揺らぎのエッセイ 1

 揺らぎのエッセイ

「揺らぎと心のデフォルトモード」という本を上梓した。やっと肩の荷が下りたというわけだが、しかし執筆にかけた二年ほどこのことを考え続けていたので、余韻が残っている。というよりは揺らぎのテーマはこれからもますます深まっていく気がする。というのも私にはこの世で起きていることがことごとく不思議で分からなくて興味をそそるからだ。物事が揺らいでいるという事は、そこに何らかの規則性と意外性や新奇性が常に一定の割合で混じっているという事だ。揺らぎというのは一種の波であり、行ったりきたり、上がったり下がったりするという性質を持つ。株価の上昇がそうであり、気温の上下がそうであり、例えば新型コロナの陽性者数だったりする。気温なら今の季節(11月初旬にこれを書いている)なら10～20度C位を行ったり来たりしている。雨は降らない日が多い。しかし全く正確な動きを見せないからこそ私たちは上着や傘の準備を怠らない。これがことごとく一定のリズムを刻み、予想できるとすると、それはいわば体験から消える。というよりはそれがルーチン化され、自動化され、考えないで毎日を送ることになる。

例えば毎日午後2時から3時半まで正確に雨が降るとしよう。おそらく人はその間は戸外に出ないようなスケジュール組むようになり、雨のことを忘れてしまう。一日の気温の変動が一定なら、羽織るものについては(少なくともその薄さ、厚さについては)考えなくなる、という風に。文明が進むという事は、この揺らぎを規則にすることでその存在を忘れさせてくれる。例えばコンセントに入れると電気がともる。蛇口をひねると水が出る。これはあまりに確かなことになったせいで、私たちは電気や水のことをあまり考えずにそれを利用するようになる。(どこかの国のように、水道が使える時間が一日のうち限られていたり、しょっちゅう停電が起きるとすれば、私たちは一日中電機や水のことが頭から離れなくなるのだ。

治療論 英訳 推敲の推敲 5

 Trauma and the origin of aggression

Issue of the actuality of trauma is closely related to another important problem: where aggression of the patients comes from? What Freud had in his mind was that the repression of sexual and aggressive drives would cause neurotic symptoms and these drives naturally derive from within. However, if we acknowledge the actuality of trauma, we need to consider the origin of the aggression somewhat differently.

One of the early papers that deal with the origin of aggression was Ferenczi’s seminal paper “Confusion of Tongues” (1936). He discussed the issue of the “identification with the aggressor”. However, what Ferenczi discussed was not exactly the way the victim turns to be another aggressor. He rather described the process of the victim’s identification with the aggressor’s wishes and desires in a masochistic way. He states that the most destructive is the “victim’s introjection of the guilt feelings of the adult” (p.162) and the resultant masochism of the victim (Frankel, 2002). Ferenczi stressed rather the way that the victim hurt him/herself instead of aggressing others.

Frankl explains this nature of Ferenczi’s description of the “identification with the aggressor” as follows. While discussing this topic, Ferenczi mainly talks about “concordant identification” with the aggressor based on Heinrich Racker’s classification of the two types of identification process (Racker, 1968). However, there should be another type of identification: “complementary identification” where the victim identifies with his aggressive nature and becomes the one. In this context, Okano (2018) also discussed this process in his discussion of “shadowy personality”. It is of interest to mention the notion of the “identification with aggressor” proposed by Anna Freud (1936). This notion describes more closely to the way this complementary identification with the aggressor, but in a quite different context.
   Let us look at the way modern analysts conceive the issue of aggression in DID. Dissociative personalities with aggressive nature have been described generally as “the internal persecutor” or “persecutory personality” by various authorities (Kluft, Putnam, Ross, Howell, van der Hart, etc.). Putnam suggests that some persecutor personalities can be recognized as introjects of the original abuser (1989, p.108).Van der Hart et al（2006）states that the persecutory part of the personality is at least one type of EPs (emotional part of personalities) and that has some protective role, and recommends clinicians that they pay respect to them (2006). Howell (2011) also stresses defensive purposes when one of these “persecutory personalities” are formed and states: “having persecutory and abuser identity states is like having an internal Al Qaeda or Taliban that punishes you for the slightest infraction of bizarre and arcane rules. It involves being emotionally attached to inner and perhaps outer persecutors, even though you were tortured by them” (2011, p.211). Howell further states that the “system depends for its safety, on the inhibition of expression or the exclusion from consciousness of powerful overwhelming affects, such as terror and rage.” (Howell, 2016, p.211).

