ISPS US Newsletter
ISPS - US Newsletter
United States Chapter of the
International Society for the Psychological treatments of the Schizophrenias and other psychoses
“...Innate among man’s most powerful strivings toward his fellow men...is an essentially psychotherapeutic striving.”
Harold F. Searles (1979)
Volume #5 Issue #1
Summer 2004
From the President
and we continue dedicated to our mission of promoting the
humane, comprehensive and in-depth treatment of psychotic
Ann-Louise S. Silver, MD
disorders. We will hold our sixth annual meeting, “Extremes of
Experience: Psychosis through many lenses” September 18 and
While I may not be posting much on the listserve, I 19 at the Chicago Institute for Psychoanalysis, to be chaired by
have been far from inactive. A lot has been happening, both David Garfield, M.D. Leston Havens, M.D. will be our
behind the scenes and on the stage, as ISPS-US continues to gain
keynoter. Each day will begin with a plenary session in which a
momentum and recognition. The ISPS meeting in Melbourne case will be presented and then discussed by leading
was exciting and interesting. I recommend that you go to the representatives of the major approaches to the psychological
www.isps.org site for a report on the meeting written by Wilfried treatment of psychosis. In the afternoons we will hear from
Ver Eecke. We are part of a powerful organization. The PORT individuals. Please consult the Call for Papers, in
Revision draft was circulated to 100 researchers and clinicians, this newsletter.
which included myself. It did not contain the onerous
As further evidence that we are for real, we now have a
Recommendations 22 and 26, which Drs. Lehman and staff. We welcome Karen Stern, M.A.T. who is now serving as
Steinwachs said was done since negative recommendations are our Executive Director, having been of invaluable assistance in
not given for modalities no longer in use, such as insulin coma making our Philadelphia meeting such a success. Karen will be
treatment or lobotomy. The Revision should appear in the sending out a new directory shortly, and then will be working on
Schizophrenia Bulletin shortly. I believe ISPS-US had a huge outreach. Please send her information on organizations and
influence in the removal of those recommendations. However, individuals who should learn about us. And we welcome Clara
our work has just begun. The recommendations should include a Hall as the web designer of our www.isps-us.org website. She is
positive recommendation for psychodynamic therapy. It should working with Jack Rosberg, Ph.D., editor of this website. They
be clear to the mental health profession that psychodynamic and
related therapeutic approaches are neither relics nor ineffective.
Continued on Page 2
Our Spring of 2003 ISPS issue in the Journal of the American
Academy of Psychoanalysis and Dynamic Psychiatry sent a
Table of Contents
forceful message, and is being used in training programs
currently. The Journal’s editor has invited us to contribute an
Regular Features
article on the Practice Guideline for the Treatment of Patients
From the President.................................................. 1
with Schizophrenia, Second Edition; I would appreciate your
From the Editor....................................................... 2
input.
From the Secretary..................................................4
Please plan to give strong support to Manuel González
From the Treasurer.................................................. 4
de Chávez Menéndez, organizer of the June 2006 ISPS meeting
From the Executive Director......................................4
in Madrid. Check its website: www.ispsmadrid2006.com. We
ISPS-US Listserve.................................................. 5
in the U.S. send Manuel our support and condolences. Manuel
is head of psychiatry at the hospital nearest to the train station
ISPS-US Web Site...................................................5
bombings occurring in March. I’ve gotten to know him through
Column: Mind and Brain......................................... 14
our work on the ISPS executive board. He is energetic, well
Book Review: After Lacan: Clinical Practice and the
organized and deeply committed to psychological approaches to
Subject of the Unconscious................................17
the psychoses. He is planning a book on the history of ISPS, to
News from Local Branches..................................... 19
be published after the meeting. Yrjö Alanen, Brian Koehler and I
will be working with him on this project.
Special Features
And it’s official! On January 31, we received word from
Internet Drop-Ins.....................................................6
the Internal Revenue Service accepting our application for non-
Culture-Bound: The Transgenerational Transmission
profit status. We now can seek research and organizational grants
of Trauma......................................................... 7
and begin a general fund-raising project. We can reach out to the
staffs of teaching centers, the state mental hospitals and
Comments on the Keynote: Strauss’ “Subjectivity in
community clinics throughout the country, locating people who
Psychiatry: How Can We Do Better?”................... 8
sense the importance of a strong therapeutic relationship for those
Panic: Have We Lost Our Minds?............................10
trying to overcome psychosis. We continue aiming at providing
Medication and Psychotherapy: Part 2.....................11
them with support and guidance, and encouraging them to
Firewalking........................................................... 16
contribute to our discourse. Our membership continues to grow,
2
ISPS - US Newsletter
From the President, continued
listened with rapt attention, and who commented that all the
can’t make this project happen on their own. They need your material was both new and inspiring. ISPS-US will organize a
material. Please send Jack the text of papers you would like to speakers bureau, so that our members can respond to invitations
have posted (by e-mail or on diskette), along with information on
to present at grand rounds and other such events.
relevant meetings, organizations with whom we should web link,
The David B. Feinsilver Award winner, Ishita Sanyal of
and your suggestions for developing this site.
Calcutta, India, gave an inspirational presentation at the ISPS
We celebrated our fifth year in grand style, with an meeting in Melbourne. She established a system of clinics that
exciting and well-attended annual meeting in Philadelphia at the work with patients and their families, the project a tribute to her
Thomas Jefferson Medical University, and are grateful to its co-
deceased brother. She is in the process of establishing an ISPS-
chairs, Harold Stern and Brenda Byrne. We mourned the passing India. Ishita’s clinics need computers (laptops or desktops). If
of Victoria Conn, who had been the co-chair of this meeting until
you have recently upgraded, and don’t have a home for your old
her untimely death. Victoria had been our very talented liaison computer, please contact me and I’ll help you in sending this to
with NAMI and had often contributed her perspective on our her.
active listserve. This meeting was our first two-track meeting.
Our listserve itself is flourishing, with a vibrant and
We thus had the opportunity to hear in depth from people we substantive discussion of theory and techniques, including
knew only through our listserve, or from people who are new to postings of clinical vignettes to which many are responding
ISPS-US. Major authorities in our field contributed to an extremely thoughtfully. It reminds me of the Wednesday
invigorating meeting. John Strauss, served as keynoter, speaking
Conferences at Chestnut Lodge, but here the discussions are not
on “Subjectivity in psychiatry: How can we do better?” His time-limited, and treatment philosophies are unfolding. Lurking
remarks were personal, intimate, and challenging, setting a tone on our site is like auditing an extraordinary seminar.
of rededication to our mission of inter-subjective, truly personal
work with our patients. We honored, in absentia, Anni
I’m closing with a plea: for donations by you or by
Bergman, recipient of our annual award, and watched a others; please do some fund-raising for us, now that these gifts
compelling documentary of her successful work with an autistic are tax-deductible. And we need suggestions on foundations to
girl. The day closed with a lively panel discussion organized by whom we should apply for grants. We’ve been an impressive
Michael Robbins, on the future of ISPS-US. One result of this team. Let’s keep up the winning streak.
discussion will be a listserve didactic seminar focusing on Ann-Louise S. Silver, M.D.
particular clinical papers, with an identified faculty.
4966 Reedy Brook Lane
Additionally, we presented a panel at the winter meeting Columbia, MD 21044-1514
of the American Academy of Psychoanalysis and Dynamic (410) 997-1751
Psychiatry, “Beyond medication: Remembering the spirit and fax (410) 730-0507
mind of the psychotic patient.” Presenters included Shelley asilver@psychoanalysis.net
Alhanati, Clare Mundell, Garry Prouty, and in absentia, Brian www.CAPsy.ws
Koehler. There were many young people in attendance, who
e
From the Editor: Phenomenology, Schizophrenia and the Self
Brian Koehler, PhD
It is with much interest and pleasure that I read a new of the field of awareness” (p.438).
article published by Louis Sass and Josef Parnas (2003),
“Schizophrenia, Consciousness, and the Self” in Schizophrenia
Louis Sass, a member of ISPS, has a long-standing
Bulletin, 29 (3), 427-444. I have been following the work of interest in psychosis. He published two well known books on
these two authors on the phenomenological foundations and this topic, including The Paradoxes of Delusion: Wittgenstein,
aspects of the schizophrenias with great interest and I was glad to Schreber, and the Schizophrenic Mind, published in 1994 by
see that they are collaborating to help elucidate and shed much Cornell University Press, and Madness and Modernism: Insanity
needed light on the enigmatic aspects of this group of illnesses. I in the Light of Modern Art, published in 1994 by Harvard
was impressed that such a journal, which seems to shy away from
University Press (both, in my opinion, excellent and well worth
phenomenologically based articles, except for their wonderful first reading). Louis Sass presented, with James Ogilvie as a
person subjective accounts of the illness, featured this topic discussant, at one of our ISPS-US New York Chapter meetings.
(although many years ago they published a special issue on His work is cogent, rich and original. He describes the self-
qualitative subjectivity research & schizophrenia). Sass & Parnas experience of some psychotic patients very perceptively. Where I
concluded: “We have argued that schizophrenia is best understood would disagree with him is in the area of his preferred
as a particular kind of disorder of consciousness and self-
epistemological model, which I see as excessively imbued with a
experience. We described specific alterations of self-experience one-body psychology. Clinically, I would prefer to relationalize
[ipseity, latin derived word for self, itself] and the self-world his concepts. For example, solipsistic positions could usefully be
relationship that we see as fundamental to the illness, especially understood as the patients attempts at achieving a form of self-
diminished self-affection, hyperreflexivity, and related disruptions holding (similar to Winnicott’s views on where good-enough
ISPS - US Newsletter
3
parenting is lacking, one takes one’s own mind as a holding Dynamic Psychiatry, 31 (1),247-268, 2003). Using this clinical
object, therefore we see such phenomena as hyperflexivity, and epidemiological research to blame families, individuals, and
obsessional defenses, etc.). It is my view, that psychosis cannot or the wider cultural zeitgeist is useless at best, and hurtful at
be understood apart from the relationship between the self and worst. Rather, one could accept that these illnesses are biological
primary, pre-reflective object. I do not believe that it is accidental illnesses (as long as the concept of biology is non-reductionistic
that virtually all psychotic symptoms, including thought disorder, and includes attachment experience, human intentionality and
disorganization, hallucinations and delusions, as well as interactionality, etc.) initiated and expressed at various levels of
anhedonia, alogia and avolition, are worsened within certain system organization with multilinear modes of interaction.
social/interpersonal contexts (much of which are subtle because
I believe that clinician/researchers like Sass and Parnas
they are internalized as a sort of object-relational template or are demonstrating the need for a phenomenological approach to
prototype) and are thoroughly imbued with self-world the classification (for a good example of this see Andrew Sims
relationships. Malcolm Pines (1998), in his “Neurological Symptoms in the Mind: An Introduction to Descriptive
models and psychoanalysis,” contained in Freud and the Psychopathology-Third Edition, published in 2003 by Saunders)
Neurosciences: From Brain Research to the Unconscious, edited and understanding of severe mental illness. As these and other
by Giselher Guttmann & Inge Schotz-Stresser for Verlag der authors have pointed out, there is no reference to the self in
Osterreichischen Akademie der Wissenschaften, noted:
DSM. If one’s understanding of the brain is that it is a type of
“Thus my thesis is of the movement from one body to two and endocrine gland, e.g., too much dopamine in the mesolimbic
three-body psychology (Richman), from Freud’s neurological pathway ‘causes’ productive symptomatology in schizophrenia, or
intrapsychic one body mental apparatus [actually, as evident in too little serotonin ‘causes’ depression or suicide, or if the mind
various articles such as Mourning and Melancholia and in his is viewed as epiphenomena to the brain (years ago, I used to say
work on group psychology and the ego, Freud had proposed a to students, it takes at least two brains in a social context to
relational model of the psyche] to the position of Bakhtin, who make a mind, or to get at the mystery of the mind/brain
writes, ‘I am conscious of myself and become myself only by relationship, in the words of TH Key: “What is mind? No matter.
revealing myself to another, through another and with the help of what is matter? Never mind”), this eclipse of the self is
another....Every internal experience ends up on the boundary. The
understandable. However, if the brain is understood as an organ
very being of[wo/]man (both internal and external) is a profound (earlier in his career, Gaetano Benedetti saw schizophrenia as a
communication. To be means to communicate....To be means to complex type of psychosomatic illness, with the brain as the
be for the other; and through [her]him for oneself. [Wo/]Man has ‘target’ organ) which is significantly altered by its processing of
no internal sovereign territory: [she]he is all and always on the experience and human relationship (neuroplasticity), then the
boundary” (p. 55).Parnas and Zahavi (2002), in their “The role of exclusion of phenomenology, self- and relational processes is a
phenomenology in psychiatric diagnosis and classification,” glaring and costly mistake.
published in Psychiatric Diagnosis and Classification edited by Brian Koehler PhD
Maj et al for Wiley, recognize the significance of intersubjectivity
New York University
in phenomenology: “...the objectivity of the world is 80 East 11th Street #339
intersubjectively constituted, and my experience of the world as New York NY 10003
objective is mediated by my experience of and interaction with 212.533.5687
other world-engaged subjects. Only insofar as I experience that brian_koehler@psychoanalysis.net
others experience the same objects as myself, do I really
e
experience these objects as objective and real” (p. 155).
