Biomedical subjects
R Caper
Publications and source records attributed to R Caper.
Psychopathology and primitive mental states.
The author discusses the psychoanalytic concept of primitive mental states, arguing that normal primitive mental states contain omnipotent fantasies that in an adult would be classified as delusions and hallucinations, but also contain sufficient reality sense to allow the infant to learn through experience that its omnipotent unconscious fantasies are not real, but only ordinary unconscious fantasies. Psychopathology of the type requiring psychoanalytic treatment is connected to persistent unconscious omnipotent fantasies (delusions). It is not the result of a regression to a normal primitive mental state, since in a normal primitive mental state, such delusions and their resultant inhibitions, symptoms and anxieties are gradually and spontaneously overcome through learning from experience. The unconscious delusions related to psychopathology persist because they are insulated from the effects of the learning from experience that would ordinarily convert them into unconscious fantasies by the use of transformations in hallucinosis, reversal of perspective and realistic projective identification by the psychotic part of the personality. Together, these mechanisms distort experience in such a way that reality appears to confirm, not challenge, the delusions, making learning impossible. The theory that psychopathology is due to a regression or fixation to a normal primitive mental state acts as a defence against the awareness that the mental states associated with current psychopathology are not like normal primitive ones, and that they differ from normal primitive mental states by containing forces that are sufficiently destructive of learning from experience to have prevented the patient's mental state from evolving in a normal fashion.
Psychic reality and the interpretation of transference.
Beginning with Freud's concept of psychic reality as the product of external events and the patient's unconscious fantasies, the author suggests that projective identification, as described by Klein, gives an account of how these two elements combine to produce one's psychic reality. The transference is an aspect of psychic reality that represents a confusion between the patient and one of his or her objects--the analyst--brought about by projective identification. A clinical example illustrates how the patient's transformation of the analyst's interpretations through projective identification contributes to the transference. Analysis of the transference in the analytic relationship allows patients to experience their role in the formation of their experience of the world, "live" and as it happens. This promotes the integration of the patient's personality. The author compares this approach with other approaches to the transference.
A mind of one's own.
The author argues that in the transference the patient unconsciously identifies the analyst with what he has projected into him, creating what Strachey called an external phantasy object. In the intimate rapport of the analytic session, the analyst tends to identify with these projections as well, which brings him into a relationship with the patient that complements the patient's narcissistic object relationship with him. The analyst's identification with the patient's projections is a type of pathology of his receptivity to the patient that is exacerbated by the patient's skill at producing states of mind in the analyst with which the analyst is supposed to identify. The analyst's ability to distance himself from the patient's projections and therefore to interpret them depends on his having links to his internal objects that survive the patient's projections and unconscious manipulations. Interpretations make the patient aware simultaneously that he and the analyst are separate and that the analyst has a link to internal objects that are not under the patient's control. The latter is a rudimentary oedipal situation. The author argues that these two 'awarenesses' are really the same, and that working through the depressive position and working through the oedipal situation are therefore fundamentally the same thing.
Play, experimentation and creativity.
Beginning with Klein's description of a psychotic boy's inability to play, published in 1930, the author explores the relationship between play and symbol-formation, and the use of play by children and adults as a serious type of experimentation by means of which one learns about the internal and external worlds. In this view, play is a way of externalising fantasies originating in one's inner world so they may be seen and learned about. Play is also a vehicle of projection, a fact that allows one to use it to assess the impact of one's inner world on the external world, especially on the minds of one's objects. In this way, playing becomes a way of probing external reality as well. This type of learning depends on the ability to keep internal and external realities distinct even while projecting the former into the latter. In psychotic states, this ability is lost, and the psychotic patient's projections, instead of being usable as a form of playful experimentation, lead to delusions and claustrophobic anxiety. A brief clinical vignette is presented to illustrate these points. The author then explores the application of these ideas to an understanding of artistic creativity, and makes some observations about possible underlying unities between play, scientific experimentation and artistic creativity.
On the difficulty of making a mutative interpretation.
