has a cr11itical importance never again to be duplicated, except in certain acute life emergencies, even if the object is not firmly perceived as such, in the sense of later object relations? And it does seem that trance impressions from the earliest contacts in the service of life preservation, and the associated instinctual gratifications, and innumerable secondarily associated sensory impressions. Are activated by the specific inborn urges of sexual maturation? These propel the individual to renew many of the earliest modes of actual bodily contact, in connection with seeking for specific instinctual gratification. Or, to look away from clear-cut instinctual matters to the more remote elaborations of human contact: Few regard loneliness as other than a source of suffering, even self-imposed, as an apparent matter of choice, and the forcible imposition of ‘solitary confinement ‘ is surely one of the most cruel of punishments.
In taking to question, we are entering an area of life in which things are other then themselves, where meaning is multifaceted, and where the line between the old and the new is blurred. It should, by, its immediate measure, help develop our recognition or meaning of the pertinent applicability as to the relevance of interrelated aspects of the psychology of ‘metaphor’. In the psychology of metaphor we will find a useful analogy to the psychology of transference interpretation. Our’s will be newly encountered as good metaphors, those it response to which we say, ‘That’s it exactly’ or ‘That really captures it‘ or ‘That says it all’.
Some literary and linguistic analysis, (e.g., Lewis, 1936 and Snell, 1953) and also people in everyday life, believe that there are experiences that can only be expressed metaphorically. And for this achievement that these metaphors, which may be entire poem or as lines or even words highly valued. But how can this be so? Just what in th e ‘it’ that the metaphor ‘is’ or ‘captures’ or ‘says’? If this ‘is’ or this ‘experience’ can only be rendered metaphorically, when we can know it only as such, that is, as the metaphor itself. Of the position out of which are put forward by, T.S, Eliot (1933) and E.W. Harding (1963) in their discussion of poetry, for in these instances we are granted that there are no known and logically independent version of the experience that can serve to validate the metaphor. Whatever the metaphor makes available to us depends on it and it and so cannot be used to prove its correctness.
It seems justifiably warrantable to consider that the metaphor is a new experience rather than a mere paraphrase of an already fully constituted expedience. The metaphor creates an experience that one has never had before. It is an experience one has not realized by oneself. The metaphor does, of course, suggest certain constituent experiences of which one may have been more or less dimly aware. One may say, therefore, that the metaphor speaks for those constituents, on the existence of which much of its appeal depends. But in its organizing and implicit ly rendering these constituents in its new way, it is a creation rather than a mere paraphrase or anew edition. Paraphrasing and new editions never speak as forcefully as good new metaphors, nor could they facilitate further new experience. One analytically familiar feature of these creations is that they make it safe and pleasing to experience something that otherwise would be considered too threatening and so would be kept in fragmented obscurity through defensive measures.
Thus, when one says, ‘That’s it exactly’ one is implicitly recognizing and announcing that one has found and accepted a new mode of experiencing oneself and one’s world, which is to say, asserting a transformation of one’s own subjectivity. Something is now said to be true, and in a sense it is true, but it is true for the first time. Nothing of one and the same can ever happen again, for the second time cannot be the same as the first. One can’ t step into the same watering point and then step once again into the same spot of that river. A revelatory metaphor re-encountered or repeated later may lose some of its force, alternatively, it may gain some significance, butt it cannot remain exactly the same metaphor or mobilize an experience identical with the first. The point applies as well as to new metaphors that are similar to familiar ones: They have to be judged or experienced through their conventionalized predecessors, as through methods of knowing or already proved instrumentally of perceiving. The audience and the performer, who may be one person, as such that may not have, as yet.
What is to be said about the psychology of metaphor is analogous to the transformational aspects of developed transference and the steadfast interpretation that both facilitate and organize them as transference. Allowing that these transferences and ‘remembered’ experiences come into existence over a period of time, nothing that is identical with them has ever before been enacted, and nothing will ever be enacted again. They are creations that may be fully achieved only under specific analytic conditions. Such that living was not reliving that moment, words like re-living, re-experiencing and reliving simply do not do justice to the phenomena, that in making this claim. A seeming contradiction over-writes some of our well-establish ideas. - in offering, - I am not contradicting some of our well-established ideas about interpretation and insight, I am, however, disputing the point that insight refers to a greater proportion or in its range of comprehension, which its distance between possible extremes extent and regain former or normal state, such that, for the recovery of lost memories, and takes in as well, a new grasp of the significance and interpretations of events one has always remembered. In point, as, Freud pointed out, ‘As a matter of fact I’ve always known it, only that I’ve never thought of it; (1914), In fact, it is to develop that point in furthering to say that it takes an adult to do that, especially with the help of an analyst. It was, after all, Freud’s analysis of adults that make it possible to define infantile psychosexuality. In this respect, but without disregard, child analysis retains a quality of applied psychoanalysis’ in the same way that the interpreted transference neurosis is: Both are always of describing as true something that was not true in quite that way at the time of its greatest developmental significance. This apparent paradox about ‘remembering’ as a form of creating goes a long way, probably that what it is, is distinctive about psychoanalytic interpretation.
This time, however, to further the discussion on the interpretive technique that surrounds the phase of a mutative interpretation - that in which a portion of the patient’s id-relation to the analyst is made conscious in virtue of the latter’s positions as auxiliary super-ego - is in itself complex. In the classical model of an interpretation, the patient will first be made aware of a state of tension of an interpretation, will next be made aware that there is repressive factor at work (that his super-ego is threatening him with punishment), and will only then be made aware of the id-impulse which has stirred up the protects of his super-ego and so given to the anxiety in his ego. This is the classical scheme. In actual practice, the analyst finds himself working from all three sides at once, or in irregular successions. At one moment a small portion of the patient‘s super-ego may be revealed to him in all its savagery, at another the shrinking defencelessness of his ego, at yet another his attention may be directed to the attempts which he is making at restitution - at compensating for his hostility, on some occasions a fraction of id-energy may even be directly encouraged to break its way through the last remains of an already weakened resistance. There is, however, one characteristic which all of these various operations has in common, they are essentially upon a small scale. For the mutative interpretation is inevitably governed by the principle of minimal doses. It is a commonly agreed clinical fact that alternations in a patient under analysis appear almost always to be extremely gradual: We are inclined to suspect sudden and large changes as an indication that suggestive rather than psycho-analyst processes are at work. The gradual nature of the change brought about in psychoanalysis will be explained, as, only to suggest, those changes are the result of the summation of an immense number of minuet steps, each of which correspond to a mutative interpretation. And the smallness of each step is in turn imposed by the very nature of the analytic situation. For each interpretation involves the release of a certain quantity of id-energy, and, if the quantity released is too large, the higher unstable state of equilibrium which enables the analyst to function as the patient’s auxiliary super-ego is bound to be upset. The whole analytic situation will thus be imperilled, since it is only in virtue of the analyst’s acting as auxiliary super-ego that these released id-energy can occur at all.
The effectuality from which follow the analytic attempt to bring unequalled amounts in the confronting collections of some improper use too a resultant quantity of id-energy into the patient’s consciousness all at once. On the one hand, nothing whatever may happen, or on the other hand there may be an unmanageable result, but in neither event will be a mutative interpretation has been effected. The analyst’s power as auxiliary super-ego may be for two very different reasons. It may be that the id-impulses were trying to bring out being not in fact sufficiently urgent at the moment: For, after all, the emergence of an id-impulse depends on two factors - not only on the permission of the super-ego, but also on the urgency (the degree of cathaxis) of the id-impulse itself. This, then, may be one cause of an apparently negative response to an interpretation, and evidently a fairly harmless one. but the same apparent result may also be due to something else, in spite of the id-impulse being really urgent, the strength of the patient’s own repressive forces (the degree of repression) may have been too great to allow his ego to listen to the persuasive voice of the auxiliary super-ego. Now we have a situation dynamically identical with the next one we have to consider, though economically different. this next situation is one in which the patient accepts the interpretation, that is, allows the id-impulse into his consciousness, but is immediately overwhelmed with anxiety. This may show itself in a number of ways, for instance, the patient may produce a manifest anxiety-attack. Or the may exhibit signs of ‘real’ anger with the analyst with a complete lack of insight, or he may break off the analysis. In any of these cases the analytic situation will, for the moment, at least, have broken down. The patient will be behaving just as the hypnotic subject behaves when, having been ordered by the hypnotist to perform an action too much at variance with his own consciousness, he breaks off the hypnotic relation and wakes up from his trance. This state of things, which is manifest where the patient responds to an interpretation with an actual outbreak of anxiety or one of its equivalents, may be latent were the patient shows no response, and this latter case may be the more awkward of the two, since it is masked, and it may sometimes be the effect of a greater overdose of interpretation than where manifest anxiety arises (though obviously other factors will be of determining importance, and in particularly the nature of the patient’s neurosis). Yet this threatened collapse of the analytic situation to an overdose of interpretation: But it might be more accurate in some ways to ascribe it to an insufficient dose. For what has happened is that the second phase of the interpretation process has not occurred: The phase in which the patient becomes aware that his impulse is directed toward an archaic phantasy object and not toward a real one.
