Collective fantasy: A way of reaching the unconscious

The experience of using active imagination and forming a collective fantasy as a means of communication with the personal and collective unconscious is described and the method and setting used to evoke these collective fantasies are reviewed. A collective fantasy produced by a group of residents and medical students is reported. The hypothesis is that a collective fantasy is an alternative way to communicate with the unconscious, which in classical analytical literature has only been accessible through dreams and free associations.     

Commençons par écarter tous les faits. Quelques réflexions freudiennes et lyotardiennes sur la réalité psychique

ObjectivesThe aim of this article is to question the Freudian notion of psychic reality, by asking ourselves whether it prefigures the recognition of a form of emancipation from the facts of the world. The assertion that fact often carry less weight than certain thoughts is at the heart of the Freudian notion of psychic reality. Indeed, Freud is not content, when he discovers the depth of hysterical fantasies, to ask that psychic reality be taken into account alongside practical reality, nor that it not be confused with material reality; instead, he endeavors to show that the unconscious literally ignores the difference between fact and desire. Thus, the difficulty is not only that of an overestimation of reality and an underestimation of fantasy. Nor is it confined to neurosis, which places psychic reality above factual reality, but it is necessary to admit the superiority and even the domination of psychic reality in the formation of many contents of representation: in the unconscious, nothing distinguishes desire from fact. Therefore it is very difficult to differentiate between “normal” beings, who would only trust realities, and neurotics, who would react with the greatest seriousness to thoughts alone. The point is delicate and will be at the heart of the Freudian discussion, an open-ended discussion on whether the original act of parricide is an historical truth or more of a fantasy.MethodTo discuss these questions, I will compare the reflections on the unconscious found in S. Freud and in the French philosopher J.-F. Lyotard, who both commented on Freudian texts devoted to fantasy but also drew inspiration from Freudian theories, while putting them at a distance, in order to forge his own conception of the unconscious and of affect. The first step will be a reconstruction of this great unconscious scene from which any formation powerfully invested with affect has more value and importance than its denial by reality or the so-called objective facts. In a second step, I will ask whether the Freudian psychic model is thus only an anticipation of the empire of the post-truth or whether Freud also fails to spot unmistakable signals of reality or signs that are not themselves mere layers of interpretation. I will then question the Freudian idea, formulated in The Interpretation of Dreams, according to which affect is always right, at least as far as its quality is concerned. It is well understood that affects, like representations, can be reversed into their opposite. It seems, however, that affects are less subject to modification than the contents of the representation. Following Jean-François Lyotard's philosophical interpretation of the Freudian notion of affect, which leads him to elaborate the notion of “affect-phrase,” I will, in a third step, summon this affective voice that would testify – in truth – without representing anything and without ever “lying.”ResultsThe comparison of Freud and Lyotard allows for the establishment of a connection between the question of the meaning to be given to the notions of psychic reality and fantasy and that of unconscious affect. Indeed, it seems that what prevents us from assimilating the unconscious to a place only containing facts of desire, completely devoid of any index of reality or referenciality, from concluding, in so doing, that nothing is a sign towards reality or that it is only constituted of interpretative layers that we never finish going through, is perhaps that fantasy can create an event on the psychic “stage” – and that this possibility is conditioned by a strong investment in affects.DiscussionThe aim is to initiate a discussion about the points of similarity between a thought and the unconscious, as well as their differences, in terms of Freud's “small unconscious things.” This is followed by a discussion on the distinction between thought and unconscious in Lyotard, in terms of sentences, affect sentences.ConclusionThe double view of affectivity based on the thoughts of Freud and Lyotard displaces the idea of an unconscious, in a way that is post-factual. Admittedly, the full and complete motivation or justification of affect derives from the recognition of psychic realities on which these affects are based. Nevertheless, these affects signify the existence of a dimension of psychic reality that goes beyond the structure of the layers of fantasy or interpretation that one never stops going through and that constitute the unconscious as a reality devoid of facts. In this article, I have insisted on the importance of the Freudian idea formulated from the Interpretation of Dreams, according to which the affect is always true, as to its quality. In the same way, I have argued that, in the last period of his thought, Lyotard presents the affect or infantia as a fact of the unconscious.     

L'objet du fantasme

A debate between a lacanian point of view and a freudian point of view, beyond the controversies about technique, deals with the nature of the “clinical” in the therapeutic process. The nature of unconscious fantasy is at the core of this question. From a criticism of the biological hypothesis, in the drive, the object of fantasy may be considered, not as a representation of the other but as the use of the representation of any other as characters in scenarios which are present in Psychic Reality, i.e. as hallucinatory representations of actions.     

