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The perception of reality and the disavowal of meaning
... In the first stage, the staff seemed to disregard the patient's overt preparations for the end of his life and his lack of recovery. The literature documents healthcare staff's avoidance of dealing with discussing the end-of-life with patients, or alternatively, their focus on minimal conversation regarding preparation of the body [18,59] as a coping strategy that helped them overcome death anxiety through mechanisms of denial and exclusion [5,30,60,61]. In the present case, the staff members' perceptions were split between the patient's mind and vital being, and deteriorating body. ...
... This liminal space is characterized by effort to construct new meaning for lifeclinging to life while simultaneously remaining conscious of its end [32]. Such double awareness enables people to create a safe and active space for themselves, limiting the invasion of the terminal illness into all life domains [28,29], and maintaining balance and meaning in coping with life and death [60]. Mind-body split strategies assist in creating an alternative social world. ...
Purpose
Prolonged living with chronic illness and disability expands the discussion of end-of-life conversation because of the complex role of intercommunication among patient, family, and healthcare staff. Little is known about such interaction from participants’ different perspectives. This qualitative case study examined end-of-life conversation among patient, family, and staff during long-term hospitalization in a neurological rehabilitation department.
Methods
After the patient’s death, 18 participants responded to in-depth semi-structured interviews: 16 healthcare staff and two family members (the patient’s wife and brother). In addition, we used the wife’s autoethnographic documentation of her experiences during end-of-life conversation.
Results
Thematic analysis produced three themes: (1) The Rehabilitation Department’s Mission – Toward Life or Death? (2) The Staff’s Perception of the Patient; (3) Containing Death: End-of-life Conversation from Both Sides of the Bed. These themes represented participants’ different perspectives in the intercommunication in overt and covert dialogues, which changed over time. Death’s presence–absence was expressed by movement between clinging to life and anticipating death.
Conclusion
The study findings emphasize the importance of practitioners’ training to accept and openly discuss death as an inseparable part of life-long disability, and the implementation of this stance during end-of-life care via sensitive conversations with patients and their families.
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IMPLICATIONS FOR REHABILITATION
• It is vital for rehabilitation professionals to be trained to process and accept end-of-life issues as a natural and inseparable part of the life discourse among people with disabilities and their families.
• Rehabilitation professionals need to acquire tools to grasp the spoken and unspoken issues related to life and death, and to communicate their impressions and understandings with people with disabilities and their families.
• Rehabilitation professionals need to encourage an open dialogue when communicating with people with disabilities and their families on processes related to parting and death.
... Denial is the refusal to recognize an unpleasant truth or emotion or the failure to acknowledge that truth (Denial, 2020). Therefore, denial is the defense mechanism for rejecting the reality that arises in response to a threatening environment/situation (Basch, 1983). On the other hand, rationalization is the mechanism that uses reason: considering his/her beliefs and desires, interpreting the experienced risk with the desire that this risk is not real, the person starts to reduce his/her risk perception (Cushman, 2019). ...
This study aimed to verify how consumers’ intention to visit restaurants during the pandemic is affected by consumers’ risk perception and different types of trust. The sample was composed of 546 consumers from 89 different cities in Brazil. An adapted 43 items questionnaire with 5-point scales was administered, and analyzed using structural equation modeling. The results indicate that consumers' trust in a restaurant and brand, fair price, solidarity with the restaurant sector, disease denial, and health surveillance trust predict intention to visit a restaurant during the COVID-19 pandemic. Age has significant moderated effects, reducing disease denial effects. The trust in restaurants and brands was the factor with the largest effect size. In a multigroup analysis, it was found that solidarity with the sector does not affect the intention to visit restaurants for consumers without formal work. It is discussed the implications of an increased consumers' risk perception, directly affecting their intentions. Special attention to consumers’ trust and fair price perception is fundamental, given consumers’ solidary inclination toward helping the restaurant sector. These aspects must be recognized by restaurant owners and managers to be improved and be used to attract consumers.