It seems to me that attributing severe mental illness
primarily to our genes, neurophysiology, or consciousness, can
A human being is a part of the whole, called by us
potentially be a form of dodge. Sociological, familial and
Universe, a part limited in time and space. He
individual-psychological factors are salient in the formation of
experiences himself, his thoughts and feelings as
self, attachment and affect regulation, and in the initiation and
something separated from the rest--a kind of
expression of psychiatric illness (see the work of Horacio Fabriga
optical delusion of his consciousness. This
Jr., e.g., “Evolutionary Theory, Culture and Psychiatric
delusion is a kind of prison, restricting us to our
Diagnosis” in “Psychiatric Diagnosis and Classification” edited in
personal desires and to affection for a few persons
2002 by Mario Maj et al as well as the research reviewed by John
nearest to us. Our task must be to free from this
Read et al in 2003, “Sexual and physical abuse during childhood
prison by widening our circle of compassion to
and adulthood as predictors of hallucinations, delusions and
embrace all living creatures and the whole nature
thought disorder”, published in Psychology and Psychotherapy:
in its beauty.
Theory, Research and Practice, 1-22 and Read & Ross,
-- Albert Einstein
“Psychological trauma and psychosis: diagnosed schizophrenics
must be offered psychological therapies” published in The
(Sent to us by Ann-Louise Silver, MD)
Journal of the American Academy of Psychoanalysis and
4
ISPS - US Newsletter
From the Secretary
a more aggressive outreach for new members.
I look forward to serving ISPS-US as treasurer, and
Julie Kipp, CSW
thank all those who have supported me during my transition to
I want to echo Ann-Louise Silver's comments in her the East Coast.
President's Column in this issue of the Newsletter in welcoming Julie Wolter
Karen Stern, our new Executive Director. This is a significant jwolter@safeplace.net e
step forward in our organization becoming more viable. In my
column in the last Newsletter I was still noting that all work in
our organization was done by volunteer effort, with the exception From the Executive Director
of the nominally paid clients of Bronx REAL Continuing Day
Treatment Program who intermittently stuffed envelopes.
Karen Stern, MAT
As the new Executive Director of ISPS-US, I am very
We continue to hold monthly organizational conference pleased to be working for this fine organization. I see as my
calls to plan for our development. Conference calls are at 11 am main purpose helping to grow ISPS-US into a larger and more
EST on the first Sunday of the month, and the minutes are effective organization. So far I have focused on recruiting new
usually posted on the listserve. Recent discussions have members and encouraging current members to renew, publishing
included planning for the annual conference to be held in Chicago
a new ISPS-US directory (coming soon!), assisting with the
in September, organizing the Newsletter and the new ISPS-US Annual Meeting, the web site and the list serve, doing the
website (www.isps-us.org), reports from the Research newsletter layout, and seeking grants and donors to enable ISPS-
Committee, which is planning a survey of our members' work US to further its mission.
with people with schizophrenia, and discussions of how to
increase our membership and expand our influence in the
A little bit about my background: I taught English as a
prevailing zeitgeist.
Second Language for 11 years, until I had my son 2 years ago. I
am now at home with him and I really value the chance to spend
Even with Karen on board, there is still opportunity for time with him and work from home part time. I also enjoy the
getting involved in the development of this organization. If opportunity to play with the ISPS-US membership database and
you're interested in seeing whether there is an ISPS-US initiative to develop new skills.
with your name on it, join us in one of our conference calls and
hear what is going on. Just contact Ann ahead of time
I’d like to thank all of our new and renewing members
(asilver@psychoanalysis.net) and tell her you are interested in for being a part of ISPS-US; a special thanks goes to those who
joining in on the call.
have contributed to ISPS-US in addition their dues (see donor
list elsewhere in this issue). I’d like to thank Ann Silver, the
Julie Kipp, CSW
Executive Board and the members for making me feel so
80 East 11th Street #439
welcome in ISPS-US. I have enjoyed meeting and working with
New York, NY 10003
you: you are very caring, brilliant and fascinating people, and
(212)533-6692
you do important work for people with psychoses.
julie_kipp@psychoanalysis.net e
Please contact me if you have any questions regarding
From the Treasurer
your membership, if you haven’t renewed your membership yet,
or if you know individuals or institutions who might be
Julie Wolter, PsyD
interested in joining or making a contribution. The best way to
reach me is by e-mail, but you can leave a message at the number
As I begin my duties as Treasurer of ISPS-US, I want to below if you prefer.
thank Barbara Cristy for her dedication and hard work during the
e
years she held this position and to also thank Ann Silver for
handling these duties during my transition from Illinois to New
ISPS-US has a new address!
Hampshire.
Some exciting news now that we officially are a
501(c)(3) non-profit: we have received a generous donation of
ISPS-US
$10,000 from Theodore and Shera Silver, for use in strengthening
P.O. Box 491
our organization. On behalf of ISPS-US, I would like to thank
them for the very generous financial assistance this provides us.
Narberth, PA 19072
Additionally, as of June 1, ISPS-US has received 23
www.isps-us.org
donations totaling $905, evidencing the importance of non-profit
status for our financial growth. We currently have 167 members,
karen.s.stern@earthlink.net
consisting of 5 institutional members and 162 individual
(610) 308-4744 (voicemail)
members. We look forward to hosting a grand meeting in
Chicago, and hope that the revenues from this meeting will allow
ISPS - US Newsletter
5
ISPS-US Listserve:
that can be posted and other important information that can be put
on our website. I encourage the membership to become more
WWW Wanderings
active in this important part of the ISPS-US organization.
Editor’s note: Contributions to the ISPS-US website
Joel Kanter, LCSW-C
should be sent as Word attachments to Jack Rosberg, PhD,
The ISPS-US listserve continues to be active with more JARosberg@aol.com. e
than half our members participating. Recent postings have
discussed an array of clinical and theoretical issues, as well as
more prosaic requests for referral information. In all of these
ISPS-US Board of Directors
discussions, the collective wealth of information and experience
Founder: David B. Feinsilver, MD
among our members is truly impressive.
President: Ann-Louise S. Silver, MD
For those interested in joining the listserve, just send a
Secretary: Julie Kipp, MSW
request to myself (joelssmd@aol.com) or Karen Stern
Treasurer: Julie Wolter, MA
(karen.s.stern@earthlink.net), the listserve moderators.
Newsletter Editor: Brian Koehler, PhD
Research Chair: William Gottdiener, PhD
I also want to call attention to several interesting
Listserve Moderator: Joel Kanter, LCSW-C
websites. ISPS International has an interesting website
Website Editor: Jack Rosberg, PhD
(www.isps.org) with reports and papers from around the world.
U.S. Member, ISPS Executive Committee
From England, the Association for Psychoanalytic Psychotherapy
Ann-Louise S. Silver, MD
in the National Health Service (www.app-nhs.org.uk) has an array
U.S. Members, ISPS PORT Revision Task Force
of information from mental health clinicians in the public sector
William Gottdiener, PhD
in England. The organization's journal is quite interesting and a
Colin Ross, MD
sample issue is available online without charge (and articles can
be easily downloaded). But the real treat here is their
Heads of Local Branches
audio/video archive where you can listen and/or view brief clips
Baltimore-Washington: Ann-Louise Silver, MD
of talks by Freud, Melanie Klein, Winnicott and Jung. And
asilver@psychoanalysis.net
members with a historical bent might also be interested in the
410-997-1751
online version of the Freud exhibit that was at the Library of
Boston: Ronald Abramson, MD
Congress in 1999 (www.loc.gov/exhibits/freud); virtually the
Rona976@aol.com
whole exhibit is available on this website. e
Chicago: David Garfield, MD
dasg@aol.com
ISPS-US Web Site:
847-578-8705
Detroit: Patricia Gibbs, PhD
www.isps-us.org
patricialgibbs@aol.com
313-274-5490
Jack Rosberg, Ph.D.
New York City: Brian Koehler, PhD
Brian_koehler@psychoanalysis.net
I just returned from the Baltic Countries and spent some
212-533-5687
time in Estonia and the majority of time in Lithuania. I
Philadelphia: Harold Stern, PhD
lectured and trained students and professionals in both countries
hstern@mail2.gis.net
and found that they were hungry for information and training.
610-949-9339
However, they are unable to pay what most professionals who are
San Francisco: (reorganizing)
Southern California: Martin Cosgro, PhD
qualified to give that training want for their services in terms of
mcosgro@charter.net
payment.
805-547-0419
I want to inform the membership of ISPS-US that we
have a website that has been in existence for the past several
Honorary Board Members
months. We are in a position to continue the process of
Gaetano Benedetti, MD
educating ourselves and others, a process which should never end,
Joanne Greenberg, DLH, author of I Never Promised You
and also provide information to professionals who are not
a Rose Garden
members of the organization and other individuals who need help
Harold Searles, MD
and direction.
For more information about ISPS-US
The ISPS-US website has important features to
Please contact Karen Stern, MAT, Executive Director
it. There is room for many more Articles, Announcements
karen.s.stern@earthlink.net • www.isps-us.org
and Recommended Books. If you look at the Home Page, you
610-308-4744 (voicemail)
will find a list of categories that are very important to assist you
in presenting your information.
ISPS-US is a 501(c)(3) nonprofit organization.
I believe that there are many members who have papers
6
ISPS - US Newsletter
Internet Drop-Ins
could help her. It was a good prognosis that she was able to
settle for what contact we could have and see what that
might do. After e-mail and phone contacts, she came to
Michael Eigen, PhD
New York City for several meetings. She looked stronger
New York University Postdoctoral Program in and clearer than I expected, although her face was stiff,
Psychotherapy and Psychoanalysis
mouth semi-frozen, with semi-constricted affect. It was
clear we could not work together, that only sporadic
Over the past few years, the number of people consultations were possible. I have no time and she lives
contacting me for help on the internet has increased elsewhere. The meetings were for their own sake and
dramatically. I'm aware there are intricate ethical issues, anything they generated.
but where I feel I can respond in possibly helpful ways, I do
-- or try to. All of these individuals have faced major
For its own sake -- a very important experience.
suffering and some struggle with psychosis.
