Splits in the fabric: A community psychoanalytic project during COVID-19.

Demonstrating how psychoanalysts can be useful in community settings outside the conventional consulting room, this paper describes consultation and group interventions conducted at a San Francisco mental health agency serving a largely Asian community. In the traumatic context of the COVID-19 pandemic, agency staff became fragmented, due to remote working conditions and differential work assignments, including mandated deployments to emergency sites. Two psychoanalysts worked with agency leadership to devise a weekly process group held by video conferencing over 6 months, in an attempt to heal resentments and splits in the fabric of the agency. Examples of the group process, interventions, and major themes that emerged are described, as well as recommendations made, including the formation of an ongoing clinical consultation group. The paper situates these interventions in the greater context of the pandemic which exposed not only a universal threat to life and health, but also structural vulnerabilities organized along lines of (racial) difference and inequity. The dynamics at the agency are thus described as rooted within greater nested histories: of the clinic, its leadership, and their relationship with a strained public health system, and more broadly, of the tangled intersection of these histories with anti-Asian racism. These are understood as manifestations of the Social Unconscious, and the intervention as an example of Community Psychoanalysis.

Addressing Bias in the Occupational Therapy Admissions Process.

This study investigated the impact of a workshop in reducing unconscious bias in admissions committee members of an occupational therapy program to determine if workshop participation increased the number of underrepresented students in the program. A convenience sample of 50 committee members was used. A Wilcoxon matched pairs signed rank test indicated a significant increase in the post-test survey question scores. A chi-square test of independence revealed a significant increase in the number of students in the program from underrepresented groups. These results suggest that an online workshop can reduce perceived bias and increase diversity in an occupational therapy program.

Brouillet's Une leçon clinique à la Salpêtrière as an epistemic tool in Charcot's research on hysterical amnesia.

Much has been written, mostly in overly critical terms, about Jean-Martin Charcot's use of images in his hysteria research. Besides the images of patients Charcot produced for his clinical research, one other image has preoccupied present-day scholars-André Brouillet's painting Une leçon clinique à la Salpêtrière. Unveiled at the 1887 Salon in Paris, this life-sized painting depicts Charcot lecturing on hysteria to his male audience while presenting a swooning female patient. For many present-day critics, Brouillet's painting symbolizes Charcot's purported misuse of his female hysteria patients. Contrary to such interpretations, this article shows that Brouillet's painting did not merely serve as an iconic visual representation of Charcot's hysteria research but was also used by Charcot as an active epistemic tool in his research on hysterical amnesia. Through a close reading of Charcot's only published lecture on hysterical amnesia, which he held on December 22, 1891, I analyze the process through which Charcot generated new medical insights into hysterical amnesia. I thereby trace the decisive role that Une leçon clinique played in this process.

Different mechanisms of contextual inference govern associatively learned and sensory-evoked postural responses.

Human standing balance relies on the continuous monitoring and integration of sensory signals to infer our body's motion and orientation within the environment. However, when sensory information is no longer contextually relevant to balancing the body (e.g., when sensory and motor signals are incongruent), sensory-evoked balance responses are rapidly suppressed, much earlier than any conscious perception of changes in balance control. Here, we used a robotic balance simulator to assess whether associatively learned postural responses are similarly modulated by sensorimotor incongruence and contextual relevance to postural control. Twenty-nine participants in three groups were classically conditioned to generate postural responses to whole-body perturbations when presented with an initially neutral sound cue. During catch and extinction trials, participants received only the auditory stimulus but in different sensorimotor states corresponding to their group: 1) during normal active balance, 2) while immobilized, and 3) throughout periods where the computer subtly removed active control over balance. In the balancing and immobilized states, conditioned responses were either evoked or suppressed, respectively, according to the (in)ability to control movement. Following the immobilized state, conditioned responses were renewed when balance was restored, indicating that conditioning was retained but only expressed when contextually relevant. In contrast, conditioned responses persisted in the computer-controlled state even though there was no causal relationship between motor and sensory signals. These findings suggest that mechanisms responsible for sensory-evoked and conditioned postural responses do not share a single, central contextual inference and assessment of their relevance to postural control, and may instead operate in parallel.

Unconscious multisensory integration: behavioral and neural evidence from subliminal stimuli.

