Jahrbuch der Psychoanalyse: Band 48: Psychotische Mechanismen bei neurotischen Patienten

Psychotic mechanisms in neurotic patients make them lose their connection to reality: to internal and external reality and to the functions of the ego which aid the perception of internal and external reality. Thus for example consciousness, attentiveness, memory, curiosity or judgemental competence are actively changed and limited. The function of these active limitations is to reverse the strain of this depressive disorder if this becomes too heavy and is experienced as a »new danger« (Freud) and causes too much fear. These psychotic mechanisms lead to particular clinical phenomena such as for example the projection of interest in the analysis on to the analyst, forgetting thought associations, latent aroused-dazed states of consciousness etc. Neurotic patients do not receive fundamental existential psychoanalytic support until there is sufficient theoretical and clinical courage to examine the psychotic elements in their ego functions in their relationship to the analyst.

Content:

• Ruth Riesenberg Malcolm: Bedeutsames Vergessen: Eine klinische Untersuchung
  Abstract

  This paper deals with a type of splitting in which the individual encapsulates a total situation that is then severed from the rest of the patient’s (mental) experience leaving the person with a »lacuna« and with mini or maxi amnesias. It postulates that the dynamics underlying such a drastic situation are used mainly against intensive depressive anxieties in which guilt is felt unbearable. It discusses the connection to perverse mechanisms used as defence and describes the role that Oedipal phenomena play in this situation and bring out the technical problems encountered in the analysis of such patients. These amnesias are experienced by the patients as a vacuum – expressed as »I don’t remember« – or false memories: »it could have been like that«. Finally the paper questions what really is being or can be recovered.
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• Herbert Rosenfeld: Die Beziehung zwischen psychosomatischen Symptomen und latenten psychotischen Zuständen
  Abstract

  »Psychotic islands« that are encapsulated in psychosomatic symptoms and split from the psychic self have a damaging influence. Their penetrating quality is linked to an omnipotent projective identification which has probably been projected onto an external object and has then been withdrawn inside. The clinical material is drawn from a patient in whom the »psychotic island« was rooted in her uterus. Under analysis, breaching of the psychotic island determined a temporary transference psychosis, in which the patient was invaded by destructive feelings that had been split before. Working through this transference situation allowed the patient to integrate her destructive and her caring self and enabled her to re-establish linking functions.
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• Helmut Hinz: Narkotisieren, Zertrümmern, Ent-Sorgen. Zur leisen Arbeit an der Vernichtung lebendiger Bedeutung
  Abstract

  It seems to make sense to restrict the term psychotic mechanisms to that part of the defence, which cuts off the connection to the inner and outer reality. From this one can separate another part, which secondarily serves to restore the relation to object and reality. Psychotic mechanisms are therefore characterised by the use of thoughts in the sense of archaic phantasies, misrepresenting the inner and the outer world: 1. as a defining hypothesis, 2. as fixation of this hypothesis, although there exists a knowledge, that this hypothesis is wrong, 3. for projective identification with its potential to induce enactment in the analyst and to equalize him with the actual archaic phantasies. Psychotic mechanisms therefore are active restrictions and alterations of ego-functions: consciousness, attention, memory, curiosity to get to know more precisely, and the ability to judge and differentiate between inside and outside, damaging and fostering. After this theoretical part which wants to give a definition of the term, a detailed clinical illustration follows in order to show, how the patient 1. projects the interest in analysis into the analyst, 2. significantly forgets the link between thoughts, 3. remembers insignificant parts of those links and 4. luxuriates in stupefaction, when oscillating between too much doubt and too much certainty. With the help of a detailed description of an analytical session the author shows, how the long lasting state of lifelessness, produced by the evacuation of meaning, gives way to a break-through of a direct and open aggressive attack. This is assessed to be a development, preceding the integration of that part of the personality, which was so long projected.
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• Joachim F. Danckwardt: »... aber ich fühle, es ist anders ...« (Paula Heimann) – Anmerkungen zum Affektsystem der Gewißheit bei psychotischen, neurotischen und »normotischen« Mechanismen
  Abstract

