Psychoanalysis

Odysseus

Myself and krd where having a discussion on psychanalysis; but it was off topic for that thread, but I think people would liked to have carried it. So I'm setting up this thread.

To start it off what does people actually know/think about paychoanalysis, I'm talking most Freud and Lacan here. Do people have any questions about it as a treatment as their are a lot nyths about it.

The one thing I will say I'm not here to defend it, I have said that since I joined boards.

TrollHammaren

I believe it has its merits insofar as talking therapy and a trained ear can be extremely beneficial for people with mental health problems. I do believe in catharsis, and that getting something off your chest can have many positive effects, but I don't believe psychoanalysis has any intrinsic mechanisms beyond that. I'm not hugely familiar with Lacan, but from what I remember from my second year his works seemed to me to be dressed up Eastern philosophy.

I'm more of a cognitive neuroscience kind of guy than psychocology, so I'm a bit biased, but we can provide strong evidence that the frontal lobe is involved in attention, or the amygdala is involved in emotional response, but we can't prove that the Ego is involved in social regulatory behaviours. I believe the whole "you can't prove nor disprove psychoanalysis" has allowed it to dodge a good bit of scrutiny, but having said that, I did read a neuroimaging study somewhere that indicated that the functional activation present in actively repressing memories is similar other functional activations associated with repression, so maybe there's something to it.

hotspur

TrollHammaren wrote: »

I'm not hugely familiar with Lacan, but from what I remember from my second year his works seemed to me to be dressed up Eastern philosophy.

I think you're mixing Lacan up with someone else, Jung maybe?

TrollHammaren

Oh, pardon me, you're very right. Lacan was a key proponent of the "mirror stage", right? If so, I wasn't largely in agreement with him, either.

Odysseus

TrollHammaren wrote: »

Oh, pardon me, you're very right. Lacan was a key proponent of the "mirror stage", right? If so, I wasn't largely in agreement with him, either.

That would be him, you raise some interesting points. What your ubderstanding of neuro-psychoanalysis which seem to be be in some of the UK universities. I'm not really up on it as my own training on neuro-science was very basic? I would give you a full response when I have a tad more time. Tihanks for joining in mate.

krd

TrollHammaren wrote: »

I'm more of a cognitive neuroscience kind of guy than psychocology, so I'm a bit biased, but we can provide strong evidence that the frontal lobe is involved in attention, or the amygdala is involved in emotional response, but we can't prove that the Ego is involved in social regulatory behaviours.

I think you're making the mistake of mixing up the model with the underlying mechanics.

The Id, ego and super-ego, are parts of a model. They are representations. There probably isn't special parts of the brain that specifically preform those functions. The frontal lobe and the amygdala are parts of the brain. They're bits of the machinery. You can study them and get a good idea of their function - but Freud's structural model tells you other things. It's not a model of the brain, more a model of the mind. And even it's something larger. Nature loves fractal geometry - the patterns and shapes in nature have an uncanny ability to repeat themselves at different scales. And some people say elements of Freud's model appear on a larger scale - in nations and societies.

Ego is involved in social regulatory behaviours, if you're going to start from the point of using Freud's model. The model itself cannot be proved. It may be incorrect or imprecise - it's still just a model. A bit like in computing now days they refer to the cloud, to represent a varying and complex mix of technology - it has a precise meaning, but the precise make up of the underlying architecture is unimportant. Even if you had a full understanding of all the mechanisms in the brain that form what appears to be the Ego, depending on your purposes it may be more practical to simply refer to it as the Ego.

But there's also a problem here. Someone could be depressed because they have a complex philosophical problem. This is something, in theory, psychoanalysis may help. Then they could be depressed because their brain is malfunctioning. And any amount of talking won't fix them.

Then if there brain is malfunctioning, there may be no treatment they may respond to. Their brain is can't be fixed.

I think there's also philosophical dead ends people tie themselves into. Reasoning may not dig them out, it could dig them in deeper. Some bad ideas could be incurable.

hotspur

I have some very general questions that I would like to ask if / when you have the time Odysseus. 10 questions in all. I think it might give a good insight into what you do and think.

1) How do you usually work? Do you use free association, dream analysis, what else? Do you aim for neutrality, anonymity, and abstinence?

2) What are you usually aiming to achieve by using your method? That is, what is the mechanism of action which is therapeutic?

3) What are your views on relational analysis, object relations theory informed analysis, and attachment theory?

4) What is your view of interpretation? I had a therapist recently for 1.5 years who was, inter alia, psychodynamically informed. It was face to face, no free association or dream analysis. She was cold and unresponsive.

Whenever she engaged in anything approaching interpretation or even rare exploration for the truth of something I was consistently exasperated by her pre-postmodern perspective in which there was a world which we could uncover truths of if we looked hard enough. As someone with a more constructivist perspective who looks at these things as narratives, I would have had to abandon my views on fundamental epistemological issues to engage with the more simplistic level she was operating with.

So my question is what is the status of interpretation for you in your work? I am guessing that it isn't an intersubjective reality. My therapist at one point claimed not to be a subject and I had no time for the concept of any person not being a subject in a room with another, irrespective of how ,much they tried not to be.

5) Say a person were an expert in every form of therapy which existed. Why, and under what circumstances, would they choose to do psychoanalytic therapy with someone?

6) How effective (relative to alternatives) do you think your form of psychoanalytical psychotherapy is for the major disorders which people seek treatment for? Do you think the empirical evidence of effectiveness ought to impress a non-psychoanalyst? Given that therapy has often been found to be dose dependent do you think that psychoanalytic therapy which is longer term should be producing larger effects than it has been found to?

7) Do you regard your form of psychoanalytical psychotherapy to be scientifically based?

8) Would you agree that it is detrimental that psychoanalysts retain psychoanalytic diagnosis and terminology insofar as it places them outside of mainstream diagnosis and makes cross-modal communication more difficult? Also would you agree that a great deal of psychoanalysts delight in abstrusely written literature. I mean reading Lacanian material for a non-Lacanian is near impossible. I think there's a lot of hiding in such Franco-obscurantistic pseudointellectualism.

9) If you were to be a non-psychoanalytic therapist then which therapeutic modality do you think you would choose?

10) Finally (phew!) I know you are interested in diagnostic systems, do you use, or what are your thoughts on, the Psychodynamic Diagnostic Manual?

Cheers

TrollHammaren

Odysseus wrote: »

What your ubderstanding of neuro-psychoanalysis which seem to be be in some of the UK universities. I'm not really up on it as my own training on neuro-science was very basic? I would give you a full response when I have a tad more time. Tihanks for joining in mate.

To be honest, I know very little about psychoanalysis beyond what we were taught in first and second year intro classes in Trinity, and I know even less about neuro-psychoanalysis apart from a brief glance at that one paper I mentioned. I'll see if I can dig it out for you!

krd wrote: »

I think you're making the mistake of mixing up the model with the underlying mechanics.

You absolutely have a point there - I do tend to look more at structural and functional aspects of the brain and neglect a lot of behaviour. I'll definitely try to take that on board.

krd wrote: »

The Id, ego and super-ego, are parts of a model. They are representations. There probably isn't special parts of the brain that specifically preform those functions. The frontal lobe and the amygdala are parts of the brain. They're bits of the machinery. You can study them and get a good idea of their function - but Freud's structural model tells you other things.

True enough, but my argument would be that it's a very poor model that not only over-simplifies very complicated processes, but it may actually be misleading. I'm finding it very hard to articulate myself at the minute because I just got back from Jujutsu training, taking a few knocks to the head, but I'll definitely try my hand at explaining my position better later :-P

krd wrote: »

It's not a model of the brain, more a model of the mind. And even it's something larger. Nature loves fractal geometry - the patterns and shapes in nature have an uncanny ability to repeat themselves at different scales. And some people say elements of Freud's model appear on a larger scale - in nations and societies.

