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This newsletter
shares with the public useful understandings of psychological matters
that are part of living today. It comes from the New York State
Psychological Association, Division of Psychoanalysis.
Our core membership includes hundreds of highly trained, licensed
clinical psychologists and psychoanalysts practicing in New York at
this time. We offer you fresh, effective understandings based on
our current and cumulative experience and knowledge. Each topic is
covered by a contemporary expert in the chosen area. We hope it helps.
We welcome your feedback, comments and questions at NYSPADIV@gmail.com
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When the Mind Heals the Body
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Pamela, 36, a physically-fit, accomplished professional
woman juggling career and two children under age 4, is sitting at the
holiday dinner table in her home, listening to her adored and adoring
father regale the family with anecdotes from childhood about her and
her brother, 2 years younger. He turns to her and says, "Oh,
Pamela, you know you were never good in math and geography." Only
a few minutes later she feels sharp pain in her back The
pain is so severe that she excuses herself and goes into her kitchen to
calm her reaction to the pain and to identify the emotional trigger for
its sudden onset.
Using the work we have done in psychoanalytic
psychotherapy for the past year, she quickly realizes that she is
furious at her father for his "sexist" point of view.
How could he say that, knowing so well her passionate feminist
leanings? Within a few minutes, the pain vanishes and she's able
to return to the dining table.
This is one of numerous, dramatic examples of the
relationship between bodily pain and emotions that I have witnessed in
the past 28 years while using a psychoanalytically-informed approach to
treat bodily pain in psychotherapy and in psychoanalysis. Pamela
was referred to me by her physiatrist. He had diagnosed her back
pain as a physical condition, Tension Myoneural Syndrome (TMS),
mediated by feelings, or emotions, that are so unacceptable, so
threatening, (e.g., anger, fear, shame, guilt, or even love).
In
my work with patients with musculoskeletal pain, I have found
that feelings that have been foreclosed from awareness can lead to
somatic pain, which distracts the sufferer from those feelings. I write
about my own experience of developing a pain symptom and show how it
was related to overwhelming feelings that were difficult to experience
fully.
My
patient, Pamela, would probably have searched immediately for a
"physical" reason for her pain, e.g., "I probably
strained my back while doing all of that hard physical work preparing
for the family holiday meal." Searching for a
"physical" or "structural" cause of musculoskeletal
pain reflects the traditional biomedical model of disease that has
dominated Western medicine for centuries.
In
that model of pain, there is a one-to-one correspondence between
physical disease or injury and pain. That model has been
challenged since the mid-1960's, beginning and continuing with the work
of the psychologist, Dr. Ronald Melzack. He and subsequent
generations of pain researchers shows that "pain" is the
outcome of a perceptual process generated by the brain, even in the
absence of external stimulation and/or injury and disease.
Further support for this argument comes from studies of people who have
"phantom limb pain," paraplegics who experience pain below
the level of their severed spinal cord, and people born without limbs
who feel pain "extremities" they do not have. Numerous
researchers have also demonstrated that our perception of
"painful" sensations is influenced by our mood, by memories of
other painful sensations, by our level of motivation, and by social and
cultural learning.
Contemporary
psychoanalysis gets the importance of all of these factors in
understanding how we function as adults. Pamela learned to
use the pain as a "signal" that she had experienced an
emotional reaction to something that had just happened. Once she
had identified and experienced anger at her father, the pain
disappeared. When her psychotherapy began, she would not have
been able to tolerate experiencing "conflicting" feelings
toward her father, i.e., she loves him AND she can feel angry at him
simultaneously.
Frances Sommer
Anderson, Ph.D.
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Marriage Today: The Fragility of Intimacy
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An article in the New York Times at the end of summer,
heralding the new television series season was headlined
"Television, in a darkening mood, looks at marriage and finds
despair." Characterizing the new, chiaroscuro landscape was
a sense of isolation and loneliness within the very institution
that promises a deep and lasting attachment.
