Obra completa. Del psicoanálisis a la psicología social.

Reseña de la obra completa de Enrique Pichon-Rivière. Del psicoanálisis a la psicología social, 1967-1977. Establecimiento, Introducción y Notas: Fernando Fabris, con la colaboración de Joaquín Pichon-Rivière. Paidós, 2023.

The psychoanalytic setting: José Bleger's encuadre.

José Bleger's paper on the setting (encuadre) is integral to his 1967 book Symbiosis and Ambiguity. Relevant concepts from the book are summarised before examining his view of the setting as a "non-process" consisting of "constants", complementing the "variables" of the analytic process. Process and setting are related as figure and ground in Gestalt psychology. The ideally maintained setting is studied as a thought experiment, uniting the categories of institution, personality, body schema, and body. Deposited in the setting, the psychotic part of the personality, or "agglutinated nucleus", is a remnant of early symbiosis with the mother. Bleger distinguishes two settings: the analyst's and the patient's. The latter can only be analysed by strictly maintaining the former. Ritualisation of the setting denies temporal reality. De-symbiotisation is not always possible. A concept of "internal" setting is suggested, but Bleger nowhere mentions this and the concept is problematic, leaving open the question of how to listen to the silence of the setting. Bleger's concept of encuadre can be applied to constants (invariants) in the wider world, the psychotic part of the personality being deposited in everything that is familiar and felt to be constant, including technology, which creates a "platform" for human activity.

The aesthetic and affective matrix of pre-reflective sensemaking at the origins of the relationship between subject and world: A dialogue between Kant's Third Critique and psychoanalysis.

The authors discuss the relevance of aesthetic and affective experience at the heart of the human being's capability to relate to the world and to found relations of sense. Faced with anguish that the world can be meaningless and with fear of uncertainty/chaos, trust and hope are needed for the world to be a hospitable place for existence. Such experience is aesthetic, sensitive and affective before being rational, reflective and deliberative. Through a dialogue between Kant, Winnicott and Bion, it is shown how foundation of trust is based on two essential aspects: (1) The illusion that reality was created to allow us to live in it (namely, the fictionality is a prerequisite for each possible development of psyche) and (2) this illusion is not generated by a solipsistic activity of the human mind; rather, it is made possible starting from the primordial relationship with the other, by containing anguish, nourishing trust and hope, and supporting psychic development and elaboration of progressive forms of symbolisation. The authors discuss how these points have a profound aesthetic implication through deepening the reflection on the ontogenetic development of the psyche, the complex intertwining between primary and secondary processes, and clinical implications.

Gratitude, freedom and refusal.

This paper is an exploration of gratitude as a fundamental concept in psychoanalysis. Melanie Klein's classic article "Envy and Gratitude" (1957) named gratitude at one pole on an axis of human suffering and flourishing, but with a few notable exceptions, the article stimulated research into envy. This paper explores the historical and philosophical traditions that have, to some extent unconsciously, influenced our contemporary understandings of gratitude. The paper also works to explore the social and ethical meanings of gratitude as well as gratitude's psychoanalytic significance. The aim is to uncover the overall psychic significance of gratitude and its place in human flourishing.

On the question of the internal frame.

This paper attempts to expand José Bleger's classic, metapsychological descriptions of the psychoanalytic frame to formulate and emphasize the role of the analyst's internal frame in establishing a psychoanalytic observational perspective in the analytic situation. The rationale for doing so follows from clinical necessity, especially when working with patients and psychic organizations that are 'beyond neurosis' and in non-traditional settings such as distance and telemetric analyses. Clinically speaking, in its most effective state, the analyst's internal frame can inform the possibility of an observational vertex aimed at the intuitive grasp of psychic reality rather than a sense-based, empirical observation of parameters denoted by the elements of a consensually validatable social reality.

Freud's interpretation in "Medusa's Head" and some alternative psychoanalytic implications of Ovid's Medusa.

