Alexithymic phenomena may result from a variety of psychological sources. Psychoanalytic observation of psychosomatic patients (and others as well) reveals that the inability to name, recognize, contain or work through one’s affective states is frequently one manifestation of defensive structures of a psychotic kind (more radical than denial which deals with certain neurotic anxieties). Such massive defense has been created as a bulwark against various dangers, such as (1) psychotic anxieties (fear of mental or physical fragmentation; loss of identity-feeling; danger of uncontrollable, explosive action); (2) profound perturbation concerning the narcissistic self-image and its fluctuations, and (3) pathological formation of the ego-ideal structure concerning affective experience. All of these may contribute to the creation of alexithymic defects.
The author attempts to conceptualize a phenomenon that frequently passes unnoticed for a considerable period of time in the course of an analysis. An apparently "normal" psychoanalytic discourse may reveal that the analysand who produces it is using words and ideas that are largely, perhaps totally, devoid of affect for him; instead, the analyst tends to become "affected." This may appear in a wide variety of clinical categories: "narcissistic personality disorders," "psychosomatic personalities," "as-if characters," etc. The author does not seek to add to the clinical categories but to study, from the point of view of the psychic economy, the manner in which this specific form of psychic functioning is maintained: in other words, the vicissitudes of unavailable affect.
is an occasion for new readers of Joyce McDougall to discover her invaluable contributions on neosexualities, addictions, somatizations, and creative sublimations. McDougall has extended the territory of what has been called perverse psychic organizations and the role of disavowal to other subjective experiences that are similar in structure and aim. Prior readers will find McDougall, as usual, working to illuminate what has been hidden in her patients' communication-the inner but not quite symbolic world underlying the oedipal dilemma. In this book, she returns to her earlier theorizing and analytic work, at many points taking the reader to clinical narratives she has discussed before but adding a new specificity and suspicion, revising and reconsidering her theoretical contributions. As we have come to expect of her, McDougall brings richly detailed patient-analyst interactions to light up her theoretical organizers. Her ability to capture and her willingness to report those behind-the-scene thoughts and dreams of the analyst provide the reader access to what is usually privileged communication.The central event of this volume, however, is McDougall's attempt to maintain the necessary tension between a truly empathic appreciation of the various solutions to the problem of the traumatic nature of human sexuality and identity and the necessary analytic "hermeneutics of suspicion" (Ricoeur, 1970) for each of her patient's attempts at a self-cure. For
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