Loading

← teresacarles.com

Divalproex


"250 mg divalproex mastercard, treatment whooping cough."

By: John Theodore Geneczko, MD

  • Assistant Professor of Medicine

https://medicine.duke.edu/faculty/john-theodore-geneczko-md

On the contrary medicine for pink eye cheap divalproex 500 mg fast delivery, it is as a rule like a piece of breccia medicine vocabulary purchase 250mg divalproex free shipping, composed of various fragments of rock held together by a binding medium medicine 319 pill buy divalproex 250 mg low cost, so that the designs that appear on it do not belong to medications like adderall buy discount divalproex 500 mg online the original rocks imbedded in it. And there is in fact one part of the dream-work, known as ‘secondary revision’, whose business it is to make something whole and more or less coherent out of the first products of the dream-work. In the course of this, the material is arranged in what is often a completely misleading sense and, where it seems necessary, interpolations are made in it. Introductory Lectures On Psycho-Analysis 3273 On the other hand, we must not over-estimate the dream-work and attribute too much to it. The achievements I have enumerated exhaust its activity; it can do no more than condense, displace, represent in plastic form and subject the whole to a secondary revision. What appear in the dream as expressions of judgement, of criticism, of astonishment or of inference none of these are achievements of the dream- work and they are very rarely expressions of afterthoughts about the dream; they are for the most part portions of the latent dream-thoughts which have passed over into the manifest dream with a greater or less amount of modification and adaptation to the context. With a few assignable exceptions, speeches in dreams are copies and combinations of speeches which one has heard or spoken one self on the day before the dream and which have been included in the latent thoughts either as material or as the instigator of the dream. Such of them as appear in the manifest dream are mostly combinations of numbers, sham calculations which are quite senseless qua calculations and are once again only copies of calculations in the latent dream-thoughts. In these circumstances it is not to be wondered at that the interest which had turned to the dream-work soon tends to move away from it to the latent dream-thoughts, which are revealed, distorted to a greater or less degree, by the manifest dream. But there is no justification for carrying this shift of interest so far that, in looking at the matter theoretically, one replaces the dream entirely by the latent dream-thoughts and makes some assertion about the former which only applies to the latter. It is strange that the findings of psycho-analysis could be misused to bring about this confusion. One cannot give the name of ‘dream’ to anything other than the product of the dream-work that is to say, the form into which the latent thoughts have been transmuted by the dream-work. Introductory Lectures On Psycho-Analysis 3274 the dream-work is a process of quite a singular kind, of which the like has not yet become known in mental life. Condensations, displacements, regressive transformations of thoughts into images such things are novelties whose discovery has already richly rewarded the labours of psycho-analysis. And you can see once more, from the parallels to the dream-work, the connections which have been revealed between psycho-analytic studies and other fields especially those concerned in the development of speech and thought. You will only be able to form an idea of the further significance of these discoveries when you learn that the mechanism of dream-construction is the model of the manner in which neurotic symptoms arise. I am also aware that we are not yet able to make a survey of the whole of the new acquisitions which these studies have brought to psychology. I will only point out the fresh proofs they have provided of the existence of unconscious mental acts for this is what the latent dream-thoughts are and what an unimaginably broad access to a knowledge of unconscious mental life we are promised by the interpretation of dreams. But now the time has no doubt come for me to demonstrate to you from a variety of small examples of dreams what I have been preparing you for in the course of these remarks. You will argue that after so many preparations you have a right to it, and you will express your conviction that after so many thousands of dreams have been successfully interpreted, it should have been possible long since to have brought together a collection of excellent sample dreams on which all our assertions about the dream-work and the dream-thoughts could be demonstrated. But the difficulties that stand in the way of the fulfilment of your wish are too many. In the first place I must admit that no one carries on the interpretation of dreams as his main occupation. Occasionally, with no particular end in view, one may interest oneself in the dreams of an acquaintance, or one may work through one’s own dreams for a time in order to train oneself in psycho-analytic work; but for the most part what one has to deal with are the dreams of neurotic patients who are under psycho-analytic treatment. These latter dreams are excellent material and are in no way inferior to those of healthy people; but the technique of the treatment necessitates our subordinating dream-interpretation to therapeutic aims, and we have to allow a whole number of dreams to drop after we have extracted something from them that is of service to the treatment. Some dreams that occur during treatment entirely escape any full analysis: since they have arisen out of the great mass of