An analysis of the changing metaphors and concepts of mental health in psychoanalysis.
Date
2010-11-09
Authors
Oskowitz, Adina
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Abstract
There is a strong focus on defining and classifying psychopathology within a
psychoanalytic paradigm. There is less emphasis on the consideration of what
it means to be mentally healthy within a psychoanalytic framework. Yet, our
understandings of mental health, whether implicit or explicit, inform our
choices with our patients; our decisions to begin analytically oriented therapy,
our treatment plans and our evaluations that termination has become
appropriate. Therefore this research explores a fundamental underlying
assumption that informs our work: what it signifies to be mentally healthy from
a psychoanalytic perspective. In order to explicate understandings of mental
health, the research explores the thought of four psychoanalytic theorists,
Freud, Klein, Bion and Winnicott. The first part of the research examines the
theories of the thinkers in order to extract their essential concepts and
metaphors about mental health. For each thinker, a different emphasis on
mental health is derived: Freud’s structural model is essential to his
apprehension of mental health, for Klein the ability to experience affects and
work through the depressive position is vital, for Bion the capacity to think and
tolerate suffering is highlighted, while for Winnicott what becomes important is
an individual’s capacity to inhabit transitional space. Next, these four
approaches are discussed, compared and contrasted and the validity, or
“mental health”, of each theory is considered. Finally, some contemporary
approaches to mental health within psychoanalysis are explored. It is
concluded that mental health in a psychoanalytic paradigm differs from
psychiatric and other psychotherapeutic approaches to mental health. Mental
health is not about cure, symptom elimination or efficient functioning in the
world. Therefore, it is very important that psychoanalytically oriented
therapists consider what it means to be mentally healthy within the terms of
our discipline. While no one single definition is offered, it becomes clear that
mental health is defined more in terms of one’s internal, psychic life as
opposed to external functioning, is about tolerating process as opposed to
fixating on end-goals and is concerned with a certain ongoing quality of
relationship rather than the foreclosed elimination of a symptom.