As semesters adjourn and quarters eye the end, InterCcECT invites you to propose summer projects. What are your summer reading goals? Writing goals? Want to convene a session or working group? InterCcECT wants you!
May is wrapping up with a theory bang around town; let some of these events this week from our calendar inspire your proposals to us!
17-19 May Which Way Forward for Psychoanalysis?
19-21 May Phenomenology Roundtable
20-21 May two talks presented by Paul of Tarsus Working Group
Jason Moheringer and I wrote this piece
For several years now, psychiatry, psychology, and the related mental health fields have been awaiting the release of the newest version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) which is being published by the American Psychiatric Association later this month. This text forms the basis for diagnosis in mental health, as the DSM contains all of the diagnostic criteria, prognostic data, and treatment recommendations for each disorder. It strives to reflect the most up-to-date empirical and conceptual knowledge of mental illness and its many manifestations, and attempts to provide a foundation for consensus in the field.
We are looking for a member to join us for a reading group of Donald Winnicott’s work. We have spent the last five months making our way through Bion’s corpus (which was fascinating). We’ll likely be spending this spring and summer making our way through selected articles from Winnicott’s original texts (including Maturational Processes and the Facilitating Environment, Playing and Reality and Through Paediatrics to Psychoanalysis). Preferably, we would like someone with a clinical background or interest in clinical work. We will likely divide our readings into six sections: Attachment, Emotional Development, Theory, Creativity, Diagnosis/Therapy and Technique. Let me know if you’re interested.
This post is by Jason Moehringer, a doctoral student in clinical psychology at George Washington University
As part of my duties in a part-time job, I recently spent three days in a conference listening to experts and industry leaders discuss the intersection of technology and neuroscience. Specifically, so-called “brain training” as a primary or secondary treatment for chronic psychiatric disorders is being explored. The idea is that cognitive deficits (for the uninitiated: difficulties with concentration, organization, memory, attention, or emotional recognition and/or regulation) are frequently, if not always, an underlying component of psychopathology. These deficits derive from subtle brain dysfunction: their brains “misfire” or don’t have the proper “wiring.” So, treating these deficits (in this case, through remediation or skill-building provided by video games, ranging from Medal of Honor to Lumosity) will improve individual functioning and treatment outcome. Additionally, these improvements will be visible in changes in brain functioning or structure that can be seen in MRIs.
Alongside this, a growing trend in mental health treatment is to measure outcome based on how a patient’s functioning “improves.” In this context, “functioning” represents the idea that the individual or group in question can perform the activities necessary for living. So, a low-functioning individual may have trouble with personal hygiene, holding down a job, forming or maintaining relationships, or controlling their impulses (anything from inappropriate angry outbursts, to excessive shopping, to wearing tin-foil hats in public). As you might have guessed, a high-functioning individual will have little difficulty completing these activities.
As a clinician in training who works intensively with individuals who have moderate-to-severe personality and psychotic disorders – a population that was of particular interest to a subset of the attendees of this conference – I was hard-pressed to set aside my attention to the undercurrents of social control implicit in this approach to mental health treatment. Central to this unwitting adherence to conformity is the unquestioned fallacy of the emerging mainstream clinical phenomenon of “functioning.”
I’ve been reading Fromm-Reichmann’s writings this weekend. She was a radical interpersonal psychoanalyst who was a trailblazer in the psychoanalytic treatment of schizophrenia. In one of her papers, she argued that it is mandatory that psychotherapists disabuse themselves of notions of social conformity or adjustment as being necessary for the psychotic individual’s recovery. She claims that the patient should have the right to choose to live the life they want and should not be forced to conform to society. In other words, she understood that the psychoanalyst ought to stay outside of the realm of ethics or social normalization precisely because it strips the patient of self-determination.
The amoral posture of psychoanalysis got me thinking about a notion that has long troubled me in my work as a psychologist, namely, forgiveness. I should clarify how I define forgiveness. From my perspective, forgiveness means the acceptance of the past event and the relinquishing of the negative affects (particularly rage and resentment) that accompany those memories. Generally, forgiveness also implies that the offended person expresses their forgiveness to the offender. As I’ve written elsewhere, a majority of my patients have experienced childhood adversity (neglect, psychological abuse, sexual abuse, physical abuse, etc.). [Parenthetically, I’ve become more and more convinced that the primary cause of mental illness is interpersonal trauma, which is unfortunately radical in this day and age of the brain.] Anyway, as the traumatized patient and I begin to delve into the trauma history the question of forgiveness invariably emerges. “Should I forgive him?”
Currently, I’m making my way through Robert Whitaker’s Mad in America, which documents the treatment of psychotic individuals in America over the last three centuries. What is so startling is about the history of the treatment of psychotic individuals is how intent psychiatry has been on avoiding everything but psychological therapy as a means of treatment. For instance, we have tried the following bizarre and violent interventions: spinning chairs, hydrotherapy, lobotomies, dental surgery, electroshock, sterilization, bloodletting, insulin-treatments and neuroleptics. It seems important to consider why psychiatry has avoided speaking with psychotic individuals about their experiences. One of the major assumptions must be that psychotic speech is not true. From this perspective, psychosis does not reveal anything of relevance about the individual’s mind and their “symptoms” are absolute nonsense. Or, perhaps they will grant us that the “content” of the hallucinations or delusions might be relevant to the individual’s history but ultimately less important than addressing psychosis with a biological or medical intervention. Read the rest of this entry »
I’ve long found Zizek’s development of the Lacanian opposition between the logic of the master signifier or constitutive exception and the logic of the non-all (or non-whole, as I wish he would translate the Lacanian pas-tout) to be a compelling and useful schema. At the same time, I’ve never really understood why he is so insistent on referring to this opposition as “sexual difference” or why it is necessary to refer to the master signifier and non-all as masculine and feminine, respectively. He uses many other examples that follow the same logic — in Less Than Nothing, the relationship between bourgeoisie and proletariat is explained in these same terms — and it’s not clear to me why the gendered language should be privileged.