Marriage as an institution has had quite an interesting
history. A contemporary sociologist, Dr. Stephanie Coontz,
notes that until 200 years ago marriage was an arrangement which
served political, social and economic functions. Individual needs
were barely in view. Beginning in the 18th century, there was a
revolutionary idea afoot which was that couples were supposed to be
more interested in each other than in friends, their extended families,
or their associates in commerce.
This concept traveled through an era of industrial
development and the separation of male (workplace) and female (home
guardian) spheres emerging as the essential "love-based,
male breadwinner family" that lasted until it was challenged by
the cultural revolution of the 1960's.
Today we know that the sands are shifting under and around
this institution. Though the number of married couples as a
proportion of households has been declining for decades, since 2005
more American women are living without a husband than with
one. "This would seem to close the book on the Ozzie
and Harriet era that characterized much of the last century."
But 93% of Americans say they still hope and plan on
forming a lasting and happy union with one person. What challenges will
they face? The following list is not exhaustive by any means:
--In an era when men and women are both in the workforce at the
intensity in which many jobs must be performed today, there is often
precious little time for intimacy, "hanging out" together.
--Feminist principles are still being absorbed into marital
culture: Is it o.k. if she makes more money? Why isn't he
responsible for an equal amount of childcare?
--The explosion of electronic and media formats burden and distract
partners who now often spend more time on their computers that in face
time with partners.
--The delay in childbearing has led to an unprecedented involvement in
fertility treatments, a known stressor of coupling.
--As the population ages, partners become not only are responsible for
each other and offspring, but are often crucial caretakers to their
aging parents or other relatives.
In the face of these challenges, how can marriage remain a source of
growth, security and nurturance to individuals?
From a psychodynamic perspective, the new challenges of marriage call
for self-reflection in a way that more clearly scripted versions of
bonding have not required in the past.
For instance, if you want to negotiate equitable gender
arrangements, you will need to think deeply and honestly about the
models your parents presented: the hidden resentments, unwilling
accommodations. In general, we find ourselves replaying
unfinished childhood struggles with our parents, and between our
parents, in our adult intimate relationships.
In an era in which self-actualization, self-realization and even
self-creation are held up as cultural ideals, it is daunting to face
the necessary dependency of intimate relationships. To tolerate,
let alone enjoy dependency on another, necessitates being honest with
oneself about the fears evoked by relying on another:
disappointment, humiliation, at the worst - abandonment.
It's crucial that each partner try to be as honest as possible about
his or her wishes, longings and irritations and discuss these as
tactfully and openly as possible. Generally, what is not
"owned" becomes "disowned" and projected onto a
partner. "It's not my rage or selfishness that's the
problem, but yours, or at the very least that you make me act this
way."
Open discussion can lead to argument, but it is wise to remember that
marital research indicates that it is the way couples argue that causes
distress, not what they argue about. Balancing positive with
negative statements about one's partner is important; much damage
can be avoided or done in the style of disagreement. Withdrawing and
stone-walling is off-limits when the goal is relationship health.
The common advice proffered today to "work at marriage" might
seem a bit dreary and unromantic. But "working" at how
we confront our disappointments and how we criticize our partners is
essential.
Mary-Joan
Gerson, Ph.D., ABPP
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From Freud to Gay Friendly: A Brief History of Psychoanalysis
and Homosexuality
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Psychoanalysis has had a tarnished reputation in the gay
community. This is understandable in light of historic analytic
attitudes toward homosexuality. Freud's Three Essays on the
Theory of Sexuality was published in 1905, a time when two theories
about homosexuality predominated. Freud disagreed with both.
"Third sex" theories originated among the 19th
century equivalent of today's gay rights activists. They believed
gay people were a "third sex," the other two being straight
men and straight women, and argued that homosexuality was normal and
should not be criminalized.
