Reapproaching Mahler: new perspectives on normal autism, symbiosis, splitting and libidinal object constancy from cognitive developmental theory

Attachment and reflective functioning in children with somatic symptom disorders and disruptive behavior disorders

Our goal in conducting this study was to examine whether children with somatic symptom disorders (SSD) and disruptive behavior disorders (DBD) have higher rates of insecure or disorganized attachment and difficulties in mentalizing (operationalized as reflective functioning) as compared to a control group. Participants were 131 children (8-15 years) spanning two groups-a clinical group (n = 85), comprised of children fitting the criteria of our target diagnostic classifications (SSD: N = 45; DBD: N = 40), as well as a comparison group of healthy control children (n = 46). Children completed the Child Attachment Interview, which was later coded by reliable raters for attachment security and reflective functioning (RF). Consistent with our predictions, children in the clinical group had significantly lower RF and were significantly more likely to have insecure (over 80%) and disorganized attachment (over 40%) than children in the comparison group. In addition, RF was significantly lower in children with DBD than children with SSD. Furthermore, in the SSD group, children's RF regarding self was significantly lower than RF regarding others. Finally, consistent with prior studies, RF and attachment were associated. The findings indicate that school-aged children with SSD and DBD have higher rates of insecure and disorganized attachment. Consistent with theory, RF and attachment were loosely coupled, but RF alone differentiated among the diagnostic subgroups. Implications for treatment and prevention are discussed.

Fluctuations of mentalization in the context of relational stimuli and representational contents

Background

Mentalization as the ability to interpret human behavior in terms of mental states is not a stable characteristic but is subject to fluctuation depending on the context. Nonlinear system theories explain the fluctuation of mentalization by stressing the context of the relationship in which there emerges a new quality of mentalization and/or activation of elements of the internal system of representations.

Participants and procedure

The aim of the study was to test whether the fluctuation of mentalization depends on the type of relational stimulus (imagining the responsiveness/unresponsiveness of a significant other) or on the interaction of the stimulus with the content aspects of representation (a predominance of relatedness/sociotropy or a predominance of self-definition/autonomy). The investigators collected the utterances of 49 students about a situation involving a significant other, which was preceded by a request to imagine that this person was responsive (Condition 1) or unresponsive (Condition 2). The level of mentalization was assessed by means of the Metacognition Assessment Scale. The investigators divided the group into two subgroups with different configu­rations of representational contents (a predominance of relatedness/sociotropy or self-definition/autonomy) bas­ed on the scores in the Personal Style Inventory.

Results

Mentalization fluctuations dependent on the interaction of the stimulus and representational contents were observed in the group with a predominance of sociotropic contents for interpersonal mentalization but not for self-reflective mentalizing.

Conclusions

Mentalization must not be decontextualized; however, it is not the stimulus alone but the interaction of the stimulus with representational content that determines the fluctuations of mentalization. Individuals with a predominance of relatedness experience a decline in the capacity for interpersonal mentalization after imagining a significant other’s unresponsiveness, which can be interpreted as resulting from a weakening of the function of differentiating.

More than enough guilt to go around: oedipal guilt, survival guilt, separation guilt

The concepts of oedipal guilt, survivor guilt, and separation guilt are examined using clinical material from a child case to demonstrate the intermingling of these constructs. A brief review of their evolution in the psychoanalytic literature reveals a frequent conflation of the terms guilt and fear, the former at times standing in for both meanings. The fear/guilt distinction and the subsequent differentiation of guilt into oedipal, survivor, and separation guilt have implications for how analysts understand and interpret particular kinds of clinical material. Two sets of adult clinical data are next presented: the first illustrates a shift from interpreting a patient's fear of retribution for forbidden desires to interpreting guilt over pursuing those desires. The second vignette illustrates a common dynamic in which a patient's fear/anxiety regarding the ability to lead an independent life defends against deeper feelings of guilt over this same desire. This latter dynamic can play an important role in negative therapeutic reactions and interminable analyses. Developmental research suggests that toward the end of the first year of life, infants' capacity to attribute independent mental states and intentionality to self and others allows for the rudimentary experience of guilt.

