Monthly Archives: July 2013

Anxiety…

The final installment of this tour of anxiety in the NYT.  Interestingly written essay, touching on the uncertainty of the difficulties of this state of mind…and the attempts to grapple with it throughout one’s life…

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July 23, 2013 · 2:57 pm

“There is no hope of joy except in human relations.” Review of Relational Trauma in Infancy

This review highlights the need for ‘touching’ in our life, and how that need is therapeutic – in our relationships and in our sense of self.  

Baradon, Tessa (Ed) (2010) Relational Trauma in Infancy: Psychoanalytic, Attachment and Neuropsychological Contributions to Parent-Infant Psychotherapy. Routledge: Taylor & Francis Group. London and New York. 

            As I read this book, my associations kept returning to the thoughts of a scientist that I had read thirty plus years ago during a psychology class.  The professor introduced the class to the work of Jacob Bronowski. The professor continued my introduction to Freud, to the stages of child development from the various schools or orientations, and highlighted each stage remarkable for its place in the mid-1970s period.  He also focused our understanding of what the goals of psychotherapy were, as he was also a practicing clinician. 

            It was this professor’s insistence on our reading this short book of essays by Bronowski (Science and Human Values) that is most memorable.  Bronowski’s underlying theme throughout this work – and undoubtedly my professor’s motivation – was “we must touch others.”  Jacob Bronowski was a scientist and a humanist – but ‘touching others’ in the relational sense was a thread that ran through much of his work. 

            The parallel in this review is on the change possible within relationships. This excellent collection of work brought together by Tessa Baradon aptly demonstrates, especially through the clinical illustrations, the need to touch others – to help those that have been so afflicted by trauma and traumatic circumstances that the relationship between a mother and an infant is so deeply affected and in need of professional understanding and aid. 

            The researcher’s contributions in this collection present their attempts to assess, to integrate, and to document the diagnostic criteria that will be useful in furthering the clinical endeavor.  The data also illustrates the efficacy of the clinician’s work with these traumatized parents and infants.  The focus is on the relationship – touching each other – and, as was underscored by Baradon and Bronfman, the capacity to increase our sensitivity to and understanding of the infant and parent in trouble – and enhancing our therapeutic efforts.  Linda Mayes also highlights this constant thread in all the psychotherapeutic work discussed in the  clinical and the research-oriented chapters, that is, the parent’s ability to reflect on the emotional needs of the infant and, importantly, to the understanding of how the parent’s needs, wishes and behavior “directly impact [the] infant’s feelings and needs.” 

            The essays in this collection cover an extraordinary range of work with parents and their infants, and in their fascinating and encompassing manner, each essay depicts a unique clinical setting.  The parent-infant programs that are established at the Anna Freud Centre are detailed, as are those centered in community locations, such as Sure Start – a governmental enterprise aimed toward preventative intervention. ‘Containment’ is offered as a contextual approach for therapeutic work that is being done with traumatized mothers and their infants.  This work is done by psychotherapy consultants in the community, and their endeavor to contain the anxiety consequent to the impact of poverty and social isolation that frequently attend these relational pairs. Several approaches are offered with richly evocative descriptions of the clinical work with the homeless population – living in hostels – and these attempts utilize health visitors, infant-parent psychotherapists, and a research psychologist. Further therapeutic efforts include the Mother Baby Units (MBU) in a prison, work with immigrants – with particular attention to the trauma visited upon them in their homeland prior to coming to the UK, and last, the enormously unsettling work with very disturbed mothers.  This last category includes vivid vignettes with a woman that could avail herself of the support offered – and those that could not, i.e., ones that could not escape their disturbance enough to progress into a closer relationship with their child. 