psychical material which is still unknown to us, it is impossible to understand them before the treatment is finished. If I were to report dreams of this kind, it would oblige me to uncover all the secrets of a neurosis as well; and that will not do for us, since it is precisely to prepare us for the study of the neuroses that we have attacked the problem of dreams. Introductory Lectures On Psycho-Analysis 3276 You, however, would be glad to dispense with this material and would prefer to be given an explanation of the dreams of healthy people or of your own dreams. It is impossible to submit either oneself or anyone else whose confidence one enjoys to the ruthless exposure that would be involved in a detailed analysis of his dreams, which, as you already know, are concerned with the most intimate part of one’s personality. But there is another difficulty in the way apart from that of providing the material. You are aware that dreams present an alien appearance to the dreamer himself, and much more so to anyone who is unacquainted with him personally. Perhaps the best example of the interpretation of a dream is the one reported by Otto Rank consisting of two interrelated dreams dreamt by a young girl, which occupy about two pages of print: but their analysis extends to seventy-six pages. So I should need something like a whole term to conduct you through a piece of work of the sort. If one takes up any comparatively long and much distorted dream, one has to give so many explanations of it, to bring up so much material in the way of associations and memories, to follow up so many by-paths, that a lecture about it would be quite confusing and unsatisfactory. I must therefore ask you to be content with what can be had more easily an account of small pieces of the dreams of neurotic patients, in which it is possible to recognize this or that point in isolation. What is easiest to demonstrate are dream-symbols and, after them, some characteristics of the regressive representation in dreams. In the case of each of the dreams that follow, I will indicate why it is that I think it worth reporting. Introductory Lectures On Psycho-Analysis 3277 (1) this dream consisted only of two short pictures: His uncle was smoking a cigarette although it was Saturday. In regard to the first picture the dreamer (a Jew) remarked that his uncle was a pious man who never had done and never could do anything sinful like that. In regard to the woman in the second picture nothing occurred to him except his mother. These two pictures or thoughts must obviously be seen in connection with each other. Since he expressly disputed the reality of his uncle’s action, it is plausible to insert an ‘if’: ‘If my uncle, that pious man, were to smoke a cigarette on a Saturday, then I might let myself, too, be cuddled by my mother. I am of course grateful to anyone who adds enough material to the dream to make an interpretation possible or who gives an interpretation himself. The following dream, dreamt by a medical student in Munich and dating from the year 1910, falls into this category. I am bringing it up in order to show you how impossible it is in general to understand a dream till the dreamer has given us his information about it. For I suspect that at bottom you consider that the ideal method of dream-interpretation is by filling in the meaning of the symbols and that you would like to discard the technique of obtaining associations to the dream; and I am anxious to disabuse you of this damaging mistake. After a little I got off, sat down on a step, and began to hit at the beast, which had bitten firm hold of me. Then I woke up and, as has often happened before, at the moment of transition to waking, the whole dream was clear to me. But the dreamer reported: ‘I have recently fallen in love with a girl, but only from seeing her in the street, and I have had no means of getting in contact with her. The dachshund might have been the pleasantest way of doing so, especially as I am a great animal-lover and I liked this same characteristic in the girl. We learn then that the girl he was attracted by was always to be seen in the company of this particular dog. As far as the manifest dream was concerned, however, the girl was omitted and only the dog associated with her was left. The fact that he was bicycling in the dream is a direct repetition of the remembered situation. In some of these dreams the person who has died is dead and at the same time still alive, because he does not know he is dead; only if he did know would he die completely. In others, he is half dead and half alive, and each of these states is indicated in a particular way. We must not describe these dreams as simply nonsensical; for being brought to life again is no more inconceivable in dreams than it is, for instance, in fairy tales, in which it occurs as a very usual event. So far as I have been able to analyse such dreams, it has turned out that they are capable of a reasonable solution, but that the pious wish to bring the dead person back to life has been able to operate by the strangest means. I will now put before you a dream of this kind which sounds sufficiently queer and senseless and the analysis of which will show you much for which our theoretical discussions will have prepared you. It is the dream of a man who had lost his father several years before: His father was dead but had been exhumed and looked bad. He had been living since then and the dreamer was doing all he could to prevent him noticing it. His having been exhumed did not correspond to reality; and there was no question of reality in anything that followed. But the dreamer reported that after he had come away from his father’s funeral, one of his teeth began to ache.

