What is Reaction Formation?

Introduction

In psychoanalytic theory, reaction formation (German: Reaktionsbildung) is a defence mechanism in which emotions and impulses which are anxiety-producing or perceived to be unacceptable are mastered by exaggeration of the directly opposing tendency.

The reaction formations belong to Level 3 of neurotic defence mechanisms, which also include dissociation, displacement, intellectualisation, and repression.

Theory

Reaction formation depends on the hypothesis that:

“[t]he instincts and their derivatives may be arranged as pairs of opposites: life versus death, construction versus destruction, action versus passivity, dominance versus submission, and so forth. When one of the instincts produces anxiety by exerting pressure on the ego either directly or by way of the superego, the ego may try to sidetrack the offending impulse by concentrating upon its opposite. For example, if feelings of hate towards another person make one anxious, the ego can facilitate the flow of love to conceal the hostility.”

Where reaction-formation takes place, it is usually assumed that the original, rejected impulse does not vanish, but persists, unconscious, in its original infantile form. Thus, where love is experienced as a reaction formation against hate, we cannot say that love is substituted for hate, because the original aggressive feelings still exist underneath the affectionate exterior that merely masks the hate to hide it from awareness.

In a diagnostic setting, the existence of a reaction-formation rather than a ‘simple’ emotion would be suspected where exaggeration, compulsiveness and inflexibility were observed. For example:

“[r]eactive love protests too much; it is overdone, extravagant, showy, and affected. It is counterfeit, and […] is usually easily detected. Another feature of a reaction formation is its compulsiveness. A person who is defending himself against anxiety cannot deviate from expressing the opposite of what he really feels. His love, for instance, is not flexible. It cannot adapt itself to changing circumstances as genuine emotions do; rather it must be constantly on display as if any failure to exhibit it would cause the contrary feeling to come to the surface.

Reaction formation is sometimes described as one of the most difficult defences for lay people to understand; this testifies not merely to its effectiveness as a disguise, but also to its ubiquity and flexibility as a defence that can be utilised in many forms. For example:

“solicitude may be a reaction-formation against cruelty, cleanliness against coprophilia”,

and it is not unknown for an analyst to explain a client’s unconditional pacifism as a reaction formation against their sadism. In addition:

“[h]igh ideals of virtue and goodness may be reaction formations against primitive object cathexes rather than realistic values that are capable of being lived up to. Romantic notions of chastity and purity may mask crude sexual desires, altruism may hide selfishness, and piety may conceal sinfulness.”

Even more counter-intuitively, according to this model:

“[a] phobia is an example of a reaction formation. The person wants what he fears. He is not afraid of the object; he is afraid of the wish for the object. The reactive fear prevents the dreaded wish from being fulfilled.

The concept of reaction formation has been used to explain responses to external threats as well as internal anxieties. In the phenomenon described as Stockholm syndrome, a hostage or kidnap victim ‘falls in love’ with the feared and hated person who has complete power over them. Similarly, paradoxical reports exist of powerless and vulnerable inmates of Nazi camps creating ‘favourites’ among the guards and even collecting objects discarded by them. The mechanism of reaction formation is often characteristic of obsessional neuroses. When this mechanism is overused, especially during the formation of the ego, it can become a permanent character trait. This is often seen in those with obsessional character and obsessive personality disorders. This does not imply that its periodic usage is always obsessional, but that it can lead to obsessional behaviour.

What is Regression (Psychology)?

Introduction

Regression, according to psychoanalyst Sigmund Freud, is a defence mechanism leading to the temporary or long-term reversion of the ego to an earlier stage of development rather than handling unacceptable impulses more adaptively.

In psychoanalytic theory, regression occurs when an individual’s personality reverts to an earlier stage of development, adopting more childish mannerisms.

Freud, Regression, and Neurosis

Freud saw inhibited development, fixation, and regression as centrally formative elements in the creation of a neurosis. Arguing that “the libidinal function goes through a lengthy development”, he assumed that “a development of this kind involves two dangers – first, of inhibition, and secondly, of regression”. Inhibitions produced fixations; and the “stronger the fixations on its path of development, the more readily will the function evade external difficulties by regressing to the fixations”.

Neurosis for Freud was thus the product of a flight from an unsatisfactory reality:

“along the path of involution, of regression, of a return to earlier phases of sexual life, phases from which at one time satisfaction was not withheld. This regression appears to be a twofold one: a temporal one, in so far as the libido, the erotic needs, hark back to stages of development that are earlier in time, and a formal one, in that the original and primitive methods of psychic expression are employed in manifesting those needs”.

Behaviours associated with regression can vary greatly depending upon the stage of fixation: one at the oral stage might result in excessive eating or smoking, or verbal aggression, whereas one at the anal stage might result in excessive tidiness or messiness. Freud recognised that “it is possible for several fixations to be left behind in the course of development, and each of these may allow an irruption of the libido that has been pushed off – beginning, perhaps, with the later acquired fixations, and going on, as the lifestyle develops, to the original ones”.

In the Service of the Ego

Ernst Kris supplements Freud’s general formulations with a specific notion of “regression in the service of the ego” … “the specific means whereby preconscious and unconscious material appear in the creator’s consciousness”. Kris thus opened the way for ego psychology to take a more positive view of regression. Carl Jung had earlier argued that “the patient’s regressive tendency…is not just a relapse into infantilism, but an attempt to get at something necessary…the universal feeling of childhood innocence, the sense of security, of protection, of reciprocated love, of trust”. Kris however was concerned rather to differentiate the way that “Inspiration -…in which the ego controls the primary process and puts it into its service – needs to be contrasted with the opposite…condition, in which the ego is overwhelmed by the primary process”.

Nevertheless his view of regression in the service of the ego could be readily extended into a quasi-Romantic image of the creative process, in which “it is only in the fiery storm of a profound regression, in the course of which the personality undergoes both dissolution of structure and reorganization, that the genius becomes capable of wresting himself from the traditional pattern that he had been forced to integrate through the identifications necessitated and enforced by the oedipal constellation”.

From there it was perhaps only a small step to the 1960s valorisation of regression as a positive good in itself. “In this particular type of journey, the direction we have to take is back and in….They will say we are regressed and withdrawn and out of contact with them. True enough, we have a long, long way to back to contact the reality”. Jungians had however already warned that “romantic regression meant a surrender to the non-rational side which had to be paid for by a sacrifice of the rational and individual side”; and Freud for his part had dourly noted that “this extraordinary plasticity of mental developments is not unrestricted in direction; it may be described as a special capacity for involution – regression – since it may well happen that a later and higher level of development, once abandoned, cannot be reached again”.

Later Views

Anna Freud (1936) ranked regression first in her enumeration of the defence mechanisms, and similarly suggested that people act out behaviours from the stage of psychosexual development in which they are fixated. For example, an individual fixated at an earlier developmental stage might cry or sulk upon hearing unpleasant news.

Michael Balint distinguishes between two types of regression: a nasty “malignant” regression that the Oedipal level neurotic is prone to… and the “benign” regression of the basic-fault patient. The problem then is what the analyst can do “to ensure that his patient’s regression should be therapeutic and any danger of a pathological regression avoided”.

Others have highlighted the technical dilemmas of dealing with regression from different if complementary angles. On the one hand, making premature “assumptions about the patient’s state of regression in the therapy…regarded as still at the breast”, for example, might block awareness of more adult functioning on the patient’s part: of the patient’s view of the therapist. The opposite mistake would be “justifying a retreat from regressive material presented by a patient. When a patient begins to trust the analyst or therapist it will be just such disturbing aspects of the internal world that will be presented for understanding – not for a panic retreat by the therapist”.

Peter Blos suggested that “revisiting of early psychic positions…helps the adolescent come out of the family envelope”, and that “Regression during adolescence thus advances the cause of development”. Stanley Olinick speaks of “regression in the service of the other” on the part of the analyst “during his or her clinical work. Such ego regression is a pre-condition for empathy”.

Demonstration of pain, impairment, etc. also relates to regression. When regression becomes the cornerstone of a personality and the life strategy for overcoming problems, it leads to such an infantile personality.