The problem, though, is that the mind is a completely intangeable concept, and many people have different definitions of what the mind is. This makes it a philosophical issue, and I'm not sure how I feel about the marriage of philosophy and health care.

krd wrote: »

Ego is involved in social regulatory behaviours, if you're going to start from the point of using Freud's model. The model itself cannot be proved. It may be incorrect or imprecise - it's still just a model. A bit like in computing now days they refer to the cloud, to represent a varying and complex mix of technology - it has a precise meaning, but the precise make up of the underlying architecture is unimportant. Even if you had a full understanding of all the mechanisms in the brain that form what appears to be the Ego, depending on your purposes it may be more practical to simply refer to it as the Ego.

I don't mind that if we're talking philosophy, but the core issue is that psychoanalysis is currently used as a mental health treatment. I'm just not sure how the constant cognitive/emotional battle between the Id and the Ego can be applied to major depression, schitzophrenia, AD/HD, and indeed addiction.

krd wrote: »

But there's also a problem here. Someone could be depressed because they have a complex philosophical problem. This is something, in theory, psychoanalysis may help. Then they could be depressed because their brain is malfunctioning. And any amount of talking won't fix them.

That's where I believe a psychoanalyst's merits are: If your issue is to do with how your upbringing affected your propensity towards aggressive behaviour, a psychoanalyst could, I believe, help a patient understand this. At the same time, though, a trained counsellor or a CBT specialist could also do this. However, it gets complicated when a patient's habituation to negative stimuli in childhood contributes to the development of clinical depression of neuropharmacological origin. This, I believe, is where a psychoanalyst falls short.

krd wrote: »

Then if there brain is malfunctioning, there may be no treatment they may respond to. Their brain is can't be fixed.

Like what, though? You'd be surprised what kind of illnesses respond to all kinds of treatment.

krd wrote: »

I think there's also philosophical dead ends people tie themselves into. Reasoning may not dig them out, it could dig them in deeper. Some bad ideas could be incurable.

That's fine for philosophy, but psychology is supposed to be a science. We should be administering treatment to people that is empirically supported, otherwise we would be treating lacerations with pixie dust.

As I said before, I'm not anti-psychoanalysis, and I could be misinformed or just simply wrong. I suppose it's important to ask yourself whether you would trust a psychoanalyst to be equipped to treat a mental illness, and if I'm honest with myself I don't believe I would.

krd

TrollHammaren wrote: »

To be honest, I know very little about psychoanalysis beyond what we were taught in first and second year intro classes in Trinity, and I know even less about neuro-psychoanalysis apart from a brief glance at that one paper I mentioned. I'll see if I can dig it out for you!

Well, it's hard enough to know much about it as there's a vast canon of literature in psychoanalysis. Freud wrote a huge amount. If you wanted to hack your way through his writings it would take years. And it's possible, quite a bit of those writings are of no real value - except they might look good in a leather bond edition on a psychoanalysts bookshelf. Powerful phallic objects and you don't even need to crack them open for them to work.

You absolutely have a point there - I do tend to look more at structural and functional aspects of the brain and neglect a lot of behaviour. I'll definitely try to take that on board.

Freud does actually relate the model to biological processes. The idea of the death drive. The process that stops biological organisms gorging themselves to death on food or activities like sex. It's an idea that makes sense. I have a feeling, it might even be observable, if you had the right set of experiments.

Freud was a fully trained physician. He would have referred to himself as a neurologist. He would have known the conventional knowledge on the brain for the time. Which would be, we know what it looks like when we cut it up, but we really have no idea what the bits do. Freud is dead before medicine begins to get a grip on what parts of the brain handle specific functions. He's dead before lots of drugs and treatments are discovered.

True enough, but my argument would be that it's a very poor model that not only over-simplifies very complicated processes, but it may actually be misleading. I'm finding it very hard to articulate myself at the minute because I just got back from Jujutsu training, taking a few knocks to the head, but I'll definitely try my hand at explaining my position better later :-P

I'm not sure it's such a great model. If you want a place to start from, it's somewhere to start from.

The problem, though, is that the mind is a completely intangeable concept, and many people have different definitions of what the mind is.

All concepts are intangible. An idea that may seem more firm to grasp could be very wrong. Like believing the Earth is flat. People have probably been realising it's round for thousands of years - these people may have ended up being stoned to death for being possessed by evil spirits.

Some truths turn out to be counter intuitive. But they can only be found out through a change in intuition. A prehistoric sailor may have seen the way ships disappear over the horizon long enough to have guessed the reason being the earth is round. That's counter-intuitive, as the world feels, and for most of the time, looks flat.

Newton believed gravity to be a force. Einstein believed it to be a fictional force - a dimension of space-time, that gives the illusion its' a force in itself. Newton's gravitational equations are correct - but it's a flat earth type reasoning. And Einstein's maths is so tricky, we still use Newton's, as Newton's gives the right answers, even if for the wrong reasons.

This makes it a philosophical issue, and I'm not sure how I feel about the marriage of philosophy and health care.

They're already married. There's philosophy all through medicine. The Hippocratic oath is a philosophical document. Why treat mentally ill people at all. Why not just gas them like the Germans did in the 30s.

There's philosophy in everything in everyday life.

I don't mind that if we're talking philosophy, but the core issue is that psychoanalysis is currently used as a mental health treatment. I'm just not sure how the constant cognitive/emotional battle between the Id and the Ego can be applied to major depression, schitzophrenia, AD/HD, and indeed addiction.

I'm not sure. If we leave drugs aside, all a psychoanalyst can do is talk to the subject about ideas. Is an idea, or a collection of ideas enough to make the subject unwell. Can they be enough to drive the functioning of the brain. Can an idea make the subject well.

The swings of a manic depressive you could put down to a malfunctioning death drive. When they're hyper, the death drive is not working. When they're down the death drive is in over kill. Anhedonia, common in depressives could be the death drive jammed in one position.

Freud had a very limited supply of psychoactive substances at his disposal. Alcohol, opium and cocaine. Problematic substances. I believe Freud said of the use of cocaine to treat opium addiction was like using Beelzebub to drive out Satan. Alcohol isn't the answer to all life's problems, but it is a solution. I've seen Freud quoted on variations of "If they're are worries, there is wine" - there's always brandy.

Had cocaine not become demonised as it has, it might used in the treatment of depression today. Just as some doctors may prescribe amphetamines for depression (I don't know if they're meant to do that - or if they do it off label - I've heard it works). Ritalin, is much the same as illicit amphetamines.

Freud started out believing cocaine could be used as a cure all for mental illness - depression at least. Then he saw the other side to it. And was no longer so sure.

That's where I believe a psychoanalyst's merits are: If your issue is to do with how your upbringing affected your propensity towards aggressive behaviour, a psychoanalyst could, I believe, help a patient understand this. At the same time, though, a trained counsellor or a CBT specialist could also do this.

The CBT cure and the analyst's cure come down to the same thing, if by different paths. That to know something, in itself is healing. I'm not so sure.

However, it gets complicated when a patient's habituation to negative stimuli in childhood contributes to the development of clinical depression of neuropharmacological origin. This, I believe, is where a psychoanalyst falls short.

That is if the psychoanalyst believes all the subject needs is analyses. Back to 'when you have a hammer in your hand, every problem looks like a nail'. Psychoanalyst do treat people who are using drugs. How many analysands are high on the rich pharmacopia of present day psychiatric drugs, you'd have to ask an analyst with the stats. I wouldn't be surprised if they're all on dope.

Like what, though? You'd be surprised what kind of illnesses respond to all kinds of treatment.

Yes, but there are people in and out of institution all their lives who never get well enough to have no further need of those institutions.

That's fine for philosophy, but psychology is supposed to be a science. We should be administering treatment to people that is empirically supported, otherwise we would be treating lacerations with pixie dust.

Science is a branch of philosophy. The split between what you might call hard science and philosophy only happened relatively recently - when the maths and stuff became really difficult. Rene Descartes had as much to say on maths as he did on the question of why we're here - or if we're really here at all. There is a problem in hard science of splitting itself from the airy fairy stuff. It can be a big mistake to turn your back on that stuff.

Why do we think we're here, and why do we care? Is a science question as much as it's a philosophical question.

And there is much to be worried about. I've been hearing of people being diagnosed as having Anti-Social personality disorder, purely based on them not sharing common social beliefs. That if you don't see the world as "everyone" else does, then you are wrong and ill. It's an idea I'm violent opposed to. It's very much like saying, that if you were in Germany in the 1930s, and Nazism was repugnant to your sensibilities, then you are sick. And everyone is fine and healthy because they are all sharing the same world view.

