SOME THOUGHTS ON SCHREBER (AND FREUD): DEPRESSION, PARANOIA AND A DELUSIONAL SYSTEM

ABSTRACT Freud's paper on Daniel Paul Schreber is a seminal psychoanalytic text (Freud 1911). In it, he sets out his argument that Schreber's paranoid delusions arose from repressed homosexuality. This paper reconsiders the case of Schreber from a contemporary perspective chiefly by studying, as did Freud, Schreber's autobiographical Memoirs of My Nervous Illness (Schreber 1903), but also by drawing upon more recent biographical information. It follows the view put forward by Lothane (1992), and recently elaborated by Steiner (2004), that Schreber's illness was originally depressive in nature, and then progressed to paranoia and finally to a settled delusional system. It reviews many of Freud's insights, contending that although some, such as his understanding of the mechanism of paranoia and the manner by which a delusion of persecution is converted into a religious delusion of grandeur, have stood the test of time, others, such as the causal relationship he proposes between homosexuality and paranoia, do not.     

ABDICATION OF A FATHER: SOME REFLECTIONS ON THE FREUD–JUNG CORRESPONDENCE1

abstract This paper explores one dimension of the complex relationship linking Freud and Jung as revealed in their correspondence between 1906 and 1912. It focuses on Freud's adoption of Jung as his heir, particularly in terms of his repeated proposal to Jung ‘to continue and complete my work by applying to psychoses what I have begun with neuroses’. The paper tracks the fate of this proposal in the words of these two men and suggests that the ambivalence of both can be seen as an expression of an unconscious dynamic portrayed in Shakespeare's King Lear, a dynamic characterized by the author as the developmental task of ‘heriting’. Emma Jung captured the heart of the dilemma of ‘heriting’ in her question to Freud: ‘Doesn't one often give much because one wants to keep much?’ Although the trajectory of the heritage Freud sought for his ‘adopted eldest son’, ‘crown prince’ and ‘successor’ was not the same as that of the tragedy of Lear, it was no less poignant in its tensions and disappointments – even for a time in its reversal of the ‘heriting’– and finally in the disintegration of the relationship.     

THE MANTLE OF FREUD: WAS ‘THE USE OF AN OBJECT’ WINNICOTT’S TODESTRIEB?

abstract    This paper considers the initial negative reaction to Winnicott's paper 'On the use of an object' in the light of its author's own reservations about it. It argues that its obscurities indicate Winnicott's own difficulties in articulating how the young child moves from subjectivity to the objective apprehension of the external world, and the part played in it by aggression. Particular attention is paid to Winnicott's interest in certain late texts of Freud where the 'death instinct' ( Todestrieb ) features prominently. It is suggested that Winnicott's interest, like Freud's, was prompted by the ambition of moving beyond psychopathology to formulate the outlines of a developmental psychology. Again like Freud it is argued that in this endeavour he was conceptually overreaching himself, though for different reasons. The paper concludes with some considerations about the inherently dual nature of any would-be comprehensive psychology of human understanding and behaviour, and of the necessarily partial contribution of psychodynamic theorizing towards it. The search for such a unitary psychoanalytic formula is what unites the two men.     

If Oedipus was an Egyptian

Freud's archaeological collection peopled his work rooms with sublimated expressions of eternal, universal desires. I suggest here that these tangible remnants from the long buried past resonated with psychic representations and dream figures in Freud's own internal world, which, nevertheless, were not always consciously available to him. Despite a fascination with Egyptology evidenced in his antiquities, library and less conventional works, Freud focused on aspects of the Greek oedipal legend in his theoretical writing, neglecting Egyptian myths associated with'prehistoric'realms of the archaic mother and Osirian/Mosaic father. I argue that convergence of traumatic events in his early childhood contributed to this delimiting Graeco-Roman filter, and that accessibility to the'dark continent'was hampered by resistances his own self-analysis could not penetrate but which may have been worked through in the transference had he had an analyst other than himself.     

