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What is the Psychoanalytic Quarterly?

Introduction

The Psychoanalytic Quarterly is a quarterly academic journal of psychoanalysis established in 1932 and, since 2018, published by Taylor and Francis.

The journal describes itself as “the oldest free-standing psychoanalytic journal in America”.

Brief History

The Psychoanalytic Quarterly was established by Dorian Feigenbaum, Bertram D. Lewin, Frankwood Williams, and Gregory Zilboorg. In the opening issue they described the journal’s aims:

This Quarterly will be devoted to theoretical, clinical and applied psychoanalysis. It has been established to fill the need for a strictly psychoanalytic organ in America…A close collaboration with associates abroad will be maintained. At the same time, a prime objective of the magazine is to stimulate American work and provide an outlet for it.

The first issue’s lead article was Libidinal Types by Freud, one of three articles by Freud translated by Edith B. Jackson and published in the journal in its first year. However, the new journal upset Ernest Jones in England, who saw it as a competitor to The International Journal of Psychoanalysis, which he edited. The new journal was also watched carefully by Smith Ely Jelliffe and William Alanson White of the National Psychological Association for Psychoanalysis (NPAP), which published Psychoanalytic Review:

the Quarterly […] is very excellent and I wish they would get on with it. I suspect that Lewin and his crows would get into hot water if someone read his paper and was after pornographic stuff; they could make it very hot. I do not know if I should warn Feigenbaum about it, as it might also include others, as you know the R. C. gentry are not asleep. The Quarterly has no special prospects. They will have to dig into their jeans or find an angel…

What is an Other Specified Feeding or Eating Disorder?

Introduction

Other specified feeding or eating disorder (OSFED) is a DSM-5 category that, along with unspecified feeding or eating disorder (UFED), replaces the category formerly called eating disorder not otherwise specified (EDNOS) in the DSM-IV-TR.

It captures feeding disorders and eating disorders of clinical severity that do not meet diagnostic criteria for anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED), avoidant/restrictive food intake disorder (ARFID), pica, or rumination disorder.

OSFED includes five examples:

  1. Atypical anorexia nervosa.
  2. Atypical bulimia nervosa of low frequency and/or limited duration.
  3. Binge eating disorder of low frequency and/or limited duration.
  4. Purging disorder.
  5. Night eating syndrome (NES).

Brief History

In 1980, DSM-III was the first DSM to include a category for eating disorders that could not be classified in the categories of AN, BN, or pica. This category was called Atypical Eating Disorder. Atypical Eating Disorder was described in one sentence in the DSM-III and received very little attention in the literature, as it was perceived to be uncommon compared to the other defined eating disorders. In DSM-III-R, published in 1987, the Atypical Eating Disorder category became known as Eating Disorder Not Otherwise Specified (EDNOS). DSM-III-R included examples of individuals who would meet criteria for EDNOS, in part to acknowledge the increasingly recognized heterogeneity of individuals within the diagnostic category.

In 1994, DSM-IV was published and expanded EDNOS to include six clinical presentations. These presentations included individuals who:

  • Met criteria for AN, but continued to menstruate;
  • Met criteria for AN, but still had weight in the normal range despite significant weight loss;
  • Met criteria for BN but did not meet frequency criterion for binge eating or purging;
  • Engaged in inappropriate compensatory behaviour after eating small amounts of food; or
  • Repeatedly chewed or spit out food, or who binged on food but did not subsequently purge.

A disadvantage of DSM-IV’s broad EDNOS category was that people with very different symptoms were still classified as having the same diagnosis, making it difficult to access care specific to the disorder and conduct research on the diversity of pathology within EDNOS. Furthermore, EDNOS was perceived as less severe than AN or BN, despite findings that individuals diagnosed with EDNOS share similarities with full-threshold AN or BN in the degree of eating pathology, general psychopathology, and physical health. This perception prevented people in need from seeking help or insurance companies from covering treatment costs. DSM-5, published in 2013, sought to address these issues by adding new diagnoses and revising existing criteria.

Epidemiology

Few studies to date have examined OSFED prevalence. The largest community study is by Stice (2013), who examined 496 adolescent females who completed annual diagnostic interviews over 8 years. Lifetime prevalence by age 20 for OSFED overall was 11.5%. 2.8% had atypical AN, 4.4% had subthreshold BN, 3.6% had subthreshold BED, and 3.4% had purging disorder. Peak age of onset for OSFED was 18-20 years. NES was not assessed in this study, but estimates from other studies suggest that it presents in 1% of the general population.

A few studies have compared the prevalence of EDNOS and OSFED and found that though the prevalence of atypical eating disorders decreased with the new classification system, the prevalence still remains high. For example, in a population of 215 young patients presenting for ED treatment, the diagnosis of EDNOS to OSFED decreased from 62.3% to 32.6%. In another study of 240 females in the US with a lifetime history of an eating disorder, the prevalence changed from 67.9% EDNOS to 53.3% OSFED. Although the prevalence appears to reduce when using the categorisations of EDNOS vs. OSFED, a high proportion of cases still receive diagnoses of atypical eating disorders, which creates difficulties in communication, treatment planning, and basic research.

Classification

The five OSFED examples that can be considered eating disorders include atypical AN, BN (of low frequency and/or limited duration), BED (of low frequency and/or limited duration), purging disorder, and NES. Of note, OSFED is not limited to these five examples, and can include individuals with heterogeneous eating disorder presentations (i.e. OSFED-other). Another term, UFED, is used to describe individuals for whom full diagnostic criteria are not met but the reason remains unspecified or the clinician does not have adequate information to make a more definitive diagnosis.

Atypical Anorexia NervosaIn atypical AN, individuals meet all of the criteria for AN, with the exception of the weight criterion: the individual’s weight remains within or above the normal range, despite significant weight loss.
Atypical Bulimia NervosaIn this sub-threshold version of BN, individuals meet all criteria for BN, with the exception of the frequency criterion: binge eating and inappropriate compensatory behaviours occur, on average, less than once a week and/or for fewer than 3 months.
Binge Eating Disorder of Low Frequency and/or Limited DurationIn this sub-threshold version of BED, individuals must meet all criteria for BED, with the exception of the frequency criterion: binge eating occurs, on average, less than once a week and/or for fewer than 3 months.
Purging DisorderIn purging disorder, purging behaviour aimed to influence weight or shape is present, but in the absence of binge eating.
Night Eating SyndromeIn NES, individuals have recurrent episodes of eating at night, such as eating after awakening from sleep or excess calorie intake after the evening meal. This eating behaviour is not culturally acceptable by group norms, such as the occasional late-night munchies after a gathering. NES includes an awareness and recall of the eating, is not better explained by external influences such as changes in the individual’s sleep-wake cycle, and causes significant distress and/or impairment of functioning.

Though not defined specifically in DSM-5, research criteria for this diagnosis proposed adding the following criteria (1) the consumption of at least 25% of daily caloric intake after the evening meal and/or (2) evening awakenings with ingestions at least twice per week.

Treatment

Few studies guide the treatment of individuals with OSFED. However, cognitive behavioural therapy (CBT), which focuses on the interplay between thoughts, feelings, and behaviours, has been shown to be the leading evidence-based treatment for the eating disorders of BN and BED. For OSFED, a particular cognitive behavioural treatment can be used called CBT-Enhanced (CBT-E), which was designed to treat all forms of eating disorders. This method focuses not only what is thought to be the central cognitive disturbance in eating disorders (i.e. over-evaluation of eating, shape, and weight), but also on modifying the mechanisms that sustain eating disorder psychopathology, such as perfectionism, core low self-esteem, mood intolerance, and interpersonal difficulties. CBT-E showed effectiveness in two studies (total N = 219) and well maintained over 60-week follow-up periods. CBT-E is not specific to individual types of eating disorders but is based on the concept that common mechanisms are involved in the persistence of atypical eating disorders, AN, and BN.

What is an Unspecified Feeding or Eating Disorder?

Introduction

Unspecified feeding or eating disorder (UFED) is a Diagnostic and Statistical Manual of Mental Disorders (DSM-5 category of eating disorders that, along with other specified feeding or eating disorder (OSFED), replaced eating disorder not otherwise specified (EDNOS) in the DSM-IV-TR.

UFED is an eating disorder that does not meet the criteria for: anorexia nervosa, bulimia nervosa, binge eating disorder, or OSFED. Individuals with EDNOS have similar symptoms and behaviours to those with anorexia and bulimia, and can face the same dangerous risks.

Signs and Symptoms

Rather than providing specific diagnostic criteria for EDNOS, the fourth revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) listed six non-exhaustive example presentations, including individuals who:

  • Meet all criteria for anorexia nervosa except they have regular menses.
  • Meet all criteria for anorexia nervosa except their weight falls within the normal range.
  • Meet all criteria for bulimia nervosa except they engage in binge eating or purging behaviours less than twice per week or for fewer than three months.
  • Use inappropriate compensatory behaviour (such as purging, excessive exercise, or fasting) after eating small amounts of food while retaining a normal body weight.
  • Repeatedly chew and spit out large amounts of food without swallowing.
  • Meet criteria for “binge eating disorder”: recurrent binge eating and no regular inappropriate compensatory behaviours.

Despite its subclinical status in DSM-IV, available data suggest that EDNOS is no less severe than the officially recognized DSM-IV eating disorders. In a comprehensive meta-analysis of 125 studies, individuals with EDNOS exhibited similar levels of eating pathology and general psychopathology to those with anorexia nervosa and binge eating disorder, and similar levels of physical health problems as those with anorexia nervosa. Although individuals with bulimia nervosa scored significantly higher than those with EDNOS on measures of eating pathology and general psychopathology, those with EDNOS exhibited more physical health problems than those with bulimia nervosa.

Diagnosis

Although no longer in the DSM-5, the three general categories for an EDNOS diagnosis are subthreshold symptoms of anorexia or bulimia, a mixture of both anorexic or bulimic symptoms, and clinically-significant disordered eating behaviours that are not described by anorexia and bulimia. EDNOS is no longer considered a diagnosis in DSM-5. Because some diagnostic criteria were loosened and new diagnoses were introduced in DSM-5, those displaying symptoms of what would previously have been considered EDNOS are now classified under anorexia nervosa, bulimia nervosa, binge eating disorder, avoidant/restrictive food intake disorder(ARFID), other specified feeding or eating disorder (OSFED), or unspecified feeding or eating disorder (UFED).

Epidemiology

Although EDNOS (formerly called atypical eating disorder) was originally introduced in DSM-III to capture unusual cases, it accounts for up to 60% of cases in eating disorder specialty clinics. EDNOS is an especially prevalent category in populations that have received inadequate research attention such as young children, males, ethnic minorities, and non-Western groups.

Treatment

When treating any eating disorder, including unspecified disorders, it is important to include a registered dietician or nutritionist working with the treatment team. Even though eating disorders are a psychological diagnosis, psychologists are not certified or licensed in dietetics or nutrition, so it is important that psychologists are not practicing outside their bounds of competence. Medical Nutrition Therapy is vital in the treatment and management of eating disorders. The dietician assists the patient by creating a meal plan that is tailored to their individual needs and treatment goals. The dietician will also provide psychoeducation that challenges nutrition misinformation and will ideally create a space where the patient feels comfortable asking questions.

What was the Vienna Psychoanalytic Society?

Introduction

The Vienna Psychoanalytic Society (German: Wiener Psychoanalytische Vereinigung, WPV), formerly known as the Wednesday Psychological Society, is the oldest psychoanalysis society in the world.

In 1908, reflecting its growing institutional status as the international psychoanalytic authority of the time, the Wednesday group was reconstituted under its new name with Sigmund Freud as President, a position he relinquished in 1910 in favour of Alfred Adler.

During its 36-year history, between 1902 and 1938, the Society had a total of 150 members.

First Meetings

In November 1902, Sigmund Freud wrote to Alfred Adler, “A small circle of colleagues and supporters afford me the great pleasure of coming to my house in the evening (8:30 PM after dinner) to discuss interesting topics in psychology and neuropathology… Would you be so kind as to join us?” The group included Wilhelm Stekel, Max Kahane and Rudolf Reitler, soon joined by Adler. Stekel, a Viennese physician who had been in analysis with Freud, provided the initial impetus for the meetings. Freud made sure that each participant would contribute to the discussion by drawing names from an urn and asking each to address the chosen topic.