Already on the day before he had behaved as though he was searching in the two Pompeii hotels to treatment kidney infection purchase divalproex now find the person who appeared to medicine grinder buy generic divalproex on-line him as Gradiva medicine qvar inhaler buy 250mg divalproex otc. And now medicine upset stomach purchase divalproex online, since he had so unexpectedly come upon a third one, he must have said to himself in his unconscious: ‘So this is where she is staying! What happened, I think, was that the sense of conviction attaching to the discovery was able to persist and was retained, while the discovery itself, which was inadmissible to consciousness, was replaced by another ideational content connected with it by associations of thought. Thus the sense of conviction became attached to a content which was in fact foreign to it and this, in the form of a delusion, won a recognition which did not apply to it. Hanold transferred his conviction that Gradiva lived in the house to other impressions which he had received in the house; this led to his credulity in regard to the landlord’s remarks, the genuineness of the metal clasp and the truth of the anecdote about the discovery of the embracing lovers but only through his linking what he heard in the house with Gradiva. The jealousy which was already latent in him seized upon this material and the consequence was the delusion (though it contradicted his first dream) that Gradiva was the girl who had died in her lover’s arms and that the clasp he had bought had belonged to her. It will be observed that his conversation with Gradiva and her hint at wooing him (her ‘saying it with flowers’) had already brought about important changes in Hanold. Traits of masculine desire components of the libido had awakened in him, though it is true that they could not yet dispense with the disguise of conscious pretexts. But the problem of the ‘bodily nature’ of Gradiva, which pursued him all that day, cannot disavow its origin in a young man’s erotic curiosity about a woman’s body, even if it is involved in a scientific question by the conscious insistence on Gradiva’s peculiar oscillation between death and life. His jealousy was a further sign of the increasingly active aspect of Hanold’s love; he expressed this jealousy at the beginning of their conversation the next day and with the help of a fresh pretext proceeded to touch the girl’s body and, as he used to do in the far-off past, to hit her. From our medical knowledge we can only reply that it is certainly the correct method, and perhaps the sole method, by which a delusion acquires the unshakable conviction which is one of its clinical characteristics. If a patient believes in his delusion so firmly, this is not because his faculty of judgement has been overturned and does not arise from what is false in the delusion. On the contrary, there is a grain of truth concealed in every delusion, there is something in it that really deserves belief, and this is the source of the patient’s conviction, which is therefore to that extent justified. If eventually it is able to penetrate into consciousness, this time in a distorted form, the sense of conviction attaching to it is over-intensified as though by way of compensation and is now attached to the distorted substitute of the repressed truth, and protects it from any critical attacks. The conviction is displaced, as it were, from the unconscious truth on to the conscious error that is linked to it, and remains fixated there precisely as a result of this displacement. The instance of the formation of a delusion which arose from Hanold’s first dream is no more than a similar, though not identical, example of such a displacement. Indeed, the method described here by which conviction arises in the case of a delusion does not differ fundamentally from the method by which a conviction is formed in normal cases, where repression does not come into the picture. We all attach our conviction to thought-contents in which truth is combined with error, and let it extend from the former over the latter. It becomes diffused, as it were, from the truth over the error associated with it and protects the latter, though not so unalterably as in the case of a delusion, against deserved criticism. In normal psychology, too, being well-connected ‘having influence’, so to speak can take the place of true worth. Gradiva had drawn a kind of contrast between the white asphodel blossoms and the red rose. Seeing the asphodel again in the window of the Albergo del Sole became an important piece of evidence in support of Hanold’s unconscious discovery, which was expressed in the new delusion; and alongside this was the fact that the red rose in the dress of the sympathetic girl helped Hanold in his unconscious to a correct view of her relation to her companion, so that he was able to make her appear in the dream as the ‘lady colleague’. But where in the manifest content of the dream, it will be asked, do we find anything to indicate and replace the discovery for which, as we have seen, Hanold’s new delusion was a substitute the discovery that Gradiva was staying with her father in the third, concealed Pompeii hotel, the Albergo del Solefi Nevertheless it is all there in the dream, and not even very much distorted, and I merely hesitate to point to it because I know that even those of my readers who have followed me patiently so far will begin to rebel strongly against my attempts at interpretation. Hanold’s discovery, I repeat, is fully announced in the dream, but so cleverly concealed that it is bound to be overlooked. But could it not also mean in the ‘Sun’ that is, Gradiva is staying in the Albergo del Sole, the Sun Hotelfi And was not the ‘somewhere’, which had no bearing on