Beth J. Seelig

Normal and Pathological Altruism

The psychoanalytic literature on altruism is sparse, although much has been written on this topic from a sociobiological perspective. Freud (1917) first described the concept in “Libido Theory and Narcissism.” In 1946 Anna Freud coined the term “altruistic surrender” to describe the psychodynamics of altruistic behavior in a group of inhibited individuals who were neurotically driven to do good for others. The usefulness and clinical applicability of this formulation, in conjunction with the frequent coexistence of masochism and altruism, encouraged psychoanalysts to regard all forms of altruism as having masochistic underpinnings. Since then, there has been a conflation of the two concepts in much of the analytic literature. This paper reexamines the psychoanalytic understanding of altruism and proposes an expansion of the concept to include a normal form. Five types of altruism are described: protoaltruism, generative altruism, conflicted altruism, pseudoaltruism, and psychotic altruism. Protoaltruism has biological roots and can be observed in animals. In humans, protoaltruism includes maternal and paternal nurturing and protectiveness. Generative altruism is the nonconflictual pleasure in fostering the success and/or welfare of another. Conflicted altruism is generative altruism that is drawn into conflict, but in which the pleasure and satisfaction of another (a proxy) is actually enjoyed. Pseudoaltruism originates in conflict and serves as a defensive cloak for underlying sadomasochism. Psychotic altruism is defined as the sometimes bizarre forms of caretaking behavior and associated self-denial seen in psychotic individuals, and often based on delusion. We consider Anna Freuds altruistic surrender to combine features of both conflict-laden altruism and pseudoaltruism. Two clinical illustrations are discussed.

An Empirical Study of the Psychodynamics of Suicide

This paper presents results from an empirical study of four key psychodynamic concepts (self-directed aggression, object loss, ego functioning disturbance, pathological object relations) of suicidal behavior. The sample consists of hospitalized psychiatric patients following a suicide attempt (attempters: n = 52) and demographically similar hospitalized psychiatric patients with no history of suicidal behavior (controls: n = 47). The study was designed to ascertain whether attempters differed from matched psychiatric control patients on the four psychodynamic constructs hypothesized to be associated with suicide. It was predicted that attempters would manifest higher levels of depression and self-targeted anger, a more significant history of loss, less adaptive defenses, and more primitive object representations. Results strongly supported an object-relational view of suicidal behavior. In addition, support for the loss hypothesis was found in the identification of one specific constellation of losses. Namely, attempters were significantly more likely to report a history of childhood loss combined with a recent loss in adulthood than were their nonattempter counterparts. Limited support was provided for the other two hypotheses in differentiating suicidal from nonsuicidal severely ill psychiatric patients. This unexpected finding is examined and suggestions are made for the refinement and greater specification of psychodynamic theories regarding the etiology of suicidal behavior, with the aim of differentiating individuals prone to such action from those with similar psychopathology and dynamic issues who do not actually attempt suicide. Limitations of the study are discussed and implications of the findings for the theory and treatment of suicidal behavior are offered.

THE RAPE OF MEDUSA IN THE TEMPLE OF ATHENA: ASPECTS OF TRIANGULATION IN THE GIRL

The relationship between the Greek goddess Athena and her father Zeus, together with the competitive hostility she displays towards other females, is presented as illustrating some previously neglected aspects of triangular developmental conflicts in the little girl. Literature on ‘the Oedipus complex in the female’ is reviewed and discussed. The mythological early histories of both Athena and the female monster Medusa are examined for the light they can shed on female developmental vicissitudes and resultant conflicts in both women and men. Unconscious split representations of women as assertive, phallic and dangerous, or alternatively passive, castrated and receptive result in defensive repudiation of the idea that a woman can be both actively assertive and also feminine and sexual. Athenas enraged action of transforming the beautiful young maiden Medusa into a monster as punishment for the ‘crime’ of having been raped in her temple is discussed as illustrating an outcome of the lack of resolution of the little girls early triangular conflicts.

ON SUPERVISING THE PREGNANT PSYCHOANALYTIC CANDIDATE

The role of the psychoanalytic supervisor is complicated when the psychoanalytic candidate is pregnant. Pregnancy is a special event that brings a unique set of opportunities, as well as problems, into the analysis, though in the past, it was usually regarded only as an impediment. The goal of this paper is to help the supervisor of the pregnant candidate to seize the opportunities and mitigate the problems. The authors make practical suggestions about the handling of maternity leave and the complex theoretical and technical issues surrounding the question of when and how to tell the patient about the analyst’s pregnancy.

