James Henderson

Is incest harmful

Classically, incest has been considered from both a psychological and sociological point of view to have harmful consequences. Genetic research, though by no means lacking controversy of its own, generally supports the notion that inbreeding has untoward genetic consequences. The psychodynamics of all three parties to father-daughter incest seem to indicate that people who become involved in incestuous behaviour are often psychologically damaged before the fact, so that if they show subsequent evidence of psychological impairment the incestuous behaviour can be as plausibly viewed as a dysfunctional attempt at solving problems as it can a cause of subsequent psychopathology. Girls involved in the father-daughter incest present in one of half a dozen frequent clinical syndromes. The presentation is influenced by the degree to which the girl may have participated in ongoing incestuous behaviour as opposed to being the presumed victim of an older adults coercive actions or her own temporary suspension of a behavioural taboo. Research is inconclusive as to the psychological harmfulness of incestuous behaviour, and evidence is reviewed on both sides of this complicated and controversial question. Quite apart from the general issue of the harmful-ness of incest, a number of indicators can be derived from the nature of the incestuous episode and the early response to therapeutic assessment which aid in the clinical forecasting of probable outcome.

Exorcism and Possession in Psychotherapy Practice

There has been an evolution in the laymans concept of mental disorder. Medieval belief in possession by demons and witches gave way to a 19th century medical model and more recently classical psychoanalytic formulations. Concurrently professional helping endeavour has moved increasingly from a more traditionally medical to psychotherapeutic process, and from a classical psychotherapeutic process wherein the therapist remained to a degree unresponsive and detached to a more modern emphasis on such qualities as empathy, sensitivity, reliability, and optimism as ingredients of successful psychotherapeutic practice. Freuds account of Haizmanns demonological neurosis usefully formulates the possession concept in psychological terms. However, recent developments in psychotherapeutic practice argue for a validity in the possession model of psychological distress. The possessing forces of object relations psychology are of course not the possessing demons and witches of medieval times but the possessing good and bad objects of early intrapsychic life set up through processes of introjection and incorporation in response to frustration in the early infant-mother relationship. Points of similarity in this comparison should not obscure features of contrast — there is no place for histrionic manipulation nor for a moralistic attitude in the practice of psychotherapy. A case is described to illustrate these points.

On Fathering (The Nature and Functions of the Father Role): Part I: Acquiring An Understanding of the Father Role*

The scientific study of fathering is urgent, comparatively sparse, and difficult but crucially important in the context of current interest in the psychiatry of the family. For science agrees that mothers are important and we now know a good deal about the infant-mother relationship. For example, the work of Bowlby (16-19) and Mahler (69) on attachment and separationindividuation respectively, underlines the crucial importance of the infant-mother relationship and its vicissitudes in predisposing to later adult psychopathology. But no such agreement emerges about

Object relations and the psychotherapy of sin.

Psychotherapists are rediscovering concepts previously stated by poets, philosophers, and theologians, and elevating them to the status of science sometimes surprisingly little altered from their traditional form (11). The notion of mans sinfulness is such a concept, though it remains latent in modern psychological theory. What were the factors in the disappearance of the concept of sin? Perhaps punishments became too severe, and we “threw out the baby along with the bathwater.” Perhaps we grew wiser, and stopped imputing a variety of evils to mans sinfulness in a way that reflected mainly guilt. Partly, however, we elevated many sins to the status of crimes and deluded ourselves that unwieldy bureaucracies could achieve what the individual conscience could not. Finally, the emergence of so-called rational psychology and of so-called scientific medicine dealt a death-blow to sin by enabling us to believe that human behaviour was there to be described, categorized and labelled, rather than morally evaluated and judged for its effect on fellow-man. Freud helps us understand sinful behaviour. He shows how it is often the result, rather than the cause, of feelings of guilt. He traces mans sinfulness to ambivalence in his relationship to a worldly father. Melanie Klein, in her mother-centred psychology, connects ambivalence to ego splitting, attendant on the death instinct, and implies that mans aggression is biologically innate and his sinfulness inevitable. Winnicott pays special attention to a therapists hatred of his patient, implying that knowing and understanding ones hatred defuses it in part, and frees up an individual to a more positive and creative life style, There is a parallel here with the theological notion of confession of sins with atonement and restitution. Narcissism is the psychological word for human egocentricity and we, as psychotherapists, are beginning to discover its importance, as did the philosophers and theologians in centuries past. Winnicotts discussion of social concern is a useful polarity to human narcissism, and mindful of his analysis of its etiology we can add social concern to the list of objectives for intensive psychotherapy practice. Is aggression innate and instinctual, or attendant on frustration in the infant-mother relationship? To view it as attendant on frustration is more acceptable, but tends to get us off the hook of moral culpability. Balints concept of a basic fault is helpful here in that it has a bedrock quality analogous to the older concept of original sin, but somehow seems more scientific and more subject to rational inquiry and study. The basic fault is a pervasive and recurring sense of having been failed by someone sometime, in a way that is only partially reversible in its damaging effects. Psychotherapists should bring a concept of sin back into their work and emphasize personal moral culpability and accountability as vital to mental health. Technical modifications in line with this theoretical revision would be a more active, warm and empathic therapeutic manner, more attention to personal growth as a therapeutic aim, and relaxed criteria for determining who may benefit from psychotherapy. Perhaps in time we can bring ourselves to say with Menninger, “If the concept of personal responsibility and answerability of ourselves and for others were to return to common acceptance, hope would return to the world with it.”

