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L A Kirshner

Publications and source records attributed to L A Kirshner.

At least 19 recordsLinked to original sources
PubMed1999

Toward a postmodern realism for psychoanalysis.

The current status of psychoanalysis is explored in the light of the postmodern critique of forms of knowledge. Analysts have tended to respond by redefining psychoanalysis in the language of the exact sciences or by finding a language that includes both (Kuhn, Rorty), thereby falling either into a reductive "scientism" or the fallacies of the "strong program" in postmodern thought. However, psychoanalytic theories do not meet the probative requirements of science. Neither is the serious problem of competing theories and interpretations adequately addressed by hermeneutics. Philosophical realism (Putnam 1981, 1988) offers some helpful ways to look at this problem. Following Lacan, we define psychoanalysis as a clinical discipline which has as its unique object of study the human subject, an indeterminate and language dependent entity. Concepts and rules specific to our field make an internal realism of psychoanalytic inquiry possible. An extended case vignette accompanies this philosophical discussion.

Humans↗
PubMed1998

Problems in falling in love.

Certain patients enter psychoanalysis because of their inability to love another person. Often they report a repetitive erotic pursuit of desired partners, without being able to experience or maintain loving feelings. Kernberg has understood such difficulties as representing effects of early narcissistic disappointments and/or of difficulties in resolving oedipal conflicts. In this paper, Lacanian concepts of the mirror phase and symbolic love are employed to develop these issues. Sexualization of problems in mirroring may be fused with oedipal conflicts in some cases. An extended vignette is presented to illustrate the technical and theoretical issues.

Humans↗
PubMed1994

Trauma, the good object, and the symbolic: a theoretical integration.

Psychic trauma has returned as a central concept for psychoanalysis after a period of relative eclipse since Ferenczi's pioneering work. Our search for a common clinical understanding of trauma, however, may have been hampered by the lack of a shared definition within the diversity of contemporary theoretical models. In this paper, the threat of destruction or loss of the good object, here redefined as a function of symbolic representation of the human world of cultural meanings and value, is proposed as a common ground for theories as diverse as those of Ferenczi, Freud, Klein, and Lacan. As a corollary, the role of the psychoanalyst in treatment of traumatised patients must be viewed in relation to the symbolic function of the good object. When this function has been damaged, the analyst cannot rely upon the intrinsic features of analytic treatment to provide conditions of safety for therapeutic re-experiencing of the past and for facilitation of a new object experience, but must at times take active measures. It is suggested that Ferenczi may have tried to become the good object for his patients, rather than using the analytic position to help restore the symbolic function. Loewald's clinical theory is presented as consistent with the latter approach.

Humans↗
PubMed1993

Concepts of reality and psychic reality in psychoanalysis as illustrated by the disagreement between Freud and Ferenczi.

In this paper, the concepts of reality and psychic reality are discussed in relationship to a number of controversies about the therapeutic and scientific aims of psychoanalysis, as illustrated by the disagreement between Freud and Ferenczi. Because the nature of psychic reality is necessarily incomplete and indeterminate, there are inherent limitations and dangers to any psychoanalytic attempt to discover historical and experiential truth. Modell's interpretation of Nachträglichkeit ('deferred action') as 'retranscription' expresses the ambiguity of psychic reality in analysis, which is not fixed or foundational but part of an evolving inner and outer dialogue in relation to new experience. It is argued that Freud accepted this ambiguity, while Ferenczi sought to overcome it through modifications of technique.

Freudian Theory↗
PubMed1992

The absence of the father.

The author discusses the role of the father in early development through the concept of triangulation. Three male patients are presented who seemed to lack images and memories of their fathers and experienced them as absent, despite their physical presence during childhood. In these men, the oedipal phase appeared skewed and a dyadic relationship with the mother dominated the material. They reported a lack of a sense of masculinity and a phobic concern about the dangers of male violence, along with feelings of specialness and grandiosity. Analytic data suggested that the image of an absent father reflected a process akin to splitting of the ego, in which the significance of the father was disavowed and the patients fantasized a special role with their mothers; via projection, the fathers reappeared as dangerous intruders. It is proposed that this structure derives from a specific developmental situation in which a disturbed parental relationship has impaired the father's position as a "third" in the early triangle. The child's sexual and aggressive tensions cannot be contained in his fantasies of the couple and must be projected outside. The absent father returns in the transference, where the analyst is reexperienced as useless and absent and as a threat to the specialness of the dyad, thereby recapitulating the predicament of the child.

Adult↗
PubMed1991

The concept of the self in psychoanalytic theory and its philosophical foundations.