the encounter with her father, made to sound so hypocritically indefinite precisely because it introduced a definite piece of information about the place where Gradiva was stayingfi From my experience elsewhere of real dreams, I myself am perfectly certain that this is how the ambiguity is to be understood. But I should not in fact have ventured to present this piece of interpretative work to my readers, if the author had not at this point lent me his powerful assistance. He puts the very same play upon words into the girl’s mouth when next day she saw the metal clasp: ‘Did you find it in the sun, perhaps, which produces things of this kindfi Critical readers will now justly enquire about the origin of the interpolation (for which I have so far given no grounds) of the reference to being ridiculed by Gradiva. The answer to this is given in the Interpretation of Dreams, which explains that if ridicule, derision, or embittered contradiction occurs in the dream- thoughts, this is expressed by the manifest dream being given a senseless form, by absurdity in the dream. This absurdity does not mean, therefore, that there is any paralysis of psychical activity: it is a method of representation employed by the dream-work. As always happens at specially difficult points, the author once more comes to our help here. The senseless dream had a short epilogue, in which a bird uttered a laughing call and carried the lizard away in its beak. It had in fact come from Zoe, who with this laugh was shaking off the gloomy seriousness of her underworld role. But the dream-image of the bird carrying off the lizard may have been a recollection of the earlier dream, in which the Apollo Belvedere carried off the Capitoline Venus. Some further support for it may be afforded by the consideration that Zoe in her conversation with her newly-married friend admitted precisely what Hanold’s thoughts about her suspected when she told her she had felt sure that she would ‘dig out’ something interesting in Pompeii. Here she was trespassing into the field of archaeology, just as he had trespassed, with his simile of lizard-catching, into the field of zoology; it was as though they were struggling towards each other and each were trying to assume the other’s character. Here then we seem to have finished off the interpretation of this second dream as well. Both of them have been made intelligible to us on the presupposition that a dreamer knows in his unconscious thoughts all that he has forgotten in his conscious ones, and that in the former he judges correctly what in the latter he misunderstands in a delusion. In the course of our arguments we have no doubt been obliged to make some assertions which have seemed strange to the reader because of their unfamiliarity; and we have probably often roused a suspicion that what we pretended was the author’s meaning was in fact only our own. I am anxious to do all I can to dissipate this suspicion, and for that reason I will gladly enter into more detail over one of the most delicate points I mean the use of ambiguous words and phrases, such as: ‘Somewhere in the Sun Gradiva was sitting. In Hanold’s case these remarks are intended by him unambiguously and it is only the heroine, Gradiva, who is struck by their second meaning. Thus, for instance, when in reply to her first answer he exclaimed ‘I knew your voice sounded like that’, Zoe, who was still in ignorance, could not but ask how that could be, since he had not heard her speak before. In their second conversation the girl was for a moment thrown into doubt about his delusion, when he told her that he had recognized her at once. She could not help taking these words in the sense (correct so far as his unconscious was concerned) of being a recognition that their acquaintance went back to their childhood; whereas he, of course, knew nothing of this implication of his remark and explained it only by reference to his dominant delusion. On the other hand, the remarks made by the girl, whose personality shows the most lucid clarity of mind in contrast to Hanold’s delusion, exhibit an intentional ambiguity. One of their meanings chimes in with Hanold’s delusion, so as to be able to penetrate into his conscious understanding, but the other rises above the delusion and gives us as a rule its translation into the unconscious truth for which it stands. It is a triumph of ingenuity and wit to be able to express the delusion and the truth in the same turn of words. Zoe’s speech in which she explains the situation to her friend and at the same time succeeds in getting rid of the interrupter is full of ambiguities of this kind. It is in reality a speech made by the author and aimed more at the reader than at Zoe’s newly-married ‘colleague’. In her conversations with Hanold the ambiguity is usually effected by Zoe’s using the same symbolism that we found in Hanold’s first dream the equation of repression and burial, and of Pompeii and childhood. Thus she is able in her speeches on the one hand to remain in the role for which Hanold’s delusion has cast her, and on the other hand to make contact with the real circumstances and awaken an understanding of them in Hanold’s unconscious. But she made her neatest use of her symbolism when she asked: ‘I feel as though we had shared a meal like this once before, two thousand years ago; can’t you rememberfi It is no chance event, so it seems to us, but a necessary consequence of the premisses of the story. It is nothing other than a counterpart to the twofold determination of symptoms, in so far as speeches are themselves symptoms and, like them, arise from compromises between the conscious and the unconscious. It is simply that this double origin is more easily noticed in speeches than, for instance, in actions.

