Artificial Intelligence on The Couch. Staying Human Post-AI.

This paper examines the human relationship to technology, and AI in particular, including the proposition that algorithms are the new unconscious. Key is the question of how much human ability will be duplicated and transcended by general machine intelligence. More and more people are seeking connection via social media and interaction with artificial beings. The paper examines what it means to be human and which of these traits are already or will be replicated by AI. Therapy bots already exist. It is easier to envision AI therapy guided by CBT manuals than psychoanalytic techniques. Yet, a demonstration of how AI can already perform dream analysis reaching beyond a dream's manifest content is presented. The reader is left to consider whether these findings demand a new role for psychoanalysis in supporting, sustaining, and reframing our humanity as we create technology that transcends our abilities.

In our own words: key terms and trends in psychoanalytic history.

Inspired by the work of Fonagy (2008) and Dent and Christian (2019), this study applies a form of quantitative textual analysis to 300 terms of psychoanalytic interest in the PEP archives by tracking their historical prevalence in five-year increments using the aggregate number of articles featuring each term in the field's journals. Our results confirm some of the more well-known inflection points in the history and application of psychoanalytic theory, while also revealing some intriguing surprises. Psychoanalysis remains fundamentally a depth psychology, yet it has increasingly acknowledged the external causes of distress and trauma. Changes in the prevalence of terminology around psychopathology, defense mechanisms, development, gender and sexuality, and psychoanalytic technique are discussed.

Film, psychotherapy, and the taming of rage at the mother.

In this essay, I show how difficult emotions, like aggression and murderous rage, are grappled with in horror movies. Patients' reactions to viewing these films can take place in a safe, creative, therapeutic space that allows for even the darkest themes. I discuss three patients who related to intense rage at the mother when viewing the films Joker and Jurassic Park. One patient watched Jurassic Park 50 times and shared his thoughts about the significance this film, and films in general, held for him throughout his life. It is theorized that when patients bring films into the clinical arena, they create a third space that exists between therapist and patient, a safe transitional space within which to explore difficult and otherwise unacceptable feelings.

Going Blind To See: The Psychoanalytic Treatment of Trauma, Regression and Psychosis.

I describe the analytic treatment of Mr. C, a highly intelligent man who began therapy claiming to have schizophrenia. He entered treatment on the verge of suicide, convinced of his utter isolation, and gradually, he confronted his lifelong paranoia, and learned to trust his analyst and the therapeutic process. Among his embodied realizations was the remarkable insight that paranoia kept him anchored to the world, attached to others, and thus, offset schizophrenic detachment. Paranoia also helped him maintain an optimal distance from others who could hurt him or discover his "true nature." Then, after six years and much hard work, Mr. C faced a confluence of factors that initiated the reactivation of childhood trauma and a regressive psychosis that threatened his life, his relationships, and all he had built in therapy. The journey through his six-month long psychosis was one of the greatest challenges he and I ever faced together.

For the Love of Death: Somnophilic and Necrophilic Acts and Fantasies.

The psychoanalytic literature on somnophilic and necrophilic fantasies and acts is indeed sparse. It is argued here that one must distinguish the forms of fantasy, playacting, and actual behavior that lie along a spectrum of romantic or sexual behavior involving people who are sleeping, drugged, immobile, inanimate, comatose, or dead. Regardless of these distinctions, however, the underlying dynamics commonly involve reunion with the mother, an inability to mourn, fear of the female, and an attempt at mastering and transcending the fear of death. To highlight these psychodynamics, a clinical case of somnophilia, Pedro Almodóvar's Talk to Her (a film about romantic relationships with comatose women), and the case of Count von Cosel, a quixotic necrophiliac, are presented. Gender differences are emphasized in the analysis of case material and cultural tropes.

Substance use following bariatric weight loss surgery.

OBJECTIVE: To assess substance use before and after bariatric weight loss surgery (WLS). There is a paucity of research investigating the occurrence of substance use following bariatric WLS. It was hypothesized that patients who underwent WLS would exhibit an increase in substance use (drug use, alcohol use, and cigarette smoking) following surgery to compensate for a marked decrease in food intake. DESIGN: Prospective study. SETTING: A major urban community hospital. PARTICIPANTS: A total of 155 participants (132 women and 23 men) who underwent WLS were recruited from a preoperative information session at a bariatric surgery center. INTERVENTION: Participants received either laparoscopic Roux-en-Y gastric bypass surgery (n = 100) or laparoscopic adjustable gastric band surgery (n = 55). Participants completed questionnaires to assess eating behaviors and substance use at preoperative baseline and 1, 3, 6, 12, and 24 months after surgery. MAIN OUTCOME MEASURE: Substance use as assessed by the Compulsive Behaviors Questionnaire. RESULTS: Participants reported significant increases in the frequency of substance use (a composite of drug use, alcohol use, and cigarette smoking, hereafter referred to as composite substance use) 24 months after surgery. Specifically, participants experienced a significant increase in the frequency of composite substance use from baseline to 24 months after surgery (P = .02), as well as significant increases from 1 month, 3 months, and 6 months to 24 months after surgery (all P ≤ .002). In addition, participants who underwent laparoscopic Roux-en-Y gastric bypass surgery reported a significant increase in the frequency of alcohol use from baseline to 24 months after surgery (P = .011). The response rate to the survey was 61% at 1-month follow-up, 41% at 3-month follow-up, 43% at 6-month follow-up, 49% at 12-month follow-up, and 24% at 24-month follow-up. CONCLUSIONS: Patients may be at increased risk for substance use following bariatric WLS. In particular, patients who undergo laparoscopic Roux-en-Y gastric bypass surgery may be at increased risk for alcohol use following WLS. Our study is among the first to document significant increases in substance use following WLS using longitudinal data.