... The emphasis on socialization and physical punishment may be at the expense of self-development. This in turn seems to involve developmental arrests in empathy and self-and-object differentiation (Basch 1983a;Basch 1988). ...
Physical punishment is a complex topic. Might psychoanalysis, child/adolescent analysis, and developmental theory and research provide further understanding of the underlying causes, the resulting psychopathology, and potential solutions? In this section, we explore various intrinsic and extrinsic perspectives in an attempt to better appreciate the controversies surrounding physical punishment and its persistence.
... In the English Standard Edition of S. Freud's writings [7]Verleugnung was translated as " disavowal " (of reality). However, subsequent psychoanalytic writers chose, mostly, to instead use 'denial' in English-language works to describe an individual's psychological defence mechanism by means of which some anxiety-producing aspect of perceived reality is kept out of awareness [8][9][10]. Denial was distinguished from another defence mechanism, repression, on the basis that denial " …defended against anxietyprovoking external perceptions and is the counterpart of repression, repression being directed toward similar demands from the inner worlds of the instincts " [9, p. 136]. ...
Denial has often been used to explain why some residents at risk from natural hazards do not take appropriate threat mitigation actions. However, there has been little critical discussion of the concept of denial in relation to natural hazards. We examined the origins and development of the concept and noted that denial, as an explanation for inaction, is an inferred construct, not an observable phenomenon. We reviewed accounts that proposed denial as an explanation for residents failing to mitigate their natural hazard risk. We concluded that the concept has been used so inconsistently as to be meaningless without an explanation of the intended sense of the term. We discuss findings from reports of post-event interviews with residents threatened by severe Australian wildfires, and from a survey of agency community safety senior managers. The reports indicated that small percentages of residents in high-risk communities could be described as perhaps being in denial. The survey found that none of the wildfire agencies employed the concept formally. We suggest that it may be more useful to view most householders’ failures to mitigate their wildfire risk as resulting from potential threats being entwined with more immediate higher priority competing demands of everyday life.
... Det ger ingen kunskap om den process patienten befinner sig i och vad hon kan finna för mening i att undvika det svåra. Många gånger handlar det snarare om att patienten, som ett led i adjustment-processen, "desavouerar" (Basch, 1983) eller "leker med verkligheten" (Salander, 2012), det vill säga hanterar det hot som sjukdomen innebär genom att tillfälligtvis förminska, förvränga eller rationalisera den personliga innebörden av att vara livshotande sjuk; att för en kortare eller längre stund se på sin situation ur ett annat perspektiv än som först och främst cancersjuk. ...
Institutionen för socialt arbete Umeå centrum för genusstudier Genusforskarskolan Umeå universitet, 2013
... En la renegación (entendida aquí como quitarle importancia al significado emocional de la experiencia) se bloquearía el flujo del hemisferio derecho al izquierdo, por lo que el hemisferio izquierdo quedaría ahora aislado. Basch (1983) aplica este mecanismo a los conceptos de memoria episódica (memoria personal, muy cargada afectivamente) y memoria semántica (impersonal y basada en el lenguage; incluye el pensamiento deductivo). Este autor considera que la conciencia del propio self requiere que las "self-experiencias" del cerebro derecho (la memoria episódica) sean traducidas en un lenguaje verbal o en otras formas de discurso. ...
... Although he remains in touch to the extent that, for example, he is well aware of my identity this is deprived of any real emotional significance. Additionally, there is much about his external reality that he seeks to 'disavow' (see Basch, 1983) in particular the 'fact' of his 'littleness' and the 'fact' of his impotence when he has to miss a session. ...
This paper reviews Frances Tustin's concept of the 'autistic object' and its development over the course of her writings. Clinical material from work with a 4-year-old boy is brought to suggest that the concept can usefully be extended to include such cultural artefacts as stories as well as the physical objects emphasized by Tustin. It is also emphasized that the awareness of reality which autistic objects are used to defend against refers both to internal as well as external reality. The paper argues that it is the function to which the object is put that is critical in determining whether or not it should be viewed as an autistic object.
