Enrique Pichon-Rivière: Relentless Interplay Between Humanity and the World

Anxiety emerges when the first signs of change begin to surface. Change can occur in any environment. However, its structure is shaped by society, which simultaneously creates the necessary conditions for that change.

There is a significant difference between crisis and change. The latter is gradually planned in the form of an ideology. When it encompasses the entire social structure, it aims to exert influence on the widest possible scale. It can be observed within our professional field and is then related to all types of adjustment disorders. When communication systems experience disruption, the individual (the subject) finds themselves in situations marked by increasing isolation and disintegration. In such cases, it is also possible to observe the collective pathological phenomenon—anomie—as described by Durkheim. It is characterized on both the individual and societal level by disintegration, fragmentation, and division. Thus, we encounter a fragmented society made up of fragmented individuals.

Revolutionary movements can serve as expressions of change. If they manage to adopt a truly authentic role, individuals (subjects) soon begin to emerge from various scientific and political domains, taking on an opposing role and representing resistance to change, with the aim of maintaining the existing structure and thereby preventing transformation. Advocates or leaders of change assume the task of planning that change, which is continually hindered by institutionalized or non-institutionalized structures—in the form of certain pressure groups that assign themselves the role of guardians of the status quo. These groups personify the resistance. They are clear expressions of a reaction driven by much larger and more numerous groups with international reach. The goal is to obstruct change and preserve the previously stereotyped situation.

A crisis arises when disintegration primarily affects the ruling class and dominant groups—financial or imperialist—whose objective is control over the economy, and who come into conflict with one another. The fragmentation within the ruling groups—who fight each other using their entire information apparatus—creates the crisis situation.

Both resistance to change and change itself are subjects of planning. History can also be perceived as a continuous struggle between these two perspectives. This applies to both societal and individual history.

On an individual level, crisis situations occur more frequently than those characterized by change. However, they can both be anticipated and prepared for. Crises trigger states of anxiety in the individual and also initiate the zigzagging, personality-developing movement that accompanies every step forward—until the change has taken shape as a definitive situation. This means becoming an actively adapted and engaged human being who has found their place. The individual (subject) thus establishes a dialectical relationship with the world and transforms its phenomena from things-in-themselves into things-for-themselves. To the extent that the individual transforms themself—through this permanent, spiraling praxis—they also transform their surroundings.

The English poet John Donne, born in 1572, expressed the following about this indissoluble relationship and relentless interplay between the human being and her surroundings

No man is an island, entire of itself;
every man is a piece of the continent, a part of the main;
if a clod be washed away by the sea, Europe is the less,
as well as if a promontory were, as well as if a manor of thy friend's or of thine own were;
any man's death diminishes me, because I am involved in mankind;
and therefore never send to know for whom the bell tolls; it tolls for thee.

John Donne: Devotions upon Emergent Occasions (1624), Meditation XVII.

Uttrycken för förändringsmotstånd har till syfte att utplåna käl­lorna till den ångest varje förändring för med sig. Såväl individ som samhälle bör möta de två primära former av rädsla som åstad­kommer en grundläg­gande existentiell stör­ning: rädslan för förlust av redan etablerade strukturer - i människans inre - och rädslan för att förlora förmågan att anpassa sig till de i den sociala omgiv­ningen föreskrivna nor­merna. Förändringen implicerar i sig en för­lust och genererar - till och med in­stitutionaliserar - starka osäker­hetskänslor, vilka utmanar eller ökar iso­leringen och ensamheten - och detta huvudsakligen på grund av att man förlorat känslan av att tillhöra en stabil social grupp.

Den andra formen av rädsla som också finns närvarande är rädslan för attack. Den beror på det faktum att individen har läm­nat sin tidigare ste­reotypi, utan att vara tillräckligt rustad för att kunna försvara sig mot de faror han föreställer sig finns i den nya situationen. Denna i vår kultur så allvarliga konflikt framkallar passivitet och marginalisering. Undan för undan har annars det mänskliga och samhälleliga arbetet omvandlats till en skapelse i vilken en grupp människor före­nats i en stor ansträngning för att genom sina samlade kun­skaper och med varandra som sporre åstadkomma en produk­tivitetsnivå vilken går långt utöver vad varje gruppmedlems enskilda insats i sig betingar.

Ett typiskt exempel på revolutionerande förändring utgör Sigmund Freud. Som operativ förvaltare av den romantiska litterära tradi­tionen mottar han som författare Goethepriset. I egenskap av förändringsagent inom psykologin revolutione­rar han sin epoks moral och skakar om den vik­torianska eti­kens grundvalar. Han ger upphov till ett nytt sätt att förstå människan, vilken härigenom omfattas historiskt i hela sitt djup. Freuds inflytande kan spåras inom alla kunskapens och konstens områden. Parallellt och påver­kade av honom utveck­las litterära strömningar som fullständigt förändrar dialogen med det estetiska objektet. Sålunda växer i Zürich dadaismen fram genom en psykoanalytisk maieutik (maieutik=en mästa­res förmåga att hos sin lärjunge belysa dennes ännu ej formu­lerade uppfattningar /övers anm.). Som ett litet barn, vilket till en början endast kan säga "Da-Da", växer den undan för undan och med vissa namn­förändringar fram tills att den kulmine­rar i surrealismen som ideologisk strömning - om den nu kan be­nämnas så - vilken slutgiltigt kommer att sätta det psykoanaly­tiska inflytandets stämpel på det konstnärliga ve­tandets område. Genom att integreras med denna moderna attityd får dagens värld också ett nytt utseende.

Freud framkallar en total förändring i bilden av människan. Han lyfter fram de dolda och förflutna element, som fungerar beting­ande på beteen­det, och gör dessa begripliga genom att avslöja den mänskliga naturens underjordiska aspekter. Lik­som den stora freudianska skapelsen domi­neras även surrea­lismen av drömele­menten, vilka utgör symboliska ut­tryck för människans fantasi och för poetiskt skapande.

Varje skapande genis verk - i egenskap av förändringsagent - möts av motstånd och upplevs som revolutionärt. Därför bru­kar inte heller konst­verket genast bli förstått och accepterat i och med att det visar fram den verkliga bilden av människan samtidigt som det förstör den dittillsvarande förvrängda - och efter formella normer anpassade - bild som hon haft av sig själv och sin värld.