New members were invited only with the consent of the entire group, and only a few dropped out. By 1906, the group, then called the Wednesday Psychological Society, included 17 doctors, analysts and laymen. Otto Rank was hired that year to collect dues and keep written records of the increasingly complex discussions. Each meeting included the presentation of a paper or case history with discussion and a final summary by Freud. Some of the members presented detailed histories of their own psychological and sexual development.

Active Years

As the meetings grew to include more of the original contributors to psychoanalysis, analytic frankness sometimes became an excuse for personal attacks. In 1908 Max Graf, whose five-year-old son had been an early topic of discussion as Freud’s famous “Little Hans” case, deplored the disappearance of congeniality. There were still discussions from which important insights could be gleaned, but many became acrimonious. Many members wanted to abolish the tradition that new ideas discussed at the meetings were credited to the group as a whole, not the original contributor of the idea. Freud proposed that each member should have a choice, to have his comments regarded as his own intellectual property, or to put them in the public domain.

In an attempt to resolve some of the disputes, Freud officially dissolved the informal group and formed a new group under the name Vienna Psychoanalytic Society. On the suggestion of Alfred Adler, the election of new members was based on secret ballot rather than Freud’s invitation. Although the structure of the group became more democratic, the discussions lost some of their original eclectic character as the identity of the group developed. The psychosexual theories of Freud became the primary focus of the participants.

After the end of World War I, the membership became more homogeneous, and the proportion of members identifying as Jewish increased. Over the course of the 36 years of its existence (until 1938), the Society registered a total of 150 members. Most members were Jewish, and 50 were (like Freud himself) children of Jewish immigrants from other Habsburg states.

Prominent Members

  • Sigmund Freud.
  • Alfred Adler.
  • Wilhelm Reich.
  • Otto Rank.
  • Karl Abraham.
  • Carl Jung.
  • Sándor Ferenczi.
  • Guido Holzknecht.
  • Isidor Isaak Sadger.
  • Victor Tausk.
  • Hanns Sachs.
  • Ludwig Binswanger.
  • Carl Alfred Meier.
  • Sabina Spielrein.
  • Margarete Hilferding.
  • Herbert Silberer.
  • Paul Schilder.

On This Day … 12 June

People (Births)

  • 1912 – Carl Hovland, American psychologist and academic (d. 1961).
  • 1962 – Jordan Peterson, Canadian psychologist, professor and cultural critic.

People (Deaths)

  • 2012 – Margarete Mitscherlich-Nielsen, Danish-German psychoanalyst and author (b. 1917).

Carl Hovland

Carl Iver Hovland (12 June 1912 to 16 April 1961) was a psychologist working primarily at Yale University and for the US Army during World War II who studied attitude change and persuasion. He first reported the sleeper effect after studying the effects of the Frank Capra’s propaganda film Why We Fight on soldiers in the Army. In later studies on this subject, Hovland collaborated with Irving Janis who would later become famous for his theory of groupthink. Hovland also developed social judgment theory of attitude change. Carl Hovland thought that the ability of someone to resist persuasion by a certain group depended on your degree of belonging to the group.

Contributions to Psychology

Psychological research was Hovland’s intellectual joy. Especially in his early career, his investigations covered many topics. His papers in psychological journals included a study of test reliability, a major review of the literature on apparent movement, as well as his four classical papers on conditioned generalisation from his doctoral dissertation.

Hovland began to emphasize micro-level analysis of propaganda and its effects. Hovland’s army experiments were the beginnings of that micro-level analysis of an individual. Hovland’s “core conceptual variable was attitude”.

Hovland believed that if he was able to recognise the attitude an individual has towards a trigger, he would be able to predict the behaviour and actions of an individual over time. However, there were many studies that argued the contrary and showed that “an attitude toward a person or object does not predict or explain an individual’s overt behavior regarding that person or object”. This revelation of low correlation did not necessarily render findings useless but instead led to further research on how under certain circumstances it was possible to change a person’s behaviour via their attitudes.

While Hovland focused on an individual rather than a group level, he began to take into consideration interpersonal communication in the form of persuasion. Specifically, Hovland was responsible for carrying out a series of studies that contributed to the “cumulative understanding of persuasion behavior that has never since been matched or even rivaled”.

To test and apply his theorisation Hovland worked proposed the SMCR model. The SMCR model consists of four components – source variables, message variables, channel variables, and receiver variables. By manipulating each of these variables, Hovland was able to advance his “message-learning approach to attitude change”. There were problems with his particular approach, however, in that by focusing on a single dimension of the SMCR model, Hovland was unable to do more than isolate a factor rather than study the synergy between the different variables.

Jordan Peterson

Jordan Bernt Peterson (born 12 June 1962) is a Canadian professor of psychology, clinical psychologist, YouTube personality, and author. He began to receive widespread attention in the late 2010s for his views on cultural and political issues, often described as conservative.

Born and raised in Alberta, Peterson obtained bachelor’s degrees in political science and psychology from the University of Alberta and a PhD in clinical psychology from McGill University. After teaching and research at Harvard University, he returned to Canada in 1998 to join the faculty of psychology at the University of Toronto. In 1999, he published his first book, Maps of Meaning: The Architecture of Belief, which became the basis for many of his subsequent lectures. The book combined information from psychology, mythology, religion, literature, philosophy, and neuroscience to analyse systems of belief and meaning.

In 2016, Peterson released a series of YouTube videos criticising the Act to amend the Canadian Human Rights Act and the Criminal Code (Bill C-16), passed by the Parliament of Canada to introduce “gender identity and expression” as a prohibited grounds of discrimination. He argued that the bill would make the use of certain gender pronouns into compelled speech, and related this argument to a general critique of political correctness and identity politics. He subsequently received significant media coverage, attracting both support and criticism.

Afterwards, Peterson’s lectures and conversations – propagated especially through podcasts and YouTube – gradually gathered millions of views. He put his clinical practice and teaching duties on hold by 2018, when he published his second book, 12 Rules for Life: An Antidote to Chaos. Promoted with a world tour, it became a bestseller in several countries. Throughout 2019 and 2020, Peterson’s work was obstructed by health problems in the aftermath of a severe benzodiazepine withdrawal syndrome. In 2021, he published his third book, Beyond Order: 12 More Rules for Life, and returned to active podcasting.

Margarete Mitscherlich-Nielsen

Margarete Mitscherlich-Nielsen (née Nielsen; 17 July 1917 to 12 June 2012) or the “Grande Dame of German Psychoanalysis” as she was often referred to as, was a German psychoanalyst who focused mainly on the themes of feminism, female sexuality, and the national psychology of post-war Germany.

Contributions to Psychology

From the 1960s, alongside the protagonists of the Frankfurt School, the Mitscherlichs played an important part in post-war Germany’s intellectual debates, employing psychoanalytic thought for explaining the causes behind Nazi Germany and its aftermath in German society to the present day. The first major book they wrote together was Die Unfähigkeit zu trauern. Grundlagen kollektiven Verhaltens (The Inability to Mourn: Principles of Collective Behaviour), first published in 1967, discussing why the Holocaust, the war crimes, and the sentiment of guilt on the offender’s part were not dealt with adequately in post-war German society.

Subsequently, Margarete Mitscherlich’s interest in feminist positions grew, as she became friends with German feminist journalist Alice Schwarzer, contributing to her magazine EMMA. In the first issue of the journal in November 1977, she confessed: “Ich bin Feministin” (“I am a feminist”). At the time, she also took an active part in legal actions against anti-women depictions in popular German media. Her book Die friedfertige Frau. Eine psychoanalytische Untersuchung zur Aggression der Geschlechter (The peaceable sex: On aggression in women and men), first published in 1987, is Mitscherlich’s most successful book to date, dealing with the roles women play in politics. Specifically, she discussed specific psychological cases pertaining to the potential for human aggression, the socialization of women, narcissism, loneliness, parenthood, and anti-Semitism within her writing. In the follow-up Die Zukunft ist weiblich (The future is feminine, 1987) Mitscherlich pleaded for values to become more feminine, even men’s values. She is notable for the highly politicised nature of her work when many of her peers considered neutrality an essential element of psychoanalysis.

Until well into her nineties, Mitscherlich worked as a psychoanalyst, advising younger colleagues and commenting political developments in the press. In her latest book, published in 2010, aged 93, Die Radikalität des Alters. Einsichten einer Psychoanalytikerin (The Radicality of Age. Insights of a Psychoanalyst) she reflects upon her own experience of ageing. She famously claimed that Germans cannot mourn.

Mitscherlich was awarded the Order of Merit of the Federal Republic of Germany in 2001. She received the Ehrenplakette der Stadt Frankfurt am Main in 1990 and the Tony-Sender-Preis der Stadt Frankfurt am Main in 2005.

Mitscherlich has a son who was born in 1949, a lawyer and executive manager. She lived in the Frankfurt Westend until her death. She died, aged 94, in Frankfurt.

What is Analytical Psychology?

Introduction

Analytical psychology (German: Analytische Psychologie, sometimes translated as analytic psychology and referred to as Jungian analysis) is a term coined by Carl Jung, a Swiss psychiatrist, to describe research into his new “empirical science” of the psyche.

It was designed to distinguish it from Freud’s psychoanalytic theories as their seven-year collaboration on psychoanalysis was drawing to an end between 1912 and 1913. The evolution of his science is contained in his monumental opus, the Collected Works, written over sixty years of his lifetime.

The history of analytical psychology is intimately linked with the biography of Jung. At the start, it was known as the “Zurich school”, whose chief figures were Eugen Bleuler, Franz Riklin, Alphonse Maeder and Jung, all centred in the Burghölzli hospital in Zurich. It was initially a theory concerning psychological complexes until Jung, upon breaking with Sigmund Freud, turned it into a generalised method of investigating archetypes and the unconscious, as well as into a specialised psychotherapy.

Analytical psychology, or “complex psychology”, from the German: Komplexe Psychologie, is the foundation of many developments in the study and practice of Psychology as of other disciplines. The followers of Jung are many, and some of them are members of national societies in diverse countries around the world. They collaborate professionally on an international level through the International Association of Analytical Psychologists (IAAP) and the International Association for Jungian Studies (IAJS). Jung’s propositions have given rise to a rich and multidisciplinary literature in numerous languages.

Among widely used concepts owed specifically to Analytical psychology are: anima and animus, archetypes, the collective unconscious, complexes, extraversion and introversion, individuation, the Self, the shadow and synchronicity. The Myers–Briggs Type Indicator (MBTI) is based on another of Jung’s theories on psychological types. A lesser known idea was Jung’s notion of the Psychoid to denote a hypothesised immanent plane beyond consciousness, distinct from the collective unconscious, and a potential locus of synchronicity.

The approximately “three schools” of post-Jungian analytical psychology that are current, the classical, archetypal and developmental, can be said to correspond to the developing yet overlapping aspects of Jung’s lifelong explorations, even if he expressly did not want to start a school of “Jungians”. Hence as Jung proceeded from a clinical practice which was mainly traditionally science-based and steeped in rationalist philosophy, anthropology and ethnography, his enquiring mind simultaneously took him into more esoteric spheres such as alchemy, astrology, gnosticism, metaphysics, myth and the paranormal, without ever abandoning his allegiance to science as his long-lasting collaboration with Wolfgang Pauli attests. His wide-ranging progression suggests to some commentators that, over time, his analytical psychotherapy, informed by his intuition and teleological investigations, became more of an “art”.

The findings of Jungian analysis and the application of analytical psychology to contemporary preoccupations such as social and family relationships, dreams and nightmares, work-life balance, architecture and urban planning, politics and economics, conflict and warfare, and climate change are illustrated in a growing number of publications and films.

Background

Jung began his career as a psychiatrist in Zürich, Switzerland. Already employed at the Burghölzli hospital in 1901, in his academic dissertation for the medical faculty of the University of Zurich he took the risk of using his experiments on somnambulism and the visions of his mediumistic cousin, Helly Preiswerk. The work was entitled, “On the Psychology and Pathology of So-Called Occult Phenomena”. It was accepted but caused great upset among his mother’s family. Under the direction of psychiatrist Eugen Bleuler, he also conducted research with his colleagues using a galvanometer to evaluate the emotional sensitivities of patients to lists of words during word association. Jung has left a description of his use of the device in treatment. His research earned him a worldwide reputation and numerous honours, including Honorary Doctorates from Clark and Fordham Universities in 1909 and 1910 respectively. Other honours followed later.