250 mg divalproex mastercard

A common example of coreference involves the use of pronouns such as “she” treatment 1st degree av block order 250 mg divalproex visa, “her” medications mexico divalproex 250 mg low cost, “he” symptoms inner ear infection divalproex 250mg free shipping, “him” treatment of hemorrhoids divalproex 500mg for sale, and “it”. Often we find that we cannot determine the reference of a linguistic expression without referring to another linguistic expression, called the antecedent, this case, and the material that we cannot identify in isolation, is called anaphor. In (36) “Vlad” and “knife” are the antecedents of the anaphors “he” and “it” respectively. Coreference does not have to involve pronouns; it can also involve other nouns referring to the same thing— “the vampire” in (37), an example of definite noun phrase anaphor —or verbs—“does” in (38). Anaphor resolution is a backward inference that we carry out to maintain a coherent representation of the text. In a story such as (39) there is only one possible antecedent: (39) Vlad was happy. What makes anaphor resolution difficult is that often it is not obvious what the antecedent of the anaphor is. The anaphor is ambiguous when there is more than one possible antecedent, such as (40): (40) Vlad stuck a dagger in the corpse. In this case we have no apparent difficulty in understanding what each “it” refers to. In more complex cases there might be a number of alternatives, or background or world knowledge is necessary to disambiguate. Whether or not these strategies are used to guide an explicit search process, or to exclude items from a search set, or both, or even to avoid an explicit search altogether, is at present unclear. Anaphor resolution is more difficult when the expectations generated by this strategy are flouted. In (41) “he” refers to “Vlad”, which comes first in “Vlad sold Dirk”, but in (42) “he” refers to “Dirk”, which comes second. We can distinguish two groups of further strategies: those dependent on the meaning of the actual words used, or their role in the sentence; and those dependent on the emergent discourse model. Of the strategies dependent on the words used, one of the most obvious is the use of gender (Corbett & Chang, 1983): (43) Agnes won and Vlad lost. Participants examined pictures of familiar cartoon characters while listening to text. Minnie Mouse and Donald Duck), participants were able to use the gender cue (“she” or “he”) very quickly to look at the appropriate picture. Micky Mouse and Donald Duck) gender was no longer a cue, and participants took longer to converge on the picture that referred to the pronoun. Rigalleau and Caplan (2000) found that people are slower to say the pronoun “he” when it is inconsistent with the only noun in the discourse (44) compared with when it is consistent (45): (44) Agnes paid without being asked; he had a sense of honour. Rigalleau and Caplan suggest that pronouns become immediately and automatically related to possible antecedents. The resolution process that ultimately determines which of the possible antecedents is finally attached to the pronoun might depend on other factors. Resolution only involves attentional processing if the initial automatic processes fail to converge on a single noun as the antecedent, or if pragmatic information makes the selected noun an unlikely antecedent. Some techniques are better at establishing the time course of anaphor resolution than others. In particular, the use of probes, as used in the earlier studies, might disrupt the comprehension process, giving a misleading picture of what is happening. Different verbs carry different implications about how the actors involved should be assigned to roles. If participants are asked to complete the sentences (46) and (47), they usually produce continuations in which “he” refers to the subject (Vlad) in (46), and the object (Boris) in (47). We might be biased, for example, to select the referent in the model that is most frequently mentioned. Antecedents are generally easier to locate when they are close to their referents than when they are farther away, in terms of the number of intervening words (Murphy, 1985; O’Brien, 1987). In more complicated examples alternatives can sometimes be eliminated using background knowledge and elaborative inferences, as in (48). In this case we infer that becoming a vegetarian would not make someone want to buy piglets, but more likely to sell them, as they would be less likely to have any future use for them. Pronouns are read more quickly when the referent of the antecedent is still in the focus of the situation being discussed than when the situation has changed so that it is no longer in focus (Garrod & Sanford, 1977; Sanford & Garrod, 1981). Items in explicit focus are said to be foregrounded and have been explicitly mentioned in the preceding text. It sounds natural to continue with “he was thirsty”, but not with “it broke down”. Instead, we would need to bring the car into explicit focus with a sentence like “his car broke down”. Experiments on reading time suggest that implicit focus items are harder to process. Items are likely to stay in the foreground if it is an important theme in the discourse, and these items are likely to be maintained in working memory. Pronouns with antecedents in the foreground, or topic antecedents, are read quickly, regardless of the distance between the pronoun and referent (Clifton & Ferreira, 1987). In conversation, we do not normally start using pronouns for referents that