I have a funny feeling about the whole ASPD idea. In a country like Ireland, the dominant ideology is a kind of anti-intellectual social conservatism. And the people who hold that ideology, look on anyone who doesn't as "cracked in the head". I don't think the "you do not believe the same things as I do, therefore you are mad" limits itself to social conservatives.

The collapse of the building boom made feel saner. I had predicted it for years, and I felt like I was going mad. When it finally happened, I had the comfort of knowing I had been correct, and the majority of people had been delusional.

As I said before, I'm not anti-psychoanalysis, and I could be misinformed or just simply wrong. I suppose it's important to ask yourself whether you would trust a psychoanalyst to be equipped to treat a mental illness, and if I'm honest with myself I don't believe I would.

But you believe CBT does? I think you could find people who say psychoanalysis helped them And equally there will be people who say it did nothing for them. I know people who've been in therapy and on drugs for years, and if anything they're getting worse.

I've robbed this from a friends facebook status

“Before you diagnose yourself with depression or low self-esteem, first make sure that you are not, in fact, just surrounded by assholes.” ~ William Gibson

Odysseus

Apologies that quote is from TrollHammaren

krd wrote: »

As I said before, I'm not anti-psychoanalysis, and I could be misinformed or just simply wrong. I suppose it's important to ask yourself whether you would trust a psychoanalyst to be equipped to treat a mental illness, and if I'm honest with myself I don't believe I would.

As this seems such a bold statement to me, can I ask why?

TrollHammaren

krd wrote: »

All concepts are intangible. An idea that may seem more firm to grasp could be very wrong. Like believing the Earth is flat. People have probably been realising it's round for thousands of years - these people may have ended up being stoned to death for being possessed by evil spirits.

Sure, but before you can treat the mind you need to define it properly. We can treat a laceration because we know what a laceration is.

krd wrote: »

They're already married. There's philosophy all through medicine. The Hippocratic oath is a philosophical document. Why treat mentally ill people at all. Why not just gas them like the Germans did in the 30s.

There is a philosophy to medicine, sure, but healthcare is not a philosophical pursuit. There will always be philosophy to it, like ethics and stuff, but treating a laceration is not a philosophy. If we were to discover what exactly the mind is, such as cells and neurons interacting, we could treat its ailments, but we cannot treat a philosophical concept of the mind. Let's think pragmatically here.

krd wrote: »

The swings of a manic depressive you could put down to a malfunctioning death drive. When they're hyper, the death drive is not working. When they're down the death drive is in over kill. Anhedonia, common in depressives could be the death drive jammed in one position.

I cannot see how an understanding of a death drive could ever treat manic depression, or any of the other illnesses I mentioned. What you're describing there is essentially giving interesting names to the treatment and conditions other healthcare practitioners work with. I could philosophically say that manic depression is caused by a constant shift between the arse factor and the Tom Cruise alignment.

I genuinely believe that most, if not all, mental illnesses have a largely biological basis, and that no amount of philosophy can treat them without some kind of intervention.

krd wrote: »

The CBT cure and the analyst's cure come down to the same thing, if by different paths. That to know something, in itself is healing. I'm not so sure.

I'll have to take your word for it for now. The jist my opinion about this is that I can't see, with my extremely limited knowledge, how therapy such as psychoanalysis could be anything more than a medium for catharsis. I'm very much open to the idea that I'm wrong.

krd wrote: »

That is if the psychoanalyst believes all the subject needs is analyses.

Sure, but my point is that if a subject doesn't need analysis, or so perceived by a psychoanalyst, then a psychoanalyst's efficacy is very limited. The same could be said about an neurologist treating a cardiac problem, but as I've said before, I can't see how a psychoanalysis can offer anything other than a medium for catharsis.

krd wrote: »

Science is a branch of philosophy...Why do we think we're here, and why do we care? Is a science question as much as it's a philosophical question.

As I said before, there will be a philosophy for everything, but we can't treat ailments with philosophy. We can philosophically ponder the mind, but it will never allow us to completely cure Alzheimer's or schitzophrenia.

krd wrote: »

And there is much to be worried about. I've been hearing of people being diagnosed as...

Which is why there is a need for scientific rigour in psychology. I don't like going on with long, tangental explanations, so I'll use the proposed DSM-V as an example. They're overhauling a huge amount of the listed disorders to remove anything that is believed to be culturally pathological, and improving the diagnostic criteria based on our improved scientific knowledge. Obviously, the more we learn, the more revisions there will be in the future.

krd wrote: »

But you believe CBT does?

I don't know enough about CBT to know whether or not it does. I'm only vaguley aware (or at least I think I am) that it has more credibility in the academic circles than psychoanalysis because the research seems to support it.


I get the impression you're just presenting counter-arguments to my arguments for the sake of it. Do you actually have an opinion on this or are you just playing devil's advocate?

TrollHammaren

Odysseus wrote: »

As this seems such a bold statement to me, can I ask why?

Because I have seen research that is mainly supportive of other mental health treatments and very little on psychoanalysis. I'm always skeptical of treatments I know little about.

Odysseus

TrollHammaren wrote: »

Because I have seen research that is mainly supportive of other mental health treatments and very little on psychoanalysis. I'm always skeptical of treatments I know little about.

OK. That's a fair response, but really be aware of those who say they work psychodynamically. I don't believe you can just mix and macth all the various thoeries, of course you can with some. However, that word psychodynamic rings the wrong type of bell in my head.

TrollHammaren

Odysseus wrote: »

OK. That's a fair response, but really be aware of those who say they work psychodynamically. I don't believe you can just mix and macth all the various thoeries, of course you can with some. However, that word psychodynamic rings the wrong type of bell in my head.

I would have no problem with anyone defending psychoanalysis as it would give me more of an opportunity to learn about it and make up my mind.
Luckily, I've never had cause to see a mental health professional for anything other than AD/HD, and I hope I never will have to.

I do see what you're saying, though: There are so many different psychodynamic theories that there will always be different types of psychoanalyst.

krd

Without sitting down and spending a few weeks boning up on Lacan, I'm in no position to have a go at him.

But.

Probably worth discussion: is psychoanalysis mystified to the point where it's on the verge of being on the level of spiritualism.

In my opinion, there isn't a place in science or medicine for mysticism - unless it actually works. Like, if getting someone to kneel and pray before a statue of the virgin mary makes them "well",it's worth it. Even if it is Voodoo. If a society is better for believing in supernatural nonsense, then it is better - which could be better than believing in "the truth" - which could be fatalistic and dangerously nihilistic.

T runner

krd wrote: »

It's an idea I'm violent opposed to. It's very much like saying, that if you were in Germany in the 1930s, and Nazism was repugnant to your sensibilities, then you are sick. And everyone is fine and healthy because they are all sharing the same world view.

I have a funny feeling about the whole ASPD idea. In a country like Ireland, the dominant ideology is a kind of anti-intellectual social conservatism. And the people who hold that ideology, look on anyone who doesn't as "cracked in the head". I don't think the "you do not believe the same things as I do, therefore you are mad" limits itself to social conservatives.

The collapse of the building boom made feel saner. I had predicted it for years, and I felt like I was going mad........ ...."

Perhaps at some level you experienced ASPD yourself?

Perhaps the cure is either to conform or, as you experienced, to realise that your variance with the pack is not as a result of any sickness of perception on your part. In the latter case having the problem explained would be, in fact, a large part of the cure.

krd

Nietzsche; Insanity in individuals is something rare - but in groups, parties, nations and epochs, it is the rule.

Charles MacKay "Men, it has been well said, think in herds; it will be seen that they go mad in herds, while they only recover their senses slowly, one by one."

T runner wrote: »

Perhaps at some level you experienced ASPD yourself?

Perhaps at some level, I haven't.

Worryingly, I've heard of people being diagnosed as having "mild" ASPD. I think that's really dangerous.

If you take one of points from the DSM-IV definition.

failure to conform to social norms with respect to lawful behaviors as indicated by repeatedly performing acts that are grounds for arrest;

That is clear cut.

