The author explores the psychodynamics of maternal filicide from an object relations perspective. Among psychotic women, the murder of the child reflects a critical interplay among the mother's neurobiology, constitution, developmental experiences, and complex internal object world. Two types of personality structure are discussed. For the disorganized type, the psychodynamic scenario involves attempts to contend with the danger of massive internal breakdown. For the organized type, the scenario involves attempts to contend with the danger of persecution and annihilation. For these women, physical violence is used because of failures in mentalization, and is an enactment of catastrophic internal anxieties.
Clinicians working with forensically committed, mentally ill patients are often confronted with a wide variety of religious ideation. This article is designed to help clinicians think therapeutically and psychoanalytically about such material, with a focus on understanding the latent meanings of religious ideation and its relationship to forensic or precursor issues. Case material and conceptualizations are offered to enhance an understanding of the following functions of religious ideation: (a) religious delusions as motivations for violence; (b) religious distortions as justifications for violence; (c) religious ideas as expressions of intrapsychic dynamics; and (d) authentic religious beliefs as defenses and resources. It is suggested that working directly with religious material can be an avenue to deeper understanding of the patient's psychic life and thus a path toward therapeutic growth and change.
The author describes a model for working psychoanalytically under less than optimal conditions. Using the television character MacGyver as a metaphor, the author explores challenging situations in which factors related to the patient, setting, and therapist preclude the possibility of conducting a standard analysis. Psychoanalytically informed clinicians need to have a simple, practical model for understanding the psychical world and the importance of the unconscious. In this "search-and-rescue operation," the therapist helps the patient make fresh contact with split-off parts of his or her personality. The main tool used is psychoanalytic understanding, enhanced by analytic listening and the interpretation of the transference. Two clinical cases demonstrate how, even when so many prohibitive factors predominate, deeper contact with the patient's unconscious life and development of the personality can be facilitated.
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