Somatization and symbolization.

Psychoanalysis had its origins in an era when feelings that could not be recognized by the mind were being manifested in the body. Psychoanalysis works towards resolving this type of split by recognizing the existence of a dual language structure that includes both body and mind as constituents of the fabric of embodied meanings. The field of psychosomatics helps to provide keys to this language, marking the essential, patterned truths that are recognized at very basic levels and increasingly organize our perceptions as we make sense of the world. In disrupting the integration of embodied meanings, trauma impedes identity development. For some patients, learning to make meaning from somatic symptoms is an important adjunct to coming to know their own embodied experience. Two cases will be offered in which somatic symptoms provided important information that was channeled through the analytic experience as a way of making sense of what otherwise remained unknown.

Canaries in the Mind: Reflections on Paul Lippmann and the World of Dreams.

Nowhere do we see the beauty of our struggles so clearly as in the world of dreams. This past year saw the passing of one of our most creative and inspiring poets of the world of dreams, Paul Lippmann. In this paper, I speak from and about the world of dreams, recognizing ways in which they call to our attention aspects of experience which, unparsed, leave us caught emotionally. Considered will be the dream itself, its forms and functions, ways in which our emotional tangles within the dream space become visual pictograms. Bion suggested that the purpose of psychoanalysis is to enhance the capacities for feeling, thinking and dreaming. The dreaming process is enhanced by and in the psychoanalytic session. Through the dream work of analyst and analysand, dream elements become more fully elaborated into meaningful symbols that enrich the evolving narratives within the sessions. I will also consider ways in which psychosocial perspectives and psychoanalytic field theory have enhanced our understanding of and ability to make sense of our dreams, providing an enlarged playing field beyond the reconstructive efforts of early psychoanalysis.

The Haunting of Hill House: psyche, soma, and destiny.

Fairy tales and horror stories inhabit the realm of terrible truths, affording opportunities to survive and work through them from the safe distance of displacement. Psychoanalysis, too, provides spaces to enter into that enigmatic realm of imagistic, oneiric meanings and explore possibilities beyond the concrete manifestations of daily life, to penetrate the mysteries and discover the patterns. I will use various lenses of theory alongside literature and screen portrayals of a haunted house, to investigate the realm of the uncanny and explore ways in which we are haunted by truths we fail to face.

Meaning, metaphor, and metabolization: the case of eating disorders.

Eating disorders mark deficits in the ability to be nourished and to symbolize embodied experience. Such deficits can be traced to difficulties in early relationships that inhibit the development of self-regulatory functions and the progressive differentiation of self from other. Often, we find mothers who are insufficiently developed, leaving the child either austerely avoiding intrusion or struggling to digest maternal provisions without becoming lost in them. Explorations that link anorexia to deficits in symbolization are in line with psychoanalytic theorizing that marks the concretization of meanings in anorexia. Bulimia, in contrast, has been linked to deficits in self-regulatory capacities that are not necessarily tied to deficits in mentalization. Clinical experience suggests that people with bulimia are often "failed anorexics" who have achieved higher levels of self-development. Case examples explore some of the dynamics underlying such difficulties and how metaphors aid the work with those for whom embodied experience remains largely unsymbolized.

The Dream and the Image: Creative Transformations in Psychoanalytic Space.

Psychoanalysis is a transformational process through which meanings become visible and foreclosed identity may be further constituted. Winnicott (1971) marks the crucial developmental function of the relationship that is good enough to tolerate the separateness of the other. The analyst's ability to "take the transference" enables the patient to locate himself in relation to another mind and being in ways that did not happen sufficiently in childhood. This process requires the signification of personal meanings that can become consensual without subverting one's own becoming in the process. The dream provides idiosyncratic images that can demarcate conceptual space in ways that can enable the individual to move from the sign to the symbol; from what Kleinians term the symbolic equation, to the symbol proper, the domain of language and consensual meanings. I describe a case in which one young man used his dreams as a way of moving from a universe in which meanings could not be made into one in which he could build meanings in relation to his own experience and ideas.

AGGRESSIVE ENACTMENTS: CONTAINING THE "NO" IN CLINICAL WORK WITH SURVIVORS OF ABUSE.

Identity development depends on the ability to say 'no.' Setting limits enables a relationship between two separate individuals to develop. Early trauma can leave the individual so vigilant to others' demands that internal prohibitions against intrusion remain silenced, which we conceptualize as a 'no' that could not be sufficiently articulated to keep the person safe. For those who have not been able to assert this fundamental limit, the consulting room provides a potential anchoring point to formulate and work through unconscious meanings. Being able to articulate and register the legitimacy of one's own no becomes an important challenge, as tensions regarding power and powerlessness, trust and distrust, are acted out within the consulting room. Case material illustrates how psychoanalytic ideas regarding transference, countertransference, and enactment help the clinician tolerate the intrusion of past into present, inviting the type of mentalization that moves towards repair rather than merely reenacting the trauma.

RACE AND RECOGNITION: THE TIME OF OUR SINGING.