  • A clear example of regressive behaviour in fiction can be seen in J.D. Salinger’s The Catcher in the Rye. Holden constantly contradicts the progression of time and the ageing process by reverting to childish ideas of escape, unrealistic expectations and frustration produced by his numerous shifts in behaviour. His tendencies to reject responsibility and society as a whole because he ‘does not fit in’ also pushes him to prolonged use of reaction formation, unnecessary generalisations, and compulsive lying.
  • A similar example occurs in Samuel Beckett’s Krapp’s Last Tape. Krapp is fixated on reliving earlier times, and re-enacts the foetal condition in his ‘den’. He is unable to form mature relationships with women, seeing them only as replacements for his deceased mother. He experiences physical ailments that are linked to his foetal complex, struggling to perform digestive functions on his own. This literal anal retentiveness exemplifies his inefficacy as an independent adult.

What is the Revolving Doors Agency?

Introduction

Formed on 17 August 1993, the Revolving Doors Agency (RDA), also known as Revolving Doors, is a charitable organisation in the United Kingdom which works across England and Wales.

Through research, policy and campaigning work, the organisation aims to improve services for people with multiple needs who are in repeat contact with the criminal justice system.

Vision

The vision of the organisation is that by 2025 there is an end to the revolving door of crisis and crime, when anyone facing multiple problems and poor mental health is supported to reach their potential, with fewer victims and safer communities as a result.

Activities

To fulfil its vision, Revolving Doors organises its work around three areas:

AreaDescription
Policy and CommunicationsWorking with policymakers in national and local government, across Whitehall and in local and regional authorities, to improve responses for the revolving doors group. This work is informed by their research, the work of the organisation’s service user forums and their partnership and development work across the country.
Service User InvolvementThe organisation operates a national service user forum and a young peoples’ forum. The Forums bring together individuals from different areas of the country who have experienced mental health and other problems and have had contact with the criminal justice system. The forums are designed to root the organizations work in the reality of people’s experiences.
Local Partnerships and DevelopmentRevolving Doors works with organisations and individuals across England and Wales to demonstrate solutions for the revolving doors group.

Definition

The revolving door group refers to the experiences of people who are caught in a cycle of crisis, crime and mental illness, whereby they are repeatedly in contact with the police and often detained in prison as well as being victims of crime themselves. This is a group that often has multiple problems for which they need the input of a wide range of agencies, including housing, drugs, mental health, and benefits. The mental health problems of the group are usually a core or exacerbating factor. Routinely, they fall through the gaps of existing mental health service provision, as their mental health problems are not considered sufficiently “severe” to warrant care from statutory services; but they are frequently excluded from mainstream services in the community, such as GPs and Housing Associations, on account of the perceived complexity of their needs and their often challenging behaviour. Consequently, the lack of support contributes to a downward spiral that brings people into contact with the criminal justice system. It is estimated that the number of individuals within the revolving door group is approximately 60,000 at any one time.

Organisation

Formation

In 1992 a report undertaken by NACRO (a social justice charity) and an ITV Telethon identified a group of people who were caught in a downward cycle of homelessness and found themselves in repeat contact with both the mental health and criminal justice system. This group was identified as the ‘revolving doors’ group, which subsequent research has estimated to include 60,000 people at any one time.

Following the publication of the report in 1993, the Revolving Doors Agency was established by some of the parties involved in the initial publication who sought to demonstrate new ways of working in these three areas of criminal justice, mental health and homelessness. The focus of the organisation was on the people who kept falling between the mainstream services in the community.

Initially, the organisation conducted research in prisons and police stations to identify the needs of the revolving doors group and establish the issues they faced.

In the late 1990s the organisation established a series of experimental services, called Link Worker Schemes, to test effective interventions for their target group. The schemes offered individuals practical and emotional support, assisting them to access appropriate services and to address the underlying causes of their offending behaviour. An independent evaluation conducted by the Home Office found that the scheme cut reoffending by 22%.

Following a strategic review in 2006, the organisation adjusted its focus to research, policy and campaigning work in relation to people who become stuck in a cycle of mental health problems and crime. The Link Worker Schemes were passed over to other voluntary sector providers.

Funding

The organisation is funded by charitable donations from individuals, grants from statutory bodies and applications to charitable foundations. Recent funders include the Big Lottery Fund, the Esmée Fairbairn Foundation, The Henry Smith Charity, the Paul Hamlyn Foundation, the Pilgrim Trust and Trusts for London. The organisation has previously received funding from Comic Relief.

Revolving Doors has also received pro-bono support from Clifford Chance who, in partnership with the University of Cambridge Pro Bono Society, assisted the organisation with additional research.

Governance

Revolving Doors is governed by a Board of Trustees who oversee the activities of the organisation, which itself is run by a team of nine members of staff who are supported by associates across the country. The organisation is a registered private company limited by guarantee, with no share capital, which means it is run for non-profit purposes. It is a recognised as a charity by the Charities Commission.

Partnerships

The organisation affiliates itself to the Criminal Justice Alliance, a coalition of 58 organisations involved in policy and practice across the criminal justice system, the Mental Health Alliance, a coalition of 75 organisations which aims to secure a better mental health legislation, and the Transition to Adulthood Alliance, which works to improve the opportunities and life chances of young people in their transition to adulthood, who are at risk of committing crime and falling into the criminal justice system.

Patrons

The current patrons of Revolving Doors are Lord David Ramsbotham GCB CBE (Former Chief Inspector of Prisons), the Rt Hon. Hilary Armstrong (Former Member of Parliament for North West Durham and Cabinet Minister for Social Exclusion and Duchy of Lancaster), Ian Bynoe (Former Acting Deputy Chair of the Independent Police Complaints Commission), Rose Fitzpatrick (Acting Assistant Commissioner for the Metropolitan Police), Professor John Gunn (Professor of Forensic Psychiatry at the University of Birmingham), Dru Sharpling CBE (London Director of the Crown Prosecution Service), His Honour Judge Fabyan Evans, Bharat Mehta OBE (Chief Executive of Trusts for London), Joe Simpson (Consultant) and Peter Wrench, Consultant and Writer, former Prison Service and Home Office Director.

Publications

Revolving Doors has published a number of works with a focus on the revolving doors group who have mental health problems within the criminal justice system, including a report on the financial impact of supporting women with multiple needs in the criminal justice system. This report established that an investment of £18 million per year England-wide in interventions could reduce the cost to the state by £384m over three years and almost £1 billion over five years.

In 2012, Revolving Doors Published Integrated Offender Management – Effective alternatives to short sentences. It also published Ending the Revolving Door – guidance for Police and Crime Commissioners.

Reception

Revolving Doors is widely regarded as one of the UK’s leading charities concerned with mental health and the criminal justice system.

In 2002 the organisation received two UK Charity Awards, which are given for outstanding achievements within the UK not-for-profit sector, in the category of Research, Advice and Support, as well as being the Overall Winner.

In 2006 the Revolving Doors Agency received an award from the Care Services Improvement Partnership, part of the Care Services Directorate at the Department of Health, for their Link Worker Scheme in the London Borough of Islington. The same year, the organisation was also highly commended by the Centre for Social Justice.

In 2010, Neighbourhood Link, a scheme in the Islington developed in partnership by St. Mungo’s and the Revolving Doors Agency, was highlighted as evidence of good-practice by the Cabinet Office. The scheme helps people with multiple and complex needs who are either involved in crime or at risk of becoming involved in crime and becoming homeless. As a result of the project, contact with the police amongst the users has fallen from 31% to 9%.

What is Paranoid Anxiety?

Introduction

Paranoid anxiety is a term used in object relations theory, particularity in discussions about the Paranoid-schizoid and depressive positions.

The term was frequently used by Melanie Klein, especially to refer to a pre-depressive and persecutory sense of anxiety characterised by the psychological splitting of objects.

Further Developments

Donald Meltzer saw paranoid anxiety as linked not only to a loss of trust in the goodness of objects, but also to a confusion between feeling and thought.

For the extreme forms of such anxiety, he coined the term ‘terror’, to convey something of the qualitatively different intensity of their nature.

External Sources

Sigmund Freud considered that there was generally a small kernel of truth hidden in the exaggerated anxiety of the paranoid – what Hanns Sachs described as an amoeba about to become monster.

The anti-psychiatrist David Cooper argued indeed that “The therapist in working with people might far more often have to confirm the reality of paranoid fears than in any sense disconfirm or attempt to modify them”, but most family therapists would probably agree that this is an extreme and one-sided position.

Defensive Functions

Idealisation (as in the transference) can be used as a defence against deeper paranoid anxieties about the actual presence of a destructive, denigrating object.

Conversely, paranoid fears, especially when systematised, may themselves serve as a defence against a deeper, chaotic disintegration of the personality.

