Freud y los Estudios sobre la Histeria II – Cúales de sus modelos teóricos sobre la histeria aún son actuales?

2015-09-01 Histeria-Banner

La diagnosis de la histeria, a cual se dedicaba Freud en esta publicación, por varias razones hoy casi ya no existe. La ciencia psicológica, especialmente en las universidades, ya mayormente está ignorando a la teoría psicoanalítica por su preferencia de casí únicamente enfoques cognitivo-conductales. Elementos del concepto de la histeria han sido repartidos en varios elementos e integrados en otras conceptos de trastornos de los manuales diagnósticos de trastornos mentales (los más importantes sean la International Statistical Classification of Diseases and Related Health Problems (ICD), publicado por la Organisación Mundal de la Salud, y el Diagnostic and Statistical Manual of Mental Disorders (DSM), publicado por la Asociación Estadounidense de Psiquatría).

La conversión de emociones y conflictos represados en manifestaciones corporales en el día de hoy pertenece a la categorías diagnósticas de

  • los trastornos somatomorfos (trastorno de somatización, hipocondría, trastorno dismórfico corporal, trastorno por dolor)
  • los trastornos disociativos (trastorno de conversión)

Otros elementos de la histeria, como la excitación, los flashbacks, y características de personalidad estan inlcuídos en las descripciónes de

  • los trastornos postraumáticos (trastorno de estrés postraumático) y
  • los trastornos de personalidad del Grupo B (trastorno límite de la personalidad/Borderline, trastorno histriónico de la personalidad, trastorno narcisista de la personalidad)
Freud (c)olafhajek

Sigmund Freud (c) Olaf Hajek (www.olafhajek.com)

Pacientes con este típo de problemas físicas frecuentamente vuelven a consultar a su médico de cabecera, como sus síntomas siguen aunque no se había podido identificar ninguna causa física de sus dolores. No obstante regresan a su médico, como las pacientes no están conscientes que tambien su estado emocional o mental puede influir so bienestar corporal. Muchas veces estas personas tienen un gran miedo de que su doctor les diga que su molestia no sea corporal, sino que nada más imaginado, una declaración que muchas veces les causa mucha verguenza y humillación y que les ofende mucho a paciente: No solo no me puede ayudar mi médico y siguen mis molestia, no, sino tambien dice el doctor que nada más me lo estoy imaginando!

Evidencia para conexiones entre experiencias emocionales y cambios físicos

Afortunadamente, la ciencia psicosomática ya tiene evidencia que las molestias no son imaginadas. Supuestamente ya no se puede distinguir muy claramente entre causas mentales y causas físicas para algun dolor corporal, como ya hay mucha evidencia que indica que nuestra mente y nuestro cuerpo están conectados en varias maneras muy complejas.

  • Si una persona está confrontada con una situación traumática, hoy sabemos que los niveles de la reaccion de estrés en su cuerpo causa que la memoria de esta situación está grabada de manera muy distincta que normalmente en su cerebro. Los aspectos emocionales y sensoriales (emociones, colores, ruidos, olor, toque) están grabados con una claridad excepcional al cerebro, mientras los detalles del contexto (cuando pasaba? En donde pasaba? Porque pasaba?) estan grabadas nada mas de manera muy imprecisa. Por eso, cuando recordado de la escena traumatica, la persona puede sentir las mismas percepciones físicas que tenía durante la situacion de antes, aunque ya pasaron meses o años y aunque no se recuerda muy bien que las percepciones que siente (por el recuerdo) pertenecen a la situación traumatica del origen. Asi que: El volumen del estrés en una situación influye como memorias están grabadas en el cerebro, y tambien influyen al cuerpo cuando nos recordamos (conscientemente o inconscientemente) de la situación.
  • Otra evidencia para la conexión entre la mente y el cuerpo enseña que psicoterápia efectivamente puede cambiar ciertas maneras de funcionar del cerebro. La terápia cambia muestras funcionales de neuronas en el celebro y se puede enseñar el cambio con tecnicas de imagenología como la tomografía de resonancia magnética (IRM) (Linden, 2006; Schauer, Elbert, Gotthard, et al., 2006). Entonces, ya no es ciencia ficción que lo que sentimos y pensamos tiene una manifestación correspondiente en nuestro cuerpo. En ambos sentidos, como consequencia de experiencias emocionales positivas (como en terápia) o negativas (como en situaciones traumaticas), nuestro estado de animo puede causar e influir percepciones reales en nuestro cuerpo.
  • Es muy interesante que otro área de investigación que tambien usa las tecnicas de IRM encontró primeras indicios que la manera en que nuestro cerebro procesa dolor físico tiene entrecruzamientos con la manera en que el celebro procesa el dolor emocional y el dolor social y emocional. En otras palabras, el procesamiento de caer al suelo o empujarse es muy similar al procesamiento del sentimiento de tristesa si otra persona nos rechaza (Eisenberger, Lieberman & Williams, 2003; Eisenberger & Lieberman, 2004, Eisenberger, 2012; Lieberman & Eisenberger, 2012). Los cientificos tambien observan que el hecho de que en varias idiomas describimos las penas de amor con una metáfora de un corazón quebrado puede aludir que aunque alguna emoción sea un sufrimiento emocional, tambien tiene alguna manifestación física. Entonces: Si el dolor físico y el dolor social y emocional están procesados de maneras similares en el cerebro, la presunción que las consequencias de las dos formas de sufrimiento podrían causar algúna manifestación corporal ya parece muy probable.