Although they began corresponding a year earlier, in 1907 Jung travelled to meet Sigmund Freud in Vienna, Austria. At that stage, Jung, aged thirty-two, had a much greater international renown than the forty-nine year old neurologist. For a further six years, the two scholars worked and travelled to the United States together. In 1911, they founded the International Psychoanalytical Association, of which Jung was the first president. However, early in the collaboration, Jung had already observed that Freud would not tolerate ideas that were different from his own.

Unlike most modern psychologists, Jung did not believe in restricting himself to the scientific method as a means to understanding the human psyche. He saw dreams, myths, coincidence and folklore as empirical evidence to further understanding and meaning. So although the unconscious cannot be studied by using direct methods, it acts as a useful working hypothesis, according to Jung. As he said, “The beauty about the unconscious is that it is really unconscious.” Hence, the unconscious is ‘untouchable’ by experimental researches, or indeed any possible kind of scientific or philosophical reach, precisely because it is unconscious.

The Break with Freud

It was the publication of a book by Jung which provoked the break with psychoanalysis and led to the founding of analytical psychology. In 1912 Jung met “Miss Miller”, brought to his notice by the work of Théodore Flournoy and whose case gave further substance to his theory of the collective unconscious. The study of her visions supplied the material which would go on to furnish his reasoning which he developed in Psychology of the Unconscious (Wandlungen und Symbole der Libido) (re-published as Symbols of Transformation in 1952) (C.W. Vol. 5). At this, Freud muttered about “heresy”. It was the second part of the work that brought the divergence to light. Freud mentioned to Ernest Jones that it was on page 174 of the original German edition, that Jung, according to him, had “lost his way”. It is the extract where Jung enlarged on his conception of the libido. The sanction was immediate: Jung was officially banned from the Vienna psychoanalytic circle from August 1912. From that date the psychoanalytic movement split into two obediences, with Freud’s partisans on one side, Karl Abraham being delegated to write a critical notice about Jung, and with Ernest Jones as defender of Freudian orthodoxy; while on the other side, were Jung’s partisans, including Leonhard Seif, Franz Riklin, Johan van Ophuijsen and Alphonse Maeder.

Jung’s innovative ideas with a new formulation of psychology and lack of contrition sealed the end of the Jung-Freud friendship in 1913. From then, the two scholars worked independently on personality development: Jung had already termed his approach analytical psychology (1912), while the approach Freud had founded is referred to as the Psychoanalytic School, (psychoanalytische Schule).

Jung’s postulated unconscious was quite different from the model proposed by Freud, despite the great influence that the founder of psychoanalysis had had on him. In particular, tensions manifested between him and Freud because of various disagreements, including those concerning the nature of the libido. Jung de-emphasized the importance of sexual development as an instinctual drive and focused on the collective unconscious: the part of the unconscious that contains memories and ideas which Jung believed were inherited from generations of ancestors. While he accepted that libido was an important source for personal growth, unlike Freud, Jung did not consider that libido alone was responsible for the formation of the core personality. Due to the particular hardships Jung had endured growing up, he believed his personal development and that of everyone was influenced by factors unrelated to sexuality.

The overarching aim in life, according to Jungian psychology, is the fullest possible actualisation of the “Self” through individuation. Jung defines the “self” as “not only the centre but also the whole circumference which embraces both conscious and unconscious; it is the centre of this totality, just as the ego is the centre of the conscious mind”. Central to this process of individuation is the individual’s continual encounter with the elements of the psyche by bringing them into consciousness. People experience the unconscious through symbols encountered in all aspects of life: in dreams, art, religion, and the symbolic dramas enacted in relationships and life pursuits. Essential to the process is the merging of the individual’s consciousness with the collective unconscious through a huge range of symbols. By bringing conscious awareness to bear on what is unconscious, such elements can be integrated with consciousness when they “surface”. To proceed with the individuation process, individuals need to be open to the parts of themselves beyond their own ego, which is the “organ” of consciousness. In a famous dictum, Jung said, “the Self, like the unconscious is an a priori existent out of which the ego evolves. It is … an unconscious prefiguration of the ego. It is not I who create myself, rather I happen to myself’.

It follows that the aim of (Jungian) psychotherapy is to assist the individual to establish a healthy relationship with the unconscious so that it is neither excessively out of balance in relation to it, as in neurosis, a state that can result in depression, anxiety, and personality disorders or so flooded by it that it risks psychosis resulting in mental breakdown. One method Jung applied to his patients between 1913 and 1916 was active imagination, a way of encouraging them to give themselves over to a form of meditation to release apparently random images from the mind in order to bridge unconscious contents into awareness.

“Neurosis” in Jung’s view results from the build up of psychological defences the individual unconsciously musters in an effort to cope with perceived attacks from the outside world, a process he called a “complex”, although complexes are not merely defensive in character. The psyche is a self-regulating adaptive system. People are energetic systems, and if the energy is blocked, the psyche becomes sick. If adaptation is thwarted, the psychic energy stops flowing and becomes rigid. This process manifests in neurosis and psychosis. Jung proposed that this occurs through maladaptation of one’s internal realities to external ones. The principles of adaptation, projection, and compensation are central processes in Jung’s view of psyche’s attempts to adapt.

Innovations of Jungian Analysis

Philosophical and Epistemological Foundations

Philosophy

Jung was an adept principally of the American philosopher William James, founder of pragmatism, whom he met during his trip to the United States in 1909. He also encountered other figures associated with James, such as John Dewey and the anthropologist, Franz Boas. Pragmatism was Jung’s favoured route to base his psychology on a sound scientific basis according to historian Sonu Shamdasani. His theories consist of observations of phenomena, and according to Jung it is phenomenology. In his view psychologism was suspect.

Displacement into the conceptual deprives experience of its substance and the possibility of being simply named.

Throughout his writings, Jung sees in empirical observation not only a precondition of an objective method but also respect for an ethical code which should guide the psychologist, as he stated in a letter to Joseph Goldbrunner:

I consider it a moral obligation not to make assertions about things one cannot see or whose existence cannot be proved, and I consider it an abuse of epistemological power to do so regardless. These rules apply to all experimental science. Other rules apply to metaphysics. I regard myself as answerable to the rules of experimental science. As a result nowhere in my work are there any metaphysical assertions nor – nota bene – any negations of a metaphysical nature.

According to the Italo-French psychoanalyst Luigi Aurigemma, Jung’s reasoning is also marked by Immanuel Kant, and more generally by German rationalist philosophy. His lectures are evidence of his assimilation of Kantian thought, especially the Critique of Pure Reason and Critique of Practical Reason. Aurigemma caracterises Jung’s thinking as “epistemological relativism” because it does not postulate any belief in the metaphysical. In fact, Jung uses Kant’s teleology to bridle his thinking and to guard himself from straying into any metaphysical excursions. On the other hand, for French historian of psychology, Françoise Parot, contrary to the alleged rationalist vein, Jung is “heir” to mystics, (Meister Eckhart, Hildegard of Bingen, or Augustine of Hippo) and to the romantics be they scientists, such as Carl Gustav Carus or Gotthilf Heinrich von Schubert in particular, or to philosophers and writers, along the lines of Nietzsche, Goethe, and Schopenhauer, in the way he conceptualised the unconscious in particular. Whereas his typology is profoundly dependent on Carl Spitteler.

Scientific Heritage

As a trained psychiatrist, Jung had a grounding in the state of science in his day. He regularly refers to the experimental psychology of Wilhelm Wundt. His Word Association Test designed with Franz Riklin is actually the direct application of Wundt’s theory. Notwithstanding the great debt of analytical psychology to Sigmund Freud, Jung borrowed concepts from other theories of his time. For instance, the expression “abaissement du niveau mental” comes directly from the French psychologist Pierre Janet whose courses Jung attended during his studies in France, during 1901. Jung had always acknowledged how much Janet had influenced his career.

Jung’s use of the concept of “participation mystique” is owed to the French ethnologist Lucien Lévy-Bruhl:

What Rousseau describes is nothing other than the primitive collective mentality which Lucien Lévy-Bruhl has brilliantly called “participation mystique”

which he uses to illustrate the surprising fact, to him, that some native peoples can experience relations that defy logic, as for instance in the case of the South American tribe, whom he met during his travels, where the men pretended they were scarlet aras birds. Finally, his use of the English expression, “pattern of behaviour”, which is synonymous with the term archetype, is drawn from British studies in ethology.

The principal contribution to analytical psychology, nevertheless, remains that of Freud’s psychoanalysis, from which Jung took a number of concepts, especially the method of inquiring into the unconscious through free association. Individual analysts’ thinking was also integrated into his project, among whom are Sándor Ferenczi (Jung refers to his notion of “affect”) or Ludwig Binswanger and his Daseinsanalyse [de], (Daseinsanalysis). Jung affirms also Freud’s contribution to our knowledge of the psyche as being, without doubt, of the highest importance. It reveals penetrating information about the dark corners of the soul and of the human personality, which is of the same order as Nietzsche’s On the Genealogy of Morality (1887). In this context, Freud was, according to Jung, one of the great cultural critics of the XIXth century.

Divergences from Psychoanalysis

Jungian Analysis, as is psychoanalysis, is a method to access, experience and integrate unconscious material into awareness. It is a search for the meaning of behaviours, feelings and events. Many are the channels to extend knowledge of the self: the analysis of dreams is one important avenue. Others may include expressing feelings about and through art, poetry or other expressions of creativity, the examination of conflicts and repeating patterns in a person’s life. A comprehensive description of the process of dream interpretation is complex, in that it is highly specific to the person who undertakes it. Most succinctly it relies on the associations which the particular dream symbols suggest to the dreamer, which at times may be deemed “archetypal” in so far as they are supposed common to many people throughout history. Examples could be a hero, an old man or woman, situations of pursuit, flying or falling.

Whereas (Freudian) psychoanalysis relies entirely on the development of the transference in the analysand (the person under treatment) to the analyst, Jung initially used the transference and later concentrated more on a dialectical and didactic approach to the symbolic and archetypal material presented by the patient. Moreover his attitude towards patients departed from what he had observed in Freud’s method. Anthony Stevens has explained it thus:

Though [Jung’s] initial formulations arose mainly out of his own creative illness, they were also a conscious reaction against the stereotype of the classical Freudian analyst, sitting silent and aloof behind the couch, occasionally emitting ex cathedra pronouncements and interpretations, while remaining totally uninvolved in the patient’s guilt, anguish, and need for reassurance and support. Instead, Jung offered the radical proposal that analysis is a dialectical procedure, a two-way exchange between two people, who are equally involved. Although it was a revolutionary idea when he first suggested it, it is a model which has influenced psychotherapists of most schools, though many seem not to realise that it originated with Jung.

In place of Freud’s “surgical detachment”, Jung demonstrated a more relaxed and warmer welcome in the consulting room. He remained aware nonetheless that exposure to a patient’s unconscious contents always posed a certain risk of contagion (he calls it “psychic infection”) to the analyst, as experienced in the countertransference. The process of contemporary Jungian analysis depends on the type of “school of analytical psychology” to which the therapist adheres, (see below). The “Zurich School” would reflect the approach Jung himself taught, while those influenced by Michael Fordham and associates in London, would be significantly closer to a Kleinian approach and therefore, concerned with analysis of the transference and countertransference as indicators of repressed material along with the attendant symbols and patterns.

Dream Work

Jung’s preoccupation with dreams can be dated from 1902. It was only after the break with Freud that he published in 1916 his “Psychology of the Unconscious” where he elaborated his view of dreams, which contrasts sharply with Freud’s conceptualisation. While he agrees that dreams are a highway into the unconscious, he enlarges on their functions further than psychoanalysis did. One of the salient differences is the compensatory function they perform by reinstating psychic equilibrium in respect of judgements made during waking life: thus a man consumed by ambition and arrogance may, for example, dream about himself as small and vulnerable person.

According to Jung, this demonstrates that the man’s attitude is excessively self-assured and thereby refuses to integrate the inferior aspects of his personality, which are denied by his defensive arrogance. Jung calls this a compensation mechanism, necessary for the maintenance of a healthy mental balance. Shortly before his death in 1961, he wrote:

In order to secure mental and even physiological stability, it is necessary that the conscious and unconscious should be integrated one with the other. This is so that they evolve in parallel. (Pour sauvegarder la stabilité mentale, et même physiologique, il faut que la conscience et l’inconscient soient intégralement reliés, afin d’évoluer parallèlement).