But if we modify it - say if we want to consider "mild" ASPD

failure to conform to social norms

That's far more nebulous. You're in a very different territory. Any form of eccentricity can be deemed to be a sign of illness.


I was following a discussion on ASPD, elsewhere, a few months back. In the discussion there were people who worked with people who have ASPD (I think they were some kind of counsellors). And then there were people who had been diagnosed with ASPD.

There was a guy, who had lost his job, had various troubles and had gone looking for help for his depression. He had been depressed by his circumstances. But he also had been depressed about the people he had been working with. He felt he had nothing in common with them - and the experience had left him feeling more isolated and depressed.

His therapist decides on this basis to diagnose ASPD. And told him the reason he had nothing in common with the people he had worked with was because the way he saw the world was sick, and they were all healthy. So, you see, if you find the people you work with to be boring unpleasant asrseholes, there's something wrong with you - if you don't share their tastes, attitudes and outlook, then you are ill. If they reject you, it is because you are sick and bad.

Then in the discussion one of the ASPD counsellors said something along the lines of the hardest thing about dealing with ASPDs, is they fail to see there is anything wrong with them.

This reminds me of a bad situation I've been through. Where I spent months being tortured by a manager. He thought I was very weird, and didn't belong in an office environment. I was fully aware I was disturbing him - but I couldn't tell what I was doing that was making him feel that way - and there was no way to ask him straight out what his problem was - the guy was a bullsh1tter, . Often, I would catch him out of the corner of my eye, staring at me in wide eyed horror. This was really stressful for me - I kept having to ask myself what the hell was I doing to upset him. And then the way he would speak to me - as if I had no self awareness - and he was trying to helpfully drop little hints to me. The hints never made any sense - often when people are "dropping hints", they're so coded as to be meaningless.


Of course, whatever was in his head was some wacky elaborate fantasy - if I knew what he wanted, I would have faked it for him - I could never figure it out. I don't lack self awareness - I do, like everyone else, lack the ability to know the precise conciousness of others - I'm not a mind reader. I would ask the people I was working with what was going on (some of these people I was and still am, very close to) they couldn't tell what was happening - they weren't even noticing anything - they thought I was imagining things. (a thing is though, they may have know my little eccentricities and not thought them that odd). They were very surprised to see me sacked.

So I end up being sacked for being "weird" - nothing to do with my performance. And he has the most sickeningly condescending chat with me, over how I really didn't understand what working in an office is about and I should try to become a builder. It was one of the absolute lowest points of my life. A dimwit. A flaky dimwit. A total incompetent, Mr. Chaos, talking to me like I was a retarded child who didn't understand how the world works. At the end of months of torment.

Perhaps the cure is either to conform or, as you experienced, to realise that your variance with the pack is not as a result of any sickness of perception on your part. In the latter case having the problem explained would be, in fact, a large part of the cure.

Conforming is a strange thing. In Nazis Germany you could be denounced for simply being "Un-German". And people did end up in the gas chambers for being "Un-German". A neighbour could write a letter saying your were a little odd, and the Gestapo would turn up. If they thought you were a little odd too, you were dead. There was a quote from a woman, in Ian Kershaws biography on Hitler, who said something along the lines that you could be a child molester, but as long as you were a good, solid, German man, you'd be fine. Mild eccentricity could get you killed.

In my personal experience in Ireland, I could say something very similar - and it's a reason so many paedophiles were let run riot in Ireland for so long. In reality the paedophile is not conforming. They are on a very superficial level - even exaggerating their conformity. To some people that is comforting, even redemptive. To me it's very disturbing.

Growing up in Ireland, when I did, where I did, to "fit in" you have to be really warped.

In the latter case having the problem explained would be, in fact, a large part of the cure.

I'd like to know how to fake conformity - without driving myself mad. I've never really been bothered by people who were/are eccentric (even more fascinated and attracted to them) - so I really don't understand the feelings of hostility and fear people have towards non-conformists. I could speculate. But it's not the same as having an understanding of the visceral feelings.

Gonzo89

Hello everyone.
I'm just curious to see what people think Freud's greatest contribution to psychoanalysis would be? I've had this debate with a colleague of mine for sometime and we've decided to put it out there to get other peoples view on the matter. Any thoughts, contributions or ideas on this subject would be greatly appreciated.

TrollHammaren

Gonzo89 wrote: »

Hello everyone.
I'm just curious to see what people think Freud's greatest contribution to psychoanalysis would be? I've had this debate with a colleague of mine for sometime and we've decided to put it out there to get other peoples view on the matter. Any thoughts, contributions or ideas on this subject would be greatly appreciated.

I'm not a fan of Freud or psychoanalysis, but of his contributions I reckon the greatest were probably his idea that catharis could benefit mental health, the defence mechanisms model, or his conceptualisation of the unconscious. Other than that, I see psychoanalysis as not far from pixie dust.

Ms.Odgeynist

Gonzo89 wrote: »

Hello everyone.
I'm just curious to see what people think Freud's greatest contribution to psychoanalysis would be? I've had this debate with a colleague of mine for sometime and we've decided to put it out there to get other peoples view on the matter. Any thoughts, contributions or ideas on this subject would be greatly appreciated.

I think it's safe to say that Freud's greatest contribution is the idea of the unconscious, and all the rich variations and insights that have sprung from there. His influence is ubiquitous...the media, the advertising, our understanding of ourselves and of the other, of agression and motivation are all deeply, if not purely influenced by Freud's work and the work that come's after. There was the world before freud, and the world after Freud.
I am not an advocate of Pschoanalysis, but to underestimate his influence and contribution is to do the man, and yourself, an injustice.

As for the unconscious, Fromm's description is as eloquent as i have read anywhere.

As to the contents of the unconscious, no generalization is possible. But one statement
can be made: it always represents the whole man, with all his potentialities for
darkness and light; it always contains the basis for the different answers which man is
capable of giving to the question which existence poses. In the extreme case of the most
regressive cultures, bent on returning to animal existence, this very wish is predominant
and conscious, while all strivings to emerge from this level are repressed. In a culture
which has moved from the regressive to the spiritual-progressive goal, the archaic forces
representing the dark are unconscious. But man, in any culture, has all the potentialities:

he is the archaic man, the beast of prey, the cannibal, the idolater, and he is the being
with the capacity for reason, for love, for justice. The content of the unconscious, then,
is not just the good or the evil, the rational or the irrational; it is both; it is all that is
human. The unconscious is the whole man—minus the part of man which corresponds
to his society. Consciousness represents social man, the accidental limitations set by the
historical situation into which an individual is thrown. Unconsciousness represents universal
man, the whole man, rooted in the Cosmos: it represents the plant in him, the
animal in him, the spirit in him; it represents the past back to the dawn of human existence,
and it represents his future to the day when man will have become fully human,

and when nature will be humanized as man will be „naturalized.”

hotspur

I listened to a podcast of a debate this month from King's College London -

44th Maudsley Debate: Wake Up to the Unconscious.
This house believes that psychoanalysis has a valuable place in modern mental health service. Chaired by Prof Sir Robin Murray. For the motion were Prof Peter Fonagy and Prof Alessandrea Lemma. Against the motion were Prof Lewis Wolpert and Prof Paul Salkovskis.

Here is the link to listen to it:
http://www.kcl.ac.uk/iop/news/Podcasts.aspx

JuliusCaesar

So Hotspur, without having to listen to the entire thing, which side carried the motion?

hotspur

JuliusCaesar wrote: »

So Hotspur, without having to listen to the entire thing, which side carried the motion?

Given that the original vote was something like 95% in favour of the motion that psychoanalysis has a place in the health service, it was hardly in doubt.

CBT'ers may exclude other therapies when it comes to financing research, but psychoanalysts are the still the masters at excluding people from a room.

I though Paul Salkovskis was surprisingly crap. Lewis Wolpert was worse. Peter Fonagy was good.

Actually, it was a pretty lousy debate now I come to think of it. 6 minute speeches aren't really fit for it.

