Presenter: Maxine Nelson, LICSW, FIPA
Discussant: Christopher Keats, MD
This paper will explore the treatment of a middle-aged man with psychotic features who unexpectedly emerged from a long-standing psychic impasse in his eighteenth year of treatment. A previous paper about this patient (2014) described the ways in which unmetaboilzed mourning had contributed to his having established a 'psychic bunker' in which he oscillated between states of being dead and being alive. Recently, a shift occurred in which slight, but significant, qualitative changes in the patient's capacity to tolerate the frustration and uncertainties inherent in being in contact with external reality were observed. Most significantly, he was able to be aware of and confront his denial of time, thus allowing him to begin mourning the many losses in his life, including the loss of his own creative potential.
Although the paper is primarily clinical, theoretical concepts from Steiner, Ogden, Searles and Winnicott that are pertinent to the case will also be discussed.
Maxine Nelson, LICSW, FIPA is a graduate of NPSI, where she currently serves on the faculty. In addition to her role as NPSI Secretary/Treasurer, Maxine is also President-Elect and Chair of Admissions. Her paper “Blade Runner as Metaphor: Encapsulation in Virtual Reality as a Defense Against Psychic Annihilation” (2014) will be included in the volume Trauma, Destruction and Transformative Potential: Clinical Perspectives, to be published by Karnac in 2018 as part of the CIPS book series. Maxine is in private practice in Bellevue where she offers psychoanalysis, psychoanalytic psychotherapy, and clinical consultation.
Christopher Keats, M.D. worked more than twenty years as staff psychiatrist at Chestnut Lodge Hospital in Rockville, MD, serving as therapist, unit administrator, and, in the end, as Director of Psychotherapy. At Chestnut Lodge, he co-authored with Tom McGlashan a book, Schizophrenia, Treatment Process and Outcome, published by American Psychiatric Press in 1989. He is a past president of the Washington Center for Psychoanalysis, where he trained, and he is currently a Consulting Analyst at the Seattle Psychoanalytic Society and Institute, and in private practice in Bellevue. Chris is also an NPSI community member.