Saul I. Harrison

Gender identity change in a female adolescent transsexual.

Two years of individual and milieu therapy are described of a 141/2-year-old girl who had presented with the persistent request to have a sex-change operation since age 12. Her past history was obtained from her parents and the records of the child guidance clinic which evaluated her at 3 years of age. She gives a history of remarkable tomboyism during her latency years and increasing withdrawal from peers and family during early adolescence. The patients personal and family dynamics are explored, and these major therapeutic themes are discussed. The individual and milieu therapy are described and discussed with some speculation about the reasons for her positive response to psychotherapy. It would appear that this is a rare case of a postpubertal female transsexual reported to have made a gender identity change.

The Hyperkinetic Child: Some Consensually Validated Behavioral Correlates

ment, in college, of high school students who participated in a program permitting enrollment in college courses concurrent with their high school studies. It seemed important to know whether such students, when they were later full time college matriculants, were as well adjusted as their nonparticipating peers of comparable ability and achievement, or if indeed these students were better adjusted because of their prior exposure to the college environment. The subjects were 131 students of superior mental ability and educational achievement Who were qualified for enrollment in college courses during their junior and senior years of high school. One group of these students (USP) enrolled for and completed college courses (at Miami University, Oxford, Ohio) concurrent with their high school studies, while another group having comparable ability and achievement (NUSP) did not enroll for such work. Subsequently, both groups of students completed in the second semester of their first year of full time college matriculation an informational questionnaire and the College of Adjustment Inventory (CAl). The CAl, a self report inventory, provides scores in the following areas of college adjustment: curricular adjustment, maturity of goals and level of aspiration, personal efficiency, planning the use of time, study skills and practices, mental health, personal relations (with faculty and associates), and composite score. The analysis of these scores and other related information represents the data of the study. The results revealed that with the exception of personal adjustment (for USP girls) there were no significant differences (as revealed by t ratios; p<.05) between the CAl scores of USP and NUSP students. The significantly lower scores on personal adjustment could have reflected the fact that even prior to their college enrollment, USP girls were more poorly adjusted, although there are undoubtedly other possible interpretations. In addition, a more detailed investigation of 32 former USP and NUSP students enrolled as full time matriculants at Miami University revealed no differences between the groups in the kinds of academic or personal problems presented to

Is Psychoanalysis “Our Science“? Reflections on the Scientific Status of Psychoanalysis