Interpersonal Psychoanalysis: History and Current Status

Interpersonal psychoanalysis is not well known outside the northeastern United States, yet it has been present since the 1930s and has influenced psychoanalysis all over the world. In this article, the origins of interpersonal psychoanalysis are described, providing at least a partial explanation for this widespread ignorance. Interpersonal psychoanalysis no longer finds much of its definition by an opposition to ego psychology, as it did in its early days. Today, instead, the more significant question for interpersonal psychoanalysis is how, and whether, it can be differentiated from relational psychoanalysis. This is especially important for those who, like me, identify as both interpersonal and relational. Interpersonal thinking was the heart of Mitchell's original conception of relational psychoanalysis. I argue that interpersonal psychoanalysis remains a coherent psychoanalytic perspective, defined by radical field theory; a deemphasis on unconscious fantasy and repressed memories as templates for conscious experience; an emphasis on fantasy as mystified experience; a correspondingly greater emphasis on the embeddedness of the past in the forms of the present; and most of all, the continuous, unconscious, mutual influence of the subjectivities of analyst and patient on one another.     

A proposed scale for the determination of maternal feeling

Summary A scale was devised, an elaboration of that of David M. Levy, to make an objective determination of the degree of maternal feeling. By constrast with Levy's scale, it gave significant consideration to the direct evaluation of unconscious factors.An additional purpose of this study was to determine whether or not Levy's conscious criteria were adequate to determine maternal feelings, and if not, whether the addition of unconscious material was necessary.The results of the study indicate that the determination of maternal feeling on the basis of observation and verbal interview alone may produce misleading conclusions and that it is only by considering specifically unconscious factors as well, that one can obtain a more complete picture of this complex phenomenon. For maternal feeling is not a single entity but a composite of factors still to be delineated clearly.The author's Maternal Feeling Scale, which is derived from Levy's,⁵ was designed to preserve what is valuable in his scale, but has been modified and expanded in order to compensate for some of its deficiencies.     

Le sondage de l'inconscient au?service de?la prédictivité de?la?violence

In order to protect the patient from violent actions against himself or against people around him it is absolutely necessary to make a synthesis of all parameters which can influence his behaviour. Within these parameters, the unconscious, which is difficult to detect, is very important. The psychiatrist must free himself from his own defence facing the discovery of his patient's unconscious. Within this context a certain new kind of approach to the unconscious has been refused for decades and almost all psychiatrists still do so today. The Multidimensional Drawing Test (MDT) has brought important progress since its publication, as compared with the projective techniques to which it may said to belong. Some examples prove that the author of this test wanted to use them to try to foresee violence and that some tragic events could have been avoided if it had been possible to deepen the analysis of the “comic strip” (TPD).     

La Théorie de la Séduction Généralisée et son corollaire, la théorie de la traduction

It is in 1987 when, in the book “New foundations for the psychoanalysis”, Jean Laplanche developed his “theory of the generalized seduction” by taking back what Freud had abandoned in his neurotica of 1897. Laplanche, about the text of Ferenczi on the “Confusion” of the languages between the adults and the child considers that the term of translation would be more suited than that of confusion but also that Freud did not develop the effects of the premature communication and the message. Now it is from the interhuman communication between an adult and a child within the “Fundamental Anthropological Situation” that the author places the genesis of the psychic device and it, independently of any biological substratum. And so the enigmatic messages which – from the sexual unconscious of the other adult – ask for a work of translation of the infans, for work the not translatable unconscious rests of which will become that Jean Laplanche names the “objects-sources” of the drive at the origin of the repression. The child of the pregenital sexuality is the only one “herméneute”, who has to translate the enigmatic messages compromised with the unconscious of the other adult. From this point of view, the “theory of the generalized seduction” is also a theory of the afterward. We present two clinical cases which show how Jean Laplanche's theory allows us to welcome the clinical material by considering the work of the patient as a event of translation-symbolization from a reopening facilitated by the experiment of the psychoanalytical situation.     

Language behavior and hierarchic integration in a psychotic child

A longitudinal study of a schizophrenic boy is presented with a focus on language behavior and hierarchic integration. Ten-minute interviews (N=13), at c.3-month intervals, were recorded and transcribed during a period commencing at the patient's age of 3 1/2 years and ending at 7. Analysis included verbal productions (linguistic factors and content), clinical play and graphic data. The child's global behavior showed increasing functional and social adaptation. Language structure in relation to fantasy level proved useful in describing his unique psychic structure and the gradual relationship to objects. Competence in language and play seemed to emerge together as though related to an underlying factor inferred as cognitive organization. The method of investigation and findings are discussed in light of broader implications for the study of deviant development and diagnosis of psychoses in childhood.     

