In this paper, I have proposed that Winnicott's concept of potential space might be understood as a state of mind based upon a series of dialectical relationships between fantasy and reality, me and not-me, symbol and symbolized, etc., each pole of the dialectic creating, informing, and negating the other. The achievement of such a dialectical process occurs by means of a developmental advance from the 'invisible oneness' of the mother-infant unit to the subjective 'three-ness' of the mother-and-infant (as symbolic objects) and the infant (as interpreting subject). Failure to create or maintain the dialectical process leads to specific forms of psychopathology that include the experience of the fantasy object as a thing in itself, the defensive use of reality that forecloses imagination, the relationship to a fetish object, and the state of 'non-experience'. The 'processing' of a projective identification is understood as the re-establishment of the recipient's capacity to maintain a dialectical process (e.g. of me and not-me) that had been limited in the course of the recipient's unconscious participation in the projector's externalized unconscious fantasy.
The author presents clinical material from a 36-year-old female patient with depressive and hysterical traits, whose personal history shows her psychosexual development to be at a pregenital level. It is intended to demonstrate the type of clinical interpretations that enabled a change towards an oedipal transference in order to reach a psychoanalytic approach. Some of the psychoanalytic interpretations during the treatment process are described, related to several behavioural changes and a discrete structural change.
Psychogenic autistic phenomena occurring in non-autistic adults are being increasingly discussed in the psychoanalytical literature. The author endeavours to determine autistoid organizations, which are understood to be a particular form of pathological retreat. Together with the use of autistic objects, two-dimensional levelling out, the failure of unconscious communication, and of projective identification, a characteristic of these retreats is that they are meant to afford protection against paranoid-schizoid fears of the external and unintegrated states of the internal world. The formation of such autistic reactions should be sought not only in traumatic separations and the inadequate containment of primary objects, but also in constitutional weakening. Intolerance accompanying projective identification and damage to primal fantasies/preconceptions are discussed. In conclusion, a clinical illustration with autistoid and hypochondriacal retreats clarifies some of the aspects discussed.
The purpose of this project was to determine if it is possible to predict from the information contained in the write-ups of the preliminary evaluations of patients accepted for Institute supervised analyses those patients who would successfully complete their analyses and those who would not. Three raters independently studied the write-ups of 183 cases treated at the Boston Institute during the period 1959-1966. Each rater filled out a questionnaire of 105 items which were thought to be of possible predictive value. Outcomes were sought from the analysts who treated the patients. 130 outcomes were obtained and revealed that the patients fell into 4 distinctly different outcome groups: (Group 1) those who completed analysis by mutual agreement between the analyst and patient; (Group 2) those who prematurely terminated their analyses against the advice of their analysts; (Group 3) those whose analyses were prematurely interrupted by their analysts; (Group 4) those whose analyses became interminable. Statistical analyses were done to see which of the 105 predictor items distinguished these four distinct outcome groups. Many of the predictor items were not useful because they either showed no variation among patients, or were too often left blank, or were rated with very low interrater agreement. Of the remaining items, we found ten items which did show a highly significant difference between Group 1 patients and those patients in at least one of the other three outcome groups. We found five other predictor items which showed large, although not quite statistically significant, differences between Group 1 and at least one of the other three groups. Of these 15 items, 7 dealt with family history. The others concerned the patient's past history (2), object relationships (2), patient's sex (1), symptomatic state (1), field of endeavour (1), and history of previous psychotherapy (1). We found it made no difference in terms of these 4 outcome groups what the patient's diagnosis was or whether he was a 1st, 2nd, 3rd or 4th supervised case. Among the other negative findings were patient's age and the ability to experience and tolerate felt anxiety. These did not distinguish any of the outcome groups. These findings show that additional predictively useful information is present in the preliminary evaluations of patients already screened and accepted for Institute analysis by trained evaluators. These results suggest that one particularly important area on which to focus future attention is family history.
This paper describes a particular form of 'silent' regression during the psychoanalytic treatment of infantile personalities (a type of character pathology related to the hysterical personality). This regression is characterized by the development of rapid interchange in the roles enacted in the transference and projected on to the analyst, an apparent 'disconnexion' of the transference material from that dominant when the patient is in non-regressed states, and the intensification of the analyst's counter-transference reactions. The diagnosis and management of these regressive transferences requires a particular interpretive style and strategy outlined in this paper and illustrated with two case vignettes.
An attempt is made here to organise a body of facts available in the published literature concerning who, when and why Freud and his ideas were first noticed during the early years of psychoanalysis. Specific citations and references mentioning Freud reveal a surprisingly wide range of different kinds of cultural interest. In fact, we can identify seven different cultural locations which adopted some element of the ideas of Freud for specific reasons: (i) the interest in the theory of hysteria, from the Society for Psychical Research, commencing in 1893; (ii) the interest in the psychoanalytic theory of sexuality, from Havelock Ellis, from about 1895, in support of radical attitudes towards sexual freedom; (iii) as part of the reaction against the pessimistic attitude to treatment in British psychiatry, from around 1905 onwards; (iv) the endeavour of W. H. R. Rivers and others to create an empirical science of psychology embracing scientific psychoanalysis, around 1910-15; (v) the application of psychoanalysis to the psychological novel by writers and also to understanding the creative process, using Freud's theory of symbols, around 1913; (vi) the attraction of some progressive educationalists to Freud's outline of child development, from 1913; and (vii) the struggle of philosophers, including Bertrand Russell, to comprehend the implications of the psychoanalytic view of the unconscious. It is claimed that the multivalent quality of Freud's ideas contributed to the success of psychoanalysis over the suggestive therapies, and in the conflicts with dissenters within the psychoanalytic movement.
The author points out that all Freud's publications and lectures from the period 1894-1896 had the aim of establishing an aetiological theory of the neuroses and psychoses. Freud found that the clinical pictures covered by the theory had a sexual aetiology and were distinguishable from each other by specific mechanisms. Numerous references are presented to show that what the author calls Freud's early clinical theory had its roots in contemporary neuropathology and psychiatry, and the prevailing views in these disciplines are discussed. He was able to build on the work of predecessors such as Möbius in regard to the causal role of psychic factors. Whereas Freud was of his time in attempting to redefine the category of 'neurasthenia' and adducing the familiar concept of 'sexual noxae', his originality lay in the elevation of these factors, hitherto seen as external, to the status of 'true' causes. In the author's view, the rejection met with by Freud's early clinical theory was due to its pre-experiential 'vision' of the sexual aetiology of the neuroses rather than to its content. She notes that Freud differed from his contemporaries on the concept of and systematic part played by sexuality, as well as on the central role of psychic mechanisms (i.e. of defence).
John Rodker (1894-1955) was the founder of the British publishing house--the Imago Publishing Company--which undertook the republication of the complete works of Sigmund Freud in German just before World War II. Rodker, himself a writer as well as a publisher, was initially tempted by a psychoanalytic career; numerous obstacles, however, lay in his path. War, along with the complicated management of the royalties from Freud's writings, compromised the progress of what seemed to him to be 'a serious venture'. Besides Rodker, we meet numerous actors of the psychoanalytic movement: Anna Freud, Marie Bonaparte, Ernest Jones, James Strachey, all of whom had worked for the dissemination of Freud's writings. This paper shows how the English language gradually became the 'official norm' for psychoanalysts. According to the editors of the Standard Edition, at that time 'nothing new [was] being written' in German or in French. The failure of the Gesammelte Werke project signalled the end of an era in which psychoanalysis was mainly written about in German.