concepts such as psychic energy and libidinal cathexes are “described” as if they were the actual data of observation. T h e distinction between description and explanation is considGAP Committee on Research (19GG). 1 See for instance Frenkel-Brunswick (1954), ll‘aelder (1.960). Guttrnan (19G5), IS PSYCHOANALYSIS “OUR SCIENCE”? 129 ered critical by Kubie (1960) who viewed theoretical formulae in psychoanalysis as usually a “hybrid and confused mixture of the two.” Indeed, it is remarkably tempting to assign causal significance to psychoanalytic propositions, even while recognizing +ataccurate and valuable psychoanalytic formulations which comprehensively include genetic, topographical, structural, economic, dynamic, and adaptive points of view may be of minimal, if any, etiological consequence. Less controversial than classifying hypotheses according to the degree of testability and the degree of validity is the valuable ordering of the same concepts in a hierarchy reflecting their distance from the data of observation. Waelder (1962) has done this as follows: 1 . The data of ohemat ion. 2. Clinical interpretation regarding the interconnections and relationships of the observed data. 3. Clinical generalizations such as the impact of certain experiences on a particular psychopathological symptom or syndrome. 4. Clinical theory, which is a derivative of the foregoing interpretations. Here, JVaelder includes readily demonstrated phenomena such as repression, defense, and regression as well as hypotheses that are not as readily demonstrated such as return of the repressed. 5 . Aletapsyclzology, which involves theories about the theories resulting in far more abstract concepts such as psychic energy and cathexis. 6. Last, IVaelder lists Freud’s plzilosoplzy. The question might be raised, however, whether this should be limited to Freud’s personal philosophy or whether there is a philosophical system implicit in psychoanalysis entailing such values as faith in reason and truth which belongs at this level most distant from the observed data. FVaelder observes that nonpsychoanalysts know the most about those more abstract levels which have the least relevance for psychoanalysis such as Freud’s personal philosophical writings about religion and civilization. Next, he feels that outsiders 130 SAUL 1. HARRISON know something about those speculative concepts that IVaelder locates “on the fringes of psychoanalytic theory,” e.g., psychic energy. He goes on to observe that some of the best analysts that he has known knew next to nothing about metapsychology. Regretfully, the criteria employed in this value judgment about “best analyst” are not articulated. In a personal communication, however, TVaelder (1966) named as examples some of the more productive clinical contributors to the psychoanalytic literature. I t is easy to agree with IYaelder to the extent that these are the vulnerable fringe areas that certain critics of psychoanalysis elect for the focus of their attack. On the other hand, it appears that there is, in fact, greater awareness as well as acceptance of the more basic concepts such as unconscious mental functioning as represented by the displacements of transference, parapraxes, mind-body interrelationships, etc. Sophisticated nonpsychoanalytic colleagues are often unrelenting in their demand for evidence that they can understand. Psychoanalysts, particularly those who are uneasy with the proprietary implications in the term “our science,” have an uneasy need to respond. Empathy with this uneasiness is common when “owscience” reflects the regrettably rigid dogmatism that resembles religious fervor in that it is born of faith rather than observation. There is more controversy about this phrase, however, when it expresses the sober, and thus far apparently accurate, appraisal that nothing demonstrates psychoanalytic theory as convincingly as the psychoanalytic method. Before responding to the demand for evidence, it is vital to recall that these nonpsychoanalytic colleagues’ attitudes toward psychoanalysis differ markedly from those with which they consider other sciences outside of their area of expertise. The chemist accepts the reports of the astronomer without examining the astronomer’s evidence and the astronomer similarly accepts the reports of the chemist at face value. Yet most scientists are curious about the proof of psychoanalytic propositions. T h e most obvious reason is that psychoanalysis deals with such personal matters that few people can be neutral about it. The fact that this demand may come less frequently from physical scientists than it does from other behavioral scientists IS PSYCHOANALYSIS “OUR SCIENCE”? 131 should not be surprising in light of the fact that the areas of study overlap. However, the crudeness of some of the demands for evidence that come from colleagues in similar fields may express other attitudes in addition to shared interests. It may take !lie form of a demanding “show me” attitude about matters that are not demonstrable. It is incumbent on psychoanalysts to realize that such demands may be encouraged in part by the psychoanalytic use of metaphorical language, particularly when it approaches the extreme of concretizing abstract concepts and classificatory systems. It is not hard to imagine a vicious cycle that begins with an analyst talking of “the ego” which the behavioral scientist, perhaps tendentiously, asks to see, following which the eager analyst attempts to “show” him. \\’hen the behavioral scientist is unable to see “it,” the analyst may be tempted to talk about the outsider’s resistance toward “our science” and to redouble his conviction that it has to be ‘‘ow science.” It is amazingly easy to forget that the structural hypothesis is nothing more than a means of ordering data in what is really a semiarbitrary though extremely useful fashion. T h e structural hypothesis encompasses abstract conceptualizations that are derived from classifying related functional components into abstract psychic systems. Underlying this classificatory scheme is the observation that established functions tend to “structuralize” in the sense of forming steady states that resist change and do not have to be created anew repeatedly. Thus, the so-called structures are really systematic groupings of functions forming theoretical constructs. I n a sense, they are logical artifacts that are inferred from behavior. As such, neither the ego, id, or superego is observable, nor are they unobservable. Their validity cannot be proved any more than the existence of the c ar d’ ~ovascular system can be demonstrated to be more valid or accurate as a system than the cardiovascularrenal system or the cerebrovascular system. Similar examples could be cited from astronomy, chemistry, and a host of other sciences. An apparently more refined, but equally impossible, external demand for evidence requests that psychoanalysts articulate what data will disprove the existence of a complex constellation like the oedipus complex. Such requests have been cited 132 SAUL I. HARRISON repeatedly by critics and defenders of psychoanalysis alike. Unfortunately, however, as tempting as this challenge is, it will not bring testimony to bear about the scientific status of psychoanalysis. In brief, a little boy’s aggression to his father or his solicitude toward his father both can be considered behavioral evidence of the oedipus complex. Such apparently irrational “heads I win, tails you lose” self-fulfilling prophecies frustrate logicians intensely, and the efforts of psychoanalysts to clarify the matter may prove even more frustrating (see Hook, 1959). The issue to be considered, however, is whether psychoanalysis should be blamed for being illogical or whether it is human personality functioning that is so filled with paradoxes. In other words, whose logic should prevail? Clearly, a means of noncircular confirmation of hypotheses would be most helpful. Noncircular methods that truly relate to the questions at hand are exceedingly difficult to design. For instance, what would be proved about psychoanalytic theory by study of autistic, retarded, and/or encephalopathic children who do not manifest evidence of an oedipus complex? IVhat criteria can be applied to assessing the value of a theory? Obviously, a useful and relevant theory should be in accord with the available data. Next, one expects a certain degree of inner consistency. This should be distinguished, however, from fitting in with the rules of logic, for the theory may be about illogical matter such as human behavior. Also, the theory should be comprehensive, which is not meant to imply that other explanations that are judged to be less encompassing should be eliminated. Indeed, it is not an either-or choice between the data of psychoanalysis and the data of learning theory, or social role theory, or neurophysiology. Each enriches the other. Last, the theory should be articulate and have a fruitful capacity for generating additional hypotheses. Psychoanalytic theory has been taken to task for translating insights derived from study of the so-called abnormal into the foundations of a general psychology. I t is probably true that exclusive study of the abnormal would be limiting in the development of a general psychology. I t ought to be recognized, however, that exclusive focus on the so-called normal could be as limiting. IS PSYCIIOANALYSIS “OUR SCIENCE”? 133 In recent years biologists have become increasingly aware of this, and many have been endeavoring to establish a reintegration of pathological and developmental biology. Psychoanalytic Investigative Methods It is agreed that the scientific method entails observation, classification, verification, developing the theory, and testing the hypotheses. Although the merit of this generalization is indisputable, one should not lose sight of a potentially tyrannical fallacy in the use of the word “method.” Ca