Introduction: The prevailing theories of consciousness consider the integration of different sensory stimuli as a key component for this phenomenon to rise on the brain level. Despite many theories and models have been proposed for multisensory integration between supraliminal stimuli (e.g., the optimal integration model), we do not know if multisensory integration occurs also for subliminal stimuli and what psychophysical mechanisms it follows. Methods: To investigate this, subjects were exposed to visual (Virtual Reality) and/or haptic stimuli (Electro-Cutaneous Stimulation) above or below their perceptual threshold. They had to discriminate, in a two-Alternative Forced Choice Task, the intensity of unimodal and/or bimodal stimuli. They were then asked to discriminate the sensory modality while recording their EEG responses. Results: We found evidence of multisensory integration for supraliminal condition, following the classical optimal model. Importantly, even for subliminal trials participant's performances in the bimodal condition were significantly more accurate when discriminating the intensity of the stimulation. Moreover, significant differences emerged between unimodal and bimodal activity templates in parieto-temporal areas known for their integrative role. Discussion: These converging evidences - even if preliminary and needing confirmation from the collection of further data - suggest that subliminal multimodal stimuli can be integrated, thus filling a meaningful gap in the debate about the relationship between consciousness and multisensory integration.

Advancing the treatment of anxiety disorders in transition-age youth: a review of the therapeutic effects of unconscious exposure.

BACKGROUND: The real-world effectiveness of exposure-based therapies for youth depends on the willingness and ability of young people to tolerate confronting their fears, which can be experienced as highly aversive and create problems with treatment engagement and acceptance. Recently, neuroscientific research on the nonconscious basis of fear has been translated into novel exposure interventions that bypass conscious processing of feared stimuli and that thus do not cause phobic youth to experience distress. We present a review of these unconscious exposure interventions. METHODS: A PRISMA-based search yielded 20 controlled experiments based on three paradigms that tested if fear-related responses could be reduced without conscious awareness in highly phobic, transition-age youth: 14 randomized controlled trials (RCTs), 5 fMRI studies (1 was also an RCT), 4 psychophysiological studies (3 were also RCTs), and 1 ERP study. We conducted meta-analyses of outcomes where feasible. RESULTS: Unconscious exposure interventions significantly (1) reduced avoidance behavior (range of Cohen's d = 0.51-0.95) and self-reported fear (d = 0.45-1.25) during in vivo exposure to the feared situation; (2) reduced neurobiological indicators of fear (d = 0.54-0.62) and concomitant physiological arousal (d = 0.55-0.64); (3) activated neural systems supporting fear regulation more strongly than visible exposure to the same stimuli (d = 1.2-1.5); (4) activated regions supporting fear regulation that mediated the reduction of avoidance behavior (d = 0.70); (5) evoked ERPs suggesting encoding of extinction memories (d = 2.13); and (6) had these effects without inducing autonomic arousal or subjective fear. CONCLUSIONS: Unconscious exposure interventions significantly reduce a variety of symptomatic behaviors with mostly moderate effect sizes in transition-age youth with specific phobias. fMRI and physiological findings establish a neurophysiological basis for this efficacy, and suggest it occurs through extinction learning. Unconscious exposure was well tolerated, entirely unassociated with drop out, and is highly scalable for clinical practice. However, a number of limitations must be addressed to assess potential clinical impacts, including combining unconscious exposure with exposure therapy to boost treatment acceptance and efficacy.

High Neural Efficiency in Unconscious Perceptual Processing among Table Tennis Athletes: An Event-Related Potential Study.

BACKGROUND: Neural efficiency refers to the brain's ability to function with reduced resource expenditure while maintaining high performance levels. Previous research has demonstrated that table tennis athletes have greater neural efficiency at the conscious level. However, it is unknown whether they exhibit greater neural efficiency at the unconscious level. Therefore, this study aims to investigate unconscious perceptual processing and neural efficiency in elite table tennis athletes through tasks involving the judgment of spin serves. METHODS: Fifty healthy, right-handed individuals participated in this study, including 25 elite table tennis athletes and 25 control participants without professional training experience. To evaluate the unconscious perceptual characteristics of both groups, we used a combination of masked priming paradigm and event-related potential techniques. RESULTS: The behavioral results reveal that, compared to the control group, the table tennis athletes displayed reduced reaction times (p < 0.001) and increased priming effects (p < 0.001) under unconscious conditions. The electrophysiological findings indicated that both groups elicited N1, N2, and P2 components. Notably, compared to the control group, the table tennis athletes exhibited significantly lower amplitude responses at the occipital lobe electrodes PO3, POz, PO4, O1, Oz, and O2 (p < 0.001). CONCLUSIONS: These results further support the neural efficiency hypothesis, indicating that prolonged professional training enhances athletes' capacities for specialized unconscious cognitive processing.