Entonces, si ya está explicado todo del fenómeno de la manifestación corporal por razones mentales por el cerebro – para que aún necesitamos Freud y sus ideas de emociones represados o el inconsciente?

La actualidad de las técnicas terapeuticas de los “Estudios sobre la histeria”

En mi opinion, la investigación cientifica por metodos neurobiologicos o la análisis psicodinámica no se excluyen ni se contradicen. Los resultados de la neurobiología aún nada más nos dan indicios, no pruebas, y aun no podemos concluir causalidades. No sabemos si el cambio de algúna estructural neural causa la percepción de alguna emoción o alguna sensación física, o si al reves alguna emoción causa los cambios cerebrales. Todos esos resultados aun son descripciones de acciones simultáneas, pero no nos dejan entender ni la secuencia ni la causalidad.

Además, como terapeuta no nos ayuda explicarles a los pacientes que sus síntomas surgen por alguna connexión en su cerebro. Un tratamiento asi no sirve ni para tener empatía com ellos, ni para curarles, porque no nos da ningúna posibilidad de intervenir. La investigación cientifica de la manera en que percepciones, emociones y funcciones corporales interactuan con mecanismos biológicos no nos capacita para entender mejor como le aparece al paciente su punto de vista de sí mismo o del mundo. Si alguien está represando alguna emoción, tal vez ya tenemos alguna idea del mecanismo de procesamiento en el cerebro, pero para curarle al paciente, necesitamos saber sus razones personales porque una emocion le parecia tan horrible, aterradora e inacceptable que en primer lugar la tenía que represar inconscientemente. Como terapeutas, necesitamos los dos lados de la historia: Como funciona, y como lo siente la persona?

Addicionalmente, fuí sorprendido durante la lectura de los Estudios sobre la histeria, que Freud de hecho propone técnicas terapeuticas que hasta el día de hoy son partes integrales de la practica de psicoterapia moderna, aunque sus observaciones ya llevan 12 años. En la terapia cognitiva-conductal para trastornos traumáticos, el concepto de confrontación (o exposicion) es un paradigma central. En la exposición imaginativa se le pide al paciente conmemorarse de exactamente todo lo que pasaba durante una situación traumática, para entender cúales aspectos le causaron temor, y para procesar el suceso. Es asombroso la manera en que ya Freud explicó el efecto terapeutico de una exposicion, ya en unas de las primeras obras de psicoterapia.

Hemos hallado, en efecto, y para sorpresa nuestra, al principio, que los distintos síntomas histéricos desaparecían inmediata y definitivamente en cuanto se conseguía despertar con toda claridad el recuerdo del proceso provocador, y con él el afecto concomitante, y describía el paciente con el mayor detalle posible dicho proceso, dando expresión verbal al afecto. El recuerdo desprovisto de afecto carece casi siempre de eficacia. El proceso psíquico primitivo ha de ser repetido lo más vivamente posible, retrotraído al status nascendi, y «expresado» después. En esta reproducción del proceso primitivo, y tratándose de fenómenos de excitación, aparecen éstos -convulsiones, neuralgias, alucinaciones, etc.- nuevamente con toda intensidad, para luego desaparecer de un modo definitivo.

S. Freud & J. Breuer – El mecanísmo psíquico de los fenómenos histéricos (comunicación preliminar), 1893.

Lo que expresa Freud en esas observaciones es exactamente lo mismo a que se refieren manuales terapeuticos cognitivo-conductales como la Prolonged Exposure de Edna Foa o la terapia cognitiva de Ehlers & Clark.

En conclusión, aunque los Estudios sobre la histeria por su edad no parecen a una investigación moderna médica, los primeros pasos de Freud a su expedición de acercarse al mundo extraño de la mente aún incluyen ideas muy modernas y útiles para entender y curar ciertas formas de trastornos mentales. Sus ideas no solo aún están elemenots existenciales en tratamientos modernos, pero las complementan con la actitud de siempre intentar de estar curioso y abierto a descubrir el sentido individual y autobiografico del sufrimiento del paciente.

Fuentes

  • Josef Breuer, Sigmund Freud (2011, 7. Ed.). Studien über Hysterie. Fischer Taschenbuch Verlag: Frankfurt am Main (publicado por primera vez en 1895) (traducción espanola aquí).
  • Illustración Freud: (c) Olaf Hajek (http://olafhajek.com/)

El efecto de psicoterápia a cambios en circuitos celebrales:

  • Linden, D. (2006). How psychotherapy changes the brain – the contribution of functional neuroimaging. Molecular Psychiatry, 11, 528-538. (free online copy here )
  • Schauer, M., Elbert, T., Gotthard, S., Rockstroh, B., Odenwald, M., & Neuner, F. (2006). Wiedererfahrung durch Psychotherapie modifziert Geist und Gehirn [Imaginary Reliving in Psychotherapy Modifies Mind and Brain]. Verhaltenstherapie, 16, 96-103 (free copy of german article with english abstract here).

El procesamiento de dolor físico y dolor social y sus similaridades cerebrales:

  • Eisenberger, N., Lieberman, M., & Williams, K. (2003) Does rejection hurt? An fMRI Study of Social Exclusion. Science, 302, 290-292. (free copy here)
  • Eisenberger, N., & Lieberman, M. (2004). Why rejection hurts: a common neural alarm system for physical and social pain. TRENDS in cognitive sciences 8 (7), 294-300. (free copy here)
  • Eisenberger, N. (2012). Broken Hearts and Broken Bones: A Neural Perspective on the Similarities Between Social and Physical Pain. Current Directions in Psychological Sciences, 21 (1), 42-47. (free copy here)
  • Lieberman, M., & Eisenberger, N. (2012). A pain, by any other name (rejection, exclusion, ostracism) still hurts the same: The role of dorsal anterior cingulate cortex in social and physical pain. In: Cacioppo, J., Visser, P., & Pickett, C. (Eds). Social Neuroscience: People Thinking About People (pp. 167-188). Massachusetts: Massachusetts Institute of Technology Press Book. (free copy here ).