(1965)

José Bleger: Psychology of the Conduct.

Foreword

In the chaotic landscape of current psychology, a large number of schools and sub-schools, methods and techniques, currents and ideologies coexist in an isolated and opposing manner. The whole presents the appearance of a true dispersion, without order, without connection, without meaning, and without communication.

This book aims to fill, to some extent, this lack of coherence and unity by presenting a sort of map or project for a general psychology of behavior. It collects, reflects, or develops the conviction that the different schools or currents have contributed fragmented knowledge of a single, unified whole, and that when each of them has believed it saw the whole in its segment, they have given rise to erroneous, distorted, or exaggerated theories. Despite this process (or thanks to it), each school or current reflects part of the reality, which must be rediscovered and re-established in the original unity and totality. The different schools or currents have taken distinct structures or fragments of the same process, but segmentation and the forgetting of the process and the total and concrete context led each of them to believe they captured the entirety in their segment. Thus, the solution to many problems lies solely in reframing them.

This dispersion of the object is compounded by the fragmentation and dispersion of the very process of knowledge and research in moments that are isolated and which have been constituted as methods on their own.

What the schools, methods, and fields of psychology fragmented and scattered, disarticulated and formalized, must be recovered. This task is not an eclecticism that seeks to resolve contradictions but, on the contrary, it accepts and confronts the contradictions because they belong to the reality of the phenomena and their respective dialectical movement. A large part of the task at hand consists of dissolving false antitheses, transforming the irreducible antinomies into what they actually are: moments of a single, unique process. The barriers between schools are no longer fixed and are collapsing. This book seeks to contribute to this, so that a framework for psychology can be built free from arbitrary, strict, and dogmatic divisions and limits.

I am not entirely sure that I have avoided the danger of wavering between a simplified presentation of some topics and a deepening of others. Of course, the main goal is to rethink psychology as the fundamental task of the psychologist. It is not just about learning or teaching psychology; it is about thinking psychologically. Here, I try to apply my conviction that books are not meant to be read, but to be thought through.


Chapter I: Psychology and the Human Being

1. Approach to Psychology

It is very difficult to precisely define what psychology is, just as it is to exactly delineate the object of any science. Definitions are always included at the beginning of books and are only fully understood at the end, when one has a comprehensive perspective of the subject. In an attempt to resolve or avoid the narrowness of definitions, it has been said of another scientific field (sociology) that it is what sociologists do. If we transplant this formula to psychology, we gain nothing, because, in addition to being a truism or tautology, psychological disciplines have not yet fully established their ground, as a practical activity or profession, in the same way that sociology has. In sociology, as various authors have described, practice preceded theoretical systematization and began as a parascience, whereas in psychology, theory and philosophical speculation preceded practice and still, to a large extent, replace it; as Boring said, psychology came first, psychologists came later.

Psychology arrived very late in structuring itself as a scientific field. Like all sciences, it gradually separated from philosophy, although it maintained very close ties with it. The term "psychology" dates back to the 16th century, but it was still very rarely used in the 18th century; it was adopted by Kant and then became more widespread. Comte did not specifically include it in his classification of the sciences, and even today, psychology faces many resistances and doubts. Both idealization and contempt represent real obstacles to its development.

Scientific knowledge increases our real power over things, but diminishes and injures our fantasy and magical omnipotence. Freud pointed out that there are three discoveries that have most damaged our narcissism: first, that our planet is not the center of the universe, but one of many, with no special position; second, that we are not the kings of creation, but products of the evolution of animal species; and third, in chronological order, that we are not entirely rational beings, but that much of our conduct is unknown to us in terms of its motivations. The study of things in the heavens and on earth has not been done without effort or anxiety, but these are compounded when studying the human being himself. Therefore, the sciences of man arrived late and are still in a formative period.

The natural sciences also had to overcome strong resistances in their time, similar to those that currently arise for the sciences of man, especially psychology and sociology. But this resistance is even greater as it approaches and includes the human being itself. Physics and chemistry, as Fenichel observes, overcame resistance before biology, and biology before anatomy and physiology. These, in turn, before psychology. It is not so long ago that anatomists and pathologists were severely prohibited from dissecting corpses. Surely, this development does not solely have its causes in the evolution of psychological resistances or in a pure progress in the domain of ideas, but it is equally true that this resistance acts independently and very intensely at certain moments. The development of science is closely linked to the development of human society and its technical needs, or, in other words, to the need for the species' survival. So far, all scientific progress has propelled the factors of social change, which, of course, clash with all social forces that tend to preserve a given social configuration. In this way, scientific and philosophical advancements and setbacks are linked to complex historical processes of class interests in conflict.

2. Psychology and its Object of Study

Strictly speaking about human beings, and based on everything we’ve discussed so far, we can say that psychology studies humans. However, this does not exactly define or delimit its area of operation, because many other sciences also focus on humans as their object of study (history, anthropology, philosophy, sociology, etc.).

If, in this sense, psychology shares an object of study with many other disciplines, the identity and respective boundaries of each can only be established in two ways: either by considering that each discipline examines a part of the object for its study, or by recognizing that each discipline exclusively and uniquely focuses on a specific aspect of the same phenomenon, an exclusive focus corresponding to a group, class, or level of the object's qualities. We believe that, in general terms, the first criterion has prevailed in the history of psychology, while the second is the one we will develop here, and it should not be confused with the position that only explains and admits the existence of "different points of view" for the same event or quality.

Among the scientific disciplines, we can recognize a group characterized by having a specific object of study that belongs entirely to it: living beings are studied by biology, and the stars by astronomy. Another group is defined and initially configured by the use of a research instrument: microbiology, spectroscopy, ultramicroscopy, etc. Another group of sciences studies different aspects of the same object: chemistry and physics study the same objects, but they differ in how they approach them, corresponding to two distinct, real aspects or qualities of the same object. A table, a muscle, can be studied both by physics and chemistry. This is not meant to be a classification of the sciences, but rather a framework to help orient us in positioning psychology. Furthermore, these delimitations are only valid to a certain extent because phenomena, in reality, overlap, continue, or occur simultaneously.