Charlie Rose did a programme a few years ago which had among others Peter Fonagy and Aaron Beck on it. They talked about Freud and psychoanalysis:
http://www.charlierose.com/view/interview/154

On that topic Charlie Rose did a fantastic series of discussions (actually 2 series - 17 shows) on the brain. Top experts on them, with the wonderful Eric Kandel as the mainstay. I would recommend them to anyone who wants to know a bit about the brain or neuroscience:
http://www.charlierose.com/view/collection/10702

steoin

TrollHammaren wrote: »

I'm just not sure how the constant cognitive/emotional battle between the Id and the Ego can be applied to major depression, schitzophrenia, AD/HD, and indeed addiction.

Excuse my ignorance (lay man/Foundation course in psy) but to the best of my knowledge addiction can be viewed as a battle between the Id, Ego & super-ego?

Am i mistaking addiction and dependence?
and if so once the physical addiction is dealt with would psychoanalysis then not be considered useful?

Either way i would imagine psychoanalysis can help an individual recognize this conflict gain a greater understanding and enable them to go about changing. Am I correct that this is the aim of the psychoanalytical therapy?

TrollHammaren

steoin wrote: »

Excuse my ignorance but to the best of my knowledge addiction can be viewed as a battle between the Id, Ego & super-ego?

Describing addiction as a battle between three very simple cognitive mechanisms is a great way of analogising how addiction works in a very simple way, but if you want to properly understand addiction, psychoanalysis, in my opinion, will never be able to explain the underlying functions and mechanisms. Psychoanalysts seem to be holding on to that Id, Ego, Superego model for dear life, but we have modern theories and models, such as the reward and control theories, that serve us better. The psychoanalysis model simplifies addiction to the point that it's misleading. You can't just lump all the neurobiological/chemical/genetic factors into an "Id" category as a catch-all for biological impulses.

steoin wrote: »

Am i mistaking addiction and dependence?

It would take an essay just to get into the conceptualisation of addiction.

steoin wrote: »

and if so once the physical addiction is dealt with would psychoanalysis then not be considered useful?

The premise there is that psychological addiction is removed from the physical, which isn't the case. This perfectly illustrates my point as to why the Id-Ego-Super model is inherently flawed. Even addictive behaviours are highly associated with dopamine and the limbic system, for example.

steoin wrote: »

Either way i would imagine psychoanalysis can help an individual recognize this conflict gain a greater understanding and enable them to go about changing.

People with severe addictions aren't going to change because they gain an understanding as to why they're addicted. I have no doubt psychoanalysis has been successful in the odd addiction case, but I don't believe it's because psychoanalysis is a sound theory. Given the massive range of individual differences in humans, there are going to be people who beat their addictions through all kinds of methods from talking to therapy, to "ah, fúck it, I'll give up the auld cigarettes", to magic pixie dust.

As I said, I believe psychoanalysis has its merits as a talking therapy and as a catalyst for catharsis, but I have no faith in it beyond that.

steoin

TrollHammaren wrote: »

People with severe addictions aren't going to change because they gain an understanding as to why they're addicted.
there are going to be people who beat their addictions through all kinds of methods from talking to therapy, to "ah, fúck it, I'll give up the auld cigarettes", to magic pixie dust.
.

Thanks for the explanation but i am wondering about once the substance abuse has stopped is this not where psychoanalysis is useful ?

Am I correct in saying that CBT (or other models or Behaviour modification) would be limited in this regard as it's aim is to modify behaviour and not change the root of the behaviour? Is that the aim of Psychoanalysis?

I know basically nothing about these therapies or alternatives it has just twigged my curiosity and if these therapeutic approaches are limited in the treatment of addiction which approaches are believed to be effective?

From what i have gathered the 12 step program is effective in terms of "recovery" but would i be correct in saying that as it promotes Dependency on a higher power for people with dependency issue?

For those with more severe issues such as personality disorders and depression/schizophrenia i assume talk therapy is futile

Basically i am curious to the opinions of those who have knowledge in the field of psychology how they view addiction and its treatment is it a case of improving the life of the person with an addiction problem? and if so i am guessing that alot of these "Behaviours" will then be passed on to the next generation.

Sorry for all the question and possibly derailing the thread. Thanks again

Lmsilvam

steoin wrote: »

Am I correct in saying that CBT (or other models or Behaviour modification) would be limited in this regard as it's aim is to modify behaviour and not change the root of the behaviour? Is that the aim of Psychoanalysis?

Behaviour modification produces changes precisely by influencing the "root" of behaviour - that is, the environmental arrangements responsible for behaviour. Nowadays there is lots of doubts regarding the effectiveness of Psychoanalysis altogether.

steoin wrote: »

From what i have gathered the 12 step program is effective in terms of "recovery" but would i be correct in saying that as it promotes Dependency on a higher power for people with dependency issue?

I'd say the evidence is mixed with regards to this. In my experience and from what I've read, the 12 step program is effective, period. Whether it promotes "dependency", I'm not sure.

steoin wrote: »

For those with more severe issues such as personality disorders and depression/schizophrenia i assume talk therapy is futile

Outcomes are better with "talk therapy" + medication in these cases.

steoin

Lmsilvam wrote: »

I'd say the evidence is mixed with regards to this. In my experience and from what I've read, the 12 step program is effective, period. Whether it promotes "dependency", I'm not sure.

Yes i agree that once something works that's obviously the most important thing! but how does it affect the offspring of the person with addiction in terms of learned behaviour and communication issues? Does this require some sort of relationship counselling?

steoin

hotspur wrote: »

3) What are your views on relational analysis, object relations theory informed analysis, and attachment theory?

I would be quite interested to hear the opinion of how attachment theory is viewed through the psychoanalytic lens, I did a project on attachment and my understanding from what I can recall attachment was viewed as a secondary drive, that the relationship between the mother and child was formed because the mother provided food.

It did not take into consideration Harlows Rhesus Monkey experiment that suggested contact was important and Bowlby/Ainsworths emphasis on proxmity has the thinking of psychoanalysis changed more in line with this?

TrollHammaren

steoin wrote: »

Thanks for the explanation but i am wondering about once the substance abuse has stopped is this not where psychoanalysis is useful ?

I'm a neuroscience man myself so I'm biased, but I think that once you kick the habit then any kind of talking therapy is useful just for the intrinsic value of moral support and attention. A lack of follow-up treatment for any ailment, mental or physical, is usually associated negative affect. Countless studies into coronary heart disease have shown that adherence to rehabilitation courses and positive prognosis significantly improve when there is follow up with support groups or family support. If you go to a psychoanalyst you're getting both attention and emotional support, which means you're less likey to relapse than if you were to have no follow-up.

steoin wrote: »

Am I correct in saying that CBT (or other models or Behaviour modification) would be limited in this regard as it's aim is to modify behaviour and not change the root of the behaviour? Is that the aim of Psychoanalysis?

I'm not expert on CBT, but I believe that any therapy that involves attention, follow-up, and mental health assessment is beneficial. I just don't believe that psychoanalysis works in the manner that psychoanalysts believe it does. I believe that even meeting someone once a week to vent would be somewhat effective if someone has kicked the habit.

steoin wrote: »

I know basically nothing about these therapies or alternatives it has just twigged my curiosity and if these therapeutic approaches are limited in the treatment of addiction which approaches are believed to be effective?

If I'm to be honest, I'm not entirely sure any treatments are particularly effective. Apparently the success rate of smoking cessation is frighteningly low. I've heard of people beating their addictions through cold turkey, accupuncture, some ridiculous "noise therapy", and there was even a guy in my club who gave up his addictions through martial arts training. As I said, individual differences.

steoin wrote: »

From what i have gathered the 12 step program is effective in terms of "recovery" but would i be correct in saying that as it promotes Dependency on a higher power for people with dependency issue?

I believe the 12 step programme would work for some people for the exact same reasons as I outlined above. I don't know whether it would promote dependency. I suppose it would if the person attending had very poor social skills or a social life and the programme was the person's only social outlet. Again, the main thing here is support and attention. For someone to say the programme is effective, period, is shocking.

steoin wrote: »

For those with more severe issues such as personality disorders and depression/schizophrenia i assume talk therapy is futile

For clinical depression, it really depends on the person. For some people, the cause is mostly environmental (although you can never disassociate environment and biology, in my opinion), and the depression can be alleviated with talking therapy. However, it's virtually impossible to tell whether it's environmental or whether something neurobiological has gone wrong somewhere, and in the latter case some more extreme interventions are necessary.

