Melville's "Bartleby, the Scrivener: A Story of Wall-Street": The Vicissitudes of Treating a Difficult Patient.

Taking the liberty of imagining the lawyer in Melville's "Bartleby, the Scrivener" as narrator/therapist and Bartleby as patient, this article, written with the therapist/reader in mind, traces the vicissitudes of countertransference and speculates on what constitutes a "good enough" therapeutic effort.

From Mourning and Melancholia to Neurobiology in an Era of Global Warming, Pandemic Disease, and Social Chasms: Grief as a Requisite for Change.

We find ourselves in a unique time in history with the confluence of a pandemic, global warming, and social chasms felt throughout the world. In this article, it is suggested that the grieving process is necessary for progress. The article addresses grief from a psychodynamic lens and progresses through the neurobiological changes that occur in the grieving process. The article discusses grief as both a result of and a necessary response to COVID-19, global warming, and social unrest. It is argued that grief is a vital process in order to fully change as a society and move forward. The role of psychiatry, and specifically psychodynamic psychiatry, is integral in paving the way to this new understanding and a new future.

Resilience, Trauma, and Coping.

The study and use of resilience is of the utmost importance to psychodynamic psychiatry. It is deeply ingrained in ideas about well-being and the treatment and care of patients. However, its neurobiology is incompletely understood, its terminology and relation to trauma and coping not well defined, and its efficacy underutilized in clinical practice. This article reviews the scientific literature on resilience, especially as it relates to trauma and coping. It also attempts to point the way for its greater application in psychiatry and mental health by utilizing resilience in more informed and individualized approaches.

Examining Racism in Psychoanalytic Training: Perspectives from a Psychiatry Resident.

The author reviews pervasive racial biases in psychoanalysis, spanning from overt instances of racial judgement to the normalized tendencies of internalized racist societal structures on individuals. A personalized account is given addressing how such issues have led to a hesitancy in the author- a Black and Hispanic psychiatry resident-to pursue psychoanalytic training. Institutes can more appropriately acknowledge how racism has affected their patients and the theories of the mind that are commonly promulgated. Academic institutions need to actively engage in creating awareness of racial bias, microaggressions, and uncovering unconscious negative attitudes. This will aid in the development of educational approaches that strive toward racial equality and inclusiveness.

Psychodynamic Psychiatry in Argentina at a Crossroads.

The authors provide an overview of the history of psychoanalysis and psychodynamic psychiatry in Argentina. They describe the evolving practice patterns of psychodynamic psychiatrists in this vibrant South American country, highlighting socio-political influences and challenges.

On the Birth of Psychodynamic Psychiatry.

Psychodynamic psychiatry emerged from psychoanalytic theory, but the influence of the latter has been only partial. Equally important are other disciplines outlined within is article. Modern psychodynamic publications and presentations should honor all of the foundational pillars of the field. In this way, the new area lends itself to bio-psycho-social integrations that remain a challenge for all researchers and clinicians who seek to understand and treat patients with mental disorders.

Psychodynamic Psychiatry, the Biopsychosocial Model, and the Difficult Patient.

This article defines psychodynamic psychiatry as the intersection between general psychiatry and psychoanalysis as a theory of mind. Psychodynamic psychiatry is built on a biopsychosocial model for understanding and treating mental disorders. Currently, a narrower biomedical model is in ascendancy, but it has not lived up to its promise and is not supported by emerging science as robustly as is the biopsychosocial model. The "difficult patient" emerges in part from the limits of our treatment models and treatment methods. Concepts like projective identification and enactment help us to understand our own contributions to our experience of a patient as difficult.

Innovative Educational Initiatives to Train Psychodynamic Psychiatrists in Underserved Areas of the World.

Psychodynamic psychiatry remains a challenging subject to teach in underserved areas, where enthusiasm to learn is substantial. Besides logistical and psychiatric workforce shortcomings, sensible cultural adaptations to make psychodynamic psychiatry relevant outside of high-income countries require creative effort. Innovative pedagogical methods that include carefully crafted mentoring and incorporate videoconferencing in combination with site visits can be implemented through international collaborations. Emphasis on mentoring is essential to adequately train future psychodynamic psychotherapy supervisors. Examples of World Psychiatric Association initiatives in countries such as Indonesia, Iran, Malaysia, and Thailand are presented as possible models to emulate elsewhere.

Resilience, Trauma, and Coping.

The study and use of resilience is of the utmost importance to psychodynamic psychiatry. It is deeply ingrained in ideas about well-being and the treatment and care of patients. However, its neurobiology is incompletely understood, its terminology and relation to trauma and coping not well defined, and its efficacy underutilized in clinical practice. This article reviews the scientific literature on resilience, especially as it relates to trauma and coping. It also attempts to point the way for its greater application in psychiatry and mental health by utilizing resilience in more informed and individualized approaches.

Criticism in the Self, Brain, Relationships, and Social Structure: Implications for Psychodynamic Psychiatry.

An integrative-psychodynamic theory of criticism in self and relationships is presented (Shahar, 2015). My theoretical starting point is the tension between Authenticity (A; our inherited potential, tantamount to Winnicott's True Self) and Self-Knowledge (SK; what we [think] we know about ourselves). Self-criticism, a formidable dimension of vulnerability to a wide array of psychopathologies, is construed as a distorted form of self-knowledge, reducing internal confusion at the expense of widening the gap between A and SK. Amalgamated by a genetic and neuroanatomic makeup, criticism of the self quickly translates into criticism-based interpersonal exchanges across the life span, culminating in an Axis of Criticism (ACRIM). A psychodynamic-integrative psychotherapy of malignant criticism in self and relationships is described. The article is concluded with some broad reflections on the implication of this work to the theory development and therapeutic action.