According to these experts, DID’s aggression is generally understood as a result of internalizing what was initially external, i.e., the aggressors, that is expressed by the victims in a self-destructive and masochistic way. Here again, we are facing the dual nature of the aggression that DID patients experience. Ferenczi and experts of DID talk mainly the influence of the aggressors when children went thorough trauma. Recognition of the actuality of trauma underscores externality of the aggression. However, by discussing the process of identification and internalization they describe how the aggression becomes a part of the victim’s internal psyche. Perhaps what is not stressed is the way that originally external aggression gets merged with what has been originally inside, which is referred to as the aggressive drive. 

治療論 英訳 推敲の推敲 4

 2.      The actuality of trauma during infancy and early childhood.

This second point that Itzkowitz raises might also invite another kind of “turn” in our conceptualization of the mind in psychoanalysis. In Freud’s drive model, the goal for psychoanalysis was to make unconscious conscious with an assumption that repressed sexual and aggressive drives in the child need to be dealt with. Freud established this theory after he rejected the actuality of the sexual trauma that a child experiences in 1897. If we accept and acknowledge the actuality of trauma, the whole basis of Freud’s theory might need to be looked at from a different angle. Howell & Itzkowitz states (2016a), “Even Freud’s most influential theories- for example, the Oedipus complex - can readily and easily be deconstructed in terms of the underlying motifs of the most heinous type of child abuse; infanticide, murder”. (Ross, 1982, 2016a, p8)

以下略

治療論 英語 推敲の推敲 3

 Stern and Bromberg 

 In recent psychoanalytic literature, there are two major figures in the theories of dissociation and dissociative phenomena: Donnel Stern and Phillip Bromberg, and their works are relevant to be discussed in this context. The current notion of dissociation proposed by them is characterized by their unique understanding of what is not conscious. Stern states: Freud accepted without reservation the idea that the mind―and, therefore, the unconscious―is composed of fully formed contents. (Stern, 2009, p.655.) Stern discusses that in traditional psychoanalysis the repression model assumes that there is one truth in the unconscious that corresponds to one objective reality. He calls this notion “correspondence theory” and proposes a different mechanism of the mind at play in dissociation.

以下略

治療論 英語 推敲の推敲 ２

 Fairbairn, Winnicott, and Sullivan.

Before moving on to discussing modern psychoanalysts’ argument on this topic, I would like to briefly summarize the stance taken by three major figures in the early part of the history of psychoanalysis: R. Fairbairn, D. Winnicott, and HS. Sullivan.

Fairbairn’s theory of a schizoid mechanism is closely linked with splitting and dissociation discussed by Janet, Morton Prince, etc. As Fairbairn goes (1952),

… So far as the manifestations of dual and multiple personality are concerned, their essentially schizoid nature may be inferred from a discreet study of the numerous cases described by Janet, William James, and Morton Prince … The personality of the hysteric invariably contains a schizoid factor in greater or lesser degree, however deeply this may be buried. (p. 5.)

 Thus, Fairbairn’s notion of dissociation was not quite specific and was discussed interchangeably with "schizoid," and "splitting” (van der Hart, et al., 2009), lacking a focus on its unique nature of division in psychic organization. Although schizoid problems became one of the main focuses of the British object relations theory, it developed apart from the concept of dissociation originally described by Breuer in his notion of “hypnoid” phenomena and double consciousness.