Persecutory Anxiety State (Panic Attack) and Persecutory Delusion

Paranoid anxiety may reach the level of a persecutory anxiety state (a form of panic attack), including various levels of persecutory delusions (the preferred term to paranoid delusions).

Heavy drinking is said to sometimes precipitate acute paranoid panic – the protagonist’s unconscious hostile impulses being projected onto all those around.

Literary Examples

Hamm in Endgame by Samuel Beckett has been singled out as a character driven by paranoid anxiety.

Noboru in The Sailor Who Fell from Grace with the Sea by Yukio Mishima is shown to have persecutory anxiety.

What is the Pan American Health Organisation?

Introduction

The Pan American Health Organisation (PAHO) is an international public health agency working to improve the health and living standards of the people of the Americas.

It is part of the United Nations system, serving as the Regional Office for the Americas of the World Health Organisation (WHO) and as the health organisation of the Inter-American System. It is known in Latin America as the OPS or OPAS (Spanish: Organización Panamericana de la Salud; Portuguese: Organização Pan-Americana da Saúde).

Brief History

The organisation was founded in December 1902. It was originally called the Pan-American Sanitary Bureau.  In 1949, PAHO and WHO signed an agreement making PAHO the American Regional Office (AMRO) of WHO. Today the usual phrasing is “Regional Office for the Americas”. The first hemisphere-wide effort to eradicate smallpox was made in 1950 by the PAHO. The campaign was successful in eliminating smallpox from all countries of the Americas except Argentina, Brazil, Colombia, and Ecuador.

Background

PAHO has scientific and technical expertise at its headquarters, in its 27 country offices, and its three Pan American centres, all working with the countries of the Americas in dealing with priority health issues. The health authorities of PAHO’s Member States set PAHO’s technical and administrative policies through its Governing Bodies. The PAHO Member States include all 35 countries in the Americas; Puerto Rico is an Associate Member. France, the Kingdom of the Netherlands, and the United Kingdom of Great Britain and Northern Ireland are the Participating States, and Portugal and Spain are the Observer States.

The Organization’s essential mission is to strengthen national and local health systems and improve the health of the peoples of the Americas, in collaboration with Ministries of Health, other government and international agencies, non-governmental organisations (NGO), universities, social security agencies, community groups, and many others.

PAHO promotes universal health coverage and universal access to health and strengthening of health systems based on primary health care strategies. It assists countries in fighting infectious diseases such as malaria, cholera, dengue, HIV and tuberculosis as well as the region’s growing epidemic of noncommunicable diseases such as cardiovascular disease, cancer and diabetes. PAHO engages in technical cooperation with ministries of health and facilitates coordination with other sectors to promote health in all policies. PAHO also promotes the use of research evidence to inform health care decisions and policymaking through the implementation of knowledge translation strategies such as the Evidence-Informed Policy Network – EVIPNet Evipnet. Through the Elimination Initiative, it targets HIV/AIDS.

In its efforts to improve health, PAHO targets the most vulnerable groups including mothers and children, workers, the poor, the elderly, and refugees, and displaced persons. It focuses on issues related to equity for those who lack access to health, and on a Pan American approach, encouraging countries to work together on common issues and build lasting capacities.

Specific initiatives spearheaded by PAHO include the Expanded Programme on Immunisation, which played a major role in the elimination of smallpox and polio from the Americas; the Tobacco-free Americas initiative; the Regional Coalition for Water and Sanitation to Eliminate Cholera in Hispaniola; the Salt Smart Consortium; the Pan American Network for Drug Regulatory Harmonization; and a blood safety initiative that seeks to improve blood safety and efficiency by helping countries reach 100% blood supplies from unpaid voluntary donors.

A major priority for the Americas is cutting infant mortality, and PAHO is mobilising new political, institutional, and financial resources to prevent an additional 25,000 infant deaths every year through the application of the Integrated Management of Childhood Illness strategy, a simple and practical approach in which primary health care workers are taught a complete process to evaluate the health status of children brought to a health post or clinic. They learn to recognise signs of disease and evaluate and treat them. They learn to give parents information on how to prevent disease in the home. If they see danger signs indicating the infant could die, they are taught to treat the child immediately or take him or her to a hospital.

Improvement of drinking water supplies, adequate sanitation, and increased access to health care for the poor are still top priorities for PAHO, with a focus on equity. The Organisation is intensifying its efforts to have countries know the true state of health of their populations and where the inequalities lie. Programme efforts focus on correcting inequality, taking into account decentralisation and change of state functions, on showing that health has a role to play in the success of other sectors, and on how attention to health affects positively other aspects of human development. Advocacy in this area is also directed to reducing pernicious gender inequity, which reflects in some health problems of women.

The Pan American approach is a part of PAHO history and the spirit of Panamericanism continues to stimulate technical cooperation among countries in health. PAHO has helped countries work together toward common goals, and to initiate multi-country health ventures in Central America, the Caribbean, the Andean Region, and the Southern Cone. Experience has shown practical benefits such as the solidarity that helped Central America after hurricane Mitch, and there are numerous other examples. Health collaboration found expression at the highest political level when American heads of state in their Summit in Santiago accepted a health initiative called “Health Technology Linking the Americas.”

The countries of Latin America and the Caribbean joined together over 20 years ago to buy vaccines through a revolving fund, bringing them tangible benefits and helping advance PAHO’s efforts to eliminate or control vaccine-preventable diseases. These are among the Organisation’s most notable successes, starting with the eradication of smallpox from the Americas in 1973; a triumph followed five years later by global eradication of the dreaded disease.

A major effort committing the Americas to embark on polio eradication in 1985 succeeded in September 1994, when a distinguished International Commission declared the Americas officially polio-free. The last case of polio in the Americas was identified on August 23, 1991, in a young boy named Luis Fermín Tenorio Cortez, in Junín, Peru. Since then, despite intensive surveillance, no cases of polio have been detected anywhere in the Americas, and the WHO is now working toward the goal of eradicating polio globally. PAHO assists the countries in mobilising the necessary resources to provide immunisation and treatment services for all vaccine-preventable diseases. PAHO is close to accomplishing the goal of eliminating measles from this hemisphere and is pressing on with the introduction of new vaccines that are currently available, such as Haemophilus influenzae B. to reduce meningitis and respiratory infections. PAHO works to reduce the toll of death and illness from diarrheal diseases, including cholera, through case management and oral rehydration therapy to prevent deaths from dehydration, and to provide adequate diagnosis and treatment of acute respiratory infections, thus saving the lives of hundreds of thousands of children each year.

PAHO disseminates scientific and technical information through its publications program, its Internet site, and a network of academic libraries, documentation centres, and local health care libraries.

The Organisation provides technical collaboration in a variety of specialised public health fields and organises emergency preparedness and disaster relief coordination. It supports efforts to strengthen national health systems, develop national health research systems, control malaria, Chagas’ disease, urban rabies, leprosy, and other diseases that affect the people of the Americas. PAHO collaborates with governments, other agencies, and private groups to address major nutritional problems including protein-energy malnutrition, and is now working to eliminate iodine and vitamin A deficiencies.

It engages in and facilitates health promotion to help countries deal with health problems typical of development and urbanisation, especially non-communicable diseases (NCDs) such as cardiovascular diseases, cancer, accidents, smoking, addiction to drugs and alcohol, and injuries among others. Beyond health promotion, PAHO also addresses health systems and quality of care issues in support of national efforts to respond to the NCD pandemic.

The Organisation also executes projects for other United Nations agencies, for international organisations such as the World Bank and Inter-American Development Bank, for official development cooperation agencies of various governments, and for philanthropic foundations.

PAHO strengthens the health sector capacity in the countries to advance their priority programmes through intersectoral action, promoting an integrated approach to health problems. It also works to improve women’s health, promoting the greater integration of women in society, as well as awareness of their importance as both recipients and providers of health services.

PAHO trains health workers at all levels, through fellowships, courses and seminars, and the strengthening of national training institutions. It leads to the use of advanced communications technologies for information, health promotion, and education, working with journalists in many countries.

The Organisation recognises the role of the private sector in the delivery of services and fosters dialogue and partnerships with the Ministries of Health. In addition to its core budget financed by quota contributions from its Member Governments, PAHO also seeks outside funding to help implement special programmes and initiatives in response to vital health needs. Voluntary tax-deductible contributions for PAHO health and education projects in the Americas may be made to the PAHO Foundation.

