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Family Dynamics and the Chicago Institute for Psychoanalysis by Jonathan Vos Post

May 14, 1995

(c) 1995 by Emerald City Publishing All rights reserved. My not be reproduced without permission. May be posted electronically provided that it is transmitted unaltered, in its entirety, and without charge.
Keywords: Blaming, Descartes, Family Dynamics, Loss, Newborn, Parent, Philosophy, Psychology, Psychosocial, Psychotherapy, Sibling, Sociology, Tragedy
Keynames: Gustav Mahler, Edvard Munch, Kaethe Kollwitz, Thomas De Quincey, Jack Kerouac, Bertha Pappenheim, Nietzsche, Goethe, Oscar Wilde, Lenin, Van Gogh, Heinrich Schliemann, James M. "Peter Pan" Barrie, Elvis Presley, Lenin, Hitler, Empress Catherine the Great, Ho Chi Minh, Joseph Stalin, John Lennon
Hyptertext Table of Contents: Introduction 1. "Child Sibling Loss: A Family Tragedy" 2. "The Dreams of Descartes: Notes on the Origins of Scientific Thinking" 3. "An Outcome Study of the Psychosocial Adaptation of Children at Risk: Protective Factors in the Severely Ill Newborn" 4. "Blaming the Parent: Psychoanalytic Myth and Language" 5. Conclusion 6. References
Introduction The Chicago Institute for Psychoanalysis is an American bastion of classical Freudian practice, far from the mainstream of modern marital and family psychotherapy. Yet a selection of recent papers from The Annual of Psychoanalysis, a publication of the Chicago Institute for Psychoanalysis, reveals a moderation of dogmatism in the direction of modern family therapy. Four examples indicate this broadened philosophy: (1) "Child Sibling Loss: A Family Tragedy", George H. Pollock, M.D., Ph.D. (Chicago), The Annual of Psychoanalysis, a publication of the Chicago Institute for Psychoanalysis, Vol.14, 1986, pp.5-34; (2) "The Dreams of Descartes: Notes on the Origins of Scientific Thinking", Alan R. Dyer, M.D., Ph.D. (Durham, N.C.), The Annual of Psychoanalysis, a publication of the Chicago Institute for Psychoanalysis, Vol.14, 1986, pp.163-176; (3) "An Outcome Study of the Psychosocial Adaptation of Children at Risk: Protective Factors in the Severely Ill Newborn", Irving Philips, M.D. (San Francisco), The Annual of Psychoanalysis, a publication of the Chicago Institute for Psychoanalysis, Vol.15, 1987, pp.215-244; (4) "Blaming the Parent: Psychoanalytic Myth and Language", F. Diane Barth, M.S.W., C.S.W. (New York), The Annual of Psychoanalysis, a publication of the Chicago Institute for Psychoanalysis, Vol.17, 1989, pp.185-201; To be sure, these four papers are not definitive examples of the Chicago school, nor do they represent a complete and consistent philosophy, but it stands to reason that the Chicago Institute for Psychoanalysis would have some degree of editorial bias in the direction of their own faculty consensus, and that a significant number of dissenting publications within their own Annual would suggest a more broad and modern understanding of family dynamics and the therapeutic process than Sigmund Freud would have expounded, or that the Chicago professors would have traditionally promulgated. 1. "Child Sibling Loss: A Family Tragedy" George H. Pollock, M.D., Ph.D., was (at least in 1986) the President of the Chicago Institute for Psychoanalysis, and hence may be considered a representative speaker for the philosophical position of its faculty. At Perspectives on Sibling Loss, a conference celebrating the opening of the Othman-Cole Center for Sibling Loss of the Southern School, co-sponsored by the Barr-Harris Center, Institute for Psychoanalysis of Chicago, and Department of Psychiatry, Northwestern University Medical School, June 8, 1985, Dr. Pollock presented an interesting survey of this issue, itself well within the boundaries of Family Therapy1. Dr.Pollock begins by quoting a tale which was also the introduction to a book by H.S. Schiff2 which has as its conclusion: " 'The prince, no fool, had realized that some things are beyond describing. No matter how eloquent the words, their impact can fall flat when not accompanied by a similar experience.' And so it is with bereaved parents." Harriet Sarnoff Schiff was herself a bereaved parent, her son having died at the age of ten. Dr.Pollock agrees with Schiff's "perspective of the parent who has lost a child -- an unexpected crisis, as parents are supposed to die before their children -- she indeed poignantly but carefully addresses the issue of the loss of a child, and how it affects the mother, the father, and the siblings." [Pollock, pp.6-7]. In particular, childhood loss is a tragedy for each person in a family, but with meanings that can differ from individual to individuals. For example, for the mother "it can give rise to guilt, severe melancholia, a lifelong bereavement" [loc.cit.]. For the father, it may be similar or different from the mother. For both parents, there is the additional burden of having to deal with their own pain and yet comfort the living children. For siblings, the reactions can vary, from lesser impacts to lifelong significance. For grandparents, "the response can vary from great despair to quiet contemplative mourning" [loc.cit.]. Pollock's focus is on the sibling, but he stresses again and again how the surviving sibling is confronted by the reactions of the parents and other siblings as well as their own responses when the death occurs. The children can feel "unloved, alone, ignored during the bereavement period, or they may become overprotected, overinvested with care and apprehension. The children may feel pushed aside, ignored, abandoned at a crucial time" [loc.cit.]