Where I was when it happened. // BOY – We Were Here (Album Review)

0_BOY_We Were Here_AlbumcoverBack in the late summer of 2011, when Boys break-through single Little Numbers was omnipresent, I was in the middle of studying for an exam in clinical psychology. I vividly remember escaping the university library for a break in the cafeteria, and I couldn’t wait to return to my headphones for that contagious hookline. When Valeska Steiner finally hit the passionate sigh of the line is there a cure for me at a-ha-halll, expressing her obsession with her fling, all I could think of was control groups, RCTs, „needs based intervention“ or „treatment as usual“. In my mind the state of having fallen in love and the vocabulary of treating mental illnesses had gotten mixed up (which makes sense, considering that all symptoms of falling in love could be expressed in clinical terminology, not indicating an illness, but a general change of state of mind. The expression of being „crazy in love“ is not necessarily just a metaphor). Anyway, the way the song conveyed the craving for the excitment of falling in love with its animatedly bouncing piano line, especially in contrast to my current studying routine, had something very tempting.

A lot of the short stories of Boy‘s 2011 debut album Mutual Friends revolve around a general vague vibe of anticipation, the situation of still standing on the threshold of entering a new, exciting and promising stage of life, but already impatiently waiting for the journey to begin. Drive Darling recapped the car ride, in which singer Valeska Steiner‘s mum took her from her hometown Zürich to Hamburg to start her musicial career. The Waitress tried to escape her monotonous it-pays-the-bills job by imagining scenarios of something happening. Even the romantic exhilaration of Little Numbers still stemmed from what could be, if the stranger she presently was only stalking, actually called her.
Since 2011, a lot has happened for the band: A gold certification, extensive touring through the USA and Japan after significant success in Germany/Austra/Switzerland, and various features of Little Numbers in movies, TV-shows and, most prominently, a TV ad for a leading german airline. So if Mutual Friends was capturing the essence of the feeling of anticipation „before“ – their second album We Were Here now recapitulates the „after“.

One of the recurrent themes of We Were Here is the intent to stay mindfully present in the storm of impressions happening around you, which probably can be led back to the experience of extensive touring. How do you stay receptive and interested if something extraordinary (visiting other countries, performing, meeting new people) suddenly becomes a regular, sometimes exhausting job routine?
In this sense, the repetition of the title-giving We Were Here in the songs chorus becomes a retrospective self-reassurance: It wasn’t all just an indistinguishable blur that passed us by in a rush. Everywhere we’ve been, we have been leaving traces. This mindful, probably buddhist inspired attitude reminds me of the opener of another very successful second album of a german band: Back in 2005, Wir sind Helden expressed their proposition of savoring every bit of the experience, not letting it slip through your fingers, in their song Wenn es passiert (roughly translated: A heartbeat just for me and the ones with me / Open your eyes, watch this / who hasn’t got any tears left for this / will become blind tomorrow / if you can’t love this, then what? (…) I never want to ask where I was).

BOY_2015_5_credit Debora Mittelstaedt(c) Debora Mittelstaedt

The back side to this is introduced in Hotel, where the sterile, impersonal comfort in hotel rooms cannot distract from the isolation of the people inhabiting: Different city, different hotel room, but the look of the room stay the same, as well as the feeling: a longing for a home instead of a house.

It’s just a stop along the way /
just a temporary place /
for nameless neighbors in the dark /
wall to wall but worlds apart /
a hotel room is a hotel room is a hotel room
.

Eventually, BOY even try to integrate the spirit of emotional discovery to their life coming home, not allowing the sudden decline of adrenaline turn into a coming-home-blues. Therefore, New York states that with the right mindset, it’s really not about the place (any street that I’m walking with you / anywhere with you could be new york (…) but i woke up all eyes and all ears, / when you whispered / (…) it’s all really happening here).

Another recurring, more personal motive is how to accompany a loved one through rough waters. Fear evokes associations to Angst (fear), a song by Fotos, the band of Boys current touring guitarist Deniz Erarslan, who Valeska Steiner sang background vocals for on their debut album before Boy had been formed. Both songs describe fear as being possesed by a demon crawling under your skin and invading every aspect of your personality and every area of your functional life as an individual (with every step i feel its weight / in my eyes you can see its face / in Angst) or as a romantic couple (in Fear).
Steiner sings from the perspective of the partner of someone with anxiety issues and illustrates the desperate attempts to help her loved one: the strong will to put up with the fight against this powerful invisible enemy, energised by her love (i’ll shield you ‘til it disappears, all my love against your fear). Eventually though, she also realizes her complete helplessness against the omnipotence of this condition. In a similar context, the character in Flames utters her resignation: „and i call your name / but i can’t get through (…) oh dear love, if only i could find / a way to ease your troubled mind“.

