Biomedical subjects
Publications and source records attributed to J S Grotstein.
Memory and desire, along with understanding and preconception, are to be abandoned (really, suspended) for the analyst to be ever open to unexpected emerging from the analysand's unconscious. The discipline that Bion suggests allows the analyst to be open to his/her own native feelings as an emotion-receptor and analytic instrument.
It is important in these changing times to reconsider the psychoanalytic conception of the unconscious and the phantasmal mental life that occupies it--so that we can recalibrate our clinical work with it. It is the foundation of all our endeavors. Recent developments in neurobiology, combined with a more pragmatic intersubjective approach in psychoanalysis and psychotherapy, have marginalized the status of the unconscious in the eyes of many mental health professionals. Moreover, considerations of realistic childhood traumata and neglect are being more and more counterposed to the traditional concept of the infantile neurosis. What is at stake is a dismissal of a concept that is still of enormous importance, yet one that has been too little understood. What is required is a dual-track conception in which an interplay can be seen to be taking place between the unconscious, neurobiology, and trauma in the intrasubjective as well as in the intersubjective matrix.
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The ancient Greek myth linking the images of the labyrinth and the Minotaur provides an allegory for Melanie Klein's conception of the archaic Oedipus complex as well as a vivid illustration of Winnicott's notions of object usage and the 'subjective object'. The labyrinth is suggestive of mother's body as the first area for an infant's exploration and putative sadistic conquest. The Minotaur, in turn, suggests the infant's unconscious phantasies about the content of mother's body, namely such projective identifications onto that body as the paternal penis and the 'internal babies'. Further, the heroic dynamic personified by Theseus in the myth of the labyrinth metaphorically signifies what is here proposed as a developmental line that involves the courage to do a number of things, including to become, to create, to seek, to explore, to do, to challenge, to undertake risks, to accept, to rescue, to initiate, to think, to know and to realize. The Minotaur can thus be thought to serve as a universal subjective signifier for an 'Object of Challenge', which, if not successfully dealt with by the ego-development of the infant, transforms that default into the 'Object of Nemesis'. Ultimately, this myth of mastery speaks to the psychoanalytic process itself as well as casting light on the transformative aspects of sexual intercourse as a personal healing ritual.
The classical psychoanalytic concept of the one-person treatment model and its assumptions concerning psychic reality are compared with the contemporary two-person model, subsumed under the concept of "alterity" (otherness). The classical model of unconscious mental life is explored in terms of the principles of "autochthony" (signifying the fantasy that self and object are created entirely from and by the self) and "cosmogony" (an aspect of primary and secondary processes that accounts for the creation of a personal and an objective world-view). Autochthony and cosmogony are subsumed under the category of "creationism." I discuss why I identify these three phenomena by these relatively unused terms.
To understand and treat patients suffering from psychoses (especially schizophrenia) and from other primitive mental disorders, it has become increasingly important to integrate the "soft science" of psychoanalysis, including its derivate, psychotherapy, with the "hard science" findings of neurobiology, infant development research, and newly emerging trauma research. The author presents such an integrated perspective, and also discusses a paradigmatic change within psychoanalysis itself, one that can be described as a transformation from the one-person ("modern") model to the intersubjective ("postmodern") model. This change is also characterized by a shift from drive theory to that of semiotic meaning and hermeneutics. In light of this transformative change and integration, the author formulates the concept of a generic type of patient, "orphans of the 'Real,'" whose illness can be described as the result of a premature awakening from the protective blanket of innocence because of hypersensitivity and/or traumatic abruption. These patients experience the "Real" without the protective blanket of imagination or symbolization.
Objective relations theory is a broad, multifaceted concept that covers a number of differing paradigms. The author highlights the historical development of this concept. Originally developed by Freud and Abraham, it gradually became a shibboleth that identified both the Kleinian and the Independent schools in Great Britain and the object relations school within the American school of ego psychology. The two British schools differed between each other and from the American school. Among these schools of thought, two major paradigms have emerged: (1) the one-person psychoanalytic model, and (2) the two-person model. More recently, derivatives of the two-person model have emerged as the schools of relationism, self psychology, and intersubjectivity. In addition, the contributions of the Lacanian school have altered concepts about the fundamental nature of object relations. What is consequently at issue in terms of the psychoanalytic conception and treatment of psychoses and primitive mental disorders (with patients suffering from being "orphans of the 'Real'") is (1) the differing conceptions of what is meant by internal objects, part-objects, selfobjects, and object-representations, and (2) the differing conceptions of unconscious mental life.
