The "voice": The dual nature of guilt reactions

ArticleinThe American Journal of Psychoanalysis 47(3):210-29 · February 1987with 41 Reads
DOI: 10.1007/BF01250340 · Source: PubMed
Ad

Do you want to read the rest of this article?

Request full-text
Request Full-text Paper PDF
  • Article
    Full-text available
    The intention of this paper is to propose a conceptualization of the relationship between attachment, detachment, and nonattachment in human's lifelong patterns of emotional, physical and spiritual health and growth. The basic premise is that people relate to their environment with attachment (intimacy) and detachment (autonomy) from their earliest (prenatal and perinatal) experiences. Ultimately people strive for synthesis of the two, i.e., balancing attachment (freedom from fear of abandonment) with detachment (freedom from fear of engulfment), resulting in liberation from the subjugation to either (the freedom to explore the external and internal worlds). An example of synthesis is the transcendence of the two opposites of parental responsive engagement and parental acceptance of withdrawal, rhythmic reciprocity (Schore, 1999). Another example of the synthesis of attachment and detachment is Lifton's (1979) proposal that a secure attachment to the world is a basic prerequisite for the capacity to "let go" of the world gracefully in approaching one's death. We review the concept of "openness to experience" and its association with that of "freedom to explore." Finally, we suggest expanding attachment theory concepts into the transpersonal realms of the personal and collective unconscious, birth, death, and spiritual nonattachment. One proposal is that the development of internal working models begins earlier than the clear-cut attachment phase; through the mechanism of procedural memory (Crittenden, 1990, 1992, 1993, 1994), available at or before birth, the infant begins to develop internal models in the preattachment and attachment-in-the-making phases. The currently proposed conceptualization launches from an outline offered by Jeremy Holmes in an article published in the British Journal of Medical Psychology (1997). Briefly, Holmes suggests that Attachment, which arises out of a secure base, provides the starting point for intimacy; the capacity for healthy protest and therefore detachment is the basis of autonomy; from non-attachment comes the capacity to reflect on oneself and so to disidentify with painful or traumatic experience (p. 231).
  • Article
    Examined in this study are factors that might account for social workers' negative affective responses to gay, lesbian and bisexual persons through analysis of individual predictors of homophobia: residence (urban/rural), gender, age, social interaction with gay persons, political opinions, and religiosity. The Hudson-Ricketts Index of Homophobia was administered to nonstudent adults and students from two social work schools (n = 177). Amount of homophobia was related to social interaction, residence, and religiosity. The authors discuss the need to individualize educational strategies for student subgroups and prepare social workers for practice with gay, lesbian, and bisexual persons in all settings, especially community practice.
  • Article
    While auditory hallucinations (AH) are prototypic psychotic symptoms whose clinical presence is often equated with a psychotic disorder, they are commonly found among those without mental illness as well as those with nonpsychotic disorders not typically associated with hallucinations in DSM-IV. This incongruity presents a significant challenge for clinical work and efforts to revise the next iteration of the DSM. Auditory hallucinations found among "normal" people suggest that either AH are not as pathologic as they are typically taken to be, or that less-than-hallucinatory experiences are routinely mischaracterized as AH. Such hallucinations in the context of conversion disorder, trauma, sensory deprivation, and certain cultural settings strengthen an association between AH and psychopathology but suggest limited diagnostic specificity and relevance. It may be useful to think of AH like coughs-common experiences that are often, but not always, symptoms of pathology associated with a larger illness. Although these issues have been known for many years, they are rarely discussed in American psychiatry and need to be addressed in future research and clinical work.
  • Article
    Negative cognitions are capable of interfering with the natural flow of excitement and sexual desire at any point prior to, during, or following a sexual encounter. The source of these inimical thought patterns can be found in internalized parental attitudes that are transmitted intergenerationally and that also form the basis of sexual stereotyping. This paper describes the application of Voice Therapy methods to the resulting sexual problems manifested in many couple relationships. Clinical material excerpted from group sessions illustrate the content of the "voice" process--the negative cognitions--and demonstrate the angry affect that accompanies the verbalization of such thoughts and attitudes. Exposing self-attacks and critical thoughts about one's partner has proved to have positive results in terms of improved sexual relationships. Also discussed are those prevailing cultural views that function to reinforce each individual's "voice," thereby contributing to much of the sexual distress experienced in personal relationships.
  • Article
    This paper builds upon current theoretical and clinical understanding of inhibited sexual desire (ISD). Kaplan's comprehensive book, Disorders of Sexual Desire, is utilized as a basis for a brief overview of the triphasic model of sexual functioning and desire phase disorders. From this model, development of theory regarding the least understood and most "severe" type of ISD (remote psychogenic causation) is presented, as well as therapeutic implications involving such disturbances. Specifically, it is proposed that preoedipal factors and psychic defenses incurred during the pregenital years may play a significant role in the etiology of ISD as well as account for the tenacious resistance to treatment found in this clinical subgroup. In conclusion, a critical analysis and speculative expansion of this model is presented.