. Pollock does not, but could have, reference the classical Japanese story of the travelling poet-monk who repaid the hospitality of a family by writing them the following poem: Grandfather Dies. Father Dies. Son Dies. When the family is outraged by the insult they see in this poem, the monk explains calmly that his poem reflects the proper state of nature, and that if you put the three lines of the poem in any other order, the result is tragedy. Pollock contends that "not all children and adolescents emerge from this family tragedy with psychopathology or distorted personalities. Some become very creative and deal with their mourning for the dead siblings in a positive way" [op.cit., p.8]. He cites Gustav Mahler, Edvard Munch, Kaethe Kollwitz, Thomas De Quincey, Jack Kerouac (dead brother Gerard), Bertha Pappenheim, Nietzsche, Goethe, Oscar Wilde, Lenin, Van Gogh, Heinrich Schliemann, and (in depth) the famous Scottish writer James M. "Peter Pan" Barrie3. He does not, but might well have in a less academic context, also cited Elvis Presley, whose twin brother died at birth. Pollock also cites Solnit4 as writing that "sibling experiences are always significantly shaped by two interacting, profound dynamic forces... there is first, the nature of the mutual relationships of parent and child; and second, the child's developmental capacities and preferences that are formative in sibling relationships and experiences." Pollock also lists (I summarize below) Patterson and McCubbin's5 list of the sources of stress when there is a chronic illness in a family who have a chronically ill child: 1) Strained family relationships 2) Modifications in family activities and goals 3) The burden of increased tasks and time commitments 4) Increased financial burden 5) Need for housing adaptation 6) Social isolation 7) Medical concerns 8) Differences in school experiences 9) Grieving Pollock concludes "that children can experience various kinds of losses that include events other than death: prolonged hospitalization, divorce with split custody, abandonment, separations during war and other disaster experiences, migrations to countries resulting in family breakups" [Pollock, p.21]. In listing famous people who reacted creatively to the death of a sibling, Pollock suggests that "in the case of Lenin, I found a partial identification with his [political assassin] executed [by the Czar] brother set the adolescent on a path that had a powerful impact on the history of man" [Pollock, p.32]. He underlines this conclusion with a reference to Hitler "who lost three siblings before he was born; the death of his brother Edmund at age six, when Adolf was eleven, may have had a serious impact on his later fascination with death" [op.cit., pp.32-22]. In another paper, Pollock6 gives a list of revolutionary and utopian leaders who lost parents or siblings while young, including Empress Catherine the Great (1729-1796), who lost a lost a brother when she was thirteen and a sister when she was sixteen; Ho Chi Minh (1890-1969), whose mother died when he was ten, and lost a younger brother when he was fifteen; and Joseph Stalin (1879-1953) who survived when three siblings died, perhaps due to an alcoholic abusive father. It is a chilling thought, that creative but twisted responses to the deaths of siblings may have led to the death of tens of millions of people to the Nazis and the Soviet Union. I personally agree with the final quote by Pollock: "as John Lennon has pointed out, 'Life is what happens while we are busy making other plans.' " 2. "The Dreams of Descartes: Notes on the Origins of Scientific Thinking" Alan R. Dyer, M.D., Ph.D. claims that dreams by René Descartes (born March 31, 1596), which themselves resulted from family dynamics, led to the basis of a new philosophy, the scientific method, which fundamentally shaped the modern world itself7. The dreams in question were on the night of November 10, 1619, and Descartes himself made the claim that they led to the scientific method. Various authors cited by Dyer have attempted to analyze the symbolism in these dreams in terms of verified biographical details of Descartes. For example, Schonberger8 has offered a Kleinian interpretation; von Franz9 has offered a Jungian interpretation; Feuer10 has offered a classical Freudian interpretation involving sexual anxieties; Hanson11 has offered a Freudian interpretation in terms of narcissistic dynamics. Freud himself12 cautioned psychoanalysts about such studies made without access to the associations of the dreamer, and noted that Descartes' dreams were of the type he called "from above," meaning that they included thoughts that were close to the dreamer's consciousness and might be had while awake. Dyer [p.163] extends Freud's warning by citing not only the lack of biographical information or even associative material, of which Descartes provided a great deal, but in trying to connect the dreams to the philosophy which Descartes claimed emerged from those dreams. Dyer holds that we should look fully at the dreams' context, including history and philosophy, to understand the anxieties and problems with which the dreamer struggled when both asleep and awake. These problems confront the modern world, and Descartes' philosophy is satisfying to us because of its bold claim for certain knowledge, and yet frustrating in its impersonality. Dyer [p.164] summarizes the importance of this subject as follows: "Yet the appreciation of Descartes' genius is ambivalent, for the price of that liberation was the split of the material and spiritual worlds with the result that Man (as a person) was to be impersonally studied by the methods of understanding physical objects in space and time. Descartes' dualistic division of the world into extended things (res extensa) and thinking things (res cogitans), claiming the former for the province of science, and leaving the latter as the province of religion, has left much uncertainty about the legitimate status of attempts at knowledge of thinking things: psychoanalysis and other psychologies, social sciences, the humanities, and medicine insofar as it concerns itself with more than just the extended body." Dyer paradoxically says that "neither Descartes' dreams nor his philosophy can be fully comprehended if we employ the Cartesian outlook of detached analysis. Cartesian epistemology must itself be reexamined in the light of the more comprehensive understanding of mental processes which we now possess" [p.164]. Freud is said to have "corrected the Cartesian error" by "candidly