With regard to psychology, we can say that it studies human beings, but it does so from a particular angle or perspective, one that attends to a specific plane of their organization as living beings. Psychology is not the only discipline that studies humans, and therefore shares its object with other sciences. Attempts to find a specific and exclusive object for each science are closely related to metaphysical assumptions about studying entities or substances. These fallacies have historically led psychology to define its object of study as the soul, consciousness, mind, or psyche, forgetting that these are abstract entities that replace concrete phenomena. With such definitions, the object of study is not clearly delimited; rather, it leads to a complicated mythology from which modern psychological currents have not entirely freed themselves. These definitions structure a verbalist psychology, or else a contradiction arises between the concrete phenomena studied and their respective theoretical formulations.

There is no such thing as a soul, psyche, mind, or consciousness; there are, however, psychological or mental phenomena, but the attribute should not be transformed into a subject or substance.

For all these reasons, it seems important to begin with the statement that psychology studies, or should study, real and concrete human beings. We know that the framing of a problem implies a limitation of the answers to it; as Socrates said, the one who answers a question is not the one who responds, but the one who formulates it. If psychology studies humans, there is always an implicit conception of the human being within it. Even within psychology, which is defined as the study of the mind or the soul, there is a conception of the human being that the human has of themselves at a particular historical moment. These assumptions are not mere speculations that arise from a purely contemplative attitude; they are always linked to the cultural and social characteristics of each era. Each historical-social organization has an image of itself.

We are interested in starting from a scientific conception of the human being, to which psychology itself has already contributed, and—fundamentally—oppose some fallacies with which traditional psychology has historically been constructed, but which still persist, to some extent, even in contemporary psychology.

3. The Myth of the Natural Man

In this type of conception, the existence of a state or original essence of the human being is postulated, one that has been corrupted or distorted by the influence of civilization. In contrast to what is socially acquired, which constitutes the artificial, the natural state of man is sustained as the genuine or ideal. From this, it has sometimes been inferred that the correct path is the "return to nature," a return to the original, natural state, discarding or setting aside everything culturally acquired and conditioned in the human being.

The religious tradition of this hypothesis is evident, even though it has been supported by non-religious authors. Nowadays, it holds historical value, but it is not uncommon to find it as part of the theoretical position or referential framework of some psychological developments.

In this type of postulation, it is implied that the natural man is good and has qualities that are lost or disturbed by the influence of social organization. Thus, an image of this ideal human being has been constructed, or it has been supposed to exist in cultures or populations of primitive organization. The development of culture, therefore, gives a superficial varnish to the human being, but beneath this lies their original nature, which in this way is unchangeable and fixed, and can be rediscovered or placed again in the foreground.

In this regard, authors as diverse as Rousseau, Klages, and Lessing held similar positions. In the seventeenth century, Hobbes, Spinoza, and Locke postulated a "natural state" prior to civilization, implying that the latter was artificial and conventional. For Rousseau, the arts and sciences had led to the decay of the essentially good primitive being, which had been corrupted by cultural influence, distancing itself from its direct and healthy relationship with nature and its original goodness. Culture was something artificial, and because it was unnatural, it caused the decline of the human being. More recently, Klages argued for an opposition between soul and spirit; the former is in direct and immediate relation with nature, while spirit is the rational sphere, the logical force that progressively destroys the former. Lessing also developed a "naturalism" as the authentic source of life, distorted by the actions of men.

In the theory of the "natural man," there are two different elements that must be recognized, as correctly established by Bidney: on one hand, the assumption of an original prehistoric natural state, from which the current human being has emerged, and—on the other hand—a universal present state, by which the human being, in all places and at all times, is the same. In the latter case, it is not a past genetic condition, but rather a universal condition of the human being that persists as such beneath cultural modifications, which are thus merely superficial.

We now know that there is no such thing as the "natural man," and that this theory is an extension, in the scientific field, of a religious fantasy that assumes the human being was created in a "pure" form by the hands of God, only to later suffer a decadence or "fall" into sin and guilt. The theory of the natural man is not an isolated postulation, but is part of a broader conception that considers the world as invariable and fixed, and that, in addition to the natural man, also postulates a natural justice, a natural right, etc. In other words, it is part of an ideology.

Anthropological research has demonstrated, incontrovertibly, that individuals in primitive cultures are not natural beings either, and that their personality is functionally correlated with the overall structure of their respective social organization, which is also not simple and straightforward, but highly complex.

We know that man is a historical product; he transforms nature, and in that process, he creates culture and transforms his own nature. With humans comes a new way of adapting: the ability to create new environmental conditions by transforming the natural environment, and this process can be carried out, in part, by anticipating the results and objectives. The human being himself is also a product of historical development and becomes a new nature: the human one.

4. The Isolated Man

This is another deeply rooted assumption in our culture and, therefore, in our scientific theories. It is assumed that the human being is originally and primitively—both as a species and as an individual—an isolated, non-social being, who gradually assimilates the necessity of relating to other individuals. Thus, one problem posed for psychology was how human beings establish relationships with one another. To address this, hypotheses were put forward—such as that of a gregarious instinct or a special energy, libido.

This abstraction is closely related to the previous one, that of the natural man, and both overlook the fact that a human is only such insofar as they are social, and that even the high degree of individuality reflected in this postulate is also a social product. In summary, it can be said that even the isolated man often considered by psychology is a social product, and this theory, often referred to as the "Robinson Crusoe theory," has no valid foundation.

The problem, in fact, is currently framed in entirely reversed terms; it is no longer a matter of understanding how isolated individuals become social beings, but rather how members of a culture and eminently social beings become isolated men. Even from the perspective of their biological development, beginning with intrauterine life, the human being exists in intense and profound interconnection with the life of other human beings, in a true symbiotic relationship. Research now focuses on the complex process of acculturation by which the human being transitions from this undivided, primitively undifferentiated state to the condition of an individual and person.

5. The Abstract Man

This is one of the most serious conceptual and methodological errors in the field of psychology, stemming from the corresponding philosophical error. It consists of studying the human being as if they were determined and isolated from the real, historical, and present situations in which their life unfolds, their personality is formed, and all kinds of relationships are established.

As a result, the more abstract the human being being studied is, the more identical all of their characteristics become, and the more fixed, eternal, and immutable the categories elaborated for them are. Abstraction leads to both the concept of the isolated man and the natural man, discarding social and cultural variants as non-essential additions to the human being, which are seen as merely superimposed or even subverting an original nature. This has led to erroneous generalizations and conclusions, to sterile concepts and notions, and to a mythology of psychological entities.