Literature affords the opportunity to consider the racial fear, hatred and hostility that can flare in moments when the otherness in the human face occludes the common bonds that join us together. Richard Powers' (2003) compelling novel, The Time of Our Singing, highlights ways in which racial tensions continue to haunt us, impeding the efforts of successive generations to heal the wounds and move forward. In the novel, the parents' efforts to move "beyond race" leave their children utterly unprepared for the ways in which race informs and obstruct their experience, as what has been denied returns to haunt them.

Klein and Lacan meet 21st century schizoid man: fairy stories for the modern era.

Melanie Klein invited us into the phenomenology of the schizoid dilemma through her depictions of the paranoid-schizoid position. By inserting his recursive arrows, Bion extended this conceptualization, showing us the folly of believing that we can ever entirely move beyond the frightening fantasies and realities of social exclusion and isolation. The 21st century has brought, along with the explosion of technology, an expulsion from the social order of many children who have found refuge from isolation and humiliation in the more accessible and less terrifying world of media and technological invention. What may look like narcissism can mask a terrible underlying schizoid failure to enter into the human race. This is the realm of fantasy run amok, where desire becomes alien and alienated such that one is haunted and hunted down by its very possibility. In this universe, conceptualizations from Klein, Bion, and Lacan help us to locate the individual who has become caught in a massive psychic retreat such that there is no subject because there are no objects. To illustrate, I describe my work with a young man who is living in a terrible "zombie zone" where people are not real and therefore are incomprehensible and terribly dangerous. The poignancy of his dilemma is heartbreaking. Perhaps that is one lesson we can still take from our old fairy tales: when one's heart can be broken by another's plight, then comes the possibility of a healing, an entry through that piercing of what had been impenetrable.

Mythological Bridge Between Intergenerational Transmission of Unmourned Loss and Addiction.

In a study looking at severe substance abuse in an inpatient clinic, an indirect relationship was found between narcissistic loss in substance abusers and the trauma that has not yet been mourned by their ancestors or parents. The authors explore these links using psychoanalytic theory, Greek mythology, and a case study to investigate how these concepts are implicated in the histories of those who struggle with drug addiction. Psychoanalysis has explored the relationship between object loss and ego development but, more recently, the concept of the intergenerational transmission of trauma has been included in these discussions.

Working with a patient claiming a direct relationship with god: encountering otherness.

Although we expect to encounter otherness in the consulting room, some types of otherness are more difficult to encounter than others. Differing ethnicities, religions, lifestyles, or other aspects of worldview can bring us into uneasy alliance with the other, as we also encounter disowned or unclaimed aspects of self in this process. I will discuss some of my difficulties working with a man who was born into my own religion-thus offering some common heritage of world view-but subsequently adopted another religion with such intensity that his faith seemed to have psychotic aspects. I struggled to keep my bearings with a man who could at times be cogent, at other times seem quite crazy, and also struggled to keep in mind how prejudices in my own culture might skew my perspective such that intense faith and devoted adherence to scripture seems suspect rather than worthy of respect.

Pattern as inspiration and mode of communication in the works of Van Gogh.

A close study of specific patterning in Van Gogh's drawings (revelatory because of their absence of his celebratory color) provides new insight into pattern as a direct expression of nonverbal meaning. A study of his articulation of pattern through form, plus a close reading of his writings about difficulties he encountered because of his unique vision, show how Van Gogh's creativity reflects a need to express the inexpressible that derives from an idiosyncratic way of perceiving self and the world. We apply critical theories of modern art as a manifestation of unconsciously expressed meaning and explications of differences between the experience of color versus form, and indices of how nonverbal meanings are noted and anchored. We conclude that Van Gogh's unique and personal perceptual style both served his developmental needs and exacerbated his distress, contributing both to his mental instability and his artistic greatness.

A view from Riggs: treatment resistance and patient authority--VIII. Standards of care and patient autonomy.

The therapeutic community at the Austen Riggs Center relies on patient authority to preserve the open setting. Patients' willingness to take on the challenges and responsibilities of citizenship makes it possible to work without bars or locks. Most patients arrive having been labeled "treatment resistant," a label that can connote noncompliance but can also mark the complexity of the trouble and a resistance to being objectified in ways that are dehumanizing. Respect for this complexity can at times counter standards of care that define and prescribe ways of viewing patients and attending to their distress that may be simplistic and undermine development. This paper will explore how current ideas about standards of care may insufficiently take into account the importance of the patient's authority--and the therapist's standards--in helping an individual to make sense of life and experience, and how facing this dilemma head on can reduce resistance.

Silent scream: the cost of crucifixion--working with a patient with an eating disorder.