Unconscious material is expressed in images through the deployment of symbolism which, in Jungian terms, means it has an affective role (in that it can sometimes give rise to a numinous feeling, when associated with an archetypal force) and an intellectual role. Some dreams are personal to the dreamer, others may be collective in origin or “transpersonal” in so far as they relate to existential events. They can be taken to express phases of the individuation process (see below) and may be inspired by literature, art, alchemy or mythology. Analytical psychology is recognised for its historical and geographical study of myths as a means to deconstruct, with the aid of symbols, the unconscious manifestations of the psyche. Myths are said to represent directly the elements and phenomena arising from the collective unconscious and though they may be subject to alteration in their detail through time, their significance remains similar. While Jung relies predominantly on christian or on Western pagan mythology (Ancient Greece and Rome), he holds that the unconscious is driven by mythologies derived from all cultures. He evinced an interest in Hinduism, in Zoroastrianism and Taoism, which all share fundamental images reflected in the psyche. Thus analytical psychology focusses on meaning, based on the hypothesis that human beings are potentially in constant touch with universal and symbolic aspects common to humankind. In the words of André Nataf:

Jung opens psychoanalysis to a dimension currently obscured by the prevailing scientism: spirituality. His contribution, though questionable in certain respects, remains unique. His explorations of the unconscious carried out both as a scientist and a poet, indicate that it is structured as a language but one which is in a mythical mode. (Jung ouvre la psychanalyse à une dimension cachée par le scientisme ambiant : la spiritualité. Son apport, quoique contestable sur certains points, reste unique. Explorant l’inconscient en scientifique et poète, il montre que celui-ci se structure non comme une langue mais sur le mode du mythe).

Principal Concepts

In analytical psychology two distinct types of psychological process may be identified: that deriving from the individual, characterised as “personal”, belonging to a subjective psyche, and that deriving from the collective, linked to the structure of an objective psyche, which may be termed “transpersonal”. These processes are both said to be archetypal. Some of these processes are regarded as specifically linked to consciousness, such as the animus or anima, the persona or the shadow. Others pertain more to the collective sphere. Jung tended to personify the anima and animus as they are, according to him, always attached to a person and represent an aspect of his or her psyche.

Anima and Animus

Jung identified the archetypal anima as being the unconscious feminine component of men and the archetypal animus as the unconscious masculine component in women. These are shaped by the contents of the collective unconscious, by others, and by the larger society. However, many modern-day Jungian practitioners do not ascribe to a literal definition, citing that the Jungian concept points to every person having both an anima and an animus. Jung considered, for instance, an “animus of the anima” in men, in his work Aion and in an interview in which he says:

“Yes, if a man realizes the animus of his anima, then the animus is a substitute for the old wise man. You see, his ego is in relation to the unconscious, and the unconscious is personified by a female figure, the anima. But in the unconscious is also a masculine figure, the wise old man. And that figure is in connection with the anima as her animus, because she is a woman. So, one could say the wise old man was in exactly the same position as the animus to a woman.”

Jung stated that the anima and animus act as guides to the unconscious unified Self, and that forming an awareness and a connection with the anima or animus is one of the most difficult and rewarding steps in psychological growth. Jung reported that he identified his anima as she spoke to him, as an inner voice, unexpectedly one day.

In cases where the anima or animus complexes are ignored, they vie for attention by projecting itself on others. This explains, according to Jung, why we are sometimes immediately attracted to certain strangers: we see our anima or animus in them. Love at first sight is an example of anima and animus projection. Moreover, people who strongly identify with their gender role (e.g. a man who acts aggressively and never cries) have not actively recognised or engaged their anima or animus.

Jung attributes human rational thought to be the male nature, while the irrational aspect is considered to be natural female (rational being defined as involving judgment, irrational being defined as involving perceptions). Consequently, irrational moods are the progenies of the male anima shadow and irrational opinions of the female animus shadow.

Archetypes

The use of archetypes in psychology was advanced by Jung in an essay entitled “Instinct and the Unconscious” in 1919. The first element in Greek ‘arche’ signifies ‘beginning, origin, cause, primal source principle’, by extension it can signify ‘position of a leader, supreme rule and government’. The second element ‘type’ means ‘blow or what is produced by a blow, the imprint of a coin …form, image, prototype, model, order, and norm’, …in the figurative, modern sense, ‘pattern underlying form, primordial form’. In his psychological framework, archetypes are innate, universal or personal prototypes for ideas and may be used to interpret observations. The method he favoured was hermeneutics which was central in his practice of psychology from the start. He made explicit references to hermeneutics in the Collected Works and during his theoretical development of the notion of archetypes. Although he lacks consistency in his formulations, his theoretical development of archetypes is rich in hermeneutic implications. As noted by Smythe and Baydala (2012):

his notion of the archetype as such can be understood hermeneutically as a form of non-conceptual background understanding.

A group of memories and attitudes associated with an archetype can become a complex, e.g. a mother complex may be associated with a particular mother archetype. Jung treated the archetypes as psychological organs, analogous to physical ones in that both are morphological givens which probably arose through evolution.

Archetypes have been regarded as collective as well as individual, and identifiable in a variety of creative ways. As an example, in his book Memories, Dreams, Reflections, Jung states that he began to see and talk to a manifestation of anima and that she taught him how to interpret dreams. As soon as he could interpret on his own, Jung said that she ceased talking to him because she was no longer needed. However, the essentialism inherent in archetypal theory in general and concerning the anima, in particular, has called for a re‐evaluation of Jung’s theory in terms of emergence theory. This would emphasise the role of symbols in the construction of affect in the midst of collective human action. In such a reconfiguration, the visceral energy of a numinous experience can be retained while the problematic theory of archetypes has outlived its usefulness.

Collective Unconscious

Jung’s concept of the collective unconscious has undergone re-interpretation over time. The term “collective unconscious” first appeared in Jung’s 1916 essay, “The Structure of the Unconscious”. This essay distinguishes between the “personal”, Freudian unconscious, filled with fantasies (e.g. sexual) and repressed images, and the “collective” unconscious encompassing the soul of humanity at large.

In “The Significance of Constitution and Heredity in Psychology” (November 1929), Jung wrote:

And the essential thing, psychologically, is that in dreams, fantasies, and other exceptional states of mind the most far-fetched mythological motifs and symbols can appear autochthonously at any time, often, apparently, as the result of particular influences, traditions, and excitations working on the individual, but more often without any sign of them. These “primordial images” or “archetypes,” as I have called them, belong to the basic stock of the unconscious psyche and cannot be explained as personal acquisitions. Together they make up that psychic stratum which has been called the collective unconscious. The existence of the collective unconscious means that individual consciousness is anything but a tabula rasa and is not immune to predetermining influences. On the contrary, it is in the highest degree influenced by inherited presuppositions, quite apart from the unavoidable influences exerted upon it by the environment. The collective unconscious comprises in itself the psychic life of our ancestors right back to the earliest beginnings. It is the matrix of all conscious psychic occurrences, and hence it exerts an influence that compromises the freedom of consciousness in the highest degree, since it is continually striving to lead all conscious processes back into the old paths.

Given that in his day he lacked the advances of complexity theory and especially complex adaptive systems (CAS), it has been argued that his vision of archetypes as a stratum in the collective unconscious, corresponds to nodal patterns in the collective unconscious which go on to shape the characteristic patterns of human imagination and experience and in that sense, “seems a remarkable, intuitive articulation of the CAS model”.

Individuation

Individuation is a complex process that involves going through different stages of growing awareness through the progressive confrontation and integration of personal unconscious elements. This is the central concept of analytical psychology first introduced in 1916. It is the objective of Jungian psychotherapy to the extent that it enables the realisation of the Self. As Jung stated:

The aim of individuation is nothing less than to divest the self of the false wrappings of the persona, on the one hand and the suggestive power of primordial images on the other.

Jung started experimenting with individuation after his split with Freud as he confronted what was described as eruptions from the collective unconscious driven by a contemporary malaise of spiritual alienation. According to Jung, individuation means becoming an individual and implies becoming one’s own self. Unlike individuality, which emphasizes some supposed peculiarity, Jung described individuation as a better and more complete fulfilment of the collective qualities of the human being. In his experience, Jung explained that individuation helped him, “from the therapeutic point of view, to find the particular images that lie behind emotions”.

Individuation is from the first what the analysand must undergo, in order to integrate the other elements of the psyche. This pursuit of wholeness aims to establish the Self, which include both the rational conscious mind of the ego and the irrational contents of the unconscious, as the new personality centre. Prior to individuation, the analysand is carefully assessed to determine if the ego is strong enough to take the intensity of this process. The elements to be integrated include the persona which acts as the representative of the person in her/his role in society, the shadow which contains all that is personally unknown and what the person considers morally reprehensible and, the anima or the animus, which respectively carry their feminine and masculine values. For Jung many unconscious conflicts at the root of neurosis are caused by the difficulty to accept that such a dynamic can unbalance the subject from his habitual position and confronts her/him with aspects of the self they were accustomed to ignore. Once individuation is completed the ego is no longer at the centre of the personality. The process, however, does not lead to a complete self-realisation and that individuation can never be a fixed state due to the unfathomable nature of the depths of the collective unconscious.

Shadow

The shadow is an unconscious complex defined as the repressed, suppressed or disowned qualities of the conscious self. According to Jung, the human being deals with the reality of the shadow in four ways: denial, projection, integration and/or transmutation. Jung himself asserted that “the result of the Freudian method of elucidation is a minute elaboration of man’s shadow-side unexampled in any previous age.” According to analytical psychology, a person’s shadow may have both constructive and destructive aspects. In its more destructive aspects, the shadow can represent those things people do not accept about themselves. For instance, the shadow of someone who identifies as being kind may be harsh or unkind. Conversely, the shadow of a person who perceives himself to be brutal may be gentle. In its more constructive aspects, a person’s shadow may represent hidden positive qualities. This has been referred to as the “gold in the shadow”. Jung emphasized the importance of being aware of shadow material and incorporating it into conscious awareness in order to avoid projecting shadow qualities on others.

The shadow in dreams is often represented by dark figures of the same gender as the dreamer.

The shadow may also concern great figures in the history of human thought or even spiritual masters, who became great because of their shadows or because of their ability to live their shadows (namely, their unconscious faults) in full without repressing them.

Persona

Just like the anima and animus, the persona (derived from the Greek term for a mask, as would have been worn by actors) is another key concept in analytical psychology. It is the part of the personality which manages an individual’s relations with society in the outside world and works the same way for both sexes.

The persona … is the individual’s system of adaptation to, or the manner assumed in dealing with the world. Every calling or profession, for example, has its own characteristic persona […] Only the danger is that (people) become identical with their personas: thus the professor with his textbook, the tenor with his voice. One could say with little exaggeration, that the persona is that which in reality one is not, but which oneself as well as others think one is.

The persona, which is at the heart of the psyche, is contrary to the shadow which is actually the true personality but denied by the self. The conscious self identifies primarily with the persona during development in childhood as the individual develops a psychological framework for dealing with others. Identifications with diplomas, social roles, with honours and awards, with a career, all contribute to the apparent constitution of the persona and which do not lead to knowledge of the self. For Jung, the persona has nothing real about it. It can only be a compromise between the individual and society, yielding an illusion of individuality. Individuation consists, in the first instance, of discarding the individual’s mask, but not too quickly as often, it is all the patient has as a means of identification. The persona is implicated in a number symptoms such as compulsive disorders, phobias, shifting moods, and addictions, among others.

Psychological Types

Analytical psychology distinguishes several psychological types or temperaments.

  • Extravert.
  • Introvert.

According to Jung, the psyche is an apparatus for adaptation and orientation, and consists of a number of different psychic functions. Among these he distinguishes four basic functions:

  • Sensation: Perception by means of the sense organs.
  • Intuition: Perceiving in unconscious way or perception of unconscious contents.
  • Thinking: Function of intellectual cognition; the forming of logical conclusions.
  • Feeling: Function of subjective estimation.

Thinking and feeling functions are rational, while the sensation and intuition functions are irrational.

Note: There is ambiguity in the term ‘rational’ that Carl Jung ascribed to the thinking/feeling functions. Both thinking and feeling irrespective of orientation (i.e. introverted/extroverted) employ/utilise/are directed by in loose terminology an underlying ‘logical’ IF-THEN construct/process (as in IF X THEN Y) in order to form judgements. This underlying construct/process is not directly observable in normal states of consciousness especially when engaged in thoughts/feelings. It can be cognised merely as a concept/abstraction during thoughtful reflection. Sensation and intuition are ‘irrational’ functions simply because they do not employ the above-mentioned underlying logical construct/process.