Moreover, as Foucault expresses, "when it comes to humans, abstraction is not just an intellectual error," because it transcends as an ideology, not only in the scientific field but also in the political and social spheres, as an instrument of domination and control.

In contrast, modern psychology tends to consider all psychological phenomena as derived from specific relationships and concrete interactions of the human being, as a social being, with the real situations of their life. This is the aspect that, even with various inconsistencies and errors, has been incorporated into psychology with the rise of the various schools of the past fifty or sixty years, and this is the most serious deficit of traditional psychology. In traditional psychology, the human being is studied in general; perception and memory, for example, are treated as entities in themselves, not as the human being who perceives or remembers, nor as that which is perceived or remembered, in a specific social and economic structure, at this moment, and in this situation.

This process of abstraction, realism, and formalism in traditional psychology and the innovative role of modern psychological currents have been skillfully analyzed by Politzer, to whom we refer the interested reader.

6. Individual-Society

This is a false antinomy that still deeply permeates psychology, as well as other scientific fields. It assumes that the individual is limited, distorted, or coerced by the social organization. It is closely related to the conception of the isolated man, as it assumes that, to achieve the benefits of social life, human beings have had to and still must sacrifice the satisfaction of individual tendencies, which are considered incompatible with social norms and the cultural organization in general.

These assumptions tend to obscure the irrational element of social organization, attributing it to a primitive animal organization of the human being that still exists in each one of us, thus superficially saving a deep contradiction inherent in the social structure itself. This structure is complex and contradictory, and such contradictions are reflected in the human being, both socially and individually considered. The aim is to "save" society in its present organization by considering the human being as bad and animal-like, attributing to them all the misalignments of our organization. This is the opposite of the myth of the natural man, in which the human being is good and society is bad. Thus, at some point, this latter thesis was supported as a social critique and as a progressive and renovative tendency.

If we take the case of delinquency, war, or prostitution, the schema proposed by this individual-society antinomy views them as resulting from primitive, instinctive, or animal impulses that still exist in all individuals and that, at a given moment, surpass the barriers of cultural control and repression. The problem actually lies in the fact that the same society that represses and prohibits delinquency, prostitution, and rejects wars, also paradoxically holds within it—the causal elements of these issues—in the form of irrational social components that are not controlled.

There is a permanent and close relationship between the individual and society, and only by understanding one can we truly understand the other. As human beings, we depend greatly on nature, our peers, and social organization to satisfy our needs.

7. Innate-Acquired

This antinomy has been the focus of research and debate for a long time and is closely related to other antinomies, such as nature-society, inheritance-learning, etc.

All these contradictions are shaped by formalism and a lack of understanding of the dialectical process. However, this does not occur only as an intellectual or ideological process but also reflects the struggle between "fixism" and progressive social currents. All those positions and forces striving to maintain the idea of a fixed, unchangeable nature and society, created once and for all, aligned themselves with theories that postulated the innate, while those advocating for the improvement and progress of social organization emphasized learning, acquisition, change, and development.

8. The Human Being

In contrast to the metaphysical dualisms that still permeate all of our scientific knowledge, the dialectical conception tends to consider the unity and interdependence of all phenomena, seeing all antitheses as phases or moments of a process. Thus, discussions and investigations that isolate the human being or treat abstractly a part of their manifestations—without connection to nature or their social environment—lose relevance. The human being can then be characterized by the following:

a) Their condition of belonging to a very peculiar nature: the human one. Since the Renaissance, humans have understood that they are part of nature, but much later did they accept that they also form part of a very distinct and particular nature. Their social condition gradually structures an integrated synthesis of nature and society, where the latter is not a superficial factor that modifies transient or non-essential characteristics of the human being, but rather profoundly and substantially changes the original state of being natural, in the sense that humans depend significantly, if not entirely, on nature.

b) Their condition of being concrete, meaning that they belong to a specific culture, social class, ethnic group, or religion, and this belonging is not accidental or random, but it is integral to their being and personality. Consciousness and attention should not be studied abstractly but rather the concrete behavior of a particular individual or group in specific conditions and at a given moment.

c) Their condition of being social, meaning that a human being is only a human because they incorporate and organize experiences with other individuals. The entire set of social relationships is what defines the human being in their personality.

d) Their condition of being historical, both individually and socially, as a product of a development in which new potentialities emerge that are not fixed and immutable once and for all. This high degree of development depends on a complex organization of living matter and reflects the social structure in the broadest sense.

e) Because the environment of the human being is a social one, from which fundamental stimuli arise for the organization of psychological qualities.

f) Because the human being cannot be understood purely by reflection; the knowledge that is acquired is, in turn, socially conditioned.

g) Because the human being is the only living being who can think of themselves as an object, use thought, conceive universal symbols, create language, foresee and plan actions, and use tools and techniques that modify their own nature. Even while being part of nature, the human being can, to a certain extent, be independent of it. All of this is closely linked to their unique ability—unlike any other animal—to produce their means of subsistence.

h) That the production of those means of subsistence creates the fundamental matrix of all human relationships.

Bibliography

Complete references for the citations in each chapter can be found in the general bibliography at the end of the book.

Brown, J. A. C.; Buber, M.; Cassirer, E.; Dujovne, L.; Engels, F. (e); Favez Boutonier (a); Foucault, M.; Goldstein, K. (a, b); Groethuysen, B.; Kardiner, A.; Marx, C. (a, b); Marx, C, and Engels, F. (a); Merleau Ponty, M. (b); Plejanov, J.; Politzer, G. (a); Rosenthal, M.

Enrique Pichon-Rivière: A theory of prevention approach within the family group.


From an integrative perspective of the "person in situation," and from an interdisciplinary approach, we cannot address the issue of prevention without trying to locate it in its proper context. Mental health, which is previously defined and implicit in this type of approach, is not an absolute value for us, and it can be evaluated in terms of the quality of social behavior.

This behavior, its operability, or its deterioration, is closely linked to socio-economic and family factors, which intervene or determine, either positively or negatively, an active adaptation to reality, where the individual engages with the environment in a creative and modifying relationship.