  How can one understand the paradox, that defensive and protective mechanisms, which ought to avoid catastrophic fear of change and loss of the self and the object, again and again stir up that fear, by which the rift in the ego’s relationship to the reality is renewed? How do the mechanisms – which undermine meaningful relationships in statu nascendi – contribute to shaping illnesses and perhaps also to shaping daily life? After a case illustration, this article tries to explore answers on four levels. (1) On the level of the infallible but so far unthought certainty of a patient concerning his »urgent point«. That is the level of certainty as a central affective motif and regulative and as a feeling of reference for therapeutic realization. Feelings are seen – following a formulation of Nussbaum (2001) – as a dimension of judgement. (2) On the level of medializing that certainty: the performance. It goes beyond enactment and productions of neurotic patients. (3) On the level of coping with trauma, formation of wishes and therapeutic fulfilment: the realization principle. (4) On the level of process identification, which is seen as the actual driving force, as »organizing activity« (Loch 1968). For the sake of coming into being, relationships are destroyed.
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Geschichte der Psychoanalyse:

• Georg Bruns: Zwei Ohnmachten Freuds in der Begegnung mit Jung. Eine Reminiszenz an seine Herzneurose und den Ambivalenzkonflikt in Männerfreundschaften
  Abstract

  Freud twice lost conscience in the presence of Jung: in the year 1909 in Bremen and in 1912 in Munich. In both cases controversies with Jung and little victories of Freud preceded the faints. Freud himself declared the faints to be psychologically induced, but he only partially explained the causes. Jones considered them to be symptoms of a case of fear of success, Schur regarded them to be an escape from emotionally exciting situations, referring to early infantile conflicts around death wishes and feelings of guilt towards an early-deceased brother. Personally, I interpret the faints as a result of the strong ambivalence Freud felt towards important male friends of his. This ambivalence had already determined the episode of his cardiac neurosis in 1894 and 1895, when he changed from Breuer to Fließ, and reevolved in the relation to Jung, who for his part felt a high degree of ambivalence rather early in the relation to Freud. Over and above that, Freud and Jung showed a specific biographical similarity: Jung’s parents lost a son soon after birth too. This and some personality traits apparently have induced a »narcissistic object-choice«, which facilitated a projective identification with the transfer of a symptom of Jung’s puberty (fainting) to Freud.
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• Hans-Joachim Rothe: Karl Landauers Exil in Amsterdam im Spiegel seines Briefwechsels mit Max Horkheimer
  Abstract

  Karl Landauer (1887-1945) was trained by Sigmund Freud and became the first psychoanalyst ever in Frankfurt am Main. His close connection to Max Horkheimer (1895-1973) led to the founding of the Frankfurt Psychoanalytical Institute in 1929 in affiliation with the Institute of Social Research. After the Institutes were forced to close in March 1933, both went into exile. Their correspondence between Amsterdam und New York from 1934 until 1941 provides insight into the contemporary theoretical discussion, the situation of the Dutch Psychoanalytical Society and above all the personal motives leading to Karl Landauers’s tragic hesitation to seek exile once more.
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Erforschung des Holocaust:

• Rachel Rosenblum: Am Sprechen sterben? - Sarah Kofmann, Primo Levi
  Abstract

  In this paper the author raises the question, if and under which conditions writing or speaking of a catastrophic traumatic experience does help or, on the contrary, has deadly consequences. Primo Levi described his imprisonment in Auschwitz shortly after his liberation in a factual report and it seemed that by this report he could free himself from the horror he had lived through. But the guilt feeling of the survivor is expressed indirectly in his later texts; Levi committed suicide when he was 68 years old. Sarah Kofman’s father was murdered by the Nazis; as a child she herself disavowed her mother in favour of the woman who had rescued her from deportation. Kofman directly formulated this experience including the feelings of guilt and shame belonging to it, in a text only when she was 61 years old, after she had only indirectly written about it before; she too committed suicide four years later. The author warns against rushing to conclusions about the connection between speaking or describing and suicide. She formulates some conditions for a helpful way to listen and to answer to such a report in the analytical situation: above all, the psychoanalyst should not react in the same unconcerned way in which the public often reacts to the report of a traumatised survivor.
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Freud als Briefschreiber:

• Gerhard Fichtner: »Wenn das Bildnis mir nicht mehr ähnlich sieht ...«. Ein Brief Freuds an Hermann Struck aus dem Jahre 1914 Buy article