Headquarters Building

In March 1960, President Eisenhower signed into law a bill passed by the US Congress authorising the US government to purchase and donate a lot for the PAHO headquarters in Washington, D.C. At the meeting of its Executive Committee in April 1960, the PAHO decided to accept the USG’s offer and set forth parameters for proceeding with the project of a new headquarters building. PAHO decided to use an international open competition as the means of selecting an architect for the project, following the recent successful model of other international organisations (most notably the United Nations New York headquarters inaugurated in 1952, and the UNESCO Paris headquarters in 1953 – both resulting in landmark designs of modernist architecture). PAHO framed the competition based on standards developed by the International Union of Architects and determined that the competition should be open to architects from all countries of the Americas. The vision was that “the new building should be a monument to international health cooperation.”

Following a review of 58 entries, the PAHO in October 1961 declared Uruguayan architect Román Fresnedo Siri the winner of its competition. At the ceremony announcing him as a winner, the organization’s Director Abraham Horwitz said “this beautiful building will become a monument to the ideal of better health for the peoples of the Americas.” He described the winning design as one of “both grace and utility,” and said, “it reflects the high ideals of the Pan-American spirit in an age when we must move ahead to build a better future for our peoples.”

The building was designed in a modernist style by Fresnedo Siri in part as a tribute to Le Corbusier, a key influence on Fresnedo Siri’s work. Constructed in 1965, the exterior features 29 round bronze seals of the founding nations of the Pan American Health Organisation set in black stone. Each medallion is 2.5 feet (0.76 m) in diameter and were designed by American sculptor Michael Lantz. They were originally meant to be carved in granite. The east side of the south façade (left to right) seals are for: France, Guatemala, Guyana, Haiti, Honduras, Jamaica, Mexico, the Netherlands, Nicaragua, Panama, Paraguay, Peru, Trinidad and Tobago, United Kingdom, United States, Uruguay, and Venezuela. The west side of the south façade seals are for: Argentina, Barbados, Bolivia, Brazil, Canada, Chile, Colombia, Costa Rica, Cuba, Dominican Republic, Ecuador, and El Salvador. In 1993 the seals were surveyed by the Smithsonian Institution’s Save Outdoor Sculpture! program and were described as needing conservation treatment.

The building is situated on a triangular lot of just over one acre nestled between Virginia Avenue, E Street, and 23rd Street, Northwest, in the Foggy Bottom neighbourhood of Washington. Constructed of reinforced concrete over a steel frame with an exterior of glass and marble, the building is one of Washington’s most recognised examples of mid-century modern architecture. The building is divided into two distinct volumes: a gracefully curved ten-story building that hosts the organization’s main offices, and an adjoining four-story cylindrical annex that serves as the congress hall for formal assemblies of the PAHO member state delegates, as well as other meetings and events. It is surrounded by George Washington University to the north and east, the Columbia Plaza office/residential complex to the west, and the State Department to the south across the E street expressway underpass.

The main building features soaring white vertical columnar ribs evenly separating dark vertical columns of glass. There are no horizontal lines to compete with the vertical symmetry; the building’s vertical ribs disappear along “blind gables” into an invisible roofline. In the formalism and attention to symmetry, Fresnedo Siri said he was trying to stay true to the “classic spirit of the city of Washington.” The interplay of light and dark is accentuated by the use of white American marble, black Mexican granite, and dark gray glass. The building’s slender, windowless west and east sides are clad in white marble, while the black granite frames all the ground floor elements, including the entry portico, the hidden downward ramp to an underground garage, and the reflecting pool and garden elements.

Fresnedo Siri placed the main building on 20 rounded pilotis (columns) that lift it a full story above ground level. He employed this signature element of mid-century modernist design to maximise the open pedestrian plaza space on the relatively small and unusually shaped lot while enhancing visual transparency and flow. He added reflecting pools with fountains at the base of each building – his vision was that the cylindrical congress hall, in particular, would appear to be “emerging from the water.” The thin vertical streams spurting up from the fountains would echo the symmetry of the columns and vertical ribbing of the main building. A row of 42 flag poles (representing each PAHO member state) reinforces still further the building’s dancing array of vertical symmetries, while also gracefully delineating the Northeastern edge of the property site. Unfortunately, the reflecting pools years later were eliminated, filled in and replaced by garden plots.

Fresnedo Siri purposefully placed the convex side of the curved main office building to the north, smoothly integrating it into the urban streetscape of similarly sized office, university and residential buildings. This allowed the concave side of the building to face the open side of the lot, gently cradling the congress hall annex while framing the contours of the small but appealing pedestrian plaza area that flows toward the site’s open southern side.

The cylindrical annex’s around the central congress hall are about 92 feet (28 m) in diameter and seat up to 300 people. The single open space soars upward, filling the top three levels of the building. Fresnedo Siri designed a dramatic spider web-like steel structure to support the building, allowing the entire interior space to be free of any supporting columns. The resulting internal space, naturally lit by windows throughout the cylinder’s full 360 degrees, achieves an impressive sense of openness and purity of design. The cylindrical building is encased on the outside by a lattice-like grill of diamond-shaped hexagons composed of white marble, quartz and Portland cement. The recessed ground floor space of the cylinder is encased in the same Mexican black granite used for all the site’s ground-level elements, creating a striking contrast with the white honeycomb grill of the upper levels it supports.

After studying the main diplomatic congress halls at the UN, State Department, the OAS and elsewhere, Fresnedo Siri devised a “floating seat” solution for the chairs in the PAHO’s hall. The seats are all anchored to the floor in the rear to curved latitudinal support elements running behind each row (and serving as hidden conduits for the simultaneous translation cabling), achieving what he described as “a great functional and aesthetic purity.” All of the furnishings for the main halls and meeting rooms were designed under his specifications by Knoll Associates, a leading New York-based producer of modernist furniture including landmark designs of the era like the Saarinen womb chair and Mies Van de Rohe’s Barcelona chair. Fresnedo Siri designed the magisterial backdrop to the presidium of the Congress hall, using vertical slats of six different kinds of wood including Honduran mahogany, Brazilian jacaranda, American walnut and oak, arranged in his words “to accentuate the dimension of the space and the importance of the function it served.” Fresnedo Siri also designed the central chandelier of the Congress hall, calling the piece “a sculpture in light.” Measuring 20 feet in diameter and weighing 16,000 pounds (7,300 kg), it consisted of 3000 long rectangular pieces of Lucite, the translucent acrylic resin invented by Dupont in the 1930s for industrial and military uses then enjoying an early-60’s boom as a “space age” material for vanguard furniture and art.

What is the National Alliance on Mental Illness?

Introduction

The National Alliance on Mental Illness (NAMI) is a United States-based advocacy group originally founded as a grassroots group by family members of people diagnosed with mental illness.

NAMI identifies its mission as “providing advocacy, education, support and public awareness so that all individuals and families affected by mental illness can build better lives” and its vision as “a world where all people affected by mental illness live healthy, fulfilling lives supported by a community that cares”. NAMI offers classes and trainings for people living with mental illnesses, their families, community members, and professionals, including what is termed psychoeducation, or education about mental illness. NAMI holds regular events which combine fundraising for the organization and education, including Mental Illness Awareness Week and NAMIWalks.

Headquartered in Arlington, Virginia, NAMI has around 1,000 state and local affiliates and is represented in all 50 US states, Washington, D.C., and Puerto Rico. NAMI is funded primarily through pharmaceutical company donations. Additional funding comes from individual donors, as well as sponsorships and grants. NAMI publishes a magazine around twice a year called The Advocate. NAMI also runs a HelpLine five days a week, which is funded in part by pharmaceutical companies Janssen and Lundbeck.

Brief History

NAMI was founded in Madison, Wisconsin, by Harriet Shetler and Beverly Young. The two women both had sons diagnosed with schizophrenia, and “were tired of being blamed for their sons’ mental illness”. Unhappy with the lack of services available and the treatment of those living with mental illness, the women sought out others with similar concerns. The first meeting held to address these issues in mental health led to the formation of the National Alliance for the Mentally Ill in 1979. In 1997, the legal name was changed to the acronym NAMI by a vote of the membership due to concerns that the name National Alliance for the Mentally Ill did not use person-first language. In 2005, the meaning of NAMI was changed to the backronym National Alliance on Mental Illness.

Mission

NAMI identifies its mission as to promote recovery by preserving and strengthening family relationships “affected by mental illness”. NAMI’s programmes and services include education, support groups, informational publications, and presentations. Although originally focused primarily on family members, in more recent years NAMI has moved toward trying to include people diagnosed with mental illness as well (although activists have criticised these efforts). In addition, NAMI has a strong focus on discriminatory attitudes and behaviours about mental illness (what they term stigma); another identified goal is “to increase public and professional understanding”, and “to improve the mental health system”.