Freud's very brief 1922 paper on the beheading of Medusa by Perseus wisely concludes with a call for a further examination of the sources of the legend. A now widespread interpretation of this legend is based (often without acknowledgement) on an addition to traditions concerning Medusa made in Ovid's Metamorphoses. It is argued here that this Ovidian innovation has often been misinterpreted, and that a more careful reading of Metamorphoses supports neither a widely alleged exclusively vengeful portrayal of Medusa, nor Freud's portrayal of Medusa's decapitation as solely a pitiable and terrible symbol of castration. Instead, Ovid's complex treatments of myths involving Medusa, Minerva and Perseus present parallels with Kleinian insights into phantasy attacks on fecundity, and into imagined revivals of dead or damaged inside babies. Thus the "displacement upwards" of the fearful castrated maternal genital envisioned in Freud's "Medusa's Head" must stand beside a quite different "displacement upwards" of the life-giving maternal genital. Indeed, tradition holds that Medusa's beheading gives rise to the birth of vigorous twins. Together with allied details, this aligns Ovid's masterwork with theories that modify or displace the so-called "sexual phallic monism" that some believe taints Freud's theories of gender development.

On the Belatedness of Psychoanalytic Clinical Writing.

The belatedness of analytic writing and its effects on analytic processes are explored through the concepts of nachträglichkeit and thirdness. The temporal gap between being with and writing about functions as a meaningful pause filled with opportunities for investigating unconscious pathways to the analyst's countertransference. The significance of analytic narration in affecting specific psychoanalytic developments is explored. The theoretical framework utilizes the concept of après coup, which brings to light new meanings in an afterwardness of time. Aspects of analytical writing dynamics are discussed as equivalent to those of nachträglichkeit. Analysts also deploy thirdness in constructing presentations of clinical material. This could be an intrapsychic third or an external figure representing an internal introjected third. A clinical vignette demonstrates the enhanced understanding achieved by writing. It specifically assisted in exploring the analyst's enactment relating to change in the setting, the background for which was a move to online analysis. This evoked infantile anxieties and painful confusions about loss. Historically, the patient had to navigate a path through miasmic ambiguities between reality and phantasy, truths and lies. A conclusion is reached, arguing that analytic processes extend beyond the duration of sessions, and that the processes of clinical writing can provide a significant contribution.

To Reveal or Not to Reveal, That Is the Wrong Question: Thoughts about Clinical Writing in Psychoanalysis.

This paper plays with the possibilities of writing about psychoanalytic work in different ways with different levels of disclosure about both patient and analyst. Various issues around anonymity, confidentiality, consent and identity are explored, highlighting the many questions that come up. These issues of how to write psychoanalytically are also addressed from the point of view of culture and the sociopolitical gestalt of our time.

Clinical Evidence, Triangulation of Perspectives and Contextualization. Part 1: The Beginning of Carla's Treatment.

We propose to critically evaluate and strengthen the level of clinical evidence in psychoanalysis, using a strategy of triangulating clinical phenomena from different perspectives and increasing contextual knowledge. Insufficient discussion of alternative hypotheses and limited contextual information are two Achilles heels of psychoanalytic case presentations. We examine the concept and quality standards of clinical evidence in psychoanalysis and related disciplines, with particular attention to the contribution of the three-level model (3-LM). We analyze the case of a patient treated with transference-focused psychotherapy (TFP), making explicit the theoretical-clinical agreements and disagreements of the authors. We discuss the strengths and limitations of triangulation and contextualization, concluding that they make clinical work and psychoanalytic writing more reliable, transparent, auditable, and replicable.

Ontological Psychoanalysis in Clinical Practice.

The author describes and then clinically illustrates what he terms the ontological dimension of psychoanalysis (having to do with coming into being) and the epistemological dimension of psychoanalysis (having to do with coming to know and understand). Neither of these dimensions of psychoanalysis exists in pure form; they are inextricably intertwined. Epistemological psychoanalysis, for which Freud and Klein are the principal architects, involves the work of arriving at understandings of play, dreams, and associations; while ontological psychoanalysis, for which Winnicott and Bion are the principal architects, involves creating conditions in which the patient might become more fully alive and real to him- or herself. The author provides clinical illustrations of the ontological dimension of psychoanalysis in which the process of the patient's coming more fully into being is facilitated by the experiences in which the patient feels recognized for the individual he is and is becoming. This occurs in an analysis in which the analyst and patient invent a form of psychoanalysis that is uniquely their own.

What We Do, What We Say, What We Don't Say: Confidentiality In The Publication Of Clinical Writing.

Questions concerning analysts' publication of material from the analyses of their patients have troubled the field of psychoanalysis since its inception. Disguise inevitably distorts the clinical material and is often insufficient to protect the patient from recognition. Asking the patient's consent for publication intrudes upon and alters the analytic process. While analysts have largely reached a consensus about the need for anonymity in published material, there is still considerable debate about the necessity for obtaining patients' consent when using their material for publication. In this paper, I will trace the evolving meanings of disguise, and particularly of consent, in the analytic literature. I will place a particular emphasis upon the differing theoretical belief systems that underlie the analyst's decision to ask consent from her patient or not to do so, and I will argue that, although decisions on asking consent remain a complex matter, such coherent belief systems should play an important part in analysts' decisions regarding consent. I will illustrate my thought processes and some clinical situations with brief examples, and I will conclude with some practical recommendations, with the hope that these will stimulate further discussion in the analytic community.

