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작성자  simonshin 작성일  2016.10.15 22:17 조회수 974 추천 0
 신현근 박사 강의안 – 병리적 타협 형성 속의 불안과 우울   
첨부파일 : f1_20161015221735.pdf

과목현대 갈등 이론 (Modern Conflict Theory)

주제Anxiety and Depressive Affect in Pathological Compromise Formation

내용:  강의안 병리적 타협 형성 속의 불안과 우울  

교재:  Brenner, C. (1982). The Mind in Conflict. New York: International Universities Press.

 1           Anxiety and depressive affect are always represented in some way in a compromise formation, be it normal or pathological, since they are among the components of every conflict and always participate in the blending together of the other components of conflict.


2           However, even in clearly pathological compromise formations, a patient is not always conscious of either unpleasurable affect.

2.1          For example, a patent with a crippling psychogenic paralysis who is indifferent to his or her physical disability - a hysteric with belle indifference – has no conscious experience of either anxiety or depressive affect, despite the fact that one or both are determinants of the disability.

2.2          Counterphobic and elated patients likewise afford striking examples of the fact that conscious unpleasure is not necessary a feature of a pathological compromise formation.


3           There are many less dramatic examples, more commonly seen in psychoanalytic practice.

3.1          One frequently encounters patients who are consciously indifferent to symptoms that obviously interfere to a major degree with their ability to find satisfaction in their lives or even to avoid misery.

3.2          It is also commonplace to encounter persons, whether they are patients or not, as far as they are consciously aware, take pride in their eccentricities, their foibles, and their incapacities and inhibitions, even when these are serious enough in their consequences to warrant being classified as pathological compromise formation.


4           Even more frequent are patients whose pathological compromise formations involve only a minor degree of conscious anxiety or depressive affect, or only occasional awareness of either.

4.1          For instance, most patients who shun flying or who avoid elevators, or bridges, or public toilets, etc. are relatively free of conscious anxiety as long as they are able to avoid the particular situation they find disturbing.

4.2          Similarly, if a pathological compromise formation consists of stereotyped thoughts or ritualized behavior, it is common for anxiety or depressive affect to become conscious only if something interferes with carrying out the stereotype in the usual way.


5           Clearly, then, some pathological compromise formations are characterized by conscious anxiety and depressive affect, while others are not.

5.1          How is one to account for this variation?

5.2          What is the significance of the difference, if any?


6           Defense opposes and wards off not only drive derivatives, but also both the unpleasure and the ideational content of anxiety and of depressive affect.

6.1          It is for these reasons that sometimes a pathological compromise formation is characterized by no unpleasure whatsoever, as far as conscious awareness goes.

6.1.1    In such cases, defense has been successful in avoiding any conscious sensation of unpleasure.

6.2          In other cases, the resulting compromise formation is characterized by slight or transient unpleasure in the form of anxiety or depressive affect, while in still others, it is characterized by a very considerable degree of unpleasure of either or both kinds.

6.3          What determines the result in every case, as far as conscious unpleasure is concerned, is the nature and the adequacy of the defensive effort.

6.4          The same is true of the ideational content of both affects.


7           Unpleasure must play a part in every conflict.

7.1          Without unpleasure associated with a pleasure-seeking drive derivative, there would be no conflict.

7.2          As to the ideational content of the anxiety and depressive affect involved in any particular conflict, one can discover it only by analysis.

7.3          Only application of psychoanalytic method will yield data adequate to the task of learning which calamities are involved, what their individual features are, and what parts they played in the patient’s psychic development and functioning.


8           With respect to the unpleasure of anxiety and of depressive affect, a patient’s defensive efforts may be conspicuously unsuccessful in other respects and yet may be successful in avoiding or mitigating anxiety and depressive affect as conscious phenomena.

8.1          Contrariwise, defense may be successful in other respects and yet be rather unsuccessful with respect to avoiding or mitigating unpleasure in consciousness.