BOY_2015_1_credit Debora Mittelstaedt(c) Debora Mittelstaedt

In the album closer Into The Wild, we find the protagonist torn between the decision of accompanying a loved person into the unknown and missing the comfort of home, or staying home and gloryfing the missed love. Realizing (and accepting) that there is no solution to the dilemma between the travel bug and the wish for a secure and comfortable home, the album ends decisively indecisive on an ambiguous note (so when the music is over / will i finally have my answer?).
Funily enough, the chorus of the song uses a very common chord progression that is also prominently used in U2’s With Or Without You, which in a way makes even sense considering the content. When I returned from a long time abroad, my mother noticed pictures of friends from another country on my wall and said: Well, over there you had fotos up from people here, now it’s the other way round. So it never actually feels right, or complete: There is always something missing.

Boy have often been accused by critics of being too accessible, of making music everybody could agree on, of being too tame and simple-hearted. And again on this record, it is pretty easy to find arguments for this: We Were here is very traditional acoustic singer-songwriter record, with maybe some new traces of the currently trendy 80’s power pop synth lines here and there. But: In a recent review, Pitchfork  defined a good mainstream pop record as capturing emotions everybody can relate to with so much individual personality that they actually can become universal representations of a certain feeling. And in this sense, Boy succeed to create pop music that represents a certain sense of simplicity, a non-judging curiosity and excitment, conveying enough character in order to still be interesting.

Boy‘s melancholy of longing or being stuck in between the attraction of new experiences and the longing for security never turns into negativity, as at the end of the day it’s an expression of richness and content: There’s just still so much to be seen and felt in this world.

Sources

  • Promotional photographs of Boy: Copyright Debora Mittelstaedt.
  • Fotos – Angst. From Porzellan – Snowwhite, 2010.
  • Wir sind Helden – Wenn es passiert. From Von hier an blind – Reklamation Records, Labels, 2005.

Freud y los Estudios sobre la Histeria I – Como se convierten emociones represadas en dolores corporales

2015-09-01 Histeria-BannerImagínese que sea un médico al comenzar del siglo 20. Llega una paciente de 21 años y le reporta de una parálisis de su brazo y todo su lado derecho, varias alucinaciones (por ejemplo confundir cepos de arboles con serpientes) y trastornos visuales. Otra paciente llega y se lamenta de la perdida de su olfato con la excepción de la presencia de un olor de una comida dulce quemada que ella reiteradamente de repente huele. En el examen físico de las pacienties no se puede encontrar ninguna forma de daño corporal en las partes respectivas de su cuerpo. Como su médico – que haría?

2015-08-30 hysteriefischerEn mi formación profesional para volverme un psicoterapeuta psicodinámico, recientemente hemos iniciado a leer y discutir la obra de Sigmund Freud, el inventor de la técnica psicoanalítica y hemos empezado con Estudios sobre la histeria. El libro está considerado un documento historico de los inicios de la psicoanálisis, porque incluye reportes detallados de los primeros intentos de Freud de investigar síntomas emocionales, perceptuales y conductales, que hoy llamariamos „trastornos mentales“, y implica algunas primeras sugerencias para curarlas.

La lectura del libro no se lee como un reporte médico formal, sino que parece mucho más el género literario de la ficción detectivesca como Sherlock Holmes. Freud se encuentra confrontado con pacientes que le cuentan de varios síntomas que el aún no puede entender ní saber su causa, y así, el Detective Freud, aún un poco desprevenido, emprende camino juntos con sus pacientes para buscar alguna otra explicación.

Freud empieza con una anamnesis extensiva y interroga a las pacientes sobre las molestias, su biografía y su historia clínica. Especialmente se concentra en preguntarles, cuando y bajo cuales circunstancias aparecieron las sintomas mencionadas por primera vez. Durante estes anamnesis el desarrolla la teoría que las síntomas no representan algún malfunción física, sino que tienen su origen en la confrontación con alguna situación traumática en el pasado de sus pacientes.

Mientras escucha a a sus pacientes, Freud desarolla la teoría que ciertas emociones que occurrieron durante situaciones traumáticas, que, por alguna razón no pudieron estár expresadas o vividas suficientemente por la persona, se graban de manera muy profunda en la memoria y en el inconsciente de la persona. Por ejemplo si nos enojamos en algún momento, podemos

a.) expresar el sentimiento directamente a la frente de nuestro adversario, o
b.) procesar la emocion racionalmente („Relájate! No vale la pena! Sabes que tienes razon“), o
c.) nada más olvidar lo que pasó.

Esas emociones pueden constituir la base de una histeria, según Freud, si las pacientes no encuentran ninguna forma de manejo o expresión de la emocion correspondiente. Razones por eso podrían ser

  • la situación del trauma (por ejemplo durante un amenazo no hay ningun tiempo para manejar el miedo porque es prioritario actuar para sobrevivir),
  • condiciones sociales (en ciertas situaciones sociales puede causar miedo, verguenza, o penalización expresar sus emociones) o
  • el simple deseo de la persona de querer olvidar lo que ocurrio, para evitar sentirse tan vulnerable de nuevo y para seguir adelante.
  • Otra razón podría ser que las emociones se formaron en una situación de choque, miedo, sueño, parálisis o disociación, así que el protagonista no tiene ni la chanca de sentir, expresar o manejar las emociones.

El problema en los casos de histeria o de emociones conectadas a situaciones traumáticos es que la emoción no simplemente desaparece. El afecto se busca una forma diferente de expresarse – y encuentra el cuerpo.