Two masked prime arrows simultaneously affect a response to a target: Revealing of an additive unconscious priming effect.

Since there are many sources of unconscious information in our minds, there is a possibility that multiple channels of unconscious information can affect a response at the same time. However, this question has been largely ignored by researchers. In the present study, we presented two opposite pointing arrows as the masked primes followed by a target arrow. The results suggested that the two directions in which the two prime arrows are pointing influenced the response to the target simultaneously and additively, that is, the overall priming effect caused by the two opposite pointing prime arrows was equal to the net effect of the individual congruent effect elicited by the same pointing prime arrow and the individual incongruent priming effect induced by the prime arrow poitning in the opposite direction. In addition, in Experiment 1, a biased delayed response to the target was observed when the target arrow and the opposite pointing prime arrow were closely positioned in space due to Gestalt continuity and closure grouping. According to these results, the "independent unconscious influence" and "reverse unconscious selection" hypotheses are proposed.

Kaës' Internal Groups and Actual Groups: A Relational Perspective.

Rene Kaës (2007), an influential French psychoanalyst relatively unknown to English-speaking readers, extends the field of psychoanalytic investigation and practice to groups. Building on Klein, Anzeiu, Bion, and Lacan, Kaës presents a dual-axes theory in which early oedipal and sibling complexes structure unconscious dynamics of internal groups. According to Kaës, analytic group psychotherapy provides access to the phantasies, affects, and action tendencies contained within internal groups that would be otherwise inaccessible. While a few reference articles have appeared in the English literature, Kaës' bold assertions, core concepts, and praxis have not been subject to critical evaluation. I introduce Kaës' main ideas, demonstrate their influence on my group work, and by comparing two case examples, from his practice and mine, articulate our differences, some of which arise from different conceptions of and approaches to intersubjectivity. The discussion continues in the final section which briefly considers the nature of psychoanalytic learning and how we may employ the therapeutic group to reach this goal.

Pupil dilation reflects covert familiar face recognition under interocular suppression.

In prosopagnosia, brain lesions impair overt face recognition, but not face detection, and may coexist with residual covert recognition of familiar faces. Previous studies that simulated covert recognition in healthy individuals have impaired face detection as well as recognition, thus not fully mirroring the deficits in prosopagnosia. We evaluated a model of covert recognition based on continuous flash suppression (CFS). Familiar and unfamiliar faces and houses were masked while participants performed two discrimination tasks. With increased suppression, face/house discrimination remained largely intact, but face familiarity discrimination deteriorated. Covert recognition was present across all masking levels, evinced by higher pupil dilation to familiar than unfamiliar faces. Pupil dilation was uncorrelated with overt performance across subjects. Thus, CFS can impede overt face recognition without disrupting covert recognition and face detection, mirroring critical features of prosopagnosia. CFS could be used to uncover shared neural mechanisms of covert recognition in prosopagnosic patients and neurotypicals.

The Public Understanding of Analytical Psychology.

In 1960, Jung lamented psychology's limited impact on global fate. Although Fordham tried to reassure him that Jungians were promoting his work, Jung was looking from the other end of the telescope, seeing the need to rescue humanity from its one-sidedness that would ultimately lead to nuclear conflict. Astronomical evidence, such as the Fermi paradox, echoes Jung's concerns about likely self-destruction. Rather than promoting Jungian ideas to interested groups, the imperative lies in identifying crucial messages for global survival and engaging the public in them. Science provides some useful lessons because its concerted efforts over centuries led to the gradual integration of scientific thinking into the public psyche. These lessons suggest that, to cross the border from the Jungian to wider public domain, compromises are necessary, such as simplifying messages and making engagement enchanting and practical. Analytical psychology's task goes beyond one individual, group, or even generation, and a debate is needed to begin to form a consensus on the way ahead. Some initial suggestions are made for adopting terminology the public can relate to, focusing on the transcendent function as the main vehicle to overcome one-sidedness and conflict, and using figures like Nelson Mandela to demonstrate practical application.