... It is brought about by a defensive disavowal of the mental existence (in terms of psychic functioning) of the object. Such disavowal is undertaken in the face of an anticipation of unbearable psychic pain and consists of the obliteration of the significance of things whilst retaining their perception (Freud, 1938); (Basch, 1983); (Grotstein, 1984a(Grotstein, ), (1984b. Whilst disavowal should not be confused with absence, it is tantamount to an inhibition, which is permitted by the incomplete development of the capacity in the first place. ...
This paper addresses a specific aspect of pathological mental functioning in so-called borderline patients. Analytic work with a borderline man is presented to show that an inhibition of, and defences against, the contemplation of one's own and others' mental states may be a hallmark of the resistance encountered in a number of such patients. It is claimed that the analysis of transference and countertransference is a crucial therapeutic factor in tackling this source of resistance. In doing this, the paper draws upon a topical notion from philosophy of mind and recent ideas from child development studies which help to clarify psychoanalytic ideas concerning the nature of the pathology of internal object relations underlying feelings of emptiness and social alienation in borderline functioning.
A presentation of emotional detachment is sometimes encountered in working with challenging patients. The term ‘disavowal’ describes a particular kind of splitting of consciousness in which the person repudiates awareness of disturbing realities or their meanings. Disavowal involves a distortion of emotional significance, rather than a distortion of perception, as in the case of a dissociative split in consciousness. Detachment protects the individual from emotional contact, which is experienced as potentially overwhelming. Safety is achieved, but at the cost of denuding mental life of meaning. With the help of detailed clinical material, the challenges of working with a person who has established a psychic retreat based upon disavowal are outlined. I describe the clinical challenges of working with someone who places themselves out of reach of emotional engagement. A state of inbetweenness protects the person from knowing about their aggressive impulses, their need for care and the passing of time. This forestalls experiencing the dangerous, shameful feelings of dependence. The clinician needs to recognize the necessity for the defensive retreat, whilst being patiently ready to enter engagement when the patient becomes available.
In a frequently repeated group phenomenon, a racial slur is spoken in psychoanalytic conferences, after which a range of defensive responses emerge to counter acknowledgment of the meanings of having done so. After a discussion of the literature relevant to the use of slurs in psychoanalytic professional settings, Freud's concept of Nachträglichkeit, or deferred action, is used to identify and explore these events as a series of discriminatory gestures that evoke racial trauma. The defensive responses that emerge to protect the use of these gestures indicate ties to the traumatic legacy of slavery and to white supremacy as it appears in contemporary psychoanalytic culture. "Gestures of the open hand" are proposed, and their profound reparative potential is discussed. The intimate link between epistemic justice and psychoanalytic endeavors is delineated.
Palliative care is one of the greatest challenges in managing care for cancer patients. In Spain, during the second decade of the twenty-first century, the arrival of new treatments and surgical techniques and more precise tools for diagnosis and prognosis and the great development of anti-tumoral products have given patients new perspectives about the evolution of their disease and have improved patient’s quality of life.
This chapter presents the current situation in Spain, some history of the different models of implementation, and how they have been adapted at various geographical autonomies. It describes how Spain has ameliorated the palliative care services in the community, in part by the National Health System’s response to palliative patients’ needs. Palliative care nurses have been vital in the development of better and more equitable care for patients, from the beginning of their illness to the end-of-life stage. The next step toward Spain achieving success in this field is to apply a complete palliative care program in the community.
The relevance of a patient’s experience of physical punishment in childhood may be obscured and difficult to acknowledge for both patient and analyst. This paper illustrates my own struggle with the issue by presenting excerpts of my work with an adult analytic patient, children in a mental health clinic, and PTSD patients in the Veterans Administration system. In the discussion that follows I demonstrate how the psychoanalytic concept of disavowal can be useful in expanding our ability to engage in meaningful discussions with our patients regarding this issue.