looking at the childhood origins of primary-process thinking as an indispensable foundation on which the more rational secondary-process thinking is built." Descartes was preoccupied with the questions "How can one know?" and "How can one be certain?", which were both previously taken to be religious questions left to ecclesiastic authority, and subsequently taken to be in the domain of science. Descartes did not directly confront the massive authority of the Catholic Church. Indeed, he declared [op.cit., p.165] a kind of psychological independence from his own parents, and by extension from God: "As for my parents, from whom it appears that I derive my birth, this does not mean that it is they who made me and produced me in so far as I am a thinking thing, since all they did was to put certain dispositions into this matter in which I judge that I, that is to say my mind, which alone I take now as being myself, is enclosed..." Descartes also declared his independence from his senses, which the Scholastic world at that time held were the guides to the intellect which in turn was the basis of knowledge. He expresses his predicament, his so-called "dream problem" of having "been deceived in sleep by similar illusions" and so was determined to "close his eyes, stop his ears, and turn away his senses from their objects" and start completely anew with a method derived from consciousness itself. I can't help but see a parallel to the traumatized child protagonist of the Who's rock opera Tommy who (by witnessing his mother's sexual unfaithfulness and her being surprised by his father returning from World War II) becomes blind, deaf, and dumb; then achieves enlightenment while playing pinball; then tries to enlighten others by similarly restricting their senses. This paper is too short to list Descartes' dreams, recorded in a manuscript called the Olympica, no longer available, but which was used by his biographer Baillet13 who preserves the text of the dreams. But Dyer [p.169] stresses how Descartes' mother suffered from a lung disease, René claimed he inherited his sickly disposition from her, that his mother died in childbirth May 13, 1597 when he was just fourteen months old, and three days later her third and last child also died. As we have seen from Pollock1, the death of a sibling (and/or parent) has a powerful effect on a child, who copes in complex ways. As a sign of René Descartes coping, Dyer quotes Vrooman as commenting that Descartes wrote incorrectly that his mother "died a few days after my birth from a lung ailment caused by some sort of grief." Related to the deaths of mother and sibling, Descartes was raised by a devoted nurse, his maternal grandmother, and (from age ten) in a Jesuit school whose methods young René hated. In Dyer's words [p.169]: "Descartes' life, his philosophy, and his dreams all reveal conflicts between a desire for certainty and security and a desire for independence and solitude, between a submission to authority and a defiance of that authority (his father, his school, the Church and its traditions) and between a fascination with his emotions and a rationality devoid of emotional content. Descartes' dreams reflect elements of classical [Freudian] sexual conflict and oedipal struggle. There are often compelling suggestions of hatred of the father and of authority and the fear of retaliation, even of castration ... a sense of keen anxiety and tension; confusion and fear...." Dyer recounts how Descartes was steered away from profligacy and a predilection for gambling by his close friend, the mathematician Mersenne. Descartes follows the fourth-century Latin poet Ausonius who provided a strategy for his rebellion by "wearing the mask" of devout Christianity and confining his work to the "innocent" fields of mathematics and science. Descartes rightly believed that a direct confrontation with Church authorities would result in the destruction of either himself or them, and probably felt that his mother's and sibling's death were somehow caused by his (age fourteen months) first steps towards independence. Yet his solution becomes the twentieth century's problem. Shall we seek intellectual freedom at the expense of personal, moral, and emotional wholeness? Such liberation from dogma is at best a compromise, since the origins of scientific thought require the repudiation of infantile thinking and yet paradoxically maintaining them in the Cartesian worldview. Modern science depends upon scientific revolutions14, and yet we do not pretend that challenges to scientific ideas will result in our own demolition. Dyer [p.172] concludes that Descartes was not himself a Cartesian "because he was a human being, and no human being, except in psychosis, could maintain the denials of sensory experience and of affectionate life which Cartesianism requires." Revisionist epistemologists such as Kuhn14, Polanyi15, and Popper16, have shown [Dyer, p.173] that "scientific knowledge does not build so much on reductionistic analysis as it does on the integration of perceptions of complex [social, historical, and psychological] realities. Polanyi stresses the rehabilitation of trust in ones' own perceptions as a fundamental step in the establishment of knowledge. Science proceeds not by a repudiation of sensory experience, but by a reliance on it." Dyer sees these contrasting approaches to knowledge in terms of the infant-mother relationship (dyadic symbiosis) which Descartes would have suddenly lost when his mother died (thus producing extraordinary self-doubt about his existence and relationship to nurturing figures) and the child-mother-father relationship (triadic social reality processing). The Cartesian philosophy, a basis for science and the modern world, is thus an incomplete attempt to describe knowledge as a solitary process of grappling with a world of which one is not a part. This way of viewing the world is a psychological defense mechanism against painful affects. How amazing, if true, that our scientific world stemmed from a troubled fourteen-month-old dealing with the loss of his mother! 