Like finding her self-feeling when she read my book. A
kind of gratuitous grace, a happening. Not a manipulation,
What I have learned is that brief contacts can be not figuring cause-effect. More a spontaneous
helpful, as part of long term work. The long term work can psychospiritual opening. Not something one can plan or
take many forms, including ongoing or intermittent therapy, predict or make happen.
church groups, day treatment centers, community support
networks, peer groups and recovery groups. I've come to
Finding her self-feeling did not cure her psychosis
believe that long term commitment to work on oneself is and did not last. It came and went. But she now knew that
necessary, whatever form it takes. What has taken me what she was going through was not irreversible. She got
longer to learn is the value of consultations and short term a taste of affective resonance, having experience validated,
contacts.
and an orientation that valued subjectivity. Previously, the
best she could do was hear that she had a biological disease
There are many stories to tell, but I must confine that medication should control, a chemical imbalance that
myself to a bit of one in this brief communication, perhaps pharmacology might correct. Sometimes she felt better,
more in future issues. It is about one person, but carries sometimes worse with medication. But the threat was
weight beyond itself. She is a twenty-three year old woman always there, that she would go under without it. On her
who suffered her first breakdown at eighteen and has been first e-mail contacts and the first minutes I saw her, she
hospitalized four times since. This young woman began insisted there was nothing in her background to explain her
hearing voices and having visual hallucinations in college. breakdowns. She had a happy childhood, loved by parents,
She felt people were talking about her, saying bad things, many activities. By the end of our second meeting, she
sometimes words of great praise. Cosmic visual spoke about constant fights between parents, wrenching
hallucinations offered ordeals, challenges, tests of courage, separations, how much they put her and life down. A bitter
hardship, messianic strivings, dreadful and impossible attitude drenched her home. Pain of childhood transferred
choices. She has had no psychotherapy. All her treatment to boarding school: she feared she was always about to be
has been medical. She came from a hard-working family criticized and whipped herself to perform. The trail of
with meager means. Out of her own initiative, driven by a trauma began early and was covered over as long as
wish to escape a suffocating life, she won scholarships to a possible. Medication enabled her to continue the cover.
competitive boarding school and then college. She hated When I saw her, I realized she waited a long time to tell a
boarding school, taxed to her limits, felt unwanted by different story. No one had spent this kind of time,
privileged others, did not fit in. In college, she felt she speaking in a slow, respectful, thoughtful way about her
could breathe, made friends for the first time, looked feelings and the states she underwent. At first she asked --
forward to studies. The world, finally, was opening.
many times -- if this would go away, if she would ever be as
It was then she began feeling numb, losing her whole as she was before. I gave her a long term
feelings, not feeling herself. The sense of self-loss was so orientation, not knowing what would happen. Some people
great she went to the university clinic, where she was put do get better completely. Some people are transformed and
on an anti-depressant. Her mood improved, but loss of I-
reach creative dimensions of living. Some learn to make do
sensation continued. After a few months, she felt the with varying states, taking the bad with the good in a larger
medication made her jittery, kept her up nights, agitated. life. Some must manage longer on the edge. There was no
They gave her a higher dose of another anti-depressant and way to know how far she would go or what form getting
in weeks she was hospitalized, the first of a series, with better might take. But, I assured her there was more to go.
regimes of anti-psychotic meds. Why did she seek me? She
By the end of two meetings, she no longer insisted
stumbled on The Psychotic Core in the university library and that her early life and "pre-breakdown" personality were
felt a simpatico resonance. "I recognized what I was going unproblematic, that she had to be problem free in order to
through in your descriptions. While I was reading, I felt be OK. She understood that she could keep growing no
myself again. I saw me, felt me." She began to wonder if matter what she went through and that the work ahead
there was another way, another treatment she was missing. would take a long time. She felt much better.
She looked up writings of mine on the internet, where my
e-mail address is posted, and screwed up courage to get in
We scanned the Internet for programs and contacts
touch. Her approach to me was a bit messianic, convinced I in her area that might be useful. Within a few months she
ISPS - US Newsletter
7
was part of a spiritual healing group and a peer self-help
(2) One never knows where life will come from.
group set up by a social worker who offered therapeutic Nina recognized her shattering and dying in my book. For
contacts. She entertained the idea of going into weekly or her the latter was a mirror that awakened her sense of self.
bi-weekly therapy with her. So, at least, a new process had Just coming into contact with a living sense of what one
begun. At last she had a chance to speak her truth and goes through can be enlivening and seed hope. Nothing in
share herself with people.
her condition changed by reading or seeing me. But she
Learnings and affirmations: (1) Any contact one has became more ready to undergo and transcend it.
may be an opening for a person. One doesn't know,
positively or negatively, what leads to what. Simple things Editor’s note: Mike Eigen’s The Psychotic Core is now
one takes for granted, may open worlds for another being reprinted by Karnac Books and will no longer be
individual. Don't put down or minimize what you have to with Jason Aronson. This is also so for Psychic Deadness
offer just because it isn't everything or something else. and The Electrified Tightrope.
Rage and The Sensitive
Feeling inadequate in face of immense processes is no Self are published by Wesleyan University Press.
excuse for not sensing your way into whatever you can
e
sense.
Culture-Bound: The Transgenerational Transmission of Trauma
Eve Huynh
Two weeks ago Mrs. X asked me to help her solve a year-old child on a tree and left it overnight in the mountain. It
personal problem. Mrs. X had refused to visit her father even was his deep conviction that if it survived the night with ghosts
when he had been hospitalized for cancer. She said, “I hate him, and snakes and tigers, then she would never fear neither darkness
but I know if I don’t go, sooner or later I’ll become screwed-up.” nor death again.
She attempted to solve the problem by writing him a seven-page
letter. The letter catalogued his many sins against her. She
Growing up in America, having studied great science and
insisted that unless he confessed his sins, there would be no advanced technology, it was easy for me to believe that my
possibility of reconciliation. Her father was seventy-five years Americanized love was far more superior than that primitive love
old.
of my parents. I standardized, legalized, and labeled love like
products on a shelf. I let my desire for justice -- an eye for an eye
Reading Mrs. X’s letter, I saw a little girl walk down a -- hinder my compassion. I followed quickly and failed to
dark alley with both sleeves soaking in tears. She called out her recognize my own culture-bound voice.
brother’s name but wished that he would not answer. For at
home her father was loading a gun and was ready to put the
I can choose to abandon my parents now, for I no longer
bullets through her brother’s head. I saw a mother who sat there need them. Quite the reverse, they are old and weak and they need
like a statue. She watched the gun rise to her son’s head. I was me. I can hold the rods but that won’t heal the wound in my
seven years old.
heart. Harboring revenge has long prevented me from seeing the
hands that had dug up the dirt to plant the maniocs that I ate.
There is a Vietnamese saying that goes like this: Shirts True, putting food on the table does not give my parents the right
are not to be worn over the heads. Children (shirts) are to obey to abuse their children. But being grateful and understanding my
and parents (heads) are always right. Had we still lived in heritage will enable me to forgive and bring me closer to
Vietnam, this issue of child abuse would have been dismissed. It reconciliation. Reconciliation may give my parents a chance to
would have been disgraceful just to bring it up. But we were now
see the scars which they had inherited and passed on to their
in the United States with liberty and justice for all. Should we children.
demand “justice?” The answer for me was no, because that would
not serve the purpose of reconciliation.
Now and then, when I take my children to visit my
father in New Jersey, I would bring some barbecued squids. He
To ask my parents to admit that they were wrong would would shred the squid for my five-year-old daughter, and as we eat,
be asking them to spit on their ancestors’ graves. When they he would tell her about the first time he had helped me catch a
grew up, rods were their daily rice. Rods filled their bodies with shark twice my size. My father's eyes would glow and I could see
wisdom and so rods became love. Love broke bones and left that he has felt love without rods. The vicious circle of abuse
scars. Such was the love that passed from generation to ends with me. Hate and hurt will not have the chance to wound
generation and built the foundation of my culture and family. my children -- that's more important to me than his admittance of
Instill fear and you shall have obedient children. Obedient guilt.
children produce a harmonious society. I believe that my father
e
was convinced that he did the right thing when he hung his five-
8
ISPS - US Newsletter
Comments on the Keynote: John Strauss' “Subjectivity
in Psychiatry: How Can We Do Better?”
Grace E. Jackson, MD
The keynote lecture at the 5th annual meeting of ISPS-US through understanding. Such a form of healing places an absolute
was delivered by Dr. John Strauss. Entitled “Subjectivity in priority on understanding others, as if we could step for a moment
Psychiatry: How Can We Do Better?” the presentation featured the into their skin.
personal insights of one of the world’s leading investigators of the
schizophrenias.
Reflecting on discoveries which he has made through years
of psychiatric practice and academic research, John’s lecture featured
I first met Dr. Strauss in the winter of 2000, when I was a variety of lessons culled from a number of professional and
still mired in a Navy practice setting which demanded my allegiance personal vignettes.
to a medication-check surreality. For a variety of reasons, my
military existence became unbearably corrosive to my soul. In the Lesson #1: Abandon the medicocentric.
depths of my misery, Brian Koehler reached out to me: do you
John opened his discussion with an anecdote from his
know the work of John Strauss?
research experience. He revealed his confusion about how to react to
an interviewee who had stopped participating in mental health after
Several serendipitous connections later, as I was seated in care. Expecting the worst, and needing to record the status of this
my Bethesda work place one day, a Connecticut area code flashed individual for research posterity (stable, improved, or deteriorating),
across my pager. I was shocked to discover the voice of John John divulged his private reflections: “schizophrenic, staying home in
Strauss on the receiving end of my return phone call. He graciously apartment, limited contact with others, socially withdrawing, illness is
invited me north for a visit, and I immediately accepted. During a worse...” Several moments into the interview, the patient revealed
subsequent sojourn to New England, I enjoyed unfettered access to that he had grown too busy to attend therapy. He had become an
the gentle wisdom of his mind and soul (meanwhile, he endured the active assistant to his landlord, helping with gardening and assisting
unbridled fury and confusion of my own). In that first contact, we less able tenants with their maintenance problems or other needs. Far
dialogued like college roommates for many hours, conversing and from having deteriorated, the patient had demonstrated something
sparring about the many mysteries of the human condition. The which few providers dare to contemplate: he had had the audacity
day was capped by the perfections of French-pressed coffee and to improve without them. This particular experience impressed John
cheese fondue.
with the lunacy of a medicocentric approach to healing. Patients
often know what they need in order to improve, and the provider’s
Three years later, I have had the privilege of a second treatment plan may not be the only part of it. The experience
contact (sans coffee and fondue). John Strauss was recently taught John to ask his patients: is there anything you do to help
introduced at the ISPS-US conference as a preeminent American yourself?
psychiatrist, but this is only partly true. For much of his life, he has
lived a split existence -- spending many weeks each year since Lesson #2: Patients reveal themselves differently to different
adolescence as an expatriate (inpatriate?) to France. I cannot help providers.
but feel that these twin personae have considerably shaped John’s
Drawing again from his work as an academic researcher
capacity to understand alienation (alien nations). Indeed, it was the who performed longitudinal assessment interviews with persons
feeling state that emerged from reading two of his French papers that suffering from schizophrenia, John shared his perception that many
expanded my appreciation of the psychological impact of context patients seemed to feel free to reveal elements of their experience
(e.g., language and culture). As the Post-Structuralists and with him, which they would not share with their regular providers.
psycholinguists have long realized, our way of being in the world In his lecture, John appeared to attribute this phenomenon to the
powerfully determines the kind of world we ultimately perceive. different obligations or responsibilities assumed by the research
This perspective necessarily leads to an appreciation of subjectivity, interviewer, versus the regular clinician. Deeply disturbed by the
and to uncertainty about the existence of universal, fixed, external implications of this notion -- namely, that an uninvolved interloper
realities.
might have access to “truths” which the patient would not
communicate to the deeply entrenched provider -- I asked John to
It has taken me time (and more serendipitous connections) explain this tension after the lecture. I wondered if the additional,
to discover the work of phenomenologists (such as Brentano, or different, information that he felt he acquired as an intermittent
Husserl, Bergson, Merleau-Ponty, Prouty). Despite the limitations of observer might be equivalent to the privileged status experienced by
my own training and experience, I feel justified in associating the grandparents relative to parents. John had no clear answers to my
work of John Strauss with the reflections of the most creative question, but conceded that it was possible that as a research
thinkers. The keynote lecture’s title -- Emphasizing Subjectivity -- clinician, he may have enjoyed the privileges of functioning as a
captures the inner spirit of a man passionately devoted to healing “super grandparent.” It seems probable to me now that John’s
ISPS - US Newsletter
9
experience demonstrates the effects of interviews conducted in the
John shared a second vignette which communicated a
presence of transferential (and countertransferential) processes of similar insight. Whenever possible, he has found it helpful to vary
varying intensity and duration.
the therapeutic setting (e.g., walking, eating together, shopping).
He recalled a visit to an IKEA furniture store, accompanying a patient
Lesson #3: Follow the patient’s agenda and priorities.
who had conveyed an interest in making a purchase there. Despite
John disclosed some discoveries which emerged from role his linguistic prowess (the event transpired in France, I believe), John
playing. He discussed several interview portrayals shared with a close remembers feeling overwhelmed by the store’s gargantuan
friend and colleague, in which he (John) had assumed the role of proportions. When he asked for staff assistance (an overt concession
paranoid schizophrenic. John emphasized his personal feelings of of his own limitations), he recalls that his patient’s symptoms seemed
rage and withdrawal during the process of being on the receiving to fade. This was another lesson into the contextuality of psychotic
end of a scheduled interview that reduced his experience to a experience, and the fact that patients are not always as ill as we
checklist of permitted symptoms. In one role play, John had imagine or intend them to be.
fabricated an entire personal history, complete with the acquisition of
a new job (he had recently been “hired” by a local McDonald’s). Lesson #5: Listening lies at the center of healing.