Complexes

Early in Jung’s career he coined the term and described the concept of the “complex”. Jung claims to have discovered the concept during his free association and galvanic skin response experiments. Freud obviously took up this concept in his Oedipus complex amongst others. Jung seemed to see complexes as quite autonomous parts of psychological life. It is almost as if Jung were describing separate personalities within what is considered a single individual, but to equate Jung’s use of complexes with something along the lines of multiple personality disorder would be a step out of bounds.

Jung saw an archetype as always being the central organising structure of a complex. For instance, in a “negative mother complex,” the archetype of the “negative mother” would be seen to be central to the identity of that complex. This is to say, our psychological lives are patterned on common human experiences. Jung saw the Ego (which Freud wrote about in German literally as the “I”, one’s conscious experience of oneself) as a complex. If the “I” is a complex, what might be the archetype that structures it? Jung, and many Jungians, might say “the hero,” one who separates from the community to ultimately carry the community further.

Synchronicity

Carl Jung first officially used the term synchronicity during a conference held in memory of his sinologist friend, Richard Wilhelm in 1930. It was part of his explanation of the modus operandi of the I Ching. The second reference was made in 1935 in his Tavistock Lectures. For an overview of the origins of the concept, see Joseph Cambray: “Synchronicity as emergence”. It was used to denote the simultaneous occurrence of two events with no causal physical connection, but whose association evokes a meaning for the person experiencing or observing it. The often cited example of the phenomenon is Jung’s own account of a beetle (the common rose-chafer, Cetonia aurata) flying into his consulting room directly following on from his patient telling him a dream featuring a golden scarab. The concept only makes sense psychologically and cannot be reduced to a verified or scientific fact. For Jung it constitutes a working hypothesis which has subsequently given rise to many ambiguities.

I chose this term because the simultaneous occurrence of two meaningfully but not causally connected events seemed to me an essential criterion. I am therefore using the general concept of synchronicity in the special sense of a coincidence in time of two or more causally unrelated events which have the same or a similar meaning, in contrast to synchronism, which simply means the simultaneous occurrence of two events. Synchronicity therefore means the simultaneous occurrence of a certain psychic state with one or more external events which appear as meaningful parallels to the momentary subjective state -and, in certain cases, vice versa.

According to Jung, an archetype which has been constellated in the psyche can, under certain circumstances, transgress the boundary between substance and psyche.

Jung had studied such phenomena with the physicist and Nobel Prize winner, Wolfgang Pauli, who did not always agree with Jung, and with whom he carried on an extensive correspondence, enriched by the contributions of both specialists in their own fields. Pauli had given a series of lectures to the C.G. Jung Institute, Zürich whose member and patron he had been since 1947. It gave rise to a joint essay: Synchronicity, an a-causal principle (1952) The two men saw in the idea of synchronicity a potential way of explaining a particular relationship between “incontrovertible facts”, whose occurrence is tied to unconscious and archetypal manifestations:

The psyche and matter are ordered according to principles which are common, neutral, and incontrovertible.

Borrowing the notion from Arthur Schopenhauer, Jung calls it Unus mundus, a state where neither matter nor the psyche are distinguishable. whereas for Pauli it was a limiting concept, in two senses, in that it is at once scientific and symbolic. According to him, the phenomenon is dependent on the observer. Nevertheless, both men were in accord that there existed the possibility of a conjunction between physics and psychology. Jung wrote in a letter to Pauli:

These researches (Jung’s research into alchemy), have shown me that modern physics can symbolically represent psychological processes down to the minutest detail.

Marie-Louise von Franz also had a lengthy exchange of letters with Wolfgang Pauli. On Pauli’s death in 1958, his widow, Franca, deliberately destroyed all the letters von Franz had sent to her husband, and which he had kept locked inside his writing desk. However, the letters from Pauli to von Franz were all saved and were later made available to researchers and published.

Synchronicity has been is among the most developed ideas by Jung’s followers, notably by Michel Cazenave, James Hillman, Roderick Main, Carl Alfred Meier and by the British developmental clinician, George Bright. It has been explored also in a range of spiritual currents who have sought in it a scientific rigour.

Although Synchronicity as conceived by Jung within the bounds of the science available in his day, has been categorised as pseudoscience, recent developments in complex adaptive systems argue for a revision of such a view. Critics cite that Jung’s experiments that sought to provide statistical proof for this theory did not yield satisfactory result. His experiment was also faulted for not using a true random sampling method as well as for the use of dubious statistics and astrological material.

Post-Jungian Approaches

Andrew Samuels (1985) has distinguished three distinct traditions or approaches of “post-Jungian” psychology – classical, developmental and archetypal. Today there are more developments.

Classical

The classical approach tries to remain faithful to Jung’s proposed model, his teachings and the substance of his 20 volume Collected Works, together with recently published works, such as the Liber Novus, and the Black Books. Prominent advocates of this approach, according to Samuels (1985), include Emma Jung, Jung’s wife, an analyst in her own right, Marie-Louise von Franz, Joseph L. Henderson, Aniela Jaffé, Erich Neumann, Gerhard Adler and Jolande Jacobi. Jung credited Neumann, author of “Origins of Conscious” and “Origins of the Child”, as his principal student to advance his (Jung’s) theory into a mythology-based approach. He is associated with developing the symbolism and archetypal significance of several myths: the Child, Creation, the Hero, the Great Mother and Transcendence.

Archetypal

One archetypal approach, sometimes called “the imaginal school” by James Hillman, was written about by him in the late 1960s and early 1970s. Its adherents, according to Samuels (1985), include Gerhard Adler, Irene Claremont de Castillejo, Adolf Guggenbühl-Craig, Murray Stein, Rafael López-Pedraza and Wolfgang Giegerich. Thomas Moore also was influenced by some of Hillman’s work. Developed independently, other psychoanalysts have created strong approaches to archetypal psychology. Mythopoeticists and psychoanalysts such as Clarissa Pinkola Estés who believes that ethnic and aboriginal people are the originators of archetypal psychology and have long carried the maps for the journey of the soul in their songs, tales, dream-telling, art and rituals; Marion Woodman who proposes a feminist viewpoint regarding archetypal psychology. Some of the mythopoetic/archetypal psychology creators either imagine the Self not to be the main archetype of the collective unconscious as Jung thought, but rather assign each archetype equal value.[citation needed] Others, who are modern progenitors of archetypal psychology (such as Estés), think of the Self as the thing that contains and yet is suffused by all other archetypes, each giving life to the other.

Robert L. Moore has explored the archetypal level of the human psyche in a series of five books co-authored with Douglas Gillette, which have played an important role in the men’s movement in the United States. Moore studies computerese so he uses a computer’s hard wiring (its fixed physical components) as a metaphor for the archetypal level of the human psyche. Personal experiences influence the access to the archetypal level of the human psyche, but personalized ego consciousness can be likened to computer software.

Developmental

A major expansion of Jungian theory is credited to Michael Fordham and his wife, Frieda Fordham. It can be considered a bridge between traditional Jungian analysis and Melanie Klein’s object relations theory. Judith Hubback and William Goodheart MD are also included in this group. Andrew Samuels (1985) considers J.W.T. Redfearn, Richard Carvalho and himself as representatives of the developmental approach. Samuels notes how this approach differs from the classical by giving less emphasis to the Self and more emphasis to the development of personality; he also notes how, in terms of practice in therapy, it gives more attention to transference and counter-transference than either the classical or the archetypal approaches.

Sandplay Therapy

Sandplay is a non-directive, creative form of therapy using the imagination, originally used with children and adolescents, later also with adults. Jung had stressed the importance of finding the image behind the emotion. The use of sand in a suitable tray with figurines and other small toys, farm animals, trees, fences and cars enables a narrative to develop through a series of scenarios. This is said to express an ongoing dialogue between the conscious and the unconscious aspects of the psyche, which in turn activates a healing process whereby the patient and therapist can together view the evolving sense of self.

Jungian Sandplay started as a therapeutic method in the 1950s. Although its origin has been credited to a Swiss Jungian analyst, Dora Kalff it was in fact, her mentor and trainer, Dr. Margaret Lowenfeld, a British paediatrician, who had developed the Lowenfeld World Technique inspired by the writer H.G. Wells in her work with children, using a sand tray and figurines in the 1930s. Jung had witnessed a demonstration of the technique while on a visit to the UK in 1937. Kalff saw in it potential as a further application of analytical psychology. Encouraged by Jung, Kalff developed the new application over a number of years and called it Sandplay. From 1962 she began to train Jungian Analysts in the method including in the United States, Europe and Japan. Both Kalff and Jung believed an image can offer greater therapeutic engagement and insight than words alone. Through the sensory experience of working with sand and objects, and their symbolic resonance new areas of awareness can be brought into consciousness, as in dreams, which through their frames and storyline can bring material into consciousness as part of an integrating and healing process. The historian of psychology, Sonu Shamdasani has commented:

Historical reflection suggests the spirit of Jung’s practice of the image, his engagement with his own figures, is indeed more alive in Sandplay than in other Jungian conclaves.

One of Dora Kalff’s trainees was the American concert pianist, Joel Ryce-Menuhin, whose music career was ended by illness and who retrained as a Jungian analyst and exponent of sandplay.

Process-Oriented Psychology

Process-oriented psychology (also called Process work) is associated with the Zurich-trained Jungian analyst Arnold Mindell. Process work developed in the late 1970s and early 1980s and was originally identified as a “daughter of Jungian psychology”. Process work stresses awareness of the “unconscious” as an ongoing flow of experience. This approach expands Jung’s work beyond verbal individual therapy to include body experience, altered and comatose states as well as multicultural group work.

The Analytic Attitude

Formally Jungian analysis differs little from psychoanalysis. However, variants of each school have developed overlaps and specific divergences through the century, or more, of their existence. They share a “frame” consisting of regular spatio-temporal meetings, one or more times a week, focusing on patient material, using dialogue which may consist of elaboration, amplification and abreaction and which may last on average three years (sometimes more briefly or far longer). The spatial arrangement between analyst and analysand may differ: seated face to face or the patient may use the couch with the analyst seated behind.

In some approaches alternative elements of expression can take place, such as active imagination, sandplay, drawing or painting, even music. The session may at times become semi-directed (in contrast to psychoanalytic treatment which is essentially a non-directive encounter). The patient is at the heart of the therapy, as Marie Louise von Franz has it in her work, “Psychotherapy: the practitioner’s experience”, where she recounts Jung’s thinking on that point. The transference is sought out (contrary to psychoanalytic treatment which distinguishes positive and negative transferences) and, the interpretation of dreams is one of the central pillars of Jungian psychotherapy. In all other respects, the rules correspond to those of classical psychoanalysis: the analyst examines free associations and tries to be objective and ethical, meaning respectful of the patient’s pace and rhythm of unfolding progress. In fact, the task of Jungian analysis is not merely to explore the patient’s past, but to connect conscious awareness with the unconscious such that a better adaptation to their emotional and social life may ensue.

Neurosis is not a symptom of the re-emergence of a repressed past, but is regarded as the functional, sometimes somatic, incapacity to face certain aspects of lived reality. In Jungian analysis the unconscious is the motivator whose task it is to bring into awareness the patient’s shadow, in alliance with the analyst, the more so since unconscious processes enacted in the transference provoke a dependent relationship by the analysand on the analyst, leading to a falling away of the usual defences and references. This requires that the analyst guarantee the safety of the transference. The responsibilities and accountability of individual analysts and their membership organisations, matters of clinical confidentiality and codes of ethics and professional relations with the public sphere are explored in a volume edited by Solomon and Twyman, with contributions from Jungian analysts and psychoanalysts. Solomon has characterised the nature of the patient – analyst relationship as one where the analytic attitude is an ethical attitude since:

The ethical attitude presupposes special responsibilities that we choose to adopt in relation to another. Thus, a parallel situation pertains between caregiver and child and between analyst and patient: they are not equal partners, but nevertheless are in a situation of mutuality, shared subjectivity, and reciprocal influence.