3. "An Outcome Study of the Psychosocial Adaptation of Children at Risk: Protective Factors in the Severely Ill Newborn" Irving Philips17 finds many methodological faults in retroactive analysis of data reported by adults or observed by mothers, in the study of child development. He quotes Freud as having also recognized these problems. Many inferences are made about mother-infant interaction from retrospective data, but there are better sources of data in the medical study of premature infants born with serious medical and surgical problems, as for example studied at the Intensive Care Nursery of the University of California, San Francisco. Neonatology as a science has blossomed in the past two decades. Hyaline-membrane disease is successfully treated; surgical complications are corrected; a higher achiever rate for lower-birth-weight-infants has been achieved; distressed neonates are vigorously treated by isolation in incubators, perceptual stimulation reduction, intubation to achieve positive pressure oxygenation, intravenous feeding or gavage, frequent measurements and laboratory tests, transfusions, and other interventions. Many such infants are extremely deprived of normal mother-infant contact. The normal affectional bonds are not achieved at birth, and may be much delayed. The unity of the mother-infant dyad is disrupted. And yet many of these infants survive, allowing us to see if they made adequate adaptation in the face of such early privation of affectional bonds. Philips cites animal experiments, such as the famous results on the effects of isolation of the rhesus monkey18; and the studies of Ribble (1943), Spitz (1965), Spock19 (1946), Erikson (1950) and others on the importance of early mother-child care, the effects of early separation, the mother-infant dyad, the crucial first two months, and even, according to Klaus and Kennel20 the necessity that the mother and father have close contact with their infant in the first minutes and hours of life, in order for development to be optimal. Infant separation and isolation can injure language acquisition, affect mental retardation, provoke cognitive disturbances, and correlate with mental subnormality. Philips summarizes the studies of children at risk, most of which deal with those reared in families with a mentally ill (schizophrenic or depressed) parent. He cites the summary by Erlenmeyer-Kimling21 as well as the "reports of children raised in compromised backgrounds who have achieved an expected level of competence. There are reports on invulnerable children or 'superkids' ... who displayed unusual talent and creativity" such as those by Grunebaum22 and Cohler23. But he found no studies of psychosocial adaptation that follow children over time who have been seriously distressed at birth and separated from maternal care for long periods. So Philips asked the Director of the Intensive Care Nursery of the University of California, San Francisco, to select ten children, eight years of age or older, who had been separated from parental caretaking, had suffered severe and intense privation for at least two months, and had nonetheless achieved a most favorable psychosocial outcome. Most of these children had been oxygen dependent for six weeks or longer, and were hospitalized in intensive care for at least two months. All were separated from their mothers for at least six weeks, many had multiple hospitalizations, and all had multiple complications, both medical and surgical. The parents were interviewed to determine the course of the child's development, and these retrospective data were further elaborated by the child's clinic chart based on periodic visits. An appraisal was made from four perspectives: the child, parent(s), family functioning, and school. This overlaps the core concerns of Family Therapy, in my opinion. There is no room in this paper for details, nor for Philips' speculations as to Biological Factors and Psychosocial Factors that might account for the results of this important study. What matters in the context of this paper and this class is the basic result [p.225]: "There is little question that full-term delivery of a healthy infant and early contact with the maternal caregiver are preferred in human development. Yet the children who are the subject of this paper have demonstrated that the human infant can indeed survive early deprivation and achieve normal psychosocial adaptation. They experienced separation, isolation, pain, respiratory and cardiac distress, sensory deprivation, surgical manipulation, and other untoward experiences inflicted over protracted periods of time, and yet 8-14 years later, despite the adversity, they had not only survived the experience but had also achieved a psychosocial adaptation indistinguishable from that of their more favored peers. They had disastrous beginnings and favorable outcomes. Developmental theory or ethological experiments would dictate otherwise. There may be many biosocial explanations." This study has emphasized that (1) the human organism can not only tolerate the harshest privation and not only survived but become indistinguishable from more favored peers; (2) for these children, early opportunities for bonding did not occur and were long delayed, questioning the assumption that such bonding must occur early to avoid poor psychosocial adaptation; (3) The most important variable in good adaptation is the ability of the family to provide care to modify early privations and develop interactions that support development during maturation; (4) The extreme stress and trauma of these children did not result in any measurable behavioral or psychological impairment. This study seems important to me. Rather than focusing on pathology, it focuses on the greatest mystery of all: how people find health and happiness against all odds. This highly optimistic possibility should be at the core of Family Therapy. 