For schizophrenia, I cannot see how psychoanalysis could possibly have any benefit outside making someone affected feel happier, which I suppose is a good thing. Schizophrenia is another illness that has a shockingly low success rate when it comes to treatment.

Odysseus

steoin wrote: »

Excuse my ignorance (lay man/Foundation course in psy) but to the best of my knowledge addiction can be viewed as a battle between the Id, Ego & super-ego?

Am i mistaking addiction and dependence?
and if so once the physical addiction is dealt with would psychoanalysis then not be considered useful?

Either way i would imagine psychoanalysis can help an individual recognize this conflict gain a greater understanding and enable them to go about changing. Am I correct that this is the aim of the psychoanalytical therapy?

I'm working in the addcition area a long time now, nearly as long as I have been studying psychoanalysis, I have never come across addiction being explained psychoanalytically this way. Where did you pick this one up?

An interesting book by an analyst who has worked in the Irish addiction field a long time is The subject of addiction by R Loose, if you are interested in the area of psychoanalysis and addiction.

Gingermagic

Hi folks,
new to the board and found the conversation interesting.....And it brought to mind a question, well, maybe more than one.

Psychoanalysis is a beneficial therapy for many many folks. Cartharsis is a word I have seen used but in what seems a negative connatation.

If it is carthartic surely that is beneficial to a patient. To learn to use tools to rid the body of toxic thoughts cannot be a bad thing. Even if it is chemical, to dismiss it out of hand as quackry i think may be evident that you have little experience with it....Maybe to get clearer understanding, don't read a book, have a few sessions a psychoanalist, books will never give you the experiences only the words.

It is slowly dawining on professionals that instead of dividing therapies, working in conjunction benefits patients holistically. And after all it is not about what you think or feel is right about the therapy especially if you are not experienced in it. It is what is right for the patient, and if all that is being treated is the chemical imbalance, the patient is losing out. In my opinion. The knock on effect of having an imbalance chemical or otherwise damages the psyche...that should not be ignored....

JuliusCaesar

Gingermagic wrote: »

Hi folks,
new to the board and found the conversation interesting.....And it brought to mind a question, well, maybe more than one.

and those questions are?

Gingermagic wrote: »

Psychoanalysis is a beneficial therapy for many many folks. Cartharsis is a word I have seen used but in what seems a negative connatation.

If it is carthartic surely that is beneficial to a patient.

Is it? Do tell.

Gingermagic wrote: »

To learn to use tools to rid the body of toxic thoughts cannot be a bad thing.

Sounds more like CBT than Psychoanalysis.

Gingermagic wrote: »

Even if it is chemical, to dismiss it out of hand as quackry i think may be evident that you have little experience with it....Maybe to get clearer understanding, don't read a book, have a few sessions a psychoanalist, books will never give you the experiences only the words.

What's chemical?

Gingermagic wrote: »

It is slowly dawining on professionals that instead of dividing therapies, working in conjunction benefits patients holistically. And after all it is not about what you think or feel is right about the therapy especially if you are not experienced in it. It is what is right for the patient, and if all that is being treated is the chemical imbalance, the patient is losing out. In my opinion. The knock on effect of having an imbalance chemical or otherwise damages the psyche...that should not be ignored....

Slowly dawning? In the 20-odd years I've been working in mental health, I've been part of a multidisciplinary team. Generally we work together, and together with the client, for the benefit of the client.

TrollHammaren

Gingermagic wrote: »

Psychoanalysis is a beneficial therapy for many many folks. Cartharsis is a word I have seen used but in what seems a negative connatation.

I could be wrong, but I'm pretty sure I'm the only one here who referred to psychoanalysis as cathartic, and I definitely didn't mean it in a negative way. My argument was that I don't believe that psychoanalysis is effective as anything more than a talking therapy, and that the underlying mechanisms by which psychoanalysts understand mental health are not founded in a scientific understanding of the brain.

Gingermagic wrote: »

If it is carthartic surely that is beneficial to a patient.

Sure, but only in a limited number of mental health issues, in my opinion. I don't believe there's anything a psychoanalyst can do for schizophrenia.

Gingermagic wrote: »

Even if it is chemical, to dismiss it out of hand as quackry i think may be evident that you have little experience with it....Maybe to get clearer understanding, don't read a book, have a few sessions a psychoanalist, books will never give you the experiences only the words.

Are you saying that my reasons for disagreeing are a lack of experience? As I said, I'm sure I'd feel great after chewing the ear of a psychoanalyst, but no more than I would doing the same with my friend or even my dog (if I had a dog - dogs are awesome). However, if I had schizophrenia or my child had autism I'd run a mile from a psychoanalyst. Especially if my child had autism.

Gingermagic wrote: »

It is slowly dawining on professionals that instead of dividing therapies, working in conjunction benefits patients holistically.

What are you basing this on? Even the HSE employs a multidisciplinary team nowadays.

Gingermagic wrote: »

It is what is right for the patient

Sure, but I don't think a psychoanalyst can do any more for a person than a good listner can.

Gingermagic wrote: »

and if all that is being treated is the chemical imbalance, the patient is losing out. In my opinion. The knock on effect of having an imbalance chemical or otherwise damages the psyche...that should not be ignored....

Yeah, I agree. I'm not saying the only means of treating mental health should be to pump them full of drugs, my argument is that psychoanalysis is no more effective than any other means of catharsis, and that it's scientifically unfounded.

sambuka41

TrollHammaren wrote: »

Sure, but only in a limited number of mental health issues, in my opinion. I don't believe there's anything a psychoanalyst can do for schizophrenia.

You should read a book The Center Cannot Hold-Elyn R Saks

Its a really interesting insight to how psychoanalytic therapy can be used in a case of schizophrenia and in conjunction with psychiatry. Very good read from the perspective of the patient.

krd

sambuka41 wrote: »

You should read a book The Center Cannot Hold-Elyn R Saks

I have read it.

Its a really interesting insight to how psychoanalytic therapy can be used in a case of schizophrenia and in conjunction with psychiatry. Very good read from the perspective of the patient.

It could be argued, that the psychoanalysis she received didn't help her. And it was the anti-psychotic drugs that did work for her. Some of the psychoanalysis she received in England doesn't really sound like it would do anyone much use - literally years of spouting word salad to an analyst.

She had a fear of Tardive Dyskensia, so she never liked taking the drugs.

Maybe there are stresses that can trigger the psychosis. Maybe psychoanalysis can help with dealing with those stresses. But if it's some kind of neurological malfunction that needs a drug, it needs a drug.

Elyn Saks had a pretty awful time. The book is a great read.

steoin

Odysseus wrote: »

I'm working in the addcition area a long time now, nearly as long as I have been studying psychoanalysis, I have never come across addiction being explained psychoanalytically this way. Where did you pick this one up?

An interesting book by an analyst who has worked in the Irish addiction field a long time is The subject of addiction by R Loose, if you are interested in the area of psychoanalysis and addiction.

Oops obviously a misunderstanding on my part! Dont imagine i picked it up anywhere specifically just my understanding of psychoanalysis.
I thought it was an issue of balance between the Id and super ego
As the Id is the part of the psyche that is responsible for our most primitive desires and if the super ego was not developed enough it would be problematic with ego being unable to create a healthy balance.

Might give that a look if nothing else it should clarify psychoanalysis a bit for me

Odysseus

steoin wrote: »

Oops obviously a misunderstanding on my part! Dont imagine i picked it up anywhere specifically just my understanding of psychoanalysis.
I thought it was an issue of balance between the Id and super ego
As the Id is the part of the psyche that is responsible for our most primitive desires and if the super ego was not developed enough it would be problematic with ego being unable to create a healthy balance.

Might give that a look if nothing else it should clarify psychoanalysis a bit for me

Don't woory about it, sure if you want to use those concepts, you can look at every disorder in that way; if you get my point. I can only type slowly at the moment, I only have the use of one hand.

