Successful Treatment of Psychosis by Means of Supervised Analysis.

The authors present some aspects of their experiences in the treatment of two psychotic patients. The first case suffered from hallucinatory mystical delusions and the second from delusional hypochondria and erythrophobia. Since these cases were followed through regular supervision during their novice analysts' psychoanalytic training, the usefulness of this kind of treatment for the development of current psychoanalytic practice is emphasized.

Mysteries, abysses and impasses in body-mind dissociation.

The author considers certain complex, sometimes mysterious clinical problems which involve the body-mind link in the analysis of difficult patients. The body-mind dissociation is the first source of impasses at these levels. Despite the recurring presence of this subject in the development of psychoanalysis, body-mind dissociation has never been considered as central as other forms of dissociation with a more specifically traumatic origin. Two clinical cases are explored in which the tendency to falsity and theft complicated the already difficult scenario of dissociation. Analytic working-through showed a direct involvement of the body through various somatic manifestations and symptoms. The article shows how activating a network of body-mind contact can precede the elaboration of relational dynamics in lowering the internal sensory pressure and constructing systems of representation which perform a function of containment in relation to the disorganizing impulse of the primitive emotions.

Entering One's Own Life as an Aim of Clinical Psychoanalysis.

The historical development of psychoanalysis has demonstrated that the aim of clinical work can change as the patient population changes. One of the main tasks of psychoanalytic working through today is to help difficult patients trapped in imitative dynamics and "never-to-be-born selves" enter a life of their own. Particular emphasis is given to activating a body-mind relationship, catalyzing emergence from the unrepressed unconscious, and constructing space-time parameters in relation to the most primitive and undifferentiated emotional experiences. Two clinical cases are presented, in the first of which the analyst found himself invested with an intense devitalization that tested his capacity to be present. In the second case the analyst was confronted by the necessity of stimulating the birth of basic functions of mental notation in relation to blind and dangerous acting out. The confrontation in the analytic relationship mobilized the patient's internal resources of self-observation and self-containment, from which the capacity to exist and be present to the self could emerge.

Death, time, and psychosis.

Working through the awareness of death and the consciousness of time, it is hypothesized, plays a decisive role in the analytic process and in the mental growth of psychotic analysands, as well as in the integration of the psychotic areas in healthier patients. Clinical material is presented from a psychotic woman treated analytically, four sessions a week, for twelve years. The patient suffered several acute relapses, during which the analytic work was not interrupted. Her fourth psychotic episode in the course of analysis, which involved a delusion about gray men and the theft of time, is explored in particular depth. This phase fostered the patient's recognition of the value of time, together with the acquisition of her own center of psychosensory integration, the basis of an ability to learn from experience.

A rare case of incidental pancreatic arteriovenous malformation correctly diagnosed with MDCT.

CONTEXT: Pancreatic arteriovenous malformations are a rare entity that can be incidentally discovered during MDCT examinations. CASE REPORT: We describe a rare case of asymptomatic arteriovenous malformation presenting at MDCT as a hypervascular mass in the pancreatic head. CONCLUSION: Pancreatic arteriovenous malformations are a rare entity, often asymptomatic, that can be correctly diagnosed by MDCT, especially with the use of specific electronic reconstructions.

The body emerging from the "neverland" of nothingness.

The author considers sensory perceptions arising from the body to be the first expressions of self-consciousness and mental existence in patients who are overwhelmed by a dimensionless abyss of nothingness. This perspective can help the analyst in catalyzing the patient's integration with his deepest levels of mental functioning. Clinical material from the four-session-per-week analysis of a psychotic patient is discussed. To this analysis and, finding the body meant finding "the land that never was," a "land" that could begin to exist in analysis thanks to a relational working through within the analytic couple.

The body, adolescence, and psychosis.

This article explores aspects of the clinical development of a male 17 year-old patient who had four weekly sessions of psychoanalysis during an acute psychotic crisis. In the context of arrested adolescent development, a psychotic crisis can present an opportunity to set the process of maturation in motion again. Adolescent psychosis is examined in the light of Bion's theories of catastrophic change - in which the container/contained relationship becomes explosive and overwhelming - as well as of Ferrari's and Matte Blanco's hypotheses on the mind-body relationship. The authors emphasize the role of denial of the body and its changes in the genesis of adolescent psychotic conflict, and show how the analytic relationship can offer crucial reverie conditions for promoting recognition of the body, bodily sensations and affects, as a prerequisite for the activation of an autonomous mental system. This clinical approach entails recognizing the urgent need to make room for the elaboration of intrasubjective relationships and for mind-body dialogue, transference interpretations being postponed. Clinical material and fragments of analytic dialogue illustrate the authors' hypotheses and demonstrate the patient's development towards recognition of his body and an incipient capacity to think associated with the perception of the limits set by time and reality.

Symmetric frenzy and catastrophic change: a consideration of primitive mental states in the wake of Bion and Matte Blanco.

The author explores the connections between Matte Blanco's notion of symmetric frenzy, i.e. the turbulence characteristic of the deepest levels of mental functioning, and Bion's concept of catastrophic change. For Bion, mental links are retrieved from the formless darkness of infinity. With catastrophic change, emotional violence and the confining nature of representation come into conflict, leaving the subject prey to an explosiveness that paralyses mental resources. Matte Blanco identifies indivisibility as the abyss in which all differentiation ceases; he bases his model on the conflict between symmetry and asymmetry. Infinity, he maintains, is where the first forms of mentalization develop. Both Bion and Matte Blanco emphasize the contrast between the immensity of mental space and the spatio-temporal order introduced by the activation of thinking functions. The author presents clinical material from the analysis of a psychotic patient, stressing the need to encourage both working through the defect of thinking (Bion) and 'unfolding' manifestations of symmetry (Matte Blanco) so as to foster the activation of the resources of thought, meanwhile postponing transference interpretation. He concludes with two later sessions, in which recognition of the analyst in the transference allows the analysand to develop his capacity for containment and asymmetric differentiation.