以下略

治療論 英訳 推敲の推敲 １

“Dissociative Turn”and its Implications in Psychoanalysis

Historically, dissociation is a topic that Sigmund Freud did not welcome in his psychoanalytic theories. This was against the background of his conflict with Joseph Breuer, Pierre Janet and Sándor Ferenczi. Since then, as Glover (1943) expressed, the term dissociation has a “chequered hisoty”(p.12) in psychoanalysis. However, since Steven Marmer (1980) took “a first step in posing a psychodynamic formulation for multiple personality (p.455), there seems to be a “growing chorus of American thinkers” “who hopes to rescue dissociation from obscurity” in the theory of psychoanalysis (Goldman, 2012. p. 338). The topic of dissociation has been discussed in an increasing number in the psychoanalytic literature. A psychoanalytic research engine (Pepweb) indicates that its number doubles in each decade for the past 40 years (405 between1980~1989, 935 between 1990~1999, 1629 between 2000~2009, and 2461 between 2010~2019). This movement can potentially invite some major reorganization in the psychoanalytic literature, that Sheldon Itzkowitz (2015) referred to as the “dissociative turn.” So, what is it about his “turn”? In his compacted paper with the same title, Itzkowitz (2015) mentions as follows.

以下略

治療論 英訳 推敲 7

 Discussion

In this paper I discussed what Izkowich refers to as “the dissociative turn” and considered what might be its theoretical and clinical implications. I indicated that this issue was related to the way psychoanalysis started in the end of the 19^th century. Freud encountered clinical cases where splitting of consciousness was indicated by Breuer and Janet, and chose to go along monopsychism. He might have felt that he needs to choose either monopsychism or polypsychism and practically picked the former. His choice must have been correct in that it resulted in this prosperity of the psychoanalytic movement that we all are familiar with. However, some analysts should have encountered dissociative cases and felt they need to take a second look at their theoretical approach to them, such as J. Rampl-de Groot (1981). She stated in her “Notes on Multiple Personality”(1981) that “the purpose of this paper is to draw attention to my experience that both ‘splitting’ and ‘multiple personality’ are originally present in all normal humans.”(p.615.)

It is remarkable that her “turn” was so drastic that she concluded that multiplicity, polypsychism, not monopsychism, is the natural state of mind.

It is worth remembering that Freud himself did not hide that he could have been a similar situation somewhat close to that of Rampl-de Groot. In a later stage of his analytic career, Freud stated as follows.

 Depersonalization leads us on to the extraordinary condition of “double conscience”, which is more correctly described as “split personality.”But all of this is so obscure and has been so little mastered scientifically that I must refrain from talking about it anymore to you. (Freud, 1936, p.245)

Freud’s candid acknowledgement about his lack of scientific knowledge and experience about “split personality” is impressive. It is unknown if, with more time and curiosity, Freud might have developed a new view about dissociative phenomenon and make his own “turn”. It is very fortunate that current analysts might not need to make an exclusive choice that Freud faced: which of monopsychism or polypsychism reflects the truth of human mind.

Here I reiterate beautiful statement of Bromberg.

A noticeable shift has been taking place with regard to psychoanalytic understanding of the human mind and the nature of unconscious mental process- away from the idea of a conscious/preconscious/unconscious distinction per se toward a view of the self as decentered, and the mind as a configuration of shifting, nonlinear ,discontinuous states of consciousnesss in an ongoing dialectic, with the healthy illusion of unitary selfhood.（Bromberg, 1998. p. 270.）

Lampl-de-Groot, J (1981) Notes on Multiple personality. Psychoanalytic Quarterly, 50;614-624

Bromberg, P (1998) Standing in the Spaces. Psychology Press, New York, London.

An inevitable question might arise. Can we really take both of these two stances in a clinically useful way? If I conjure up an image of a clinical case who demonstrates several different personalities, I still think that she is a single person, perhaps that I would refer to as “they”. However, I think I have different way of having relationship with each of them as well. Usually a patient of DID has some sense of “we-ness” with a recognition that they share the same body, and perhaps the same identity. As much as they have this sense, a therapist develops some type of “generic” transference as well as that with each personality. Clinically I cannot determine whether I am dealing with one person or many. Instead of either or attitude, modern clinicians should opt flexibility and latitude in choosing their view about dissociative patients, depending on the clinical context they are in. I hope that I discussed some of the points clinicians can bear in mind in choosing their ways.