8.2           With respect to the ideational content of anxiety and of depressive affect, what appears as a conscious part of the compromise formation has been disguised, distorted, altered, opposed, ignored, denied, or shrugged off, in the patient’s defensive effort to reduce unpleasure to a minimum.

8.3          The ideational content of the component affects of the conflict can be discovered or correctly inferred only by analysis.


9           Depressive affect or anxiety as a feature of a pathological compromise formation is a defensively altered version of the depressive affect and anxiety which are among the components of the conflict of which the pathological compromise is a consequence.

9.1          This statement applies to every pathological compromise formation.

9.2          For example, perceptual disturbances, such as experiences of depersonalization, or feeling unreality, or a sensation of déjà vu may be accompanied by anxiety or depressive affect.

9.3          When they are, the anxiety or depressive affect is not a consequence of the perceptual disturbance.

9.4          Both the perceptual disturbances and unpleasurable affect are consequences of conflict.


10       A case of a physician

10.1      A physician in his thirties, in the midst of an analytic session, suddenly remarked that everything looked yellow.

10.1.1 At the same time he felt unaccountably sad.

10.2      It occurred to him that his brother, three years his junior, had not only had heart disease, but had died of it at the age of seven.

10.2.1 The brother’s favorite story book was bound in bright yellow and was referred to by both boys as the yellow book.

10.3      Despite the unusual nature of his perceptual disturbance, my patient felt no anxiety.

10.3.1 Instead, he felt sad, though not intensely so, an affect which, like his yellow vision, could be understood only after components of the conflict in question had been explicated with the help of the analytic method.


11       A case of a psychotic patient

11.1      What he complained of was anxiety that he might lose control of his temper and strike a man on the street.

11.2      As he walked along, strange men offended him by the way they look at him.

11.2.1 By the way they looked at him, it was clear to the patient that strange men were thinking to themselves that he was not a real man.

11.2.2 By dint of further, careful analytic work it was possible for the patient to say that he was aware, from time to time, of an impulse to kiss a man.

11.3      The conscious anxiety which was part of patient’s symptom was not caused by his impulse to attack men on the street.

11.3.1 On the contrary, one of the functions served by the desire to knock a man down was defensive.

11.3.2 It did not intensify his anxiety; it tended to alleviate his anxiety by assuring him he was very much a man.

11.3.3 It was the castration anxiety associated with his wish to make love to a man which, though unconscious, was the important cause of his anxiety, as far as the available analytic data how.

11.3.4 His defensive efforts were not adequate to the task of eliminating his anxiety, and it appeared in consciousness as part of his symptom.


12       Depressive affect

12.1      Depressive affect is unpleasure plus the idea that a calamity has already occurred and is a present fact of life.

12.2      When depressive affect is a part of a pathological compromiser formation, it is a defensively altered version of the depressive affect which is a component of the conflict of which the pathological compromise formation is a consequence.

12.3      The unpleasure has been defensively mitigated and the ideas of childhood calamity have been defensively altered and distorted


13       Relation between depressive affect and orality

13.1      The psychological view of depressive affect which has been generally accepted until now posits a close, causal relation between depressive affect and orality.

13.2      In fact, however, depressive affect is or, at the very least, can be a component of every conflict caused by drive derivatives, whether they are oral, anal, or phallic.

13.3      Oral wishes of childhood origin are components of every pathogenic conflict, just as anal and phallic wishes are.

13.4      It is as true that anal and phallic drive derivatives are causally related to depressive affect as part of a pathological compromise formation as it is that oral drive derivatives are.


14       Relation between depressive affect and the calamity of object loss

14.1      One cannot, as analyst often do, assume a priori that when depressive affect is part of a pathological compromise formation, object loss is its principal ideational content.

14.2      Still less one can assume, as many analysts do, that the principal trauma responsible for the symptom of depressive affect in later life was the real or fantasied loss of mother or of mother’s attention and care.