The Analytic Surface

NDEKBITZIN OPENED T H E PANEL With a brief historical and COIlCeptUal I overview. Freud originally used the term surface as an equivalent of consciousness in his topographic model, and later (19 14) modified the concept to include unconscious resistances observed by the analyst. Fenichel’s (1941) idea of surface closely approximated the later view of Freud. Loeivenstein (1951, 1954) added two descriptions of surface: (1) “the state and the nature of conflicts between drives and defenses at a given moment”; and (2) “all aspects of the patient’s mental life which are at the disposal of his autononious ego functions.” Although “surface” does not appear as a psychoanalytic concept in any of the specialized psychoanalytic glossaries or dictionaries (Paniagua, 1985), analysts continue to use the term in different ways and contexts associated with different frames of reference. The meaning of the surface within the framework of the structural theory remains largely unexplored. An exception to this is the work of Gray (1973, 1982, 1986); he defines an “optimum analytic surface” as being the specific and discriminating focus of attention of both analyst and anal ysand. Equating surface with the data of observation is problematic for a number of reasons, some of which Paniagua (1991) points out. Levy and Inderbitzin (1990) describe the analytic surface as “some aspect of the patient’s verbal and nonverbal behavior to which the analyst and the a i ia l j sad can direct their attention in order to gain access to important material that will be explored in a consistent, systematic manner” (p. 374). Inderbitzin elaborated that the analytic surface is that subset of data of observation from which a conjecture is formed leading to systematic exploration and interpretation. He suggested that a focus on the analytic surface may help us to understand how

Constructing and deconstructing woman's power

Constructing and Deconstructing Womans Power explores power and gender issues from a variety of psychoanalytic, as well as social, cultural and philosophical perspectives. The first three papers examine the complex notion of external and internal glass ceiling brought to life by clear and illustrative clinical vignettes. The creation of life, a uniquely female power, is subsequently considered in two fascinating papers exploring motherhood and the conflicts it brings. The development and expression of feminine creativity more generally is further examined in two unique studies. The final three essays address mens relation to women and their power.

On those wrecked by success: a clinical inquiry.

Freuds description of those wrecked by success outlines conflicted oedipal triumph as the central underlying dynamic in this character type. It does not distinguish those patients who avoid success from those driven to achieve and then wreck their success. We present a complex picture that we believe is prototypic of patients who destroy their success. A clinical case illustrates our point of view. We emphasize the developmental problems we believe typical of patients who dramatically wreck the success they achieve. We hope to extend rather than replace Freuds landmark contribution to our understanding of this type of character pathology.

A sadomasochistic transference: its relation to distortions in the rapprochement subphase.

The development of a rageful sadomasochistic transference early in an analysis is presented. We describe key interventions that foster its resolution and offer a reconstruction of the patients early life, focusing on difficulty in the rapprochement phase. We believe that the intense and difficult to manage sadomasochistic transference was linked to a repudiation of both preoedipal and oedipal triangulation, resulting in the perpetuation of a hostile dependent mother-child dyad and in the patients unconscious belief that sadomasochistic interactions were the only means of establishing and maintaining a close relationship.

Altruism and Boundary Violation

ABSTRACT The desire to help others is a common motivation for becoming a therapist, and boundary crossings are an expectable part of psychotherapeutic work. However, progression to boundary violation is rare. The concept of an altruistic boundary violation is presented and illustrated with detailed clinical material drawn from the analysis of Mrs. A,1 a generally ethical therapist, whose violation of the therapist/patient boundary with her patient, M, began as an altruistically motivated enactment and boundary crossing. In Mrs. A’s case, and arguably in all similar altruistic boundary violations, a specific fit existed between patient and therapist. The intense need to rescue this particular patient was fueled by Mrs. A’s history of early physical and abandonment trauma, which increased her vulnerability to overidentification with her traumatized patient. The stress of relocation to another city and closing her practice further magnified her susceptibility. The complex clinical, professional, ethical, and legal issues inherent in consulting on such a case are discussed. I describe my countertransference and my parallel enactment, an initial crossing of the boundary between the roles of supervisor and therapist.