The doctor-lawyer dilemma: a problem of mental set (an examination of the doctor-lawyer interface in civil cases).

Clinical psychiatrists often try to avoid medicolegal collaboration because pragmatic difficulties and philosophical differences combine with a sense of diminishing return to make it seem an unproductive area of professional activity. There is a need for rapprochement in the working relationship of lawyers and physicians. In an attempt to facilitate such rapprochement several sources of potential conflict which currently exist are delineated. Differences in subject matter and in methodology are important. Differences in philosophy of practice contribute to a sense of strain and the very nature of the adversarial courtroom situation offends many physicians who fail to appreciate its potential virtues. Lawyers and physicians differ in their approaches to decision-making processes in ways that are mutually vexatious. Some suggestions are reiterated which, if more widely practised, could help us collaborate more effectively with our legal colleagues to the ultimate betterment of our patients and clients.

A Service of Liaison to the Isolated North: A Proposal for ‘Community Transference’

This is a report of a one-year pilot project of community psychiatric service to three small towns in the northern part of the Province of Ontario. Data acquired in the course of this project are described and an attempt is made to derive from them a more accurate assessment of the mental health requirements of these communities. The concept of ‘community transference’ is advanced to cover the complex of reactive tensions set up in a community by visitors attempting to change deeply-held attitudes to psychiatric disturbance and to alter traditional modes of dealing with these patients. ‘Community transference’ is a theoretical construct which may prove useful in projects where success depends upon modifying community attitudes.

Play in the psychotherapy of selfobject relating

Current literature dealing with narcissistic character disorder attempts to differentiate between mature relating with consensually validated whole objects and immature, more primitive relating with mirroring and validating selfobjects. In the latter case the object is especially valued for its role in buttressing a damaged or fragile self. The persistence into adult life of this more primitive relating to selfobjects can be viewed as a restitutive attempt, a healing by second intent. Through such a mechanism, attempts are made to make good deficits left by perceived failures of the primary object. These attempts include the setting up of relationships with figures whose empathic capacity is in some way sensed to be corrective, and the setting up of relationships with selfobjects which are in part created by the subject to provide himself with the kind of validating selfobject which has been longed for, yet never experienced. Winnicott conceives of transitional experience as an intermediate area allowed to the infant between primary creativity and objective perception based on reality testing. Transitional relating usefully clarifies the concept of selfobjects in emphasizing its common features with the transitional object. Transitional objects and selfobjects both contain the idea that the psychic apparatus is equipped with self-healing capacities. They tell us something about the nature of those self-healing capacities. The mental apparatus, as the physical apparatus, can attempt to heal itself in the face of injury or disease. The mechanism of that psychic healing may have to do with the importance of transitional phenomena and illusory experience in permitting the relinquishing of omnipotence and grandiosity which goes hand in hand with the formation and consolidation of the structurally mature self. An understanding of the transitional area can facilitate the therapists work in helping certain patients overcome immature and fixed character traits often associated with narcissistic psychopathology. The psychopathology of transitional experience is reviewed and the importance of play in the therapeutic situation is stressed. Evidence is presented for the existence of a common neurophysiological substrate for play and transitional experience. This discovery is deemed evidence supporting our thesis of the importance of the transitional area in fostering psychic growth and in promoting healing in the analytic situation. Case material is described to illustrate these points. The relationship of psychosomatic symptomatology to transitional experience is discussed and illustrated with clinical case material.

Community psychiatry--a hard look at feasibility. Toward a socioanalytic understanding.

This paper has reviewed the concept of community transference and has discussed its relation with the use of illusory phenomena in alleviating the discomfort of maintaining object-relatedness (23), and with nonpathological paranoia as a practically universal phenomenon of human groups (19-21). The importance of community transference in contemporary psychiatry is discussed and its challenge is described to the community psychiatrist who aspires to a clearer definition of his professional role. Training programs for community mental health personnel are proposed as a pragmatic response to a call for effective parsimonious services, and as a plausible alternative to woolly notions of the large scale prevent-ability of mental illness.

Community transference: toward a psychiatry-of-the-community.

HE challenge for community psychiatry is to spread a service thinly enough that ~ it meets a public need in some comprehensive way, yet to maintain a methodology of sufficient rigour that in our zeal to provide equal service to all, we do not create a clinical style which is practically worthless to everyone. Hollister and RaeGrant approach this dilemma more eloquently in their discussion of prodigality, parsimony and &dquo;effective parsimony&dquo;. &dquo;We are well aware today that there exists, along side inadequate or non-existent coverage for many, a prodigality of resources devoted to small selected groups in the population.&dquo; &dquo;There are increasing signs of a polarization between community mental health on the one side, and the practice of individual care on the other. They are not mutually exclusive, and in fact, the movement to separate them will debilitate both.&dquo; ( 14) A mental health centre’s attempt to provide a comprehensive service to an entire community (and I include in my concept of &dquo;community&dquo; its existing providers of health care) gives rise to certain phenomena which, if insufficiently understood and managed, can, and indeed commonly do, seriously compromise our capacity to design and implement effective but parsimonious services. I have designated these phenomena collectively as &dquo;community transference&dquo;, and shall presently define this term somewhat more precisly.