Con cada sesión más, Freud puede reconstruir las escenas que causaron las síntomas de la primera paciente, la famosa Anna O.: En un tiempo en que ella se encargaba de cuidar a su padre enfermo, se había sentado en un sillón cerca de la cama de su padre, con el brazo derecho puesto sobre el ladillo. En un momento empezó a adormecerse, cuando vió un serpiente acercandose a su padre. En el intento de espantar la serpiente se dió cuenta que su brazo se le habia dormido a causa de su posición arriba del ladillo, así que sintió una gran desesperación por no estar capaz de proteger bien a su padre. Cuando más al rato su padre le preguntó por la hora, ella aún estuvo tan movida que le salieron las lagrimas de los ojos. Ella intentó de esconderlas, pero no obstante su vista fue desvaída.

La segunde paciente, Lucie R., era un caso un poco más facil. Ella trabajaba como educadora de dos niños en una casa de un señor, y en algun momento tenía la impresión que su patrón podría sentir algo por ella, así ella se enamoró de él. A continuación tenía varias peleas con los otros empleados de la casa, que sintieron que Lucie ya actuaba como si fuera la señora de la casa. Esas peleas, y el entendimiento, que el señor no sintía por élla en la misma manera, le humilló tanto que planeaba de despedirse de la casa. Mientras aún contemplaba su futuro, le llegó una carta de su mama, a quien le había prometido que iba a cuidar los niños del señor, como la madre de los niños, que habia muerto, habia sido una gran amiga de la mama de Lucie. Le llegó esta carta de su mama en el momento en que preparó una comida dulce en el horno, y su emoción de estar destrozado entre su obligación a su madre y los niños del señor, el intento de apartir de su mente su amor para el patrón y la humillación por los otros empleados se conectaron con el olor de la comida quebrada.

2015-08-28 egocompletoEn los dos casos se dejan identificar ciertas emociones que parecián inaceptales a las mujeres: A Anna, le pareció inaceptable sentir el agotamiento (de cuidar su padre) o la culpa (si el serpiente le hubiera dañado a su padre.). Como no pudieron entrar a la consciencia de Anna por su contenido tan inaceptable, se manifestaron en limitaciónes físicas. En momentos en que Anna sintía miedo, o culpa, de nuevo su brazo pareció haber dormidose, y su vista parecía desvaída. A Lucie, a un lado es inaceptable despedirse de la casa, por la promesa que habia dado a su mama y a la mama de los niños. Al otro lado es inaceptable quedarse en la casa, porque es inaceptable sentir su amor por su patrón, pero tampoco aguanta apartarlo de su mente. Su idea de „Estoy decepcionando a mi mama, si no cuido bien a los niños“ occurre en el momento en que llega la carta de su mama, y porque no puede entrar al consciente de ella, se manifesta en una alucinación olfatoria.

No importa que insólito y irracional las síntomas pueden aparecer a primera vista, con el saber de la historia y el contexto en que ocurrieron por primera vez, uno puede entender que las síntomas tienen un sentido, el sentido de servir como expresión sustitutiva de una emoción represada.

El enfoque de Freud de tratar las síntomas consiste de trés partes.2015-08-28 mecanismos de cura1.) Durante hipnosis, descubrir la historia de origen de las síntomas, su significado y las emociones represadas. Darles instrucciones positivas instrucciones positivas („Ya no tengas miedo de serpientes“) para llegar a su subconciente.

2.) Ordenar y animar a las pacientes a verdaderamente sentir, vivir y expresar la emoción de atrás.

3.) Reflexionar juntos con las pacientes sobre una manera racional de entender y manejar sus emociones. („Ya sabemos los dos que los serpientes verdaderamente representan el miedo y la culpa de no haber cuidado suficientemente a su padre enfermo.“).

En un segundo blog post, voy a reflexionar sobre la actualidad de la teoria de Freud sobre la histeria y compararé los planes de tratamiento de Freud y del presente.

Sources

  • Josef Breuer, Sigmund Freud (2011, 7. Ed.). Studien über Hysterie. Fischer Taschenbuch Verlag: Frankfurt am Main (publicado por primera vez en 1895) (hold the copyright for the book cover above).
  • Se puede encontrar el texto completo de Estudios sobre la histeria de Josef Breuer y Sigmund Freud en traduccion castellana en la Biblioteca del Instituto Nacional de Bienestar Magisterial de la República Dominicana
  • You can find the whole text of Studies on Hysteria by Josef Breuer and Sigmund Freud (first published in 1895) in english on archive.org in pdf or txt  format.

Is Anakin Skywalker suffering from Borderline Personality disorder? / No kidding, this article actually exists!

Are you just as excited for the upcoming first part of the new Star Wars Trilogy starting in December? Well, then this is fun for you: In 2011, Eric Bui, an Italian psychiatrist from the Toulouse University Clinic, published a letter to the editor in a serious psychiatric journal, in which he applied diagnostic criteria for mental disorders on none other than Anakin Skywalker, also known as Darth Vader. Bui stated that Skywalker fulfiled various criteria sufficiently in order to get a diagnosis of Borderline Personality Disorder (BPD). The symptoms Ani fulfilled included

  • impulsivity
  • anger issues (Patience you must learn, young padawan…)
  • sudden changes between idealisation and degradation in relationships with close persons (could be applied on his relationship with Obi-Wan Kenobi, his Jedi Master),
  • an incomplete sense of identity, an incapacity of feeling his inner self (indicated by sudden changes of personality – the changing of his name might count as an indicator)
  • an excruciating fear of losing his partner (talking of Natalie Portman Padme Amidala here)
  • experiencing dissociative episodes due to stressful events (dissociative episodes refer to a condition in which patients can’t feel their body or experience their surroundings as not feeling “real”. The article e.g. interpretes the moment when Anakin kills a whole tribe after discovering the death of his mother as an dissociative episode.).