However, as a significant amount of the HSE addcition services therapists are psychoanalyticlly trained. More than CBT trained therapists, but we are quite a mixed group. The thingh is we respect the differences in how others work, and that helps the client, especially from being told the disease model is the only way too go.

What i see here tells me some peopleknow little about psychoanalysis, so keep that in mind.

There has been a lot said and I will try to respond over the next week, just remeember the Queen's statement in Hamlet, when you read some oif them.

As you don't know me I'm a Lacanian analyst, but have trained in many different modaliti9es over the years. If you want to learn about modren Psychoanalysis nlook up Lacan. His rreturn to Freud and speech and language is where we start from.

I wish i could write more but my hand is playing up. Best of luck with you research. Feel free to ask any questions. Apologies for any typos but nmy nrighthand has little power and I have lost the ability to move it, e.g, I cannot write or sign my name.

I though we where using this thread to swp0ea\k about the clinical use of psychoanalysis, not whether people believe in it or not. Respect is the key here people, the therapist I work with is CBT trained but we make an excellent team because we respect each others work.

Odysseus

krd wrote: »

I have read it.



It could be argued, that the psychoanalysis she received didn't help her. And it was the anti-psychotic drugs that did work for her. Some of the psychoanalysis she received in England doesn't really sound like it would do anyone much use - literally years of spouting word salad to an analyst.

She had a fear of Tardive Dyskensia, so she never liked taking the drugs.

Maybe there are stresses that can trigger the psychosis. Maybe psychoanalysis can help with dealing with those stresses. But if it's some kind of neurological malfunction that needs a drug, it needs a drug.

Elyn Saks had a pretty awful time. The book is a great read.

Psychoanalysis only deals with language, if something is rooted within the biological framework, we are not that interested as our interventions work only at the level of language.

A lot of my psychotic dual diagnosed patients have benefited from regular psychoanalysis, though it is different in terms of interventions for psychotics rather that neurotics.

A lot of Irish consulants are interested i neuro-psychoanalysis but it is not my cup of tea.

sambuka41

krd wrote: »

It could be argued, that the psychoanalysis she received didn't help her. And it was the anti-psychotic drugs that did work for her. Some of the psychoanalysis she received in England doesn't really sound like it would do anyone much use - literally years of spouting word salad to an analyst

There are times in my own analysis that I feel all I do is 'spout word salad' There is a purpose to it though and that's the difference. I have experienced the Freudian slips and the real knowledge that comes from them; so I guess I buy psychoanalysis as a valid type of talk therapy (granted I am not psychotic so the interventions are very different for me)

I think where the medical model and empahsis on medication falls short is regarding looking at a whole person rather than purely a collection of nerves and synapses. Elyn herself said,

While medication had kept me alive, it had been psychoanalysis that helped me find a life worth living

Lacanian psychoanalysis is an incredibly in-depth study, I wish luck to anyone wanting to delve into it. I have been studying it on a part time basis (as an extra subject in my degree, and HDip) for a few years and its not easy going I think that's why its misunderstood and misrepresented at times, as it isn't the most accessible subject.

krd

Odysseus wrote: »

Psychoanalysis only deals with language, if something is rooted within the biological framework, we are not that interested as our interventions work only at the level of language.

I'd have to dig out Ellen Saks' book to get the details. She was a resident at an English psychiatric institution for years. Most of the time she was not on anti-psychotics. The treatment she was receiving was from an analyst working for the institution. Again, to get the precise details, I'd have to dig out the book. Her analyst was following some method, where she believed that within the 'word salad' there was actually coherent language. So, Ellen would babble, and her analyst would write down the babble, look to see if she could see something she could judge to be coherent. And then respond to Ellen in a similar 'word salad' babble. And that went on for years.

But you see, I think all this can work the other way around. Analysis for Ellen, who was an unmedicated schizophrenic, who was floridly psychotic most of the time, probably did her no good. In her book she says she can't think of any trauma in her childhood, or early life that would have brought the illness on. She may or may not have been telling the truth. However. If someone is suffering through trauma that does have it's roots in real events, situations, putting them on drugs as a treatment for their distress, may be an inappropriate treatment as much as Ellen's English analyst.

A lot of my psychotic dual diagnosed patients have benefited from regular psychoanalysis, though it is different in terms of interventions for psychotics rather that neurotics.

I would assume - completely without evidence or proof - that a persistent psychological crisis, could eventually lead to a biological breakdown. Saying that, you may not need the psychological crisis for the biological failure.

You know. If a distressed adolescent presents themselves, or is presented, to mental health services. They may be babbling that their family is plotting against them, tormenting them, and trying to drive them crazy. That may all, unfortunately, be true.

Then again. What if the person can't verbalise their crisis. Or, it's on a level that is mystified and not available to them.

sambuka41

krd wrote: »

I'd have to dig out Ellen Saks' book to get the details. She was a resident at an English psychiatric institution for years. Most of the time she was not on anti-psychotics. The treatment she was receiving was from an analyst working for the institution. Again, to get the precise details, I'd have to dig out the book. Her analyst was following some method, where she believed that within the 'word salad' there was actually coherent language. So, Ellen would babble, and her analyst would write down the babble, look to see if she could see something she could judge to be coherent. And then respond to Ellen in a similar 'word salad' babble. And that went on for years.

Elyn wasn't in the institution for years, it was months,she was an out patient attending a day hospital for most of that time. She refused her medication more for fear of the side effects. Neither of her analysts were against her taking the medication. The analyst was not connected to the hospital as far as I remember, I think it was Cambridge that put her in contact with the analyst.

She was not spouting word salad back to Elyn in fairness, her intervention was to help Elyn to metaphorize her existence as for the psychotic there is a difficulty with metaphor. But I'm not a practising analyst so my knowledge is limited.

krd

sambuka41 wrote: »

Elyn wasn't in the institution for years, it was months,she was an out patient attending a day hospital for most of that time.

She had quite a debilitating condition. She had pretty look function as far as quality of life went.

She refused her medication more for fear of the side effects. Neither of her analysts were against her taking the medication. The analyst was not connected to the hospital as far as I remember, I think it was Cambridge that put her in contact with the analyst.

I'm fuzzy on that detail without looking at the book again.

She was not spouting word salad back to Elyn in fairness, her intervention was to help Elyn to metaphorize her existence as for the psychotic there is a difficulty with metaphor. But I'm not a practising analyst so my knowledge is limited.

Her analyst may have had the best of intentions, but Elyn was in a horrifying condition.

Now, I'm not an analyst either. There may not be that much value in having a metaphor for your existence. If, analysis is about revelation. Then it should be about demystification, and untangling mysteries. A metaphor, is another entanglement. And if you don't really understand what I mean, I have succeeded in making my point.

sambuka41

krd wrote: »

Her analyst may have had the best of intentions, but Elyn was in a horrifying condition.

But that wasn't the result of her analysis? Elyn made her choices regarding her meds, so then we come to the debate about free will and the individual's choice to be medicated or not.

krd wrote: »

Now, I'm not an analyst either. There may not be that much value in having a metaphor for your existence.

Thats where a Lacanian analyst would disagree, the Paternal Metaphor is what brings the subject into the symbolic order, it substitutes the desire for the mother with the Name-of-the-Father. The problem with the psychotic is a problem with metaphor, with signification.


I don't think the practical side of working with people with mental health difficulties is a segregated as the academic side is, and rightly so imo.

Out Of The Night

Psychoanalysis if chosen as a therapy is usually a very long process. I'm talking about years in analysis. At the heart of it is a belief in the unconscious. That it holds the key to our behaviour and whatever difficulties we may be experiencing. During analysis the client will engage in 'free association'. Talking about whatever comes to mind. Talking freely. Freud believed this was a way of unlocking the person's unconscious. Dream work is also believed to serve the same purpose. There are so many famous psychoanalysts which came after Freud. The basic principle remains the same yet some of their theories differ. Kleinian analysis for example is quite divisive in the psychoanalytic community. Klein believed we either occupied a paranoid-schizoid position or a depressive position. All leading back of course to our early infantile experiences.