When the interviewer displayed no interest in his real life experiences,
If it is true that attunement lies at the core of healing, then
John shut down completely. The role play painfully illuminated the John Strauss offered several approaches to expanding this essential
advisability of following the patient’s agenda, rather than one’s own.
capacity. One technique he described was based upon his experience
of “listening to voices.” He commented upon the discoveries which
John next mentioned the histories of several patients, who emerged from wearing a walkman for a day, while a tape cassette
had made significant progress once their first children were born. played pre-recorded voices (auditory hallucinations). John spoke of
When asked in assessment interviews what had happened to trigger the impossibility of attending to anything other than the voices
recovery, these patients had emphasized the fact that their conditions (such as locating a good movie in the local newspaper) -- even
had changed because they had “needed to be well” for their infants. though he could reach down and stop the tape at any time. The
While such recoveries and motivations are surely not universal or experience strongly reinforced how hard it is for psychotic clients to
common, I believe that John offered them to underscore the concentrate or function, when they under the distracting and
importance of not forgetting that our patients have lives, too. seductive influence of internal stimuli.
Simply stated, our clients need not be defined by our ideas about
how their conditions must limit them. Perhaps as an outgrowth of
In closing his address, John spoke admiringly of the
these perceptions, John has found it helpful to ask each patient how interviewing skill of James Lipton -- the host of the TV program
the illness experience has affected his or her life. (Another way of “Inside the Actor’s Studio.” He emphasized Lipton’s capacity to
“hearing” this might prompt us to inquire about how the illness listen. John moved on to relate the story of his personal struggle as
experience has affected each person’s life.)
an artistically-challenged human. He referred to his childhood
attempts at illustrating the perfect tree. At age 5, his art work was
Lesson #4: Context determines reality.
considered fairly capable. By age 12, he drew the tree the same
John proceeded to tell a story from his clinical practice. He way. His art work was considered acceptable. In his early 20s, he
described the problems of a patient, troubled with the symptoms of still drew the same tree. Now, his art work had become an
a borderline psychosis. Due to the severity of this individual’s embarrassment. John eventually summoned the courage to pursue
condition, she had been confined to the hospital and placed on ward art instruction. He enrolled for a beginning course in drawing,
restrictions. One day during treatment, the patient approached where his teacher encouraged him to stop drawing pre-conceived
John with a special request: could she leave the hospital each day, notions of any ideal (stereotypical) tree. Instead, John was
to participate in a drama production at a church across the street? instructed to focus on the spaces in and around the limbs and leaves.
Every staff member told John that this was neither advisable, nor For the first time in his life, his hand captured the essence of what his
allowed. Despite their negative reactions, John arranged to have the eyes could see, and he reproduced his first real tree.
patient chaperoned and consented to her wish.
John closed his lecture with this metaphor, in order to
Some weeks later, John sat in the audience. Amazingly, his demonstrate an approach to receiving others more authentically. If
problem patient was the star of the show. At the end of the we listen only for the pre-conceived notions to which we expect
performance, the director appeared on stage with the cast members, others to conform, we may never hear anything real. If we learn to
praising John’s patient as the “glue” that had had held the ensemble listen through the spaces, though, we may allow our ears and souls
together. The experience epitomized the contextuality of illness. to become more fully opened. In that process, we might evolve as
Moreover, it demonstrated the curative potential of certain kinds of John did -- assuming the role of mature artist, who finally captures
rule breaking. If the provider cared about the patient so much that the authentic images of each client's subjective reality.
he was willing to accept the consequences of breaking certain rules
[borderlines are not supposed to leave the hospital], then the patient
e
may have received the message that she was worthy of a higher level
of self-care.
10
ISPS - US Newsletter
Panic: Have We Lost Our Minds? (Letter to The New York Times)
Brian Koehler PhD
New York University
In a recent article “Panic Spells Are Traced to Chemical Roose and Robert Glick’s Anxiety as Symptom and Signal
in the Brain” by Anahad O’Connor published in the science published in 1995 by The Analytic Press
section of the NY Times on 1/27/04 the error of not adequately
differentiating cause from correlation was made. In particular, the
Panksepp and colleagues (1988) demonstrated that
author espoused a Cartesian perspective of brain separate from stimulation of neural areas that produce the “separation distress
mind and experience. There was a striking neglect of a robust call” also produces symptoms of panic, e.g., hyperventilation. It
research literature on developmental psychobiology
is widely known in molecular biology that a number of
demonstrating the massive effects of experience (e.g., separation environmental inputs, including sensory inputs, medications,
distress, trauma, etc.) on CNS structure and function. The author psychological stress, learning (including psychotherapy), can lead
noted reductions in 5HT1A (serotonin) receptors in three neural to a biological cascade leading to the synthesis of various
regions. Yet, it is widely known by neuroscientists that proteins (including neuroreceptors) as a result of transcriptional
downregulation of receptors occur during excessive and translational processes involved in the trans-synaptic
neurotransmission of a host of neurotransmitters, including 5HT regulation of gene expression (see Hyman & Nestler The
(see Stephen Stahl’s Essential Psychopharmacology: Molecular Foundation of Psychiatry published by American
Neuroscientific Basis and Practical Applications: Second Psychiatric Press).
Edition published in 2000 by Cambridge University Press)
which takes place during stress/anxiety. This has been
To the author’s credit there was a suggestion that the
capitalized on by pharmaceutical companies in drug development, depletion of 5HT receptors could be the result of the disorder
e.g., the SSRI’s. Dennis Charney, chief of the mood and anxiety rather than the cause. However, the emphasis is on a primary
disorders research program at NIH, was quoted as saying: “Panic neural causation of panic disorder. The average, uniformed
disorder is due to a specific abnormality in the brain, not a reader, would certainly be led to interpret their symptoms of
weakness of character.” Unfortunately, opposing neural causation panic, anxiety, sadness, etc. as being “caused” by a brain
with “weakness of character” is a loaded, forced choice option. disorder. This reductionistic trend in our ‘mindless’ psychiatry,
What about other explanations, e.g., anticipatory separation to my way of thinking, is ethically as well as scientifically
distress? Research, that Charney himself participated in, suspect., in that it can potentially lead patients away from
demonstrated that perceived, threatened, or actual separation may effective forms of treatment, e.g., psychoanalytic therapy, CBT,
precede the onset of panic (Charney & Heninger, 1986; Breier, etc., for anxiety disorders. For an excellent summary of the
Charney & Heninger, 1986). Gorman, Papp and Coplan (1995) effects of anxiety/stress on the brain see New Frontiers in Stress
suggested: “...that very early traumatic events, especially insecure Research: Modulation of Brain Function edited by Aharon Levy
infant-parent attachment, may produce neurobiological changes et al in 1998 for Harwood Academic Publishers.
that ultimately lead to panic susceptibility” (p. 52). Non-
Brian Koehler, PhD
reductionistic perspectives on panic and anxiety can be found in New York University e
many psychoanalytically oriented sources, including Steven
Face to Face with Children: The Life and Work of Clare Winnicott
Edited and Compiled by Joel Kanter
Soft cover / 350 pages / ISBN:1855759977 / £25.00 Eur 37.50 $35.00 • Available at karnacbooks.com
This book presents the life and work of one of the leading British social workers of the 20th century. The
wife of Donald Winnicott, an analysand of Melanie Klein, a wartime innovator in helping evacuated children, a
teacher and mentor to a generation of British social workers and a gifted psychoanalyst, Clare Winnicott's life
encompassed a remarkable richness of relationships and accomplishments.
“Joel Kanter has edited for us mental health professionals a most important and timely book. Its focus is on the
thinking and practice of Clare, whose original profession was social work, and the story of the mutual influences
between her and Donald Winnicott, the medical analyst who became her husband. It is as though Clare and
Donald began a dialogue that has grown in volume and intensity, and out of which both professions may broaden
and deepen in knowledge and therapeutic competence.” Jean Sanville, Ph.D., Training Analyst, Los Angeles
Institute and Society for Psychoanalytic Studies; Founding Dean, California Institute for Clinical Social Work
“Joel Kanter has woven together so many diverse events, ideas, tasks, achievements that are all part of Clare’s life,
and at the same time he has managed to depict the essential inter-relationship between Clare and Donald which
kept the importance of playing and enjoying each other’s company as the context within which the struggles of
their lives took place. I am grateful to him.” Pearl King
ISPS - US Newsletter
11
Medication and Psychotherapy: Part 2*
[Editor’s Note: This is part 2 in a 2-part series.]
Wilfried Ver Eecke, PhD, Georgetown University
*This paper is extracted from Phenomenology and Lacan on Schizophrenia, after the Decade of the Brain by Alphonse De Waelhens
and Wilfried Ver Eecke. Leuven. Leuven University Press, 2001.
The Michigan State project developed a research
The findings at 20 months were that the patients of
design that was free of the major defects of the California the psychotherapy group had 31 to 51% less hospitalization
project. 1/ In the Michigan project there were no reluctant days, and had less thought disorder than the control group
therapists. The two supervisors were therapists, using medication only and the patients of the experienced
experienced in the treatment of schizophrenic patients, therapists had improved more than the patients of the
knowledgeable of the subculture of the patient group (inner-
trainees (Ibid., 430-3).
city of Detroit), and known to their colleagues to be
clinically efficient (Ibid., 396) . They trained and closely
Karon and VandenBos confirm their conclusion that
supervised their trainees. The study also differentiated the psychotherapy is more helpful than medication alone by
impact of the experienced therapists from that of the quoting the results of a Wisconsin and a Massachusetts
trainees (Ibid., 448, 455). 2/ The Michigan project study that reported more hospital days for patients on
included a test (the Feldman-Drasgow Visual-Verbal Test, medication than psychotherapy patients the year after
abbreviated as VVT) specifically designed to measure termination of therapy (Ibid., 440). They reconcile the
schizophrenic thought disorder, which according to Bleuler apparent contradiction between their findings and those of
is the primary symptom of schizophrenia. The Michigan the California study as follows: “The California project has
project used the VVT test both as a major index of imputed little to say about the effectiveness of psychotherapy, with or
deep-structure improvement of the patient and as a predictor without medication. It does answer the question: ‘Is
of long term condition as defined by other measures such as psychotherapy provided by inappropriately trained but
hospitalization days (Ibid., 431). 3/ Improvement was medically qualified residents of much use?’ The answer is
measured at preset times (6, 12 and 20 months) not at time ‘no.’ The Michigan State Project asks the question: ‘Is
of discharge which is presumed to bias against measurement psychotherapy provided by appropriately trained
of improvement caused by psychotherapy.
professionals (psychiatrists and psychologists) useful?’ The
answer is ‘yes.’ The fact that the trainees in the Michigan
The findings of the Michigan study after 6 months State Psychotherapy Project really did learn to do
were that in comparing the hospital group, called Group C psychotherapy effectively, as evidenced by the actual
(treated with medication), with the combined psychotherapy progress of their patients during the project, clearly
groups (Group A was treated psychoanalytically without indicates that psychotherapy with schizophrenic patients is a
medication; Group B used ego-analytic therapy with skill that is both teachable and learnable” (Ibid., 460).
adjunctive medication progressively decreased; both groups
used about 70 sessions over a 20-month period) (Ibid., 391,
Having argued that medication only is not the
399), psychotherapy contributed little (Ibid., 425).
treatment that produces the best results for schizophrenics,
However, if the psychotherapy group is subdivided between do the authors of the Michigan Project advocate
experienced and inexperienced therapists, then the patients psychoanalysis or psychotherapy only? They do not.
of the experienced therapists did significantly better than Rather they provide arguments for a dualist approach by
the patients of both the inexperienced therapists and those writing: “It would be a mistake to cite our position as
of the hospital group treated by medication (Ibid., 425) as objecting to all uses of medication. Medication is better
measured by both thought disorder tests and days of than no treatment at all, and it may even be better than
hospitalization (Ibid., 423, 425).
treatment provided by inappropriately trained and
unmotivated therapists. As an adjunct to psychotherapy, it
The findings after a twelve month period were: the may be helpful to some psychotherapists in the beginning of
pooled psychotherapy patients were hospitalized less, treatment, or as an adjunct to weather a particularly
exhibited less thought disorder (VVT test), and are judged to upsetting crisis” (Ibid., 436; also 209-10).
be functioning healthier (Clinical Status Interviews
abbreviated as CSI) than the hospital patients treated by C. Importance of psychoanalysis or psychodynamic
medication. Looking specifically at the patients treated by approach to severe mental illness.
inexperienced psychotherapists (trainees), the authors noted
One statistical result in the Michigan study not
imbalanced improvement of these patients as a group. pointed out by the authors is that the VVT statistic
Indeed, patients of A’s trainees had longer hospitalization (measuring thought disorder) and days of hospitalization
and much improvement in thought disorder; whereas (corrected for male/female difference) indicated a greater
patients of B’s trainees had much less hospitalization but efficiency of the approach by Supervisor A (psychoanalytic
their thought disorder remained similar to that of the therapy) than the approach by Supervisor B (ego-analytic
control group C treated by medication (Ibid., 428).