From this perspective, the central issue is not the methodology of prevention but rather the strategies for changing the socio-economic structure from which mental illness emerges. The patient is the spokesperson for the conflicts and tensions of their immediate group, the family. But, it is also for this reason that the patient is the symbol and the repository of the alienated aspects of their social structure, a spokesperson for insecurity and the climate of uncertainty. To cure them is to assign them a new role, that of agent of change, and for us to transform ourselves into elements of change as well.

It is important to note, from a perspective focused on prevention techniques, the instrumental and operational nature of the family group as the support of the social organization, the primary unit of interaction, which is established based on an interplay of differentiated roles.

Its structural nature arises from the necessary interdependence of the roles corresponding to the basic triangular situation: father, mother, and child, emerging from the functional and biological relationships and differences. This basic and universal triangular situation, with its potential cultural variables, determines the model that family interrelations will follow.

The mentioned structural nature of the family group allows us to approach it as a unit of analysis, in the sense that we can engage with it as a diagnostic, prognostic, therapeutic, and prophylactic unit.

As a basic unit of interaction, the family appears as the socializing instrument, within which the individual acquires their identity, their individual position within the interactional network. The functionality and mobility of this position will indicate the degree and nature of adaptation within that group context, of which each individual is the spokesperson.

When, within this structure, which acts as a vehicle for cultural norms, mediating between the individual and reality through relational ties, illness emerges as a new quality in the interaction process, we understand this deviant behavior as an anomaly that affects the entire structure in its intra-systemic or inter-systemic process of interrelation.

The illness is the emerging quality, a new quality that refers us, as investigators, to an implicit, underlying situation, shaped by a particular modality of group interaction, which at that moment becomes alienating. The patient is the spokesperson through which the pathological situation manifests itself, affecting the whole structure.

That is, the spokesperson (patient) is the vehicle through which the implicit process causing the illness begins to manifest.

We can affirm that any implicit process manifests itself through the appearance, within the observation field, of a new quality in that field, which we call emerging, and which refers us, as investigators, to an implicit occurrence, or in other words, to an order of underlying facts, subjected to a constant process of structuring and de-structuring.

In a previous work, we stated that madness is the expression of our inability to endure and process a certain amount of suffering. When a neurosis or psychosis emerges within the family group, we discover that a certain degree of insecurity had previously settled within that group, rendering it impotent.

This dynamically means that a member of the family group assumes a new role, becoming the spokesperson and repository of the group's anxiety. They take on the pathological aspects of the situation in an interactional process of assigning and assuming roles, involving both the individual recipient and the ones assigning them. The stereotype forms when the projection of pathological aspects arising from this insecurity is massive.

The individual becomes paralyzed, fails to process such intense anxiety, and becomes ill (at which point there is a shift from the quantitative to the qualitative).

From this moment on, the cycle of forming a pathological security mechanism is completed, triggered by increased tensions, which consists of the massive deposition, followed by the segregation of the repository due to the dangerousness of the deposited contents.

The interplay of roles is characterized in this situation by its rigidity and immobility, no longer governed by a law of complementarity but by a principle of supplementarity. That is, once the interactional process has established a stereotyped and repetitive pattern, an entire feedback system is put at the service of that pattern.

As a prevention strategy for the emergence of pathological situations within the family group, we will propose some clarification techniques aimed at reinforcing aspects of mobility and operability within the group. Our goal is to create an adaptive and creative security device that enables the group to face the situations of change that generate insecurity.

As approaches, we will follow the proposals in our inverted cone scheme, where we categorize the modes of interaction observed in any task group within the vectors of belonging, cooperation, pertinence, communication, learning, and tele. The operational group and the family group are susceptible to the same definition: a set of people gathered by constant time and space and articulated by their mutual internal representation, who implicitly or explicitly propose a task, which constitutes their purpose. In this case, within the family group, we will add kinship ties to the constants of time and space. The family group's task is, as previously stated, the socialization of the individual, providing a framework and foundation for achieving active adaptation to reality, in which both the individual and the environment undergo a permanent dialectical interplay.

This model can provide a reference framework for the operator, whether they work in what is generally understood as primary, secondary, or tertiary prevention.

The clarification and operational handling of the vectors of belonging, cooperation, pertinence, communication, learning, and tele will allow the group unit to address the anxieties triggered by the situations of change that any family group necessarily goes through.

Among these situations, we are particularly interested in highlighting two critical ones: adolescence, marked by the transition from the child's role to the adult's role, and entering old age, characterized in our family structure by the loss of operational roles. We see that in both cases, there are significant alterations in the process of assigning and assuming roles within the family group.

We understand belonging as the feeling of being part of a group, identifying with the events and vicissitudes of that group. Through belonging, group members visualize each other as such, feel the other members included in their internal world, and internalize them. Through this belonging, they can count on each other and plan the group's task, including them. Belonging allows the establishment of the group's identity and the individual's identity as part of the group. For Sartre, any group that does not reflect, as an act, upon itself runs the risk of falling into what he calls "seriality." The individual who sees themselves as a member of a group, as belonging, acquires an identity, a basic reference that allows them to situate themselves and develop strategies for change. However, optimal belonging, like the other vectors of approach, is not "given," as consanguinity ties might be, but acquired, something achieved by the group as such.

Through belonging, cooperation, and mainly pertinence, in which communication, learning, and tele play a role, the group reaches totalization in the sense of becoming in its process, in its task, in its work as a group.

Following Sartre's view of the group as an act, as something that constitutes itself permanently as a group, we must consider the fundamental role that internal dialectic plays in establishing the constitutive relationships of the group. This is why we have emphasized in this definition the fact that the group is a set of people articulated by their mutual internal representation. This representation follows the characteristics of the dramatic model. The internal dialectic is the dialectic of the internal group whose chronicle – always following the mentioned model – is unconscious fantasy. Through this dialectic, each member achieves a totalization, a synthesis, that constitutes the group as a group. Put in Sartrean terms, this internal and external dialectic leads the group to transcend seriality, understood as dispersion.

The task, the group's sense, and the mutual internal representation made in relation to the task constitute the group as a group. The task is the group's march towards its goal; it is a becoming and a dialectical doing towards an end, a praxis, and a trajectory.