Se exponen los análisis de dos niños, de cuatro años y medio y cinco años. Uno de ellos tenía una inhibición grave y era casi mudo; el otro era desorganizado, frenético y violento. En el contexto de estos tratamientos, el autor plantea varias preguntas relacionadas con la teoría clínica y técnica, incluyendo el uso de la interpretación precoz del afecto con esos niños; el posible beneficio de verbalizar los afectos primarios en ese trabajo interpretativo precoz; y los roles de la verbalización y del afecto en el trabajo con cuidadores y pacientes adultos.
Datan et al. (1987), extending Neugarten’s (1984) earlier observation regarding the significance of the manner in which persons recount the story of their lives, well portray both the manner in which contemporary psychoanalysis understands the course of life and emphasize the goal of psychoanalytic study of adult lives as a search for factors accounting for a presently constructed story of experience and the determinant of wish and action. The present chapter focuses on the significance of contemporary clinical theory within psychoanalysis, additionally informed by study within the human sciences, as a means for understanding the management of lived experience reflected in the successively rewritten life story from childhood to oldest adulthood. These life stories, told by the analysand to the analyst, provide the foundation for a shared effort at remaking accounts of lived experience in an effort to provide the analysand with increased sense of personal integrity and vitality.
To walk in Jerusalem is to learn the essence of archaeology. Any new structure must displace not just the old, but the archaic, for there is only a finite space that can be occupied by humans. The building stones of the biblical era are the pathstones of today; shards of our shared history are venerated in shrines at our museums or hawked by vendors in the marketplace. The evolution of a culture is vertical, the new built upon the rubble of the old, which itself was built on the rubble of that which died before, its predecessor. In such a world, one searches to learn the past, to learn from the past, to retrieve or recapture from the past.
Falstaff (Henr> IV, pt. II, a. I, sc. II) responds to the Chief Justice’s exclamation: “You hear not what I say to you,” by claiming: “Very well, my lord, very well. Rather, an’t pleases you, it is the disease of not listening, the malady of not marking, that I am troubled withal.” Eventually the Justice gives in: “But since all is well, keep it so. Wake not a sleeping wolf. ” Whereupon Falstaff gives that quintessential answer that could be the motto for all his followers unto this day: “To wake a wolf is as bad as to smell a fox. ”
Alessandra Lemma - Winner of the Levy-Goldfarb Award for Child Psychoanalysis!.
This is the first revised, expanded, and updated edition of Psychoanalytic Terms and Concepts since its third edition in 1990. It presents a scholarly exposition of English-language psychoanalytic terms and concepts, including those from all contemporary schools of theory and practice. Each entry starts with a brief definition that is followed by an explanation of the significance of the term/concept for psychoanalysis, its historical development, and the present-day controversies about best usage. © 2012 by Th e American Psychoanalytic Association. All rights reserved.
The analyses of two young boys, 4½ and 5 years old, are presented. One child was severely inhibited and nearly mute; the other was disorganized, frenetic, and violent. In the context of these treatments, the author raises several questions related to clinical theory and technique, including the use of early interpretation of affect with such children; the possible benefit of verbalizing primary affects in this early interpretive work; and the roles of verbalization and affect in work with caregivers and adult patients.
Copyright © 2015 Institute of Psychoanalysis.
While "splitting" is a familiar concept, its meaning is not as self-evident as is commonly assumed. In different contexts, it refers to different phenomena and is supported by different understandings of psychic dynamics. In this paper, the author presents four different conceptualizations of splitting, which capture the essential aspects of contemporary psychoanalytic discourse on the concept. There is a dissociative kind of splitting, which involves splitting off, in the face of trauma, whole personalities, which to some extent remain accessible to consciousness; there is a disavowal kind of splitting that splits off our awareness of disturbing realities or their meanings in our efforts to avoid the inner restraints imposed by repression; and there are two forms of splitting of the object into good and bad-one focusing on the splitting of representations of the object due to ego weakness and environmental determinants, and the other on the splitting of the mind itself in a primarily destructive act aimed at sparing the good from the destructiveness of our death instinct. All four conceptualizations have their origins in Freud's writing and then are further developed in the work of later analysts. The author argues that understanding the nature of these various conceptualizations of splitting can contribute to analytic theory and practice. It also sheds light on the essential nature of analytic approaches and how they offer different perspectives on the unity and disunity of man's basic nature.
