Introduction: Psychiatry, psychotherapy, and psychoanalysis in the Third Reich.
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Biomedical subjects
Publications and source records attributed to Z Lothane.
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The author dissents from the widely accepted interpretation that the relationship between Sabina Spielrein and Carl Jung in the years 1904-1910 included sexual intercourse and constituted an ethical breach of the doctor-patient boundary in the course of a treatment. Spielrein declared that her treatment ended with her discharge from the Burghölzli hospital as Jung's patient in 1904-1905. Jung maintained he 'prolonged the relationship' in order to prevent a relapse and also referred to it as a friendship. Materials published in 1994 (letters, drafts, diaries, hospital chart) and unpublished letters recently found by the author in the Claparède archive in Geneva shed new light on previously published documents and interpretations by Carotenuto that have dominated the secondary literature since 1980. The new materials provide a more nuanced view of the Spielrein-Jung relationship and point to the function of non-erotic love in the therapeutic relationship. A new look at the Freud-Jung correspondence about the Spielrein-Jung relationship shows that Jung's perception that a sex scandal was initiated by Spielrein resulted from Jung's misreading of rumors concerning another woman; the episode had no ill effect on the relationship between Freud and Jung.
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A psychiatry based on operational and dynamic principles requires a new definition of hallucinations which is both heuristically useful and helpful for the understanding of the phenomenon of hallucinations. The time-hallowed definition of hallucinations as 'perceptions without stimulation of the sense organs' is both incorrect and a relic of late 19th century para-physiological thinking. Heuristically it leads into a blind alley. Central to the redefinition of hallucinations is the conception of the hallucinator, the author of his hallucinations, homologous to the dreamer, the author of his dreams. This idea was held firmly by early French 19th century clinicians, who were inspired by a holistic and operational conception in philosophy. Hallucinations are a multifaceted complex human mental activity and defined by means of a number of parameters held together as an indivisible whole. Hallucinations are described phenomenologically, psychologically, dynamically, psychodynamically, emotionally, logically, nosologically, and interpersonally.
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Starting from certain unpublished remarks by Otto Isakower about "the analyzing instrument," we de define it more precisely. The analyzing instrument has two constituents: a voluntary and controlled, situation-specific and goal-specific regressed state of mind in the analysand and a near-identical one of the same nature in the analyst. These parts function together through mutually evocative communication, leading to the elucidation of the analysand's unconscious fantasy-memory constellations.
Ethics plays a dual role in psychiatry. The extrinsic role is in defining the rules of ethical conduct for the psychiatrist as a professional dealing with patients, peers and society at large. The intrinsic role is in defining ethical or moral conflict as a determining component in the construction of symptoms of mental disorder. Ethical considerations play a role in the truthful description of the disorder, diagnosis, dynamic formulation and the doctor-patient relationship in treatment. In treatment, there is a need to acknowledge 2 dimensions of psychological conflict: (1) an appraisal of the actual realistic moral conflicts due to symptomatic unethical conduct that goes against one's normative conscience, and (2) resolution of past conflicts arising from unconscious or repressed aspects of the neurotic conscience or superego, i.e. a holdover of unreflected obedience to parental authority. The resolution of past and ongoing conflicts promotes growth toward autonomy of moral judgment, free choice and moral responsibility.
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