In working with individuals who have experienced extreme deprivation in early relationships, the pain is often depicted silently and repetitively. There can be a tension between the need for validation and an avoidance of growth. The analyst, then, can find herself caught between her empathic resonance to the silent scream and the need to keep in mind the "cost of crucifixion." The latter has become my inner way of fixing in my own mind the type of dilemma that ensues when the individual truly feels helpless and at the mercy of outside sources and also resents and fears the other's power. Marking (and often magnifying) the distress, then, becomes a way of inviting salvation. The dramatic element lends an air of inauthenticity to what is, in fact, very real pain. If we are unable to note the air of dissonance with which we receive these distress calls, we miss a crucial healing element: that the self is paying a huge price for defining the other as a source of salvation, and that part of the distress ensues from the denial of the hostility expressed toward the object for being an insufficient savior. We find ourselves cast in the role of savior/persecutor, and must find some means for healing these splits so that we might become a deidealized support for the other's emerging attempts toward constructing a more viable self. This is a dilemma we encounter when working with individuals who communicate protosymbolically, as is the case with eating disorders.

Ashes of Remembrance: Reconfiguring the Phoenix.

Literature affords the possibility of diverse perspectives, inviting the reader to try a character or experience on for size and to consider ways in which culture affects the narrative. What it means to be a person and then to become an adult within one's own ancestral tradition is inherited directly, through being with others and also through the stories that are passed along from parent to child, through which one finds one's place in the social world. Whatever the conscious intention of the author, traumatic texts are uniquely colored by the heritage that gives rise to them. Traumatic tales offer us bits and fragments from dream and fantasy, present and past, through which the reader can begin to see how meanings coalesce and cohere around signs that become symbols as we gain greater facility in reading them. In this article, I consider three threads of traumatic tales and their similarities and differences, hoping that the reader will be able to recognize both commonalities and differences, ways in which richness and texture might be added to our lives if we can recognize consciously what otherwise might haunt us.

Factors discriminating creative engagement on an unstructured task: Creativity and the Rorschach.

In an attempt to find variables that would discriminate between creativity and psychopathology on the Rorschach, Rorschach data from two groups were compared. The first group was an inpatient sample of creative individuals who also carried a diagnosis of psychosis. The second was a group of creative writers. Both groups were engaged in intensive psychoanalytic psychotherapy. Comparing the most creative versus the least creative of the protocols in each group showed that more creative engagement was characterized by a higher response rate and greater and more idisosyncratic elaboration. Differences also emerged between groups: Whereas the inpatient sample relied more heavily on ideational coping, the writers relied more heavily on affective resources.

On faith, hope, and possibility.

The idea of faith invites us into treacherous territory, as we try to negotiate the lines between hope and fear, possibility and madness. Our faith can open up untold possibilities or, alternatively, can leave us at the mercy of forces of destruction. In psychoanalysis, we need to be able to make our way through this difficult terrain, which necessitates fine-tuning our capacities to build the requisite ground on which hope might become possibility. Both Bion and Lacan have attempted to articulate the importance of being able to move beyond whatever is ostensibly known in order to be able to consider and to envision new possibilities. I would contend further that faith, at times, creates the possibility of profound growth and transformation. Several vignettes are presented by way of exploring the potentially transformative quality of faith.

Bion's grid: a tool for transformation.

The author explicates the principles underlying Bion's "Grid" in a way that makes them useful for the clinician. The grid represents an attempt to provide a tool by which we might better understand the abstract rules and principles that facilitate understanding in the analytic process. Bion believed that content often obscures meaning unless we can move beyond the ostensible meaning in our attempts to understand the complexity of a statement and the uses to which it is being put. For Bion, the grid itself was not so important as the attempt to increase one's powers of observation, intuition, interpretation, and transformation. A clinical illustration is provided in which the grid provides a useful means for facilitating these endeavours.

Microprocess examination of therapeutic immediacy during a dynamic research interview.

This study examines the interviewer's use of immediacy during a dynamic interview to enhance the patient's ability to process affective material and deepen personal exploration. Using a microprocess design, immediacy events were identified and rated using the Consensual Qualitative Rating method. Moment-to-moment in-session activity was rated by trained observers with a focus on measuring patient process using the Therapist-Patient Interaction Rating Scale and interviewer process using the Therapeutic Environment Scale. Five immediacy events were identified and were found to range in depth from mundane exchanges to more active exchanges with affective depth. Mundane events were characterized by little attention to the affective component of the here-and-now relationship, dismissive and unsupportive comments, and had either no effect, or a negative effect on patient process. In contrast, immediacy events characterized by even limited affect and acknowledging engagement between patient and interviewer were followed by greater patient disclosure and increased capacity to process emotional information. Thus, attention to the quality of the immediacy intervention in future research appears warranted.

Falling Man: encounters with catastrophic change.

The assault on the twin towers thrust Americans into an encounter with catastrophic change. Previously protected by the illusion of security fed by our relative imperviousness to others' points of view, we are harshly awakened to our defensive blindness. This rupture helps us see the particular beyond the seeming universality, locating culture as a variable frame defining meanings through the narratives that hold complexities of human experience in conceptual space. Don DeLillo's Falling Man offers a reading of catastrophe as a forced encounter with fallibility, breaking apart illusions of sameness and difference, towards integration of what trauma excludes from awareness.