Speech behavior and neurotic personality structure. Is there a neuroses-specific communication behavior in the psychoanalytic situation]

Speech behaviour of the patient and the analyst is considered with regard to the psychoanalytic situation and its regulating factors such as transference and countertransference. It appears that the scientific viewpoint of the researching analyst determines the conception as well as the interpretation of a possible connection between verbal behaviour and neurotic personality structure. If the psychoanalytic situation is regarded as a means to investigate the patient and his symptoms, his verbal behaviour seems to depend on the unconscious motives forming his neurotic structure of personality. On the contrary, if the psychoanalytic situation is regarded as a communicative situation, the verbal behaviour of the patient as well as of the analyst depends rather on their 'here-and-now' transference relationship in a certain phase of the psychoanalytic process.     

Familial neurofibromatosis 1 with germinoma involving the basal ganglion and thalamus

Intracranial germinoma associated with neurofibromatosis 1 (NF-1) has never been documented previously. We report a case of familial NF-1 with a germinoma involving the right basal ganglion and thalamus. A 12-year-old boy presented with multiple café-au-lait spots and a family history of neurofibromatosis in his mother, one of two siblings, and his maternal grandfather. His intracranial lesion was subtotally resected. Histologically, it was a pure germinoma. Serum -feto protein and -human chorionic gonadotropin levels were within the normal range. Postoperative myelographic examination and cerebrospinal fluid cytology study showed no evidence of subarachnoid seeding. The patient received postoperative combination chemotherapy resulting in complete response and clearance of the residual tumor. Although this finding of an intracranial germinoma in a patient with familial NF-1 may be coincident, it is suggestive of a potential genetic predisposition. Longitudinal evaluation for the possibility of neoplasm, especially germ cell tumor, in basal ganglion lesions in NF-1 patients is necessary.     

Sexual orientation, fraternal birth order, and the maternal immune hypothesis: a review

In 1996, psychologists Ray Blanchard and Anthony Bogaert found evidence that gay men have a greater number of older brothers than do heterosexual men. This “fraternal birth order” (FBO) effect has been replicated numerous times, including in non-Western samples. More recently, strong evidence has been found that the FBO effect is of prenatal origin. Although there is no direct support for the exact prenatal mechanism, the most plausible explanation may be immunological in origin, i.e., a mother develops an immune reaction against a substance important in male fetal development during pregnancy, and that this immune effect becomes increasingly likely with each male gestation. This immune effect is hypothesized to cause an alteration in (some) later born males’ prenatal brain development. The target of the immune response may be molecules (i.e., Y-linked proteins) on the surface of male fetal brain cells, including in sites of the anterior hypothalamus, which has been linked to sexual orientation in other research. Antibodies might bind to these molecules and thus alter their role in typical sexual differentiation, leading some later born males to be attracted to men as opposed to women. Here we review evidence in favor of this hypothesis, including recent research showing that mothers of boys develop an immune response to one Y-linked protein (i.e., H-Y antigen; SMCY) important in male fetal development, and that this immune effect becomes increasingly likely with each additional boy to which a mother gives birth. We also discuss other Y-linked proteins that may be relevant if this hypothesis is correct. Finally, we discuss issues in testing the maternal immune hypothesis of FBO.     

Sensibility to the unconscious (Balint approach)

The physician-patient relationship is recognized as having an essential role in the process of medical care, providing the context in which caring and healing can occur. Good patient-doctor relationship goes far deeper than the behaviour of physicians, particularly those behaviours recognized in popular culture as acting in a professional manner, being respectful of the patients' circumstances and bedside manner. The therapeutic relationship is a relationship between two persons--on one side is the patient who is psychologically modified in his illness, in regression, with resistance mechanisms, defences, fears and need for gratification, care and also for secondary profit. On the other side is the physician with his authority, knowledge, personality, habits, defences, unconscious of his own pharmacological effect on the patient, as the most potent drug. In the patient-centred medical model, based on contemporary scientific knowledge of disease, the physician has to understand the patient's "world of illness", and to accept the patient as a person with his whole conscious and unconscious reasons for suffering and not only as a"collection of symptoms".     

Ferenczi's “Madness”

Seven contributions from a combination of psychoanalysts, writers, and one academic are discussed. All contributors try to arrive at some understanding of how psychoanalysis has been depicted in the media and why so many of these portrayals tend to be outlandish. The authors' speculations range from efforts to deal with the threat of someone who can see unconscious process to a satirization and exaggeration of what may be actual qualities in many analysts. Each author's implicit or explicit psychoanalytic theory has much to do with his or her respective hypotheses.     