As a conclusion (and justification for it, if you ask me), the essay lists three reasons why this investigation might be helpful in real life: 1.) It might explain the appeal of Star Wars to adolescents, as (sane) adolsecents are known to show a lot of these symptoms due to their normal development. 2.) It aims at reducing social stigmatization of people suffering from BPD. 3.) It might be useful in order to illustrate the main features of the illness and to train future psychiatrists and psychologists.

Even though I am very fond of the whole Star Wars universe, and enthusiastically enjoy to apply psychological knowledge to popcultural phenomena and characters, I still see the danger of hurting the feelings of people actually suffering from this horrible and excruciating disease. It might be received as offensive, either because it apparently makes fun of symptoms that severly impede their everyday lives or by apparently declaring them as morally flawed by comparing them to one of the worst villans of all movie history. But this is just one side of the story.

If you read the article closely, you’ll realize that there’s not one sentence in it that makes fun of people with BPD, but that it is driven by the desire to understand what the subjective reality of this people has to look like. It also states possible traumas in the autobiography of Anakin Skywalker, as shown in the movies, that are known to be vulnerability factors to BPD (lack of a father, early seperation from the mother, not to mention growing up in poor and dangerous surroundings, and having been sold as a slave). Furthermore, I feel like, if anything, the whole point of the Prequel Trilogy is for the audience to identify with Anakin, even though he does all these terrible things – in order to allow the audience to relate to him. Why does he do this? It’s probably not right – but you still can relate to it. And, in my opinion, this is exactly the attitude sane people need in order to be able to understand subjective realites and perceptions of people with mental disorders, even though they don’t experience the same feelings as these people.

Obviously, various pop cultural magazines picked up on the article. There even is a professional reply to the investigation in the same journal that questions the diagnosis, stating that other Cluster B personality disorders as narcissistic or antisocial personality disorders might have a better overall fit to Skywalker. The article I liked the most (from Wired) concluded with a statement by Carolyn Kaufman, a clinical psychologist from Columbus, Ohio, who said, probably with a winking eye:

As for the 30-year-old Star Wars series, “We’re probably lucky nobody has started analyzing the lightsabers as phallic symbols,” said clinical psychologist Kaufman. “Come to think of it, someone probably has.”

Sources

Stages of Grief / Sufjan Stevens – Carrie & Lowell (Album Review)

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Sufjan Stevens / (c) Selective Artists

In 1969, the swiss-american psychiatrist Elisabeth Kübler-Ross introduced a theory on how people with terminal illness deal with being confronted with their diagnose. This model later on was adapted to how people close to the sick person dealt with their loss after their loved one had died. The so called stages of grief included various phases of attempts to deal with this shattering life-changing situation:

  • denail („This can’t be true! S/He’s still alive.“),
  • anger („Why does s/he do this to me? I need her/him!“),
  • bargain („Maybe if I just live in my memories, it’s gonna feel like s/he’s still there!),
  • depression („Life without her/him isn’t worth living any more. All my sense of purpose has died with my loved one)
  • and acceptance (Even though it’s hard and difficult, at some point I’ll have to continue my own life, even if it’s hard“).

Encountering people in our lifes leaves traces inside of us, not only memories, but according to object relations theory, we develop an inner image (an object) of a person. This image includes how we see this person, of what they remind us, associations, expectations, fears, mutual experiences etc. These objects, either via identification or demarcation („I am like this person!“ vs. „I’m so different than this person!“), become part of our identity and how we see ourselves. Morgenthaler says, refering to Freud:

When an object relation ends, commonly an identification with the lost object occurs. Freud wrote in „Mourning And Melancholia“ that objects possibly can never really be relinquished, but always leave their traces as identifications in the Ego. As the Ego develops itself through its relations to the objects, one can state that the Ego is constructed out of identifications with former love objects.

Speaking in less technical terms, American poet e. e. cummings expresses a similar sentiment by simply saying:

I carry your heart with me (i carry it in my heart)

While listening to Sufjan Stevens‘ latest record Carrie & Lowell, which deals with the death of Stevens‘ mother Carrie in 2012, in many moments I felt reminded of these descriptions of a desperate mind trying to come to terms with the experience of such an existential crisis.

Sufjan Stevens is an US-American singer-songwriter, who’s been particularily known for his storytelling, dressed in beautifully arranged alternative folk / country-songs. By now, I’ve grown tired of journalists still mocking his idea of making a concept album of every of the 50 states of the USA after gaining commercial success with his albums on Michigan (Greetings From Michigan: The Great Lake State, 2003) and Illinois (Come on Feel The Illinoise, 2005), respectively (Seriously, guys! It was a joke! A promo joke! It’s been ten years! Can we let this one rest, please?). In 2010 he dipped into ornamenting his songs with delicate electronic experimentation, resulting in The Age Of Adz. This record explored the perceptions and subjective realities of people suffering from schizoprenia, and was inspired by his personal experiences of his mother suffering from the illness, and the work of american artist Royal Robertson.

On his recent album Carrie & Lowell, the listener is invited to peer through Stevens inner eye while it passes reminiscing through various biographical scenes of his relationship with his mother and his time of grieving. You see a person being thrown around by his emotions and impulses in reaction to what is happening: the numbing, the paralysis, an inability to react in any way, helplessness, desperation, that eventually lead to an outburst of emotions – and still everything inside of you is fighting the moment of realizing the dimensions of what is happening here.