we have not mentioned for some time. In general, unstressed pronouns are used to refer to the most salient discourse entity—the one at the centre of focus—while definite noun phrase anaphors. In general, then, the more salient an entity is in discourse, the less information is contained in the anaphoric expression that refers to it. The informational load of an anaphor with respect to its antecedent should either aid the identification of the antecedent, or add new information about it, or both. The processing of anaphors is a balance between the benefits of maximum informativeness and the cost of minimizing working memory load. This idea that anaphor processing is a balance between informativeness and processing cost leads to four predictions. For example, anaphors with a high informational load with respect to their antecedent but which do not add new information about them, will be difficult to process when the antecedent is in focus. Here the antecedent (“a bird”) is in focus and the default antecedent, so a pronoun (“it”) will do. It is only justified when the antecedent is out of focus (51), because then it aids the identification of the antecedent. At this stage some caution is necessary to avoid a circular definition of accessibility Accessibility is a concept related both to anaphora and to the work on sentence memory. It can be measured by recording how long it takes participants to detect whether a word presented while participants are reading sentences is present in the sentence. Common ground is shared information between participants in a conversation (Clark, 1996; Clark & Carlson, 1982). A piece of information is in the common ground if it is mutually believed by the speakers, and if all the speakers believe that all the others believe it to be shared. Information that is in the common ground should have particular importance in determining reference. That is, according to the restricted search hypothesis, things in the common ground should be more accessible than things that are not. The evidence currently favours the unrestricted search hypothesis (Keysar, Barr, Balin, & Paek, 1998). He decides not to call because she is probably asleep given the transatlantic time difference. If the restricted search hypothesis were correct, and search is restricted to possible referents in the common ground, the lover should not be considered, as the wife is not informed about the lover. However, entities that are not in the common ground still interfere with reference resolution, as measured by error rates, verification times, and eye-movement measures. Although common ground might not restrict which possible referents are initially checked, it almost certainly plays an important later role in checking, monitoring, and correcting the results of the initial search. Generally we are biased to referring back to the subject of a sentence; there is also an advantage to first mention.

safe 250mg divalproex

We led the patient’s attention directly to medications 377 buy divalproex 500mg low price the traumatic scene in which the symptom had arisen 2c19 medications buy cheap divalproex 250 mg, and we endeavoured to symptoms xanax withdrawal divalproex 250mg discount discover the mental conflict in that scene and to medicine klonopin order 500mg divalproex amex release the suppressed affect in it. In the course of this we discovered the mental process, characteristic of the neuroses, which I later named ‘regression’. The patient’s associations moved back from the scene which we were trying to elucidate to earlier experiences, and compelled the analysis, which was supposed to correct the present, to occupy itself with the past. This regression led constantly further backwards; at first it seemed regularly to bring us to puberty; later on, failures and points which still eluded explanation drew the analytic work still further back into years of childhood which had hitherto been inaccessible to any kind of exploration. It appeared that psycho-analysis could explain nothing belonging to the present without referring back to something past; indeed, that every pathogenic experience implied a previous experience which, though not in itself pathogenic, had yet endowed the later one with its pathogenic quality. The temptation to confine one’s attention to the known present exciting cause was so strong, however, that even in later analyses I gave way to it. In the analysis of the patient I named ‘Dora’, carried out in 1899, I had knowledge of the scene which occasioned the outbreak of the current illness. I tried innumerable times to submit this experience to analysis, but even direct demands always failed to produce from her anything more than the same meagre and incomplete description of it. Not until a long detour, leading back over her earliest childhood, had been made, did a dream present itself which on analysis brought to her mind the hitherto forgotten details of this scene, so that a comprehension and a solution of the current conflict became possible. This one example shows how very misleading is the advice referred to above, and what a degree of scientific regression is represented by the neglect of regression in analytic technique which is thus recommended to us. On the History Of the Psycho-Analytic Movement 2881 the first difference between Breuer and myself came to light on a question concerning the finer psychical mechanism of hysteria. He gave preference to a theory which was still to some extent physiological, as one might say; he tried to explain the mental splitting