The neurobiology of personality disorders: implications for psychoanalysis

As advances in neuroscience have furthered our understanding of the role of brain circuitry, genetics, stress, and neuromodulators in the regulation of normal behavior and in the pathogenesis of psychopathology, an increasing appreciation of the role of neurobiology in individual differences in personality and their pathology in personality disorders has emerged. Individual differences in the regulation and organization of cognitive processes, affective reactivity, impulse/action patterns, and anxiety may in the extreme provide susceptibilities to personality disorders such as borderline and schizotypal personality disorder. A low threshold for impulsive aggression, as observed in borderline and antisocial personality disorders, may be related to excessive amygdala reactivity, reduced prefrontal inhibition, and diminished serotonergic facilitation of prefrontal controls. Affective instability may be mediated by excessive limbic reactivity in gabaminergic/glutamatergic/cholinergic circuits, resulting in an increased sensitivity or reactivity to environmental emotional stimuli as in borderline personality disorder and other cluster B personality disorders. Disturbances in cognitive organization and information processing may contribute to the detachment, desynchrony with the environment, and cognitive/perceptional distortions of cluster A or schizophrenia spectrum personality disorders. A low threshold for anxiety may contribute to the avoidant, dependent, and compulsive behaviors observed in cluster C personality disorders. These alterations in critical regulatory domains will influence how representations of self and others are internalized. Aspects of neurobiological functioning themselves become cognized through the medium of figurative language into an ongoing narrative of the self, one that can be transformed through the analytic process, allowing for the modulation of genetic/biological thresholds.

Narcissism and the self: psychoanalytic considerations

This article addresses the relation of narcissism to the concept of the self. Based on the concept of the self-as-person, distinction is drawn between the self as a substantial, relatively autonomous source of agency and of both conscious and unconscious mentation and action on one hand and the self as the object of narcissistic investment on the other. The argument presumes abandonment of both the concept of narcissism as libidinal drive cathexis of the self (the most common understanding of narcissism among analysts) and the converse proposition defining the self as derived from and reflecting narcissistic origins. It is proposed that development of self structure arises on the basis of other than narcissistic considerations, but once established it can become the object of narcissistic investment. As such the self cannot be reduced to or defined in terms of narcissistic derivation. Implications for the understanding of self-esteem are explored and clinical implications suggested.

Some thoughts on empathy and countertransference

Two aspects of countertransference-namely, the countertransference reaction and empathic understanding-must be distinguished. The term countertransference should be reserved exclusively for the conscious reactions of the analyst emerging from the preconscious by virtue of the patient's current transferences; the term empathy should be used to denote a perspective whereby the analyst employs current countertransference reactions for an understanding of the patient's inner life.

Psychoanalytic developmental theory: a contemporary reconsideration

Psychoanalytic developmental theory has never enjoyed a broad consensus among psychoanalytic thinkers. In today's postmodern era, its relevance and basic premises are even more in question as a legitimate part of psychoanalytic theorizing. Part of the problem has been (1) the serious errors perpetrated historically in the name of psychoanalytic developmental theory and (2) its current state of disarray in the wake of piecemeal efforts to rectify these errors. Nonetheless, its presence is discernible in every psychoanalyst's theory and clinical work, whether or not it is acknowledged or brought into a cohesive theoretical frame. The point of view of "intersubjective ego psychology" (Chodorow 2004), embraced by a growing number of analysts interested in development, offers a more flexible and inclusive paradigm for psychoanalytic developmental thinking in order to preserve its rightful place in contemporary psychoanalysis.

Living within the cellular envelope: subjectivity and self from an evolutionary neuropsychoanalytic perspective

A growing literature has been exploring the implications of reconciling psychoanalytic understandings of human behavior with the research findings of neuroscience. This essay proposes a new linking perspective--neurodarwinian psychoanalysis--as a way to revise the predominantly disembodied nature of existing analytic theory by grounding it in the biological realities of human nature, development, and psychopathogenesis. Beginning with a focus on the evolutionary significance of the cellular envelope within which all living organisms exist, it provides theoretical and clinical examples of how evolved neural assemblies in the brain play a key role in the representational depictions of both typical and atypical human predicaments. Conventional psychoanalytic concepts of such theoretical entities as the self and tripartite concretizations of intrapsychic tropes are reformulated in terms of naturally selected neural innervations. Accordingly, dynamically unconscious functioning and psychoanalytically-informed therapeutic process are considered as crucial adaptations that warrant natural selection.

Affect consciousness or mentalization? A comparison of two concepts with regard to affect development and affect regulation

Affect consciousness refers to the ability to adequately perceive, reflect upon and express affect. The concept is used in clinical work with adults, but lacks an equivalent for children's experience of affect. This paper examines the developmental prerequisites for affect consciousness, as well as the concept's applicability to work with children. The main focus is on the development of affect regulation throughout the first 6 years of life. Special emphasis is put on the role of attachment and the unfolding of mentalization ability in this development. The role of play as an organizing factor for affective experience is discussed. Observation of play is highlighted as a strong indicator of affect consciousness in children.