The Status of Prevention in the Education of Child Psychiatrists

While the pioneers of modern child psychiatry focused much of their attention on prevention, the situation today is markedly different. A questionnaire survey of child psychiatric residency programs suggests that when attention is devoted to prevention in the education of child psychiatrists, it is often ambiguous, haphazard, and minimal. This impelled the authors to sample the current status of available knowledge about preventive child psychiatry with an assessment of the validity of the knowledge and its potential utility. These are followed by some suggestions for child psychiatric education.

RESIDENTIAL TREATMENT OF CHILDREN: The Utilization of Transference Behavior

A unique therapeutic condition of residential psychiatric treatment of emotionally disturbed children lies in the transference potential which the institution provides. The child who is separated from his family and from the original partners in conflict re-experiences and re-enacts these conflicts within the institution. As the conflicts emerge in the new setting, the child tends to seek transference figures within the institution with whom to re-enact the old conflicts. He relives the past with this new cast of characters-the staff of the residential treatment center. Intensive study of certain cases within our hospital demonstrates that the recorded events of the daily life of a child in residential treatment can be constructed as a narrative; reading such data carefully, with meticulous attention to detail, reveals the history of the disorder, the major conflictual figures in the illness, and the specific meanings of the child’s pathological behavior and defense. In these respects, the transference behavior of the child toward institutional figures as well as to the psychotherapist provides a diagnostic key to the nature and origins of the emotional disorder as well as the therapeutic instrument for effecting change in the personality through insight and corrective emotional experience. In order to