Structure

The National Alliance on Mental Illness is a 501(c)(3) non-profit run by a board of directors who are elected by membership. NAMI National is the umbrella organisation; state and local affiliates operate semi-independently, in an attempt to more accurately represent those in the surrounding communities. Since 2015, NAMI has been using a four-year strategic plan which expires in 2019.

The national chief executive officer from 2014-2019 was Mary Giliberti, who resigned on 24 April 2019. She was immediately preceded by Michael Fitzpatrick. Gilberti, who has a law degree from Yale University and clerked for Judge Phyllis A. Kravitch. Before coming to NAMI, Giliberti worked as a senior attorney at Bazelon Centre for Mental Health Law for almost ten years and the Senate Health, Education, Labour, and Pensions Committee from 2008 to 2014. She worked for NAMI National during this time as the director of public policy and advocacy for federal and state issues. In 2017, she was “appointed by the Secretary of the U.S. Department of Health and Human Service (HHS) to serve as one of 14 non-federal members of HHS’ Interdepartmental Serious Mental Illness Coordinating Committee.”

National and state NAMI organisations function to provide Governance, Public Education, Political Advocacy, and management of NAMI’s Educational Programmes. At the local level, the local NAMI chapters also provide assistance in obtaining mental health resources, scheduling and administration of NAMI’s programmes, and hosting local meetings and events for NAMI members.

In February 2020, NAMI Sioux Falls has merged with the South Dakota Office. The move was a result of a decision by the national NAMI office.

Partnerships

In 2017, NAMI partnered with Alpha Kappa Alpha (since 2015), Instagram, tumblr, Women’s Health, Fox Sports, Stanley Centre for Psychiatric Research at Broad Institute, Jack and Jill of America, The Jed Foundation, and Lokai. Celebrity partnerships included Utkarsh Ambudkar, Maria Bamford, Andrea Barber, AJ Brooks, Sterling K. Brown, Corinne Foxx, Naomi Judd, Dawn McCoy, Stefania Owen, Alessandra Torresani, Wil Wheaton, DeWanda Wise, and Chris Wood.

Philosophy and Positions

NAMI generally endorses a medical model approach to mental illnesses, and previously was a major proponent of terming them “serious brain disorders” during the “decade of the brain”. NAMI endorses the term anosognosia, or “that someone is unaware of their own mental health condition or that they can’t perceive their condition accurately”. While NAMI previously referred to mental illnesses as “serious brain disorders”, current advice on their “How we talk about NAMI” page recommends against this language.

Programmes

NAMI programmes are generally in the area of support and education for individuals and families, often for no cost. The programmes are set up through local NAMI Affiliate organisations, with different programmes varying in their targeted audience.

NAMI Family-to-Family

The NAMI Family-to-Family Education Programme is a free eight-week course targeted toward family and friends of individuals with mental illness, providing education from a medical model perspective of mental illness. Originally offered as a twelve-week programme, but updated to a shorter model in 2020, the courses are taught by a NAMI-trained family member of a person diagnosed with a psychiatric disorder. Family-to-Family is taught in 44 states, and two provinces in Canada. The programme was developed by clinical psychologist Joyce Burland. Facilitators are required to teach material from the curriculum without alteration.

Purpose

The Family-to-Family programme provides general information about mental illness and how it is currently treated from a medical model perspective. The programmes cover mental illnesses including schizophrenia, depression, bipolar disorder, etc., as well as the indications and side effects of medications. Family-to-Family takes a biologically-based approach to explaining mental illness and its treatments.

According to the NAMI website, Family-to-Family programme states its goals as teaching coping and advocacy skills, providing mutual support, how to “handle a crisis”, “information on mental health conditions and how they affect the brain”, and locating resources in the community

Evidence Base

The NAMI Family-to-Family programme has initial research evidence; one randomised clinical trial showed gains in empowerment, increases in problem solving and reductions in participant anxiety scores following the class; these changes persisted at 6 month follow up. These studies confirm an earlier finding that Family-to-Family graduates describe a permanent transformation in the understanding and engagement with mental illness in themselves and their family. Because a randomized controlled trial is at risk of poor external validity by mechanism of self-selection, Dixon and colleges sought out to strengthen the evidence base by confirming the benefits attributed to Family-to-Family with a subset of individuals who declined participation during initial studies.

The NAMI Family-to-Family programme was found to increase self efficacy in family members involved in caring for a family member with schizophrenia while reducing subjective burden and need for information. In light of recent research, Family-to-Family was added to the SAMHSA National Registry of Evidence-Based Programmes and Practices (NREPP), although as of January 2018 this database and designation has been eliminated by SAMHSA.

NAMI Peer-to-Peer

The NAMI Peer-to-Peer is an eight-week educational programme aimed at adults diagnosed with a mental illness. The NAMI Peer-to-Peer programme describes the course as a holistic approach to recovery through lectures, discussions, interactive exercises, and teaching stress management techniques. The programme provides information about biological explanations of mental illness, symptoms, and personal experiences. The programme also includes information about interacting with healthcare providers as well as decision making and stress reducing skills. The Peer-to-Peer philosophy is advertised as being centred around certain values such as individuality, autonomy, and unconditional positive regard. The programme is also available in Spanish.

Preliminary studies have suggested Peer-to-Peer provided many of its purported benefits (e.g. self-empowerment, disorder management, confidence). Peer interventions in general have been studied more extensively, having been found to increase social adjustment.

NAMI In Our Own Voice

The NAMI In Our Own Voice (IOOV) programme started as a mental health consumer education program for people living with schizophrenia in 1996, and was further developed to IOOV with grant funding from Eli Lily & Co. in 2002. The programme was based on the idea that those successfully living with mental illness were experts in a sense, and sharing their stories would benefit those with similar struggles. The programme approached this by relaying the idea that recovery is possible, attempting to build confidence and self-esteem. Because of the initial success of the programme and positive reception, IOOV also took on the role of public advocacy.

NAMI In Our Own Voice involves two trained speakers presenting personal experiences related to mental illness, in front of an audience. Unlike the majority of NAMI’s programmes, IOOV consists of a single presentation educating groups of individuals with the acknowledgement many are likely unfamiliar with mental illness. The programme’s aims include raising awareness regarding NAMI and mental illness in general, addressing stigma, and empowering those affected by mental illness. Other than those directly affected by mental illness, In Our Own Voice often educates groups of individuals like law enforcement, politicians, and students.

In Our Own Voice has been shown to be superior at reducing self stigmatisation of families when compared to clinician led education. Research into the effectiveness of the NAMI In Our Own Voice programme has shown the programme also can be of benefit to Graduate level therapists and adolescents. A 2016 study evaluating IOOV in California found significant reductions in desire for social distancing after attending an IOOV presentation, although no validated measures were used in the evaluation.

NAMI Basics

The NAMI Basics Programme is a six-session course for parents or other primary caregivers of children and adolescents living with mental illness. NAMI Basics is conceptually similar to NAMI Family-to-Family in that it aims to educate families, but recognises providing care for a child living with mental illness presents unique challenges in parenting, and that mental illness in children typically manifest differently than in adults. Because of the development of the brain and nervous system throughout childhood and adolescence, information regarding mental illness biology and its presentation is fundamentally different from with adults. The NAMI Basics programme has a relatively short time course to accommodate parents’ difficulty in attending because of their caregiver status.

NAMI Connection

The NAMI Connection Recovery Support Group Programme is a weekly support group for adults living with mental illness. The programme is for adults 18+ diagnosed with mental illness and groups are usually weekly for 90 minutes. The support groups are led by trained facilitators who identify as having experienced mental illness themselves.

NAMI On Campus

NAMI On Campus is an initiative for university students to start NAMI On Campus organisations within their respective universities. NAMI On Campus was started to address the mental health issues of college-aged students. Adolescence and early adulthood are periods where the onset of mental illness is common, with 75% of mental illnesses beginning by age 24. When asked what barriers, if any, prevented them from gaining support and treatment, surveys found stigma to be the number one barrier.

Ending the Silence

This 50-minute or one hour programme is available for students, school staff, and family members. It involves two presenters: one who shares educational information and one who is a young adult living well in recovery who shares their personal story. This programme has been shown to improve the mental health knowledge of middle- and high school students.