15       A case of a depressive woman

15.1      The patient was a woman of thirty who was chronically depressed.

15.1.1 She was truly in a slough of despond.

15.2      It gradually became evident that she had been overwhelmed by penis envy since childhood.

15.2.1 She had never felt comfortable with her body since the age of twelve.

15.2.2 She explained that she had always felt one of the ugliest things in the world is a toilet with the seat up.

15.3      The patient’s envy of men and her unconscious anger at every man for having the penis she so envied and wished for did not prevent her from having sexual relations with men.

15.3.1 It did, however, make it impossible for her to be happy with a man or to marry one.

15.3.2 Marriage meant to be irrevocably a woman.

15.3.3 To remain unmarried meant, unconsciously, to be a man – a gay blade with a stable of sexual partners to pick from.

15.3.4 To marry meant to be castrated, as numerous dreams and associations made clear.


16       Castration depressive affect

16.1      My own clinical experience underlines the importance of castration depressive affect in childhood as a determinant of depressive affect later in life as a feature of a pathological compromise formation.

16.2      All of the childhood calamities play a part in every case, in my experience, and either object loss or loss of love may be principal ideational content.

16.3      In the majority of cases, however, castration seemed to be the most prominent.


17       Aggression and depressive affect

17.1      Like anxiety, depressive affect is a component of every psychic conflict.

17.2      Depressive affect is not a result of a particular defense, more specifically, identification.

17.3      It triggers defense.


18       Conventional view on depressive affect

18.1      I shall summarize the view of the dynamics and genesis of depressive affect as a part of compromise formation that has been accepted by psychoanalyst prior to the publication of my first papers on the subject (1974, 1975).

18.2      Depressive affect as a conscious feature of a pathological compromise formation has been thought to be a kind of pathological mourning, i.e., to be due invariably to real or fantasied object loss.

18.3      The loss has been assumed to relate to the oral phase of development, either directly, by regression, or by the combination of the two.

18.4      The prevalent view among psychoanalysts has been that the real or fantasied object loss of one’s mother in the earliest months of life is an essential precondition of pathological depressive affect.

18.5      Loss was thought to result in ingestion of the lost object in fantasy, i.e., to result in a fantasy of oral incorporation of the (ambivalently) loved and hated lost object.

18.6      What was originally an ambivalent object tie to the mental representation of an object is replaced by identification with the mental representation of an object.

18.7        As a result, the aggression originally directed to the object became directed against oneself, it was believed, since the object of aggression had become part of oneself via identification.

18.8      The consequence of this was believed to be self-hate, i.e., depressive affect.

18.9      In pathological mourning, as a result of ambivalence and regression, an individual is thought to identify with the lost object, resulting in self-hate and depression.

18.10  Pathological depressive affect was thought to be aggression turned against oneself by identification with an object lost either really or in fantasy.


19       Relevance of the differences to clinical analytic practice

19.1      It is as true of depressive affect as it is of anxiety that when it is present as a feature of a pathological compromise formation it is a defensively altered version of the unpleasurable component affect of the conflict of which the pathological compromise formation is a consequence.

19.2      Its genesis and dynamics cannot be known a priori because they are different in all the respects from one patient to the next.

19.3      The ideational content of pathological depressive affect in any given case is but a derivative of the depressive affect of the childhood origin which is a component of the conflict of which pathological depressive affect is one part of the consequence.

19.4      Like pathological anxiety, pathological depressive affect is part of a symptom and as such, it must by analyzed to be understood correctly.


20        Relevance of the differences to nosology

20.1      All psychotic patients, like all neurotic ones, suffer from conflicts in which both depressive affect and anxiety play major roles.

20.2      It appears as unlikely that a valid and useful classification of mental illness can be based on the presence (or absence) of depressive affect as a feature of a patient’s symptomatology as that a valid and useful classification can be based on the presence (or absence) of anxiety.


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