Disordered Thought and Development: Chaos to Organization in the Moment PDF
Preview Disordered Thought and Development: Chaos to Organization in the Moment
Disordered Thought and Development The Vulnerable Child: Studies in Social Issues and Child Psychoanalysis Series Editors: M. Hossein Etezady and Mary Davis The VulnerableChildseries isbased onworkthatcomes outof an ongoingVulnerable ChildStudyGroup,foundedbyTheodoreCohen,MD.ItissponsoredbytheAmerican Psychoanalytic Association, and in the past was co-sponsored by the Association for Child Psychoanalysis. For many years the group has met regularly to discuss what life eventsrenderchildrenmorevulnerabletodevelopmentalandemotionaldisturbances,and whatinterventionshelptoreducethatvulnerability.Thestudygrouppresentsaworkshop lookingatvariousaspectsoftheseissuesatthemeetingsoftheAmericanPsychoanalytic Association.Co-chairsofthestudygroupareM.HosseinEtezady,MD,andMaryDavis, MD;Dr.CohenremainsinvolvedasChairEmeritus. The VulnerableChildseries publishesvolumeswhich arisefrom theworkof theStudy Group,andlookstowardexpandingofferingstootherpublicationsthataddresstheissues whichmakechildrenmorevulnerabletomentalhealthproblems,aswellasinterventions thathelptoamelioratethatvulnerability. TitlesintheSeries VulnerableChildVolume1editedbyBernardPacella,TheodoreB.Cohen,andM.Hosse- inEtezady VulnerableChildVolume2editedbyBernardPacella,TheodoreB.Cohen,andM.Hosse- inEtezady VulnerableChildVolume3editedbyBernardPacella,TheodoreB.Cohen,andM.Hosse- inEtezady ClinicalPerspectivesonReflectiveParenting:KeepingtheChild’sMindinMindedited byM.HosseinEtezadyandMaryDavis MotheringwithoutaHome:AttachmentRepresentationsandBehaviorsofHomeless MothersandChildrenbyAnnSmolenwithAlexandraHarrison DisorderedThoughtandDevelopment:ChaostoOrganizationintheMomentbyTheo- doreFallonwithSusanP.Sherkow Disordered Thought and Development Chaos to Organization in the Moment Theodore Fallon, Jr. with Susan P. Sherkow JASONARONSON Lanham•Boulder •NewYork•Toronto•Plymouth,UK PublishedbyJasonAronson AwhollyownedsubsidiaryofRowman&Littlefield 4501ForbesBoulevard,Suite200,Lanham,Maryland20706 www.rowman.com 10ThornburyRoad,PlymouthPL67PP,UnitedKingdom Copyright©2014byJasonAronson Allrightsreserved.Nopartofthisbookmaybereproducedinanyformorbyany electronicormechanicalmeans,includinginformationstorageandretrievalsystems, withoutwrittenpermissionfromthepublisher,exceptbyareviewerwhomayquote passagesinareview. BritishLibraryCataloguinginPublicationInformationAvailable LibraryofCongressCataloging-in-PublicationData Fallon,Theodore,1954-author. Disorderedthoughtanddevelopment:chaostoorganizationinthemoment/TheodoreFallon;with SusanP.Sherkow. p.cm. Includesbibliographicalreferencesandindex. ISBN978-0-7657-1017-8(cloth:alk.paper)--ISBN978-0-7657-1018-5(electronic) 1.Childdevelopmentdeviations.2.Developmentallydisabledchildren--Servicesfor.3.Develop- mentallydisabledchildren--Familyrelationships.4.Pediatricneuropsychiatry.I.Sherkow,SusanP., 1944-author.II.Title. RJ135.F352014 618.92'8--dc23 2013042482 TMThepaperusedinthispublicationmeetstheminimumrequirementsofAmerican NationalStandardforInformationSciencesPermanenceofPaperforPrintedLibrary Materials,ANSI/NISOZ39.48-1992. PrintedintheUnitedStatesofAmerica Contents Foreword vii M.HosseinEtezady Introduction 1 1 PsychoanalyticProcessinaPsychoticAdolescent 15 2 PsychoanalyticProcessinaYoungChildwithaPervasive DevelopmentalDisturbance 25 3 AModeloftheMoment 31 4 NeurodevelopmentandPsychoanalysis:DiscussionofEvanandJay 47 SusanP.Sherkow,MD 5 BriefNotesfromThreeClinicalCases 63 6 Summary,Comments,ImplicationsandOpenQuestions 73 References 81 Index 85 AbouttheAuthors 89 v Foreword M. Hossein Etezady Therapidaccumulationofnewfindingsintheexpandingfieldsofneurosci- ence and molecular biology has greatly contributed to the gradual filling of gaps in our appreciation and understanding of the