  • Article
    Although Sylvia Plath apparently sought psychotherapeutic help following her first suicide attempt in her twenties, she did not have access to specialized forms of suicide assessment and intervention available in the present day. In this 'thought experiment,' the authors drew on material available in her journals and literary work to formulate a treatment plan for Plath, were she to be seen by a contemporary psychotherapist skilled in voice therapy. In particular, they focused on her inwardness, her preference for fantasy gratification, her self-denial, her addictive attachment to her mother and husband, and her negative thoughts toward self and cynicism toward others. The authors then sketched out suicide risk assessment procedures as they might be applied in her case, and illustrated a hypothetical voice therapy session designed to ameliorate her pertubation and lethality during her last suicidal crisis.
  • Article
    A sample of 98 Canadian homosexual and bisexual men, 46 of South Asian and 52 of European origin, who had sex with other than an exclusive primary partner were asked about their high-risk sexual behaviours during the previous six months. They were also queried about internalized homophobia, acculturation to the gay community, and for South Asians acculturation to the majority culture. Participants who reported more internalized homophobia were more likely to engage in both high-risk anal and oral sex. South Asian men exhibited significantly greater levels of homophobia. In addition, South Asian men who were less acculturated to the majority culture were more likely to engage in both types of high-risk sex. These data suggest a need to address internalized homophobia in HIV prevention programmes with homosexual and bisexual men generally, and further suggest the need to target less acculturated South Asian men in particular.
  • Article
    This study compared suicide potential and suicide attempts in 50 Pakistani and 50 American psychiatric patients all of whom reported a positive history of suicide attempts during the past 1-5 years. It further explored the role of nationality, gender, diagnosis, and marital status in respondents' potential for suicide and suicide attempts. The American sample reported a higher degree of suicide potential on the Firestone Assessment of Self-Destructive Thoughts (FAST), more suicide attempts, and a larger number of suicide precipitants (family conflicts, work pressure, wish for death, loneliness, financial problems, and mental disorders/drug withdrawal) than did the Pakistani sample. For suicide attempts, effects of 3-way interaction for gender, marital status and nationality were found significant. However, these effects were non-significant for respondent's potential for suicide. In addition, the FAST was found to have a significantly high correlation with suicide attempts. Thus, it may be inferred that the FAST can be used as a valuable screening instrument for the identification of patients at risk for suicide in diverse cultural settings. However, more prospective validity studies are needed to enhance our cross-cultural understanding of suicide; identification of psychiatric patients at risk for suicide by the FAST; and for effective treatment and prevention programs for Eastern and Western societies.
  • Article
    The current study examined the psychometric properties of the Turkish version of the Internalized Homophobia Scale (IHS; Herek, Cogan, Gillis, & Glunt, 1997) in gay men living in Turkey. Participants were 132 men in romantic, intimate, or sexual relationships with men, and they identified themselves as homosexual (n=112) or bisexual (n=20). Alpha and split-half reliability coefficients revealed good internal consistency of the scale. Consistent with the original scale, the construct validity revealed a single factor for the scale. Regarding convergent validity, the IHS had significant correlations with psychological problems, particularly with symptoms of depression and anxiety; the scale also had a significant positive correlation with negative affect and a negative correlation with self-esteem. Regarding discriminant validity, the IHS had very low correlations with positive affect and hostility attitudes. The association between internalized homophobia and psychological problems remained significant even after controlling for the variance explained by self-esteem, negative affect, and positive affect. Hence, the psychometric properties of the Turkish version of IHS appear quite promising.
  • Article
    Hypothesizes that deprived infants form a primary fantasy bond (a delusion of being connected to the mother) that persists as a defense through childhood and into adult life and that deprivation variables are conducive to the formation of subsequent damage, ranging from mildly neurotic behavior to schizophrenic regression. The primary fantasy leads to a posture of pseudo-independence, relieves fears, and allays the anxiety of feeling separate and alone. In adult life, individuals who defend with the primary fantasy cannot tolerate moving in and out of closeness; they avoid real sexuality, physical intimacy, and honest communication. A letter written to her therapy group by a woman who idealized her family and built a defense of self-hatred illustrates the concept. It is suggested that the hypothesis of a primary fantasy bond explains the underlying dynamics of resistance to change. (13 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
  • Autobiography of a Schizophrenic Girl
    • G Rubin
  • Death Anxiety: the Loss of the Self Separation and guilt
    • J B Mccarthy
    • J Truth And Reality
    McCarthy, J. B. (1980). Death Anxiety: the Loss of the Self, New York: Gardner Press, Inc. Rank, O. (1936). Separation and guilt. In Will Therapy and Truth and Reality, J. Taft, transl. New York: Alfred A. Knopf, 1972.
