Reading Winnicott Slowly… Winnicott,Language and the Science of Psychoanalysis

The author makes a plea for a reading of Winnicott's writings that searches for Winnicott's way of thinking besides searching for specific ideas and concepts. He addresses the question of Winnicott's language, which, the author suggests, may reveal itself at odds not so much with classical Freudian psychoanalysis, as is often purported, as with an entrenched and dogmatic attitude that reigned in many quarters of the psychoanalytic community around him. A parallel reading of his papers and of his correspondence shows that Winnicott avoided writing in a desiccated, formulaic fashion or in reverence to some leading figure in the psychoanalytic society. He rather opted for thinking his own thoughts and thinking the psychoanalytic experience anew.     

Strachey's Shadow: A Re-examination of the Use of the Mutative Interpretation

James Strachey published his seminal paper on the nature of therapeutic action in 1934 in which he introduced his ideas on the mutative interpretation. He saw interpretation as the cornerstone of the psychoanalytic method. Since then, there has been a great deal of work looking at the essential nature of the interpretation and how it can promote change. By the1960s, Loewald and others were discussing how interpretation needed to incorporate new psychoanalytic thinking, particularly in the area of object relations. As the intersubjectivity of the psychoanalytic encounter gained more prominence, the use of the structural interpretation decreased. The author suggests that there is still need for further work on how interpretation can promote change. Using theoretical ideas and clinical examples, the paper concludes that the mutative interpretation continues to offer something potentially transformative, but that the technique has to take account of relational aspects of the treatment and the developmental issues of the patient. However, the clinician's relationship with the ideas about a mutative interpretation can also affect the clinician's ability to use it to a therapeutic effect.     

From Dualism to Dynamism: Fairbairn's Critique of Libido Theory 1930–1950

In 1930 Fairbairn wrote ‘Libido theory re‐evaluated’, which remained unpublished until 1994. It contains the beginnings of theoretical arguments that, I argue, resulted in his more famous 1940s papers. I posit that Fairbairn's 1930 critique of Freud's analytical dualist theoretical foundation is consistent with, and lays the ground for, his later work. Using the papers ‘Schizoid factors in the personality’ (1940), ‘The repression and return of bad objects’ (1943), ‘Endopsychic structure considered in terms of object‐relationships’ (1944), and ‘Object‐relationships and dynamic structure’ (1946), I show how Fairbairn's 1930 critique is relevant to his later propositions and elucidate Fairbairn's metatheoretical assumptions, about which he was not explicit after 1930. I argue that his theoretical propositions arise as a result of his longstanding, consistent critique that led him to replace analytical dualism with dynamical structure. Further, I argue that Klein, and Khan and Winnicott's criticism is unjustified; Fairbairn did not challenge the content of a theory he describes as ‘truths of fundamental importance’, he challenged its theorization. Because it resulted in his important theoretical propositions, Fairbairn's longstanding critique of libido theory is important within the history of psychoanalytic thought and deserves scholarly attention.     

‘I have been obliged to Send Nassaw’: an enslaved healer’s medical labour and skill in eighteenth-century Virginia

This article examines the medical career of an enslaved physician in Virginia named Nassaw from the mid eighteenth-century until the period of the American Revolution. I develop a taxonomy of Nassaw’s labours as a nurse caring for the sick, a healer administering medicines at the behest of his enslaver and as a doctor in his own right making medical judgements as he treated his patients. Nassaw is in some ways comparable to other enslaved healers of African descent in the Atlantic world, including well-known Mohanes and ritual specialists in Brazil and Latin America. However, due to his role as a physician employed by his slaveholder to principally heal other enslaved people, Nassaw struggled to find satisfaction in his labours as a healer as other enslaved people rightly perceived him as an agent of their enslaver whose medical work healed their bodies while extending their oppression. I argue that Nassaw became frustrated and depressed, and turned to drinking because of his inability to pursue or experience what Sharla M. Fett terms a ‘relational vision of health’ in the Chesapeake. Moreover, I interpret his drinking as a rebuke to the racist pretensions of his enslaver – who instructed him in pharmacy and surgery – who aimed to transform Nassaw into an Enlightened ‘black exhibit’ by training him to be a doctor. I conclude by returning to how precisely different Nassaw was from other enslaved healers in the Chesapeake like Tom of Nomini Hall or Romeo, and make the case that Nassaw deserves a place in histories of slavery and medicine precisely because he was an enslaved plantation doctor rather than a popular healer or conjuror.     

