Kingsley Hall: The Politics of Madness

This article replies directly to the two cornerstones of Hobson's legendary transposition of Freud's dream theory, that is, the theory's presumed empirical untestability and its scientific obsolescence or replaceability in the scientific arena. After an outline of Freudian dream theory, empirical data coming from two research paradigms (“children's dreams” and “drug dreams”) are reported. From a theoretical-epistemological point of view, the studies show that Freud's dream theory includes clear “potential falsifiers,” that is, in Popper's terms, certain events, which if found to be true, would unequivocally show Freud to be wrong. This challenges Hobson's accusation concerning the empirical untestability of Freud dream theory. From an empirical viewpoint, these studies show that Freudian dream theory is not even remotely scientifically outdated and obsolete. The results of these studies are consistent with the cornerstones of Freudian dream theory (e.g., the hypothesis of dreams as wish-fulfillment, the disguise-censorship model) and suggest the viability and worth of further investigation in this arena. Indeed, Freud's dream theory is alive and useful in explaining the phenomenon of dreams in various fields of application. These authors believe that J. A. Hobson's dismissal of Freudian dream theory is thus misguided and premature because, to date, the findings indicate that Freud was essentially correct.     

The “Voice” of Breakdown: On Facing the Unbearable Traumatic Experience in Psychoanalytic Work

This article weaves together three major contributions to the theory of trauma and repetition compulsion: Freud's (1920/1955b) reformulation in “Beyond the Pleasure Principle” of his metapsychological theory regarding the notion of trauma and the compulsion to repeat traumatic experiences and traumatic dreams; Cathy Caruth's (1996) elaboration, based on a dramatic story in Freud's article, of “the voice that cries out, a voice that is released through the double wound”; and Winnicott's (1963/1986, 1965/1989a) unique ideas about the early unthinkable breakdown that has not yet been experienced and has to be relived and experienced in analysis.

The author explores the clinical implications of the intricate relation between knowing and not-knowing in facing trauma, which is simultaneously demanding and inaccessible, massively dissociated, and thus never and forever there. In particular, she relates to the profound difficulty of hearing the “voice” of breakdown that cries out from the belated “double wounding,” the critical importance of experiencing the unexperienced with the analyst; and the immensity of the terror and hope that is at the heart of reaching to the original unbearable traumatization in psychoanalytic work. Three detailed clinical illustrations from psychoanalytic writings and an autobiographical essay by Virginia Woolf are presented.     

On a Case of Bulimia

Freud proposed two sharply contrasting conceptions of the body's place in mental structure. Both were radical departures from established views of the mind. In the first, body-based thought is rooted in the drives and instincts. It is primitive in contrast to the body-free, logical, and rational thought of maturity. Freud remained committed to this view in his formal conceptions of the mind throughout his working life. It remains the one most fully accepted in psychoanalytic thought today.

Less formally, particularly in conceptions of the “accidental” factors that structure the primary processes, “stereotype plates” that pattern our experience, thinking as “action in the mind,” and “internalizations” that form our inner worlds, he suggested an even more radical notion. In this view, “bodily” refers to the behavioral patterns (of personal motivation, action, attitude, wish, and feeling) as opposed to mental ones. Body-based patterns occur primitively, but they may also become mental and structure the mind at the highest levels of sophistication. Neither in Freud's time nor subsequently, however, has it been possible to integrate this second view of the bodily in mental functioning into the accepted psychoanalytic theory of mind.

Now, however, developing perspectives in psychoanalysis provide a framework in which this second view can be accommodated. In this model the mind is initially composed of social-emotional-behavioral patterns (in Stern's useful term, “patterns of lived experience”) established in familial life (Freud's “accidental” factors that form “stereotype plates”). These patterns, articulated and modified in the course of development, can increasingly be activated mentally with or without accompanying bodily action (Freud's “action in the mind” and “internalization”). These, rather than the rational-logical processes of traditional thought, constitute the mature mind.     