Copyright © 2015 Institute of Psychoanalysis.
The author questions whether disavowal is to be understood as a defence mechanism in its own right. After discussing the different understandings of disavowal as a defence mechanism, as the outcome of defence mechanisms and as a synonym for defence in general, he recapitulates Freud's use of disavowal and confronts it with Freud's concept of defence mechanisms. He concludes that in Freud's conceptual framework, disavowal does not qualify as such a mechanism. To avoid the confusion produced by using disavowal with reference to a process, the outcome of a process, the individual in the general and the general in the individual, he recommends using the concept in Freud's conceptualisation only in agreement with Brenner, and Moore and Fine, to denote the properties of defence mechanisms and substitutive formations.
Background:
Lung cancer is associated with biomedical and psychological symptoms as well as a generally poor prognosis. When healthcare staff communicate with lung cancer patients it is essential that they consider the patients' own views of the situation to avoid putting unnecessary strain upon the patients' shoulders. The purpose of the present study is to better understand how a group of patients with lung cancer reflects upon their new life situation after diagnosis and primary treatment.
Method:
Fifteen patients with non-small cell lung cancer were consecutively included and, where possible, repeatedly interviewed during the course of the disease process. The 29 interviews were conducted in a thematically structured narrative form that facilitated a dialog between the interviewer and the patient. The interviews covered experiences with health care, living an everyday life, and thoughts about the future. FINDINGS AND REFLECTIONS: By focusing on how the patients more or less preconsciously elaborated mentally with their vulnerable situation, it was possible to detect different mental manoeuvres that they used as a way of creating hope. The patients distanced themselves from their disease, relied on a feeling of a sound body, idealised treatment possibilities, relied on healthy behaviour, focused on a concrete project, found that they were better off than others, and took solace in the fact that there were patients who had successfully managed the disease.
Discussion:
The patients were not passive victims in the face of their diagnosis, but were actively trying to find ways of looking at their despairing situation in a positive light. A creative process for psychological survival had thus been initiated by the patients. We suggest that acknowledging this process should be the starting point from which physicians can engage in hope work with their patients.
The author takes as his starting point the view that mental health requires the existence of a satisfactory relationship between internal (psychic) and external reality. He discusses the nature of the ‘membrane' that exists between these two realities and the qualities required for it to function adequately. He explores the possible developmental origins of this ‘membrane', and the different ways in which its establishment may miscarry. He illustrates one of the ways in which this process may go wrong when the ‘membrane' has become excessively reinforced. He illustrates this with clinical material from a schizoid, adult patient who had taken refuge in external reality and with material from a child patient with autistic spectrum disorder. Links are made to Freud's views on the establishment of the Reality Principle, the process of splitting and the importance of the mechanism of disavowal. There is some speculation as to the possible aetiology of the pathology in the two cases described, and the developmental importance of acquiring a valid sense of potency .
This essay seeks to contribute to the theoretical base guiding the treatment of alexithymia by highlighting the concepts of two scholars, psychologist Lev Vygotsky and psychoanalyst W.R. Bion. While their research was not directly concerned with alexithymia, their formulations, nonetheless, make a singular contribution to understanding its dynamics. The author demonstrates these concepts with clinical case material
In presenting an account of a psychoanalytically informed therapy with a severely traumatized patient, this paper attempts to address questions of how such a patient can psychically survive such a trauma, and how she may make use of her objects. What kind of countertransference experience the therapist may need to bear and what may be the aim of such kinds of therapy is considered.