Concepts of "the self" in psychoanalytic theory have important philosophic underpinnings which may not be adequately appreciated. Both self psychology and ego psychology, with their contrasting positions on the self as a mental structure, retrace paths taken by Western philosophy beginning at least with Hume and Descartes. They reflect traditional philosophic questions, notably of a homuncular self internal to consciousness and the isolation of the subject from other selves. Psychoanalysis has not utilized Hegel's conception of the intersubjective origins of the self, in which the self emerges only in an encounter with another subject, although this approach is implicit in the work of Winnicott on the mother-infant dyad. This movement from a one- to a two-person psychology also presents conceptual problems, as illustrated by the psychoanalytic theories of Sartre and Lacan, who take up opposing positions on the status of consciousness and on intersubjectivity in the formation of the self. Sartre's phenomenology, with its emphasis on the questing nature of the subject in search of an identity, resonates with contemporary theories of narcissism in which the painful isolation of self from self-affirming and mirroring objects is central to clinical practice. Lacan's insight into the role of acquisition of language helps us to understand the formation of the subject in pursuit of a virtual selfhood, as Sartre described, but embedded within an intersubjective matrix.

Cognition↗
PubMed1988

A model of time-limited treatment for the older patient.

In conclusion, brief treatment can be offered to a majority of patients when focused around current difficulties in the life structure, as opposed to past unconscious dynamic conflicts relived in the transference. Some aspects of the life structure, of course, are also unconscious, namely, those having to do with attempted solutions to core personality conflicts and those reflecting modes of ego functioning. We have utilized Loevinger's model of stages of ego development to understand the latter aspect. Personality and cognitive operations are the portals through which life-cycle tasks are experienced and interpreted. In order to formulate the problems of the life structure and of accomplishment of life tasks, the clinician must understand the major dynamic issues as they present themselves within the particular stage of ego development. In our example, Mr. S.'s sense of defect and injury was processed within a fairly "high level" of development which enabled him to undertake the therapeutic task with considerable autonomy and initiative, compatible with his view of himself and optimal interaction with others. Presentation of a therapeutic task or focus which fits the dynamic issues and the developmental stage in a manner which is readily comprehensible and relevant to the patient is the major task of the therapist in brief treatment. In this model, the patient uses the therapy to work on a life task and life structure in a goal-oriented manner jointly constructed with the therapist. This reality orientation and focus on aspects of the person closest to awareness make the model applicable to a broad spectrum of patients and to a time-limited setting in which the work can be done in different phases over time.

Adaptation, Psychological↗
PubMed1985

Length of stay on a short-term unit.

In this retrospective study of length of stay (LOS) and outcome on a general hospital unit, utilizing analysis of variance techniques, the authors found institutional, psychiatric, and economic factors significantly related to LOS. Patients with diagnosis of major mental illness and lower scores on The Global Assessment Scale tended to stay longer and improve more. The involvement of a private (versus staff or clinic) psychiatrist and a history of previous hospitalization were also significant, when controlled for other variables. These findings are discussed in relation to previous research showing the advantages of a brief LOS.

Adult↗
PubMed1983

Effects of gender on inpatient psychiatric hospitalization.

In this study of inpatient hospitalization, gender was found to be a significant variable. Effects of gender upon admission and discharge Global Assessment Scale scores raises the possibility of differential criteria for men and women to be admitted or discharged: a "gender bias effect." Results also support the hypothesis of a "patient gender effect" of greater responsiveness to treatment by women. As predicted, gender showed complex interactions with other variables, including diagnosis, age, marital status, and prior hospital experience. Length of stay was not found to be related to gender.

Adult↗
PubMed1982

Current status of milieu psychiatry.

Appreciation of the role of milieu in psychiatry has waxed and waned in response to various scientific, ideologic, and social pressures. In this review, historical trends in the use of environment in treatment of mental illness are integrated with social science and empirical research studies of milieu. While the insights of social scientists of the prepsychotropic drug era helped sensitize psychiatry to deleterious effects of hospitalization, the 1960s saw development of a schism between an antipsychiatry movement and a defensive medical reaction, now critical of the excesses and claims of proponents of milieu treatment methods. Recent research studies, however, have begun to document significant effects of milieu upon treatment outcomes, suggesting an opportunity for renewed collaboration between social scientists and hospital psychiatrists. The importance of directing future research efforts toward more specific parameters of milieu in interaction with different diagnoses or patient populations is discussed.

Hospital Units↗
PubMed1982

Length of stay of psychiatric patients. A critical review and discussion.

In this paper, length of stay for psychiatric inpatients (LOS) is discussed in terms of controlled studies of hospitalization, research on patient factors contributing to LOS, and variation in mean or median LOS between institutions and within units. Although the multiplicity of variables involved precludes ready generalization, it can be said that open-ended hospital stays, above 28 days, have not been demonstrated to improve outcomes. However, the complexity of specific circumstances makes it unrealistic to impose rigid uniform standards within or across units. Medically managed units with a director as the locus of decision making may be in a better position to control LOS. Research into relationships between different treatment milieus and outcomes for specific diagnoses is suggested as a promising avenue for further research into cost effectiveness of hospitalization.

Activities of Daily Living↗