Stanley M. Kaplan

Effects of imipramine on anxiety and hostility levels

Summary1.An initial longitudinal study of the psychologic effects of imipramine on one patient in which the active drug was alternated with a placebo, led to short term studies on four other subjects. A measure of emotional reaction was used which was derived from small samples of speech; it was demonstrated to be an objective and sensitive instrument for the detection of changes in anxiety and hostility.2.While imipramine was consistently associated with an increase in the expression of hostility directed outward for the one patient, the increase in hostility outwards for four additional patients was not sufficiently great to reject, with conviction, the hypothesis of chance. However, these four other patients did show a significant increase in a subcategory of hostility directed outward, namely, overt hostility outward.3.Imipramine, as compared to a placebo, significantly increased levels of anxiety in the verbal samples of the subjects tested.4.No significant changes were noted with imipramine on scores of hostility directed inwards or ambivalently directed hostility, probably because none of these patients was clinically depressed.

The analyst, the transference, and the representational world

Viewing the phenomenon of transference within the metapsychological context of the representational world, and the shapes of the important past and present object representations in it, has a clarifying value. Any new approach to what Freud characterized as “the almost inexhaustible topic of transference”1 is justified because of the central position it holds in the analytic treatment process. The basic idea presented in this paper is that transference can be viewed in terms of the changing shapes of the object representation of the analyst as he is formed and transformed in the representational world during the course of the analysis. These changes are affected by the regression during analysis, the influences of the patients important past object and self representations which are laid down in his representational world (particularly in the unconscious part of it), the interventions of the analyst, and other occurrences during the course of the analysis. The term “transference” has been defined in a variety of ways. I will use the definition of Sandler et al.2—“a special illusion which develops in regard to the other person, one which, unbeknown to the subject, represents, in some of its features, a repetition of a relationship towards an important figure in the persons past … this is felt by the subject, not as a repetition of the past, but as strictly appropriate to the present and to the particular person involved.” The term transference has also been described in terms of the transference neurosis, the externalization of the superego, projections of the id or aspects of the patients own self-representation onto the analyst, “character” transferences, the “basic” or “primary” transference of the working alliance, “ready-made” transferences, acting-out of transference, and so on. Some of these will be dealt with in this paper.

Clinical, cultural and literary elaborations of the negative ego-ideal

Summary We have presented a conceptual approach to a clinical phenomenon characterized by the avoidance of certain types of roles or behavior which are ego alien to the individual. We have called this the negative ego-ideal since it seems to be closely related to but different than the positive ego-ideal which encourages a certain standard of performance from the individual. The negative ego-ideal is a structural concept which belongs to the superego configuration. Transgression of the negative ego-ideal brings forth an affect closely allied to shame but often quantitatively stronger described by terms such as humiliation or mortification.

Psychosomatic Aspects of Cardiovascular Disease

Emotions may play a role in the development of some cardiovascular disorders, and heart disease often gives rise to psychologic problems. Perceptions and thoughts about the heart may also become interwoven into the symptoms of neurotic and psychotic disorders. To add to the confusion, a cardiac problem may even serve an adaptive function psychologically by alleviating a neurosis.