Three problems with the theory of cognitive therapy are presented. Each is argued as a problem for the model of change in cognitive therapy, not for their impact (if any) on treatment. They are (a) the unpredictability of cure and relapse, (b) the epistemologically irreconcilable differences between the model of pathology and the model of change, and (c) the inability to conceive of ambivalence. Each problem is discussed, and some counterarguments are offered.
Self psychology provides a theoretical framework for understanding the psychology of the animal hoarder. The following ideas from self psychology can be applied to animal hoarders and their animals to gain insight into the nature of the bond between them: 1) animals can serve a crucial selfobject function, such as cohesion, for hoarders, regardless of the actual, objective reality of the state of the animals; 2) the concept of archaic vs. mature selfobject functioning elucidates how hoarders are stuck in self-centered, archaic forms of relating with little empathic capacity; 3) the merger selfobject relationship allows hoarders to see animals as being one with them; and 4) disavowal and the vertical split explain how hoarders can live with animal suffering and be apparently oblivious to it. Similarities between self psychology and attachment theory are discussed.
Not all forms of deception are alike. Unlike pathological lying or frank antisocial behavior, moral hypocrisy reflects the deceptive pursuit of self-interest in which the individual uniquely violates his or her own moral standards. Four hypotheses relevant to this concept are identified in a critical review of the psychoanalytic literature. These hypotheses are evaluated logically and in light of findings from contemporary research. The author argues that explanations resting on the concepts of superego weakness, impulse strength, and/or narcissism fail to provide an adequate account of the complex intentions betokened by hypocrisy. By contrast, the mechanism of disavowal enjoys strong, broad-based support once it is freed from the narrow confines of perception and reality testing. Rather than a attenuation of reality testing, hypocrisy represents a mode of perception in which contradictory moral imperatives coexist without conflict. Authentic engagement and empathy with patients is facilitated by a nonjudgmental appreciation of the human capacity for moral disengagement. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Using psychoanalytic constructs of necrophilia and disavowal, the author revisits Stanley Kubrick's (1999) film
Eyes Wide Shut from a cultural perspective. Disavowal, the failure to fully grasp the meaning of what is perceived, may help explain why viewers missed disturbing necrophilia meanings in this film. Various faces of necrophilia (as orientations against life, neurotic fantasies, and true perversions) are discussed. The author speculates that participants in a contemporary culture may also use disavowal vis-a-vis values against life that some current institutions endorse. Kubrick's eye-opening message could be that people do not have their eyes wide open to see the violence embedded in the necrophilous model that some institutions hold, values that, in a marketing society, people may consume without sufficient awareness or questioning. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Drawing on Freud's late work, I argue that the social traumas created by neoliberalism bring about perverse modes of subjectivity. When a truth is too painful to bear, Freud argues, we substitute for truth a less painful lie, a disavowal that, when regularly practiced, can issue in perversion. I argue that irrational exuberance, the shared delusion in the United States that, for example, housing prices and the stock market must always go up, ought not be attributed to the greed of ‘human nature’ but rather must be understood in its social context: as a response to the abandonment of the citizenry by government and by the free market fundamentalism that, after the mid-1970s, no longer provided even the bare minimum of security and safety offered by the US form of the welfare state. Clinical material illustrates some of the ways that neoliberal versions of subjectivity appear in symptoms and in the relational dynamics of treatment.
Appreciation of Descartes' importance to Lacan's reading of Freud is a point of entry into Lacan's seemingly hermetic theoretical system. Lacan's analysis of Descartes' search for ontological certainty draws him, in Freud, to the ontological implications of castration anxiety, disavowal, and splitting of the ego. Lacan's theory both derives from and develops Freud's late work on the narcissistic origins of conflict within the ego.