Prelexical representations and processes in reading: Evidence from acquired dyslexia

We report a detailed and extensive single-case study of an acquired dyslexic patient, L.H.D., who suffered a left-hemisphere lesion as a result of a ruptured aneurysm. We present evidence that L.H.D.’s reading errors stem from a deficit in visual letter identification, and we use her deficit as a basis for exploring a variety of issues concerning prelexical representations and processes in reading. First, building on the work of other researchers, we present evidence that the prelexical reading system includes an allograph level of representation that represents each distinct visual shape of a letter (e.g., a, A, etc., for the letter A). We extend a theory proposed by Caramazza and Hillis [Caramazza, A., & Hillis, A. (1990a). Spatial representation of words in the brain implied by studies of a unilateral neglect patient. Nature, 346, 267–269] to include an allograph level, and we probe the nature of the allograph representations in some detail. Next, we explore the implications of visual similarity effects and letter perseverations in L.H.D.’s reading performance, arguing that these effects shed light on activation dynamics in the prelexical reading system and on the genesis of L.H.D.’s errors. We also probe the processing of letter case in the visual letter identification process, proposing that separate abstract letter identity and case representations are computed. Finally, we present evidence that the allograph level as well as the abstract letter identity level implement a word-based frame of reference.     

Diminished ability to interpret and report internal states after bilateral medial temporal resection: case H.M

These experiments centered around H.M., a 54-year-old man who became amnesic 27 years ago after a bilateral resection in the medial temporal lobe region for epilepsy. In order to document the clinical reports that he rarely comments on such internal states as pain, hunger, and thirst, his thermal pain perception was examined in relation to his other somatosensory capacities, and his reports of hunger and thirst were assessed before and after meals. In order to investigate the effect of limited memory ability on the reporting of internal states, H.M.'s performance was compared with that of 5 other subjects with global amnesia. The results provided evidence that H.M.'s information about internal states is less available or less accessible than normal and that his impairment is not attributable to his well-documented memory deficit. Instead, it is believed that the bilateral resection of the amygdala accounts for H.M.'s poor appreciation of his internal states.     

The Dream of Psychoanalysis: Irma's Dream, Some Commentaries, and a Contemplation of its Navel

Freud's dream of 1895, 'Irma's Dream', stands at the beginning of psychoanalytic theory, but Freud's analysis only glancingly refers to the 'unknown' elements that are found at 'the navel of the dream'. The imagery of the dream suggests this phrasing is significant and that unconscious elements refer to the oracle at Delphi. At Delphi a chthonic goddess was supplanted by a patriarchy; the 'unknown' at the centre of the dream is the archaic mother, repressed by Freud and by the patriarchal character of early psychoanalytic theory.     

The Sexual Abuse of Children

This paper looks at aspects of child abuse: the psychoanalytical approach, the contribution of psychological research and the problems of residential care. It traces Freud's views from his early statement of the part played by sexual trauma in the aetiology of hysteria to hs later emphasis on the role of fantasy. Masson's criticism of Freud and of his attitude to Ferenczi's paper'Confusion of Tongues between Adults and the Child'is discussed.
The paper also deals with the research on personality characteristics of paedophiles and the children involved with them, polarities of viewpoint on the long-term effects of such experiences and, finally, attitudes towards sexuality in residential establishments and the task of staff in fostering the adolescent's emotional development.     

The Sexologist Albert Moll �C between Sigmund Freud and Magnus Hirschfeld

Albert Moll was one of the most influential sexologists during the first three decades of the twentieth century. In contrast to his rivals Sigmund Freud and Magnus Hirschfeld, his achievements have not yet been recognised adequately. The author gives a comparative account of the work of these three protagonists. This shows that Moll formed some ideas which are regarded as psychoanalytical today before Freud, and that he, in contrast to Hirschfeld, was able to reflect critically on contemporary discourses, such as the debates on racial improvement through eugenics. As scientific theories, Freud’s psychoanalysis represented the unconscious, fantasy, experience and latency, while Moll’s sexology represented consciousness, ontological reality, behaviour and manifestation. Moll’s major disagreement with Hirschfeld’s sexology was his advocacy of apolitical and impartial science, whereas Hirschfeld’s aim was to achieve sexual reforms politically. Added to these differences were strong personal animosities. Freud called Moll a ‘beast’ and ‘pettifogger’; and Moll complained about Hirschfeld’s ‘problematic’ character. When Hirschfeld escaped the Nazi terror and went to Paris, Moll denounced him in order to prevent him rebuilding a new existence in exile.     