4. "Blaming the Parent: Psychoanalytic Myth and Language" F. Diane Barth24 worked in a residential treatment center with a severely disturbed girl who both infuriated and charmed the staff with her standard response to criticism. Whenever the girl was chastised for inappropriate behavior that the staff thought the girl could control, the girl whined "I can't help it. It's the way my mother made me." In therapy, she took the same position, always blaming her mother or a hallucination as responsible for the girl's actions. It made the staff laugh when they were most annoyed, but it also encapsulated her basic difficulty with life. She had no sense of personal agency, of personal power to have an impact on her environment. Yet at the same time she saw herself as a helpless victim, exploited by others, she herself was exploiting those others so that they responded with feelings of helplessness and hostility towards her, thus perpetuating her experience of other people as hostile and potentially dangerous. Barth cites numerous psychoanalysts who regard the sense of personal agency as an important component of the sense of self, and thus of mental health. But although the girl in question was psychotic, her behavior illuminates the way many analysts and analysands alike fall into the trap of "parent-blaming." When Barth supervises candidates in analytic training, those candidates often see family dynamics in terms such as "the patient is repeating a pattern of interaction which occurred with his or her mother (or father)." When Barth asks what purpose the repetition has for the patient, many candidates (no matter how old or sophisticated) are taken by surprise. Some then explain this in terms of "the repetition compulsion, or a need for the familiar, or an attempt to master a painful experience. Even these dynamic explanations tend to be based on a belief that analysands are caught in a pattern of repeating early experiences for the purposes of mastery or defense, and that such behavior is necessary because of the damage caused by failures in the parents' ability to provide what the child needed." Yet even though these candidate psychoanalysts agree that "psychodynamics evolve from an intricate interplay between actual experience and the meaning such experience has for the individual," they still almost always imply a belief that someone -- either the analysand (classical Freudian drive-conflict theory) or the parents (many contemporary theories) -- is AT FAULT in the development of the individual's dynamics. As Schafer25 points out, this language interferes with psychoanalysis by promoting an attitude of passivity on the analysand, and a superficial understanding of psychodynamics by the analyst. I hereafter skip over the detailed examination of the literature by Barth, and the many secondary references which could be cited, and summarize the key ideas. (1) The concept of the child as a passive victim of parental behavior is contrary to the findings of current infant research. (2) Parent-blaming is one end of a continuum with intrapsychic factors at one end and environmental factors at the other. (3) Freud struggled with this conflict throughout his writings. (4) Much of the criticism directed against Freud and his followers come from Freud's final lack of adequate recognition of the impact of actual interaction with important people on the development of the human psyche. (5) Psychoanalysis has moved away from a meta-psychology of drive-structure conflict and towards one that integrated drive theory with, or abandoned it for, ego psychology, object relations, interpersonal relations, and the development of the self. (6) But this brings a risk that we leave a theory that blames the child for his neurosis and embrace a theory that blames his parents. (7) Blaming parents, like blaming instincts, is reductionist and not explanatory. (8) This mistake can slip in through the assumption that a "healthy" mother gladly and automatically meets all the child's needs, and so an adult with emotional difficulties must have had a mother who did not do so. (9) Many analysts today believe that "good-enough mothering" requires "perfect attunement" between parent and child. But the concept of "good" and "bad" internalized objects has been misunderstood by many as "good" and "bad" parents. (10) Language is the tool of analysis; analytical language must thus be cleared of undesirable consequences. (11) The belief that a perfect parent is humanly possible, is itself a fantasy. (12) The belief that nobody should have a child unless they are a perfect parent, is completely unrealistic. (13) Theory is important, but tends to reduce complexity -- sometimes too much. (14) The historical "truth" of an individual changes over time; memory is unreliable; hence a single childhood incident is less important than a general atmosphere and ongoing experience of relating and being related to. (15) The adult often understands (or misunderstands) childhood experiences from the child's perspective, and cannot capture the "actual" reality of childhood experiences. (16) Hence the adult cannot be understood simply on the basis of childhood experiences, even experiences of abuse. (17) Interpersonal experiences and subjective elaborations of these must both be understood, with the help of the analyst. (18) Most analysts consider developmental history only as a metaphor. (19) The past is constantly being constructed and reconstructed through the analytical work. (20) Different theories are useful for explaining different patients, or even for the different times in the course of one patient's analysis. (21) Different theories explain why different people react to similar experiences (i.e. abuse) in different ways. (22) Almost all abused children develop fantasies to explain the parents' behavior, and perhaps to avoid conscious awareness of parents' murderous intent. (23) But it is not enough to say "you are this way because you were abused" or "because your mother or your father drank." (24) Parent-blaming is an attitude, not a theory. (25) "Given the reality that human perfection does not exist, analytic theory needs to take into account the possibility that 'good enough' parenting is indeed good enough, and psychoanalysts need to beware of language and theory implying that only perfect is good enough. 