Treatment of conversion disorder in an African American Christian woman: cultural and social considerations.
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Adult↗
Biomedical subjects
B J Seelig
Publications and source records attributed to B J Seelig.
Normal and pathological altruism.
The psychoanalytic literature on altruism is sparse, although much has been written on this topic from a sociobiological perspective. Freud (1917) first described the concept in "Libido Theory and Narcissism." In 1946 Anna Freud coined the term "altruistic surrender" to describe the psychodynamics of altruistic behavior in a group of inhibited individuals who were neurotically driven to do good for others. The usefulness and clinical applicability of this formulation, in conjunction with the frequent coexistence of masochism and altruism, encouraged psychoanalysts to regard all forms of altruism as having masochistic underpinnings. Since then, there has been a conflation of the two concepts in much of the analytic literature. This paper reexamines the psychoanalytic understanding of altruism and proposes an expansion of the concept to include a normal form. Five types of altruism are described: protoaltruism, generative altruism, conflicted altruism, pseudoaltruism, and psychotic altruism. Protoaltruism has biological roots and can be observed in animals. In humans, protoaltruism includes maternal and paternal nurturing and protectiveness. Generative altruism is the nonconflictual pleasure in fostering the success and/or welfare of another. Conflicted altruism is generative altruism that is drawn into conflict, but in which the pleasure and satisfaction of another (a proxy) is actually enjoyed. Pseudoaltruism originates in conflict and serves as a defensive cloak for underlying sadomasochism. Psychotic altruism is defined as the sometimes bizarre forms of caretaking behavior and associated self-denial seen in psychotic individuals, and often based on delusion. We consider Anna Freud's altruistic surrender to combine features of both conflict-laden altruism and pseudoaltruism. Two clinical illustrations are discussed.
Altruism↗
On those wrecked by success: a clinical inquiry.
Freud's description of those wrecked by success outlines conflicted oedipal triumph as the central underlying dynamic in this character type. It does not distinguish those patients who avoid success from those driven to achieve and then wreck their success. We present a complex picture that we believe is prototypic of patients who destroy their success. A clinical case illustrates our point of view. We emphasize the developmental problems we believe typical of patients who dramatically wreck the success they achieve. We hope to extend rather than replace Freud's landmark contribution to our understanding of this type of character pathology.
Humans↗
A sadomasochistic transference: its relation to distortions in the rapprochement subphase.
The development of a rageful sadomasochistic transference early in an analysis is presented. We describe key interventions that foster its resolution and offer a reconstruction of the patient's early life, focusing on difficulty in the rapprochement phase. We believe that the intense and difficult to manage sadomasochistic transference was linked to a repudiation of both preoedipal and oedipal triangulation, resulting in the perpetuation of a hostile dependent mother-child dyad and in the patient's unconscious belief that sadomasochistic interactions were the only means of establishing and maintaining a close relationship.
Adult↗
Altruism and the volunteer: psychological benefits from participating as a research subject.
Psychiatric assessment of potential volunteers for hazardous biomedical experimentation should include an assessment of the motivations underlying the altruistic action of volunteering. Screening goals include evaluation of informed consent as well as screening out experimental subjects who would be likely to be psychologically harmed by participation. This discussion of psychological issues to be considered, beyond those of informed consent and screening for severe psychopathology, originated in the psychiatric screening of the small group of original volunteers for the "Dobelle eye" Artificial Vision Project. These individuals entered the project over 20 years ago at a time when they could expect no tangible benefit from participation. Superficially altruistic behavior, such as volunteering for this project, serves multiple psychological functions and in a given clinical case, the determinants are often complex. A spectrum of altruistic behavior is suggested, based on interviews with these original subjects as well as from extensive evaluation of patients studied in the setting of psychoanalytic treatment with one of the authors (B.J.S.). We suggest that adaptive altruism can explain the finding that some volunteers gained actual psychological benefit from their participation. This unanticipated finding, that participating in research as an experimental subject can result in lasting improvement in self-esteem, is discussed. Suggestions are made for increasing the likelihood of such benefit. Ethical ramifications are addressed.
Altruism↗