History of Aphasia Freud as an aphasiologist

Between 1891 and 1901, Sigmund Freud published both psychoanalytic and neurological works. This review analyses the interactions between Freud's On the interpretation of the aphasias (1891) and the development of psychoanalytic concepts, as well as Freud's theoretical views on brain–mind interrelations and his neurolinguistic theory. It is pointed out that in his aphasia book, Freud developed elements of a neurobiological theory of cognition and behaviour that became important for the theoretical foundation of psychoanalysis. Although Jackson, whom Freud regarded highly, had understood that people communicate by propositions, Freud followed Wernicke in that the word and the word concept were the basis of language. This assumption guided the interpretation of associations in psychoanalysis. For aphasiology, Freud is one proponent among others who criticised mechanistic localisationist theories. His major obstacle was the lack of linguistic theories. Freud's influence on aphasiology was rather limited, mainly because his book was hardly read, to his dismay.     

Therapeutic Action and the Story of the Middle

Abstract. The work of Sándor Ferenczi anticipates various challenges of contemporary psychoanalysis—clinical, technical, and theoretical. Among the most novel is his elaboration of the concept of trauma. Ferenczi's 1930s writings were mostly read by the psychoanalysts of his time, including Freud, as a return to Freud's seduction theory. Nevertheless, in Ferenczi, there is an innovation that distinguishes him from Freud. Although today's psychoanalytic community expresses a growing interest in Ferenczi's trauma theory, the field pays less attention to his focus on the traumatic dimension of language itself and the effects language has on the subject. In fact, Ferenczi's later work uniquely explores the relationship between trauma and language. In part, what makes Ferenczi's trauma theory unique is that it anticipates Jacques Lacan's work on the traumatic dimension of language, which the French psychoanalyst referred to in his final theoretical production through the concept of lalangue.     

Si je vous dis « rouge », à quoi pensez-vous ?! Discussion autour d’une dynamique associative inconsciente

PurposesThis article aims to deepen a theoretical model of the psychic apparatus introduced in a previous work, in particular one of its main characteristics: the presence, at the center of its functioning, of an unconscious dynamic of perceptive association partly inherited from the primary process of the Freudian theory.MethodThe article first surveys Freud's writings about three psychic phenomena: dreams, slips of the tongue, and jokes. Analyzing these works suggests a theoretical difficulty concerning two processes (primary and secondary) considered to be opposites by Freud, and leads to an alternative applied by our model. The article then moves on to the famous experiments conducted by Alfred Binet with his hysterical patients at the end of the 19th century, in which the so-called phenomenon of “double consciousness” was put on display.ResultsIt appears that the unconscious dynamic of perceptive association is always a driver of psychic life, in both unconscious phenomena as well as in regular thinking. It typically operates when we facetiously ask the reader: “If I say ‘red’, what comes to mind?” This dynamic seems to bring to the natural mechanism of thinking some proprieties of condensation and displacement already identified by Freud, in a more intense form, in the making of dreams and attributed to his primary process. More precisely, thinking appears to be the product of this dynamic, given that it is supervised by the activity of the field of consciousness, simultaneously able to activate and channel it.DiscussionThe irruption of dreams possibly results from a kind of switching in the collaboration between consciousness and the unconscious system during sleep: the lowering of conscious activity then opens the way for the associative dynamic of the unconscious whereas, on the contrary, the former tightens its grips in the alert thinking. More generally, we can consider that thinking, in all its forms, always depends on the control exercised by the field of consciousness over the associative dynamic of the unconscious. A great freedom given to the latter would necessarily be a condition for artistic creation, for example.ConclusionOur reflections and model clearly borrow from Freudian theory, while also clearly departing from it in several respects. Starting from the dynamic of the unconscious system, this article highlights the importance of conscious activity when Freud instead tended to minimize it. From this perspective, our model would appear to occupy a middle ground between Freud's and Janet's.     