DEHUMANIZATION,GUILT AND LARGE GROUP DYNAMICS WITH REFERENCE TO THE WEST,ISRAEL AND THE PALESTINIANS

Following his participation in a visit by health professionals to Israel/Palestine, the author reflects on the sense of apprehension that accompanied his intention to share his impressions on his return. In this paper he turns to psychoanalysis and the analysis of large group phenomena to discuss socio‐psychological factors that seem to determine the context for discourse in the West relating to the Israel/Palestine conflict. He argues that psychoanalytic theories concerning the unconscious element in inter‐communal conflicts are a useful starting point in understanding large‐group psychological responses to the dehumanization of both Jews and Palestinians. He seeks to understand the anxiety and inhibition that seems to attend reflection on Israel/Palestine in public space in particular, and within the psychoanalytic community. He argues that ‘neutrality’, the proper stance of the clinician in the consulting room, has come to inhibit the profession in its non‐clinical thinking. He proposes that ‘universalism’, the philosophical basis of the extension of the human rights agenda in the years since 1945, provides the appropriate moral underpinning for psychotherapeutic practice.     

The Imposter in the Land of Illusion

This is the story of Fred, a city banker who came for psychotherapy when he was on the verge of a nervous breakdown. Fred styled himself as an alchemist who could turn dross metal into gold and had achieved remarkable success until global recession hit. Fred's psychopathology had driven him to believe that he had supernatural powers – and this made him special. He instinctively gravitated to a world in which his magical powers would be admired and rewarded – the world of derivatives. Here Fred excelled. Every deal turned into a river of gold that, seemingly, had no end. But just as Fred's success had been meteoric, his downfall was catastrophic. The false self he had created crumbled and he catapulted into the void without bearings, surrounded by the flotsam of dead objects. With this terrible loss, his journey towards life had only just begun. Fred's story is a modern day allegory for the psychopathology that has infected the major financial institutions over the last twenty years, creating a precarious world based on illusion. Fred's trajectory illustrates not only the powerful lure of illusion but also how a perverse system is structured with the implicit aim of attacking mind and reality.     

Albert Schweitzer. The man as a symbol

Albert Schweitzer, the great missionary physician from the XXth century, had a versatile personality that integrated multiple talents, leading to the slightly frequent conjunction of the thinker with the man of action, and the humanist with the scientist and the artist. He studied all these disciplines in a brilliant manner: Philosophy, Theology, Music and Medicine; he was also a great scholar of Bach's work, Jesus Christ and the civilization history. In his maturity, this great man renounced to the fame and glory gained as intellectual and musician, to dedicate his life as a physician for the forgotten African natives. His deeply religious spirit allowed him to penetrate into the most recondite of the human soul; in his personality, he expressed in its entire dimension the eternally unsatisfied desire of the solitary man, against the immensity of the universe. His philosophy, based on the respect for life, was realized throughout the practice of the medical profession. His noble character and personality was based on the man as symbol, since it was not so much what he did helping people but what people could do to others due to him. His singular example represented a moral force in the world, superior to millions of men armed for a war. In 1953, he received the Nobel Peace Prize for his philanthropic work in Africa during more that fifty years, and for his deep love to the living beings. He was transformed in a perennial legend as the Lambaréné doctor.     