In a family group, cooperation is based on differential roles. We emphasize the heterogeneity that roles within the family must exhibit. This heterogeneity is supported by the biological and functional differences on which a family structure must be configured. The family, as we have said, thus becomes the realm of learning biological roles and social functions.

Only through heterogeneity can we achieve the complementarity needed in an operational group, that is, in a group capable of instrumental and situational achievements.

A clarification of the group's communication networks, along with addressing family mysteries and analyzing ideologies, will allow, along with the adjustment between internal images and external reality, the resolution of misunderstandings, thus creating the appropriate climate for the family task.

Bibliography Sartre, J.P., Critique of Dialectical Reason, Losada, Buenos Aires, 1963
Lapassade, G., Institutions, Groups, and Organizations, Gauthier-Vilars, Paris, 1968.
Pichon-Rivière, E., "Family Groups: An Operational Approach," in this volume.
__,"Praxis and Psychiatry," ibid.
__,"Use of Tofranil in Individual and Group Psychotherapy," ibid.





Enrique Pichon-Rivière: Presentation to the chair of psychiatry at the Faculty of Medicine, National University of La Plata.

PRESENTATION TO THE CHAIR OF PSYCHIATRY AT THE FACULTY OF MEDICINE, NATIONAL UNIVERSITY OF LA PLATA

Responding to item i) of the list of requirements for the application, which states: "Outline regarding how, in case of selection, the applicant will conduct their chair. This presentation is entirely voluntary."

The teaching of psychiatry, as a particular situation, needs to be regarded as an object of study in itself. As it is generally carried out in our country it proves to be of little use both for medical students and for postgraduates.

The psychiatrist today, whether they like it or not, operates in a broad social context where interpersonal relationships and group dynamics are the primary focus of their work.

This is not a systematic plan; I merely intend to outline some possible, or rather necessary, lines of work.

  1. It is essential that students are exposed to the emotional and social problems of the sick individual - considered as a whole - as early as possible. The best opportunity for this arises when they have "live" contact with the patient during the learning of semiological techniques in a General Hospital. I say "live" contact because the first contact students have in their studies is a "dead" one, with the object of their future profession. This link with the cadaver, which is unique in the early stages of medical training, leaves remnants that shape certain future attitudes.

  2. This training could last for three years, during which students would receive knowledge in dynamic psychology, psychopathology, social psychology, anthropology etc as well as the learning of psychological and social techniques, which should run parallel to those that focus on the body as the field of work. This knowledge could be integrated in the final year through psychiatric clinical practice, alongside the study of individual and collective psychotherapy. A new way of viewing the patient, the doctor, and their interrelation should emerge from the Institute of Psychiatry.

  3. Patients (the object of study) should come from various classes, groups, areas or zones. For example, psychiatric patients can come from a Psychiatric Hospital (inpatient), a General Hospital (inpatient), or outpatient clinics, both from Psychiatric Hospitals and General Hospitals. The area corresponding to the Psychiatric Hospital, which is the primary source of educational material, is the least expansive and has the fewest social applications; however, almost all mental pathology has been constructed based on this material, and it is the one typically taught.

  4. A Psychiatry Institute must take special care in the training of postgraduates. These active professional groups can contribute significantly to the creation of a psychiatric awareness. Two types of training could be offered: a) for those who wish to specialize in psychiatry, and b) for those who wish to deepen their psychiatric understanding of their patients in general clinical practice or other specialties. It is also important to train auxiliary psychiatric staff with knowledge of dynamic psychiatry, particularly in areas such as child psychiatry and industrial psychiatry.

  5. A Psychiatry Institute should contribute to public education. For this purpose, it must first conduct research on public opinion (prejudices), social attitudes, etc. These are key situations that need to be clarified and managed by a Social and Preventive Psychiatry. The medical student must become familiar with social research techniques, such as surveys, interviews, group observations, statistical methods, etc.

  6. Every University Center should have a Mental Health Service for students as an annex to the Psychiatry Institute, as is common in some American institutes. The learning of psychiatry is often disrupted by the emergence of anxiety situations involved in the patient-doctor interpersonal relationship. Collective therapies can be of great help in this context.

  7. Research closely tied to practice (and this to learning) depends on the type of psychiatrist's training. This is our main focus because no "psychiatric issue" is unrelated to the psychiatrist's training and ideology.

In summary, we must break the narrow confines in which academic psychiatry operates. By expanding its operational field, psychiatry will take its rightful place in the university education of today’s medical professionals.

Enrique Pichon-Rivière: Corporal Schema.

Notes by Dr. Fernando Taragno

In Schilder's definition, Pichon-Riviére introduces a new dimension, the time factor: "The body schema is the four-dimensional image that each one of us has of ourselves." He conceives it as a social structure, configuring notions of space and time that govern many aspects of our relationships with others.

He considers the divisions established between mind, body, and the external world as formal separations, as phenomenological areas or dimensions of the self or person. He describes three areas: Area 1 (the mind), Area 2 (the body), and Area 3 (the external world). This division is purely formal, as everything that happens in the mind, body, or world is related to common basic situations across all of them. In other words, both neurotic and psychotic structures can be expressed in the mind, body, or external world. Nothing that happens in a specific area is not experienced by the entirety of the person. This three-dimensional schema is a phenomenological designation, a way to place different categories of good and bad objects in various areas.

He attempts to conceive this schema as a unity in constant function, where the totality is included, expressed through an outward behavior that is visible and called objective behavior, and through an internal behavior, the emotional life through the body, in a constant relationship with the object. Of the three areas, Area 2 (the body) is the most "scotomized" for the self, where the objects projected there are less recognized, as well as the connection and unconscious fantasy accompanying it.

This mind-body division, which has emerged as a result of one of the most primitive defense mechanisms (Scott), serves to separate the mind from the body, creating two "bags," if you will, to place the first introjected objects, both good and bad, so that they don’t mix and contaminate.

The child conceives his body and mind as a unit. In the progressive postnatal integration of his body schema, Pichon-Riviére introduces a new concept: these integrations occur around a prenatal axis that he calls the proto-body schema, which is made up of interoceptive, proprioceptive, etc., stimuli originating during fetal life. In progressive structuring, the body schema in a child develops particular characteristics based on oral, anal, or genital primacies. The interplay of projections occurs through these openings and primarily concerning problems of distance. For example, in hallucinations, we can see a pathology of space related to the body schema.