            Developmental scientists find their mark in this collection by demonstrating the significant strides that are made in epigenetics, with attention to the gene-environment interaction – and the advances made in molecular genetics in relation to that interaction. The need to integrate the findings of these studies with psychoanalytic theory is addressed, with a very comfortable perspective on understanding the role of environment, the psychological, and genetics in relation to traumatic experiences. The impact of these experiences and their consequences for the individual are discussed.  The ultimate benefit of much of the work presented in this volume will be in early intervention efforts with parents and infants – efforts that have shown dramatic therapeutic results.  Further work in this area of genetics revisits the concept of resilience.  Though not new to the field, the concept is attracting attention once again in light of recent research and findings, and the complex role of resilience in counterbalancing or moderating the effects of adversity is understood more comprehensively in relation to trauma. 

            Similarly, the role of attachment research is featured with respect to neurobiology, as well as the assessment work with the Adult Attachment Interview (AAI), both in relation to preventative work with infants and trauma.  The Parent-Infant Relational Assessment Tool (PIRAT), developed at the Anna Freud Centre, has been shown to be valuable in the effort to identify risk in the relationship between parents and their infants. 

            The “therapeutic endeavor for change,” to use Baradon’s term from this volume, may be thought of as the particular focal point in each of the contributions made in this collection. More directly to the point, the therapeutic work being done by all participants is exceptionally well illustrated by the metaphoric use of ‘ghosts’ and ‘angels’ in the nursery – ghosts or angels that aid or hinder the transformation of a healthy, forward-moving relationship between a parent and their infant.  I am also reminded of a phrase from The Little Prince, “There is no hope of joy except in human relations.”  This is the sine qua non of our therapeutic work.     

Rudy Oldeschulte

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Therapeutic Change

Good review – on elements of change in psychotherapy. 

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July 18, 2013 · 1:57 pm

NEW PAGES to visit – Contact information and Confidential questions…

I have added some new pages to the site – for confidential questions or personal concerns – that I will be pleased to explore with you.  There is also a more complete Contact page. These are available beneath the Home and About page links.  

Feel free to write your questions, using one of the two email addresses – and I will respond within 24 hours.  

I look forward to offering this free consultation.  

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Book review on Love…

As a contrast to the last couple posts, here is a review done in 2012 on All About Love…(published in Metapsychology Reviews) http://metapsychology.mentalhelp.net/poc/view_index.php?idx=214

Appignanesi, L. (2011) All About Love: Anatomy of an Unruly Emotion. New York: W.W. Norton & Company.

Several years ago, while reading a review of a then new book by Peter Ackroyd, I was struck by the wording used to describe London. Having lived in London for many years, I thought of the city as vibrantly alive, certainly one with personality, psychological spirit and flavor.  The review described London as a living organism.  The reviewer emphasized that London “…can be located nowhere in particular… its circumference is everywhere.”  This particular wording persisted in my memory.

In reading Appignanesi’s All About Love, I kept coming back to those words and that idea  of something alive, perhaps growing, sometimes decaying, at other times quietly subsisting.  That is, love, in a similar way, might be brilliant, lustful, subtle, or alternatively, be quite crepuscular in nature – amorphous – yet often in the background as twilight may sometimes be experienced.  Perceiving love as an organism allows one the freedom to dissect that body, as Appignanesi not only suggests in her using the word anatomy in her title, but also does brilliantly throughout the book – dissecting the anatomy of that unruly emotion.

Through her analysis, Appignanesi uses literature, history, and film to illustrate – to enlighten our understanding of the intensity of our desires and emotions, of our ambivalence and our conflicts – as we grapple with our own individual stories of love.  The book begins with a personal perspective highlighting her experiences as a child, as a teen, and as an adult. The book moves on to a detailed and incredibly thorough – and thoughtful contemporary examination of love.  Using psychoanalytic insights, developmental concepts, scientific findings and research for support, she plays with how love as a living organism has been captured throughout history in our philosophical investigations, in our literature, and even in our therapeutic attempts to right peoples’ lives.

From this personal perspective and the explanation of her interest in the subject, Appignanesi goes on to anatomize our first loves in youth, our love in marriage. She dissects the emotions involved in ‘triangles’ and families,  and finishes by looking at friendship, the latter being something on which Montaigne had much to say. Montaigne’s observations are used throughout the book to illustrate the historical perspective on how this emotion is experienced, and to draw some generalizations that have relevance in contemporary views – be those generalizations drawn from psychological and sociological research, or developmental theory.   More specifically, Appignanesi immerses us into the dynamics of this emotion.