In the second phase of a complete interpretation, therefore, a crucial part is played by the patient’s sense of reality: For the successful outcome of that phase depends upon his ability, at the critical moment of the emergence into consciousness of the released quantity of id-energy, to distinguish between his phantasy object and the real analyst. The problem is closely related to one that has been discussed elsewhere, namely that of the extreme liability of the analyst’s position as auxiliary super-ego. The analytic situation is all the time threatening to degenerate into a ‘real’ situation. But this actually means the opposite of what it appears to. It means that the patient is all the time on the brink of turning the really external object (the analyst) into the archaic one; that is to say, he is on the brink of projecting his primitive introjected images onto himself. In so far as the patient actually does this, the analyst becomes like anyone else that he meets in real life - a phantasy object. The analyst then ceases to possess the peculiar advantages derived from the analytic situation, he will be introjected like all other phantasy objects into the analytic situation, he will be introjected like all other phantasy objects into the patient’s super-ego, and will no longer be able to function in the peculiar ways which are essential to the effecting of a mutative interpretation. In this difficulty the patient’s sense of reality is an essential but a very feeble [-ally]: An improvement in it is one of the things that we hope the analysis will bring about. It is important, therefore, not to submit it to any unnecessary strain, and that is the fundamental reason why the analyst must avoid any real behaviour, that is likely to confirm the patient’s view of him as a ‘bad’ or a ‘good’ phantasy object. This is perhaps more obvious as regards the ‘bad’ object. If, for instance, the analyst were to show that he was really shocked or frightened by one of the patient’s id-impulses, as the patient would immediately treat him in that respect as a dangerous object and introject him into his archaic severe super-ego. Therefore, on the one hand, there would be a diminuation in the analyst’s power to function as an auxiliary super-ego and to allow the patient’s to become conscious of his id-impulses - that is to say, in his power to bring about the first phase of a mutative interpretation, and on the other hand, he would, as a real object, become sensibly less distinguishable from the patient’s ‘bad’ phantasy object and to that extent the carrying through of the second phase of a mutative interpretation would also be made more difficult. Or, agin, there is another case. Supposing the analyst behaves in an opposite way and actively urges the patient to give free rein to his id-impulse. There is then a possibility of the patient confusing the analyst with the image of a treacherous parent who, at the beginning, encourage him to seek gratification, and then suddenly turns and punishes him. In such a case the patient’s ego may look for defence by itself suddenly turning upon the analyst as though he were his own id-, and treating him with all the severity of which his super-ego is capable. again, the analyst is running a risk of losing his privileged position. But it may be equally unwise for the analyst to act really in such a way as to encourage the patient to project his ‘good’ introjected object on to him. For the patient will then tend to regard him as a good objective and archaic sense and will incorporate him with his archaic ‘good’ images and will use him as a protection against his ‘bad’ ones. In that way, his infantile positive impulses as well as his negative ones may escape analysis, for there may no longer be a possibility for his ego to make a comparison between the phantasy external object and the real one. it will, perhaps, be argued that, with the best of wills in the world, the analyst, however careful he may be, will be unable to prevent the patient from projecting these various images on to him. This is, of course, indisputable, and, the whole effectiveness of analysis depends upon its being so. The lesson of these difficulties is merely to remind us that the patient’s sense of reality has the narrowest limits. It is a paradoxical fact that the best way of enuring that his ego will be able to distinguish between phantasy and reality is to withhold reality from him as much as possible. but it is true, his ego is so weak - so much at the mercy of his id and super-ego - that he can only cope with reality if it is administered in minimal doses. And these doses are in fact what the analyst gives him, in the form of interpretations.
A mutative interpretation can only be applied to an id-impulse which is actually on a state of cathexis. This seems self-evident; for the dynamic changes in the patient’s mind implied by a mutative interpretation can only be brought about by the operation of a charge of energy originating in the patient himself: The function of the analyst is merely to ensure that the energy should or can flow along one channel rather than along another. It follows that the purely informative ‘dictionary’ type of interpretation will be non-mutative, but useful it may be a prelude to mutative interpretations. And this leads to a number of practical inferences. Every mutative interpretation must be emotionally ‘immediate, but the patient must live through it as something actual or genuine. This requirement, that the interpretation must be ‘immediate’, may be expressed in another way by saying that interpretation must always be directed to the ‘point of urgency’. At any given moment some particular id-impulse will be generated in activity, this is the impulse that is susceptible of mutative interpretation at the time, and no other one. It is, no doubt, neither possible nor desirable to be giving mutative interpretations all the time. as Melanie Klein has pointed out, it is a most precious quality in an analyst to be able at any moment to pick out the point of urgency.
But the fact that every mutative interpretation must deal with an ‘urgent’ impulse takes us back one more to the commonly felt fear of the explosive possibilities of interpretation, and particularly of what is vaguely referred to as ‘deep’ interpretation. The terminological description is, no doubt, as the interpretation of material which is neither genetically early and historically distant from the patient’s actual experience nor under an especially heavy weight of repression – material, in any case, which is in the normal course of things exceedingly inaccessible to his ego and remote from it. There seems reason to believe, moreover, that the anxiety which is liable to be aroused by the approach of such material to consciousness and may be of peculiar severity. The question whether it is ‘safe’ to interpret such material will, as usual, mainly depend upon whether an interpretation can be carried through, in the ordinary run of the case, as this material which is urgent during the earlier stages of the analysis is not deep. We have to deal at first only with more or less far-going displacements of the deep impulse. And the deep material itself is only reached later and by degrees, so that no sudden appearance of unmanageable quantities of anxiety is to be hesitorially anticipated. In exceptional cases, however, owing to some peculiarities in the structure of the neurosis, deep impulses may be urgent at a very early stage of the analysis. We are then faced by a dilemma. If we give an interpretation of this deep material, the resultant amounts of anxiety produced in the patient may be so great that his sense of reality may not be sufficient to permit of its accomplishment, and the whole analysis may be jeopardised, but, it must not be thought that, in such critical cases as we are now considering, the difficulty can necessarily be avoided simply by not giving any interpretation or by giving more superficial interpretations of non-urgent material or by attempting reassurances. It seems probable, in fact, that these alternative procedures may do little or nothing to obviate the trouble, on the contrary, they may even exacerbate the tension created by the urgency of the deep impulses which are the actual cause of the threatening anxiety. Thus the anxiety may break out in spite of these palliative efforts and, if so, it will be doing so under the most unfavourable conditions, that is to say, outside the mitigating influences afforded by the mechanism of interpretation. It is possible, therefore, that, of these alternative procedures which are open to the analyst faced by such a difficulty. The interpretation of the urgent id-impulses, deep though they may be, will actually be the safer.