New Developments of the Therapeutic Alliance (TA): Good News for Psychodynamic Psychiatry.

Clinicians have long known that successful psychotherapy, including successful psychodynamic psychotherapy, depends upon the interaction between therapist and patient. In other words, it is important to have a strong therapeutic alliance. This article presents the history of the concept of the therapeutic alliance (TA). It also explores three areas of research that have bearing on the TA. The importance of the TA and the extensive research work that pertains to it hold promise for psychodynamic psychiatry, both in terms of understanding, and in the treatment of mental suffering.

Chronic physical illness: a psychophysiological approach for chronic physical illness.

Growing evidence demonstrates that psychological risk variables can contribute to physical disease. In an effort to thoroughly investigate potential etiological origins and optimal interventions, this broad review is divided into five sections: the stress response, chronic diseases, mind-body theoretical models, psychophysiological interventions, and integrated health care solutions. The stress response and its correlation to chronic disorders such as cardiovascular, gastrointestinal, autoimmune, metabolic syndrome, and chronic pain are comprehensively explored. Current mind-body theoretical models, including peripheral nerve pathway, neurophysiological, and integrative theories, are reviewed to elucidate the biological mechanisms behind psychophysiological interventions. Specific interventions included are psychotherapy, mindfulness meditation, yoga, and psychopharmacology. Finally, the author advocates for an integrated care approach as a means by which to blur the sharp distinction between physical and psychological health. Integrated care approaches can utilize psychiatric nurse practitioners for behavioral assessment, intervention, research, advocacy, consultation, and education to optimize health outcomes.

Psiquiatria biológica, psiquiatria psicodinâmica e a integração bio-psico-social para o sucesso do tratamento / xxx

O autor inicia mostrando que no final do século XIX, o exame do paciente psiquiátrico estava sujeito às mesmas regras metodológicas do exame médico geral. Mostra que em 1913, Jarpers introduziu uma visão mais humanística do paciente, o que significa um retorno à empatia primitiva e à valorização semiológica das vivências internas do paciente. A partir desse ponto, Freud passa a influenciar a psiquiatria até meados da década de 50 do século passado, quando a psicofarmacologia teve grande avanço com a descoberta dos antipsicóticos e antidepressivos tricíclicos. O autor mostra a evolução da psiquiatria biológica nos últimos vinte anos, levando a sua aproximação tanto da neurologia como da psicologia. A seguir, estuda o nível de especialização dos hemisférios cerebrais e mostra as alterações do transtorno mental chamado TDAH. Ainda demonstra que uma abordagem puramente biológica é insuficiente com a consequente dificuldade de aplicar as classificações da DSM e CID. Ainda aborda a psiquiatria psicodinâmica e mostra que o tratamento psicológico tem como objetivo refrear a compulsão à repetição e convertê-la em recordação. Concluindo, expõe a necessidade da integração biopsicossocial para o sucesso do tratamento.

El autor empieza explicando que al final del siglo XIX el examen del paciente psiquiátrico estaba sujeto a las mismas reglas metodológicas del examen médico general. Explica que en 1913, Jarpers presentó una visión más humanística del paciente, lo que significa un retorno a la empatía primitiva e a la valoración semiológica de las experiencias internas del paciente. Desde este punto, Freud empieza a influir en la psiquiatría hasta meados de los años 50 del siglo pasado, cuando la psicofarmacología tuvo un gran avanzo con la descubierta de los antipsicóticos y antidepresivos tricícliclos. El autor explica la evolución de la psiquiatría biológica en los últimos veinte años y su aproximación de la neurología e de la psicología. En la continuación, estudia el nivel de especialización de los hemisferios cerebrales y explica las alteraciones del trastorno mental TDAH. Explica también que un enfoque puramente biológico es insuficiente y hay una consequente dificultad de aplicar las clasificaciones de DSM e CID. El autor habla también de la psiquiatría psicodinámica y explica que el tratamiento psicológico tiene como objetivo frenar la compulsión a la repetición y conviértela en recordación. En la conclusión, expone la necesidad de integración biopsicosocial para el éxito del tratamiento.

The author begins showing that at the end of the 19th century, the psychiatric patient's exam was held with the same methodology of a regular medical exam. He also shows that in 1913, Jaspers introduced a more humanistic view of the patient, which means coming back to the primitive empathy and to the semiological value of the patient's internal experience. From this point on, Freud influenced psychiatry until the 50s of the last century, when psycopharmachology had a great advance because of the discovery of antipsychotic and tricyclical antidepressive medications. The author shows the develepment of biological psychiatry in the last twenty years, which led it to being close to neurology and psychology. Next, he studies the level of specialization of the brain hemispheres and shows the changes caused by a mental problem called TDAH. He also demonstrates that a biological approach is not enough and that it is dificult to use the DSM and CID classifications. He also studies psychodinamic psychiatry and shows that the psychological treatment aims to stop the repetition compulsion and to turn it into remembrance. As a conclusion, the author emphasizes the necessity of the biopsychosocial integration for the sucess of the treatment.