mind and the various aspects of emotional and cognitive functions in the course of development. This has provided us with new means and methods of objectification and quantification in many areas of particular interest from a psychoanalytic perspective.Examplesamongmanysuchareasmightbementalization,theo- ry of mind,thought process,organization of thought andmemoryand, more specifically,theroleofaffectsandtheirsignalfunctionindefense,inconflict resolution and in compromise formation. Another major area thus made availableforexaminationandexplorationistheinterfacebetweentheexperi- ential/subjectiveandrepresentational/interactive,ononehand,andtheircor- respondingorganic/physiologicalsubstratesontheotherhand.Thisinterface is where we might look for answers to questions regarding the nature and machinationsofthemagicalmysterythatbridgesthesomatothepsycheand thebraintothemind. Inconsideringsubjectivestatesasthemaindomainofpsychoanalysis,we find that they are capable of being directly accessed only by the individual subjectalone.Otherscanonlyperceivethisindirectly,inverbalnarrative,via identification or empathy, for example, in part or parts, or may or may not recognize,affirm,repudiate,mirror,negateorelaboratethem,insomeorall aspects. Since the essential subject of psychoanalysis is subjectivity itself, directlyaccessibleonlytothatindividualalone,wecanrelyonneuroscience to inform us about the elemental ingredients that constitute the concretely objectivegroundingthatabalancedviewofanystateofmindwouldrequire. Interactions, whether viewed developmentally, casually in mundane daily dealingsortherapeuticallyasinclinicalencounters,occurinaninter-subjec- vii viii Foreword tivefieldwhichisexperienceddifferentlybyeachside,andevensoinareas ofsharedsubjectivityandoverlappingsaliency.Thisdifferenceisparticular- lyinformativewithregardtoattachmenttypesaswellasmodesandstatesof relatednessthateachsidemaybecapableofengaging. States of relatedness can be distinguished by their developmental levels andfunctionalrelevancyinthreeorganizationalmodes:1.themonadicmode (oral/primary narcissism/autoerotic), 2. the dyadic mode (transitional/anal- sadistic),and3.thetriadicmode(oedipal/normal-neurotic).Atriadicstateof relatedness implies satisfactory oedipal resolution of the infantile neurosis, sufficiently demarcated id, ego, superego boundaries as well as predomi- nanceofrealityprincipleandsecondaryprocessoverprimaryprocessthink- ing. The capacity to be alone in the presence of another emerges by the end of the first year, coinciding with the “dawning of inter-subjectivity.” With the advent of rapprochement at about the middle until the end of the second yearboththemotherandthechildfacethechallengeoflearningtobeinthe presenceofanother,inanewway,asinfantileomnipotencebeginstorecede andapostambivalentstageisentered. The transition from a dyadic state of relatedness to one that is triadic occurshandinhandwithestablishingthebeginningsofthecapacityforself and object constancy (by end of the 3rd year), which itself is reliant on the optimalresolutionofrapprochement.Theso-calledcriticalsub-phaseofrap- prochementcoincideswiththelatterhalfofthesecondyear.Optimalresolu- tion of rapprochement is considered to be critical for the “healing of the split,” to come about incrementally during one year of consolidation, from about ages 2 to 3, characterized by battles of will, often referred to as the terribletwo’s.Bytheendofthethirdyearweshouldnormallybeabletosee the germinating beginnings and gradual emergence of self and object con- stancy,tolerance of ambivalenceas well as thecapacityforselfandinterac- tive regulation guided by signal affects. By about age 4, having established the beginnings of self and object constancy, a triadic state of relatedness in the context of an oedipal organization can now be entered. By this time symbolic representation, the pretend mode