En 1960 Jung se désolait du faible impact de la psychologie sur le destin global. Bien que Fordham ait essayé de le rassurer, lui disant que les Jungiens faisaient la promotion de son travail, Jung regardait les choses d'un point de vue différent. Il voyait le besoin de sauver l'humanité de sa partialité, partialité qui l'amènerait en fin de compte au conflit nucléaire. Les indices venant de l'astronomie, comme le paradoxe de Fermi, font écho aux préoccupations de Jung concernant une probable autodestruction. Plutôt que de promouvoir les idées jungiennes à des groupes de personnes intéressées, l'impératif serait d'identifier des messages cruciaux pour la survie globale et de mobiliser le public avec de tels messages. La science fournit des leçons utiles parce que ses efforts d'ensemble sur une durée de plusieurs siècles ont apporté l'intégration progressive du penser scientifique dans la psyché publique. Ces leçons suggèrent que ­ pour traverser la frontière entre le monde Jungien et un domaine public plus large ­ des compromis sont nécessaires, tels que de simplifier les messages et de rendre l'implication séduisante et réaliste. La tâche de la psychologie analytique va au­delà d'un individu, d'un groupe, ou même d'une génération, et nous avons besoin d'un débat afin de commencer à élaborer un consensus sur le chemin devant nous. Quelques suggestions initiales sont faites pour adopter une terminologie à laquelle le public puisse s'identifier, se concentrant sur la fonction transcendante comme véhicule principal pour surmonter la partialité et le conflit, et utilisant des personnalités telles Nelson Mandela pour démontrer l'utilité pratique.

En 1960, Jung se lamentaba del limitado impacto de la psicología en el destino global. Aunque Fordham intentó asegurarle que los Junguianos estaban promoviendo su trabajo, Jung mirando desde el otro extremo del telescopio, estaba viendo la necesidad de rescatar a la humanidad de su unilateralidad que, en última instancia, conduciría al conflicto nuclear. La evidencia astronómica, como la paradoja de Fermi, refleja las preocupaciones de Jung sobre la probable autodestrucción. En lugar de promover las ideas de Jung entre los grupos interesados, el imperativo reside en identificar los mensajes cruciales para la supervivencia global e implicar al público en ellos. La ciencia ofrece algunas lecciones útiles porque sus esfuerzos concertados durante siglos condujeron a la integración gradual del pensamiento científico en la psique pública. Estas lecciones sugieren que, para cruzar la frontera de lo Junguiano a un dominio público más amplio, son necesarios compromisos, como simplificar los mensajes y hacer que el compromiso sea encantador y práctico. La tarea de la psicología analítica va más allá de un individuo, grupo o incluso generación, y es necesario un debate para empezar a formar un consenso sobre el camino a seguir. Se hacen algunas sugerencias iniciales para adoptar una terminología con la que el público pueda identificarse, centrándose en la función trascendente como vehículo principal para superar la unilateralidad y el conflicto, y utilizando figuras como Nelson Mandela para demostrar la aplicación práctica.

Use of Countertransference to Advance Therapeutic Efficacy.

Countertransference is a basic tenet of psychodynamic theory. Although it was initially considered an unwelcome phenomenon in psychiatry, attitudes have shifted, and many mental health professionals now consider it to be a useful therapeutic tool. In this article, the author discusses countertransference as defined by the International Psychoanalytical Association's Inter-Regional Encyclopedic Dictionary of Psychoanalysis (IRED) and examines its clinical impact by using constructed vignettes of psychodynamic psychotherapies to illustrate theoretical points. As IRED delineates, countertransferences may exist at the conscious or unconscious level. In addition, the author suggests that countertransference may also exist at the preconscious level. Clinicians' examination of all levels of countertransference has the potential to be revelatory and facilitate therapeutic action, whereas unexamined countertransference can interfere with effective treatment. For this reason, self-reflection on the part of psychiatrists is essential.

War, terror and mourning. Cultural memory in the inner dialogue.

This text compares four essays dealing with war, state terror in dictatorships, social violence such as racism, mourning and the avoidance of mourning. It shows that dictatorships share similarities in their techniques of manipulation, linguistic style and reference to history. They seek to exploit national myths through manipulative alienation. Myths are a central element of cultural memory, and their effect can be understood through a model of internal dialogue. This dialogue determines whether the regime's attempts at manipulation are successful.

Rethinking the concepts of the unconscious and analytic time.

The author proposes ways of rethinking the concepts of the unconscious and time in the analytic setting, including the very existence of the unconscious. Freud (1915) stated that the success psychoanalytic thinking has in making inferences about the patient's unconscious makes the existence of the unconscious "incontrovertible." The author submits that this success does not establish the existence of the unconscious; rather, the inferences we think we make about the unconscious are inferences about consciousness itself - the totality of our experiences of thinking, feeling, sensing, observing, and communicating with ourselves. The author then offers thoughts about a second analytic concept, the experience of time in the analytic setting. He conceives of there being two inseparable sorts of experiences of analytic time that stand in a dynamic relationship with one another: diachronic time (clock time) and synchronic time (dream time). In diachronic time, time is sequential; one thing leads to another. In synchronic time, all time is contained in the present. In analysis, childhood trauma is experienced for the first time (in synchronic time) in the co-created subjectivity of patient and analyst.

