Validation in the clinical process: four settings for objectification of the subjectivity of understanding.

Clinical material is presented for discussion with the aim of exemplifying the author's conceptions of validation in a number of sessions and in psychoanalytic research and of making them verifiable, susceptible to consensus and/or falsifiable. Since Freud's postscript to the Dora case, the first clinical validation in the history of psychoanalysis, validation has been group-related and society-related, that is to say, it combines the evidence of subjectivity with the consensus of the research community (the scientific community). Validation verifies the conformity of the unconscious transference meaning with the analyst's understanding. The deciding criterion is the patient's reaction to the interpretation. In terms of the theory of science, validation in the clinical process corresponds to experimental testing of truth in the sphere of inanimate nature. Four settings of validation can be distinguished: the analyst's self-supervision during the process of understanding, which goes from incomprehension to comprehension (container-contained, PS-->D, selected fact); the patient's reaction to the interpretation (insight) and the analyst's assessment of the reaction; supervision and second thoughts; and discussion in groups and publications leading to consensus. It is a peculiarity of psychoanalytic research that in the event of positive validation the three criteria of truth (evidence, consensus and utility) coincide.

[Changes produce old ghosts anew--the insecure Europe]. / Umwälzungen gebären alte Geister neu--Das verunsicherte Europa.

Since the fall of the Berlin Wall and the collapse of existing socialist dictatorships, some of the ghosts that we thought to have long since exorcised have returned to haunt us anew-aggressive forms of nationalism, which we have turned a blind eye to for decades, and a violent species of xenophobia on occasion openly homicidal in nature are prominent features of present-day European reality. In Beland's view, such alarming phenomena can only be controlled successfully if we can contrive-both on an individual and collective plan- to de-activate the psychic mechanism of projecting our own evils and flaws onto others (i.e. "foreigners") and to achieve what Melanie Klein calls the "depressive position", i.e. attain to a higher guilt tolerance. This, Beland contends, is the central utopia of European humanism.

[Critical comment on Helmut Thomä's essay on "Idea and reality in teaching analysis]. / Kritischer Kommentar zu Helmut Thomäs Aufsatz über "Idee und Wirklichkeit der Lehranalyse".

H. Thomä's reformist ideas about training analysis are controversial. Beland reproaches Thomä for his insinuation that national as well as international training institutions for psychoanalysis supposedly have quantitative rather than qualitative motivations for increasing the length of training analyses--after the motto "the longer, the better". Against that the author claims that a future analyst, in order to qualify, has to become aware of the defenses against his fears of annihilation and loss. This goal cannot be reached in 300-400 sessions. He argues that the training institutions' artificial restriction on the length of analysis would influence the training analyst's analytical attitude negatively and would expose the candidate to institutional violence.

[Religious roots of antisemitism]. / Religiöse Wurzeln des Antisemitismus.

In agreement with Freud, the author characterizes the unconscious structure of ecclesiastic and of contemporary racist anti-Semitism as paranoid projections of unconscious guilt feelings and of profound narcissistic injury. Chasseguet-Smirgel's thesis concerning the perverse character of anti-Semitism and Ostow's attempt to relate anti-Semitism to apocalyptic ideas are discussed as well.

Alteration of the ego due to defensive processes and the limitations of psychoanalytic treatment.

I have elucidated some of the main clinical and theoretical currents of the last few decades which belong under the general heading of 'alteration of the ego due to defensive processes', making use of Freud's dynamic structural concept. As examples of pathologically altered structures which connect all or some of the functions and agencies of the personality and rule as a state within a state, I have adduced the neurotically ego-syntonic character, a narcissistic defensive organization and the psychotic part of the personality. The possibility of therapeutic change depends on whether the pathogenetic path that led to the formation of the prevailing self-object relation can be retraced in the transference. The retracing of the ego-superego disturbance to its traumatic origins and the facilitation of a therapeutic regression are old-established basic psychoanalytic concepts which go back to Freud and Ferenczi and which, it seems, at present allow a synthesis of the clinical experiences gained under the aegis of different theories.

Rehabilitation for patients with multiple sclerosis?

In the epidemiological area of Southern Lower Saxony 92 patients with clinically definite or probable diagnosis of multiple sclerosis (MS) were interviewed and examined. This group contained a remarkably high percentage of benign cases (52%) in comparison with a sample of hospitalized patients. Neurological examination revealed spasticity and pareses to be the most important disturbances followed by ataxia and bladder/bowel problems. After a mean duration of 18.4 years, 52% received a pension and about 30% were still working full time. The pension was granted too early to 11 patients and vocational rehabilitation services would be required for 13 men. Although only half of the patients had an acceptable income, the socioeconomic situation of the families was adequate in 71%; 80% lived with their own families and could stay there in case more ambulant services were offered. Psychotherapeutic measures are required among these to relieve the stress within the families (present in 42%)and to improve the coping behavior (unsatisfactory in 60%).