5. Conclusion The Chicago Institute for Psychoanalysis, although a bastion of classical Freudian practice, is (based on examining four particular papers) not really so far from the mainstream of modern marital and family psychotherapy. Reading these papers carefully reveals a moderation of dogmatism in the direction of modern family therapy. (1) "Child Sibling Loss: A Family Tragedy", by George H. Pollock1 showed a nuanced relationship between the development of a personality and the family and societal stresses surrounding the death of a sibling. Examples such as Lenin, Stalin, Ho Chi Minh, and Hitler suggest that Family Therapy for a handful of dysfunctional families might have prevented tens of millions of tragic deaths by war. (2) "The Dreams of Descartes: Notes on the Origins of Scientific Thinking", by Alan R. Dyer7 looks at a philosophy said to be derived from one night of dreams, shows that those dreams must be examined in a family dynamic context, and suggests that the modern scientific world partly derived from a troubled fourteen-month-old 399 years ago dealing with the loss of his mother. (3) "An Outcome Study of the Psychosocial Adaptation of Children at Risk: Protective Factors in the Severely Ill Newborn", by Irving Philips17, experimentally rejects a considerable modern literature on development and ethology. It strongly suggests that humans can not only tolerate the harshest privation and not only survive but become indistinguishable from more favored peers, despite absent or late opportunities for bonding, so long as the family provided good care and develop interactions. (4) "Blaming the Parent: Psychoanalytic Myth and Language", by F. Diane Barth24 wisely criticized the common psychoanalytical attitude that blames the parents for the child's problems. Barth suggests, in an almost Confucian way, the need to "purify the language" to avoid these errors of theory and practice. To be sure, these four papers are not definitive examples of the Chicago school -- I have not read widely enough even to define the Chicago school -- but these four papers in the key publication of the institution in question suggest a more broad and modern understanding of family dynamics and therapy than Sigmund Freud would have expounded. I found the same sort of support in two other, even more recent papers: (5) "Fatherhood and the Preference for a Younger Child", Helen R. Beiser26; and (6) "Edgar Allan Poe, James Ensor, and the Psychology of Revenge", David S. Werman27, but this paper is already twice the requested length, so I shall stop here. Freud and his followers seem weirdly naive and unrealistic compared to the wonderful range of modern Family Therapy practices, but it is clear to me that these modern perspectives have enlightened the most conservative repositories of Freudian theory. Psychopathology is still a mystery, but the greater mystery of the Dynamics of the Healthy Family and the healthy individual shed light upon even that dark abyss.

6. References

1. "Child Sibling Loss: A Family Tragedy", George H. Pollock, M.D., Ph.D. (Chicago), The Annual of Psychoanalysis, a publication of the Chicago Institute for Psychoanalysis, Vol.14, 1986, pp.5-34; 2. Harriet Sarnoff Schiff, The Bereaved Parent, New York: Penguin Books, 1978; 3. James M. Barrie, Margaret Ogilvy: By Her Son, London: Hodder & Stoughton, 1896; 4. A.J. Solnit, "The Sibling Crisis", The Psychoanalytic Study of the Child, 38:281-284, New Haven, CT: Yale University Press, 1983, p.283; 5. J.M. Patterson & H.I. McCubbin, "Chronic Illness: Family Stress and Coping", in Stress and the Family, Vol.2: Coping With Catastrophe, ed. C.R. Figley & H.I. McCubbin, New York: Brunner/Mazel, 1983, pp.21-36; 7. "The Dreams of Descartes: Notes on the Origins of Scientific Thinking", Alan R. Dyer, M.D., Ph.D. (Durham, N.C.), The Annual of Psychoanalysis, a publication of the Chicago Institute for Psychoanalysis, Vol.14, 1986, pp.163-176; 8. S. Schonberger "A Dream of Descartes: Reflection on the Unconscious Determinants of the Sciences", Internat.J.Psycho-Anal., 1939, 20:43-57; 9. M.L. von Franz, "The Dream of Descartes", in Timeless Documents of the Soul, Evanston, IL: Northwestern University Press, 1968, pp.55-136; 10. L. Feuer, "The Dreams of Descartes", Amer. Imago, 1963, 20:3-26; 11. J.H. Hanson, "René Descartes and the Dreams of Reason", in The Narcissistic Condition: A Fact of Our Life and Times, New York: Human Sciences Press, 1977, pp.15-178; 12. Sigmund Freud, "Some Dreams of Descartes", Standrad Edition, 1929, 21-199-206, London: Hogarth Press, 1961; 13. A. Baillet, Vie de Monsour Descartes, Paris: Table Konde, 1946; English text available in Feuer (1963) and Dyer (1986); 14. Thomas S. Kuhn, The Structure of Scientific Revolutions, Chicago: University of Chicago Press, 1962; 15. Michael Polanyi, Personal Knowledge: Towards a Post-Critical Philosphy, London: Routledge and Kegan Paul, 1952; 16. Karl Popper, The Logic of Scientific Discovery, New York: Basic Books, 1959; 17. "An Outcome Study of the Psychosocial Adaptation of Children at Risk: Protective Factors in the Severely Ill Newborn", Irving Philips, M.D. (San Francisco), The Annual of Psychoanalysis, a publication of the Chicago Institute for Psychoanalysis, Vol.15, 1987, pp.215-244; 18. M. Rutter, Qualities of Mothering: Maternal Deprivation Reassessed, New York: Aronson, 1974; 19. Benjamin Spock, The Common Sense Book of Baby and Child Care, New York: Duel, Sloan & Pearce, 1946; 20. M.H. Klaus & J.H. Kennell, Maternal Infant Bonding: The Impact of Early Separation or Loss on Family Development, St.Louis: C.V. Mosby, 1976; 21. L. Erlenmeyer-Kimling, "A Prospective Study of Children at Risk for Schizophrenia: Methodological Considerations and Some Preliminary Findings", in Life History Research in Psychopathology, ed. R. Wirt, G. Winokur, & M. Rolf, Minneapolis: University of Minnesota Press, 4:23-46; 22. H. Grunebaum, B. Cohler, C. Kauffman, et.al., "Children of Depressed and Schizophrenic Mothers", Child