Beginning with Strachey's formulation of the mutative interpretation as the vehicle of the therapeutic action of psychoanalysis, the author considers what makes a mutative interpretation difficult for the analyst. He concludes that this difficulty stems from a relationship of mutual projective identification between patient and analyst, which produces an atmosphere antagonistic to analysis. By viewing the analytic dyad as a group of two, it is possible to relate this anti-analytic atmosphere to Freud's and Bion's theories of group mentality. The author also concludes that Strachey's 'auxiliary superego' is indistinguishable in practice from the analyst's ego, since it is concerned only with 'real and contemporary' events, and suggests that our understanding of what is specific to the therapeutic action of psychoanalysis would be simplified and improved if we replaced Strachey's terms 'auxiliary superego' and 'mature superego' with 'ego'. A successful mutative interpretation is a victory of ego over superego; this process requires that the analyst free himself from the intellectual deterioration that the fusion of superegos has produced; and this accomplishes one of the purposes of analysis: to help the patient think and feel what is true.
What is a clinical fact?
The author approaches the problem of defining what a clinical psychoanalytic fact is by proposing that there is such a thing as a 'psychoanalytic apparatus'--a working psychoanalysis--the proper functioning of which is revealed by the presence of certain emotional states. One of these is the presence of a sense of intimacy shared by patient and analyst within the analytic relationship, combined with a simultaneous sense of isolation of the participants. Another is a painful conflict engendered by the beauty of the analytic experience, similar, but not identical to a negative therapeutic reaction. He goes on to suggest that, when this apparatus is working properly (i.e. when psychoanalysis is occurring), both analyst and patient find that they gain a type of conviction about the patient's psychic reality or inner world that can only be obtained in analysis. The patient's psychic reality is therefore the domain of psychoanalytic clinical facts. The author concludes by proposing that, despite appearances to the contrary, this type of definition of a clinical fact can be used in a rigorous scientific manner, and he briefly discusses what is required to do so.
Does psychoanalysis heal? A contribution to the theory of psychoanalytic technique.
Beginning with Freud's controversial admonition to psychoanalysts to model themselves on the surgeon who 'dresses the wound, but does not heal it', the author attempts to explore the limits of the therapeutic effect of psychoanalysis. After briefly reviewing the role of projective identification in the transference, and the origin of the analyst's need to be a healer in his anxieties about the strength of his own destructive impulses, he describes certain emotional difficulties that arise in the analyst when he accepts the fact that he can only do analysis. He goes on to suggest that, while psychoanalysis is able to reduce the psychic distance between parts of the patient's mind that have been separated by splitting, this in itself does not provide the patient with a corrective emotional experience, mitigate the severity of his superego, or guide him along the correct developmental path. He further suggests that the analyst's acknowledgement of this limitation--which is equivalent to acknowledging that he can help the patient to grow, but he cannot 'grow' him--is part of a state of mind that the analyst must have to do analysis, and that this state of mind helps to distinguish the practice of psychoanalysis from that of other psychotherapies.
Effect of cations on structure-linked sedimentability of lysosomal hydrolases.
1. A partially purified lysosomal preparation was obtained from mouse liver sucrose homogenates by differential and discontinuous gradient centrifugation. 2. Triton X-100 or repeated freezing and thawing of the lysosomal suspension (subfraction B) allowed comparison of free and activated values for acid phosphohydrolase, beta-glucuronidase and N-acetylglucosaminidase in the presence and absence of ascorbate. 3. The distribution of hydrolase activities between supernatant and pellet after high-speed centrifugation was measured and the percentages of total enzyme found in the supernatant were: acid phosphohydrolase, 40.7; beta-glucuronidase, 51; N-acetylglucosaminidase, 39.4. 4. Differential rates of elution of the three hydrolases from the membrane fraction occurred with increasing Na(+) and K(+) concentrations, whereas complex biphasic elution curves were obtained as a function of bivalent cation concentration with Ca(2+) and Mg(2+). 5. Sucrose-density-gradient centrifugation of frozen-and-thawed subfraction B demonstrated highly significant changes in the protein gradient profile in the presence of a low concentration of bivalent cation, indicating membrane aggregation and enzyme-membrane association. 6. The data provide further evidence for the nature of lysosomal enzyme binding and indicate the presence of different enzyme-membrane bonds conferring structure-linked latency upon individual lysosomal enzymes.