International Journal of Psychoanalysis最新文献

Psychoanalysis has a troubled history with regard to sexual minorities. Throughout much of the twentieth century, prominent analysts endorsed a highly pathologising and coercive approach to homosexuality, which was essentially a form of conversion therapy. This departure from accepted analytic technique persisted for decades due to psychoanalytic elitism and the rejection of mounting empirical science contradicting the psychoanalytic position. Today, a pressing concern for psychoanalysis is to avoid repeating this history when theorising about and working with transgender people. Psychodynamic explorations of trans identity formation are being framed as new iterations of conversion therapy, wrongly implying coercion and falsely conflating psychodynamics with pathology. Furthermore, the author cautions that unquestioning gender affirmation shares an important conceptual similarity with gay conversion therapy, in that it can collude with a wish to eliminate a shame-filled or hated part of the self. In our haste to avoid repeating the past, psychoanalysis is deploying the very same tactics that insulated its stance on homosexuality from revision and course correction, but now with regard to trans. The author argues that if we are to avoid causing further harm to our patients and our profession, we ignore the science at our own peril.

In today's world of rapidly evolving digital technology, guaranteeing the anonymity of a psychoanalytic patient in a published paper is very much harder than it may seem. Anonymisation in publishing is part of a wider problem of psychoanalytic confidentiality. Identifying details can be changed but information relating to external reality may still be present in the text. The risk of deanonymisation often cannot be estimated and is instead subject to radical uncertainty. The paper considers various sources of this radical uncertainty. Anonymisation of a patient may need to remain effective for decades. The conditions for ensuring this are exacting and rarely likely to be met in practice. Possible consequences of abandoning belief in the safety of anonymisation are briefly considered.

This paper explores the ethical challenges child and adolescent psychoanalysts encounter in trying to preserve the confidentiality of their patients and their families while still sharing what they have learned from this work by writing about it for professional colleagues. These challenges are made even more difficult in our digital age, when almost anything one has written can be discovered. An example of an adult who found papers written by an analyst seen in childhood serves as a cautionary tale.

This paper discusses whether the Internet and related technologies that we can imagine in future may have made it unsafe for psychoanalysts to publish clinical material in an anonymised form. The author notes, first, that algorithms work with identifiers of various sorts to tie information subjects together across space and time. It means that what is an anonymised clinical report today might, in future, potentially be joined with other documents to allow a patient to be re-identified. Discussing the current literature from computer science, the case is made that while there will be risks, if anonymisation is done less than rigorously, they can be removed by a variety of measures, most important of which are both the generalisation and falsification of potential identifiers. Exploring the merits and ethics of this approach, the author argues that psychoanalytic data are not externally valid data but internally consistent subjective data. It means that ensuring external identifiers are absent or distorted in clinical reports to convey the analyst's understanding but to safeguard against jigsaw puzzle re-identification does not de-authenticate them. Indeed, the process of anonymisation, focusing on the status of psychoanalytic data as inherently subjective, should deepen and strengthen rather than reduce their evidential values.

The author investigates voice and body-self in the analytic space. A look at the role of music and voice in Stone Age ritual, being the core of human culture, and at the role of the mother's voice, being the unborn child's first encounter with the Other, shows the influence of the voice on psychic life. Beyond the symbolic discourse, voice and body-self organize the exchange of emotions. This level becomes crucial when a symbolization disorder dominates the encounter as a result of traumatization. The analytic couple is not limited to a focus on words and images. Both analyst and patient have access to the perception of their body-self; moreover, the sound of the voice proves to be isomorphic to the states of the body-self and provides vocal information. In the analytic space a traumatic inscription in the body-self (encapsulated body engram) can be focused on. Somatic narration describes a way to work through such an engram. Here, the patient is invited to describe his or her body perceptions and thus the disorganized tensions of traumatization can unfold in the analytic space. This enables a cathartic process of overcoming the destructive qualities of traumatic memory. A case report illustrates the method.

Scientific communication about clinical work is complicated for psychoanalysts by the requirement to protect confidentiality, the potentially disruptive effect that seeking consent may have on the treatment, and questions about whether informed consent is possible if the unconscious is taken seriously. For these reasons, the balance of opinion has tended to favour disguise over consent, but in the digital age and with the advent of AI doubts have arisen about whether it is possible to achieve a level of disguise that would prevent any third party from recognising the patient. The papers in this Psychoanalytic Controversies section by John Churcher, Denia Barrett, Aden Evens and Sarah Ackerman, Vittorio Lingiardi and Mariana Liotti, and David Tuckett explore different aspects of the question of whether in the digital age effective anonymisation is possible.

Human development unfolds within a psychic ecology increasingly shaped by AI: we have entered technogenetic times. No longer merely a tool, AI structures how we understand ourselves and relate to others. In AI-mediated contexts, self-exploration often remains superficial, particularly among adolescents, eclipsing the messy, non-linear process of self-discovery, which depends on the capacity to tolerate uncertainty. I propose the metaphor of the meniscus - the tense, curved surface where liquid clings to the edge of its container - to describe a defensive psychic structure emerging in this context. It captures my clinical experience with adolescents who engage intensively with AI, where the self, like a liquid, adheres to the surface of its container to maintain its form. However, it does not allow penetration or integration. Just as water molecules cling to the container's wall to form a meniscus, an adolescent may cling to the digital interface or AI feedback as an external 'skin' that contains the self. This results in a one-dimensional self, held together at a surface level, preventing psychic integration. In the consulting room, the analyst's task becomes one of (re)-establishing psychic three-dimensionality by "claiming" the patient through the here-and-now transference.

Freudian psychoanalysis holds a conception of personhood in which patients are divided by a conflict between their outward presentation and their hidden, inner turmoil. The Freudian analyst too is split, occupying a position within the patient's internal dialogue while also listening in from outside of it. Addressing the analyst as both self and other, the patient's confidentiality is necessarily preserved but also inherently violated. As digital technologies reshape psychic structure, this paradox in confidentiality, constitutive of the analytic situation, may no longer arise. Personhood in the digital age is arguably less grounded in the patient's internality and instead diffused into a distributed, online self. How should our analytic task-including the preservation of confidentiality-be altered for patients who construct their selves in external digital networks? Whether the patients' growing disregard for privacy and evacuation of innerness is a defensive resistance or a tectonic shift in the structure of the psyche, the analyst must remain committed to an ethics in practice, as abstinence, neutrality, and anonymity (confidence) are not only gestures of professional respect for the analysand but in situ features of a successful treatment, features whose intransigence safeguards the fundamental rule and so makes it possible to vary other aspects of technique to discover what complementary subject position best frees the patient's desire, regardless of the shape of her psyche (Report on Confidentiality, 2018, p. 6).