It is, of course, a matter of common experience, that it possible with certain patients to continue indefinitely giving interpretations without producing any apparent effect whatever. There is an amusing criticism of this kind of ‘interpretation-fanaticism’ in the excellent historical chapter of Rank and Ferenczi. But it is clear from their words that what they have in mind are essentially extra-transference interpretations, for the burden of their criticism is that such a procedure implies neglect of the analytic situation. This is the simplest case. Where a waste of time and energy is the main result. But there are other occasions, on which a policy of giving strings of extra-transference interpretations is apt to lead the analyst into more positive difficulties. Attention was drawn by Reich a few years back, in the course of some technical discussions in Vienna too a tendency among inexperienced analysts to get into trouble by eliciting from the patient great quantities of material in a disordered and unrelated fashion: This may, be maintained, be carried to such lengths that the analysis is brought to an irremediable state of chaos. He pointe out truly that the material we have to deal with is stratified and that it is highly important in digging it out not to interference, more that we can help with th e arrangement of that state. He had in mind, of course, the analogy of an incompetent archaeolist, whose clumsiness may obliterate for all time the possibility of reconstructing the history of an important site. However, the results in the case of a clumsy analysis do not hold of any pessimistic cause to happen, as it were, re-stratification itself of its own accord if it is given the opportunity; That is to say, in the analytic situation. At the same time, is that of the presence of the risk, and it seems to be particularly likely to occur where extra-transference interpretation is excessively or exclusively restored to. The means of preventing it, and the remedy if it has occurred, lie in returning to transference interpretation at the point of urgency. For if we can discover which of the material is ‘immediate’ in the sense that the problematic occurrence enabling stratification is automatically solved, and it is a characteristic if most extra-transference material that it has no immediacy and consequently stratification is far more difficult to decipher. The measures suggested by Reich himself for preventing the occurrence of this state of chaos are consistent with those that he stresses the importance of interpreting resistance as opposed to the primary id-impulses themselves - and this, was a policy that was laid down at an early stage in the history of analysis. But it is, of course, one of the characteristics of a resistance that it arises in relation to the analyst. Thus, interpretation of a resistance will almost inevitably be a transference interpretation.
But the most serious risks that arise from the making of extra-transference interpretation are due to the inherent difficulty in completing their interpretation, for a successful outcome as such, depends upon his ability, at which time of the emergence into consciousness and the released quantity of id-energy. They are from their nature unpredictable in their effects. There seems to be a special risk of the patient not carrying through to a competed interpretation, hitherto, namely that the extreme liability of the analyst’s position as auxiliary super-ego, is that, the analytic situation is all the time threatening to degenerate into a ‘real’ situation. It means that the patient is all the time perched upon the circumference edge-horizon of turning the external object (the analyst) into the archaic one, but of projecting the id-impulse that has been made conscious on to the analyst. This risk, no doubt, applies to some extent to transference interpretations. However, the situation is less likely to arise when the object of the id-impulses is actually present and is moreover the same person as the maker of interpretation. We may, once, more, recall the problem of ‘deep’ interpretation, and point out that its dangers, even in the most unfavourable circumstances, seem to be greatly diminished if the interpretation in question is a transference interpretation. Even so, there appears to be more of a chance that in this whole process occurring silently and so being overlooked in the case of an extra-transference interpretation, particularly in the earlier stages of an analysis. For this reason, it would seem to be important after giving an extra-transference interpretation to be specially in the ‘qui-vive’ for transferences complications. This last peculiarity of the extra-transference interpretation is actually one of their most important from a practical stand-point. For on account of it they can be made to act as ‘feeders’ for the transference situation, and so to pave the way for mutative interpretations. In other words, by giving an extra-transference interpretation, the analyst can often provide a situation in the transference of which he can then give a mutative interpretation.
Therefore, it is probable that a large majority of our interpretations are outside the transference - though it should be added that it often happens that one is ostensibly giving an extra-transference interpretation one is implicitly giving a transference one. A cake cannot be made of nothing but currants, and, though it is true that extra-transference interpretations, are not for the most part, mutative and do not they bring about the crucial results that involve a permanent change in the patient’s mind. They are, nonetheless essential, if taken to an analogy of trench warfare, the acceptance of a transference interpretation corresponds to the capture of a key position, while the extra-transference interpretations correspond to the general advance and to the consolidation of a fresh line of defence, which are made possible by the capture of the key position. But when this general advance goes beyond a certain point, there will be another check, and the capture of a further key position will be necessary before progress can be resumed. An oscillation of this kind between transference and extra-transference interpretations will represent the normative course of events in an analysis.
Although the giving of mutative interpretations may thus only occupy a small portion of psycho-analytic treatment, it will, upon being, that the most important part from the point of view of deeply exerting affective percussions. Do so, because of the influencing characteristic confirmations as drawn upon the spoken-exchange of the patient’s mindful knowing, in that the individuals that feel, perceive, think, wills, and especially reasons are all taken into heedful compliance. It may be of interest to consider how a moment which is such importance to th e patient affects the analyst himself. Mrs. Klein has suggested that there must be some quite special internal difficulty as to involve the analyst in interpretations. This is shown in their avoidance by psycho-therapists of non-analytic schools, but many psycho-analysts will be aware of traces of the same tendency in themselves. It may be rationalized into mutative interpretations. This is shown in the avoidance by psycho-therapists of non-analytic schools, in that, are not many consisting of a psycho-analyst flow of some passing over the peculiarity of empty space or the nothingness to themselves, nonetheless, this dialectic awareness traces of the same tendency as 1in themselves. But behind this there is somewhat of a lurking difficulty in the actual giving of the interpretation, for there seems to be a constant temptation for the analyst to do something else instead. Questions may be asked of whether o r not. As given to the reassurances or advice or discourses upon theory, or may give interpretations -but interpretations that are not mutative, extra-transference interpretations, interpretations that are non-immediate, or ambiguous, or in exacting of two or more alternative interpretations simultaneously, or he may, perhaps, give interpretations and at the same time, show his own scepticism about them. All of this strongly suggests that the giving of a mutative interpretation is a crucial act for the analyst as well as for the patient. And this inturn will become intelligible when we reflect that at the moment of interpretation the analyst is in fact deliberately Evoking a quantity of the patients id-energy while it is a live and actual and unambiguous and aimed directly himself. Such a moment must be above all others put to the test his relations with his unconscious impulses.
Psychoanalysis, since the earliest days of the, Studies on Hysteria (Breuer and Freud, 1993-1905), have always given special attention to the transference and to the interpretation of transference, believing it to be central in our theory and technique. While there, has never been a lack of interest in transference interpreting. It is not clear why this is so, and the reasons may vary in different parts of the international psychoanalytic community. In America, at least, Gill’s (1982) recent, and somewhat radical presentation of transference interpretation has surely helped to the grasping upon our developing attentions, nevertheless, of another reasons for our intensified interests in transference interpretation is the opportunity it provided for rhetorically dialectic awareness, in that discussions, have lead us to the diverse analytic theories and techniques that today complete of the global diversities in our lives’. Our attentions and allegiance. In this respect, transference interpretation seems to have replaced self-psychology as the encompassing topic that allows analysts of varied persuasions among many structural and fundamental elements that forge out the shape for taking upon the imparting of instinctual information, as to know, and knowing that you know, however, its depthful concerning contemplations are distinguished by the evolving characterizations that are of knowing that you know is really n1othing whatsoever.
Despite the diversity of the transference and its interpreting in analytic process and cure, differing only in whether transference is everything or almost everything to give a clear-cut definition of what transference is.
Laplanche and Pontalis (1973) had written that, ‘The reason it is so difficult to produce a definition of transference is that for many authors the notion has taken on a very broad extension, even coming to connote all the phenomena which constitute the patient’s relationship with the psychoanalyst, as a result the concept is burdened down more than any other with each analyst’s particular view on the treatment - on its objective, dynamics, tactics, scope, and so forth. The question of the transference is thus beset by a whole series of difficulties which have been the subject of debate in classical psychoanalysis.’
Sandler (1983) has discussed how the terms transference and transference resistance, as well as other terms have undergone profound changes in meaning as new discoveries and new trends of psycho-analytic technique assume ascendency. He said, . . . major changes in technical emphasis brought about the extension of the transference concept, which now has dimensions of meaning which differ from the official definition of the term. I am not sure there has ever been a simplified definition of the term. While a certain flexibility of definition makes conversation possible in a field of diverse views, which we may never be clear on what any two people mean when they use the term is a significant disability to our discourse.
However: with this in mind we might review one of Freud’s last comments on transference. In ‘An Outline of Psycho-Analysis’ (1940), published posthumously, he wrote on the analytic situation:
The most remarkable thing is this. The patient is not satisfied with regarding the analyst in the light of reality as a helper and advisor who, moreover, is remunerated for the trouble he takes and who would himself be content with some role that of a guide on a different mountain to climb, on the contrary, the patient sees in him, the return, and the reincarnation, of some important figure out of his childhood or past, and consequently transfer onto him, feelings and reactions which undoubtedly apply this prototype. This fact of transference soon proves to be a factor of an undreamt-of importance, on the other hand bud an instrument of irreplaceable value and on the other, that he set out on a different undertaking without any suspicion to the extraordinary power that would be at his command. . . .
