Arthur F. Valenstein

The older patient in psychoanalysis

The demographic shift toward extended longevity has led to a commensurate increase in the length of the working and productive years, and with it an increase in the number of so-called “older” patients who come into psychoanalysis or psychoanalytic psychotherapy. This led the Psychoanalytic Research and Development Fund to support a four-year study by a small group of experienced psychoanalysts of “the older patient in psychoanalysis.” Aging and old age are considered to be the final developmental crisis of the successive epigenetic phases of the life cycle. Eleven case presentations and various briefer clinical vignettes informed us that older and even old individuals, who seek treatment themselves or who are appropriately referred, respond in a positive and effective fashion to psychoanalysis and psychoanalytic psychotherapy. As do younger patients in analysis, such older people, motivated by the wish to make the most of what time is left, become interested in understanding their pasts with respect to the present and the future. The life stories of two older men who undertook analysis, and the courses and outcomes of their analyses, illustrate our findings and impressions. In both cases conflicts and difficulties from earlier developmental phases, extending back even as far as the oedipal and preoedipal years, were revived during their older years. And although these conflicts might have been beyond definitive resolution, what is salient is the extent to which they were ameliorated: sufficiently that they did not impede a satisfactory adaptive solution of the final crisis of the normative sequences of the life cycle.

Psychophysiological correlation of 17-ketosteroids and 17-hydroxycorticosteroids in 21 pairs of monozygotic twins ☆

Abstract Twenty-one pairs of healthy monozygotic male twins of college age have been observed in an attempt to correlate individual personality structure with characteristic and relatively enduring patterns of pituitary adrenocortical function. Ten pairs of comparable dizygotic male twins have been studied by the same methods. High levels of 17-OHCS excretion were found in individuals with forceful yearnings for close personal involvement or with active defenses against the threat of intimacy. Individuals with low 17-OHCS levels were more effectively isolated by well-organized neurotic defenses. High 17-KS levels were found in energetic, ambitious individuals with strong aggressive drives and equally strong defenses against them. Those with low 17-KS were over-controlled with apparently limited innate drive endowment. A one way analysis of variance was computed for both monozygotic and dizygotic. twins. The F ratio indicated that height, 17-KS mean values, and day-to-day variation in 17-KS might be influenced by genetic factors. The intra-class correlation in 17-OHCS means was just as great in dizygotic as in monozygotic pairs but the correlation in 17-KS means in monozygotic pairs was much higher than in dizygotic pairs. A contingency table was constructed by grouping the variation in 17-OHCS and 17-KS into quartiles. In 14 out of the 21 pairs of monozygotic twins both members of the pair were in the same quartile for 17-OHCS and 17-KS and both members of all the other pairs were in adjoining quartiles. The pyschological characteristics shared by all of the subjects in each contrasting quartile suggest meaningful correlations of steroid patterns with different but interrelated quantifiable ranges of psychological response corresponding respectively to the mean levels of the 17-OHCS and of the 17-KS.

Current Concepts of Normality

Dr. Arthur F. Valenstein opened the panel by observing that normality has both a statistical and a normative definition which do not coincide. The statistical elevates what is into what ought to be and is not synonymous with mental health; the normative defines the normal in terms of what ought to be and is synonymous with mental health. He stressed the importance for the psychoanalyst of recognizing that the choice between the two definitions is not a matter of semantic curiosity because the differing attitudes which lie behind each definition affect all aspects of his work. Citing the work of Jahoda and Jones, he found support for his conclusion that the psychoanalytic concept of mental health is normative. While not disputing the view that psychoanalysis began as a psychology of the abnormal in human behavior, Valenstein asserted that embedded within it from the beginning were concepts that later would be developed into a psychology of normality, including a normative theory of psychic development. Through quotations from Freud from 1900 to 1940 Valenstein documented his opinion that the study of the abnormal and the normal are areas of legitimate concern for psychoanalysts. In “The Interpretation of Dreams” and “The Psychopathology of Everyday Life” Freud reported his discoveries that both symbolism in the formation of dreams and parapraxes could be considered phenomena that bridge the gap between normal mental life and the abnormal mental life of neurotics. He became increasingly confident that distinctions between the two were ones of degree not of kind, and in “On The Sexual Theories of Children” he observed