Does it Appear to 'Resemble' Reality? on the Ethics of Psychoanalytic Writing.

This paper explores the intricate nexus of writing and psychoanalysis by addressing a key question: In what and how many directions should analytic writing be ethical? The author structures the argument across three axes. First, in an introduction, writing's role as a psychoanalytic invariant is emphasized. Then, an exploration ensues, delving into writing as praxis, navigating complex technical choices, from micro- to macro-perspectives in clinical vignettes, their autobiographical essence, their relevance as models for theory, self-revelation, etc. Lastly, a succinct epilogue considers the relationship between aesthetics and ethics in psychoanalytic writing.

Psychoanalytic Contributions to Psychodynamic Psychiatry and Psychotherapy: Erik Erikson's Psychosocial Developmental Theory.

Erik Erikson gives us a comprehensive psychosocial schema encompassing the life cycle from birth to death. In elucidating key issues at each life stage-the epigenetic crises-he defines important parameters of development that distinguish between the normative and the pathologic. Individuals at any developmental stage can be evaluated with respect to these fundamental milestones.

Fifty Years of Change: A Shared Journey.

The author shares a personal account of 50 years of experience practicing psychodynamic psychiatry and psychoanalysis after migrating from Argentina to the United States. Her career developed in parallel as a clinician and as an academic psychiatrist, with leadership roles in the American Psychiatric Association, the Association of Women Psychiatrists, and the American Academy of Psychodynamic Psychiatry and Psychoanalysis. After describing what constitutes the essence, substance, and form of psychoanalysis, she reviews the historic shift within psychoanalysis in the United States from intrapsychic dyadic practice with selected patients to the application of psychodynamic concepts to everyday psychiatric care of patients with complex morbidities in multiple clinical settings.

Letter from Florence.

It is a fascinating decision to hold a conference on identifications in Florence. Now identified for more than five centuries with a brief portion of its millennial story, it sometimes seems imprisoned in its apparently timeless beauty, which is in fact extremely fragile and precarious. In this alternation of isolation and openness Florence is undoubtedly an ideal representation of Italian history. In the end, the characteristics of the development of psychoanalysis in Italy could also be summed up in the oxymoronic pairing of Isolation and Openness. It is thanks to this evolutionary niche that linguistic isolation has been transformed from a difficulty into an advantage. Italian psychoanalysis is a blend of different psychoanalytic traditions interpreted and retranslated into an autonomous psychoanalytic language. If we wish to trace a common feature in Italian psychoanalysis we could point to the concept of relationship as one of its most important transformations, with a shift of focus onto the work of the analytic couple. "Psyche is extended, knows nothing about it", the later Freud's most enigmatic legacy, seems to be one of the compasses for contemporary psychoanalytic research in Italy, one that spins around extensions of practice and the widening of technique.

Inhibition.

This article explores the notion of inhibition at a theoretical and clinical level in psychoanalysis. The first part follows the development of the notion in Freud's work, from the "Project" (1950a [1895]) to Inhibitions, Symptoms and Anxiety (1926d). It identifies the two approaches to inhibition, the first from an energetic point of view, the second from the angle of its relations to anxiety. The second part of the article is devoted to the links between inhibition and Freud's thoughts about death, in particular in Inhibitions, Symptoms and Anxiety and the links to the death drive. It draws on some of Jones' notes and presents a brief clinical illustration. The third part focuses more particularly on general inhibition, especially in depression and melancholia. Based on the treatment of one patient, the author shows how the slow process of overcoming general inhibition is achieved through the gradual use of negation. From an economic point of view, it is suggested that psychoanalytic treatment, through the transference and associative speech, has an effect on the depletion of energy by diverting the "suction" of stimuli, paving the way for the formation of drive representatives, or inhibitions as symptoms, which will need to be dissected.

Alan Roland: A Personal Reflection on the Legacy.

This appreciation of the work of Alan Roland reviews his pioneering contributions to the field of cross-cultural psychoanalysis based on the clinical experience with patients from non-Western cultures, most notably India and Japan.