Jungian Social, Literary and Art Criticism

Analytical psychology has inspired a number of contemporary academic researchers to revisit some of Jung’s own preoccupations with the role of women in society, with philosophy and with literary and art criticism. Leading figures to explore these fields include the British-American, Susan Rowland, who produced the first feminist revision of Jung and the fundamental contributions made to his work by the creative women who surrounded him. She has continued to mine his work by evaluating his influence on modern literary criticism and as a writer. Leslie Gardner has devoted a series of volumes to analytical psychology in 21st century life, one of which concentrates on the “Feminine Self”. Paul Bishop, a British German scholar, has placed analytical psychology in the context of precursors such as, Goethe, Schiller and Nietzsche.

The Franco-Swiss art historian and analytical psychologist, Christian Gaillard, has examined Jung’s place as an artist and art critic in his series of Fay lectures at the Texas A&M University. These scholars draw from Jung’s works that apply analytical psychology to literature such as the lecture “On the Relation of Analytical Psychology to Poetry”. In this presentation, which was delivered in 1922, Jung stated that the psychologist cannot replace the art critic. He rejected the Freudian art criticism for reducing complex works of art to Oedipal fantasies of their creators, stressing the danger of simplifying literature to causes found outside of the actual work.

Criticism

Since its inception, analytical psychology has been the object of criticism, emanating from the psychoanalytic sphere. Freud himself characterised Jung as a “mystic and a snob”. In his introduction to the 2011 edition of Jung’s “Lectures on the Theory of Psychoanalysis”, given in New York in 1912, Sonu Shamdasani contends that Freud orchestrated a round of critical reviews of Jung’s writings from Karl Abraham, Jung’s former colleague at the Burghölzli hospital, and from the early Welsh Freudian, Ernest Jones. Such criticisms multiplied during the 20th century, focusing primarily on the “mysticism” in Jung’s writings. Other psychoanalysts, including Jungian analysts, objected to the cult of personality around the Swiss psychiatrist. It reached a crescendo with Jung’s perceived collusion with Nazism in the build up and during World War II and is still a recurrent theme. Thomas Kirsch writes: “Successive generations of Jungian analysts and analysands have wrestled with the question of Jung’s complex relations to Germany.” Other considered evaluations come from Andrew Samuels and from Robert Withers.

The French philosopher, Yvon Brès, considers that the concept of the collective unconscious, “shows also how easily one can slip from the psychological unconscious into perspectives from a universe of thought, quite alien from traditional philosophy and science, where this idea arose.” (“Le concept jungien d’inconscient collectif “témoigne également de la facilité avec laquelle on peut glisser du concept d’inconscient psychologique vers des perspectives relevant d’un univers de pensée étranger à la tradition philosophique et scientifique dans laquelle ce concept est né'”).

In his Le Livre Rouge de la psychanalyse (“Red Book of psychoanalysis”), the French psychoanalyst, Alain Amselek, criticises Jung’s tendency to be fascinated by the image and to reduce the human to an archetype. He contends that Jung dwells in a world of ideas and abstractions, in a world of books and old secrets lost in ancient books of spells (fr: grimoires). While claiming to be an empiricist, Amselek finds Jung to be an idealist, a pure thinker who has unquestionably demonstrated his intellectual talent for speculation and the invention of ideas. While he considers his epistemology to be in advance of that of Freud, Jung remains stuck in his intellectualism and in his narrow provincial outlook.[clarification needed] In fact, his hypotheses are determined by the concept of his postulated pre-existing world and he has constantly sought to find confirmations of it in the old traditions of Western Medieval Europe.

More problematic has been, at times, the ad hominem criticism of academics outside the field of analytical psychology. One, a Catholic historian of psychiatry, Richard Noll, wrote three volumes but was able to publish only the first two in 1994 and 1997. Nolls argued that analytical psychology is based on a neo-pagan Hellenistic cult. These attacks on Jung and his work prompted the French psychoanalyst, Élisabeth Roudinesco, to state in a review: “Even if Noll’s theses are based on a solid familiarity with the Jungian corpus […], they deserve to be re-examined, such is the detestation of the author for the object of his study that it diminishes the credibility of the arguments.” (“Même si les thèses de Noll sont étayées par une solide connaissance du corpus jungien […], elles méritent être réexaminées, tant la détestation de l’auteur vis-à-vis de son objet d’étude diminue la crédibilité de l’argumentation.”). Another, a French ethnographer and anthropologist, Jean-Loïc Le Quellec, criticised Jung over his alleged misuse of the term archetype and his “suspect motives” in dealings with some of his colleagues.

What is the American Board of Professional Psychology?

Introduction

The American Board of Professional Psychology (ABPP) is the primary organisation for specialty board certification in psychology.

Mission Statement

“The mission of the American Board of Professional Psychology is to increase consumer protection through the examination and certification of psychologists who demonstrate competence in approved specialty areas in professional psychology.”

Brief History

1947-1999

The American Board of Professional Psychology was founded and incorporated in 1947, as the American Board of Examiners in Professional Psychology (ABEPP). When established, ABEPP replaced a committee that was formed by the American Psychological Association (APA) to explore the development of a credentialing body for individual psychologists. According to Bent, Goldberg & Packard, APA had come to realise that a membership organisation, such as itself, could not advocate for its members at the same time that it performed certification functions designed to protect the public. Determining that a distinction should be made between basic and advanced levels of competence, ABEPP focused its attention to the latter and identified three fields of certification:

  • Clinical Psychology;
  • Personnel-Industrial (later becoming Industrial Psychology, and then Industrial/Organizational Psychology); and
  • Personnel-Educational (later becoming Counselling and Guidance, and then Counselling Psychology).

In order to recognize those psychologists already working in applied and practice areas, persons deemed to have sufficient experience and training (and awarded Bachelor of Arts degrees prior to 31 December 1935) were allowed to be “grandfathered” without examination. Those requiring examination were administered both written and oral components.

In 1968, the current name – American Board of Professional Psychology – was adopted, and a fourth specialty – School Psychology – was introduced. In 1972 multimember regional boards were implemented – Northeast, Midwest, Mideast, Southeast, Intermountain West and Far West. In 1974, the ABPP Board of Trustees (BOT) authorized the establishment of the National Register of Health Service Psychologists. Throughout the 1980s and early 1990s, new specialty boards were recognised – Clinical Neuropsychology (1984), Forensic Psychology (1985), Family Psychology (1991) and Health Psychology (1991). As new specialties were introduced, each seated a trustee on the BOT. As the 1990s progressed, additional specialties were identified – Behavioural Psychology (1991), Psychoanalysis in Psychology (1996), and Rehabilitation Psychology (1997). Specialty Academies were also introduced as definitive membership organisations for specialists certified by ABPP.

2000-Present

During the early 2000s, ABPP implemented several initiatives to further its mission. The Early Entry Option was created for graduate students, interns, and residents to start the board certification process early in their careers. In 2008, ABPP began to convene an annual conference with workshops. As a means of raising funds to support education on board certification, the American Board of Professional Psychology Foundation was formed in 2010. In 2015 ABPP seated its first Early Career Psychology (ECP) trustee. Maintenance of Certification was implemented in 2015, requiring that psychologists board-certified on or after 01 January 2015 undergo a formal review, ensuring their commitment to lifelong learning. Psychologists who received their board certification prior to 2015 received the option to opt-in to maintenance of certification or to waive the requirement.

Certification Requirements

There are various requirements to obtain the ABPP certification, which are referred to as diplomas in the specialized area. The minimum requirements include:

  • A doctoral degree.
  • Licensure within the psychology field.
  • At least five years of experience.

In addition to the minimum requirements, there are also additional specialisations demonstrated by the candidate. The candidate must also demonstrate the following:

  • Specialised Training.
  • Evidence of substantial experience.
  • Continuing education in one of the thirteen specialty areas.

A review of the candidate’s work as well as an oral examination are also required to obtain ABPP certification. Some specialties require an additional written exam in addition to the oral component.

Recognised Specialties

In 2018, ABPP recognises the following psychology specialties (year of affiliation with ABPP in parentheses):

  • Behavioural & Cognitive (1992).
  • Clinical Child & Adolescent (2003).
  • Clinical Health (1991).
  • Clinical Neuropsychology (1984).
  • Clinical (1947).
  • Counselling (1947).
  • Couple & Family (1990).
  • Forensic (1985).
  • Geropsychology (2014).
  • Group (1997).
  • Organisational & Business Consulting (1948).
  • Police and Public Safety (2011).
  • Psychoanalysis (1996).
  • Rehabilitation (1997).
  • School (1968).
  • One subspecialty is also recognised under the umbrella of Clinical Neuropsychology – Paediatric Neuropsychology.

Board of Trustees

The Board of Trustees consists of:

  • A representative from each of the specialty boards.
  • Members of the Executive Committee (President, President-Elect, Past-President, Treasurer and Secretary).
  • The Executive Officer.
  • A Public Member.
  • An Early Career Psychologist trustee.
  • A trustee from the Council of Presidents of Psychology Specialty Academies (CPPSA).
  • The Editor of the ABPP newsletter, The Specialist, serves as an ex-officio member of the Board of Trustees.

What was the Alleged Lunatics’ Friend Society?

Introduction

The Alleged Lunatics’ Friend Society was an advocacy group started by former asylum patients and their supporters in 19th-century Britain.

The Society campaigned for greater protection against wrongful confinement or cruel and improper treatment, and for reform of the lunacy laws. The Society is recognised today as a pioneer of the psychiatric survivors movement.

Background

There was concern in the United Kingdom in the 19th century about wrongful confinement in private madhouses, or asylums, and the mistreatment of patients, with tales of such abuses appearing in newspapers and magazines. The Madhouses Act 1774 had introduced a process of certification and a system for licensing and inspecting private madhouses, but had been ineffectual in reducing abuses or allaying public anxiety. Doctors in the 19th century were establishing themselves as arbiters of sanity but were reliant on subjective diagnoses and tended to equate insanity with eccentric or immoral behaviour. Public suspicion of their motives was also aroused by the profits that were made from private madhouses.

In 1838, Richard Paternoster, a former civil servant in the East India Company, was discharged after 41 days in a London madhouse (William Finch’s madhouse at Kensington House) having been detained following a disagreement with his father over money. Once free, he published, via his solicitors, a letter in The Times announcing his release. The letter was read by John Perceval, a son of prime minister Spencer Perceval. Perceval had spent three years in two of the most expensive private asylums in England, Brislington House in Bristol, run by Quaker Edward Long Fox, and Ticehurst Asylum in Sussex. His treatment had been brutal in the Brislington House; at Ticehurst the regime was more humane but his release had been delayed. Perceval contacted Paternoster and they were soon joined by several former patients and others:

  • William Bailey (an inventor and business man who had spent several years in madhouses);
  • Lewis Phillips (a glassware manufacturer who had been incarcerated in Thomas Warburton’s asylum);
  • John Parkin (a surgeon and former asylum patient);
  • Captain Richard Saumarez (whose father was the surgeon Richard Saumarez and whose two brothers were Chancery lunatics); and
  • Luke James Hansard (a philanthropist from the family of parliamentary printers).

This group was to form the core of the Alleged Lunatics’ Friend Society, although the Society would not be formally founded until 1845.

The group began their campaign by sending letters to the press, lobbying Members of Parliament (MPs) and government officials, and publishing pamphlets. John Perceval was elected to the Board of Poor Law Guardians in the parish of Kensington (although he was opposed to the New Poor Law) and was able to join magistrates on their visits of inspection to asylums. Richard Paternoster and Lewis Phillips brought court cases against the people who had incarcerated them. John Perceval published two books about his experience. Richard Paternoster wrote a series of articles for The Satirist magazine; these were published in 1841 as a book called The Madhouse System.

Formation

On 07 July 1845, Richard Paternoster, John Perceval and a number of others formed the Alleged Lunatics’ Friend Society. A pamphlet published in March the following year set out the aims with which the Society was founded:

At a meeting of several Gentlemen feeling deeply interested in behalf of their fellow-creatures, subjected to confinement as lunatic patients.

It was unanimously resolved:… That this Society is formed for the protection of the British subject from unjust confinement, on the grounds of mental derangement, and for the redress of persons so confined; also for the protection of all persons confined as lunatic patients from cruel and improper treatment. That this Society will receive applications from persons complaining of being unjustly treated, or from their friends, aid them in obtaining legal advice, and otherwise assist and afford them all proper protection.