Neurophysiological Pathways of Unconscious Emotion Processing in Depression: Insights from a simultaneous EEG-fMRI Measurement.

BACKGROUND: Major depressive disorder (MDD) is characterized by strong emotional dysregulation. Mechanisms driving the negative affect in depression may be fast processes existing on an unconscious level. METHODS: A priming task was conducted using simultaneous EEG-fMRI measurement involving presentation of facial expressions (happy, sad, neutral) to examine the neurophysiological pathway of biased unconscious emotion processing in MDD. Priming prior to a target emotion created unconscious (16.7 ms primer) and conscious (150 ms primer) trials. A large sample of N = 126 was recruited, containing healthy controls (HC; n = 66; 37 women) and MDD (n = 60; 31 women). RESULTS: HC showed a shorter reaction time in happy, but not in sad or neutral trials compared to MDD. N170 amplitudes were lower in trials with unconscious compared to conscious primer presentation. N170 amplitudes correlated with cortical (right fusiform gyrus (FFG), right middle temporal gyrus, right inferior temporal gyrus, left supplementary motor area, right middle frontal gyrus) and subcortical brain regions (right amygdala). The strength of N170 and brain activity correlation increased when the stimulus was consciously presented. Presented emotions did not affect the correlation of N170 values and brain activity. CONCLUSIONS: Our findings show that MDD may exhibit biased emotion regulation abilities at a behavioral and neurophysiological level. Face-sensitive event-related potentials demonstrate a correlation with heightened brain activity in regions associated with both face recognition (FFG) and emotion processing (amygdala). These findings are evident in both MDD and HC, with lower effect sizes in MDD indicating reduced emotion recognition and processing abilities.

Freud in Bulgaria: Psychoanalysis, Literature, Translation: An Experience with the Singular.

This contribution considers a monthly seminar, Literature and Psychoanalysis, that has been taking place at Sofia University (Sofia, Bulgaria) since 2017. Three of the seminar's founders reflect on the transferences between literature and psychoanalysis, and on the ways in which literature and psychoanalysis can meaningfully converse. The exchange also touches on the fate of Freud's textual legacy in communist and post-communist Bulgaria.

Does the right hemisphere retain functional characteristics typical of the emotional adaptive system? An evolutionary approach to the problem of brain asymmetries.

The right and left hemispheres host two complementary adaptive systems with a right-sided prevalence of automatic and unconscious processing modes, typical of the 'emotional system', and a left-sided prevalence of propositional and conscious processing modes typical of the 'cognitive system' The principal right hemispheric syndromes (and the functioning modes typical of this hemisphere) are, indeed, characterized by automatic and unconscious processing modalities. Thus, the unilateral neglect syndrome discloses a defective automatic (and spared intentional) spatial orienting of attention; face and voice recognition disorders are due to disruption of mechanisms that automatically generate familiarity feelings and anosognosia seems due to the unconscious loss of personal significance attributed by the patient to the pathological event. Since emotions were the only adaptive system existing before the development of language (which is provided of a strong capacity to develop and shape cognition), the persistence in the right hemisphere of mechanisms typical of the emotional system strongly supports an evolutionary model of brain laterality. (160 words).

Unconscious Perception of Vernier Offsets.

The comparison between conscious and unconscious perception is a cornerstone of consciousness science. However, most studies reporting above-chance discrimination of unseen stimuli do not control for criterion biases when assessing awareness. We tested whether observers can discriminate subjectively invisible offsets of Vernier stimuli when visibility is probed using a bias-free task. To reduce visibility, stimuli were either backward masked or presented for very brief durations (1-3 milliseconds) using a modern-day Tachistoscope. We found some behavioral indicators of perception without awareness, and yet, no conclusive evidence thereof. To seek more decisive proof, we simulated a series of Bayesian observer models, including some that produce visibility judgements alongside type-1 judgements. Our data are best accounted for by observers with slightly suboptimal conscious access to sensory evidence. Overall, the stimuli and visibility manipulations employed here induced mild instances of blindsight-like behavior, making them attractive candidates for future investigation of this phenomenon.