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In this groundbreaking volume, Drs. David Garfield and Ira Steinman bring us into the immediacy of the analyst's consulting room in direct confrontation with the thought disorder, delusions and hallucinations of their patients grappling with psychosis. From the early days of psychoanalysis when Freud explicated the famous Schreber case, analysts of all persuasions have brought a variety of theories to bear on the problem of schizophrenia and the other psychoses. Here, as William Butler Yeats notes, "the center cannot hold" and any sense of self-esteem--positive feelings about oneself, a continuous sense of self in time and a functional coherence and cohesion of self--is shattered or stands in imminent danger. What makes psychoanalytic self psychology so compelling as a framework for understanding psychosis is how it links together the early recognition of narcissistic impairment in these disorders to the "experience-near" focus which is the hallmark of self psychology. Now, with Garfield and Steinman's descriptions of healing in the mirroring, idealizing and twinship experiences of treatment, the theory of self psychology, in a comprehensive fashion, is brought to bear on the psychoses for the very first time. Join Garfield and Steinman as they bring the reader into these analytic journeys, inspired by Kohut and his followers and crafted with their own original insights as patients find their way back to a meaningful and functional existence.
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SELF PSYCHOLOGY AND PSYCHOSIS
SELF PSYCHOLOGY AND PSYCHOSIS The Development of the Self during Intensive Psychotherapy of Schizophrenia and Other Psychoses
David Garfield and Ira Steinman
First published in 2015 by Karnac Books Ltd 118 Finchley Road London NW3 5HT Copyright © 2015 by David Garfield and Ira Steinman The rights of David Garfield and Ira Steinman to be identified as the authors of this work has been asserted in accordance with §§ 77 and 78 of the Copyright Design and Patents Act 1988. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the publisher. We are indebted to Karnac Books for allowing the republication of material previously published in Treating the “Untreatable”: Healing in the Realms of Madness by I. M. Steinman, 2009, London: Karnac. British Library Cataloguing in Publication Data A C.I.P. for this book is available from the British Library ISBN-13: 978-1-78220-228-8 Typeset by V Publishing Solutions Pvt Ltd., Chennai, India Printed in Great Britain www.karnacbooks.com
SONNET X
When to the sessions of sweet silent thought I summon up remembrance of things past, I sigh the lack of many a thing I sought, And with old woes new wail my dear time’s waste: Then can I drown an eye, unused to flow, For precious friends hid in death’s dateless night, And weep afresh love’s long since cancelled woe, And moan the expense of many a vanished sight: Then can I grieve at grievances foregone, And heavily from woe to woe tell o’er The sad account of fore-bemoaned moan, Which I new pay as if not paid before. But if the while I think on thee, dear friend, All losses are restor’d and sorrows end.
—William Shakespeare
CONTENTS
ACKNOWLEDGEMENTS
ix
ABOUT THE AUTHORS
xi
PREFACE Coming to self psychology
xiii
INTRODUCTION Self psychology and psychosis
xxiii
PRELUDE AND ENTRE Cross modal attunement and revitalization of the self
xxxi
PART I: MIRRORING CHAPTER ONE The opening phase—the case of Judith
vii
3
viii
CONTENTS
CHAPTER TWO Judith—the middle phase
23