The conceptualisation of dreams by adults with intellectual disabilities: relationship with theory of mind abilities and verbal ability

Background Empirical studies suggest that individuals with intellectual disabilities (ID) have difficulties in conceptualising dreams as perceptually private, non‐physical, individuated and potentially fictional entities. The aim of the current study was to replicate the results found by Stenfert Kroese et al. using a comparative sample size, and to examine putative cognitive correlates of accurate dream conceptualisation [receptive language and 1st order theory of mind (ToM) abilities]. Method Conceptualisation of dreams, real objects and photographs was assessed with a structured closed‐question interview schedule, together with receptive language, and ToM abilities. Results Findings from the current study replicated those of previous research, finding that many adults with ID tend to think that dreams take place around them, can be witnessed by others, can be touched and manipulated, can be shared by others and are about real events. The ability to accurately conceptualise dreams was found to increase along with receptive language ability, and there was a non‐significant association between ToM ability and the ability to understand that dreams can be about potentially fictional entities. Conclusions Some individuals with ID have a different understanding of mental phenomena such as dreams, which has implications for several aspects of care and support, particularly relating to mental health and therapeutic work.     

Playing with Boundaries

Immigrant psychology and mental health have become of interest to academics, mental health professionals, and governments, which is not surprising because issues of immigration have important social, political, economic, and psychological dimensions. Boulanger (2004) notes that although psychoanalysis was created and dominated for a long time by immigrants, the number of psychoanalytic authors addressing immigration remains small, and the contributions themselves are relatively recent. I contend that unformulated (Stern, 1997) dissociative experiences of temporo-spatial discontinuity (Akhtar, 1999) lie at the heart of the immigrant's experience. Sometimes these experiences find expression in dreams, or are revealed in unexpected feelings and thoughts triggered by an event that concretely represents discontinuity. In this article, I offer case illustrations from my clinical work to describe and analyze various expressions of this unformulated, dissociative experience. I also identify some variations, which I label as the awareness surge, the perplexing clarity, and the two-point existence.     

Unusual case report: Do violent dreams cause violent acts?

For most people most of the time nocturnal dreams seem to have a life of their own with little, if any, recognisable relevance to life in the waking state. Freud and other theorists have attempted to relate nocturnal dreams to underlying impulses and conflicts which also affect one's mental state when awake. In only a few mental disorders has the manifest content of dreams achieved widely accepted diagnostic significance. The case presented here demonstrates that a patient's tenuous hold on reality can allow manifest dream content to direct the patient's waking behaviour. In this case the dream content seemed to identify the potential victim and to prime the patient to take violent action. For the astute clinician, careful attention to violent dreams may help to anticipate both violent acts and specific victims and to make appropriate, preventive interventions.     

Erich Fromm: Clinician and Social Philosopher

After many years of radical criticism of Freudian dream theory on the grounds of his and others' neurophysiological findings, Allan Hobson now proposes a new model of the dreaming brain that is remarkably consistent with Freud's. This revision was necessitated by recent neuroscientific findings. Hobson is to be commended for his openness to the new evidence, but he does not make sufficiently clear how closely his new model resembles Freud's. The main focus of my article is to make these parallels explicit, so as to clarify the remaining points of difference. Fortunately, it appears that these points can now be resolved experimentally.     

The Cross-Cultural Therapeutic Dyad

The impact of Nikos Kazantzakis's memoir Report to Greco on the author is explored. Writing a “letter” to Kazantzakis in a style that mimics Freud's 1936 public letter, A Disturbance of Memory on the Acropolis: An Open Letter to Romain Rolland on the Occasion of his Seventieth Birthday, the author muses on an epiphany while facing the Parthenon. The author's personal sense of aliveness and deadness is presented as a measure of the interpenetration of psychoanalysis and the humanities.     