  • Attachment and Loss, Vol. II. Separation: Anxiety and Anger
    • J Bowlby
  • The Revolution in Psychiatry: The New Understanding of Man
    • E Becker
  • The Trial, W. & E. Muir, transl
    • F Kafka
  • Adolescence: The Farewell to Childhood
    • L J Kaplan
  • The importance of symbol-formation in the development of the ego. InContributions to Psycho-Analysis
    • M Klein
  • Separation and guilt. InWill Therapy and Truth and Reality
    • O Rank
  • Compassion and Self-Hate
    • T I Rubin
  • Interpretation of Schizophrenia G. Rubin-Rabson, (transl.) New York: Grune & Stratton The Revolution in Psychiatry: The New Understanding of Man The Denial of Death Attachment and Loss
    • S Arieti
    • E Becker
    Arieti, S. (1955). Interpretation of Schizophrenia. New York: Robert Brunner. Autobiography of a Schizophrenic Girl (1951). G. Rubin-Rabson, (transl.). New York: Grune & Stratton, 1970. Becker, E. (1964). The Revolution in Psychiatry: The New Understanding of Man. New York: Free Press. Becker, E. (1973). The Denial of Death. New York: Free Press. Bowlby, J. (1973). Attachment and Loss, Vol. II. Separation: Anxiety and Anger. New York: Basic Books.
  • Article
    This reprinted article originally appeared in (Journal of Humanistic Psychology, 1961, Vol 1[1] 1-7). (The following abstract of the original article appeared in record 1962-06728-001.) The healthy psyche is not only an adaptational instrument, but exhibits a tendency to look within for the guiding values and rules to live by. Healthy people show a detachment, independence, and self-governing character which transcends their environment and does not stop with extrapsychic success, but also includes intrapsychic health. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
  • Article
    existential psychotherapy is not a specific technical approach that presents a new set of rules for therapy / it asks deep questions about the nature of anxiety, despair, grief, loneliness, isolation, and anomie / it also deals centrally with the questions of creativity and love overview / basic concepts / the "I-Am" experience / normal and neurotic anxiety / guilt and guilt feelings / the three forms of world / the significance of time / our human capacity to transcend the immediate situation other systems / behaviorism / orthodox Freudianism / the interpersonal school of psychotherapy / Jungian psychology / client-centered approach history / current status / theory of personality / the Freudian model of psychodynamics / the interpersonal (neo-Freudian) model of psychodynamics / existential psychodynamics / death / freedom / isolation / meaninglessness variety of concepts / specialness / the belief in the existence of an ultimate rescuer / theory of psychotherapy / process of psychotherapy / mechanisms of psychotherapy / death and psychotherapy / death as a boundary situation / death as a primary source of anxiety / existential isolation and psychotherapy / meaninglessness and psychotherapy applications / problems / evaluation / treatment / management / case example existential therapy is concerned with the "I Am" (being) experience, the culture (world) in which a patient lives, the significance of time, and the aspect of consciousness called transcendence (PsycINFO Database Record (c) 2012 APA, all rights reserved)
  • Article
    The fundamental contribution of existential therapy is its understanding of man as being. It holds that drives or dynamisms, by whatever name one calls them, can be understood only in the context of the structure of the existence of the person we are dealing with. The distinctive character of existential analysis is, thus, that it is concerned with ontology, the science of being, and with Dasein, the existence of this particular being sitting opposite the psychotherapist. The first section of this chapter provides definitions of being and related terms. The second section discusses anxiety and guilt as ontological characteristics of human existence. The third section addresses one of the major and far-reaching contributions of the existential therapists--the understanding of the person-in-his-world. The fourth section discusses the three modes of world. The existential analysts distinguish three modes of world, that is, three simultaneous aspects of work which characterize the existence of each one of us as being-in-the-world. First, there is Umwelt, literally meaning "world around"; this is the biological world, generally called the environment. There is, second, the Mitwelt, literally the "with-world," the world of beings of one's own kind, the world of one's fellow men. The third is Eigenwelt, the "own-world," the mode of relationship to one's self. The fifth section examines time and history as approached by existential analysts. One of the distinctive contributions of the existential analysts to this problem is that, having placed time in the center of the psychological picture, they then propose that the future, in contrast to present or past, is the dominant mode of time for human beings. The existential analysts take history very seriously, but they protest against any tendency to evade the immediate, anxiety-creating issues in the present by taking refuge behind the determinism of the past. A final characteristic of man's existence ( Dasein) which is discussed in section six is the capacity to transcend the immediate situation. Section seven addresses implications for psychotherapeutic techniques. The chapter concludes with two final caveats. One is a danger that lies in the existential approach, the danger of generality. The other caveat has to do with the existential attitude toward the unconscious. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
  • Article
