EARLY AND SUSTAINED DYNAMIC INTERVENTION IN SCHIZOPHRENIA

This paper is based on the Danish National Schizophrenia Project manual for psychodynamic individual psychotherapy with persons in states of schizophrenia. The methods for engaging with and treating a patient with schizophrenia in a supportive, psychodynamic way are described

Freud og psykiatrien

Freud viewed psychoanalysis as a basic psychological theory of psychiatry. At the same time he maintained that the concepts of psychoanalysis, its methods of observation and the causal explanations used in psychoanalysis were different from the concepts, methods and explanations used in psychiatry. In his article "The QuestionsofLay-analysis" he attacked impetuouslythe doctors who performed psychoanalysis without having gained the necessary expertice by a formal education.By ways of examples the article examines how psychiatrists today view psychoanalysis, how psychiatry and psychoanalysis influence each other mutually, and how this mutual influence can lead to progress in clinical treatment as well as to theoretical derailments as far as psychoanalytic theory is concerned. Lastly, the article refers to ethics as a field in which psychoanalysis and psychiatry are characterized by taking different positions.Artiklen gennemgår ved nogle eksempler, hvorledes psykiatere med forskellig orientering ser på psykoloanalysen i dag, hvorledes psykiatrien og psykoanalysen gensidigt påvirker hinanden, samt hvorledes denne påvirkning kan føre til kliniske fremskridt for begge felter såvel som til teoretiske afsporinger, ikke mindst af psykoanalysens teori. Til sidst i artiklen omtales etikken som et felt, hvor psykoanalyse og psykiatri indtager forskellige positioner

»DAS UNHEIMLICHE« OG MULIGHEDEN FOR AT INTEGRERE DET FREMMEDE

Artiklen gennemgår Freuds essay »Das Unheimliche« (»Det uhyggelige«), som understreger, hvorledes ‘det fremmede’ i os selv driver individet mod forvrængede opfattelser af selv og virkelighed. Med udgangspunkt i to sociologer, Alfred Schutz og Georg Simmel, påpeges to fænomener, der knytter sig til ‘den fremmede’. Det ene er den homogene gruppes reaktion på den fremmede, som anses for et marginalt væsen. Gruppen udvikler sin egenforståelse, fuld af modsigelser, og bedrager sig selv til at tro, at den fremmede tænker på nøjagtig samme måde som gruppen. Effekten er en modsætning mellem den fremmede og gruppen. Simmel derimod anskuer den fremmede som en produktivkraft, hvis radikalt skæve, »unheimlich« marginaliserede position, producerer en erkendelseseffekt, som ikke ville kunne produceres andetsteds fra. I denne forstand har psykoanalytikerens position ligheder med den fremmedes. Artiklen afsluttes med refleksioner over traumets transgenerationelle struktur og dets funktion som bindeled mellem symptom og psykopatologi i Nachträglichkeit’ens perspektiv. Desuden, at mødet med det fremmede er funderet i en struktur, hvor noget assimileres, akkomoderes og integreres, men at der altid tilbagestår en rest, som ikke lader sig integrere

OBJEKTRELATIONENS STRUKTUR, ETIK OG ÆSTETIK: Et forsøg på at placere Donald Meltzers psykoanalytiske tænkning

Artiklen er et forsøg på at beskrive Meltzers placering i psykoanalysens landskab som en original tænker i den neo-kleinianske tradition. Originaliteten ligger dels i måden, de kliniske beskrivelser konceptualiseres på, dels i Meltzers insisteren på, at der i tillæg til den strukturale og etiske dimension i forståelsen af objektrelationen og symboldannelsen må tilføjes en æstetisk dimension. Denne ligger »i bunden« af enhver teori om tænkning som emotionel erfaring, for den er forbundet med sindets fundamentale optagethed og interesse i livet, som gør det til »food for thought«, og som omdanner begivenheder til erfaringsøjeblikke. Artiklen gennemgår synspunkter fra en række af Meltzers værker og afsluttes med Meltzers kritiske syn på psykoanalysens institutioner og betydningen heraf for det analytiske sinds dannelse.The paper is an attempt to describe the location of Meltzer in the landscape of psychoanalytic theory as an original thinker in the Neo-kleinian tradition. The originality reveals itself in the conceptualisation of the clinical descriptions, and in his insisting on the importance of the aesthetic dimension in the conceptualisation of symbolformation in addition to the structural and ethical ones. The aesthetic dimension is basic to the understanding of thinking as emotional experience. It is essentially linked to the engagement and interest in life which makes it food for thought, and which transforms ‘events’ to ‘moments of experience’. The paper highlights ideas from several of Meltzer’s books. In the end, the paper looks into Meltzer’s critical voice against the instutionalization of psychoanalysis, and the impact of this on the formation of the psychoanalytic mind