Speaking Through Action,Acting Through Speech: Acting and Enacting in the Analytic Process

In this paper the author looks at the significance of different forms of action in the psychoanalytic situation. He traces the development of related concepts, going back to Freud's early concept of a ‘symptomatic act’ and the introduction of his concept of ‘acting out’ with the Dora case, through to more modern and complex ideas of enactment. He shows that acting out can have a defensive as well as a communicative function. Actions can be a way of ‘speaking’ to the analyst, of communicating things that cannot be thought or put into words. On the other hand, speech itself can become an action rather than a form of symbolic communication, a way of putting pressure on the analyst to fit in with a projective phantasy. Important theoretical contributions to the concept of enactment, by Sandler, Joseph, Feldman and Tuckett, are described in some detail. Looking at Freud's Dora from such a perspective, the author argues that an enactment developed between Freud and his patient. Detailed clinical material is presented to show how the author uses these concepts in his own analytic work. Finally, the relationship between enactment and containment is discussed.     

BOOK REVIEWS

Book Reviewed in this article:
Frances Tustin: Makers of Modern Psychotherapy by Sheila Spensley.
Narcissus and Oedipus: The Children of Psychoanalysis by Victoria Hamilton; with a new Foreword by Eric Rayner, and a new Preface by Murray M. Schwartz.
Sincerity and Other Works: Collected Papers of Donald Meltzer edited by Alberto Hahn.
The Correspondence of Sigmund Freud and Sandor Ferenczi, Vol. 1(1908–1914) edited by Eva Brabant, Ernst Falzeder and Patrizia Giampieri-Deutsch.
The Curve of Life: Correspondence of Heinz Kohut 1923–1981 edited by Geoffrey Cocks.
R.D. Laing: A Biography by Adrian Charles Laing.
On Flirtation by Adam Phillips.
The Truth about Freud's Technique: The Encounter with the Real by M. Guy Thompson.
Seductive Mirage: An Exploration of the Work of Sigmund Freud by Allen Esterson.
Understanding Eating Disorders edited by LeeAnn Alexander-Mott and D. Barry Lumsden.
The Good Body – Asceticism in Popular Culture edited by Mary G. Winkler and Letha B. Cole.
How Humans Relate: A New Interpersonal Theory by John Birtchnell.
Letters to the Living and the Dead by Nini Herman.     

On Not Being Able to Symbolize

This paper explores ideas from Marion Milner which the author has found helpful in conceptualizing work with a patient who felt tyrannized by her objects, terrified that she would be swallowed up by them never to re‐emerge. Her terror interfered with her capacity to symbolize. The paper looks at the concept of a bodily self and its creative engagement with the world especially in the form of fusion with the object. It places Milner's theory in the larger context of psychoanalytic and neuroscientific thinking from Freud and Winnicott to Damasio as well as relating it to philosophical and Romantic accounts of creative apperception and personal knowledge. Although confidentiality precludes a detailed account of the analysis, the author provides an outline of the gradual development of her capacity to symbolize alongside her growing sense of a continuous self. He further comments on her finding what Milner called ‘intuitive images’ to bridge intellect and intuition and to allow them to co‐exist peacefully. The patient brought drawings to sessions and the paper reflects on these as an index of change as well as on the importance of the process of creating them in relation to her anxiety over the tyranny of objects.     

RETAIL THERAPY: THE ENJOYMENT OF THE CONSUMER

The discourse of economics and consumerism has not only penetrated into the clinical setting; it has had a pervasive effect upon each of us and upon the society in which we live. This state of affairs is taken up by reference to the now commonly used phrase ‘retail therapy’, in order to examine the implications of the promotion of this concept. These ideas are further elaborated through an examination of the consumerist bent our societies have taken, promoting as they do an unfettered enjoyment of consumer goods. But for society to function and for desire to take root in the subject, it is proposed that there is a necessary loss of enjoyment which from psychoanalysis we can designate as castration. The contemporary difficulty to undergo such a loss is tied here to a prolongation of the state Freud described as polymorphously perverse. It is here that the psychoanalyst has an ethical responsibility to unveil whatever discourses function to alienate the subject from his or her desire.     