Another advantage of transference, too, in that in it the patient produces before us with plastic clarity an important part of his life-story, of which he would, otherwise have probably given us only an insufficient account. He acts it before us, as it were, instead of reporting it to us.
Freud saw the transference interpretation as a method of strengthening the ego against past unconscious wishes and conflicts.
It is the analyst’s task constantly to tear the patient out of his menacing illusions and to show him again and again, of what it takes to be or begin of a new life, are the reflections of the past. And least, he should fall into a state in which he is inaccessible to all evidences, the analyst takes that neither the love nor the hostility reaching an extreme height. This is effected, by preparing him in good time for these possibilities and by not overlooking the first signs of them. Careful handling of the transference on these lines is as a role richly rewarded. If we succeed, as we usually can, in enlightenment the patient on the true nature of the phenomena of the transference, we thus have struck a powerful weapon out of the hand of his resistance and will have converted dangers into gains. For a patient never forgets again what he has experienced in the form of transference, it carries a greater force of conviction than anything he can acquire in other ways.
We have used the term ‘transference’ several times, and in the last, we attributed the therapeutic results to the transference without further definition of the word. As our concerning considerations are more closely intertwined by its emotional relationship, which the word or, perhaps, a combination of words, by which something can be called and by means of which it can be distinguished or identified. During a psychoanalytic treatment, the patient allows the analyst to play a predominating role in his emotional life. This is of great importance in the analytic process. After the treatment for and situation is changed. The patient builds up feelings of affection for the resistance to his analyst which, in their ebb ans flow, so exceed the normal degree of feeling that the phenomenon has long since actuated the theoretical interests of the analyst. Freud studied this phenomenon thoroughly, explained it, and gave it the name ‘transference’
I cannot reproduce for you, all of Freud’s research about the transference, bu t must limit myself to essentials, such as the statement of ‘counter-transference’, is the emotional attitude of the analyst toward the patient, the analyst toward his charge, the therapist toward the patient. The feeling which the child develops for the mentor is conditioned by a much earlier relationship to someone else. We must take cognizance of this fact in order to understand these relationships. The tender relationship which go to make up the child’s love life are no longer strange to us. Many of these have already been touched upon in the foregoing contentual frames. We have learned how the small boy takes the father and mother as love objects. We gave in following the strivings which arose in this relationship, the oedipus situation, in that we have seen how this runs its course and terminates in an identification with the parent. We have also had opportunity to consider the relationship between brothers and sisters, how their original rivalry is transformed into affection through the pressure of their feeling for the parent. We know that the boy at puberty must give up his first love objects within the family and transfer his libido to individuals exteriority or outside of the family. not allows the analyst to play a predominating role in his emotional life. This is of great importance in the analytic process, after all the treatment for and situation is changed, as the patient builds up feelings of affection for the resistance to his analyst which, in their ebb and flow, exceed the normal degree of feeling that the phenomenon has long since actuated the theoretical interests of the analyst. Freud studied this phenomenon thoroughly, explained it, and gave it the name ‘transference’
I cannot reproduce for you, all of Freud’s research about the transference, but must limit myself to essentials, such as the statement of ‘counter-transference’, is the emotional attitude of the analyst toward the patient, the analyst toward his charge, the therapist toward the patient. The feeling which the child develops for the mentor is conditioned by a much earlier relationship to someone else. We must take cognizance of this fact in order to understand these relationships. The tender relationship which go to make up the child’s love life are no longer strange to us. Many of these have already been touched upon in the foregoing contentual frames. We have learned how the small boy takes the father and mother as love objects. We gave in following the strivings which arise in this relationship, the oedipus situation, we have seen how this runs its course and terminates in an identification with the parent. We have also had opportunity to consider the relationship between brothers and sisters, how their original rivalry is transformed into affection through the pressure of their feeling for the parent. We know that the boy at puberty must give up his first love objects within the family and transfer his libido to the individuals exteriority or outside of the family.
The key to understanding the essential pathology as well as the therapeutical impasse was in the failure of the patient to develop a reliable working relation with the analyst. In each case the patient was unable to either establish or maintain a durable working alliance with the analyst and the analyst neglected this fact, pursuing instead the analyst of other transference phenomena, as this error in technique was observable in psychoanalysts with a wide range of clinical experience and to recognize the same shortcomings when resuming the transference interpretations.
In this connection, and, if transference is to be regarded as a significant ego function, a number of inferences are rather obvious. One is that analysis does not ‘cause’ transference. Yet, although not caused by analysis, transference as it occurs in analysis does seem unique. What is unique, however, may not be transference itself, but rather the effect upon transference of the unique conditions of the analytic situation. These conditions may affect most strongly such things as the choice of content of transference reaction, the intensity of these reactions, their exclusiveness, and their sharp focus on the person of the analyst. Although, as a result of these conditions, transference developments in analysis may differ from those occurring elsewhere, this does not mean that in analysis transference as a function is any different.
Another rather obvious inference, following from the first, is that transference can never be resolved. The content may be, but not the function. Through analysis, the symptomatic, neurotic and historical plexuity have been brought into the transference may be resolved, but not the function itself. The function of transference, like other functions of the ego, may be affected by analysis in many ways, but it never goes away.
Still, another inference is a general one concerning transference and the analyst. If transference is to be regarded as an ever active ego function, then the analyst’s transference goes on all the time too, just like the patient’s, and despite what he might wish to think. His transference has not been resolved in his own analysis. Admittedly, the impact of the analytic situation upon the analyst is vastly different from what it is upon the patient, but many aspects of that situation do favour development in the analyst of transference relations involving his patient. This does not mean, however, that it would be correct too believe the analyst should attempt to inhibit his transference function, much less disavow it. Yet, what the analyst should do about this transference is a question that has never been significantly pondered over. Aside from any belief that the analyst’s transference is remarkably useful in the process of analysing and may be essential for certain aspects of analysis, what can be said?
Would it be wrong, to propose that this ego function be dealt within the same way the analyst deals with his other ego function? Just as the analyst must consciously regulate his responses to the functions in order to create and sustain the analytic situation, should he not also regulate his responses to his transference activity?
This does not mean nor should mean his responses and sustain the analytic situation he not also regulate his responses to his transference activity? This does not mean, not to be thought that the analyst must decide either whether or when a transference reaction to his patient exists. Such an attempt is the point on which has in itself, at least two counts. For one thing, significant transference reactions are usually not conscious, and, fo r another, transference activity in some form is always going on.
In view of these considerations, the simplest position for the analyst to take, and the one most likely to be helped, may be to assume that all feelings and reactions of the analyst concerning the patient are ‘prima-facie’ evidence of the analyst’s transference. Under this arrangement every feeling of warmth, pity, sadness, anger, hope, excitement, even interest, every feeling of coldness, indifference, disinterest, boredom, impatience, discouragement, and every absence of feeling, should be assumed to contain significant elements of the analyst’s transference as focussed on the patient. This would mean, essentially, that everything arising in the analyst about his patient assumed to be part of the substance of analysis, that nothing presents merely the analyst’s ‘real’ reaction to his patient, and that especially when something seems most real it can be counted on to contain important aspects of the analyst’s transference.
Were the analyst to take this rather imperative view of his own transference potential, he might be much more likely to remain abreast of the personal, neurotic meaning of the myriad but often subtle reactions and attitudes he develops toward his patient. This in turn might make it possible for him, at least to keep his transference out of the patient’s way and hopefully to use it to further the analysis.
Th e final inference from all this is perhaps the most promising. This is that transference, if it belongs to the family of ego functions, can be counted on to posses many of this family ‘s characteristics. Thus, presently existing knowledge about the ego should provide many ready-made leads as to the nature of transference. The ego’s way of reality testing, for instance, its responses to internal and external stimuli, its uses of defence mechanisms, may all reveal much about the basic phenomonenology of transference. Similarly, much may be surmised about transference’s functional vicissitudes by assuming that transference suffers the same general developmental and neurotic deficiencies, distortions, limitations, and fixations to which various other functions of the ego are susceptible. A particularly important study would seem to be the special strengths of transference functioning, especially its way of joining with other agencies to serve and facilitate the individual’s idiosyncratic interests and developments. Such a study, for instance, might centre on the ego’s object relations to the reference to the question of whether transference is the ego function mainly responsibly for their development.