Psychosis as a Disorder of Reduced Cathectic Capacity: Freud's Analysis of the Schreber Case Revisited

Approximately 100 years ago, a prominent German public figure name Daniel Schreber wrote memoirs of his experiences in asylums. His case was diagnosed Dementia Praecox at times and Paranoia at others by his treaters. Freud analyzed Schreber''s memoirs from the perspective of his “libido” theory of developmentally organized mental “cathexes” or ideational/emotional investments in self and others. Revisiting Freud''s analysis of the Schreber case suggests that it may represent the first theoretical articulation that the pathophysiologic core of psychosis is one of deficit, i.e., of diminished (organic) cathectic capacity for normal mental and affective investments in life.     

The Marc Dax (1770–1837)/Paul Broca (1824–1880) controversy over priority in science: Left hemisphere specificity for seat of articulate language and for lesions that cause aphemia

One of the most fascinating and frustrating issues in the priority of discovery in science is over just who, for the first time, went on record in the public forum, either orally at a conference or through a published communication, proclaiming that the faculty of articulate human speech was located in the left, not the right, cortical hemisphere. The disputed paper was purportedly written in 1836 by Marc Dax, who died subsequently in 1837. He was a physician in southern France in the city of Montpellier—far from the medical center of Paris. Little note was made of the presumed paper until the early and mid‐1860s, when the issue of language localization in the human brain took on increased activity, as the clinico‐pathological method of explanation continued to flourish in the “Art of Physick.” Marc Dax's son, Gustave, happened to be studying medicine in Paris in the 1860s, and, as most of the neuroscientific and anthropological researchers, came to know of Broca's published work, which in 1861, agreed with phrenological theory that this faculty was, indeed, in the anterior lobes, but further claimed, de novo, that the region in the anterior lobe was more precisely focused at the foot of the 3^rd frontal convolution in that lobe, still assuming with phrenological theory and the “Law of Symmetry” that the faculty was bilaterally located. It was not until 1865 that Broca clearly, non‐hesitatingly, and unambiguously claimed that the faculty was in the left hemisphere. As it turned out, Gustave, six weeks before Broca's paper appeared, had published the paper he said his father had written in 1836. In 1863, in fact, Gustave had submitted his (Gustave's) long monograph on aphemia, integrating what he claimed to be his father's 1836 pronouncement along with his own data. He sent this communication to the French Academy of Sciences and to the French Academy of Medicine; he heard nothing back from either academy. After waiting two years, he managed to publish his material. Gustave's valiant move to promote his father's priority for one of the most significant conclusions in the history of the neurosciences is a lesson in frustration. Broca's attitude towards Gustave's case was disarmingly nonchalant; the issue deserves further historical inquiry.     

Debate: Academics should collaborate with the technology industry,but not in lieu of noncollaborative research

Academic research collaborations with the technology industry should be complementary to and, importantly, must not replace noncollaborative research that is independent from the industry (and, in particular, ‘adversarial research’ whose negative findings will likely operate against industry interests). Reflecting on the author's own research projects concerning companies' compliance with video game loot box regulation, he agrees with Livingstone et al.'s proposition (Child and Adolescent Mental Health, 2022, 28, 150) that research seeking to identify problems (and thereby work against the industry's interests) should be conducted independently (p. 151), at least initially. He also echoes the sentiment expressed by Zendle and Wardle (Child and Adolescent Mental Health, 2022, 28, 155) that ‘a moratorium’ (p. 156) or a ban on industry collaborations is not a proportional response to legitimate concerns about conflict of interest stemming from the video game industry's discretionary provision of data access. A combined approach that conducts both noncollaborative and collaborative research, but with the latter being conducted only after the former's unbiased results are known, might prove fruitful. Academics must bear in mind that industry involvement at any particular stage of the research, or at all, is not always appropriate. Some research questions should not and cannot be answered objectively with industry involvement. Funding bodies and other stakeholders should also recognise this and not render industry collaboration compulsory.     