The concept of 'denial' emanates from psychoanalytic psychology. Within this framework it is regarded as a primitive defence mechanism related to personality disorder. The concept has been adopted by coping research but invested with quite other implications. Different researchers operationalize 'denial' in different ways which contributes to this confusion. This paper views 'denial' from the different perspectives of psychoanalysis and coping research and, based on a previous qualitative study, it proposes a reconceptualization which distinguishes between three different processes: 'avoidance', 'disavowal' and 'denial'. 'Disavowal', self-deception in the face of accurate perception, is, more than 'denial', regarded as the appropriate concept covering everyday experiences of patients dealing mentally with their strain.
The author presents a psychoanalytic reading of Borges's 'The secret miracle' (1943), a short story about the Shoah, for which Freud's concept of negation (Verneinen) and recent psychoanalytic approaches to symbolisation and the functions of fiction form the theoretical background. She argues that the effects of negation, present in literary fiction, become forcefully magnified in the fiction of the Shoah, because of its specific inversion of the relations between life and art. This magnification increases the perplexing effect that is characteristic of Borges's heterotopies. The story is read as a metaphor of transformative processes that closely follow Freud's dual conceptualisation of negation as a defence and as allowing the repressed a way into consciousness. This study illuminates the conservation of the relations between external and internal realities as a basic difference between negation and related concepts such as disavowal (Verleugnung), and repression, in relation to creative imagination. The author relates the story's perplexing effect to its subversion of fundamental axioms such as temporality, questioning the existence of sense itself and suggests that the malaise the story produces may stem from the way in which its narrative structure negates time, the fabric from which narratives--and life--are woven.
Beginning with the ways in which the use of the couch lends 'depth to the surface' (Erikson, 1954), I explore the topography of the inter- and intrasubjective psychoanalytic situation and process. I suggest that defences are not by definition unconscious but rather can be observed operating at conscious and preconscious levels, particularly under these conditions. A focus on preconscious disavowal provides a window on what has become unconscious repression. As a result of eliciting and then verbalising the operation of such defences with regard to anxieties in the here-and-now transference, declarative memories of increasingly specific childhood fantasies and events begin to hold sway over unmanageable procedural remnants from the analysand's past. With this may even come the possibility of neuronal regeneration, the more generalisable enhancement of declarative and symbolic functions and the sense of identity with which these are associated. Herein may lie one enduring therapeutic effect of the 'talking cure' - putting feelings into words - as one among a variety of psychotherapeutic modalities.
People experiencing unexpected negative events tend to cope with the situation through causal attributions. It seems that having some sort of answer to 'why-me' makes the event less shattering and the world more controllable. We know for example that the great majority of women with breast cancer tend to have clear ideas about its causes. Lung cancer, in contrast to breast cancer, has a well-known significant cause, as smoking accounts for about 80% of the incidences. This paper deals with the attribution process in lung cancer. It examines how lung cancer patients attribute the cause of their disease and how this relates to an understanding of how people deal with strain. Twenty-three patients with advanced non-small cell lung cancer were consecutively followed by means of repeated interviews throughout the course of the disease. It emerged that among the smokers the most common attribution was 'don't know'--smoking was not seen as the prime cause of their cancer. This finding is discussed in relation to the few earlier, somewhat contradictory studies that exist; and it is argued that the findings coincide well with the concept of 'disavowal', which is deemed to be the central process concerned in dealing with strain.
The concept of unconscious fantasy should be retained as fundamental to any psychoanalytic approach. The concept is reexamined in the face of two challenges: today's theoretical pluralism and the recent integration of findings from academic research. The first section reviews post-Freudian theoretical contributions to Freud's original concept, concluding that in its evolved form it is flexible enough to serve multiple perspectives. The second section examines four features identified with primary process thinking, demonstrating that a model of early mentation based on adult dream work cannot be supported by research on early development. However, the contemporary concept of unconscious fantasy is compatible with research findings from child development studies and cognitive neuroscience, permitting psychoanalysts to enter dialogue with those fields. Our contribution is not the posit of a new form of thinking (primary process) but an understanding of how general cognitive processes are enlisted for motivated purposes.
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