Viewing transference in this way as an ego function means, of course, relinquishing certain elements of our existing viewpoint. One prominent feature of these existing viewpoints, no matter what form they take, is how hard they are to define or even to elicit. Another is how unquestioning we seem to be about the viewpoints we grew up with, how easily we assume transference to be, but a therapeutically helpful given, an isolated psychological event having little to do with other psychological event s, and, except in the analytic situation, to be lacking useful purpose. Assigned, without even wondering why, to neither ego nor id, it is usually dropped somewhere in-between. Labelled but rarely described, it is most commonly called a ‘projection’ or a ‘repetition’ of the past, neither of them labels of great distinction.
Nevertheless, no matter how inadequate the form in which transference presently exists, it is a form that is deeply entrenched and that does not beg for change. Accordingly, wresting transference from its syntonic limbo is not likely to be easy and may be impossible, but doing so, bringing it out into open view where it can be contemplated as a major member of the ego family, is an utterly fascinating prospect, one that permits one to see transference not only as the best tool clinical analysis has, but possibly the best tool the ego has. It well may be, as Freud suggested, the basis of all human relationship and, as suggested, many may be involved in all the ego’s differentiations, integrative and creative capacities. It is these aspects of transference that offer the most exciting questions, and it is with these questions that we will continue.
Without minor exceptions or flaws we are founded against the realm of fact that holds with the distinctive quality of being actual, but, nonetheless, it was from very early times that Freud had called attention to the fact that transference manifested itself in two ways - negatively as well as positively - a good deal less said or known about the negative transference than about the positive. This, of course, corresponds to the circumstance that interest in the destructive and aggressive impulses in general, is only a comparatively recent development. Transference was regarded predominantly as a libidinal phenomena. It was suggested that in everyone there existed a certain number of unsatisfied libidinal impulses, and that whenever some new person came upon the scene these impulses were readily attach themselves to him. This was the account of transferences a universal phenomenon. In neurotics, owing to the abnormally large quantities of unattached libido present in the tendency to transference would be correspondingly greater, and the peculiar circumstances of the analytic situation would further increase it. It was evidently the existence of these feelings of love, thrown by the patient upon the analyst, that provided the necessary y extra force to induce his ego to give up its resistance, undo the repressions and adopt a fresh solution of its ancient problems. This instrument, without which no therapeutic result could be obtained, was at once seen to be no stranger; it was in fact the familiar power of suggestion, which had ostensibly been abandoned long before. Now, however, it was being employed in the very different way, in fact in a contrary direction. In pre-analytic days it had aimed at bringing about an increase in the degree of repression, now it was used to overcome the resistance of the ego, that is to say, to allow the repression to be removed.
But the situation became more and more complicated as more facts about transference came to light. In the first place, the feelings transferred turned out to be of various sorts, besides the loving ones there were the hostile ones, which were naturally far from assisting the analyst’s efforts. But, even apart from the hostile transference. The libidinal feelings themselves fell into two groups; friendly and affectionate feeling which were capable of being conscious, and purely erotic ones which has usually too remain unconscious. And these latter feelings, when they became too powerful, stirred up the repressive forces of the ego and thus increased its resistances instead of diminishing them, and in fact produced a state of things that was not easily distinguishable, from a negative transference. And beyond all this there arose the whole question of the lack of permanence of all suggestive treatments. Did not the existence of the transference threaten to leave the analytic patient in the same unending dependence upon the analyst?
All of these difficulties were got over by the discovery that the transference itself could be analysed. Its analysis was soon found to be the most important part of the whole treatment. It was possible to make consciously its roots in the repressed unconscious just as it was possible to make conscious any other repressed material - that is, by inducing the ego to abandon its resistance - and there was nothing self-contradictory in the fact that the forces used for resolving the transference was the transference itself. And once it had been made conscious, its unmanageable, infantile, permanent characteristics disappeared, what was left was like any other ‘real’ human relationship. But the necessity for constantly analysing the transference became still more apparent from another discovery. It was found that, as work proceeded the transference tended, as, it were, to eat up the entire analysis. More and more of the patient’s libido became concentrated upon their relation to the analyst, the patient ‘s original symptoms were drained of their cathexis, yet and there appeared instead an artificial neurosis to which Freud gave the name of the ‘transference neurosis’. This original conflict, which have to the onset of neurosis, began to be re-enacted in the relation to the analyst, now this unexpected event is far from being the misfortune than at first. Sight it might seem to be. In fact, it gives us our great opportunity. Instead, of having to deal as best we may with conflicts of the remote past, Which are concerned with dead circumstances and mummified personalities, and whose outcome is already determined, we find ourselves involved in an actual and immediate situation, in which we and the patient are the principal characters and the development of which is to some re-extent, at least under control. But if we bring it about, that in this revivified transference conflict the patient chooses a new solution instead of the old one, a solution in which the primitive and unadaptable methods of repression is replaced by behaviour more in contact with reality, then, even after his detachment from the analysis, he will never be able to fall back into his former necrosis, the solution of the transference conflict implies as the simultaneous solution of the infantile conflict of which it is a new edition. The ‘blame’, says Freud in his, ‘Introductory Lectures‘ has been made possible by alterations in the ego’s occurring as a consequent of the analyst’s suggestion. At the expense of the unconscious, the ego becomes wider by the words of interpretation. In which brings the unconscious material into consciousness; through education it becomes reconciled to the individual and is made willing to grant it a certain degree of satisfaction, and its horror of the claim of its libido is lessoned by the new capacity it acquires to expend a certain amount of the libido in sublimation, the more nearly the course of the treatment corresponds with this ideal description the greater will be the success of the psycho-analytic therapy.
Freud made it clear that the ultimate factor in the therapeutic action of psychoanalysis was suggestion on the part of the analyst acting upon the patient’s ego in such a way as to make it more tolerant of the libidinal trends. However, Freud had produced extremely little that bears on the subject, and that little goes to show that he had not altered his views on the main principles involved. In additional lectures which were published last year, he explicitly states that he has nothing to add to the theoretical discussions upon therapy given in the original lectures fifteen years earlier. At the same time, there has in the interval been a considerable further development of his theoretical opinions. And especially in the region of ego-psychology. He had, in particular, formulated the concept of the super-ego. The restatement in super-ego terms of analysis may not involve many changes. But it is reasonable of resistance information about the super-ego will be of special interest from our point of view, and in two ways. In th e first place, it would at first glance seem highly probable that the super-ego should play an important part, direct or indirect, in the setting up and maintaining of the repressions and resistances the demolition of which has been the chief aim of analysis, and is confirmed by an examination of the classification of the various kinds of resistance made by Freud in, ‘Hemmung Symptom and Amgst’ (1926). Of the five sorts of resistance there mentioned it is true that only one is attributed to the direct intervention of the super-ego, but two of the ego-resistances - the repression resistance and the transference resistance - although actually originally from the ego, as a rule set up by out of fear of the super-ego. It seems likely enough therefore that when Freud wrote the words which, in effect, are the favourable change in the patient. ‘Is made possible by alterations in the ego’, he was thinking, in part at all events, of that portion of the ego which he subsequently separated off into the super-ego? Quite apart from this, moreover, in another of Freud’s more recent works, ‘The Group Psychology’ (1921), there are passages which suggest a different point - namely, that it may be largely through the patient’s super-ego that the analyst on the nature of hypnosis and suggestion. He definitely rejects Bernheim’s view that all hypnotic phenomena are traceable to the factor of suggestion, and adopts an alterative theory that suggestion is a partial manifestation of the state of hypnosis. The state of hypnosis, again, is found in certain respects, to resemble the state of being in love. There is, ‘the same humble subjection, the same compliance, the same absence of criticism toward the hypnotist as towardly the loved object, has stepped into the place of the subject’s ego-ideal’. Now since suggestion is a partial form of hypnosis and since the analyst brings about his changes in the patient’s attitude by means of suggestion. It seems to follow that the analyst owes into effectiveness, at all events in some respects, to his having stepped into the place of th e patient’s super-ego. Thus, there are two convergent lines of argument which point to the patient’s super-ego as occupying a key position in analytic therapy. It is a part of the patient’s mind in which a favourable alteration would be likely to lead to general improvement, and it is a part of the patient’s mind which is especially subject to the analyst’s influence.