According to his theory of the unitary conception of neuroses, psychoses, characteropathies, and psychosomatic diseases, he establishes that the main difference between them lies in the area of expression of conflicts, whether in the mind, in the mental representation of the body, or in the mental representation of the external world. Always keeping in mind that the totality of the person is engaged, though one structure predominates.

The bond with the object is not only established with the psyche but also expressed through the body. Thought is manifested through the mind, but the entire organism is involved in the situation.

The basic psychotic anxieties underlying the different neurotic, psychotic, characteropathic, perverse, and psychosomatic structures are the same in all of them. They are depressive and paranoid anxieties, which shape the depressive and schizoparanoid positions. In the first position, the relationship is with a total object, both good and bad at the same time, before which the person experiences the feeling of ambivalence. In the schizoparanoid position, the objects are partial, divided into good and bad, creating what Pichon-Riviére has called "divalence," meaning the simultaneity of opposing partial feelings.

According to the technique used for controlling and managing these internalized partial objects, different nosographic pictures will be configured. It can be said that the basis of all mental pathology lies in the schizoparanoid position. When the partial bad or persecutor object is projected in Area 2 (the body), we have hypochondria. The persecution is experienced in the body. This is where the self feels the threat, the danger of death. It is posed as an alienation localized within the body schema. Madness is confined to the body or part of it; it has a particular meaning; the symptom appears in a specific situation, with a particular connection and an unconscious fantasy. This notion of the relationship with a persecuting object within the mental representation of the body is fundamental. The hypochondriac becomes megalomaniac by identifying with the internalized good partial object within his mind, feeling omnipotent when he manages to control his persecutors internalized in his body, control which he establishes through his mind. It can be said that he is a patient who specializes in controlling his persecutors by putting them inside his body.

In the internalization of this bad and persecuting object, a division and dispersion of the object throughout the body occur initially, resulting in generalized suffering. The fragmentation of the object is a mechanism aimed at making it easier to control the parts, it’s a "divide and conquer" approach, as M. Klein would say.

In the vast majority of cases, internalization occurs orally, within the digestive system, later spreading to other organs. As for the choice of organ within which the hypochondriacal situation is established, it falls on the one that, due to a previously learned "profession," has greater control within the limited space of the reference organ.

The hypochondriac often chooses a hypochondriacal woman who has failed to control her own persecutors. He projects his own sick organs, including the persecutors, onto her body. This externalization of his sick organs allows the hypochondriac to observe and control them from the outside. It’s what Pichon-Riviére calls externalized hypochondria. She, in turn, has chosen him because she feels he is capable of controlling her own persecutors, control in which she feels she has failed. Together, they form an inseparable pair.

In conversion hysteria, the basic situation is hypochondria. In pure hypochondria, which doesn’t actually exist, the inclusion of the bad object occurs without provoking any reaction from the organ in which it is included. When the organ reacts with its own functions, with the purpose of managing the persecuting object included within it, we find the phenomenon of conversion. For example, in hysterical paralysis, which is the prototype of neuroses that take part of the body schema and eliminate it from the rest, the self deposits the conflictual situation in a paralyzed limb, isolating it from the rest of the self through the mechanisms of division and repression.

Persecution in the body is not "psychologically" experienced because the body-mind division mechanism is permanently active. At the same time, a part of the body is isolated and its content repressed, giving rise to the feeling described by Charcot as "la belle indifférence."

The reason why conflicts are presented in the body dimension brings forth the issue of the choice of expression area, which would be related to the individual history, hereditary factors, and dispositional characteristics of each subject.

The hysterical symptom is situational because it includes a specific object relationship, which occurs in the body dimension, with that object being administered, controlled, expelled, etc., meaning it undergoes all the vicissitudes of objects, but within the mental representation of the body. In the body, defensive techniques are more limited, as they are confined to the specific functions of each organ.

The concept of conversion implicitly includes a dualism, i.e., the conversion of one system into another, or from something that belongs to it. This is why Pichon-Riviére thinks the word is beginning to be troublesome. Because if one considers that what happens in the body is relational, a specific way of approaching the object within a total situation with a particular fantasy, conversion disappears. This term complicates the total understanding of the phenomenon, the organic symptom. On the other hand, the concept of situational relationship, connection, or visceral behavior facilitates it.

Conversion hysteria can be divided into two groups, depending on the system that intervenes in the control of internalized persecutor objects. On one hand, we have true conversion hysteria, where control is carried out through the central nervous system, in the neuromuscular and sensory system, such as in paralysis, blindness, convulsions, etc. On the other hand, there are so-called psychosomatic diseases, where control is established through the autonomic or neurovegetative system, expressing itself in the visceral field. Psychosomatic disease must be understood, in relational terms, as the establishment of a particular bond with a given object, within the body schema, with the functions of the organ regressing to earlier stages, where certain types of bonds predominated. This regression in organ functions creates a mismatch in the total economy, leading to the disease (Pichon-Riviére). The regression is towards the dispositional point, which is the developmental moment when certain types of visceral behavior were organized, achieving at a given point the control of anxieties.

During the phenomenon of regression, this does not only occur in the sense that objects are deposited in the body, but the organ itself also undergoes regression regarding its functions. For example, the stomach of an ulcer patient is a stomach that has regressed to its infantile stage, as the rhythm of hunger and satisfaction is similar to that of that period. The painful hunger of the ulcer patient is equivalent to the painful hunger of the infant. Here, the regression of functions to a specific stage and particular connections can be seen, with the totality of the person returning to a type of behavior that was operative in defending against anxiety.

The illness would arise from the conflict between the regression of an organ to a more primitive function and the persistence of the rest of the body at a more adult level. This would explain the pathology specific to the organ and the influence of the organ on the total economy. According to Pichon-Riviére, the organ that becomes ill is not the weakest, as it has been considered so far, but rather the strongest, the most resistant. Because the chosen organ is the place where the ego is most entrenched, where there is the most communication between it and the functions of the organ in question. The choice is made for the organ that already knows the task. Thus, the ulcer patient has long been thinking and acting with their stomach, trying to control the pursuing objects that determine their paranoid anxieties.

From a dispositional perspective, the chosen organ is the one that, at a given moment, has tended to establish a defense from there.