The best explanation I can come up with is his loyalty to the psychoanalytic tradition, where “sexuality” comes to name the fundamental derangement of the human animal (as opposed to any notion of a “natural” procedure of reproduction, etc.). And it’s possible that I’m being an overly squeamish feminist and not following my own rule that generalizations refer fundamentally to social forces rather than to the idea that “they’re all like that.” But still.
Any thoughts?
As I’ve mentioned in a previous post, this year I’m spending my internship at a community mental health clinic in a rural setting. I have the opportunity to work with individuals who have been diagnosed with various disorders such as: schizophrenia, bipolar disorder, personality disorders, PTSD, depression, etc. Part of my work has also been conducting psychotherapy with individuals who are in abusive situations. On the weekend I work part-time at a local domestic violence shelter, which has been a real joy. Back in college I had the opportunity to work for two years at a domestic violence crisis center but I did not continue this work during graduate school. I am very excited to get back working in the field of domestic violence because it always been something that I’ve cared about both politically and personally. However, mental health and domestic violence sometimes have an antagonistic relationship. Many activists in domestic violence are skeptical of mental health because they fear that survivors of domestic violence are going to be pathologized and that the reactionaries will use this to dismiss domestic violence. Some of this anxiety is understandable considering all of the idiots out there who have claimed that battered women (although not all survivors of domestic violence are women) want to be abused. Domestic violence workers counter that everybody is at risk for domestic violence (which is true) and that mental health professionals should recognize that the psychological and emotional issues of battered women are simply a product of the abusive situation.
This leads me to this weekend where I had the chance to read and reflect on David Celani’s text The Illusion of Love: Why the Battered Women Returns to Her Abuser (1994). Read the rest of this entry »
Over the last month I’ve been reading through Melanie Klein’s published works in Love, Guilt and Reparation and Other Works 1921-1945. Tonight I had the joy of reading her paper “Symposium on Child-Analysis” (1927) which is a response to Anna Freud’s critique of Klein’s play technique with children. I wanted to describe some of Klein’s intriguing arguments and then describe how Kleinians have a radically different way of approaching analysis for patients from all populations: children, adult neurotics and psychotics.
As I was presenting my doctoral work at the International Society for Psychological and Social Approaches to Psychosis in Chicago a couple of weeks ago, we had an interesting discussion during the Q&A. In my paper, I shared my work of a two-year case study with a patient who was occasionally psychotic and I described a couple of uncanny experiences I had with the patient. My first experience occurred during one session when I was daydreaming about eating eggs once the session was completed. Instantly, the patient shifted the discussion to describe a new diet he was planning to begin. He reported that this new diet would require him to eat many eggs. Shaken from my reverie, I was baffled to hear the patient discuss eating the exact food that I had just been fantasizing about. The patient rarely described food and had never before mentioned eggs (this was around our 80th session together). Another instance happened when he was describing his religious beliefs and principles. During the conversation, he disclosed to me that he believes that I have an extensive religious background and that I know a lot about religion. I asked if he meant that I had some sort of pastoral background and he replied that I had simply studied religion on my own. His intuition was completely spot on although I had no idea how he discerned this about me. I never spoke about my religious background nor did I ever encourage him to talk about religious matters (except when he wanted to). During the Q&A, my professor described another uncanny experience when he was working at an inpatient hospital where both he and his wife used to work. One day a patient verbally attacked him and told him to go home and ‘fuck his wife already’. Unbeknownst to my professor, at that exact moment his wife was buying a pregnancy test, and it turned out that was she actually pregnant. My professor described that certain psychotic individuals have a ‘radar’ for understanding such matters.
Well how do we understand these experiences psychoanalytically? Psychosis is an experience that is related to the unconscious. Freud described the unconscious as operating with primary process thinking, which is the same logic that underlies psychotic processes. Moreover, in psychosis the repression barrier between id and ego is much more porous. Neurotics are notoriously defensive and they spend their entire life trying to avoid the terror of the unknown unconscious whereas psychotic individuals are often much more intimately acquainted with it. Perhaps this porous internal boundary (what Federn called the inner-ego boundary) allows these individuals to unconsciously detect the repressed and dissociated elements of the other person’s mind. Searles often spoke about the ways in which the therapist’s unconscious processes can drastically impact the psychotic individual. Searles reported that these individuals are much more susceptible to the other person’s unconscious and can in fact internalize those feelings and fantasies and express these through the creation of new symptoms. In analytic theory, we tend to think of psychotic individuals as constantly projecting internal impulses, wishes and fantasies into the outside world (e.g. paranoia) but Searles realized that they also are vulnerable to introject the unconscious processes of others. I also heard at the conference a quote that in almost every case of suicide one can find in that individual’s history a person who harbored deep and intense murderous fantasies towards that individual.
I don’t know if others have had similar experiences but I’ve found in my clinical work that working with psychotic individuals is the greatest proof of psychoanalytic theory.