SufjanStevens_Carrie&Lowell_Admat11x17

(c) Selective Artists

Stevens voice has a very soft, almost mumbling quality, to the effect that the vocals crawl right up your skin, creating the notion that the things he sings about are so intimate that they can’t be spoken out loud. An example is the opener Death With Dignity, where the sparse arrangement mirrors the process of hesitantly, timidly approaching what it is there in your stomach (both, Stevens reflecting, and the listener entering the record), and how, when you found out, it overfloates your whole being and your body. A lot of the songs start restrained and reduced, before, when coming to the core of the sentiment, expanding into a sonical landscape, where the intensity of piano sounds, crescending electric guitar feedback, reverb, tremoulous and wafting notes build up to a lulling and washed out sound cloud where everything sinks into the sentiment. This is the moment where the running away, the fighting and rearing up against what has happened doesn’t work anymore and the barriers break. The songs become haunted by faded nostalgic memory flashbacks and the echoes and traces left by the people who disappeared come to the surface, accompanied by the anger, the sadness and the remorse experienced by the one who was left behind.

The different stages of grief can be found all over Carrie & Lowell. The process of passing through these stages typically is not linear, but curved, with various fall-backs and advances, and in Should Have Known Better, Stevens, still in shock, tumbles between the stages: Don’t back down, concentrate on seeing / the breakers in the bar, the neighbor’s greeting (denial) // Don’t back down, there is nothing left / the breakers in the bar, no reason to live (depression) // Don’t back down, nothing can be changed (…) My brother had a daughter / The beauty that she brings, illumination (acceptance). The mentioning of his newborn niece alludes to the (cruelly? consolatingly?) neverending circle of life: We all die. And at the same time, new human begins get born. Life ending and beginning.

SufjanStevens_Carrie&Lowell_Admat11x17 Album Artwork

(c) Selective Artists

There is the overwhelming moment of Fourth Of July in the hospital, a recap of the ultimate conversation – a mother trying to console her son before she dies. The scene is not unlike Death Cab For Cuties heartbreaking hospital drama What Sarah Said, where Ben Gibbard concludes: There’s no comfort in the waiting room: Suddenly the realization hits that you never really grows up and you’re never as much faced with being responsible completely for yourself and on your own, as much as when the person who always has been there in your life – your mother – is gone, and you subsequentley loses all balance: „Was it all a disguise, like Junior High / Where everything was fiction, future and prediction / Now, where am I? My fading supply“. I think everybody has, despite of all loving, certain issues with their parents. But knowing that a mentally ill mother who under the burden of trying to stay stable for herself, asks her son, probably worried or regretful: „Did you get enough love, my little dove / Why do you cry? (…) Make the most of your life, while it is rife, while it is light“ – it just tears my heart apart.

On various occasions in the lyrics, Stevens refers to the part inside of him that now feels dead as for having been so closely connected with the person who died. The variety of religious and biblical images serve to illustrate his personal Job’like theodicy conflict, and these pressing questions after a sense gets asked in Drawn to the Blood: „How? How did this happen? (…) What did I do to deserve this?“ His desperation and rage reach its peaks in The Only Thing, where he resignes: „Do I care if I survive this? (…) Should I tear my eyes out now? Everything I see returns to you somehow / Should I tear my heart out / Everything I feel returns to you somehow“ before rhetorically, sarcastically asking: „How do i live with a ghost?“.

In another song, All Of Me Wants All Of You, he is alluding to the loss of a unresponsive and ignoring partner („You’re not the one to talk things through / you checked your text while i masturbated“). Again, he comes to the conclusion that the deepest anger and animosity often stem from a previous deep, frustrated love. An explicit attempt of steering clear of her („Now all of me thinks less of you) changes to moments of missing her („on the sheet i see your horizon / all of me pressed onto you (…) I’m just a ghost you walk right through“) until it eventually changes back into the primary sentiment of affection, longing and missing („all of me wants all of you“). Anger is a phase, but unfortunately it’s not remedy, and not the end of the process.

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(c) Selective Artists

A remarking quality of this record is that even though it deals with heavy states of mind like regret, frustration and depression, it always succeeds in guiding the listener a certain mood which is mainly charactered by innocence. While listening to this record, one is so closely connected to the protagonists feelings that one is never tempted to follow him in his self-reproaches, one never actually wants to judge on anyone, etc., because the sheer authenticity of his suffering is so apparent. We intuitively feel that in order to „get“ what he is saying, thinking is not the way to go. You get completely absorbed by his suffering, his longing and his craving for redemption.

To loose someone is such an existential moment that consequently it puts everything else in perspective: „The real world“, the functioning, the reasoning. Instead, by brutal force of the situation, we are very close in touch with who we really are in a very pure way, even though it might still be hold off by the impulse of avoiding the pure desesperation and the feeling of finding yourself being completely lost.

There is something about country / folk music that makes it appear a perfect soundtrack to road trips or movies: a sense of being open, curious and particularily receptive of the unknown surroundings. So maybe, after all, it does make sense: On this record, Sufjan Stevens does not take the listener on a journey through an US-American state. He takes us on a journey through our insides.

Sources:

  • Elisabeth Kübler-Ross (1969). On Death And Dying. Routledge.
  • Fritz Morgenthaler (1986). Technik. Zur Dialektik der psychoanalytischen Praxis. Taschenbücher Syndikat / EVA: Frankfurt am Main (translated by the author).
  • Sufjan Stevens – Carrie & Lowell. Asthmatic Kitty, 2015.