Psychiat. Hum. Dev., 1978, 8:219-228; 23. B. Cohler, H. Grunebaum, C. Kauffman, et.al., "Social Adjustment Among Schizophrenic, Depressed, and Well Mothers and Their Children", 131st Annual Meeting of the American Psychiatric Association, Atlanta, 1978; 24. "Blaming the Parent: Psychoanalytic Myth and Language", F. Diane Barth, M.S.W., C.S.W. (New York), The Annual of Psychoanalysis, a publication of the Chicago Institute for Psychoanalysis, Vol.17, 1989, pp.185-201; 25. R. Schafer, A New Language for Psychoanalysis, New Haven: Yale University Press, 1983; 26. "Fatherhood and the Preference for a Younger Child", Helen R. Beiser, M.D., (Chicago), The Annual of Psychoanalysis, a publication of the Chicago Institute for Psychoanalysis, Vol.17, 1989, pp.203-212; 27. "Edgar Allan Poe, James Ensor, and the Psychology of Revenge", David S. Werman, The Annual of Psychoanalysis, a publication of the Chicago Institute for Psychoanalysis, Vol.21, 1993, pp.301-314; *** The End ***

Extending Life, Enhancing Life Book Review by Jonathan Vos Post

May 14, 1995 (c) 1995 by Emerald City Publishing All rights reserved. My not be reproduced without permission. May be posted electronically provided that it is transmitted unaltered, in its entirety, and without charge. Keywords: Sociology, Aging, Gerontology, Sociocultural Introduction This book report is about Extending Life, Enhancing Life: A National Research Agenda on Aging.1 The authors (more than 150 contributed) are the Committee on a National Research Agenda on Aging, Division of Health Promotion and Disease Prevention, Institute of Medicine (operating under Congressional charter of the National Academy of Sciences). The editor is Edmund T. Lonergan, and the publisher is the National Academy Press, Washington, D.C. This book was published in 1991. Including index, it is 152 pages long. The theme follows the sub-title literally: an "agenda" is a "list of things to be done." This book, an extension of earlier studies such as Our Future Selves2 in 1978, and Toward an Independent Old Age3 in 1982. It offers a limited number of general research priorities for the coming decades. To carry out this program, the committee recommends a significant increase in the funding of approved research grants on aging, expansion of training of faculty in age-related studies, widening of the scientific infrastructure base, and additions to present centers for the study of aging. The central concept is that increased fundamental research on aging holds the most promise to improve the lives of an ever-increasing number of older Americans. It is now the task of the leaders of this country to join with an informed public, and make it happen. Outline The book has a 39-page Executive Summary on background, a National Research Agenda on Aging, Cross-cutting Issues, Recommendations for Funding, Implications for Funding Agencies, and Concluding Comments. There is then a 6-page Introduction as Chapter 1; a 10-page Chapter 2 on Basic Biomedical Research; a 14-page Chapter 3 on Clinical Research; a 16-page Chapter 4 on Behavioral and Social Sciences; a 19-page Chapter 5 on Health Services Delivery Research; a 12-page Chapter 6 on Research in Biomedical Ethics; a 16-page Chapter 7 reviewing Resources Committed to Research on Aging; and two appendices covering acknowledgments, Liaison Teams, Experts Providing Information, Directors of various Centers and various Pharmaceutical research companies, and background documents. The relationship to the subject and interests of Social Gerontology are mostly in Chapter 4, and so that is where this book report will concentrate. Behavioral and Social Sciences Chapter 4 of this book emphasizes that "recent behavioral and social research has advanced our understanding of the aging process, the health and well-being of older adults, and the experience of growing older in our society." It summarizes a review of this research as having three main conclusions: (1) Socioeconomic contexts are an important influence on aging processes; (2) Significant variability in aging exists among individuals and between social groups; (3) Skills, behaviors, and competence can be modified in old age. Since length of life has increased, the age structure of populations have dramatically changed. In combination with changes in social policy and family structure, this forces us to learn more about the nature of aging today and the likely effects on future generations. The essential goal of aging and health research must be to "compress and diminish the duration of morbidity, disability, and suffering during the extra years provided by increased life expectancy; and to enhance both productivity and the quality of life during that time." But life processes are complex, so much of this research needs to be interdisciplinary. It should also be longitudinal and cohort sequential, working within existing knowledge, methodology, and resources. For example, behavioral and social studies can help to explain the response to clinical intervention, or to the factors that access older persons' to participation in health care services. This book emphasizes traditional approaches to research in such areas, but admits that long-term payoffs from less-established but promising areas of research should not be neglected. There are three themes on how individuals age, experience aging, and respond to aging: (1) The dynamic interactions of older individuals and sociocultural contexts; (2) Differentiation among older individuals and in the aging process itself; and (3) Modifiability through interventions to improve the quality of aging. Three approaches are outlined to scientifically study sociological and behavioral factors in aging: (1) Refinement of measurement and analytic instruments; (2) Cooperation and coordination by different disciplines in large-scale investigations using carefully selected, culturally representative panels to be followed longitudinally and cohort sequentially; and (3) Application and evaluation of research findings through systematic field studies to test the appropriateness