That the Society will endeavour to procure a reform in the laws and treatment affecting the arrest, detention, and release of persons treated as of unsound mind…

John Perceval was listed as the honorary secretary, Luke James Hansard as treasurer, and Henry F. Richardson as honorary solicitor (Gilbert Bolden would later become the Society’s lawyer). Sixteen vice-presidents included both Tory and Liberal MPs; notable amongst them was the radical MP for Finsbury, Thomas Duncombe. New legislation, championed by Lord Ashley, was being introduced in parliament (the Lunacy Act 1845 and County Asylums Act 1845) and the creation of a formal society put the group in a better position to influence legislators. Four days after the Society was founded Thomas Duncombe spoke in the House of Commons, arguing for the postponement of new legislation pending a select committee of inquiry, and detailing a number of cases of wrongful confinement that had come to the Society’s attention. The legislation however went ahead, and the Society would have to wait until 1859 for an inquiry, although the Society’s supporters in parliament managed to secure a number of clauses to safeguard patients in the 1845 Act.

Although the Society had influential supporters such as Thomas Duncombe and Thomas Wakley (surgeon, radical MP for Finsbury and coroner), they did not gain widespread public support, probably never having more than sixty members and relying upon their own money for funding. A critical article in The Times of 1846 revealed the views and prejudices that the Society would have to counter:

“We can scarcely understand what such a society can propose to accomplish… There have been, no doubt, many cases of grievous oppression in which actual lunatics have been treated with cruelty, and those who are only alleged to be insane have been most unlawfully imprisoned… These, however, are evils to be checked by the law and not tampered with… by a body of private individuals… Some of the names we have seen announced suggest to us the possibility that the promoters of this scheme are not altogether free from motives of self-preservation. There is no objection to a set of gentlemen joining together in this manner for their own protection… but we think they should be satisfied to take care of themselves, without tendering their services to all who happen to be in the same position.”

John Perceval replied that the law afforded patients insufficient protection, and that the Society existed to give legal advice to individuals and draw the government’s attention to abuses as well as to encourage a more general discussion about the nature of insanity. In response to the article’s reference to the fact that several members of the Society had been patients in asylums, Perceval had this to say:

“I would remind the writer of that article, that men are worthy of confidence in the province of their own experience, and as the wisest and best of mankind hold the tenure of their health and reasoning faculties on the will of an Inscrutable Providence, and great wits to madness are allied, he will do well to consider that their fate may be his own, and to assist them in saving others in future from like injustice and cruelties, which the ignorance of the fondest relations may expose patients to, as well as the malice of their enemies.”

Social worker Nicholas Hervey, who has written the most extensive history of the Alleged Lunatics’ Friend Society, suggested that a number of factors may have contributed to the lack of wider public support, namely: alignment with radical political circles; endorsement of localist views, rather than support of the Lunacy Commission’s centralism; fearless exposure of upper-class sensibilities regarding privacy on matters concerning insanity, thus alienating wealthy potential supporters; attacks on the new forms of moral treatment in asylums (what John Perceval referred to as “repression by mildness and coaxing”).

Achievements

As well as lobbying parliament and campaigning through the media and public meetings, during the next twenty years or so the Society took up the cases of at least seventy patients, including he following examples:

  • Dr Edward Peithman was a German tutor who had been falsely imprisoned in Bethlem Hospital for fourteen years after he had tried to gain access to Prince Albert.
    • John Perceval took up his case and, after the Commissioners in Lunacy released him in February 1854, took him home with him to Herne Bay.
    • Dr Peithman promptly tried to speak to Prince Albert again, and was committed to Hanwell Asylum.
    • Again Perceval obtained his release, this time escorting him back to Germany.
  • Jane Bright was a member of a wealthy Leicestershire family, the Brights of Skeffington Hall.
    • She was seduced by a doctor who took most of her money and left her pregnant. Soon after the birth of her child, her brothers had her committed to Northampton Hospital.
    • On her release she enlisted Gilbert Bolden, the Society’s solicitor, to help her recover the remains of her fortune from her family.
  • Anne Tottenham was a Chancery lunatic who was removed from the garden of Effra Hall Asylum in Brixton by Admiral Saumarez.
    • This course of action was a rare exception to the Society’s more usual rule of following legal routes to secure the release of patients who had been wrongly confined.
  • Charles Verity was serving a two-year prison sentence when he was transferred to Northampton Hospital. He contacted John Perceval in 1857 about abuses in the refractory ward and the Society secured an inquiry.
    • The Commissioners in Lunacy reported in 1858 that charges of cruelty and ill-usage had been established against attendants and the culprits had been dismissed.

Not all the Society’s cases were successful:

  • James Hill (father of Octavia Hill) was a Wisbech corn merchant, banker, proprietor of the newspaper the Star of the East and founder of the United Advancement Society.
    • He had been declared bankrupt and had been committed to Kensington House Asylum.
    • After his release in 1851 the Society helped him sue the proprietor of Kensington House, Dr Francis Philps, for wrongful confinement but the case was unsuccessful.
  • Captain Arthur Childe, son of William Lacon Childe, MP, of Kinlet Hall in Shropshire, was a Chancery lunatic who had been found to be of unsound mind by a lunacy inquisition in 1854.
    • The Society applied on his behalf for another lunacy inquisition in 1855, claiming he was now of sound mind.
    • The Society was unsuccessful; the jury found Captain Childe to be of unsound mind and there was a quarrel about costs.

The Society was successful in drawing attention to abuses in a number of asylums. Notable amongst these was Bethlem Hospital, which, as a charitable institution, had been exempt from inspection under the 1845 Lunacy Act. The help of the Society was enlisted by patients and they persuaded the home secretary to allow the Commissioners in Lunacy to inspect the asylum. The Commissioner’s critical report in 1852 led to reforms. Together with magistrate Purnell Bransby Purnell, the Society ran a campaign to expose abuses in asylums in Gloucestershire.

One of the aims of the Society had always been to persuade parliament to conduct a committee of inquiry into the lunacy laws. This, after numerous petitions, they finally achieved in 1859. John Perceval, Admiral Saumarez, Gilbert Bolden and Anne Tottenham (a patient they had rescued from Effra House Asylum) gave evidence to the committee. The results were disappointing; the committee made a number of recommendations in their 1860 report but these were not put into place.

Legacy

The Society’s activities appear to have come to an end in 1860s. Admiral Saumarez died in 1866, and Gilbert Bolden had a young family and moved to Birmingham. In 1862 John Perceval wrote a letter to the magazine John Bull:

“I am sorry to say that this Society is so little supported, in spite of the great good it has done, and is in consequence so entirely disorganised, that I have repeatedly proposed to the committee that we should agree to a dissolution of it, and I have only consented to continue acting with them, and to lend my name to what is rather a myth than a reality, from their representation that however insignificant we were, we had still been able to effect a great deal of good, and might still be further successful…”

Nicholas Hervey concluded:

“The Society’s importance lies in the wide panorama of ideas it laid before Shaftesbury’s Board. Unrestrained by the traditions of bureaucratic office, it was free to explore a variety of alternatives for care of the insane, many of which were too visionary or impolitic to stand a chance of implementation. The difficulty it faced was the blinkered perspective of the Commission and of Shaftesbury in particular… it would not be an exaggeration of the Society’s worth to say that patients’ rights, asylum care, and medical accountability all suffered with its demise in the 1860s.”

The cause for lunacy law reform was taken up by Louisa Lowe’s Lunacy Law Reform Association, whose aims were very similar to those of the Alleged Lunatics’ Friend Society. In more recent years the Society has been recognised as a pioneer of advocacy and the psychiatric survivors movement.

On This Day … 11 June

People (Births)

  • 1914 – Jan Hendrik van den Berg, Dutch psychiatrist and academic (d. 2012).

People (Deaths)

  • 1934 – Lev Vygotsky, Belarusian-Russian psychologist and theorist (b. 1896).

Jan Hendrik van den Berg

Jan Hendrik van den Berg (11 June 1914 to 22 September 2012) was a Dutch psychiatrist notable for his work in phenomenological psychotherapy (cf. phenomenology) and metabletics, or “psychology of historical change.” He is the author of numerous articles and books, including A different existence and The changing nature of man.

Between 1933 and 1936, he earned diplomas in primary school and high school education, the latter with a focus on mathematics. He also published papers on entomology. He then entered medical school at Utrecht University specialising in psychiatry and neurology. He completed his doctoral dissertation in 1946. One year later, after studying in both France and Switzerland, Dr. Van den Berg was appointed to Head of Department at the psychiatry clinic at Utrecht. At Utrecht, he lectured in psychopathology in the medical school and was also appointed to Professor of Pastoral Psychology in the theology department. In 1954, Dr. van den Berg took a position of Professor of Psychology at Leiden University. Since 1967, he has been a visiting professor at many universities and conducted lecture tours internationally.

Having lived most of his later life in a monumental house at the market in the historical centre of Woudrichem, he died in nearby Gorinchem.

Lev Vygotsky

Lev Semyonovich Vygotsky (Russian: Лев Семёнович Выго́тский; Belarusian: Леў Сямёнавіч Выго́цкі; 17 November 1896 to 11 June 1934) was a Soviet psychologist, known for his work on psychological development in children. He published on a diverse range of subjects, and from multiple views as his perspective changed over the years. Among his students was Alexander Luria.

He is known for his concept of the zone of proximal development (ZPD): the distance between what a student (apprentice, new employee, etc.) can do on their own, and what they can accomplish with the support of someone more knowledgeable about the activity. Vygotsky saw the ZPD as a measure of skills that are in the process of maturing, as supplement to measures of development that only look at a learner’s independent ability.

Also influential are his works on the relationship between language and thought, the development of language, and a general theory of development through actions and relationships in a socio-cultural environment.

Vygotsky is the subject of great scholarly dispute. There is a group of scholars who see parts of Vygotsky’s current legacy as distortions and who are going back to Vygotsky’s manuscripts in an attempt to make Vygotsky’s legacy more true to his actual ideas.

What is Binge Eating Disorder?

Introduction

Binge eating disorder (BED) is an eating disorder characterised by frequent and recurrent binge eating episodes with associated negative psychological and social problems, but without the compensatory behaviours common to Bulimia Nervosa, OSFED, or the Binge-Purge subtype of Anorexia Nervosa.

BED is a recently described condition, which was required to distinguish binge eating similar to that seen in bulimia nervosa but without characteristic purging. Individuals who are diagnosed with bulimia nervosa and binge eating disorder exhibit similar patterns of compulsive overeating, neurobiological features of dysfunctional cognitive control and food addiction, and biological and environmental risk factors. Some professionals consider BED to be a milder form of bulimia with the two conditions on the same spectrum.

Binge eating is one of the most prevalent eating disorders among adults, though there tends to be less media coverage and research about the disorder in comparison to anorexia nervosa and bulimia nervosa.

Brief History

The disorder was first described in 1959 by psychiatrist and researcher Albert Stunkard as “night eating syndrome” (NES). The term “binge eating” was coined to describe the same bingeing-type eating behaviour but without the exclusive nocturnal component.

There is generally less research on binge eating disorder in comparison to anorexia nervosa and bulimia nervosa.

Signs and Symptoms

Binge eating is the core symptom of BED; however, not everyone who binge eats has BED. An individual may occasionally binge eat without experiencing many of the negative physical, psychological, or social effects of BED. This may be considered disordered eating rather than a clinical disorder. Precisely defining binge eating can be problematic, however binge eating episodes in BED are generally described as having the following potential features:

  • Eating much faster than normal, perhaps in a short space of time.
  • Eating until feeling uncomfortably full.
  • Eating a large amount when not hungry.
  • Subjective loss of control over how much or what is eaten.
  • Binges may be planned in advance, involving the purchase of special binge foods, and the allocation of specific time for binging, sometimes at night.
  • Eating alone or secretly due to embarrassment over the amount of food consumed.
  • There may be a dazed mental state during the binge.
  • Not being able to remember what was eaten after the binge.
  • Feelings of guilt, shame or disgust following a food binge.

In contrast to bulimia nervosa, binge eating episodes are not regularly followed by activities intended to compensate for the amount of food consumed, such as self-induced vomiting, laxative or enema misuse, or strenuous exercise. BED is characterised more by overeating than dietary restriction. Those with BED often have poor body image and frequently diet, but are unsuccessful due to the severity of their binge eating.

Obesity is common in persons with BED, as is depression, low self-esteem, stress and boredom. Those with BED are also at risk of Non-alcoholic fatty liver disease, menstrual irregularities such as amenorrhea, and gastrointestinal problems such as acid reflux and heartburn.