In 2017, Former Second Lady of the United States Tipper Gore gave a $1 million donation to the Ending the Silence programme.

Funding

NAMI receives funding from both private and public sources, including corporations, federal agencies, foundations and individuals. NAMI maintains that it is committed to avoiding conflicts of interest and does not endorse nor support any specific service or treatment. Records of NAMI’s quarterly grants and contributions since 2009 are freely available on its website.

In 2017, NAMI had a 16% increase in overall revenue.

NAMIWalks

The 2017 annual report noted “$11.3 million raised across the country by 68,000 participants.”

Criticism

The funding of NAMI by multiple pharmaceutical companies was reported by the investigative magazine Mother Jones in 1999, including that an Eli Lilly & Company executive was then “on loan” to NAMI working out of NAMI headquarters.

During a 2009 investigation into the drug industry’s influence on the practice of medicine, US Senator Chuck Grassley (R-IA) sent letters to NAMI and about a dozen other influential disease and patient advocacy organisations asking about their ties to drug and device makers. The investigation confirmed pharmaceutical companies provided a majority of NAMI’s funding, a finding which led to NAMI releasing documents listing donations over $5,000.

Dr. Peter Breggin refers to NAMI as an “AstroTurf lobbying organisation” of the “psychopharmaceutical complex”.

What is Malignant Narcissism?

Introduction

Malignant narcissism is a psychological syndrome comprising an extreme mix of narcissism, antisocial behaviour, aggression, and sadism.

Grandiose, and always ready to raise hostility levels, the malignant narcissist undermines families and organisations in which they are involved, and dehumanises the people with whom they associate.

Malignant narcissism is a hypothetical, experimental diagnostic category. Narcissistic personality disorder (NPD) is found in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR), while malignant narcissism is not. As a hypothetical syndrome, malignant narcissism could include aspects of NPD alongside a mix of antisocial, paranoid and sadistic personality disorder traits. The importance of malignant narcissism and of projection as a defence mechanism has been confirmed in paranoia, as well as “the patient’s vulnerability to malignant narcissistic regression”.

Brief History

The social psychologist Erich Fromm first coined the term “malignant narcissism” in 1964, describing it as a “severe mental sickness” representing “the quintessence of evil”. He characterised the condition as “the most severe pathology and the root of the most vicious destructiveness and inhumanity”. Edith Weigert (1967) saw malignant narcissism as a “regressive escape from frustration by distortion and denial of reality”, while Herbert Rosenfeld (1971) described it as “a disturbing form of narcissistic personality where grandiosity is built around aggression and the destructive aspects of the self become idealized.”

On 11 May 1968, psychoanalyst Otto Kernberg presented his paper Factors in the Psychoanalytic Treatment of Narcissistic Personalities, from the work of the Psychotherapy Research Project of The Menninger Foundation, at the 55th Annual Meeting of the American Psychoanalytic Association in Boston.[6] Kernberg’s paper was first published in hard copy on 01 January 1970. In Kernberg’s 1968 paper, first published in 1970 in the Journal of the American Psychoanalytic Association (JAPA), the word ‘malignant’ does not appear once, while ‘pathological’ or ‘pathologically’ appears 25 times.

Developing these ideas further, Kernberg pointed out that the antisocial personality was fundamentally narcissistic and without morality. Malignant narcissism includes a sadistic element creating, in essence, a sadistic psychopath. In his article, “malignant narcissism” and psychopathy are employed interchangeably. Kernberg first proposed malignant narcissism as a psychiatric diagnosis in 1984. So far it has not been accepted in any of the medical manuals, such as the ICD-10 or the DSM-5.

Kernberg described malignant narcissism as a syndrome characterised by a NPD, antisocial features, paranoid traits, and egosyntonic aggression. Other symptoms may include an absence of conscience, a psychological need for power, and a sense of importance (grandiosity). Psychoanalyst George H. Pollock wrote in 1978: “The malignant narcissist is presented as pathologically grandiose, lacking in conscience and behavioral regulation with characteristic demonstrations of joyful cruelty and sadism”. Of note, M. Scott Peck uses malignant narcissism as a way to explain evil.

Kernberg believed that malignant narcissism should be considered part of a spectrum of pathological narcissism, which he saw as ranging from Hervey M. Cleckley’s antisocial character (what is now referred to as psychopathy or antisocial personality) at the high end of severity, through malignant narcissism, and then to narcissistic personality disorder at the low end. So according to Kernberg’s hierarchy, psychopathy trumps malignant narcissism as a more extreme form of pathological narcissism. Malignant narcissism can be distinguished from psychopathy, according to Kernberg, because of the malignant narcissist’s capacity to internalise “both aggressive and idealized superego precursors, leading to the idealization of the aggressive, sadistic features of the pathological grandiose self of these patients”.

According to Kernberg, the psychopath’s paranoid stance against external influences makes him or her unwilling to internalise even the values of the “aggressor”, while malignant narcissists “have the capacity to admire powerful people, and can depend on sadistic and powerful but reliable parental images”. Malignant narcissists, in contrast to psychopaths, are also said to be capable of developing:

“some identification with other powerful idealized figures as part of a cohesive ‘gang’…which permits at least some loyalty and good object relations to be internalized… Some of them may present rationalized antisocial behavior – for example, as leaders of sadistic gangs or terrorist groups…with the capacity for loyalty to their own comrades.”

Psychopathy

The terms malignant narcissist and psychopath are sometimes used interchangeably because there is little to clinically separate the two. Individuals with narcissistic personality disorder, malignant narcissism, and psychopathy all display similar traits which are outlined in the Hare Psychopathy Checklist. The test has 20 items scored on a three-point scale, with a rating of:

  • 0 if it does not apply at all;
  • 1 if there is a partial match or mixed information; and
  • 2 if there is a reasonably good match.

With a maximum score of 40, the cut-off for the label of psychopathy is 30 in the US and 25 in the UK. High scores are positively associated with measures of impulsivity and aggression, Machiavellianism, persistent criminal behaviour, and negatively associated with measures of empathy and affiliation.

Malignant narcissism is highlighted as a key area in the study of mass murder, sexual, and serial murder.

Contrast with Narcissism

The primary difference between narcissism and malignant narcissism is that malignant narcissism includes comorbid features of other personality disorders and thus consists of a broader range of symptoms than pathological narcissism (NPD). In the term “malignant narcissism”, the word “malignant” is used in the sense of the word described by the Merriam-Webster Dictionary as “passionately and relentlessly malevolent: aggressively malicious”. In malignant narcissism, NPD is accompanied by additional symptoms of antisocial, paranoid and sadistic personality disorders. While a person with NPD will deliberately damage other people in pursuit of their own selfish desires, they may regret and will in some circumstances show remorse for doing so. Because traits of antisocial personality disorder are present in malignant narcissism, the “malignant narcissist” suffers from a more pervasive lack of empathy than someone with NPD alone and will lack feelings of guilt or remorse for the damage they cause. Since sadism is often considered a feature of malignant narcissism, an individual with the syndrome may not only lack feelings of guilt or remorse for hurting others but may even derive pleasure from the gratuitous infliction of mental or physical pain on others. These traits were formerly codified in the DSM-III under sadistic personality disorder (SPD).

Therapy

Typically in the analysis of the malignant narcissist, “the patient attempts to triumph over the analyst by destroying the analysis and himself or herself” – an extreme version of what Jacques Lacan described as “that resistance of the amour-propre… which is often expressed thus: ‘I can’t bear the thought of being freed by anyone other than myself'”.

What is the Term: ‘Kick the Cat’?

Introduction

Kick the cat (or kick the dog) is a metaphor used to describe how a relatively high-ranking person in an organisation or family displaces (see below) their frustrations by abusing a lower-ranking person, who may in turn take it out on their own subordinate.

Displacement

In psychology, displacement is an unconscious defence mechanism whereby the mind substitutes either a new aim or a new object for goals felt in their original form to be dangerous or unacceptable.

Origin of the Idiom

The term has been used at least since the 19th century. According to author John Bradshaw, humans were far more cruel to cats at that time, to the extent that kicking one was not perceived to be unusual and hence entered the language as a popular idiom.

The concept was reinforced in British culture by a scene in the Blackadder episode Nob and Nobility in which Edmund Blackadder kicks the cat when annoyed, and the cat bites the mouse, and the mouse bites Baldrick.

In current usage, the name envisions a scenario where an angry or frustrated employee comes home from work looking for some way to take out his anger, but the only thing present is the cat. He physically abuses it as a means of relieving his frustration, despite the cat playing no part in causing it.