I’m a bit broken and a bit messed up” – Darren Hayes on growing and accepting personal flaws

When reflecting on recurring schemes or patterns in your life, we’d often love to apply a very pragmatic approach: Something doesn’t work. We analyze it. We have an hypothesis. We fix it. Everything’s fine. Bad news is: Experience shows that it’s normally not that easy.

There are things that can be fixed, and other things that will probably follow us through the rest of our lives. There is a saying that even 20 years of psychotherapy won’t change a penguin into a giraffe. Obviously, you can recommend to the penguin that he might feel better leaving the ecosystem of giraffes in order to find something more comfortable for himself. But, nevertheless, both patients and therapists normally agree on a lesson learned by experience: By analyzing your patterns, you do not learn not to fall into the same hole over and over again. Normally, you just learn how to get out of it quicker and how to try to avoid it.

At first sight, this might seem a bit frustrating and disappointing. But actually, it’s not that bad, because in the moment we accept it, we feel the relief of not having to fight for change any more, and the sensation of a burden lifted can be enormous. Therefore, almost every form of therapy concentrates on two aspects: Acceptance and Change. Or, as my father used to tell me: If you can’t root out your neuroses, pour them some water.

To illustrate the point of acceptance, I’d like to quote one of my favourite Pop Singers, Darren Hayes.

2015-08-24 ttmabIn both, his career as the lead singer and songwriter of 90’s pop band Savage Garden and as a solo artist, Hayes used music and his lyrics to express feelings like alienation, solitude, anger, depression and longing. One of the first hits of his former band, To The Moon & Back told the story of an alienated lonely girl escaping herself in Science Fiction fantasies in order to express the wish to run from her bleak and desolate reality (which might even include an allusion to suicide). I have already mentioned Two Beds And A Coffee Machine, a song from Savage Garden’s second album Affirmation that describes a mother escaping from her home after experiencing domestic violence, caught between the responsibility to protect her children and the reality of not being able to provide them on her own. Especially his second solo record The Tension And The Spark dealt with many of these topics in a very blunt way: The lyrics to Unlovable illustrate how a recent rejection experience can reanimate 2015-08-24 ttatsold schemes of self-accusation, anger, aggression, shame, blame and self-hatred (You make me feel like my mother, she abandoned me / You make me feel like the act of love is empty / Am I so unlovable? / Is my heart unbreakable? / Do I remind you of a part of you that you despise?)

During the campaign of his third solo record This Delicate Thing We’ve Made, Darren consciously decided to disclose how his personal background and the way he grew up influenced him and caused a lot of these emotional turbulences:

“My whole career as a big commercial pop artist was fed through self-hatred, basically. It was all about escapism in a fraudulent way. I became a pop star because I knew I had to become something extraordinary to escape”.

If you trace a line through the work of both Savage Garden and Darren Hayes solo, there is a recurring theme of being unloved and unlovable. It is part of what connects him at his most popular to a mass audience. If Darren is a master at articulating the simple sentiment of what it feels like to be rejected, it does not come without its own poignant back-story.

Darren grew up in the working class suburbs of Australia’s Brisbane. In the early 80s, on the run from his Father’s violence and alcoholism he was just 10 when his Mother took him and his siblings to live in a caravan to escape regular scenes of violence. His relationship with his father has been both the making and undoing of Darren Hayes. His father having long since recovered and redeemed himself (sober for 25 years) – the childhood clearly left an indelible mark on Hayes. It was his need to please that propelled him to invent a life as a pop star. The fame came but could not fill an emotional hole.

(from the official promo biography 2007 written by Paul Flynn, source below)

In a blog interview during this promotional campaign, Hayes was asked about whether his view on these topics has changed thorough the years, and he gave some remarkable answers.

Do you feel that your prior concept of being “unloved and unlovable” is still a melancholic reality for you? I think there will always be a part of me that feels hideous. I am very lucky that I am in a really gorgeous relationship – I am loved by someone that just sees me for all my strengths and weaknesses and accepts me whole. I never thought I would find that, I always thought I would end up alone. (…). The fact that I can’t lie about my insecurities is my thing. I’m a bit broken and a bit messed up. Thankfully, I’ve worked out how to put one foot in front of the other one and get through life and smile.
(…)

What’s the symbolism behind the paper crane that features on the cover artwork? It seems complicated, but it’s not. It’s an album about relationships and how fragile we all are. The paper crane is a metaphor for being alive. When you unfold it, you can see all of the creases representing the scars and choices that we have made, whether they are good or bad. That’s our life, that’s what 2015-08-24 tdtwmmakes us who we are. The idea of This Delicate Thing We’ve Made is just my way of saying that everything that happens to us, creates us. Essentially you see a whole life unfold when you unwrap the bird. [Darren then begins to fold a paper crane for me.]

Sources:

Erich Fried – Fügungen

Fügungen (no traducible, juego de palabras de „destino“ y „juntura“)

Se dice
un poeta
es alguien
que ensambla
palabras

Eso no es cierto

Un poeta
es alguien
que aún está
medianamente
ensamblado
por palabras

si tiene suerte

si tiene mala suerte
las palabras le
parten a el.

 

Es heißt
ein Dichter
ist einer
der Worte
zusammenfügt

Das stimmt nicht

Ein Dichter
ist einer
den Worte
noch halbwegs
zusammenfügen

wenn er Glück hat

Wenn er Unglück hat
reißen die Worte
ihn auseinander

Erich Fried: Lebensschatten (1981)