Causes

As with other eating disorders, binge eating is an “expressive disorder” – a disorder that is an expression of deeper psychological problems. People who have binge eating disorder have been found to have higher weight bias internalisation, which includes low self-esteem, unhealthy eating patterns, and general body dissatisfaction. Binge eating disorder commonly develops as a result or side effect of depression, as it is common for people to turn to comfort foods when they are feeling down.

There was resistance to give binge eating disorder the status of a fully fledged eating disorder because many perceived binge eating disorder to be caused by individual choices. Previous research has focused on the relationship between body image and eating disorders, and concludes that disordered eating might be linked to rigid dieting practices. In the majority of cases of anorexia, extreme and inflexible restriction of dietary intake leads at some point to the development of binge eating, weight regain, bulimia nervosa, or a mixed form of eating disorder not otherwise specified. Binge eating may begin when individuals recover from an adoption of rigid eating habits. When under a strict diet that mimics the effects of starvation, the body may be preparing for a new type of behaviour pattern, one that consumes a large amount of food in a relatively short period of time.

Some studies show that BED aggregates in families and could be genetic. However, very few published studies around the genetics exist.

However, other research suggests that binge eating disorder can also be caused by environmental factors and the impact of traumatic events. One study showed that women with binge eating disorder experienced more adverse life events in the year prior to the onset of the development of the disorder, and that binge eating disorder was positively associated with how frequently negative events occur. Additionally, the research found that individuals who had binge eating disorder were more likely to have experienced physical abuse, perceived risk of physical abuse, stress, and body criticism. Other risk factors may include childhood obesity, critical comments about weight, low self-esteem, depression, and physical or sexual abuse in childhood. A systematic review concluded that bulimia nervosa and binge eating disorder are more impacted by family separations, a loss in their lives and negative parent-child interactions compared to those with anorexia nervosa. A few studies have suggested that there could be a genetic component to binge eating disorder, though other studies have shown more ambiguous results. Studies have shown that binge eating tends to run in families and a twin study by Bulik, Sullivan, and Kendler has shown a, “moderate heritability for binge eating” at 41%. More research must be done before any firm conclusions can be drawn regarding the heritability of binge eating disorder. Studies have also shown that eating disorders such as anorexia and bulimia reduce coping abilities, which makes it more likely for those suffering to turn to binge eating as a coping strategy.

A correlation between dietary restraint and the occurrence of binge eating has been shown in some research. While binge eaters are often believed to be lacking in self-control, the root of such behaviour might instead be linked to rigid dieting practices. The relationship between strict dieting and binge eating is characterised by a vicious circle. Binge eating is more likely to occur after dieting, and vice versa. Several forms of dieting include delay in eating (e.g. not eating during the day), restriction of overall calorie intake (e.g. setting calorie limit to 1,000 calories per day), and avoidance of certain types of food (e.g. “forbidden” food, such as sugar, carbohydrates, etc.). Strict and extreme dieting differs from ordinary dieting. Some evidence suggests the effectiveness of moderate calorie restriction in decreasing binge eating episodes among overweight individuals with binge eating disorder, at least in the short-term.

In the US it is estimated that 3.5% of young women and 30% to 40% of people who seek weight loss treatments, can be clinically diagnosed with binge eating disorder.

Diagnosis

International Classification of Diseases

BED was first included in the Diagnostic and Statistical Manual of Mental Disorders (DSM) in 1994 simply as a feature of eating disorder. In 2013 it gained formal recognition as a psychiatric condition in the DSM-5.

The 2017 update to the American version of the ICD-10 includes BED under F50.81. ICD-11 may contain a dedicated entry (6B62), defining BED as frequent, recurrent episodes of binge eating (once a week or more over a period of several months) which are not regularly followed by inappropriate compensatory behaviours aimed at preventing weight gain.

Diagnostic and Statistical Manual

Previously considered a topic for further research exploration, binge eating disorder was included in the DSM in 2013. Until 2013, binge eating disorder was categorized as an Eating Disorder Not Otherwise Specified, an umbrella category for eating disorders that don’t fall under the categories for anorexia nervosa or bulimia nervosa. Because it was not a recognised psychiatric disorder in the DSM-IV until 2013, it has been difficult to obtain insurance reimbursement for treatments. The disorder now has its own category under DSM-5, which outlines the signs and symptoms that must be present to classify a person’s behaviour as binge eating disorder. Studies have confirmed the high predictive value of these criteria for diagnosing BED.

According to the World Health Organization’s ICD-11 classification of BED, the severity of the disorder can be classified as mild (1-3 episodes/week), moderate (4-7 episodes/week), severe (8-13 episodes/week) and extreme (>14 episodes/week).

One study claims that the method for diagnosing BED is for a clinician to conduct a structured interview using the DSM-5 criteria or taking the Eating Disorder Examination. The Structured Clinical Interview takes no more than 75 minutes to complete and has a systematic approach which follows the DSM-5 criteria. The Eating Disorder Examination is a semi-structured interview which identifies the frequency of binges and associated eating disorder features.

Treatment

Counselling and certain medication, such as lisdexamfetamine and selective serotonin reuptake inhibitor (SSRIs), may help. Some recommend a multidisciplinary approach in the treatment of the disorder.

Counselling

Cognitive behavioural therapy (CBT) treatment has been demonstrated as a more effective form of treatment for BED than behavioural weight loss programmes. 50% of BED individuals achieve complete remission from binge eating and 68-90% will reduce the amount of binge eating episodes they have. CBT has also been shown to be an effective method to address self-image issues and psychiatric comorbidities (e.g. depression) associated with the disorder. The goal of CBT is to interrupt binge-eating behaviour, learn to create a normal eating schedule, change the perception around weight and shape and develop positive attitudes about one’s body. Although this treatment is successful in eliminating binge eating episodes, it does not lead to losing any weight. Recent reviews have concluded that psychological interventions such as psychotherapy and behavioural interventions are more effective than pharmacological interventions for the treatment of binge eating disorder. A meta-analysis concluded that psychotherapy based on CBT not only significantly improved binge-eating symptomatology but also reduced a client’s BMI significantly at posttreatment and longer than 6 and 12 months after treatment. There is the 12-step Overeaters Anonymous or Food Addicts in Recovery Anonymous. Behavioural weight loss treatment has been proven to be effective as a means to achieve weight loss amongst patients.

Medication

Lisdexamfetamine is a US Food and Drug Administration (FDA)-approved drug that is used for the treatment of moderate to severe binge eating disorder in adults.

Three other classes of medications are also used in the treatment of binge eating disorder: antidepressants, anticonvulsants, and anti-obesity medications. Antidepressant medications of the selective serotonin reuptake inhibitor (SSRI) have been found to effectively reduce episodes of binge eating and reduce weight. Similarly, anticonvulsant medications such as topiramate and zonisamide may be able to effectively suppress appetite. The long-term effectiveness of medication for binge eating disorder is currently unknown. For BED patients with manic episodes, risperidone is recommended. If BED patients have bipolar depression, lamotrigine is appropriate to use.

Trials of antidepressants, anticonvulsants, and anti-obesity medications suggest that these medications are superior to placebo in reducing binge eating. Medications are not considered the treatment of choice because psychotherapeutic approaches, such as CBT, are more effective than medications for binge eating disorder. A meta-analysis concluded that using medications did not reduce binge-eating episodes and BMI posttreatment at 6-12 months. This indicates a potential possibility of relapse after withdrawal from the medications. Medications also do not increase the effectiveness of psychotherapy, though some patients may benefit from anticonvulsant and anti-obesity medications, such as phentermine/topiramate, for weight loss.

Blocking opioid receptors leads to less food intake. Additionally, bupropion and naltrexone used together may cause weight loss. Combining these alongside psychotherapies like CBT may lead to better outcomes for BED.

Surgery

Bariatric surgery has also been proposed as another approach to treat BED and a recent meta-analysis showed that approximately two-thirds of individuals who seek this type of surgery for weight loss purposes have BED. Bariatric surgery recipients who had BED prior to receiving the surgery tend to have poorer weight-loss outcomes and are more likely to continue to exhibit eating behaviours characteristic of BED.

Lifestyle Interventions

Other treatments for BED include lifestyle interventions like weight training, peer support groups, and investigation of hormonal abnormalities.

Prognosis

Individuals suffering from BED often have a lower overall quality of life and commonly experience social difficulties. Early behaviour change is an accurate prediction of remission of symptoms later.

Individuals who have BED commonly have other comorbidities such as major depressive disorder, personality disorder, bipolar disorder, substance abuse, body dysmorphic disorder, kleptomania, irritable bowel syndrome, fibromyalgia, or an anxiety disorder. Individuals may also exhibit varying degrees of panic attacks and a history of attempted suicide.

While people of a healthy weight may overeat occasionally, an ongoing habit of consuming large amounts of food in a short period of time may ultimately lead to weight gain and obesity. Bingeing episodes usually include foods that are high in fat, sugar, and/or salt, but low in vitamins and minerals, as these types of foods tend to trigger the greatest chemical and emotional rewards. The main physical health consequences of this type of eating disorder are brought on by the weight gain resulting from calorie-laden bingeing episodes. Mental and emotional consequences of binge eating disorder include social weight stigma and emotional loss of control. Up to 70% of individuals with BED may also be obese, and therefore obesity-associated morbidities such as high blood pressure and coronary artery disease type 2 diabetes mellitus gastrointestinal issues (e.g. gallbladder disease), high cholesterol levels, musculoskeletal problems and obstructive sleep apnoea may also be present.

Epidemiology

General

The prevalence of BED in the general population is approximately 1-3%, with BED cases usually occurring between the ages of 12.4 and 24.7, but prevalence rates increase until the age of 40. Binge eating disorder is the most common eating disorder in adults.

The limited amount of research that has been done on BED shows that rates of binge eating disorder are fairly comparable among men and women. The lifetime prevalence of binge eating disorder has been observed in studies to be 2.0% for men and 3.5% for women, higher than that of the commonly recognised eating disorders anorexia nervosa and bulimia nervosa. However another systematic literature review found the prevalence average to be about 2.3% in women and about 0.3% in men. Lifetime prevalence rates for BED in women can range anywhere from 1.5 to 6 times higher than in men. One literature review found that point prevalence rates for BED vary from 0.1% to 24.1% depending on the sample. This same review also found that the 12-month prevalence rates vary between 0.1% to 8.8%.

Recent studies found that eating disorders which included anorexia nervosa, bulimia nervosa and binge-eating disorder are common among sexual and gender minority populations, including gay, lesbian, bisexual and transgender people. This could be due to the minority stress and discrimination this population experiences.

Due to limited and inconsistent information and research on ethnic and racial differences, prevalence rates are hard to determine for BED. Rates of binge eating disorder have been found to be similar among black women, white women, and white men, while some studies have shown that binge eating disorder is more common among black women than among white women. However, majority of the research done around BED is focused on White women. One literature review found information citing no difference between BED prevalence among Hispanic, African American, and White women while other information found that BED prevalence was highest among Hispanics followed by Black individuals and finally White people.

Worldwide Prevalence

Eating disorders have usually been considered something that was specific to Western countries. However, the prevalence of eating disorders is increasing in other non-Western countries. Though the research on binge eating disorders tends to be concentrated in North America, the disorder occurs across cultures. In the USA, BED is present in 0.8% of male adults and 1.6% of female adults in a given year.

The prevalence of BED is lower in Nordic countries compared to Europe in a study that included Finland, Sweden, Norway, and Iceland. The point prevalence ranged from 0.4 to 1.5% and the lifetime prevalence ranged from 0.7 to 5.8% for BED in women.

In a study that included Argentina, Brazil, Chile, Colombia, Mexico, and Venezuela, the point prevalence for BED was 3.53%. Therefore, this particular study found that the prevalence for BED is higher in these Latin American countries compared to Western countries.

The prevalence of BED in Europe ranges from <1 to 4%.

Co-Morbidities

BED is co-morbid with diabetes, hypertension, previous stroke, and heart disease in some individuals.

In people who have obsessive-compulsive disorder or bipolar I or II disorders, BED lifetime prevalence was found to be higher.

Additionally, 30 to 40% of individuals seeking treatment for weight-loss can be diagnosed with binge eating disorder.

Underreporting in Men

Eating disorders are oftentimes underreported in men. Underreporting could be a result of measurement bias due to how eating disorders are defined. The current definition for eating disorders focuses on thinness. However, eating disorders in men tend to centre on muscularity and would therefore warrant a need for a different measurement definition. Further research should focus on including more men in samples since previous research has focused primarily on women.