Increasingly, psychoanalysis has confronted the issue of recovered memories of childhood trauma. Based on trauma research, the concept of a special traumatic memory has evolved. Overwhelming psychic experience is thought to generate a defensively altered state of consciousness (specifically dissociation), which encodes memory in unassimilated visual, somatic, and behavioral, rather than linguistic modes. Analytic reevocation and interpretation of the original altered states of consciousness then permits the transformation of "early" traumatic memory into "later" explicit memory. Examined from the vantage point of contemporary cognitive research and theory, underlying flaws may be found in these propositions when they are extended to patients without explicit memory of trauma: first, dissociation is a chameleonlike process, perhaps as closely associated with suggestibility as with trauma; second, state-dependent learning does not adequately account for the absence of explicit memory; and third, implicit memory does not map onto explicit memory in any direct or simple fashion. Consequently, the clinical application of current propositions about traumatic memory to patients without explicit memory of trauma may warrant considerable caution. Provisional guidelines are offered for estimating the validity of retrieved memories of trauma.
Psychoanalysis has long presented ideal listening as an oscillation between Freud's "evenly suspended attention" and a more focused attention. This paper explores modes of listening as they are manifest in the author's clinical experience. Two modes are evident: a receptivity, mostly out of awareness, which becomes shaped and primed toward specific expectations; and a concurrent, more conscious and directed mode of listening through specific filters. The former is described as "listening alertly from a distance" and the latter as "listening for implications."
Two of the most influential factors in psychiatry over the past decade have been the increasing availability of more sophisticated psychotropic medication and the widespread acceptance of DSM-III. These factors, along with the increased use of computers, have dramatically skewed the field toward an atheoretic symptom/syndrome orientation and away from an appreciation that meaning is an indispensable aspect of human life. This threatens to lead to a serious deterioration in our capacity to communicate with, understand, and treat people. In championing the notion that "biology drives psychology," psychiatry must not lose sight of the fact that often "psychology drives biology." Modest training proposals are offered to counterbalance these trends.
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