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Biomedical subjects

M Viederman

Publications and source records attributed to M Viederman.

At least 19 recordsLinked to original sources
PubMed1999

Presence and enactment as a vehicle of psychotherapeutic change.

This article addresses an aspect of psychoanalytic and psychotherapeutic process that leads to change. Focusing on an aspect of the patient-therapist interaction that the author calls "presence" of the therapist, it demonstrates how the experience of this may lead the patient to unconscious enactment of early wishful fantasies concerning the good parent. The gratification of these wishes implicit in the interaction influences the therapist-patient relationship and plays a significant role in change.

Aged↗
PubMed1996

Psychiatric complications in a patient with complex partial seizures.

This case highlights the complexities of evaluating and treating psychiatric symptoms that are concurrent with a seizure disorder. Interictal and postictal psychoses, affective disorders, personality changes, and cognitive deficits are common problems that require modified psychiatric treatments.

Atrophy↗
PubMed1995

The reconstruction of a repressed sexual molestation fifty years later.

The current public concern about childhood molestation and abuse has fueled the debate in psychoanalysis about historical versus narrative truth, a subject that has implicitly and explicitly been an important theme since the origin of psychoanalysis. The evocation of false memories by suggestion has had significant social consequences. This raises important questions about the role of real trauma as contrasted with fantasy in the genesis of psychic conflict. This paper explores the conditions for the emergence of long repressed trauma. It is argued that such traumatic memories emerge only after significant structural change has occurred, in particular modifications in the representational world (self and object representations). This substantive change may be viewed as a macroscopic way station in the evolution of the analysis. This is demonstrated in the description of the analysis of a patient born with a congenital anomaly. The analysis of her unconscious fantasies about her deformity, her identifications with defective people, and of a negative paternal transference had to occur before the development of an erotic transference. It was then that fragments of the memory of the sexual trauma emerged. Details of the reconstruction are presented. The successful integration of this painful experience is described. Six years after termination of the analysis, the patient wrote a letter describing a confirmation of the event, now sixty years past, from the sole other survivor of the period who had knowledge of what had happened.

Child↗
PubMed1995

An artist's defense against the fear of loss of creativity toward the end of life.

A creative artist in his mid-sixties had a strong desire to own and carry with him a drawing by Picasso--a self-portrait done three days before his death. The drawing created a sense of calm in the patient, such as had never occurred before with the possession of an object. An apparent preoccupation with death might have obscured the primary concern of the artist, which was about the loss of creative power, and it was for this reason that he wanted to possess the drawing. The idea that this might be viewed as a transitional object at the end of life is discussed.

Anxiety↗
PubMed1994

The uses of the past and the actualization of a family romance.

This paper elaborates an aspect of the therapeutic experience of analysis that pertains to the examination of the past as it influences a patient's view of his self-worth and relationship to the world. It is complementary to the usual view of psychoanalytic process that involves analysis of transference resistance, revelation of transference, and the discovery of its genetic roots. I propose an additional therapeutic aspect of the reexperience of the past in which the changed representation of patient as child is validated by a new object, the analyst, who is experienced as a benevolent witness to the past and as a benevolent presence in the past, thereby consolidating the change and influencing the patient's adult self-representation. This therapeutic effect is more likely to be of significance in patients who have experienced parental loss or significant deprivation in childhood. Segments of the analysis of a patient illustrate this point. The patient described "listening to himself with compassion for the child he had been" and being listened to by me in the same way. He became thereby "tolerant and empathetic with the child he had been." The more general implications of this as a vehicle for change in psychoanalysis are discussed. Of ancillary interest was the patient's research into his past and ultimately his actualization of a family romance fantasy with a particular ironic twist.

Adult↗
PubMed1993

The anatomy of a consultation: a teaching method.

The Anatomy of a Consultation is a teaching method useful in introducing residents to Consultation-Liaison psychiatry. It is designed to stimulate them to think actively about the process of consultation in its broadest implications, including interaction with staff. The residents are encouraged to observe, make inferences, establish hypotheses about the evolution of the consultation, and to test these hypotheses by obtaining new information. The analogy of an unfolding detective story is used. A resident is asked to present the evolution of a consultation chronologically for ongoing group discussion. A vertical and a horizontal approach to the examination of the material are used. The vertical proceeds with clarification of the consultation as it evolves toward closure. The horizontal takes as its point of departure various topics that emerge to illustrate general principles and applications in different situations. These topics are approached more systematically and in greater detail in later teaching. Emphasis is placed upon coping and adaptation and the principles of active interventions useful for people in crisis. Patient data is organized within two broad categories: 1) the diagnostic, phenomenologic, and psychopathologic; and 2) the psychodynamic, conflictual, and life historical. An illustrative example is presented.