To do this, individual stories are the medium.  That is, how do we ‘live’ love; how do we come to not only experience love in our daily lives, but begin to ‘know’ love – as Forster attempted to show us in Howard’s End, or Cavell in his philosophical writings on reciprocity in a relationship?  Freud noted for us that, “Side by side with the exigencies of life, love is the great educator.”  This education – this ‘work’ as Rilke put it, is expressed, “For one human being to love another; that is perhaps the most difficult of all our tasks, the ultimate, the last test and proof, the work for which all other work is but preparation.”  Thus, the conviction of E.M. Forster in ‘only connect’ demonstrates the direction of our desire to be connected in love with another – and to have what Stendhal suggests: “Half – the most beautiful half – of life is hidden from him who has not loved passionately.”  This ‘crystallization,’ of love, as Stendhal wrote of it, is yet another way to depict the transformative quality that Appignanesi wants to illustrate through the use of literary, film, and psychological references.

The historical elements of understanding love – its anatomy – are also emphasized in this work. She does this in a penetrating fashion, keeping one’s attention drawn to the ancients, the classical elements, and yet drawing these together with our contemporary perspectives in our current literature, in the medium of film and how this absorbed within our culture, that is, within our cultural understanding of love and its mishaps.  Appignanesi also characterizes how Freud wanted to convey that sense of cure through love – a conception that has been detailed now in so many theoretical and clinical viewpoints in the psychological literature.

Appignanesi has given us a sophisticated and an extraordinarily well textured analysis – one that will expand our perspectives on this organism we designate ‘love’.  Concluding with a comment by Rilke, the essence of the book’s message may be conveyed: “It is not enough for two people to find each other, it is also very important that they find each other at the right moment and hold deep, quiet festivals in which their desires merge so that they can fight as one against storm.  Before two people can experience unhappiness together, they have to have been blissful together and possess a sacred memory of that time, which evokes a kindred smile on their lips and a kindred longing in their souls.”

Rudy Oldeschulte trained in psychoanalysis with Anna Freud and her colleagues in London, and in law at DePaul University. He now has a clinical practice of psychotherapy, supervision and teaching.    roldeschulte@gmail.com

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Review of book – Mental health, suicide, literature…

I have included this review, as it includes a few references to mental illness and literature, particularly in its attempts to understand suicide. (This review was published in ‘Metapsychology Online Reviews’ – 2010).  Of particular interest are Redfield Jamison’s books, many of which offer compelling stories about her own struggles with mental health issues – as well as fascinating synopses of mental health and literary works.   

Review of:  Suicidal Behavior in Children and Adolescents (2009). Barry M. Wagner.  Yale University Press, New Haven and London.

             Our imagination is usually befuddled in our attempt to make sense of suicide – to find the rationality or the reasoning. The act of suicide – or its attempt – perplexes us. The task of explaining suicide, either psychologically, philosophically, or sociologically, has been approached from the viewpoint of these different disciplines for centuries. Volumes of work have been published on suicide in an effort to shed some light on this long-standing practical problem – to draw lines around the trajectory of its development in the young and to find means of prevention.  Scholarly examinations, such as Kay Redfield Jamison’s Night Falls Fast, provides us with an eloquent and rich account of the history and understanding of the despair and hopelessness felt by those that commit or attempt to commit suicide.  Literature and film give us pause on the subject. A work by A. Alvarez (The Savage God) looked historically at writings about suicide – in both literature and psychological studies, and noted that while there are innumerable writings on the subject, we still realize after reading these works, “that they are concerned with that shabby, confused, agonized crisis which is the common reality of suicide.”  More recently, characterized in book and in film, Michael Cunningham drew our attention to the despair and the psychological strain leading to the contemplation of suicide in The Hours – a rich literary depiction of Virginia Woolf’s suicidal struggles and conflicts, with accompanying illustrative stories that portray the developmental and psychopathological trajectory of the events.