in hysterical patients by the absence of communication between various mental states (‘states of consciousness’, as we called them at that time), and he therefore constructed the theory of ‘hypnoid states’, the products of which were supposed to penetrate into ‘waking consciousness’ like unassimilated foreign bodies. I had taken the matter less scientifically; everywhere I seemed to discern motives and tendencies analogous to those of everyday life, and I looked upon psychical splitting itself as an effect of a process of repelling which at that time I called ‘defence’, and later, ‘repression’. I made a short-lived attempt to allow the two mechanisms a separate existence side by side, but as observation showed me always and only one thing, it was not long before my ‘defence’ theory took up its stand opposite his ‘hypnoid’ one. I am quite sure, however, that this opposition between our views had nothing to do with the breach in our relations which followed shortly after. This had deeper causes, but it came about in such a way that at first I did not understand it; it was only later that I learnt from many clear indications how to interpret it. It will be remembered that Breuer said of his famous first patient that the element of sexuality was astonishingly undeveloped in her and had contributed nothing to the very rich clinical picture of the case. I have always wondered why the critics did not more often cite this assertion of Breuer’s as an argument against my contention of a sexual aetiology in the neuroses, and even to-day I do not know whether I ought to regard the omission as evidence of tact or of carelessness on their part. Anyone who reads the history of Breuer’s case now in the light of the knowledge gained in the last twenty years will at once perceive the symbolism in it the snakes, the stiffening, the paralysis of the arm and, on taking into account the situation at the bedside of the young woman’s sick father, will easily guess the real interpretation of her symptoms; his opinion of the part played by sexuality in her mental life will therefore be very different from that of her doctor. In his treatment of her case, Breuer was able to make use of a very intense suggestive rapport with the patient, which may serve us as a complete prototype of what we call ‘transference’ to-day. Now I have strong reasons for suspecting that after all her symptoms had been relieved Breuer must have discovered from further indications the sexual motivation of this transference, but that the universal nature of this unexpected phenomenon escaped him, with the result that, as though confronted by an ‘untoward event’,fi he broke off all further investigation. He never said this to me in so many words, but he told me enough at different times to justify this reconstruction of what happened. When I later began more and more resolutely to put forward the significance of sexuality in the aetiology of neuroses, he was the first to show the reaction of distaste and repudiation which was later to become so familiar to me, but which at that time I had not yet learnt to recognize as my inevitable fate. The fact of the emergence of the transference in its crudely sexual form, whether affectionate or hostile, in every treatment of a neurosis, although this is neither desired nor induced by either doctor or patient, has always seemed to me the most irrefragable proof that the source of the driving forces of neurosis lies in sexual life. This argument has never received anything approaching the degree of attention that it merits, for if it had, investigations in this field would leave no other conclusion open. As far as I am concerned, this argument has remained the decisive one, over and above the more specific findings of analytic work. But, one day, certain memories gathered in my mind which disturbed this pleasing notion, but which gave me in exchange a valuable insight into the processes of human creative activity and the nature of human knowledge. The idea for which I was being made responsible had by no means originated with me. It had been imparted to me by three people whose opinion had commanded my deepest respect by Breuer himself, by Charcot, and by Chrobak, the gynaecologist at the University, perhaps the most eminent of all our Vienna physicians. These three men had all communicated to me a piece of knowledge which, strictly speaking, they themselves did not possess. Two of them later denied having done so when I reminded them of the fact; the third (the great Charcot) would probably have done the same if it had been granted me to see him again. But these three identical opinions, which I had heard without understanding, had lain dormant in my mind for years, until one day they awoke in the form of an apparently original discovery. One day, when I was a young house-physician, I was walking across the town with Breuer, when a man came up who evidently wanted to speak to him urgently. As soon as Breuer was free, he told me in his friendly, instructive way that this man was the husband of a patient of his and had brought him some news of her. The wife, he added, was behaving in such a peculiar way in society that she had been brought to him for treatment as a nervous case. On the History Of the Psycho-Analytic Movement 2883 Some years later, at one of Charcot’s evening receptions, I happened to be standing near the great teacher at a moment when he appeared to be telling Brouardel a very interesting story about something that had happened during his day’s work. I hardly heard