Such plausible notions as these were followed up almost immediately after the super-ego made its first début. It has been developed by Ernest Jones, for instance, in his paper on, ‘The Nature of Auto-Suggestion’. Soon thereafter, Alexander launches his theory that the principal aim of all psycho-analytic therapy must be the complete demolition of the super-ego and the assumption of its functions by the ego. According to his account, the super-ego are handed over to the analyst, and in the second phase they are passed back again to th e patient, but this time to his ego. The super-ego, according to this view of Alexander’s (though he explicitly limits his use of the word to the unconscious parts of the ego-ideal), is a portion of the fundamental apparatuses which is essentially primitive, out of data and out of touch with reality, which is incapable of adapting itself, and which operates automatically, with the monotonous uniformity of a reflex. Any useful functions that it performs can be carried out by the ego. And there is therefore, nothing to be done with it but to discard it. This wholesome attack upon the super-ego seems to be of questionable validity. It seems probable that its abolition, even if that were practical politics, would involve the abolition of a large number off highly desirable mental activities. But the idea that the analyst temporarily takes over the functions of the patient’s super-ego during the treatment and by so doing on some way alters it agrees with the tentative literatures.
So, too, do some passages in a paper by Radô upon ‘The Economic Principle in Psycho-Analytic Technique’. The second, as such was to have dealt with psych-analysis, that in which has unfortunately never been published, but the first one, on hypnotism and catharsis, contains much that is of interest. It includes a theory that the hypnotic subject introjects the hypnotist in the form of what Radô calls a ‘parasitic super-ego’, which draw off the energy and takes over the functions of the subject’s original super-ego. One feature of the situation brought out by Radô is the unstable and temporary nature of this whole arrangement. If, for instance, the hypnotist gives a command, which is too much in opposition to the subject’s original super-ego. The parasite is promptly excluded. And, in any case, when the state of hypnosis comes to an end, the sway of the parasite super-ego also terminates and the original super-ego resumes its functions.
However debatable may be the details of Radô description, it not only emphasizes once again, the notion of the super-ego as the function of psych-therapy, but it draws attention to the important distinction between the effects of hypnosis and analysis in the matter of permanence. Hypnosis acts essentially in a temporary way, and Radô theory of the parasitic super-ego, which does not really replace the original one but merely throws it out of action, gives a very good picture of its apparent workings. Analysis, on the other hand, in so far as it seeks to effect the patient’s super-ego, aims at something much more far-reaching and permanent - namely, at an integral change in the nature of the patient’s super-ego itself. Some even more recent developments in psych-analytic theory give a hint, so it seems as though it seems as the kind of thing, that along which a cleaver understanding of the question may perhaps be reached.
This latest growth of theory has been very much occupied with the destructive impulses and has brought them for the first time into the centre of interests, and attention has at the same time been concentrated on the correlated problems of guilt and anxiety. That is to say, that in the mind, especially are the ideas upon the formation of the super-ego, recently developed by Melanie Klein and the importance which she attributes to the processes of ‘introjection’ and ‘projection’ in the development of the personality. In a schematic outline, the individual, she holds, is perpetually introjecting and projecting the objects of its id-impulses, and the character of the introjected objects depends on the character of the id-impulses, directed toward the external objects. Thus, for instance, during the stage of a child’s libidinal development in which it is dominated by feelings of oral aggression, its feelings toward its external object will be orally aggressive; It will then introject the object, and the introjected object will now act (in the manner of a super-ego) in an orally aggressive way toward the child’s ego. (The next even will be the projection of this orally aggressive introjected object back onto the external object, which will now in its turn appear to be orally aggressive). The fact of the external object being thus felt as dangerous and destructive once more causes the id-impulses to adopt an even more aggressive and destructive attitude toward the object in self-defences. A vicious circle is thus launched in the celebrations that this process seeks to account for the extreme severity of the super-ego, in that of small children, as well as for their unreasonable fear of outside objects. In the course of the development of the normal individual, his libido eventually reaches the genital stage, at which the positive impulses predominant, and his attitude toward his external objects will thus become more friendly. That according to his introjected object, or super-ego will become less severe and his ego’s contact with reality will be less distorted. In the case of the neurotic, however, for various reasons - whether an account of frustration of the destructive components - development to the genital stage does not occur, but the individual remains fixated at a pre-genital level. His ego is thus left exposed to the pressure of a savage id on the one hand and a correspondingly savage super-ego on the other, and the vicious circle is perpetuated.
At the arriving considerations that are marked and noted, through which the essence of functional dynamics as based of the transference in the psychoanalytic process or the basic underlying the most basic of beliefs that in politics there is neither good nor evil, however, in that something that forms part of the minimal body, character or structure of that thing predetermines the properties to the good life. Nonetheless, most psychoanalysts maintain that schizophrenic patients cannot be treated psychoanalytically because they are too narcissistic to develop with the psychotherapist as interpersonal relationship that is sufficiently reliable and consistent for psychoanalytic work. Freud, Fenichel and others have recognized that a new technique of approaching patients psychoanalytically must be found if analysts are to work with psychotics. Among those who have worked successfully in recent years with schizophrenics, Sullivan, Hill, and Karl Menninger and his staffs have made various modifications of their analytic approach. The techniques that are in use with psychotics are different from our approach to psychoneurotics. This is not a result of the schizophrenic’s inability to build up a consistent personal relationship with the therapist but due to his extremely intense and sensitive transference reactions.
Let us see first what the essences of the schizophrenic’s transference reactions are and how we try to meet these reactions.
We think of a schizophrenic as a person who has had serious traumatic experiences in early infancy at a time when his ego and its ability to examine reality were not yet developed. These early traumatic experiences seem to furnish the psychological basis for the pathogenic influence of the flustrations of later years. At this early time the infant lives grandiosely in a narcissistic world of his own. His needs and desires seem to be taken care of by something vague and indefinite which he does not yet differentiate. As Ferenczi noted, they are expressed by gestures and movements since speech is as yet undeveloped. Frequently the child’s desires are fulfilled without any expression of them, a result that seems to him a product of his magical thinking.
Are a person’s characteristics primarily shaped by early influences, remaining relatively stable thereafter throughout life? Or does change spontaneously occur continuously throughout life? Many people believe that early experiences are formative, providing a strong or weak foundation for later psychological growth. This view is expressed in the popular saying ‘As the twig is bent, so grows the tree.’ From this perspective, it is crucial to ensure that young children have a good start in life. But many developmental scientists believe that later experiences can modify or even reverse early influences; studies show that even when early experiences are traumatic or abusive, considerable recovery can occur. From this vantage point, early experiences influence, but rarely determine, later characteristics.
Traumatic experiences in this early period of life will damage a personality more seriously than those occurring in later childhood such as are found in the history of psychoneurotics. The infant’s mind is more vulnerable the younger and less used it has been, furthers, the trauma has quickened the infant ‘s egocentricity. In addition early traumatic experiences shorten the only period in life in which an individual ordinarily enjoys the most security, thus endangering the ability to store up as it was a reasonable supplies of assurance and self-reliance for the individual’s later struggles through life. Thus, as such, a child sensitized considerably more toward the frustrations of later like than by later traumatic experiences. hence many experiences in later life which would mean little to a ‘healthy’ person and not much to a psychoneurotic, mean a great deal of pain and suffering to the schizophrenic. His resistance against frustration is easily exhausted.
Once he reaches his limit of endurance, he escapes the unbearable reality of his present life by attempting to reestablish the autistic, delusional world of the infant, but this is impossible because the content of his delusions and hallucinations are naturally coloured by the experiences of his whole lifetime.
How do these developments influence the patient’s attitude toward the analyst and the analyst’s approach to him?
Due to the very damage and the succeeding chain of frustrations which the schizophrenic undergoes before finally giving in to illness, he feels extremely suspicious and distrustful of everyone, particularly of the psychotherapist ho approaches him with the intent of intruding into his isolated world and personal life. To him the physician’s approach means the threat of being compelled to return to the frustrations of real life and to reveal his inadequacy to meet them or, - still worse – a repetition of the aggressive interference with his initial symptoms and peculiarities which he has encountered in his previous environment.