Continued on Page 12
12
ISPS - US Newsletter
Medication and Psychotherapy, continued
psychotherapy at least four times a week” (Blatt & Ford
approach) after twelve and twenty months of treatment and 1994, 197). According to DSM-IIIR diagnostic
in the two year follow-up study.
“approximately 20% (n=29) of the sample were considered
psychotic, 70% (n=50) as severe personality disorders
Notwithstanding the success in the Michigan study (including borderline and narcissitic disorders), and 10%
of psychoanalytic oriented psychotherapy in Group A, many (n=11) as primarily depressed” (Ibid., 32). Blatt and Ford
remain still skeptical about psychoanalysis because it is conclude that evidence for significant progress in these
difficult to create valid empirical studies about patients was observed in systematic and reliable ratings
psychoanalytic treatments. Fisher and Greenberg write in made on clinical records...and on variables independently
their book Freud Scientifically Reappraised: “In fact, there is derived from several different types of psychological
no study of psychoanalysis as a treatment that cannot be assessment procedures (i.e., Rorschach, Thematic
dismissed because of seriously contaminated or compromised Apperception Test [TAT], human figure drawings, and
data” (Fisher & Greenberg, 201). Rolf Sandell and his co-
Wechsler intelligence tests)” (Ibid., 197; 149-57 for the
authors of the Stockholm Outcome of Psychoanalysis and statistics).
Psychotherapy Project, however, write: The requirements
of this [Fisher and Greenberg’s] gold standard is that
The progress took different forms for two different
patients be randomized to treatment groups, either categories of patients--anaclytic versus introjective ones
comparative therapy groups or to a therapy group and a (Ibid., 201).1
non-treated group, and that the ensuing treatment should
be strictly controlled and monitored, so that one may be sure
In a second article, surveying a wealth of research,
that the treatment in question was really delivered the way Blatt distinguishes between anaclytic forms of
it was intended to. This in turn requires a thorough psychopathology (nonparanoid schizophrenia, borderline
standardizing training of therapists in adhering closely to a personality disorder, infantile--or dependent--character
therapy manual. Unfortunately, it will never be possible disorder, anaclitic depression, and hysterical disorders) and
for an outcome study on psychoanalysis to be conducted so introjective pathologies (paranoid schizophrenia,
as to satisfy these requirements. This is not only a matter overideational--or guilt-ridden, self-critical--borderline
of the fact that psychoanalysis could not ever be manualized personality disorder, paranoid and schizoid personality
without ceasing to be psychoanalysis or that psychoanalysts disorders, obsessive-compulsive disorders, introjective--guilt-
in general could never be expected to accept being ridden--depression, and phallic narcissism) (Blatt 1995,
manualized, in any case. It is also a matter of the fact that 1013). The anaclytic disorders involve exaggerated concern
such degrees of control are inevitably impossible for such with interpersonal relations and use “avoidant defenses
long durations as are typical of psychoanalysis. Not only ranging from withdrawal and denial to repression to cope
would we have to control the practices of analysts for years; with psychological conflict and stress” (Ibid.). The
if we had a non-treatment control group, we would also introjective pathologies are overly concerned with autonomy
have to control the adherence of the non-treated patients to and control and “primarily use counteractive defenses (e.g.,
this condition. Or, if we had a comparative treatment projection, rationalization, intellectualization, doing and
group, we would have to enforce that the patients stayed in undoing, reaction formation, and overcompensation)”
their respective therapies during the whole trial, let alone (Ibid.). Blatt argues that a dialectic between those two
that we would have had to enforce their compliance with strategies is necessary in human development. This remark
the randomized treatment assignments to begin with. That hints at a profound reason for dealing with the psychic side
is not a realistic plan. Patients actively seek out their of the treatment of mentally ill people: developmental
therapies, interrupt those they are not satisfied with and balancing acts that were not performed or were performed
seek other, new ones. So, as some scholars argue...self-
badly need to be allowed to occur for the first time or need
selection is part and parcel of psychotherapy and to be allowed to be redone and corrected.
psychoanalysis, not only to begin with but all the way
through, that is, in choosing to stay in treatment, to go to
Blatt further reports that introjective pathologies do
today’s session, day after day (Sandell et al. 1998, 1-2).
not respond as well to brief pharmacological and
psychological outpatient treatment for depression [the
If one cannot provide empirical proofs, that meet specific illness upon which the article is focused, using
the “gold standard” of empirical research for the usefulness however generalizable arguments] as other patients do.
of psychoanalysis, it does not mean, however, that there They do better than other patients in long-term, intensive,
are no empirical proofs at all. Studies by Blatt and his co-
psychodynamically oriented therapy. Furthermore, a
workers provide evidence, first, of the therapeutic efficacy of reanalysis of the data of the Menninger Psychotherapy
psychodynamic treatment of severely disturbed young adults Project (MPRP) indicated that introjective outpatients made
and, second, of the greater efficacy of psychoanalysis in the significant greater therapeutic gain in intensive (5 times
treatment of one group of patients. In a first publication, 90 weekly) psychoanalysis than in long-term, twice weekly)
patients at the Austen Riggs Center, Stockbridge, psychotherapy. .... Their therapeutic gain in psychoanalysis
Massachusetts, were studied at admission and some 15 was also significantly greater than was that of anaclitic
months later, having received during the interim period patients who were also treated in psychoanalysis (Ibid.,
“psychodynamically informed treatment, including
1015).
ISPS - US Newsletter
13
Thus at least in some cases there is indication that Psychotherapy and Psychoanalysis Project (STOPPP), Geilo,
psychoanalysis is more effective than other forms of Norway, June 25-29.
psychotherapy. This is confirmed in one of the reports from
the Stockholm Outcome of Psychotherapy and De Waelhens, A., & Ver Eecke, W. (2001) Phenomenology
Psychoanalysis Project. In that report one studies the and Lacan on Schizophrenia after the Decade of the Brain. Leuven:
“capacity to prevent the return of symptoms after treatment” Leuven UP.
rather than “the sheer reduction of acute symptoms”
(Blomberg, 1). The report documents that both Fisher, S., & Greenberg, R. (1996). Freud Scientifically
“psychotherapy and psychoanalysis produce highly stable Reappraised. New York: Wiley.
effects” (Ibid., summary), but “patients who--for whatever
reason did not undergo the recommended psychoanalysis Gabbard, G. ). (1997). More is more. Review of Sidney J.
were significantly worse off than patients who did not Blatt and Richard Q. Ford. The Therapeutic Change. An
undergo the recommended psychotherapy” (Ibid., 3). Object Relations Perspective. Contemporary Psychology,
Stability means that the patient did not fail a Clinically 42(12), 1103-04.
Significant Outcome (CSO) once he had achieved the CSO
in one of three measurements at 12 months interval (Ibid., Kafka, J. S. (1990). On the question of insight in psychosis.
1). A clinically significant outcome was defined as scoring In A. S. Silver & Cantor Morton B. (Eds.), Psychoanalysis &
“better on the SCL-90, Social Adjustment Scale and the Severe Emotional Illness (pp. 18-28). New York: The Guilford
Sense of Coherence Scale, than the worst or lowest scoring Press.
10% in a norm group consisting...of psychology students and
a random community sample” (Ibid., 2). If psychoanalysis is Kaplan, H. I., & Sadock, B. J. (1995). Comprehensive Textbook
in some cases the treatment of choice, then the therapeutic of Psychiatry. Vol I-II (Sixth). Baltimore: The Williams &
community can benefit from a dialogue with updated Wilkins Company.
psychoanalytic theory.
Karon, B. P. (1999). The tragedy of schizophrenia. The
Conclusion
General Psychologist, 34(1), 1-12.
In this paper I have reported some shortcomings of
medication. I have argued in favor of a dualist approach in Karon, B. P., & VandenBos, G. R. (1981). Psychotherapy of
the treatment of mental illness in which psychoanalysis Schizophrenia. The Treatment of Choice. New York: Jason
could be either the secondary or the primary approach. Aronson.
Finally, I have argued that there is scientific evidence, both
in the form of statistics and in the form of arguments, that Loeb, F. F., & Loeb, L. R. (1987). Psychoanalytic
psychoanalysis or psychoanalytically inspired psychodynamic Observations on the Effect of Lithium on Manic Attacks.
approaches are superior to other approaches.
Journal of the American Psychoanalytic Association, 35(2), 877-
902.
REFERENCES
Apollon, W. (1990). Psychanalyse et traitement des Sandell, R., Blomberg, J., Lazar, A., Schubert, J., Carlsson,
psychotiques. In W. Apollon, D. Bergeron & L. Cantin J., & Broberg, J. (1998). The importance of time in
(Eds.), Traiter la psychose (pp. 77-110). Québec: Grific.
treatment and follow-up. Long-term outcomes of
psychoanalysis and long-term psychotherapy in the
Awad, G. A. (1995). Quality-of-Life Issues in Medicated Stockholm Outcome of Psychoanalysis and Psychotherapy
Schizophrenic Patients. In C. L. Shriqui & H. A. Nasrallah Project (STOPPP). Paper presented by Rolf Sandell at
(Eds.), Contemporary Issues in the Treatment of Schizophrenia conference "Problèmes methodologiques posés par
[Chapter 31.] (pp. 735-47). Washington, D.C.: American l'évaluation des psychothérapies psychanalytiques et de la
Psychiatric Press.
psychanalyse." Organized by l'Association de Psychanalyse
et Psychothérapies, l'Assciation de Santé Mentale du 13ème
Blatt, S. J. (1995). The destructiveness of perfectionism. Arrondissement de Paris et le Département de Psychiatrie
Implications for the treatment of depression. American de la Salpètrière, Paris.
Psychologist, 50(12), 1003-20.
Slater, L. (1998). Prozac Diary. New York: Random House.
Blatt, S. J., & Ford, R. Q. (1994). Therapeutic Change. An
Object Relations Perspective. New York and London: Plenum Vergote, A. (1993). Dépression et mélancolie. In J.
Press.
Florence, A. Vergote, J. Corveleyn, R. Bernet, P. Moyaert
& L. Cassiers (Eds.), Psychanalyse. L'Homme et ses Destins (pp.
Blomberg, J., Sandell, R., Lazar, A., & Schubert, J. (1997). 109-129). Louvain: Peeters.
Stability of Therapeutic Effects in Terms of Relapse-Rate in
the STOPPP-Study. Paper presented at the 28th Annual Warner, R. (1985). Recovery from Schizophrenia. Psychiatry and
Meeting of the Society for Psychotherapy Research. June Political Economy. London: Routledge & Kegan Paul.
26, Panel: Findings of the Stockholm Outcome of
e
14
ISPS - US Newsletter
Column: Mind and Brain
A Theory of the Neural Basis for the Psychoanalytic Perspective on Schizophrenia
Brian Koehler, PhD
As a psychoanalyst who has worked with individuals Daniel Wolpert’s edited 2003 volume The Neuroscience of
with a diagnosis of schizophrenia or bipolar disorder for many Social Interaction: Decoding, Imitating, and Influencing the
years, I became quite impressed with the contributions of many in
Actions of Others published by Oxford University Press) have
our field, colleagues of mine in ISPS, etc., but in particular the opened up an important area of research in their discovery of
work of Gaetano Benedetti (1987) and his younger colleague, ‘mirror-neurons’ in primates. These neurons, some of which are
Maurizio Peciccia (Peciccia & Benedetti 1998). I feel myself in the rostral sector of the ventral premotor cortex which have
fortunate to have the opportunity to dialogue with them about specific histochemical and cytoarchtectonic characteristics and
their clinical work and theories concerning schizophrenic which have been termed area F5, respond when primates see an
psychoses. In particular, their view on impaired integration of other performing a specific action as well as when they do the
separate and symbiotic selves in schizophrenia made a great deal particular action themselves. They are thought to be the neural
of sense to me. In this model, aggression and hate arises from basis of imitation. Studies in humans have demonstrated that
annihilation anxiety secondary to fusion or autistic isolation. As observing an other’s action facilitates the neural pathways the
someone who continues to relate psychoanalytic/
observer would use to perform the same action (applied to affects,
psychotherapeutic observations with affective neuroscience (social this may be a neural basis for the mutual identificatory processes
cognitive neuroscience), I would like to ground Benedetti’s and so necessary to achieve in psychotherapy). Arnold Modell (2003)
my own findings/ theories in current neuroscience research, in pointed out that Vittorio Gallese and Giacomo Rizzolatti, co-
particular contrasting the closed-system model of the brain discoverers of mirror neurons, recently demonstrated that the
articulated by NYU neuroscientist, Rodolfo Llinás (2003), and experience of witnessing pinpricks that an experimenter applied to
what neuroscientists such as Gallese (2003a&b) and Rizzollatti his own finger stimulates the very same neurons as when an
have been discovering about mirror-neurons and their relationship observer receives a pinprick. Modell noted: “The implication is
to the neural basis of empathy and intersubjectivity. I believe the that our brains resonate to the other’s feelings in manner similar
latter research holds great promise to those of us attempting to to how we resonate with the other’s intentional actions...This
formulate a more effective and helpful psychotherapy and research suggests that we use our bodies as a template that
psychoanalysis for persons diagnosed with schizophrenia. I shall enables us to feel our way into the other’s experience. This
begin by summarizing the basic research of Llinás.
