Implicitly or explicitly, time dominates the psychoanalytic situation. The precision, consistency of duration, and regularity of analytic sessions enhance the patient's ego boundaries, counteracting the regressive effects of timelessness induced by free association. The extended overall duration of psychoanalysis and the high frequency of sessions favor the development of transference neurosis. The interpretation of the transference in the here and now of the analytic situation illuminates the past, and as a result, the patient's self-image and that of the world become better integrated. The sense of time in the analytic situation for both patient and analyst varies along with the vicissitudes of transference and countertransference.
In a sample of 80 mothers of psychotic patients from Southwestern Greece, 85 % entertained strong metaphysical beliefs of a magico-religious nature concerning the cause of psychotic illness. This finding was more prevalent among the less educated. A comparable number of patients with magico-religious delusions had mothers who attributed their children’s illness to supernatural causes, a finding suggesting that family beliefs and attitudes influence the content of the patient’s delusional thinking. Resorting to exorcism or magic, alone or in combination with formal psychiatric help, was very common. Awareness of lay beliefs about psychosis and the proper handling of such beliefs by the treating psychiatrist may facilitate cooperation with the patient and his family, increasing the prospect of a more favorable outcome.
Out of the concept of neurasthenia, the main non‐psychotic diagnosis of nineteenth‐century psychiatry besides hysteria, and on the basis of psychophysiological problems of his own, self‐diagnosed as neurasthenia, Freud developed the notion of ‘actual neurosis’, a ‘contentless psychic state’ manifested by various somatic symptoms and a depressive mood, which he attributed to a chemical factor associated with aberrant sexual practices and in particular masturbation. Rejected by post‐Freudian analysts as such along with the diagnosis of neurasthenia, the concept of ‘actual neurosis’ has survived under various theoretical schemes that seek to explain psychosomatic illness and somatisation, in general, with its concomitant poverty of affects and dearth of fantasy life. In more recent years, the concept of ‘actual neurosis’ has resurfaced under the label of chronic fatigue syndrome, a medical entity thought to be an immunological deficiency, while in psychoanalysis Freud's idea of a contentless mental state has been replaced by that of unconscious fantasy and symbolisation at a pre‐genital or pre‐verbal level.
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