The difficulty that the patient’s dilemma through his frustrations is the product through which is called ‘delusion’: Delusion itself is a false belief which is firmly held by a person even though other people recognize the belief as obviously untrue. For example, a person who truly believes he is Napoleon Bonaparte is delusional. Religious beliefs or popular conceptions, such as the beliefs that people have been abducted by aliens, are not delusions because they are widely held beliefs. Delusions are a type of psychotic symptom that indicate a person has lost contact with reality.
There are many different types of delusions. A person with a paranoid delusion believes that others - such as the FBI, or the CIA, even the Mafia as trying to harm or plot against him. A person with a delusion of reference believes that events or people refer specifically to him or her when they do not. For example, a woman with schizophrenia may believe that a television news broadcaster is talking personally to her rather than to the entire viewing audience. A grandiose delusion is a belief that one is extremely famous or that one has special powers, such as the ability to magically heal people.
A delusion of control is a belief that others are able to control one’s thoughts, feelings, or actions. For example, a man with this type of delusion may believe that someone has implanted a microchip in his brain that enables other people to control his thoughts. A somatic delusion is a belief that something is wrong with one’s body - for example, that one’s brain is rotting away - even though no medical evidence supports this belief. A person with an erotic delusion believes that someone is in love with him or her despite a lack of evidence for this belief. In a delusion of jealousy, a person believes that his or her spouse or lover is unfaithful despite evidence to the contrary.
Delusions commonly occur in certain severe mental illnesses, such as schizophrenia, bipolar disorder (also called manic-depressive illness), some cases of major depression, Dissociative disorders, post-traumatic stress disorder, and paranoid personality disorder. In addition, delusions may result from abuse of certain drugs, including alcohol, cocaine, amphetamines, and hallucinogens such as lysergic acid diethylamide (LSD), phencyclidine (PCP), and mescaline. Medical conditions affecting the brain, such as syphilis and brain tumours, may also cause delusions.
Delusional disorder is a relatively uncommon mental illness characterized by delusions. People with this disorder have one or more delusions that persist for at least one month. In addition, they do not suffer from other symptoms of schizophrenia, such as disorganized speech and bizarre behaviour. Usually their delusions are less bizarre than those that occur in schizophrenia and seem merely odd or unsupported by facts. Examples of nonbizarre delusions include beliefs that one is being followed, loved by someone famous, or deceived by one’s spouse. Because delusional disorder is relatively rare, little research has systematically examined its treatment. However, doctors most often use Antipsychotic drugs (also called neuroleptics) to treat this disorder. These drugs help reduce or eliminate delusions, hallucinations, and other psychotic symptoms.
In spite of his narcissistic retreat, every schizophrenic has some underlying notion of the unreality and loneliness of his substitute delusionary world. He longs for human contact and understanding, yet is afraid to admit of himself, or his therapist for fear of further frustration.
That is why the patient may take weeks and months to test the analyst before being willing to accept him, however, once he has accepted him. His dependence on the analyst is greater and he is more sensitive about it than is the psychoneurotic because of the schizophrenic’s deeply rooted insecurity, the narcissistic seemingly self-righteous attitude is but a defence.
Whenever the analyst fails the patient from reasons to be discussed later - one cannot at times avoid failing one’s schizophrenic patients - it will be severe disappointment and a repetition of the chain of frustrations the schizophrenic has previously endured.
The instinctually primitive part of the schizophrenic’s mind that does not discriminate between himself and the environment, it may mean the withdrawal of the impersonal supporting forces of his infancy. Severe anxiety will follow this vital deprivation.
In the light of his personal relationship with the analyst it means that the therapist seduced the patient to use him as a bridge over which he might possibly be led from the utter loneliness of his own world to reality and human warmth, only to have him discover that this bridge is not reliable. if so, he will respond helplessly with an outburst of hostility or with renewed withdrawal as may be seen most impressively in catatonic stupor.
The symptoms of mental illness can be very distressing. People who develop schizophrenia may hear voices inside their head that say nasty things about them or command them to act in strange or unpredictable ways. Or they may be paralysed by paranoia—the deep conviction that everyone, including their closest family members, wants to injure or destroy them. People with major depression may feel that nothing brings pleasure and that life is so dreary and unhappy that it is better to be dead. People with panic disorder may experience heart palpitations, rapid breathing, and anxiety so extreme that they may not be able to leave home. People whom experience episodes of mania may engage in reckless sexual behaviour or may spend money indiscriminately, acts that later cause them to feel guilt, shame, and desperation.
Other mental illnesses, while not always debilitating, create certain problems in living. People with personality disorders may experience loneliness and isolation because their personality style interferes with social relations. People with an eating disorder may become so preoccupied with their weight and appearance that they force themselves to vomit or refuse to eat. Individuals who develop post-traumatic stress disorder may become angry easily, experience disturbing memories, and have trouble concentrating.
Experiences of mental illness often interact differently but depend on one’s culture or social group, sometimes greatly so. For example, in most of the non-Western world, people with depression complain principally of physical ailments, such as lack of energy, poor sleep, loss of appetite, and various kinds of physical pain. Indeed, even in North America these complaints are commonplace. But in the United States and other Western societies, depressed people and mental health professionals who treat them tend to emphasize psychological problems, such as feelings of sadness, worthlessness, and despair. The experience of schizophrenia also differs by culture. In India, one-third of the new cases of schizophrenia involve catatonia, a behavioural condition in which a person maintains a bizarre statue like pose for hours or days. This condition is rare in Europe and North America.
With appropriate treatment, most people can recover from mental illness and return to normal life. Even those with persistent, long-term mental illnesses can usually learn to manage their symptoms and live productive lives.
By a variety of symptoms, including loss of contact with reality, bizarre behaviour, disorganized thinking and speech, decreased emotional expressiveness, and social withdrawal. Usually only some of these symptoms occur in any one person. The term schizophrenia comes from Greek words meaning ‘split mind.’ However, contrary to common belief, schizophrenia does not refer to a person with a split personality or multiple personality. For a description of a mental illness in which a person has multiple personalities. To observers, schizophrenia may seem or appear for being as some sorted kind of madness or a manufacturing insanity.
Perhaps more than any other mental illness, schizophrenia has a debilitating effect on the lives of the people who suffer from it. A person with schizophrenia may have difficulty telling the difference between real and unreal experiences, logical and illogical thoughts, or appropriate and inappropriate behaviour. Schizophrenia seriously impairs a person’s ability to work, go to school, enjoy relationships with others, or take care of oneself. In addition, people with schizophrenia frequently require hospitalization because they pose a danger to themselves. About 10 percent of people with schizophrenia commit suicide, and many others attempt suicide. Once people develop schizophrenia, they usually suffer from the illness for the rest of their lives. Although there is no cure, treatment can help many people with schizophrenia lead productive lives.
Schizophrenia also carries an enormous cost to society. People with schizophrenia occupy about one-third of all beds in psychiatric hospitals in the United States. In addition, people with schizophrenia account for at least 10 percent of the homeless population in the United States. The National Institute of Mental Health has estimated that schizophrenia costs the United States tens of billions of dollars each year in direct treatment, social services, and lost productivity.
Approximately 1 percent of people develop schizophrenia at some time during their lives. Experts estimate that about 1.8 million people in the United States have schizophrenia. The prevalence of schizophrenia is the same regardless of sex, race, and culture. Although women are just as likely as men to develop schizophrenia, women tend to experience the illness less severely, with fewer hospitalizations and better social functioning in the community.
Schizophrenia usually develops in late adolescence or early adulthood, between the ages of 15 and 30. Much less commonly, schizophrenia develops later in life. The illness may begin abruptly, but it usually develops slowly over months or years. Mental health professionals diagnose schizophrenia based on an interview with the patient in which they determine whether the person has experienced specific symptoms of the illness.
Symptoms and functioning in people with schizophrenia tend to vary over time, sometimes worsening and other times improving. For many patients the symptoms gradually become less severe as they grow older. About 25 percent of people with schizophrenia become symptom-free later in their lives.
A variety of symptoms characterize schizophrenia. The most prominent include symptoms of psychosis—such as delusions and hallucinations - as well as bizarre behaviour, strange movements, and disorganized thinking and speech. Many people with schizophrenia do not recognize that their mental functioning is disturbed.