supports the contention that the roots of empathy are in the body,
and as with projective identification, this process occurs
Rodolfo Llinás (2003), Professor of Neuroscience and unconsciously” (p. 187). This mirroring system could underlie
Chair of the Department of Physiology and Neuroscience at the the development of empathic attunement (e.g., Benedetti’s theory
New York University School of Medicine, described the brain as a of the therapist’s identification with the catastrophes occurring
reality emulator that is basically a dreaming brain that constructs within the patient) and intersubjectivity. The research of Meltzoff
virtual models of the real world. He maintained that although the (Frith & Wolpert 2003) has demonstrated perception and action
brain receives various sensory inputs, it is also a self-contained (e.g., identification and countertransference?) are not independent
system. Llinás noted: “The closed-system hypothesis...argues for and that the very early capacity of infants to imitate their
a primarily self-activating system, one whose organization is caregivers may have as a neural base this innate mirroring
geared toward the generation of intrinsic images....It follows that system. Along with this immersion in the experience of the
such a self-activating system is capable of emulating reality other is the capacity to distinguish the self from other which
(generating emulative representations or images) even in the neuroimaging studies have suggested is mediated by the right
absence of input from such reality [e.g., hallucinations and inferior parietal lobe. The integration of representing others as
delusions?], as occurs in dream states or daydreaming....This both like me and different from me is fundamental for the
intrinsic order of function represents the fundamental, core establishment of intersubjectivity. This neural viewpoint is
activity of the brain” (p. 57). This state seems to represent the similar to Benedetti’s emphasis on the de-integration of separate
autistic position of the psychotic patient who must ‘down-
and symbiotic selves at the core of the psychotic structure.
regulate’ stimuli, particularly interpersonal, from the world and Gallese (2003a) examined three fundamental aspects of
replace it with solipsistic internal stimuli in the form of self-
interpersonal relationships: imitation, empathy and mentalization
resonance, e.g., hallucinations, as a way of maintaining self-
(intuiting feelings and intentionality in the minds of others and in
coherence and a sense of personal existence. However, Llinás one’s own mind) and has suggested that they all share a common
creates a place for the salience of the environment in his concept basic operative defining a shared interpersonal space: embodied
of the ‘mindness state’ evolving to allow predictive interactions simulation which is pre-reflective, automatic and unconscious
between mobile organisms and their environment.
(Searles and Benedetti’s point on unconscious symbiosis with
Neuroscientists Gallese (2003a&b) and Rizzolatti and others). Gallese hypothesizes that this basic level of embodied
colleagues at the University of Parma, Italy (see Chris Frith and simulation processes enables the construction of a shared
ISPS - US Newsletter
15
meaningful interpersonal space. Gallese noted: “The shared mind, empathy, intersubjectivity, to see the degree of plasticity
intersubjective space in which we live from birth continues to involved in these neural regions mediating empathy and
constitute a substantial part of our semantic space. When we intersubjectivity). I believe that we have a coherent theory of the
observe other acting individuals, and face their full range of psychobiological basis of psychosis if we combine the basic
expressive power (the way they act, the emotions and feelings neuroscience research on the brain as primarily a self-activating
they display), a meaningful embodied interpersonal link is system, one whose organization is geared toward the generation of
automatically established by means of simulation” (p. 177).
intrinsic images (e.g., in dreams), articulated by Rodolfo Llinás
Gallese (2003b) has applied his shared manifold (2003), which articulates the pole of autistic protection and
hypothesis and the neural base of intersubjectivity to the withdrawal from invasive control and colonization by an other,
phenomena of schizophrenia. He noted: “In schizophrenia, self with the research on “mirror-neurons” by such neuroscientists as
and other are not anymore mutually interrelated, but they tend Gallese (2003a&b) and colleagues, depicting the pole of
more and more to diverge and crystalize into segregated, symbiosis and intersubjectivity. Both are essential for
incomprehensible and impenetrable realms. In spite of this lack interpersonal relatedness; however, the more disintegrated they are
of interpersonal relatedness, the self can experience dramatic loss (psychically and in terms of co-opting and “hijacking” neural
of its boundaries...as epitomized by Schneiderian positive systems), the more difficult it is for the patient to establish
symptoms such as thought insertion, auditory hallucinations, and continuous and cohesive embodied subjectivity within the realm
delusion of action control” (pp. 177-178).
of interpersonal relations. Our “job” as psychotherapists with
psychotic patients is to struggle to achieve this within ourselves
Minkowski (1927), like Eugen Bleuler (1911), was as we struggle to achieve this with our therapeutic partners in the
impressed by the nature of schizophrenic autism, the patient’s countless interactions and enactments taking place within the
impaired vital contact with her or his world and incapacity to transitional therapeutic space.
resonate, to establish meaningful emotional bonds with others.
Gallese (2003b) commented on the patient’s difficulties in REFERENCES
establishing a precognitive, intuitive interpersonal bond with an Benedetti, G. (1987). The Psychotherapy of Schizophrenia. NY:
other in schizophrenia.
New York University Press.
Gallese views schizophrenia as a “lack of resonance,” as Gallese, V. (2003a). The manifold nature of interpersonal
an empathic disorder; the shared manifold of intersubjectivity is relations: the quest for a common mechanism. In Christopher
disrupted. This approach emphasizes the relational character of Frith & Daniel Wolpert (Eds.) The Neuroscience of Social
the psychopathology of schizophrenia and therefore “has the merit Interaction: Decoding, Imitating, and Influencing the Actions of
to disclose the possibility to establish a more insightful Others, 159-182. Oxford University Press.
therapeutic bond with psychotic patients” (p. 178).
Gallese, V. (2003b). The roots of empathy: the shared manifold
I believe that the psychoanalytic approach of Gaetano hypothesis and the neural basis of intersubjectivity.
Benedetti (1987) affords us a relational “way-of-being” with a Psychopathology, 36, 171-180.
person with schizophrenia which holds promise in terms of Koehler, B. (2003). Interview with Gaetano Benedetti, M.D. The
establishing the emergence of self from the dual terrors of the Journal of the American Academy of Psychoanalysis and
disintegrated self-states constituted at the poles of autistic Dynamic Psychiatry, 31 (1), 87.
loneliness and pathological symbiosis/fusion. Benedetti and
Peciccia (Koehler 2003; Peciccia & Benedetti 1998), in a series of Llinás, R. R. (2001). I of the Vortex: From Neurons to Self.
papers, have been articulating forms of psychotherapy based on Cambridge, MA: The MIT Press.
their view of the psychotic structure in which the integration of Modell, A. H. (2003). Imagination and the Meaningful Brain.
separateness (autonomy, agency) and symbiosis (relatedness in Cambridge, MA: The MIT Press.
which the patient discovers her or his own boundaries in the Peciccia, M. & Benedetti, G. (1998). The integration of sensorial
relationship and their therapeutic partner outside of the psychotic channels through progressive mirror drawing in the psychotherapy
transference -- which is so palpable in working with these of schizophrenic patients with disturbances in verbal language.
individuals, e.g., recently one of my patients, who has a history The Journal of the American Academy of Psychoanalysis, 26
of paranoid unprovoked violent attacks on others, was convinced I (1), 109-122.
was out to kill him, etc.) has an opportunity to cohere.
I believe I can now state my thesis: we have within our Brian Koehler PhD
grasp a potentially fruitful neural basis for the psychotic New York University
structure, and its amelioration within psychotherapy and other 80 East 11th Street #339
forms of psychosocial interventions, e.g., involvement in a New York NY 10003
therapeutic community, identified by Gaetano Benedetti as well as 212.533.5687
many other psychotherapists working in depth with persons brian_koehler@psychoanalysis.net
diagnosed with schizophrenia (it is possible to study this utilizing
e
fMRI for both partners of an interaction involving theory of
16
ISPS - US Newsletter
Firewalking
ISPS-US thanks our donors!
Grace Jackson, MD
Every contribution counts. We thank you
straining --
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something inside me
screams out against
To $50
the weight of systems gone insane
Anonymous
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each one,
Jessica Arenella, PhD
demanding conformity with
Daniel Basora, PhD
profitable mechanical assaults
Kenneth Blatt, MD
upon objects who have no names and no
Jane Bloomer, MSW, CSW/R
stories --
Thomas Fink, PhD
there can be no subjects, after all
Patricia Gibbs, PhD
Harriet D. Knapp, PhD
suffering like Sisyphus --
Catherine L. Penney, RN
the rock of a soul-less psychiatry
Edward M. Stephens, MD
rolls down again
and I feel weary, alone, and misused
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sinking
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into the depths
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of the Pharmacaust,
James Gottstein
I lie daily in the embers
Robert Kay, MD
seething and suppressed
Robert Kurtz, MD
Jack Rosberg, PhD
waiting
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for the fuel that rekindles me
Scott Schwartz, MD
through communion
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with listeners who know
the gift of hearing,
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ISPS - US Newsletter
17
Book Review:
After Lacan: Clinical Practice and the Subject of the Unconscious
By Willy Apollon, Danielle Bergeron and Lucie Cantin. New York: State University of New York
Press, 2002, 192 pages, $19.95.
Charles Turk, MD
Cultivating Lacan's Garden in Quebec
the City of Lights on a tour of its sewers. Through this
In Quebec City, adjacent to the rolling Champ de metaphoric journey "behind the scene," and "into the depths," she
Bataille high above the Saint Laurence river, lies a large formal demonstrates how Lacan transformed Freud's unconscious
garden. From the statue of Jeanne d'Arc implanted in its center, "memory traces" (wahrnehmenzeichen) into "psychoanalytic
summer breezes course across lush lawns, setting the vibrant signifiers" (as distinct from the purely linguistic signifier).
heads of massed flowers to nodding in defiance of the winter-
Lacan taught that the subject is determined by and
winds that in a few months will still them. Willy Apollon, positioned with respect to three fields of experience: the Real,
Danielle Bergeron and Lucie Cantin reside and work in this most the Imaginary and the Symbolic. The authors emphasize the
European of North American cities. The fruits of their long particular relevance of the latter field, the symbolic order, to
collaboration have been collected in a slim volume, entitled After
analytic work. In practice this means that the analyst has only
Lacan -- a work that occupies a unique place among the speech to rely upon, a fact that Willy Apollon develops in a
profusion of books about Lacan. The authors come "after Lacan," sequence of three chapters. He traces out a trajectory, starting
first in the sense of following in his footsteps, next by creatively from the unrepresentable, to its partial inscription in "letters of
reworking Lacan's concepts.
the body," to its partial capture in the symptom, and finally to
The authors support a logical unfolding of various the symptom's dissolution into fantasy.
Lacanian concepts: signifier, the Other, jouissance, "letters of the
This tracing of the path of "the cure" brings home the
body," absence and desire with clinical vignettes which bring disquieting proposition that much of the difficulty encountered in
them to life. The chapters of After Lacan are interwoven through the course of analytic work is often aided and abetted by the
a discursive style where one senses that the authors speak to each analyst himself. Furthermore, the implications for practice as the
other--a notion corroborated at times by their explicitly referring full meaning of "absence" dawns upon the reader, will lead him
the reader to each other's chapters. Thus the book itself is as a to question whether he can ever be "an object" for the analysand,
fabric of concepts laid out in three tiers: the authors speaking as an "object relations" perspective might imply. We note that
among themselves, the authors drawing upon Lacan, and Lacan "object relations" are representations and thus lie within Lacan's
returning to Freud.