Lexical competition for production in a case of nonfluent aphasia: converging evidence from four different tasks

We report an individual with Broca's aphasia (J.H.M.), who exhibited powerful lexical context effects in word production tasks. In an adjective-noun production task (Experiment 1), J.H.M.'s production accuracy decreased as the number of adjectives in the phrase increased (e.g., curly hair vs. long curly hair). In a picture pair naming task (Experiment 2), J.H.M.'s naming accuracy was high, but her naming latencies were abnormally delayed when pairs were semantically related (e.g., goat and pig). This pattern was not observed for older controls. In a computerized Stroop task (Experiment 3), J.H.M.'s naming latencies were abnormally prolonged in the conflict condition, relative to a baseline colour naming task. This effect was far in excess of that for controls. Finally, in a blocked cyclic naming task (Experiment 4), J.H.M.'s accuracy was poorer and her latencies slower when the pictures were semantically related than when they were unrelated, and this effect built up across successive presentation cycles. It was far in excess of that exhibited by older controls. We propose that J.H.M.'s pattern of impairment across these four very different tasks suggests an impairment to a lexical control mechanism, whose normal function is to modulate the flow of activation throughout the lexical network, so as to minimize the competitive effects of nontarget lexical items.     

Anorexia nervosa: a case study.

D.R., a single 19-year-old female experiencing anorexia nervosa, was admitted to a mental health center inpatient unit weighing 64 lb, approximately 54 lb underweight, with liver, kidney, and pancreas damage. D.R. was hospitalized for 59 days. Treatment consisted of utilizing a hierarchy of reinforcements in the form of privileges mutually agreed upon between patient and therapist, psychodynamic and supportive psychotherapy, and involvement in the ward milieu therapeutic program. All privileges had to be earned. Access to food was controlled by the staff. For pounds gained privileges were granted, for pounds lost privileges were curtailed. Dynamically, D.R.'s eating behavior was viewed as an unconscious spite and revenge reaction toward her parents as well as an attempt to elicit attention. At the time of discharge D.R. weighed 104.5 lb. Prior to discharge D.R. agreed that if her weight dropped below 100 lb she would return for readmission. Five months later D.R.'s weight stabilized between 102 and 104 lb. Two years later, D.R.'s weight remains at that level. The study cautions against using solely a behavior modification approach in the treatment of anorexia nervosa.     

MATTE BLANCO AND THE MULTIDIMENSIONAL REALM OF THE UNCONSCIOUS

The author offers an introduction to the work and thinking of the Chilean psychoanalyst, Ignacio Matte Blanco (1908–1995), which can be understood as the exploration of the logical properties inherent in Freud's five characteristics of the unconscious ( Freud, 1915 ). One consequence of these properties is that unconscious phenomena behave as if they occupy dimensions that are greater than those of conscious phenomena. These are the three dimensions of space and one dimension of time. The unconscious has to be ‘unfolded’ or ‘translated’ out of this higher number of dimensions into those available for conscious representation and thought. This characteristic, together with the fact that the individual is lost in the unconscious, makes the experience terrifying and bewildering. In addition, Matte Blanco shows that the logical properties of the unconscious and those of emotion are indistinguishable, suggesting an equation between the two. Material from a patient's analysis is offered to illustrate this phenomenology and the clinical application of Matte Blanco's thinking.     

To Live or Not To Live: That is the Question

This paper attempts to explore the stranglehold on the life of a patient who is be-devilled by his inner world. It suggests that the opposite of Evil is the word itself backwards, that is, ‘Live’. In other words, reverse Evil and we have Live. Living is about loving (whole object relating) and working (being creative). Freud said that a normal person should be able to love and to work—‘Lieben und Arbeiten’ (Erikson, Childhood and Society, 1965, p. 256), which meant that the individual would not be so preoccupied with work productiveness ‘to the extent that he loses his right or capacity to be a genital and loving being’ (Erikson, p. 256). In this paper, the author considers the word ‘Live’—living in its fullest form of loving and working to be the counterpart to a non-life dominated by the grip of destructiveness and evil thoughts. This theme is fleshed out through the clinical material on Mr A.     

THE O OF EMPTINESS AND THE EMPTINESS OF O

In this paper I try to show how Bion's sense of ‘O’ may usefully be seen as similar to the Buddhist notion of emptiness. I try to instantiate some of his ideas and I hope that by doing so I might contribute to the realization in the consulting room of his injunctions. I try to explore a possible difference in interpretation between the terms identity and identification and to use the distinction to suggest how emptiness can clarify the real nature of the ego as Freud accounted of it and how its realization can instantiate ego strength.