The use of the psychodynamic life narrative in crisis supervision

The psychodynamic life narrative is a statement that is made to the patient that gives current emotional reaction meaning in the context of his life history, and shows it to be a logical and inevitable product of previous life experiences. Because the patient in crisis characteristically present feeling overwhelmed, confused and needy, there is a sense of urgency and helplessness which impacts on the resident therapist's intervention. Common countertransference reactions which can result are assuming omnipotent control, a grandiose rescue fantasy or passivity. The authors present a clinical vignette to illustrate the supervisory process and its vicissitudes in the use of the psychodynamic life narrative in supervision of crisis work. The early identification of the "rescuing" response led to the rapid formulation of the psychodynamic life narrative and a successful outcome.     

La « folie à deux » dans l'œuvre de Clérambault

In this text, the author presents G. Gatian de Clérambault's interventions concerning « folie à deux ». These are viewed from a historical perspective from a draft of a nosography of mental diseases. The evolution of his different contributions shows de Clérambault's concern with the concept of mental automatism in his nosography, which, as it is based on the clinical identification of a supposed psychoses-generating mechanism, is similar to a structural approach. To that extent, de Clérambault's work brought a new vision to psychotic disorders in small groups and deserves recognition.     

The object and the dream: Mark Rothko

An exploration of unconscious determinants provides useful insights in considering Mark Rothko's creativity and behavioral characteristics. A basic focus is the issue of childhood loss and unresolved grief. The studies of Martha Wolfenstein on preadolescent and childhood parent loss are paramount in considering Rothko the man. Rothko, as a result of early losses, was predisposed to recurrent depressions and bouts of anger which created difficulties in his intimate relationships. Rothko evidenced a lifelong mistrust of male authority figures which may also account for his antipathy toward psychoanalysis. His psychological life was complicated by his experiences of institutionalized anti-Semitism which further diminished his trust in others.     

Reluctance to accept life-saving treatment.

The patient is a twenty-three-year-old man with end-stage kidney disease who has major conflicts about receiving maintenance hemodialytic treatment. These conflicts stem in part from the patient's hospitalization at the age of seven and the witnessing of heroic medical procedures used in an attempt to treat his father's eventually successful suicide. His unconscious doubts of his manliness result in a pseudoindependent behavior and a pose of hypermasculinity which induce a rejection of passivity and the dependent position necessitated by being a patient on hemodialysis. Rejection of hemodialysis may be a conscious or unconscious suicide attempt. In this patient, it may be a consequence of guilt in relation to his father's death and of other psycho-social factors. Effective treatment for this patient should include allowing him to exercise his independence in as many ways as is possible. Home dialysis and renal transplantation lend themselves to greater feelings of independence and may be preferable to center hemodialysis in this patient. The feelings surrounding the death of his father should be explored with a liaison physician or psychiatrist.     

Antigenic phenotypes of cultured malignant astrocytomas: identification of lineage-consistent, lineage-independent and putative tumor-restricted antigenic expression

The treatment of CNS neoplasms with monoclonal antibody-mediated immunotherapy optimally requires the identification of tumor restricted cell surface antigens. However, little is known regarding the antigenic phenotype(s) of malignant astrocytomas. The interrelated expression of four neuroectodermal tumor antigens, CNT/11, AJ8, A010 and CNT/2, has been studied in cultured malignant gliomas and correlated with anchorage independent growth, morphology, glial fibrillary acidic protein, and the surface expression of other antigens. Many of these latter antigens have been reported to be expressed by specific fetal and differentiated adult cell lineages or tissues, as well as certain classes of malignant tumors. The tumor-associated expression of these antigens may be broadly classified as lineage-consistent, lineage-independent or putatively tumor-restricted. Malignant glioma tumor antigenic heterogeneity represents the expression of neuroectodermal and non-neuroectodermal cell surface markers. The importance of this observation is 2-fold. Lineage-independent antigen expression may be an indication of altered genome regulatory processes within tumor cells, and thus reflect the degree of anaplasia. The identification of lineage-consistent and lineage-independent tumor associated antigens may contribute to the selection of "target" antigens and the prediction of toxicity for monoclonal antibody mediated immunotherapy.     

The actor,the act and the environment: forensic psychotherapy and risk

The assessment and management of risk is a complex task best achieved by interdisciplinary professional collaboration. This paper discusses the specialist contribution of forensic psychotherapy to this increasingly important area. The assessment and management of risk may be enhanced by psychodynamic understanding of the internal world of the offender patient and the unconscious meaning of the forensic act as well as by psychodynamic examination of the interactions between the patient and his environment.