Imaginary field. As the analyst properly works within the
In the first chapter, “The Trauma of Language,” Lucie Symbolic field, it would appear that our ears would be the only
Cantin lays out the foundation of Lacanian theory: that our satisfactory "object" we could offer. To offer ourselves as an
humanity rests upon the phylogenetic rise of a creature who "object"--as in the contemporary preoccupation with the "here and
speaks. Once this being speaks, he is irrevocably detached from now"--is to risk impasse by frustrating the subject's drives and
the rest of the animal kingdom, destined to live as a human in a obscuring the fact that his unconscious is ready and waiting to
manner totally different from any other creature. Willy Apollon speak.
pursues this theme in the next chapter by tracing out how
After Lacan helps the reader negotiate Lacan's dense
language structures us as subjects. He describes how the most thickets. In a chapter entitled “Perverse Features and the Future
obvious property of language--that speech is addressed to of the Drive in Obsessional Neurosis,” Danielle Bergeron
someone--produces the concept of the Other. As language provides access to Lacan's difficult text, "The subversion of the
separates us from animals, it also severs us from the instinctual subject and the dialectic of desire." By using some of Lacan's
satisfactions we assume animals enjoy. This split-off "graphs of desire," she delineates how Freud's system of ideals
inaccessible remainder, Lacan termed jouissance. While it is (superego, ego ideal and ideal ego) are framed within a linguistic
often mis-translated as "pleasure," jouissance in fact is beyond context and how this system functions with respect to the drives.
pleasure; thus it is not by accident that Freud was interested in By way of contrast with the neurotic structure, Lucie Cantin
what lay "beyond the pleasure principle" nor that Lacan linked illustrates the perverse structure in a pair of chapters: “Perversion
jouissance to Freud's death drive. Apollon explicates the and Hysteria” and “The Fate of Jouissance in the Pervert-Hysteric
attribution of jouissance to the Other and its relation to Couple.” Cantin draws a useful distinction between the
narcissism, to sexual difference and to the drives-and how, if “scenario” that the pervert orchestrates with his partner, and the
unchecked, it can course destructively through us.
“perverse features” of the neurotic that Bergeron describes above.
Next, as if in response to Lacan's oft-quoted phrase, By revisiting such terms as: signifier, desire, Other, organism
"The unconscious is structured like a language," Danielle and "letters of the body," Cantin evolves a coherent linguistic
Bergeron deftly illustrates the "stuff of language"--the signifier--
framework for understanding perversion, connecting what is
by inviting the reader to accompany her on an excursion, first demonstrated in the pervert’s scenario to the structure that
behind the stage at the Paris Opera, and then into the bowels of determines it.
Continued on Page 18
18
ISPS - US Newsletter
After Lacan, continued
While delusion and dream bear a superficial
Lacan considered the Lack that language introduces into resemblance, they have totally different relationships with
the human being to be symbolized by the phallus, imaginatively jouissance. When the psychotic breaks down he constructs a
assumed to be missing part of a woman's body. Where better to delusion that first attempts to explain what happened as he
distinguish between organism (women lack nothing biologically) witnessed the destruction of the world, and next activates a
and body (universally fantasized to be actually or potentially restitutional effort. The hallmark of delusion is absolute
missing a part). Thus women's bodies come to be "lettered" as certainty. Delusional work requires that the psychotic must right
"lacking a phallus." The pervert denies castration by some wrong or repair some great damage--generally viewed as a
orchestrating a scenario that demonstrates that "nothing is defect in the universe. In contradistinction, the dream employs
missing." Such demonstrations serve to erase the (linguistically language in a functional way to interpret what arises from the
derived) drive and reduce the "drive-lettered" body to an organism unconscious. This provides the psychotic with an alternative to
pervaded by jouissance. The pervert promises access to the delusion that traps him. The true dream offers access to the
Jouissance. But as Jouissance is impossible for the human, the past, including the events that traumatized him.
pervert never succeeds, and so is compelled to repeat his scenario.
At stake in the treatment of the pervert is to get him "off stage,"
The distinction between delusion and dream is exploited
to give up his demonstration and to speak of it.
to clinical advantage by regarding the psychotic as a speaking
subject and offering him a place where he can speak his mind.
Lacan formulated psychosis to be a structure determined But he is also required to produce and report dreams. By
by the "foreclosure of the Name-of-the-Father." This means that listening the analyst demonstrates that he "does not know,"
the psychotic lacks the symbolic father, as a position, upheld tacitly acknowledging that it is only the psychotic "who knows."
within the family structure, necessary for the reliable In this way the psychotic's delusional certainty remains
transmission of cultural values. After Lacan draws to a close in unchallenged, and this ensures that persecutory and erotomanic
a style reminiscent of Freud's Schreber case, which relied solely transferences will not be generated. The awaited dream will
on the memoirs of that unfortunate man. Danielle Bergeron emerge like tendrils that grow and break into the frozen delusion.
explores the works of a psychotic writer, Yukio Mishima, to There develops a new transference that the psychotic makes use of
draw out his struggle to compensate for the absence of the "Name to experiment with the reliability of the spoken word, whose
of the father." He attempted to use his extraordinary talent to source in the dream opens him to the truth of his history.
capture unfathomable jouissance within a network of words.
But, unable to stem with his pen the workings of jouissance that
Over the past twenty years, the young psychotics treated
coursed violently within him, he took up a sword and ended his at "388" have all engaged in analysis. They were not "previously
life in ritual suicide.
high functioning" individuals, who constituted those "rare" cases
of psychotics who are amenable to psychoanalytic treatment.
In a panoramic introduction, Robert Hughes and Kareen Quite to the contrary, they were a group of repeatedly
Ror Malone, the editors of After Lacan, locate this work within hospitalized schizophrenic young people, already embarked on a
the breadth of the Lacanian field. They go on to describe how chronic downward course unaltered by the administration of high
over thirty-five years ago Willy Apollon, Danielle Bergeron and doses of medication that had served only to perpetuate their
Lucie Cantin founded an organization known as GIFRIC (Groupe frozen delusional world.
interdisciplinaire Freudienne de recherches et d'interventions
cliniques et culturelles) that developed both a school, EQF (Ecole
If After Lacan had simply explicated Lacanian difficult
Freudienne du Quebec) and a treatment program for psychotic concepts and animated them with clinical vignettes, it would
young adults, known as "388" (its street address). The have accomplished a great deal. But clearly this volume is more
painstaking work the authors have done on the problem of than that. It reshapes the psychoanalytic landscape by recasting a
psychosis excerpted in After Lacan provided the foundation for theory of psychosis and basing successful treatment upon it. At
"388" -a wedding of theory and practice that seems to fulfill the same stroke it provides an answer to neurobiological concepts
Freud's prophecy that one day a method of treating psychosis and treatments, by demonstrating how the psychotic can take
would be found. To achieve this they focus upon the interplay of
leave of his illness by having his speech well received.
jouissance, delusion and dreams in the treatment of psychosis.
e
Noteworthy ISPS Books
Davoine, F. & Gaudilliere, J-M. (2004). History Beyond Trauma: Whereof one cannot speak, thereof one
cannot stay silent. NY: Other Press.
Dorman, D. (2004). Dante’s Cure: A Journey Out of Madness. NY: Other Press.
Honig, A. M. (2001) Hard Boiled Eggs and Other Psychiatric Tales: The Rebirth of Psychotherapy of
Severe Mental Illness. To order: www.dramhonig.net
ISPS - US Newsletter
19
News from Local Branches of ISPS-US
Baltimore-Washington, D.C.
Chicago
Ann-Louise Silver, MD
Editor’s note: The Chicago branch is busily organizing the
The Washington Chapter has not held meetings ISPS-US Annual Meeting (Sept. 18-19), and it promises to
this past year, but we did gather for the Washington be a fascinating conference. For more information, please
School of Psychiatry's Frieda Fromm-Reichmann Lecture contact:
on March 19, 2004. ISPS Board Member, John Read, PhD
of Auckland, New Zealand spoke on “’Schizophrenics’ David Garfield, MD
have Childhoods Too: Resurrecting Buried Knowledge.” dasg@aol.com
I'm taking this opportunity to urge everyone to read the
e
book he has co-edited with Loren Mosher and Richard Detroit
Bentall, Models of Madness: Psychological, Social and
Biological Approaches to Schizophrenia, published for Patricia L. Gibbs, PhD
ISPS by Brunner-Routledge. ($80 hardback; $28.95
The ISPS-US Detroit Chapter now has nine members.
paperback) e-mail orders at book.orders@tandf.co.uk.
Though the Chapter has never met as a group (and may not ever
meet!) the members are active in the community and within
We are very proud of Joel Kanter's major various organizations as they engage in professional activities
accomplishment this year, publication of his excellent supportive of the mission of ISPS-US to promote humane,
book Face to Face with Children: The Life and Work of psychological treatment of schizophrenic and psychotic patients.
Clare Winnicott. You can order this book ($35) through The Chapter's Head, Patricia L. Gibbs, Ph.D., is currently
usa@karnacbooks.com or call 866-312-2894.
teaching classes on psychosis to Candidates and Psychotherapy
students at the Michigan Psychoanalytic Institute. The classes
Next year, the Columbia (Maryland) Academy of assume recovery from schizophrenia and psychosis is possible,
Psychodynamics (www.CAPsy.ws) will focus on severe and emphasize a psychoanalytic approach. Her paper, "The
mental illness and the most difficult symptoms. Our Struggle to Know What Is Real," will be published later this year
monthly meetings are co-sponsored by Sheppard Pratt in The Psychoanalytic Review. Patrick B. Kavanaugh, Ph.D.,
Health System, which allows us to provide continuing presented two papers in the past year. The first, "The Dead Poets
education credits to all mental health professionals. We Society Ventures into a Radioactive Space," was presented at the
meet on the second Wednesday of each academic month Academy for the Study of the Psychoanalytic Arts. The Academy
from 8:00 to 9:30 at Humanim, a mental health system in is an ISPS-US Institutional member. Dr. Kavanaugh's second
Howard County. We will also co-sponsor with the ISPS-
paper was presented though the Michigan Society for
US-Baltimore and Washington Branch, and hold an ISPS-
Psychoanalytic Psychology (MSPP), and was entitled
US-DC & Baltimore Branch dinner meeting preceding "Frankenstein's Genie-ology: The Magical Visionary Experience
some of the regular meetings. Wilfried Ver Eecke and and the Associative Method." Bertram Karon, Ph.D., continues
Richard Chefetz will be among our speakers. The to be active in MSPP, and had his paper, "The Tragedy of
schedule should be posted by early August.
Schizophrenia without Psychotherapy," published in The Journal
of the American Academy of Psychoanalysis and Dynamic
Ann-Louise S. Silver, M.D.
Psychiatry, Spring 2003. Ms. Mary Karon is active in the
4966 Reedy Brook Lane
Michigan Psychoanalytic Council. Ms. Susan Knapp, M.A. is a
Columbia, MD 21044-1514
member in the Rochester Hills area. Teresa Bernardez, MD, a
(410) 997-1751
training and supervising analyst at the Michigan Psychoanalytic
fax (410) 730-0507
Council, has published a recent paper (Spring 2004) in the
asilver@psychoanalysis.net
Journal of the American Academy of Psychoanalysis and
www.CAPsy.ws
Dynamic Psychiatry entitled "Studies in Countertransference and
e
Gender: Male patient/Woman analyst in two cases of childhood
Boston
trauma". Elizabeth Waiess, Psy.D., is in private practice in the
East Lansing area. She is active in the Michigan Psychoanalytic
Editor’s note: The Boston branch is being organized. For Council and teaches psychology classes for Lansing Community
more information, please contact:
College. Henry Krystal, M.D., teaches and supervises Candidates
and Psychotherapy students at the Michigan Psychoanalytic
Ronald Abramson, MD
Institute, and has written many books and papers on the areas of
Rona976@aol.com
affect, trauma, and alexithymia. Margaret Walsh, Ph.D., is a
e
Continued on Page 20
20
ISPS - US Newsletter
News from Local Branches: Detroit, continued
greatly assisted by Karen Stern, now Executive Director of ISPS-
Candidate at the Michigan Psychoanalytic Institute with previous US. Included in our monthly meeting presentations were Paul
experience at the Menninger Foundation which sparked her Fink, Leigh Whitaker, and David Wilson. Our only presentation
interest in psychoanalytic work with schizophrenic and psychotic this year was given by Brenda Byrne, who spoke on the
patients.
"Assessment and Early Treatment of a Woman With A
Dissociative Identity Disorder." The meeting was on Thursday,
We are a group that tries to remain free-thinking, and February 19th, at Harold Stern's home. In May, Harold Stern
opposes restrictive and dogmatic interpretations of psychoanalysis addressed the Montgomery County Pennsylvania Chapter Of
and psychotherapy. Though we do not wish to meet in yet NAMI and spoke about "Successfully Treating Schizophrenia."
another organizational setting demanding of our time, most of us His talk was well received and he was requested to return again to
are active periodically on the ISPS-US Listserv. We welcome all speak.
interested in joining our loosely knit "freely associated" Chapter!