Workplace or Family Dynamics

Kicking the cat is commonly used to describe the behaviour of staff abusing co-workers or subordinates as a mechanism to relieve stress. This behaviour can result in a chain reaction, where a higher-ranking member of the company abuses their subordinate, who takes it out on their own subordinate, and so on down the line. This domino effect can also be seen in family dynamics, where the father yells at the mother who yells at the older child who yells at the younger child who yells at the pet.

Blaming others can lead to kicking the dog where individuals in a hierarchy blame their immediate subordinate, and this propagates down a hierarchy until the lowest rung (the “dog”). A 2009 experimental study has shown that blaming can be contagious even for uninvolved onlookers.

Psychological Theories

According to Psychology Today, “Anger and frustration in one part of life can lead us to lash out at innocent people (or pets) in another.” The technical term for this kind of behaviour is “displaced aggression”.

Kicking the cat is looked upon unfavourably and viewed as a sign of poor anger management. According to author Steve Sonderman, “Men funnel 90 percent of their emotions through anger” and may “kick the cat” as a substitute for grief, anxiety or other emotions. Psychology author Raj Persaud suggests that people “kick the cat” as a means of catharsis because they fear expressing their full emotions to the peers and colleagues.

What is Identification (Psychology)?

Introduction

Identification is a psychological process whereby the individual assimilates an aspect, property, or attribute of the other and is transformed wholly or partially by the model that other provides.

It is by means of a series of identifications that the personality is constituted and specified. The roots of the concept can be found in Freud‘s writings. The three most prominent concepts of identification as described by Freud are:

  • Primary identification;
  • Narcissistic (secondary) identification; and
  • Partial (secondary) identification.

While “in the psychoanalytic literature there is agreement that the core meaning of identification is simple – to be like or to become like another”, it has also been adjudged ‘”the most perplexing clinical/theoretical area” in psychoanalysis’.

Freud

Freud first raised the matter of identification (German: Identifizierung) in 1897, in connection with the illness or death of one’s parents, and the response “to punish oneself in a hysterical fashion…with the same states [of illness] that they have had. The identification which occurs here is, as we can see, nothing other than a mode of thinking”. The question was taken up again psychoanalytically “in Ferenczi’s article, ‘Introjection and Transference’, dating from 1909”, but it was in the decade between “On Narcissism” (1914) and “The Ego and the Id” (1923) that Freud made his most detailed and intensive study of the concept.

Freud distinguished three main kinds of identification. “First, identification is the original form of emotional tie with an object; secondly, in a regressive way it becomes a substitute for a libidinal object-tie…and thirdly, it may arise with any new perception of a common quality which is shared with some other person”.

Primary Identification

Primary identification is the original and primitive form of emotional attachment to something or someone prior to any relations with other persons or objects: “an individual’s first and most important identification, his identification with the father in his own personal prehistory…with the parents”. This means that when a baby is born he is not capable of making a distinction between himself and important others. The baby has an emotional attachment with his parents and experiences his parents as a part of himself. “The breast is part of me, I am the breast”.

During this process of identification children adopt unconsciously the characteristics of their parents and begin to associate themselves with and copy the behaviour of their parents. Freud remarked that identification should be distinguished from imitation, which is a voluntary and conscious act. Because of this process of emotional attachment a child will develop a super ego that has similarities to the moral values and guidelines by which the parents live their lives. By this process children become a great deal like their parents and this facilitates learning to live in the world and culture to which they are born.

“By and large, psychoanalysts grant the importance and centrality of primary identification, even though…the concept varies ‘according to each author and his ideas, its meaning in consequence being far from precise’ (Etchegoyen 1985)”.

Narcissistic (Secondary) Identification

Narcissistic identification is the form of identification following abandonment or loss of an object. This experience of loss starts at a very young age. An example: wearing the clothes or jewellery of a deceased loved one. In “Mourning and Melancholia” Freud, having “shown that identification is a preliminary stage of object-choice”, argued that the experience of loss sets in motion a regressive process that “served to establish an identification of the ego with the abandoned object”. In “The Ego and the Id”, he went on to maintain that “this kind of substitution has a great share in determining the form taken by the ego and that it makes an essential contribution towards building up what is called its ‘character'”.

Lacan, in his theory of the Imaginary, would develop the latter point into his view of “the ego is constituted in its nucleus by a series of alienating identifications” – part of his opposition to any concept of an “autonomous” and conflict-free ego.

Partial (Secondary) Identification

Partial identification is based on the perception of a special quality of another person. This quality or ideal is often represented in a “leader figure” who is identified with. For example: the young boy identifies with the strong muscles of an older neighbour boy. Next to identification with the leader, people identify with others because they feel they have something in common. For example: a group of people who like the same music. This mechanism plays an important role in the formation of groups. It contributes to the development of character and the ego is formed by identification with a group (group norms). Partial identification promotes the social life of persons who will be able to identify with one another through this common bond to one another, instead of considering someone as a rival.

Partial Identification and Empathy

Freud went on to indicate the way “a path leads from identification by way of imitation to empathy, that is, to the comprehension of the mechanism by which we are enabled to take up any attitude at all towards another mental life”. Otto Fenichel would go on to emphasize how “trial identifications for the purposes of empathy play a basic part in normal object relationships. They can be studied especially in analyzing the psychoanalyst’s ways of working”. Object relations theory would subsequently highlight the use of “trial identification with the patient in the session” as part of the growing technique of analysing from the countertransference.

Anna Freud and Identification with the Aggressor

In her classic book The Ego and the Mechanism of Defence, Anna Freud introduced “two original defence mechanisms…both of which have become classics of ego psychology“, the one being altruistic surrender, the other identification with the aggressor. Anna Freud pointed out that identification with parental values was a normal part of the development of the superego; but that “if the child introjects both rebuke and punishment and then regularly projects this same punishment on another, ‘then he is arrested at an intermediate stage in the development of the superego'”.

The concept was also taken up in object relations theory, which particularly explored “how a patient sometimes places the analyst in the role of victim whilst the patient acts out an identification with the aggressor” in the analytic situation.

With the Analyst

Mainstream analytic thought broadly agrees that interpretation took effect “by utilizing positive transference and transitory identifications with the analyst”. More controversial, however, was the concept of “the terminal identification” at the close of analysis, where “that with which the patient identifies is their strong ego…[or] identification with the analyst’s superego”.

Lacan took strong exception to “any analysis that one teaches as having to be terminated by identification with the analyst…There is a beyond to this identification…this crossing of the plane of identification”. Most Lacanians have subsequently echoed his distrust of “the view of psychoanalysis that relies on identification with the analyst as a central curative factor”. How far the same criticism applies, however, to those who see as a positive therapeutic result “the development of a self-analytic attitude…[built on] identification with and internalization of the analyst’s analytic attitude” is not perhaps quite clear.

Marion Milner has argued that “terminal identification” can be most acute in those analysands who go on to become therapists themselves: “by the mere fact of becoming analysts we have succeeded in bypassing an experience which our patients have to go through. We have chosen to identify with our analyst’s profession and to act out that identification”.

Contemporary Psychoanalytic Thinking

Much has been written on identification since Freud. Identification has been seen both as a normal developmental mechanism and as a mechanism of defence. Many types of identification have been described by other psychoanalysts, including counter-identification (Fliess, 1953), pseudoidentification (Eidelberg, 1938), concordant and complementary identifications (Racker, 1957), and adhesive identification (Bick, 1968): “the work of Bick and others on adhesive identification, exploring the concept of the ‘psychic skin'”.

What was the Icarus Project?

Introduction

The Icarus Project was a media and activist endeavour broadly aligned to the anti-psychiatry movement and recovery approach, arguing that mental illness should be understood as an issue of social justice and that a person’s mental state can improve through greater social support and collective liberation.

It shares similarities with the academic fields of Psychopolitics and Mad Studies. The name is derived from Icarus, a hero in Greek mythology, and is metaphorically used to convey that the experiences of mental distress and other extreme mental states can lead to “potential[ly] flying dangerously close to the sun.”

Brief History

In 2002, musician Sascha Altman DuBrul wrote “Bipolar World”, an article published in the San Francisco Bay Guardian. The article described his experiences being diagnosed with bipolar disorder. Among the dozens of e-mails and other correspondence that he received after this publication was a letter from Ashley McNamara, now known as Jacks, an artist and writer who identified strongly with DuBrul’s experiences. DuBrul and McNamara corresponded for a few weeks before finally meeting in person and deciding to start The Icarus Project. Years later, musician-activist Bonfire Madigan Shive and counsellor/activist Will Hall became a key leader in The Icarus Project’s administration and development.