Playing dead: an unconscious fantasy, bodily focused defenses, and their roots in infancy

A patient's unconscious fantasy of being her mother's dead baby emerged during the course of a long analysis, and was understood as her expression and explanation, constructed and elaborated throughout her development, of a fundamental and formative early infant state and experience. This patient's identification with a baby who had died before she was born was connected to her major complaint, a pervasive feeling that she could not act with intention, and to her obsessive ruminations, compulsive actions, and masochistic attacks on her body. The bodily based aspects and focus of these defenses were autistic-like, self-directed activities that can be understood as having their roots in what was experienced as catastrophic loss in the earliest weeks and months of life. Infant research, particularly on contingency detection, is especially useful in clarifying the ways in which these defenses may form, and in reconstructing and tracing the trajectories and intricate transformations of body ego, self- and other representations, and defenses from their earliest beginnings to their current manifestations in patients' fantasies and symptoms.

Mahler's concepts of "symbiosis" and separation-individuation: revisited, reevaluated, refined

Mahler's developmental theories are reviewed in the light of subsequent clinical experience and theoretical and empirical critique. Several modifications are proposed, each tending to particularize and focus the nature and scope of developmental events. Particular attention is accorded the "symbiosis" concept, and focus placed on transmission of psychodynamic issues from mother to infant and on the progressive buildup of self-sustaining pathological systems. Overall, an argument is advanced for the continued developmental import of Mahler's "symbiotic" and "separation-individuation" phase formulations, though with recognition of significant individual differences in their role in individual lives. An argument is advanced also for the clinical utility of these ideas, and illustrations presented, though the link between clinical applications and psychoanalytic theories of early development remains problematic.

Revisiting rapprochement in the light of contemporary developmental theories

Margaret Mahler's thinking, revolutionary for its time, led to the observational study of mother-infant pairs, followed almost day by day as the preverbal infant developed into a toddler whose increasing cognitive capacities made new demands on the mother's presence and emotional availability. The rapprochement crisis, as formulated based on these observations, is reexamined in the light of contemporary theory, and the concept of co-construction is used to show how mother and toddler repair misunderstandings and inevitable conflicts. With the growth of new verbal capacities during rapprochement, the toddler moves from early, sensorimotor interactions to interactions governed by language, in the process gaining new understanding of his or her emotional life.

Separation-individuation theory and attachment theory

Separation-individuation and attachment theories are compared and assessed in the context of psychoanalytic developmental theory and their application to clinical work. As introduced by Margaret Mahler and John Bowlby, respectively, both theories were initially regarded as diverging from traditional views. Separation-individuation theory, though it has had to be corrected in important respects, and attachment theory, despite certain limitations, have nonetheless enriched psychoanalytic thought. Without attachment an infant would die, and with severely insecure attachment is at greater risk for serious disorders. Development depends on continued attachment to a responsive and responsible caregiver. Continued attachment to the primary object was regarded by Mahler as as intrinsic to the process of separation-individuation. Attachment theory does not account for the essential development of separateness, and separation-individuation is important for the promotion of autonomy, independence, and identity. Salient historical and theoretical issues are addressed, including the renewed interest in attachment theory and the related decline of interest in separation-individuation theory.

A contingency-based approach to the etiology of 'disorganized' attachment: the 'flickering switch' hypothesis

The authors present a new approach to the etiology of disorganized attachment based on contingency detection theory. According to this view, the relevant common factor in parental maltreatment and unresolved loss that leads to disorganized attachment has to do with the type of "deviant contingency environment" that both of these conditions generate. In such environments, infants experience periods of being in control followed by periods of sudden loss of control over the caregiver's behavior. The authors hypothesize that this adversely affects the developmental unfolding of the infant's innate "contingency detection module" (Gergely & Watson, 1999), which normally involves a maturational shift around 3 months from an initial attention bias for perfectly contingent stimulation to an emerging preference for less-than-perfect social contingencies. The periodically changing controllability of abusive and dissociating "unresolved" attachment figures is hypothesized to block this process and to lead to the defensive fixation of a dysfunctional "flickering contingency switch" mechanism with two dominant and competing target positions (self-oriented vs. other-oriented). This results in the dissociative style of attention and behavioral organization characteristic of disorganized infant attachment. The authors summarize the preliminary results of an empirical study that provides support for this model in 6.5-month-old infants using a modified Still-Face situation (the Mirror Interaction Situation). The study demonstrates differential emotional and behavioral reactions to sudden loss of maternal contingency and a specific interest in exploring the perfectly contingent self-image in the mirror in infants who at 12 months become categorized as "disorganized" in the Strange Situation.