    This Swiss psychoanalyst presents a detailed account of how she achieved an understanding of and effected a complete cure of a schizophrenic girl diagnosed incurable by fifteen psychiatrists. Her method of treatment rested primarily on analyzing the relationship between the schizophrenic delirium and infantile traumatisms. The delirious idea is a morbid satisfaction and compensation for the legitimate needs and desires which have been frustrated in infancy. The symbolic realization of these fundamental emotional demands (by treating symbols as the "reality" of the patient) resulted in a remarkable therapeutic success. 17 of the patient's symbolic drawings are reproduced. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
  • Article
    This book is a continuation of my Motivation and Personality, published in 1954. It was constructed in about the same way, that is, by doing one piece at a time of the larger theoretical structure. It is a predecessor to work yet to be done toward the construction of a comprehensive, systematic and empirically based general psychology and philosophy which includes both the depths and the heights of human nature. The last chapter is to some extent a program for this future work, and serves as a bridge to it. It is a first attempt to integrate the "health-and-growth psychology" with psychopathology and psychoanalytic dynamics, the dynamic with the holistic, Becoming with Being, good with evil, positive with negative. Phrased in another way, it is an effort to build on the general psychoanalytic base and on the scientific-positivistic base of experimental psychology, the Eupsychian, B-psychological and metamotivational superstructure which these two systems lack, going beyond their limits. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
  • Article
    The Fantasy Bond sets forth a new concept of resistance, demonstrating the relationship between the structure and organization of psychological defenses and the fear of change, individuation, and personal power. This work has broadened the concept of resistance in psychotherapy to include an understanding of a core resistance to a "better life." The problem, according to author Robert Firestone, is that people behave in a way that is motivationally dishonest, reacting perversely to movement in the direction of their stated goals. In other words, they don't really want what they say they want. The concept of a Fantasy Bond is a powerful theoretical construct which unifies neopsychoanalytic and existential frames of reference. The Fantasy Bond originates as an illusion of connection with the mother that is used by the infant to relieve anxiety and emotional pain. Later, it is extended to other individuals, mates, authority figures and other parental substitutes, and destructive bonds are formed which impair the individual's functioning. The book develops the concept of emotional hunger and distinguishes it from parental love with which it is frequently confused. The author analyzes the organization of psychological defenses around the important core defense of the Fantasy Bond and relates this structural process to the basic resistance in psychotherapy. He describes the dimensions of the Fantasy Bond and the secondary defenses that protect this core defense: The idealization of parents and family; the development of a negative or critical view of self; the displacement of negative parental traits onto other objects and the development of a victimized, paranoid orientation to life; the withdrawal into an inward state with accompanying loss of feeling for self; the withholding of affectional responses and capabilities in general; and the involvement with self-nourishing habits and painkillers. The core concepts of this book have been drawn from three diverse populations: the deeply disturbed behavior of regressed schizophrenics; the typical neurotic conflicts of psychotherapy clients; and the everyday behavior of normal, successful people living in a unique psychological community. The fact that similar behavior can be found in such outwardly different populations underscores both the essential similarity of all human beings and the reliability of the data. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
  • Article
    This book represents the fruition of four years labor--most of it, fortunately, a labor of love. The idea of translating these papers, originating with Ernest Angel, was welcomed by Basic Books because of their enthusiasm for bringing out significant new material in the sciences of man. I was glad to accept their invitation to participate as one of the editors since I, too, had long been convinced of the importance of making these works available in English, particularly at this crucial moment in the development of modern psychiatry and psychology. We asked Dr. Ellenberger to join us as the third editor because of his extensive knowledge of the literature of phenomenological and existential psychiatry and his clinical experience in using these methods in Switzerland. He and Mr. Angel are chiefly responsible for the selection of the particular papers translated. In our introductory chapters, Dr. Ellenberger and I have undertaken the task of making a bridge between these contributions and American psychiatry and psychology, while Mr. Angel has borne the major weight of the translations themselves. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
  • Article
    Defines microsuicide as behaviors, communications, attitudes, or life-styles that are self-induced and threatening to one's physical health, emotional well-being, or personal goals. Progressive self-denial, withdrawal, withholding, destructive dependency, and physically harmful life-styles are analyzed in terms of their function as a defense against separation and death anxieties. Rather than considering suicide and suicidal ideation as subclasses of mental illness, mental illness is conceptualized as a form of suicide. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
  • Article
    In this award-winning book, Interpretation of Schizophrenia, Silvano Arieti presents the history of the medical research on schizophrenia, the summary of the ideas of the major scholars who devoted their careers to the illness and finally the conclusions drawn by the author himself.