of thinking, as well as language andnarrativeformationarebeginningtobemorereliablyavailable. “The three calamities of childhood,” namely fear of loss of the object initially,followedbythefearofthelossoftheloveoftheobjectandfinally, fear of punishment represented by castration anxiety, may now be regulated bytheuse of signal-affects, in theserviceof thehomeostaticfunctionof the ego,maintainingnarcissisticequilibriumaswellasfinetuningselfandinter- active regulation. This, at this time, is best accomplished mainly by using defensiverepression,astheoedipalresolutionoftheinfantileneurosisbegins totakehold.Repressionthusfuelsegogrowthbydivertingneutralizedlibidi- nalandaggressive energiesinto sublimatedchannels of dischargeandadap- tiveaims,whichallowstheegoanditsresourcestogrow,leadingtoincreas- Foreword ix ing autonomy of the superego and the ego-ideal. Individuals may be fixated at,orregresstoearlierlevelsoflibidinaloregodevelopment,archaicobject relations,infantileomnipotenceandgrandiosity characteristicof pre-oedipal modes of relatedness. Fixations are more common in organic entities while regression is usually associated with psychological conditions or organic pathologyarrivinglaterinlife. Engagementinatriadicstateofrelatednesspresentsanoedipalconstella- tion with new challenges that may be insurmountable for those who are vulnerable or at risk, due to nature, nurture or both. In an inter-subjective view, when we consider development, parenting, interactive regulation or relationships either in daily life or in the course of analytic treatment, levels oforganizationandmodesaswellasstatesofrelatednessmatterwithsimilar importanceonbothsidesoftheintersubjectivefield. In dealing with the subject of thought disorder and in order to better understand our patient’s needs and experiences, or to identify needed inter- ventions and formulate the therapist’s part during treatment, insights pro- vided by an ego-psychological conceptual model can be uniquely illuminat- ing.Hartmann’smeta-psychologyof psychosisisbased ontheego’slackof capability to neutralize primitive aggressive energy. Un-neutralized, aggres- sion can overwhelm existing structures and derail developmental organiza- tion.Neutralizationofaggressioninthisframeisoriginallyprovidedviathe mother’s function as an auxiliary ego, while she strives to libidinize the interactive experience. Neutralization,or thefusion of aggressive andlibidi- naldrives,cruciallydependentuponcaregivers’libidinalconstancyandem- pathicresonance,providesthedevelopingegowithasustainablereservoirof fuelforself-re-enforcingactivity,growthandadaptation.Incasesofpsycho- sis we encounter a predominance of primary process thinking and primary narcissism, insufficient self and object differentiation, diffuse ego boundar- ies,impairedrealityprocessingandblurringofwishandthoughtwithreality andaction.Realitybecomesintolerableunlessbrokendownordistortedtofit in with the delusional reconstitution of an inner world which consists of archaic introjects and narcissistic part-objects. Briefly put, any factor inter- feringwiththecapacityoftheegotosufficientlyneutralizeaggressiveener- gy in order to fuel progressive development and to establish organizational mastery at various levels of development, in susceptible individuals may produce psychosis. Such a pathogenic causation may be found anywhere from the molecular, organic and genetic levels to acquired vulnerability, whether internal or external, transient or permanent, at any developmental level and in any part of the life cycle. Risk and vulnerability take many shapes and run deep and far, both on the side of the innate givens, tempera- ment and genetics as well as on the side of the facilitating environment, for example,concerningthequalityandadequacyofthecareandsometimesthe fitbetweentheparticularchildandtheprimarycaregiver.
The list of books you might like