 With so many perspectives and so many approaches in trying to understand and prevent suicide – all of which grapple with the real life problem of suicide – where does the clinician go?  Barry Wagner’s Suicidal Behavior in Children and Adolescents has given us the resource – a plentiful and detailed look at the current state of professional understanding – with a thorough and, though he humbly states otherwise, a comprehensive account of the enormous theoretical and clinical research to date. Wagner has done this in a qualified and masterful way, drawing together in one place an extraordinarily broad scope of research and clinical work, with attention to every possible avenue in comprehending suicide in young people. Every theoretical perspective – developmental, family, cognitive, psychodynamic, biological, and psychosocial (as well as others, lest I miss one) – is examined at length in his attempt to provide us with an integrative model.  Wagner deals very effectively with the definitional problems, as well as the evolutionary quality of the diagnostic classification system – a system that is far more useful in predicting, diagnosing, and ultimately benefiting prevention in young people. Wagner’s inclusion of the facts, the factors, and the statistics is impressive, as he integrates these within a framework that aids our understanding of the myriad contributory factors in suicidal behavior. He gives us a fuller picture of the reality of the crises that suicidal youngsters struggle with in their mental lives. For example, and though only indicative of one of the factors involved in youth suicidal behavior, there is the “sense of fundamental disconnection from others,” (Wagner). This sensibility is also characterized by other authors in their literary works or psychological treatises – be it Virginia Woolf, A. Alvarez, or Kay Redfield Jamison. However, in Wagner’s  Suicidal Behavior in Children and Adolescents, a sound and solid foundation for understanding the child or adolescent’s attempt to escape the experiences that they encounter each day and find so disturbing – and potentially dangerous – is offered. This intolerable experience within the child’s mental life may be described as E.M. Forster characterized being ‘muddled:’ that is, the individual’s failure of connection and the ‘tendency to live in fragments.’  This ‘muddled’ experience may and often does reflect a movement toward a more substantial reaction to the crisis.

             Our ability to respond to the practical nature of the problem and our need to understand all that we can of this “confused, agonized crisis” experienced by so many children, is well illustrated through Freud’s letter to Einstein (1933) regarding our wish to prevent war.  Freud commented: “The result, as you see, is not very fruitful when an unworldly theoretician is called in to advise on an urgent practical problem.  It is a better plan to devote oneself in every particular case to meeting the danger with whatever means lie at hand.” This attitude of practicality was further evident in Freud’s comments in a letter to Rev. Oskar Pfister about a young patient in 1926. Freud wrote: “What weighs on me in his case is my belief that unless the outcome is very good it will be very bad indeed; what I mean is that he would commit suicide without any hesitation.  I shall therefore do all in my power to avert that eventuality.” (quoted in Litman, 1967)

             The challenges and the complexity of understanding and responding in a practical, effective manner to suicidal behavior in our young people may seem overwhelming to clinicians, or to use Wagner’s term, “daunting.”  However, Wagner has brought together for us a rich and thorough examination of what we need to know, and his work provides sensible suggestions for our main task – that of what Freud was referring to in 1926 – prevention

 Litman, R. (1967) Sigmund Freud on Suicide.  In Shneidman, E.S. (Ed.) Essays in Self- Destruction. Science House, New York. 

Rudy Oldeschulte trained in psychoanalysis with Anna Freud and her colleagues in London, and in law at DePaul University. He now has a clinical practice of psychotherapy, supervision and teaching.    roldeschulte@gmail.com

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Mental health and literature

I have been pleased to see the responses to my posts on Virginia Woolf and her difficulties with depression and anxiety.  Many of her contemporaries, as well as those artists before and following her, grappled with issues of mental health – all the which were contributed to or exacerbated by societal, medical, as well as scientific (or lack of) factors.  I will continue to bring to this forum some of the literary sources that highlight these issues. I would welcome your suggestions and thoughts. 

Following is a review done that includes some interesting references.

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