In contrast, many physicians of Freud's era believed
homosexuality a form of hereditary, nervous "degeneracy,"
that it was not normal, and labeled it an illness.
Freud, arguing against degeneracy theory, noted that
homosexuality was found in people with no other mental problems and in
individuals "distinguished by especially high intellectual development
and ethical culture." However, he also rejected third-sex
theories, or "any attempt at separating off homosexuals from the
rest of mankind as a group of special character." Instead, Freud,
believing everyone was bisexual to some degree, said homosexuality
"cannot be classified as an illness; we consider it to be a
variation of the sexual function, produced by a certain arrest of
sexual development." Not normal, not an illness, but a form
of psychological immaturity.
Freud's beliefs, contradictory by today's standards, were
progressive for his time. Yes, he thought heterosexuality the
culmination of evolutionary design, including homosexuality with
pedophilia and bestiality as "deviations" in respect to an
adult heterosexual object. However, though he did not accept
homosexuality as normal, he publicly opposed its criminalization.
He also expressed pessimism about changing sexual orientation with
psychoanalysis.
Following his death in 1939, psychoanalysts disputed
Freud's theory of bisexuality, claimed only heterosexuality as normal,
and labeled homosexuality a mental disorder-a phobic avoidance of
heterosexuality due to inadequate, early parenting.
This illness theory predominated in the 1950s and 1960s
and informed analytic efforts to "cure" homosexuality.
In 1973, this theory was publicly repudiated when the American
Psychiatric Association officially removed "homosexuality"
from its diagnostic manual. Gradually, a shift in psychoanalytic
attitudes and theorizing about homosexuality ensued.
In the late 1980s and early '90s, openly gay analysts
began coming out. They raised new issues and asked different
questions: Should analysts come out to their patients? Is
there a "cause" of heterosexuality? What do we mean by
masculine and feminine? What is normal and who decides?
What is the psychological impact of not being able to marry? How
do antihomosexual attitudes affect a gay person's development and
self-esteem? Can psychoanalysis help people with HIV?
In the last two decades, gay and lesbian analysts have
been strong advocates for the psychological needs of gay and lesbian
patients. As a result, most analysts no longer try
"curing" gay people, but instead help them achieve Freud's
original goals of psychoanalysis: to work well and love well.
Jack Drescher,
MD
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About Our Authors
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Fran Sommer Anderson, Ph.D. ("When the Mind
Heals...") is a clinical psychologist and
psychoanalyst who specializes in healing physical pain through
therapy. She is on Faculty at the NYU Medical
School, and National Institute of the Psychotherapies, in
New York . Her most recent book is Bodies in Treatment
(Analytic Press). You can find her website at www.francessommeranderson.com.
Mary-Joan
Gerson, Ph.D., ABPP, ("Marriage Today") is
Faculty, Supervisor and Director of the Advanced Specialization in
Couple and Family Therapy at the N.Y.U. Postdoctoral Program in
Psychotherapy and Psychoanalysis. She is in private practice in
New York City. She has published a full-length book and numerous
articles on this subject, which can be found on her website, www.maryjoangerson.com.
Jack
Drescher, M.D., ("From Freud to
Gay-Friendly"), is a psychiatrist and psychoanalyst who is on
faculty at the N.Y.U. Postdoctoral Program in Psychoanalysis and
Psychotherapy, and the William Alanson White Institute, in New
York. He has published numerous distinguished articles on this
topic which you may find on his website: www.jackdreschermd.net.
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Susan Parlow,
Ph.D., Editor in Chief;
Sharon Brennan, Ph.D., Stefan R. Zicht, Psy.D, Sheldon Itzkowitz,
Ph.D., ABPP, Editorial Board;
Jane Tucker, Ph.D., Dan Hill, Ph.D., editorial consultants
NYSPA, Division of Psychoanalysis
With special thanks to the Psychoanalytic Society of the Post
Doctoral Program in Psychotherapy and Psychoanalysis at NYU, for
initial funding.
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