In the phenomenon of conversion, the relationship with the internal object is not explicitly stated, but it is implied, although not visible. What is visible are the defensive mechanisms that cause all the symptoms of conversion, either through the central nervous system, the peripheral nervous system, or the neurovegetative system. These are different levels of expression of behaviors through the body.

The subject configures a psychosomatic illness at a given moment with the purpose of "escaping" from psychosis (Pichon-Riviére). From a social perspective, it has the great advantage that this illness does not appear in the category of alienation. The subject suffering from it is considered a body patient and not recognized as a mental patient.

We should consider it as a pattern of repetitive behavior expressed through the body. A pattern that includes both the organ and the object, its connection, and the unconscious fantasy in totality. There is always an alternation between a bodily expression and a mental expression, and quite frequently the succession of psychosomatic conditions with psychotic episodes.

It can be said that children who have been overprotected in a situation of illness in a particular organ tend to escape from the mental situation and develop a psychosomatic illness. Meanwhile, children who have suffered from a situation of bodily neglect tend to develop mental elaboration. Repeating a situation of bodily neglect is much more dangerous for them, so they try to elaborate the situation through the mind. Among these three nosographic pictures—hypochondria, conversion hysteria, and psychosomatic illness—only phenomenological differences exist, having instead a common dynamic unity.

The phantom limb highlights a serious disturbance of the bodily schema. It is of particular interest because it poses the problem of alienation in the body. It is characterized by the compensatory illusion of the amputation on an amputated limb. It occurs in an unconscious, conflicted, and situational context. It appears in some cases, and specifically in front of certain people, with specific unconscious content. The phantom, by occupying a spatial position, that empty space from the stump, raises the problem of externalization, in the same way as in visual or auditory hallucinations, for example. The essential mechanism is the division of the bodily schema, followed by repression. It appears mainly in narcissistic structures, where internal relationships in the bodily domain are fundamental. The illusion of the amputee is a mechanism for recovering the object through the phantom limb (Pichon-Riviére). Thus, we find: 1) a narcissistic structure; 2) the loss of the limb; 3) the depression following the loss of the object included in that part of the body, and 4) the recovery or establishment of the lost bond through a hallucinatory mechanism. The reintroduction of the object occurs through the stump, a displaced oral route. The phantom detaches itself from the rest of the body through the mechanism of division.

In any kind of hallucination—whether visual, auditory, etc.—the problem of externalization is posed. There is an alteration of the bodily schema in the sense that a part of oneself is placed outside, through the mechanism of division and projection. It is the situation of one divided into two, and one of those parts placed outside and later perceived as though it belongs to someone else. This occurs during waking in hallucinatory delusions, where, for example, the voice heard from outside is produced by the extension of the bodily schema, which has been divided and functions by creating a situation of two.

The "influence apparatus is, ultimately, a part of the body itself that has been placed outside through the projection mechanism. It then appears as the representation of the own penis or sexual organs projected into the outside world.

In depersonalization, the bodily schema is massively compromised. It can involve both the sphere of the mind and the body. The first symptom of a hypochondriacal delusion evolving into a Cotard delusion is the estrangement from the body. It appears before the specular vision as different. In Cotard syndrome, the first situation that occurs is the internalization of the persecutor in the body, configuring hypochondria. It then denies the incorporated object, including the organ where it has been included, expressing, for example, that they have no stomach, heart, etc. Finally, they rationalize the reason for not having that organ by constructing the delusion of denial.

Anosognosia is the failure to perceive a zone of the bodily schema, whether altered or not, functionally and organically, for example, in the case of hysterical paralysis, blindness, etc. Here we find the mechanism of denial through the bodily schema.

Negative external autoscopy is the failure to perceive one’s own specular image in the mirror, i.e., not perceiving the image reflected in the mirror. Positive autoscopy occurs when the subject sees their double outside, in any place, as if in front of the mirror.

In the phenomenon of levitation, sudden sensations of lightness occur, with alterations in body weight and consistency. It is the expression of a manic bond in the bodily area (Pichon-Riviére).

In epilepsy, sudden alterations of the bodily schema occur, with paroxysmal character being the most typical element. These disturbances are very frequent and should be systematically searched for.

During the application of biological treatments, very frequent and significant changes to the body schema occur. Upon awakening from an insulin coma, alterations can even reach experiences of metamorphosis (Pichon-Riviére). The same occurs with the administration of mescaline and LSD-25. Electroshock, electronarcosis, etc., also cause changes in the body image, as does prolonged sleep application.

Space is comprised of three areas: mind, body, and external world, functioning with a given time and situation, the dynamic origin of which is constituted by the bond, a functional structure that includes the subject, the object, and a two-way communication that can suffer disturbances specific to each neurosis, psychosis, characteropathy, perversion, and the so-called psychosomatic phenomena.



Summary:

Schilder defines the body image as "the three-dimensional mental representation that each of us has of ourselves." This image is constructed based on multiple sensations that dynamically integrate into a Gestalt of the body. It is a structure in constant disintegration and restructuring. Libido plays a fundamental role. He describes the space of the ego, the objective space, and the space of the id, where affections bring objects closer or push them away. There is also the body space and the external space.

Scott suggests that the mind-body division arises from an early defense mechanism aimed at resolving specific anxieties. The phenomenon of the bodily surface is fundamental for establishing the domain of the self and the non-self.

Pichon-Riviére describes three phenomenological areas of the self or person: mind, body, and the external world. The integration of the schema is based on a prenatal proto-body schema. According to his theory of the unitary conception of neuroses, psychoses, character disorders, and psychosomatic diseases, he establishes that the main difference between them is the area of conflict expression. When these conflicts are expressed in the body (Area 2), and depending on the technique used to control the internalized pursuing objects, we have hypochondria, conversion hysteria, and the so-called psychosomatic diseases. The control is established, respectively, through the mind, the central nervous system (expressed in the muscular and sensory territories), and the neurovegetative system (expressed in the visceral field). The organ that becomes ill is the strongest, not the site of least resistance.

The author proposes the designation of the self-schema as a conceptual, referential, and operational schema that includes the three dimensions: mind, body, and the external world, functioning with a given time and link that includes the subject, the object, and their communication.

Acta Neuropsiquiátrica Argentina, 1959.