On “Remembering,Repeating and Working Through,” Again

This article examines Freud's key paper "Remembering, Repeating, and Working Through” for its significance in the history of psychoanalysis. Each of the words in Freud's title are taken to be integral to Freud's writing.     

Editor's Note

Dr. Donald L. Burnham was the distinguished Editor of Psychiatry from 1962 to 1985. He continued founding editor Harry Stack Sullivan's vision of the Journal and established the Journal as an important voice in understanding mental illness, behavior, psychotherapy, and the mind.     

Development and implementation of a peer-based mental health support programme for adolescents orphaned by HIV/AIDS in South Africa

Aim: The article describes a framework and the process for the development of the peer-based mental health support programme and its implementation. The development of a peer-based mental health support programme is based on Erikson's theory on the adolescent phase of development, the psycho-educational processes; the peer approach and the orphaned adolescents lived experiences as conceptual framework.

Methods: A triangulation of five qualitative methods of photography, reflective diaries, focus groups, event history calendar and field notes were used to capture the lived experiences of adolescents orphaned to HIV and AIDS. Analysis of data followed Colaizzi's method of data analysis.

Results: The combination of psycho-education, Erikson's stages of development and peer support assisted the participants to gain knowledge and skills to overcome adversity and to assist them to become to more resilient.

Conclusion: The peer based mental health support programme if used would enhance the mental health of adolescent orphans.     

The Core Conflictual Relationship Theme

This article presents a brief but comprehensive guide to the Core Conflictual Relationship Theme (CCRT) method, including its scoring, its reliability, and its validity in relation to CCRT congruent evidence that is within Freud's observations about transference. The usual CCRT method is concretely illustrated through its application to a sample interview; an extension of the CCRT is also illustrated in order to help distinguish parts of the CCRT of which the person is less aware.     

‘Recognisable Psychiatric Injury’ and Tortious Compensability for Pure Mental Harm Claims in NegligenceSaadati v Moorhead [2017] 1 SCR 543(McLachlin CJ and Abella,Moldaver, Karakatsanis,Wagner, Gascon,Côté, Brown and Rowe JJ)

Since at least 1970, one of the constraints upon compensability for pure mental harm at common law has been that a plaintiff must have suffered not just adverse psychological consequences from negligence but a ‘recognisable psychiatric illness’. In a powerful unanimous decision, the Supreme Court of Canada in Saadati v Moorhead [2017] 1 SCR 543 has controversially removed this requirement. This paper reviews the reasoning in the decision and considers its ramifications, concluding that while it is likely to extend the liability of defendants, this will occur only in a small cross-section of cases where a plaintiff exhibits significant symptomatology of a mental disorder albeit falling short of sufficient for an unequivocal diagnosis within the meaning DSM-5 or ICD-10. It notes that in the post-Ipp reforms in Australia, a ‘recognised psychiatric illness’ has been statutorily enshrined as a prerequisite to recovery by plaintiffs, so statutory law reform would be required to implement the Saadati decision. While it welcomes the contribution of the Saadati approach to reducing the law’s discrimination against mental (as opposed to physical) injuries, it calls for close scrutiny of the actual effects of the Saadati decision.     

Mentally disordered offenders: Clinical,political and legal developments in the United States

Australians with only passing knowledge of what transpires on the other side of the Pacific are probably aware that law in the United States is neither a stagnant nor a very stable enterprise. Where it intersects with the business of psychiatry, the law's in‐flux character is especially pronounced. The last decade or so has seen as much change as any, as the law has sought to keep pace with advances in medical theory and technology and with psychiatric reconceptualizations that have affected both the diagnosis and treatment of mental disorders. “Keeping pace” means not just the incorporation of what is new, but sometimes also its rejection (not to mention its exploitation or distortion for partisan legal gain or to accommodate the winds of political change). A review of the more significant legal changes shows the various ways whereby the law has sought to accommodate new developments in psychiatric medicine.