Delusions are false beliefs that appear obviously untrue to other people. For example, a person with schizophrenia may believe that he is the king of England when he is not. People with schizophrenia may have delusions that others, such as the police or the FBI, are plotting against them or spying on them. They may believe that aliens are controlling their thoughts or that their own thoughts are being broadcast to the world so that other people can hear them.
Research suggests that the genes one inherits strongly influence one’s risk of developing schizophrenia. Studies of families have shown that the more close one is related to someone with schizophrenia, the greater the risk one has of developing the illness. For example, the children of one parent with schizophrenia have about a 13 percent chance of developing the illness, and children of two parents with schizophrenia have about a 46 percent chance of eventually developing schizophrenia. This increased risk occurs even when such children are adopted and raised by mentally healthy parents. In comparison, children in the general population have only about a 1 percent chance of developing schizophrenia.
Some evidence suggests that schizophrenia may result from an imbalance of chemicals in the brain called neurotransmitters. These chemicals enable neurons (brain cells) to communicate with each other. Some scientists suggest that schizophrenia results from excess activity of the neurotransmitter dopamine in certain parts of the brain or from an abnormal sensitivity to dopamine. Support for this hypothesis comes from Antipsychotic drugs, which reduce psychotic symptoms in schizophrenia by blocking brain receptors for dopamine. In addition, amphetamines, which increase dopamine activity, intensify psychotic symptoms in people with schizophrenia. Despite these findings, many experts believe that excess dopamine activity alone cannot account for schizophrenia. Other neurotransmitters, such as serotonin and norepinephrine, may play important roles as well.
Although scientists favour a biological cause of schizophrenia, stress in the environment may affect the onset and course of the illness. Stressful life circumstances - such as maturing in age and character as for living in poverty, the death of a loved one, an important change in jobs or relationships, or chronic tension and hostility at home—can increase the chances of schizophrenia in a person biologically predisposed to the disease. In addition, stressful events can trigger a relapse of symptoms in a person who already has the illness. Individuals who have effective skills for managing stress may be less susceptible to its negative effects. Psychological and social rehabilitation can help patients develop more effective skills for dealing with stress.
Although there is no cure for schizophrenia, effective treatment exists that can improve the long-term course of the illness. With many years of treatment and rehabilitation, significant numbers of people with schizophrenia experience partial or full remission of their symptoms.
Treatment of schizophrenia usually involves a combination of medication, rehabilitation, and treatment of other problems the person may have. Antipsychotic drugs (also called neuroleptics) are the most frequently used medications for treatment of schizophrenia. Psychological and social rehabilitation programs may help people with schizophrenia function in the community and reduce stress related to their symptoms. Treatment of secondary problems, such as substance abuse and infectious diseases, is also an important part of an overall treatment program.
Antipsychotic medications, developed in the mid-1950s, can dramatically improve the quality of life for people with schizophrenia. The drugs reduce or eliminate psychotic symptoms such as hallucinations and delusions. The medications can also help prevent these symptoms from returning. Common Antipsychotic drugs include risperidone (Risperdal), olanzapine (Zyprexa), clozapine (Clozaril), quetiapine (Seroquel), haloperidol (Haldol), thioridazine (Mellaril), chlorpromazine (Thorazine), fluphenazine (Prolixin), and trifluoperazine (Stelazine). People with schizophrenia usually must take medication for the rest of their lives to control psychotic symptoms. Antipsychotic medications appear to be less effective at treating other symptoms of schizophrenia, such as social withdrawal and apathy.
Because many patients with schizophrenia continue to experience difficulties despite taking medication, psychological and social rehabilitation is often necessary. A variety of methods can be effective. Social skills training help people with schizophrenia learn specific behaviours for functioning in society, such as making friends, purchasing items at a store, or initiating conversations. Behavioural training methods can also help them learn self-care skills such as personal hygiene, money management, and proper nutrition. In addition, cognitive-behavioural therapy, a type of psychotherapy, can help reduce persistent symptoms such as hallucinations, delusions, and social withdrawal.
Because many patients have difficulty obtaining or keeping jobs, supported employment programs that help patients find and maintain jobs are a helpful part of rehabilitation. In these programs, the patient works alongside people without disabilities and earns competitive wages. An employment specialist (or vocational specialist) helps the person maintain their job by, for example, training the person in specific skills, helping the employer accommodate the person, arranging transportation, and monitoring performance. These programs are most effective when the supported employment is closely integrated with other aspects of treatment, such as medication and monitoring of symptoms.
Some people with schizophrenia are vulnerable to frequent crises because they do not regularly go to mental health centres to receive the treatment they need. These individuals often relapse and face rehospitalization. To ensure that such patients take their medication and receive appropriate psychological and social rehabilitation, assertive community treatment (ACT) programs have been developed that deliver treatment to patients in natural settings, such as in their homes, in restaurants, or on the street.
People with schizophrenia often have other medical problems, so an effective treatment program must attend to these as well. One of the most generally shared in or participated in things conforming to a type without noteworthy excellence or faults just as common a rule, by ordinary, frequent and ordinarily as an idea or expression deficient in originality or freshness, yet, only of its exchanging the commonplace of the common associated problems is vehemently and usually coarsely expressed condemnation or disapproved, as the interpretative category of an unequalled vocabulary is itself a genuine abuse. Successful treatment of substance abuse inpatients with schizophrenia requires careful coordination with their mental health care, so that the same clinicians are treating both disorders at the same time.
The high rate of substance abuse in patients with schizophrenia contributes to a high prevalence of infectious diseases, including hepatitis B and C and the human immunodeficiency virus (HIV). Assessment, education, and treatment or management of these illnesses is critical for the long-term health of patients.
Other problems frequently associated with schizophrenia include housing instability and homelessness, legal problems, violence, trauma and post-traumatic stress disorder, anxiety, depression, and suicide attempts. Close monitoring and psychotherapeutic interventions are often helpful in addressing these problems.
Several other psychiatric disorders are closely related to schizophrenia. In schizoaffective disorder, a person shows symptoms of schizophrenia combined with either mania or severe depression. Schizophreniform disorder refers to an illness in which a person experiences schizophrenic symptoms for more than one month but fewer than six months. In schizotypal personality disorder, a person engages in odd thinking, speech, and behaviour, but usually does not lose contact with reality. Sometimes mental health professionals refer to these disorders together as schizophrenia-spectrum disorders.
Severe mental illness almost always alters a person’s life dramatically. People with severe mental illnesses experience disturbing symptoms that can cause of such difficulties and holding to a job, or go to school, relate to others, or cope with ordinary life demands. Some individuals require hospitalization because they become unable to care for themselves or because they are at risk of committing suicide.
The symptoms of mental illness can be very distressing. People who develop schizophrenia may hear voices inside their head that say nasty things about them or command them to act in strange or unpredictable ways. Or they may be paralysed by paranoia - the deep conviction that everyone, including their closest family members, wants to injure or destroy them. People with major depression may feel that nothing brings pleasure and that life is so dreary and unhappy that it is better to be dead. People with panic disorder may experience heart palpitations, rapid breathing, and anxiety so extreme that they may not be able to leave home. People whom experience episodes of mania may engage in reckless sexual behaviour or may spend money indiscriminately, acts that later cause them to feel guilt, shame, and desperation.
Other mental illnesses, while not always debilitating, create certain problems in living. People with personality disorders may experience loneliness and isolation because their personality style interferes with social relations. People with an eating disorder may become so preoccupied with their weight and appearance that they force themselves to vomit or refuse to eat. Individuals who develop post-traumatic stress disorder may become angry easily, experience disturbing memories, and have trouble concentrating.
Experiences of mental illness often take issue upon its stability for depending on one’s culture or social group, sometimes greatly so. For example, in most of the non-Western world, people with depression complain principally of physical ailments, such as lack of energy, poor sleep, loss of appetite, and various kinds of physical pain. Indeed, even in North America these complaints are commonplace. But in the United States and other Western societies, depressed people and mental health professionals who treat them tend to emphasize psychological problems, such as feelings of sadness, worthlessness, and despair. The experience of schizophrenia also differs by culture. In India, one-third of the new cases of schizophrenia involve catatonia, a behavioural condition in which a person maintains a bizarre statue like pose for hours or days. This condition is rare in Europe and North America.
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