Der Anatom Johann Samuel Eduard d''Alton (1803–1854) — Leben und Wirken in Halle (Saale)

After the death of Johann Friedrich Meckel (1781–1833), Eduard d'Alton was appointed to be his successor. From 1834 to 1854, he was Professor of Anatomy and head of the “Anatomisches Theater” at the University of Halle. In the literature we can only find little details about him. The aim is to investigate his life and work. Before he came to Halle, he was first professor at the Academy of Arts in Berlin. Then few years later he received the professorship of anatomy and physiology at the Friedrich-Wilhelm-University in Berlin. During his work as anatomist and physiologist in Halle he was rector twice, in 1845 and 1846. d'Alton worked very accurately and highly engaged. He supported the students' education very conscientiously but, since he was strict and exacting at the same time, he was not very popular. His extraordinary drawings of human and comparative anatomy earned him great recognition. In 1850, he published the “Handbuch der menschlichen Anatomie”. d'Alton was mainly engaged in comparative anatomy, embryology and teratology and performed experimental embryological tests. In 1853, he published a catalogue of teratological preparations many of which can still be found in the Anatomical Collections in Halle.     

Attitudes and use of homework assignments in therapy: a survey of German psychotherapists

There has been continued empirical research on the role of homework assignments in psychotherapy, but little is known about their use in clinical practice. Although attitudes are an important factor in determining whether practitioners use homework assignments, existing data is limited to the frequency and types of assignments used in therapy. One hundred and forty German psychologists were surveyed regarding their use of and attitudes towards homework assignments. Practitioners reported a variety of attitudes regarding the effects of homework on treatment outcome, the process of integrating homework into therapy and patient compliance with homework. We suggest that consideration should be given to therapist attitudes (or beliefs) in future conceptual or empirical work designed to examine homework effects in psychotherapy. Copyright © 2004 John Wiley & Sons, Ltd.     

Laennec and the creation of auscultation signs

Toward the end of the 18th century, clinical diagnosis in medicine shifted its focus from reliance on symptoms, which translates to subjective experience of illness, to signs, objective manifestations of pathologic changes. Several techniques were developed to elicit signs in clinical practice, and Laennec used them routinely. He palpated and prodded his patients to get an idea of changes in internal organs. He also applied his ear directly to his patient's chest to hear their heartbeat. On one occassion, he was unable to use these techniques and had the happy occurrence of rolling up a notebook to hear his patient's chest. This led him to hear a great number of new sounds. Through detailed observations, he was able to describe, classify, and correlate these sounds with autopsy findings, thus creating a new semiology of chest diseases. In this essay explore how in which Laennec created his instrument and system of signs of chest diseases, and how he was able to transmit his inventions to his colleagues.     

Patients' perspective on homework assignments in cognitive–behavioural therapy

Homework assignments are an indispensable part of cognitive–behavioural therapy. During the past two decades, a growing number of studies have shed light on its characteristics and effects. However, most studies primarily consider the therapists' view, and little is known about the use of supportive strategies to implement homework assignments in psychotherapy and about patients' attitudes towards regular assignments. To fill this gap, we assessed the attitudes towards homework assignments of 80 outpatients. In addition, those who had received a task during the past session (75%) were asked to report characteristics of their task as well as therapists' behaviour strategies during the assignment of the task. One week later, therapists rated the extent of completion of the task. Results showed that the patients generally had a positive attitude towards homework and that they accomplished most of the tasks. With regard to the therapists' behaviour during the assignment of the task, there seems to be room for improvement. Copyright © 2008 John Wiley & Sons, Ltd.     