W.R.D. Fairbairn was a noted Scottish psychoanalyst who helped launch the "object-relations revolution." While working within the traditional Freudian and Kleinian framework, he developed ideas of importance that have hitherto been eclipsed but that are now resurfacing, thanks to current awareness of primitive mental disorders, child abuse, and infant development research. Fundamentally, he challenged the primacy of the drives and the pleasure principle and stated that the infant is object-seeking from the beginning. Furthermore, he established the dissociative nature of the schizoid personality in particular and the schizoid aspects of all psychopathology in general. The author summarizes Fairbairn's work from historical, theoretical, and clinical perspectives.
Creativity is a capacity with many faces, some sublime, others pathological, and still others somewhere in between. Creativity plus the talent to use it are the necessary ingredients of the great artist. People who have had the experience of emotional depths and who have had talent may constitute the majority of artists. Those with talent who have been taken over by their emotions may still be great artists--but there is a difference.
The psychoanalytic treatment of psychotic disorders has had a long and complicated history because of the historic preference of psychoanalysis for neurotics. Nevertheless, it has survived the prejudice of psychoanalysts and empirical psychiatrists and now enters an interdisciplinary phase in which psychotic psychopathology is understood as primarily an emotional disorder, but one that must also be considered from the point of view of neurobiology and neuropsychology as well as sociology. In this contribution, I offer the idea that perhaps the most important subtext in the psyche of the psychotic is what has been called the black hole. This massive deficit is ultimately attributable to a precocious abruption of the mother's physical and psychical presence from the infant, a phenomenon that has hereditary, congenital, perinatal, and continuing developmental reinterpretive elaborations. The psychoanalytic treatment of the psychotic consists of reversing the direction of his or her cataclysmic descent into the black hole and, at the same time, empathically loosening the control that the protective psychotic alterego has on the surviving self. Further, the psychoanalytic treatment of schizophrenia, in particular (as well as many of the other primitive mental disorders), now frequently involves both an interdisciplinary orientation and perspective and choices of interdisciplinary modalities extending across the whole biopsychosocial spectrum.
The lateralization of the cerebral hemispheres constitutes a neuropsychologic parallel to the functioning of the mind. It is proposed that that the dual-track theorem generally and the Siamese-twin configuration (with the Moebius-strip twist) specifically offer a unique and useful paradigmatic perspective that allows us to organize and integrate the characteristics and functions of the brain-mind continuum. A hypothetical "psychology" for the corpus callosum and the two hemispheres was conjectured which would tentatively help to account for some of the brain's behavior, which conceivably approximates that of the mind. Ultimately, the concept of dialectics is suggested as being the best way of understanding all aspects of the brain-mind.
The dual-track theorem is offered as a paradigm for mental and neurobehavioral processes by inferring a subjective as well as objective dualism of perspectives. This model is necessary in order to more easily account for paradoxes, ambiguities, conflicts, discrepancies, and inconsistencies that are left over from the unitary hypotheses, the latter of which lead to dogma and to demonism in their quest for the absoluteness of certainty.
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Autoscopy is thought to be a rare phenomenon in which a person visualizes or experiences a veritable hallucinatory image of his double. It may be more common than has hitherto been thought, however. It has no general pathological significance compared with its counterpart, the Capgras syndrome, where there is the experience of the object as a double, but it can occur in psychotic and borderline states and in afflictions of the central nervous system. Autoscopy has been known since ancient times but came into prominence only in the nineteenth century, both in the romantic literature of the double and in neuropsychiatric research. This paper details its history in literature as well as in psychiatry and neurology and also offers clinical examples from the author's caseload. It is the contention of the author that the phenomenon is far more common as an intrapsychic (nonhallucinatory) experience and that it is especially common in dreams. Autoscopy can ultimately be considered the quintessence of a "Cartesian artifice" in which one mind-body ("I") is caught in the act of regarding its compatriot self as a mind-body with sufficient distance as to register the ultimate meaning of self-recognition. A theory is offered that autoscopy is a special form of depersonalization which may be related to the "split-brain" phenomenon neurophysiologically and which is due to special forms of splitting and projective identification psychically.
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