Når virkeligheden svigter: - om udforskningen af reparative foranstaltninger ved psykotiske tilstande

The psychotherapeutic interactions with psychotic persons, especially individuals with schizophrenic disorders, challenge to a maximal degree the competence and countertransference of the psychotherapist. In the research of the psychotherapeutic process many scientific problems are pushed to their extremes. Some of these problems are adumbrated. The theoretical formulation of this paper is coherent with psychoanalytic thinking. The formulations are based on my own experience with schizophrenic patients in psychotherapy and, furthermore, a Danish project concerning psychotherapy with schizophrenic persons. The Danish project is part of a Nordic multicenter investigation. The paper discusses the ethics of treatment, problems of establishing a treatment alliancewith patients dominated by an initial state of non-experience, the meaning of metaphors in psychotherapy, and the significance of the in-exact interpretation.Det psykoterapeutiske møde med psykotiske mennesker, ikke mindst mennesker i skizofrene tilstande, er ofte maximalt udfordrende for behandlerens kompetence og modoverføring. I udforskningen af den terapeutiske proces stilles mange forskningsmæssige problemer på spidsen. Eksempler på disse vanskeligheder diskuteres. Artiklen tager teoretisk udgangspunkt i psykoanalytisk tænkning. Dens praktiske udgangspunkt er egne erfaringer samt erfaringer fra et dansk projekt vedrørende psykoterapi af mennesker med skizofreni eller skizofreniforme tilstande (det danske projekt er et delprojekt i en fællesnordisk undersøgelse). I artiklen diskuteres bl.a.: behandlingens etik, problemer med at etablere en behandlingsalliancemed patienten for hvem en initial »state of non-experience« er fremherskende, metaforens betydning i psykoterapi samt betydningen af den unøjagtige fortolkning

Mobning, psykisk lidelse og selvskade

The aim of the paper is to investigate how childhood experiences of bullying may later create self-destructive and self-harming behavior. The paper summarizes the empirical quantitative research, but has its main focus on structural qualitative interviews with young adults who participate in group therapy treatment program. The empirical materialclarifies how young adults understand early experiences with bullying and its relation to psychic sufferings and self-destructivity, and the difficulties in addressing the difficulties on a social level. The paper investigates, from a phenomenological and psychoanalytic perspective, howchildhood experiences of bullying are associated with strong, dominating, often unconscious, emotions of shame. The hidden and diffuse character of shame leads to both direct and indirect self-harm. Patterns of repetition with self-devaluation and experiences of exclusion hinder the possibilities of the person to build interpersonal relationships thatmay contribute to development of the self. The retrospective and prospective effects of bullying are elucidated empirically and theoretically, and the concepts of complexity, trauma, Nachträglichkeit, repetition and intersubjectivity play a core role. The paper also points out how hindrances of verbalization – in families, among friendsand in therapy – may contribute further to self-harming behavior

Deficiency of annexins A5 and A6 induces complex changes in the transcriptome of growth plate cartilage but does not inhibit the induction of mineralization

Initiation of mineralization during endochondral ossification is a multistep process and has been assumed to correlate with specific interactions of annexins A5 and A6 and collagens. However, skeletal development appears to be normal in mice deficient for either A5 or A6, and the highly conserved structures led to the assumption that A5 and A6 may fulfill redundant functions. We have now generated mice deficient of both proteins. These mice were viable and fertile and showed no obvious abnormalities. Assessment of skeletal elements using histologic, ultrastructural, and peripheral quantitative computed tomographic methods revealed that mineralization and development of the skeleton were not significantly affected in mutant mice. Otherwise, global gene expression analysis showed subtle changes at the transcriptome level of genes involved in cell growth and intermediate metabolism. These results indicate that annexins A5 and A6 may not represent the essential annexins that promote mineralization in vivo