The Impact of Jack Stimpfling's Recombinants on Immunogenetics

An angler dreams of a rising rainbow, chooses just the precise fly currently hatching in order to complete the dream of a mountain stream battle that would ensue. The fly must land and drift perfectly so that the trout will be fooled. A camper dreams of just the right location for a warm fire to rest his tent where he will be protected from the wind, yet be able to view the natural beauty surrounding him. A scientist hopes that by pursuing his love of truth and awe of the unknown, he will be contributing to the benefit of his fellow man. Once upon a time, just such a scientist began such a career on the island of Mount Desert. He not only fulfilled his scientific dreams, but also in later years would enjoy the tranquility of nature, open space and the big skies. This is a chronicle of one aspect of his scientific contribution to his fellow man.     

Marcello Malpighi: the father of microscopic anatomy

Biographical data of Malpighi to justify naming him "the father of microscopic anatomy", as he used the microscope, soon after its invention, to study and discover and accurately describe many biological, particularly anatomical, structures. Although he utilized the microscope as a scientific instrument, his ideas, innovations and discoveries caused such an opposition that the microscope could be considered as Malpighi's weapon to start a scientific revolution. He was a naturalist for whom the "natural world, known and experienced scientifically, was all that existed". He was also a "cardiocentrist", who opposed Galen's "hepatocentrism". Several anatomical structures known eponymically to honor Malpighi are listed followed by their synonyms. Malpighi is another example of a genius as an extraordinary man who stood on the shoulders of giants, such as Galilei, Hans and Zacharias Janssen, Borelli, Harvey, B. Massari, among others.     

German pathology professor Philipp Schwartz: His enduring life from Frankfurt to Istanbul during the Second World War era: A “forgotten savior”

Many scientists were forced to leave Germany mostly under challenging circumstances as a result of the pressure applied to anti-Nazi German scientists and artists (mostly from the medical field) who were or were not of Jewish origin before World War II. They emigrated primarily to the United States, Switzerland, Turkey and South America. Two eminent pathology professors, namely Prof. Philipp Schwartz (from Frankfurt) and Prof. Sigfried Oberndorfer (from Munich) came to Istanbul University. They regarded Turkey as their second homeland. They were obliged to leave Germany due to mounting pressure. Schwartz settled in his father-in-law's house in Zurich. Schwartz was an organizer. He established the “Emergency Society of German Scholars Abroad” (Notgemeinschaft) to gather German scientists and artists in his situation. During the same period, the founder of modern Turkey, Mustafa Kemal Atatürk wanted to apply reforms at Istanbul University to make it attain a Western structure. He invited Swiss pedagogue Prof. Malche and asked him to prepare a report for this purpose. Malche highlighted the need for Western experts is advised. Contact was made with Schwartz's organization in Switzerland. Numerous scientists specialized in almost all fields of science starting with medicine as well as many artists came to Istanbul University and other public institutions. Schwartz established the Pathology Department at Istanbul University while Prof. Oberndorfer established the Department of Experimental Pathology at the same university.Schwartz enabled pathology to gain a contemporary identity in Turkey. Pathology was mostly focused on autopsy during those years. Schwartz attached importance to the pathology training of medical students. He initiated clinico-pathology classes and encouraged surgeons to take a biopsy for surgical pathology. He produced numerous publications. Schwartz worked in Turkey for 19 years and then moved to the US. Thus, a generation of pathologists following the footsteps of Schwartz was raised in Turkey. Frankfurt University, in which he was obliged to leave, erected a stele in his memory at the entrance of the main hospital building. Schwartz thus became an unforgotten savior.     

Rudolf Virchows Spuren in der Medizin nach 100 Jahren

100 years after Rudolf Virchow's death, we find it necessary to demonstrate the mark his work has left on present day medicine. Curt Froboese wrote 50 years ago: "To come to know Rudolf Virchow well, it is sufficient to read him". Therefore the present collection of literal quotations from Virchow tries to show how valid many statements of Virchow still are. His definition of "health" precedes the well-known formulation of the World Health Organization. Virchow had a presentiment of molecular pathology, without defining this word, when he ascribed molecular forces to the cell and particularly to the cellular nucleus. As a terminologist he played a guiding role. His linguistic sense enabled him to prematurely find out "barbarisms" in medical terminology. At the same time, he also supported an international understanding. In particular the surgeons came to know through Virchow that malignant tumors are also primarily local events to be surgically treated preferably in the early stage. Therefore he requested a population-based statistical survey as developed by the cancer registries today. The legend that Virchow fought against bacteriology is not true. He did not stop in his efforts to differentiate between etiology, germs and the course of infection which presupposes knowledge of the respective cellular phenomena. Summing up it can be said that Virchow still plays an important role in our medical world.     