Harold Stern, PhD
Patricia L. Gibbs, Ph.D.
610-949-9339
313-274-5490
hstern@mail2.gis.net
patricialgibbs@aol.com
e
e
San Francisco
New York
Editor’s note: The San Francisco branch is being
Brian Koehler, PhD
reorganized. For more information, please contact:
The New York Chapter of ISPS-US has been Ann-Louise S. Silver, M.D.
meeting monthly on a regular basis since October 1997. 410-997-1751
We are a group of about 30 active members from the asilver@psychoanalysis.net
various mental health disciplines. At our meetings,
e
which take place once per month (except for August), Southern California
we take turns presenting case material, articles and
papers we have published and/or presented at Marty Cosgro, PhD
conferences, etc. We also invite outside distinguished
Jack Rosberg and I have a list of 13 present, past or
clinicians/authors/ researchers to meet us and present prospective members to use a starting point for a new branch on
their work to us. Meetings are held on late Saturday the west coast. With the training institutes in the LA area we
afternoons (usually 4:00-6:30 p.m.) and they take place expect to stimulate much more interest for our new local group.
in Manhattan at the New York University Postdoctoral Our goal is to solidify an initial membership and have a local
Program in Psychotherapy and Psychoanalysis, 1 meeting by the end of the year. With any luck we'll be hosting a
Washington Place (corner of Broadway), conference fall symposium before too long!! Anyone with names of
room. We are co-sponsored by the Independent Track prospective members in the southern California area are asked to
of the NYU Postdoctoral Program and ISPS-US. For E-mail them to:
information on how to participate, please contact:
Marty Cosgro, PhD
Brian Koehler, PhD
MCosgro@charter.net.
212.533.5687
e
brian_koehler@psychoanalysis.net.
e
Philadelphia
Check out the ISPS Website:
Harold R. Stern, PhD
www.isps.org
The past twelve months were very eventful for our
And the new ISPS-US
Philadelphia group. The passing of Victoria Conn left us with
not just sadness at losing a very precious member and leader, but
Website: www.isps-us.org
also someone who was contributing in a very energetic way. Her
Send contributions and comments
loss was especially felt in the preparation and implementation of
the ISPS-US annual meeting here in Philadelphia held at the
about the ISPS-US website to:
Thomas Jefferson Medical University. Brenda Byrne and Harold
Jack Rosberg, PhD, JARosberg@aol.com
Stern as co-coordinators of that meeting managed to create what
appears to have been a very successful conference. We were
ISPS - US Newsletter
21
The International Society for the Psychological treatments of the Schizophrenias and other psychoses: U. S. Chapter
ISPS-US Sixth Annual Symposium
Extremes of Experience: Psychosis through many lenses
Chicago, IL, Saturday - Sunday, September 18-19, 2004
Cosponsored by and located at the Institute for Psychoanalysis
122 South Michigan Avenue, Suite 1300, Chicago, Illinois, USA
Keynote Speaker: Leston Havens, M.D.
PRESENTERS INCLUDE:
Danielle Bergeron, MD
Joanne Greenberg, DLH
Greg Rosen, MA
Richard Chessick, MD, PhD
Bert Karon, PhD
Adam Savitz, MD, PhD
Bert Cohler, PhD
Brian Koehler, PhD
Jorge Schneider, MD
Katerina Daniel
Yulia Landa, PsyD
Ann-Louise Silver, MD
Françoise Davoine, PhD
Paul Lysaker, PhD
Steven Silverstein, PhD
Max Day, MD
Mimi Neathery, MA
Frank Summers, PhD
Daniel Dorman, MD
Catherine Penney, RN
Wilfried Ver Eecke, PhD
David Garfield, MD
Gertrude Pollitt, DPsa
Jessica Wall, LCSW
Jean-Max Gaudilliere, PhD
Garry Prouty, DSc
This year ISPS-US will be dedicating its annual symposium to exploring the various ways psychosis is understood by individuals
from a variety of disciplines and theoretical lenses. While differences are apparent between these conceptual lenses, they overlap, often
clarifying our picture rather than blurring it. Psychosis is an extreme experience as is its treatment. In our era, many have given up
on bearing with the psychotic patient, opting instead to keep him or her at a safe distance. It is hoped that this symposium will
provide us with some grounding in the severe and trying conditions of psychosis and help us to face the patient and the treatment.
Presenters from a variety of disciplines are invited to explore different ways of understanding psychotic conditions and the challenging
treatment of persons suffering with them.
We are honored to have renowned author and clinician Leston Havens, M.D. as our keynote speaker and
recipient of our 2004 ISPS-US lifetime award. On each day, a detailed case report will be presented by a seasoned clinician
with two discussants from different theoretical orientations. Well-known clinician/scholars from the object relations, self
psychological, interpersonal/relational and classical/Lacanian schools will offer their insights and perspectives into these cases. In
addition, there will be afternoon papers and workshops and finally, participants will be able to share their own thoughts in lunchtime
and small group discussions. A dinner for all will be held on Saturday night. Details on CE credits pending: see www.isps-us.org.
Special needs: ISPS-US is committed to providing access and support to persons with special needs who wish to participate in the programs we sponsor. For
more information and accommodations, please e-mail Karen Stern at karen.s.stern@earthlink.net or call 610-308-4744.
ISPS-US is a 501(c)(3) non-profit organization. Your donations are welcome and are tax deductible. WWW.ISPS-US.ORG
-
Registration Form: Please make check payable to ISPS-US and mail with form to ISPS-US, P.O. Box 491, Narberth, PA 19072
NOTE: PREREGISTRATION IS REQUIRED! THERE WILL BE NO ON-SITE REGISTRATION.
Before August 24, 2004
After August 24, 2004
___Conference fee 2 days $150
___Conference fee 2 days $175
___Conference fee 1 day $100
___Conference fee 1 day $125
___Non-members must add $40 (for annual dues)
___Non-members must add $40 (for annual dues)
___Student fee $20
___Student fee $30
___Students may add $20 for annual dues
___Students may add $20 for annual dues
___I will be attending the small group lunch discussion. I have enclosed $10 to cover the cost of lunch.
Total amount enclosed: $_________ (Conference fees may be refunded, less a $15 administrative fee, prior to Sept. 12, 2004.)
Special needs (dietary, other)___________________________________________________________________
Name__________________________________________________________Degrees_____________________
Address____________________________________________________________________________________
City__________________________State_____Zip___________Country if not U.S._______________________
Phone(s) (list preferred phone first)_____________________________________Fax______________________
E-mail address__________________________________Web address___________________________________
Institutional affiliation(s)_______________________Professional interests______________________________
22
ISPS - US Newsletter
Models of Madness: Psychological, Social and Biological Approaches to Schizophrenia
Edited by John Read (Director, Clinical Psychology, Psychology Dept., The University of Auckland), Loren
Mosher (Clinical Professor of Psychiatry, University of California at San Diego), Richard Bentall, (Professor of
Experimental Psychology, Manchester University)
ISBN 1-58391-905-8 2004 400 pp. US$80.00 hbk • ISBN 1-58391-906-6 2004 400 pp. US$28.95 pbk
Published by Brunner-Routledge for ISPS, the International Society for the Psychological treatments of the
Schizophrenias and other psychoses
Models of Madness shows that hallucinations and delusions are understandable reactions to life events and circumstances rather
than symptoms of a supposed genetic predisposition or biological disturbance. International contributors:
• Critique the “medical model” of madness
• Examine the dominance of the “illness” approach to understanding madness from historical and economic perspectives
• Document the role of drug companies
• Outline the alternative to drug based solutions
• Identify the urgency and possibility of prevention of madness.
Models of Madness promotes a more humane and effective response to treating severely distressed people that will prove
essential reading for psychiatrists and clinical psychologists and of great interest to all those who work in the mental health
service.
CONTENTS
Part I: The Illness Model of “Schizophrenia”
John Read, Loren R. Mosher, Richard P. Bentall: “Schizophrenia” is Not an Illness • John Read: A History of Madness • John
Read: The Invention of “Schizophrenia.” • John Read, Jeffrey Masson: Genetics, Eugenics and Mass Murder • John Read: Does
“Schizophrenia” Exist? Reliability and Validity • John Read: Biological Psychiatry’s Lost Cause • Jay Joseph: Schizophrenia and
Heredity: Why the Emperor Has No Genes • John Read: Electroconvulsive Therapy • Colin A. Ross, John Read: Antipsychotic
Medication: Myths And Facts • Loren R. Mosher, Richard Gosden, Sharon Beder: Drug Companies and Schizophrenia: Unbridled
Capitalism Meets Madness.
Part II: Social and Psychological Approaches to Understanding Madness
John Read, Nick Haslam: Public Opinion: Bad Things Happen and can Drive You Crazy • Jim Geekie: Listening to the Voices
We Hear: Clients’ Understandings of Psychotic Experiences • John Read: Poverty, Ethnicity and Gender • Richard P. Bentall:
Abandoning the Concept of Schizophrenia: The Cognitive Psychology of Hallucinations and Delusions • Ann-Louise Silver,
Brian Koehler, Bertram Karon: Psychodynamic Psychotherapy of Schizophrenia: Its History and Development • John Read, Lisa
Goodman, Tony Morrison, Colin A. Ross, Volkmar Aderhold: Childhood Trauma and Stress • John Read, Fred Seymour, Loren
R. Mosher: Unhappy Families.
Part III: Evidence-Based Psychosocial Interventions
Emma Davies, Jim Burdett: Preventing “Schizophrenia”: Creating the Conditions for Saner Societies • Judi Chamberlin: User-
Run Services • Anthony P. Morrison: Cognitive Therapy for People with Psychosis • William H. Gottdiener: Psychodynamic
Psychotherapy for Schizophrenia: Empirical Support • Jan Olav Johannessen: The Development of Early Intervention Services •
Volkmar Aderhold, Evelin Gottwalz: Family Therapy and Schizophrenia: Replacing Ideology with Openness • Loren R. Mosher:
Non-Hospital, Non-Drug Intervention with First Episode Psychosis
Articles, commentaries, vignettes, poems,
book reviews, movie reviews???
Contribute your piece to the next issue of the ISPS-US Newsletter
Deadline: August 31, 2004
Newsletter Editor - Brian Koehler
brian_koehler@psychoanalysis.net 212-533-5687
(All contributions should submitted by e-mail or on diskette.)
ISPS - US Newsletter
23
15th ISPS Symposium:
Global Views and Integrated Therapies
June 13-16, 2006 • Madrid, Spain • Palacio de Congresos de Madrid
For more information, contact:
Dr. Manuel González de Chávez Menéndez
Chairman of the Organizing Committee
Chief of Psychiatric Service
General University Hospital “Gregorio Marañón”
c/ Ibiza no. 43 - 28009 Madrid. Spain
Phone + 34 91 586 81 32
Fax + 34 91 426 51 10
E-mail: mchavez.hgugm@salud.madrid.org
Website: www.ISPSMadrid2006.com
Combined ISPS and ISPS-US Membership Application
(Please note: Local branches may assess additional dues.)
Name________________________________________________Degree(s)_____________________________
Address___________________________________________________________________________________
City___________________State_____Zip___________Country if not U.S.____________________________
Phone(s) (list preferred phone first)____________________________________Fax______________________
E-mail address__________________________________________Web address__________________________
Institutional affiliation(s)_____________________________________________________________________
Specific interests:___________________________________________________________________________
Join listserve: Yes:____No: ____ List in directory: Yes:____No:____ List on website: Yes:____No:_____
Annual Dues:
___Mental health professionals: $40.00 (licenses allowing private practice)
___Institutional: $100.00
___All others: $20.00
Additional tax-deductible contribution: $_______
Total amount enclosed: $_______
Checks payable to ISPS-US
Send to:
ISPS-US
P.O. Box 491
Narberth, PA 19072
24
ISPS - US Newsletter
ISPS-US is proud to offer you a copy of the current issue of
The Journal of the American Academy of Psychoanalysis and Dynamic Psychiatry
Volume 31, Number 1, Spring 2003
Guest-edited by ISPS-US president, Ann-Louise S. Silver, M.D.
and Tor K. Larsen, M.D. of Norway
Special Issue: "The Schizophrenic Person and the Benefits
of the Psychotherapies -- Seeking a PORT in the Storm."
Issue price: $10
Contact:
Ann-Louise S. Silver, M.D.
Phone: (410) 997-1751
4966 Reedy Brook Lane
Fax: (410) 730-0507
Columbia, MD 21044-1514
www.CAPsy.ws
asilver@psychoanalysis.net
ISPS-US Newsletter
c/o Brian Koehler, PhD
80 East 11 Street #339
New York, NY 10003