Adaptation, Psychological↗
PubMed1993

An unusual relationship: the final encounter of Picasso and Matisse.

Picasso and Matisse renewed their relationship in 1946 as the aging Matisse approached death. Picasso, ordinarily contemptuous of others and indifferent to their needs, revealed a markedly different attitude toward Matisse, whom he admired and whose affection and approbation he sought. The roots of Picasso's attitude are traced to his morbid concern about bodily deterioration and fear of death. Matisse, apparently serene in his confrontation with approaching death, represented an ideal to Picasso, a hoped-for remedy for anxiety, a confident paternal representation so unlike his father. Freud's view of death, poetically expressed in his paper, "On Transience," is a model for contrasting Picasso's "revolt . . . against mourning" with Matisse's sense of symbolic immortality.

Aged↗
PubMed1991

The real person of the analyst and his role in the process of psychoanalytic cure.

This paper focuses on the real relationship with the analyst in the psychoanalytic situation as an aspect of the therapeutic process that leads to change. The role of free association, clarification, and interpretation of the transference are taken for granted as major activities of the analyst, and the real relationship with him is seen as a complementary but important ingredient for change. In particular, his emotional availability determines the climate of analysis. The concepts of neutrality, anonymity, and abstinence, though of importance as guideposts in the conduct of an analysis, have conceptual limitations that not infrequently bind the analyst in a stance that is not useful for the progress of the analysis. On occasion, confirmation by the analyst of the verity of an experience in the patient's early life facilitates the analytic process. This occurs particularly in situations of early trauma, but at times may include chronically traumatic early life experiences. An important motivating force in analysis is the patient's unconscious wish to find the ideal parent absent in early life experience, a wish that is experienced and ultimately analyzed. This is to be distinguished from a defensive idealized transference. Psychoanalytic developmental psychology contributes to our understanding of how the real person of the analyst, his emotional availability, his responsiveness at particular times, his attitude toward action and progressive change in the patient, affect the therapeutic process that leads to change.

Adult↗
PubMed1988

A developmental-psychodynamic model for diabetic control.

This paper elaborates a psychodynamic-developmental model as a framework for understanding the wide range of adaptive and maladaptive responses to the self-care requirements of diabetes. Early life experience participates with other factors in influencing the ease with which diabetics implement diabetic control. This model emphasizes the importance of the mother-child interaction during the second phase of development, the toddler phase, at which time the child begins to establish a sense of autonomy and control over his own body and its functions, with bowel training viewed as a paradigm for body control. It is postulated that certain types of mothers such as controlling-intrusive mothers, overprotective mothers, or guilty, indifferent, or rejecting mothers create problems for the child related to the development of autonomy and the sense of comfortable and pleasurable control over his bodily functions. Conflicts generated during this period are reactivated with the onset of diabetes and lead to difficulty in implementing control. In some situations where conflicts with the caretaker figure were predominantly limited to aspects of control, trusting relations acted as a substrate for change and improvement in control in a supportive medical environment. Specific management recommendations based upon this model are presented.

Adaptation, Psychological↗
PubMed1987

René Magritte: coping with loss--reality and illusion.

René Magritte was profoundly influenced in his painterly style and in the content of many of his paintings by his mother's suicide when he was fourteen. This paper explores the influence of this traumatic event on his work. My thesis is that the nighttime suicide of Magritte's mother by drowning: (1) had a profound impact on the form and style of his paintings; (2) his paintings represented an effort, mostly successful, to contain and master through intellectual control with isolation of affect the trauma of this experience, which must at the time have evoked helplessness and despair; (3) the contents of a series of his paintings directly reconstruct the traumatic experience under control and in the service of mastery; and (4) there are paintings, mostly painted at the time he clearly developed his own style (1926-1930), that reveal a breakthrough of projected primitive aggressive impulses and unconscious representations of the aggressive mother. In these latter paintings, both form and content are dramatically different from the main corpus of Magritte's work.

Aggression↗
PubMed1986

A case report of dissociative pseudodementia.

The authors report the case of a patient admitted to a medical hospital for seizures and considered for more than 1 month to be demented. Psychiatric examination revealed a fluctuating cognitive capacity, suggesting a psychogenic etiology. Following a sodium amytal interview, the patient's symptoms dramatically resolved. Diagnosis, treatment, and the importance of considering dissociative pseudodementia are discussed.

Amnesia↗