Expanding the Role of Supervision in Child Psychiatric Education

Despite the burgeoning of available therapeutic interventions, the sparse literature devoted to child psychiatric supervision concentrates on individual psychotherapy. The non-cognitive aspects of the expanding supervisory challenge continues to converge on the clinicians personality, which is a focus of educational attention only in sequestered or haphazard parts of programs. The unidimensional supervisory literature addresses this issue by questioning the extent to which supervision should resemble traditional pedagogy or personal psychotherapy. In contrast to this emphasis on elusive unconscious influences on clinical work, scant attention has been devoted to other influences stemming from the clinicians current experiences, affiliations, identifications, aspirations and similar more easily modifiable factors that exert considerable leverage and tend to be more accessible to rational scrutiny in supervision. The latter half of this paper discusses these factors.

Development Rights to Privacy and Independent Decision-Making

This paper considers the historical aspects of parental autonomy in decision making for children, current legal issues regarding childrens rights, and relates them to developmental criteria rather than chronological age. It anticipates future problems as it translates these rights to developmental age. Benchmark court decisions are cited and the contrast between the reasoning in these decisions and the either/or decisions the law must make are matched against considerations of the degree of maturity for independent decision making, and the obligation of parents and society to help the evolution of this capacity.

PROMOTING THE DEVELOPMENT OF EGO FUNCTIONS IN THE MIDDLE PHASE OF TREATMENT OF PSYCHOTIC CHILDREN

The initial therapeutic goal of providing a need-satisfying relationship for these children seems relatively uniform, whether the therapists etiological concept of early infantile autism is that of dysmaturation, an environmentally induced series of traumata, or a combination of constitutional and experiential factors (Alpert, 1959; Bender, 1956; Betz, 1947; Despert, 1947; Escalona, 1948). Before autistic children can change, some external force must be imposed upon them. Weiland and Rudnik (1961) showed that the responsibility for the initiation of a relationship with an autistic child is clearly the therapists. This requires a considerable investment of time and individual attention from the therapist. The therapist must work with the patient at least daily, gradually making himself more useful to

RELATIONSHIPS BETWEEN SOCIAL FORCES AND HOMOSEXUAL BEHAVIOR OBSERVED IN A CHILDREN'S PSYCHIATRIC HOSPITAL

joseph was admitted to Childrens Psychiatric Hospital when he was thirteen years of age because, in addition to a long history of academic difficulty, he had recently become markedly withdrawn socially, behaved in a bizarre fashion which included fire setting, and was preoccupied with fantasy. His background was most traumatic. He was the product of the illegitimate union between a thirteen-year-old mentally retarded girl and a fifty-year-old alcoholic man. He spent the initial half of his first year of life in an orphanage, the last half of that year in a foster home, and was adopted at one year of age. His adoptive mother weaned him from the bottle on his first day under her care. When he was three, a little sister was adopted. When joseph was six the adoptive father fell ill and died several months later, and the funeral took place the day before Josephs seventh birthday party. His adoptive mother remarried when he was ten and he assumed his stepfathers name, although his stepfather never adopted him.

What Is Psychotherapy

The psychotherapist endeavors to alter, if not abolish, pathologic adaptive and defensive mechanisms of the personality. The expressive-exploratory approach relies on improvement through resolution of buried conflicts; assistance is given through interpretations of irrational emotional reactions. In contract, the aim of suppressive-supportive psychotherapy, in which interpretation is minimized, is repression through a substitution of new defensive and adaptive technics. Flexibility is essential in psychotherapy in order to apply the most appropriate technics in a given situation. A unique feature of all psychotherapeutic efforts is the use of self.