TrollHammaren

Out Of The Night wrote: »

Psychoanalysis if chosen as a therapy is usually a very long process. I'm talking about years in analysis. At the heart of it is a belief in the unconscious. That it holds the key to our behaviour and whatever difficulties we may be experiencing. During analysis the client will engage in 'free association'. Talking about whatever comes to mind. Talking freely. Freud believed this was a way of unlocking the person's unconscious. Dream work is also believed to serve the same purpose. There are so many famous psychoanalysts which came after Freud. The basic principle remains the same yet some of their theories differ. Kleinian analysis for example is quite divisive in the psychoanalytic community. Klein believed we either occupied a paranoid-schizoid position or a depressive position. All leading back of course to our early infantile experiences.

What various theorists believe is all well and good, but do you actually believe that what goes on in psychoanalytic sessions works by the mechanisms described by psychoanalysts (unlocking the unconscious, reconciling childhood issues etc)? If so, how can we provide evidence that what's happening in psychoanalytic sessions is actually what psychoanalysts claim and not just the patient undergoing catharsis?

This isn't just a rhetorical question, I'm genuinely interested in hearing how people who support psychoanalysis answer this.

Out Of The Night

TrollHammaren wrote: »

What various theorists believe is all well and good, but do you actually believe that what goes on in psychoanalytic sessions works by the mechanisms described by psychoanalysts (unlocking the unconscious, reconciling childhood issues etc)? If so, how can we provide evidence that what's happening in psychoanalytic sessions is actually what psychoanalysts claim and not just the patient undergoing catharsis?

This isn't just a rhetorical question, I'm genuinely interested in hearing how people who support psychoanalysis answer this.

Well we can't provide that evidence. Psychoanalysis is just another treatment approach. Take the Rogerian model for example. There is no scientific evidence of its success. Yet it works. Engaging in a therapeutic relationship where the therapist is displaying congruence and empathic understanding works. Its what you believe. What exactly is catharsis? Surely most therapies prove cathartic. Our adult selves are formed not only by our early environment but also our very early pre-verbal experiences. Psychoanalysis delves deep.

krd

sambuka41 wrote: »

But that wasn't the result of her analysis? Elyn made her choices regarding her meds, so then we come to the debate about free will and the individual's choice to be medicated or not.

Yeah. That is a different discussion. No, I would not like to be in the position where drugs were forced on me. I would not like to have my brain fried by electric shock therapy either.

Thats where a Lacanian analyst would disagree, the Paternal Metaphor is what brings the subject into the symbolic order, it substitutes the desire for the mother with the Name-of-the-Father.

The problem with the psychotic is a problem with metaphor, with signification.

Well...That might be true, if the pathology of the psychosis was Oedipal in nature. With these "metaphors" it could look like trying to find and accept a holy spirit.

I have had problems with my family, that I'm finally coming to accept have caused me terrible suffering - they haven't made me psychotic, and they are definitely not Oedipal in nature. Having any end of metaphors for myself, will not answer simple questions, like why did my family attack me so viciously - why were they so destructive - why did they torture me. If you want a metaphor - I believe at some point, possibly before my birth, I was anointed as a sacrificial goat.

I believe Lacan takes his idea of the symbolic order from Sartre. With Sartre it's more a social construction - it's not just something within the subject. If you're in the wrong place in the order - or if you're not embedded in it - or if on some level you're seen as a threat to the order - if you are symbolically disruptive to the spectacle. Then, on an existential level, you can experience great suffering. And the experiences will be real, and not just in the imagination.

TrollHammaren

Out Of The Night wrote: »

Well we can't provide that evidence. Psychoanalysis is just another treatment approach. Take the Rogerian model for example. There is no scientific evidence of its success. Yet it works.

That's exactly what I'm talking about; we're relying on anecdotes. How do we know it works? Have we seen any scientific evidence that demonstrates that people genuinely improve after psychoanalytic sessions? If there is some evidence for that, how can we prove it's not just because talking to someone who's listening is cathartic? If I'm right, then psychoanalysis is about as effective as having a chat with a very attentive golden retriever. By that I don't mean it's a waste of time, you'll still feel much better after that long chat with your dog, but it's not because you've resolved the conflict between the id, ego, and superego or anything like that.

Out Of The Night wrote: »

Engaging in a therapeutic relationship where the therapist is displaying congruence and empathic understanding works. Its what you believe. What exactly is catharsis? Surely most therapies prove cathartic.

Sure, and psychoanalysis is in no way unique in that respect. If I were to start a therepeutic model tomorrow, call it "Trollhammarenalysis", and provide a platform for a person to discuss how they feel, it would have more or less the same results.

Out Of The Night wrote: »

Our adult selves are formed not only by our early environment but also our very early pre-verbal experiences. Psychoanalysis delves deep.

What are you basing this on? Most of the research seems to indicate that people's behaviour is a due to an interaction between biological predisposition, such as genetics, and environment.

I think psychoanalysis has escaped scrutiny for too long because "you can't disprove it". Pixie dust is my favourite analogy for psychoanalysis, as if you rub pixie dust on a wound you'll likely see it heal.

krd

TrollHammaren wrote: »

If there is some evidence for that, how can we prove it's not just because talking to someone who's listening is cathartic?

Why would you think there would be "scientific" evidence. You're not dealing with some physical phenomena here - like gravity, or the speed of light, or electricity. It's not something easy to quantify.

If I'm right, then psychoanalysis is about as effective as having a chat with a very attentive golden retriever.

If you really spend any serious amount of time, talking to a dog.......Maybe you should seek professional help.

By that I don't mean it's a waste of time, you'll still feel much better after that long chat with your dog, but it's not because you've resolved the conflict between the id, ego, and superego or anything like that.

Well, the dog is not going to talk back to you, and maybe help guide you a little through some existential crisis. But at the same time.....The dogs is not going to tell, that really your problem is you want to kill your father, and ***** your mother. Which may not be all that helpful.

Sure, and psychoanalysis is in no way unique in that respect. If I were to start a therepeutic model tomorrow, call it "Trollhammarenalysis", and provide a platform for a person to discuss how they feel, it would have more or less the same results.

I don't think it's as simple as a crisis just being something someone needs to get off their chest.

What are you basing this on? Most of the research seems to indicate that people's behaviour is a due to an interaction between biological predisposition, such as genetics, and environment.

Yes, but how you navigate that environment or how it navigates you, is also important. And is malleable, given the right tools.

I think psychoanalysis has escaped scrutiny for too long because "you can't disprove it". Pixie dust is my favourite analogy for psychoanalysis, as if you rub pixie dust on a wound you'll likely see it heal.

It hasn't escaped scrutiny. Maybe some people have benefited from it. And there are clearly cases where there are people who have not.

And as for Pixie dust - the homoeopath business is doing a roaring trade.

Odysseus

TrollHammaren wrote: »

What various theorists believe is all well and good, but do you actually believe that what goes on in psychoanalytic sessions works by the mechanisms described by psychoanalysts (unlocking the unconscious, reconciling childhood issues etc)? If so, how can we provide evidence that what's happening in psychoanalytic sessions is actually what psychoanalysts claim and not just the patient undergoing catharsis?

This isn't just a rhetorical question, I'm genuinely interested in hearing how people who support psychoanalysis answer this.

Sorry that I can write very much with my injury, but to respond to you questio Analyst I have studied with and even with my own practice within the HSE believe the mechanisms you have described. My evidence is the evidence of the clinic and that is what most analysts i know would say.

It is not the evidence of say CBT, but we can measure psycoanalytic practice in the way we measure other therapies. In my part of the HSE there is plently of research saying that we should practice this way, as current evidence supports it. Most of the therapists in my sector do not work that way, as they find that clinical practice does not support current research. I hope that mkes some sense.

What is evidence in clinicalm practice? The resolution of the presenting symptom? Quality of life indicators? The question of what is a cure is that, a question. As some who tries to work in an analytic way, I am working with subjectivity, how do we objectively measure subjectivity?

I do not aim to answer your question, but what are your thoughts on the above? Keep in mind that I started this thread stating I am not here to prove anything about paychoanalysis, it is more about talking about it. There is a lot more to be said but my hand is at me know. I can't even write my notes up at the moment, I have to quickly tape them at the end of a session, however, I will add what I can when I can. Hopefully though this responds in some way to your question