Body, affect, thought: reflections on the work of Matte Blanco and Ferrari.

The author takes the body to be the point of departure- and the central foundation of symbolization-in psychoanalytic theory and practice. This perspective recognizes the body as a precondition for the formation of affects and for their registration in conscious awareness. Ignacio Matte Blanco (1975, 1984, 1988) considers that sensation-feeling is the link that connects emotion with thinking, the unrepressed unconscious with consciousness, and the body with the mind. Armando Ferrari (1986, 2004) conceptualizes the body as the concrete original object (COO), from whose inchoate promptings the sensory function and perceptual activity upon which mental functioning is founded are derived. The author suggests that these hypotheses offer a structure that facilitates psychoanalytic process in the treatment of difficult patients.

Through the eye of the needle: the unfolding of the unconscious body.

The body is the starting point of experience and the original source of psychic life. In the course of analysis "the camel" must "go through the eye of the needle," in the sense that the body must become the specific object of mental working through, although no link between the corporeal and the mental can be taken for granted. The body-mind relationship is explored in the light of Matte Blanco's hypothesis that symmetric and asymmetric relationships are always present in the mind in differing proportions, and that the realm of symmetry is the deep unconscious. In primitive mental states the body may be completely unperceived: just as H. G. Wells's invisible man could be seen only when dressed, so the body appears on the mind's horizon only when asymmetric thought is directed at it. Three clinical vignettes show the contribution of the body-mind relationship to the overcoming of serious impasses in analysis.

Time, music, and reverie.

Time is an important source of containment vis-à-vis the pressure of affects and the nondimensional immensity of mental space experienced by difficult patients. A more articulated spatiotemporal integration can be facilitated by the analyst's musical "reverie" during intense emotional exchanges in analytic sessions. This reverie can be visual, olfactory, kinaesthetic, etc., no less than auditory or musical. Music is indeed connected with both the concrete world of bodily sensations and the symbolic expressions of culture, and may be an important transitional phenomenon in analytic communication on both unconscious and conscious levels. Two clinical cases are presented in which the patient's awareness of the passage of time, associated with the analyst's internal musical experiences, made it possible in one case to reduce intense panic attacks and, in the other, to overcome the patient's rigid obsessive defenses, giving him access to fluid and unforeseen emotions. In these two instances of working through, the perception of time helped establish confidence in the creative contribution of the "unheard melodies" (Keats) of affects to the functioning of thought.

The logic of turmoil: some epistemological and clinical considerations on emotional experience and the infinite.

The idea of the infinite has its origins in the very beginnings of western philosophy and was developed significantly by modern philosophers such as Galileo and Leibniz. Freud discovered the Unconscious which does not respect the laws of classical logic, flouting its fundamental principle of non-contradiction. This opened the way to a new epistemology in which classical logic coexists with an aberrant logic of infinite affects. Matte Blanco reorganized this Freudian revolution in logic and introduced the concept of bi-logic, which is an intermingling of symmetric and Aristotelic logics. The authors explore some epistemological and clinical aspects of the functioning of the deep unconscious where the emergence of infinity threatens to overwhelm the containing function of thought, connecting this topic to some of Bion's propositions. They then suggest that bodily experiences can be considered a prime source of the logic of turmoil, and link a psychoanalytic consideration of the infinite to the mind-body relation. Emotional catastrophe is seen both as a defect-a breakdown of the unfolding function which translates unconscious material into conscious experience-and as the consequence of affective bodily pressures. These pressures function in turn as symmetrizing or infinitizing operators. Two clinical vignettes are presented to exemplify the hypotheses.

The body in the analytic session: focusing on the body-mind link.

The author focuses on the importance of the body in the analysis of patients with a defect of thinking. In many cases this defect is not fully evident until concrete and bodily aspects begin to emerge in sessions. In the absence of awareness of the body, the patient's personality is deprived of the main source of emotional stimulus, and mental growth is consequently paralysed. Hence the body is considered the starting point of mental processes and a progressive source of experience requiring the exercise of responsibility and thought. To indicate the theoretical background to this essentially clinical paper, some hypotheses about the body-mind link are very briefly considered. Specific emphasis is given to the development of Freud-Klein-Bionian theories about this subject and to some of Ferrari 's recent proposals. The author discusses four clinical cases, emphasizing the encounter with the body in analysis and its integration in emotional and thinking processes. The analyst's function in such cases is conceived mainly as that of midwife for a dialogue between the analysand 's body and mind.

On the psychoanalytic treatment of a psychotic breakdown.

The author discusses the four-session-a-week psychoanalysis of a patient in psychotic breakdown with outbursts of violence. The analyst's first appearance in the transference was as a "rattle" (the noise made by his shifting in his chair), which constituted undeniable evidence of corporality--first the analyst's and then the patient's--leading eventually to the awareness of there being two separate persons in the psychoanalytic relationship. This case highlights the analyst's need to function in a particular way, and to allow him- or herself to be used in a particular way, in working with very disturbed patients, where issues of the body-mind relationship and of separation from the other are often central to the analytic work.