In the Journal of Medical Humanities, co-founder DuBrul wrote of The Icarus Project:

Though we did not fully understand it in the early days, we were walking in the footsteps of a large body of knowledge and thought from the 1960s, grouped under the category of Anti-Psychiatry.

He also noted the group and its members were inspired by a range of social trends and schools of thought including anarchism, permaculture/sustainable ecology, LGBTQ rights, harm reduction, global justice movement, the Beat Generation, counterculture, and punk rock. He writes, “Our response to the label ‘bipolar’ was not a ‘normal’ response, which is why the Icarus Project brought a new perspective to psychic diversity. To create this perspective, we drew inspiration from many social movements and subcultural communities that came before us. So even though our response was unusual, it did not arise in a vacuum. In creating the Icarus Project, we wove together the ideas and practices in these movements to imagine a powerful new counter narrative to the dominant mental health narrative that went beyond a questioning of the language around ‘bipolar’ and critiqued the system itself.”

The first step, they decided, was creating a website where people who identified with “bipolar and other ‘mental illness’ [could] find real community and contribute to it.” DuBrul states that by 2003, “The Icarus Project website was up and running, and a virtual community began to evolve around the discussion forums.” He notes that user-generated content online enabled The Icarus Project’s growth: “We were attracting interesting people, creating discussion forums with names like ‘Alternate Dimensions or Psychotic Delusions’ and ‘Experiencing Madness and Extreme States.’ There was no place else where people who used psych meds and people who did not, people who identified with diagnostic categories and people who did not, could all talk with each other and share stories. Because of the outreach in the anarchist and activist community, there was a high percentage of creative people with a radical political analysis. And with the (seeming) anonymity of the Internet, people felt comfortable being honest and sharing intimate stories about their lives. Our website served as a refuge for a diverse group of people who were learning the ways in which new narratives could be woven about their lives.”

Mission

The Icarus Project’s stated aims are to provide a “support network and education project by and for people who experience the world in ways that are often diagnosed as mental illness.” The national Icarus Collective staff is set up to support local groups instead of creating the smaller organisations themselves. The responsibilities of the local group are to gather people locally for support, education, activism, and access to alternatives to mainstream medical diagnosis and treatment. The Project advocates self-determination and caution when approaching psychiatric care. It encourages harm reduction, alternatives to the prevailing medical model that is accepted by the vast majority of mental health professionals, and self-determination in treatment and diagnosis. Key members of The Icarus Project state that they “envision a world with more options to navigate mental health issues: options that support self-determination, centre people who are most impacted by mental health-based oppression, and most critically, uplift social transformation as central to individual wellbeing.”

In 2005, Journalist Jennifer Itzenson noted that the Icarus Project accepts those with a wide range of perspectives on mental health issues, but also describes “an edge of militancy within the group,” particularly among those who reject medication. Itzenson also writes that while medical professionals applaud groups like the Icarus Project for providing a sense of support and community, and combating social stigmas related to bipolar and other mental health issues, the group’s questioning of the medical paradigm is “misguided” and that rejecting medication is a “potentially fatal choice” for those with bipolar disorder. A Newsweek article provides the following perspective on The Icarus Project’s stance towards medication: “While some critics might view Icaristas as irresponsible, their skepticism about drugs isn’t entirely unfounded. Lately, a number of antipsychotic drugs have been found to cause some troubling side effects.”

Writer Mark Lukach describes in an article for Pacific Standard his experience asking co-founder Sascha Altman DuBrul about the role of psychiatric medication as a part of his wife’s recovery from a bipolar diagnosis. Lukach articulates The Icarus Project’s approach to self-determination in psychiatric treatment. Lukach wrote:

“As for medication, DuBrul said that he believed that the answer to the question of whether or not to use pharmaceuticals needed to be far more nuanced than yes or no. The best response might be maybe, sometimes, or only certain medications. For instance, DuBrul shared that he takes lithium every night because he’s confident that, after four hospitalizations and over a decade with the label bipolar, the medication is a positive part of his care. Not the whole solution, but a piece.”

Anthropologist Erica Hua Fletcher describes Icarus Project member’s diverse ways of discussing altered mental states in the Journal of Medical Humanities. Fletcher writes:

While many Icarus contributors have found relief through the use of psycho-pharmaceutical interventions and other bio-psychiatric technologies, they also have experienced the limitations of medical paradigms and language to recognize the fullness of their lives. Because of this, they frequently adopt alternative words and phrases beyond bio-psychiatric terms to describe their mental states such as “neurodivergent processing,” “diasporas of distressing symptoms,” “sensory/cognitive/emotional trauma,” or “cognitive-emotional terror.” “Bipolar disorder” is interchangeable with highs and lows; “psychosis” can be seen as a reckoning; and nonconsensus realities can describe extreme experiences, which psychiatrists could label as symptoms of “schizophrenia” (such as hearing voices others do not hear or seeing objects others do not see). Such alternative words and phrases do not diminish the utility of bio- psychiatric terminology nor do they directly undermine medical treatment options, yet they allow for a range of descriptors and call for attention to individual needs and desires. They call us to listen to personal stories, to forces at work within communities, and to reevaluate the languages that enframe mental illness as such.” She goes on to state, “Alternative language beyond the biomedical paradigm of mental illness fosters a diversity of paradigms. Moreover, it can create a reflective space for those with mental suffering (and for their healthcare providers) to see themselves outside of a medical identity, reevaluate their self-care regimens, advocate for the care they would like to receive, and connect to others who may have similar concerns about ascribing to solely psycho-pharmaceutical interventions.”

As of early 2018, Icarus Project staff describe their expertise in social activism, herbalism, and labour organising; none is a licensed medical or mental health professional. Icarus Project advisory board members describe themselves as educators, artists, activists, writers, healers, community organisers, and other creative types and some identify as Latinx, queer, trans, people of colour or mixed race, and trauma survivors; none is a licensed medical or mental health professional. Leadership currently offers publications on self-care and community care, workshops and training for peers, training and talks for providers, peer support spaces, webinars, and other events.

Structure/Funding

The Icarus Project is currently under the fiscal sponsorship of FJC, a non-profit 501(c)3 umbrella organization arm of an investment firm, based in New York City. The Icarus Project currently gets the bulk of its money from foundation grants, including the Ittleson Foundation, but it also has many individual donors.

The Icarus Project Network

Places where local chapters met included Anchorage, Alaska; Asheville, North Carolina; Atlanta, Georgia; Boston, Massachusetts; Conway, Arkansas; Chicago, Illinois; Los Angeles, California (Wildflowers’ Movement); Minneapolis, Minnesota; Madison, Wisconsin; New York City, New York; Northampton, Massachusetts (Freedom Centre); Philadelphia, Pennsylvania; Portland, Oregon; San Francisco (Bay Area), California; Columbus, Ohio; Gainesville, Florida.

Media Mentions

The Icarus Project has been mentioned in passing in The New York Times as a resource for those who “don’t want to ‘get better'”, by Frontline 20/20, and many local media outlets.

Publications

Educational materials published by The Icarus Project have been published in Spanish, German, French, Italian, Japanese, Greek, and Bosnian/Croatian. Some of these publications are listed below:

  • In March 2004, The Icarus Project released Navigating the Space Between Brilliance and Madness; A Reader and Roadmap of Bipolar Worlds. The book is currently in its 6th printing.
  • In July 2006, The Icarus Project released the first draft of Friends Make the Best Medicine: A Guide to Creating Community Mental Health Support Networks.
  • In 2008, The Icarus Project released Through the Labyrinth; A Harm Reduction Guide to Coming Off Psychiatric Drugs, and in 2009 this publication was translated into Spanish and German and made available for free download on the Icarus Project website.
  • In 2012, The Icarus Project released Mindful Occupation: Rising Up without Burning Out.
  • In 2015, The Icarus Project released Madness and Oppression: Personal Paths to Transformation and Collective Liberation.

Filmography

Films about Icarus Project members are listed below:

  • Ken Paul Rosenthal (2010). Crooked Beauty. 30 min. Poetic documentary featuring Jacks McNamara. In Mad Dance Mental Health Film Trilogy.
  • Ken Paul Rosenthal (2018). Whisper Rapture. 36 min. A doc-opera featuring Bonfire Madigan Shive.