Using homework in therapy for depression

There is a growing body of research evidence that demonstrates that completion of homework assignments is significantly correlated with outcome in cognitive therapy. The cognitive model of depression sees homework as an intrinsic aspect of the therapy process. Homework serves a number of purposes, including generalizing learning from the session into everyday life and fostering the independent practice of skills acquired during treatment. We review a number of commonly occurring problems that arise when seeking to engage the client in homework. The negotiation and implementation of homework assignments is a core clinical skill, and we present a range of strategies the clinician can use to optimize its effectiveness. It is vital that practitioners have an awareness of their own role and expectations in developing homework assignments.     

Disremembering the Holocaust

The essay describes an elderly Holocaust survivor, who re-experiences the horrors of the Holocaust through his senile hallucinations. Although he is demented, telling and re-telling the story to a therapist helps him regain a sense of control and feel less frightened. He is finally able to revise the nightmarish story into a narrative that enables him to find strength and meaning.     

Professor J. M. F. Landsmeer (1919–1999)

Johan Matthijs Frederik (Hans) Landsmeer, Professor Emeritus of Anatomy and Embryology at the University of Leiden, died on 12 June 1999, at the age of 80. He was a gifted scientist who had devoted his professional life to research in Anatomy and Embryology. During his career he was successful in blazing new trails in the relation of morphology to function. This resulted in an impressive list of publications frequently cited in the literature. His sharp analytical approach to problems was a striking feature and illustrated his aversion to superficiality. In this way he collected a profound and inspiring knowledge of human and comparative anatomy and embryology and he knew exactly how to pass on this knowledge to others. Therefore it is not surprising that he guided a substantial number of disciples to the completion of a PhD thesis, thus forming a school. His ability to translate his concepts in a way to have them accepted in the solution of clinical problems is also generally recognised. He was a skilful dissector. The results of his work were brought together in Landsmeer's Atlas of Anatomy of the Hand, published in 1976. This volume represents his meticulous morphological analysis of structures and his ability to intermingle the gross and fine structure of the hand to its function. This has opened perspectives for the surgeon engaged in the treatment of this most difficult area. Hans Landsmeer had a strong affiliation to the University of Leiden. Born on 14 January 1919 in Rotterdam, where he spent his youth, he started his medical studies at the Leiden University in 1935. In 1939, before graduating he entered the Department of Anatomy and Embryology, and he stayed there until his retirement. This continuity was only interrupted during World War II. In November 1940 the University of Leiden was closed by the Nazis in connection with a rectorial address on 26 November protesting against the exclusion of the Jewish professors. Without any doubt this major event made a deep impression on him. During his career he consistently refused any invitation from countries where democracy was violated.     

CLINICAL COMMENTARY

ABSTRACT: My impression on reading this observation is that the mother does not hold the baby enough in her mind. She does not hold him in her arms either and generally conveys the impression of experiencing him as clinging and potentially dangerous. He seems to use his muscles to hold himself together and appears compliant and does not protest by crying in several instances where crying might have been appropriate. His skin rash and snuffling are in my view somatisations of his feeling unheld and distanced by mother. Note that mother associates her cold and bronchitis with the loss of her father. Jimmy seems to be somatising the loss of the breast.
This mother and baby couple appear very often not to be in tune with each other. The only good and rewarding experience for Jimmy appears to be the bottle-feeding although again mother interrupts before he has finished.