of particular intervention techniques. The Dynamic Interaction of Individuals and Sociocultural Contexts The process of aging is "highly mutable" -- that is, factors in the social and physical environment extrinsic to the individual can dramatically alter the course of aging. Social and behavioral interventions might materially improve the functioning and quality of life for older people. Successful aging has multiple determinants, and there are also multiple causes of dysfunction and disability. To study all these matters, research must be embedded in the broader sociocultural context of race, ethnicity, cultural identity, and the social environment. When we say that genetic and other biological forces affect health and behavior within specific sociocultural contexts, this is backed up by research in four areas: (1) Comparative aging in different societies, cultures, racial/ethnic groups, and other subpopulations; (2) The influences on aging of different environments (geographic, workplace, treatment); (3) The effects on behavioral and health outcomes of older persons' individual characteristics coupled with the varying opportunities and constraints of different social milieus; and (4) the brain/behavior relationship A number of references4-10 suggest four conclusions: (1) The characteristics of the setting (structural and interpersonal) affect outcome; (2) Personal characteristics (cognitive appraisal and coping) can somewhat compensate for repressive controlling environments; (3) The "fit" between personal characteristics and independence-enhancing environments predicts a beneficial health outcome; and (4) The social processes that route individuals toward beneficial milieus are as important as providing a beneficial environment in the first instance. Research Priorities Three major research priorities flow from these themes: (1) Investigation of the basic social and psychological processes of aging and the specific mechanisms underlying the interrelationships among social, psychological, and biological aging functions; (2) Research that addresses issues of population dynamics, including the question of whether morbidity is being postponed commensurate with increases in longevity; (3) Research that examines how social structures and changes in those structures affect aging. Resource Recommendations Supports for behavioral and social research on aging were estimated at $80-$100 million from the federal government in 1989 and $10-$15 million from nonfederal sources such as foundations. The committee recommends budget increases of over 100% to be phased in over a five-year period. Extra funds should be allocated to: (1) studies of social, psychological, behavioral, and biological interrelationships; (2) "at-risk" populations; (3) population dynamics; and (4) changing social structures. Reactions and Recommendations I liked this book very much, and strongly recommend it to anyone interested in the Sociology of Aging. Although some 150 people contributed to it, it does not read as if were authored by committee. The range of subjects addressed is comprehensive, yet the structure of the book and its index makes it easy to find information, and the language is very clear, even when technical terms must be used by necessity. There was nothing that I read in it which contradicted what I've learned in this class, or what I've experienced in my own family. I did sometimes feel sad that the optimistic agenda for doubling expenditures in research is unlikely in the current political environment. But as the population itself ages, and older people are often more likely to vote than younger people, the "at risk" population may eventually insist that the politicians take heed of the recommendations of the greatest experts in the field. Entirely by chance, while reading this book and preparing this report, I ran into a quote11 that suggests the personal value of gerontology: "The French chemist Eugene Chevreul was born in 1786 and died in 1889 at the age of nearly 103. No other important scientist has lived to such an age. He remained active into his nineties, when he studied what we now call gerontology (the science of old age) using himself as a subject." References 1. Extending Life, Enhancing Life: A National Research Agenda on Aging, Committee on a National Research Agenda on Aging, Division of Health Promotion and Disease Prevention, Institute of Medicine (operating under Congressional charter of the National Academy of Sciences), editor Edmund T. Lonergan, Washington, D.C.: National Academy Press, 1991 2. Our Future Selves, National Institute on Aging, Bethesda, MD: U.S. Government Printing Office, 1978 3. Toward an Independent Old Age: A National Plan for Research on Aging, National Institute on Aging, Bethesda, MD: U.S. Government Printing Office, 1982 4. Toward an Independent Old Age: A National Plan for Research on Aging, National Institute on Aging, Bethesda, MD: U.S. Government Printing Office, 1982 5. D. Featherman & R. Lerner, "Ontogenesis and sociogenesis: Problematics for theory and research about development and socialization over the lifespan," American Sociological Review, 50: 659-676, 1985 6. G. Maddox & R. Campbell, "Scope, concepts, and methods in the study of aging", Handbook of Aging and the Social Sciences, R. Birnstock & E. Shanas, eds., New York: Van Nostrand Reinhold, 1985 7. R.T. Campbell & A. O'Rand, "Settings and sequence: The heuristics of aging research", Emergent Theories in Aging, pp.58-82, J. Birren & V. Bengtson, eds., New York: Springer Publications, 1988 8. M.W. Riley, ed., Social Changes and the Life Course, Vols. 1 and 2, Beverly Hills, CA: Sage, 1988 9. K. Spenner, "Social stratification, work, and personality", Annual Review of Sociology, 14:69-97, 1988 10. R. Moos, Evaluating Treatment Environments: A Social Ecological Approach, New York: John Wiley & Sons, 1974 11. Isaac Asimov, Professor of Biochemistry, Boston University Medical School, Isaac Asimov's Book of Facts, New York: Fawcett/Columbine, p.477 *** The End ***

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