the beginning, but gradually my attention was seized by what he was talking of: a young married couple from a distant country in the East the woman a severe sufferer, the man either impotent or exceedingly awkward. For Charcot suddenly broke out with great animation: ‘Mais, dans des cas pareils c’est toujours la chose genitale, toujours. I know that for a moment I was almost paralysed with amazement and said to myself: ‘Well, but if he knows that, why does he never say sofi A year later, I had begun my medical career in Vienna as a lecturer in nervous diseases, and in everything relating to the aetiology of the neuroses I was still as ignorant and innocent as one could expect of a promising student trained at a university. One day I had a friendly message from Chrobak, asking me to take a woman patient of his to whom he could not give enough time, owing to his new appointment as a University teacher. I arrived at the patient’s house before he did and found that she was suffering from attacks of meaningless anxiety, and could only be soothed by the most precise information about where her doctor was at every moment of the day. When Chrobak arrived he took me aside and told me that the patient’s anxiety was due to the fact that although she had been married for eighteen years she was still virgo intacta. In such cases, he said, there was nothing for a medical man to do but to shield this domestic misfortune with his own reputation, and put up with it if people shrugged their shoulders and said of him: ‘He’s no good if he can’t cure her after so many years. I am well aware that it is one thing to give utterance to an idea once or twice in the form of a passing apercu, and quite another to mean it seriously to take it literally and pursue it in the face of every contradictory detail, and to win it a place among accepted truths. It is the difference between a casual flirtation and a legal marriage with all its duties and difficulties. Among the other new factors which were added to the cathartic procedure as a result of my work and which transformed it into psycho-analysis, I may mention in particular the theory of repression and resistance, the recognition of infantile sexuality, and the interpreting and exploiting of dreams as a source of knowledge of the unconscious. The theory of repression quite certainly came to me independently of any other source; I know of no outside impression which might have suggested it to me, and for a long time I imagined it to be entirely original, until Otto Rank (1911a) showed us a passage in Schopenhauer’s World as Will and Idea in which the philosopher seeks to give an explanation of insanity. What he says there about the struggle against accepting a distressing piece of reality coincides with my concept of repression so completely that once again I owe the chance of making a discovery to my not being well-read. Yet others have read the passage and passed it by without making this discovery, and perhaps the same would have happened to me if in my young days I had had more taste for reading philosophical works. In later years I have denied myself the very great pleasure of reading the works of Nietzsche, with the deliberate object of not being hampered in working out the impressions received in psycho-analysis by any sort of anticipatory ideas. I had therefore to be prepared and I am so, gladly to forgo all claims to priority in the many instances in which laborious psycho-analytic investigation can merely confirm the truths which the philosopher recognized by intuition. It is the most essential part of it; and yet it is nothing but a theoretical formulation of a phenomenon which may be observed as often as one pleases if one undertakes an analysis of a neurotic without resorting to hypnosis. In such cases one comes across a resistance which opposes the work of analysis and in order to frustrate it pleads a failure of memory. The use of hypnosis was bound to hide this resistance; the history of psycho-analysis proper, therefore, only begins with the new technique that dispenses with hypnosis. The theoretical consideration of the fact that this resistance coincides with an amnesia leads inevitably to the view of unconscious mental activity which is peculiar to psycho-analysis and which, too, distinguishes it quite clearly from philosophical speculations about the unconscious. It may thus be said that the theory of psycho-analysis is an attempt to account for two striking and unexpected facts of observation which emerge whenever an attempt is made to trace the symptoms of a neurotic back to their sources in his past life: the facts of transference and of resistance. Any line of investigation which recognizes these two facts and takes them as the starting-point of its work has a right to call itself psycho-analysis, even though it arrives at results other than my own. But anyone who takes up other sides of the problem while avoiding these two hypotheses will hardly escape a charge of misappropriation of property by attempted impersonation, if he persists in calling himself a psycho-analyst. If anyone sought to place the theory of repression and resistance among the premisses instead of the findings of psycho-analysis, I should oppose him most emphatically. Such premisses of a general psychological and biological nature do exist, and it would be useful to consider them on some other occasion; but the theory of repression is a product of psycho-analytic work, a theoretical inference legitimately drawn from innumerable observations.

cheap divalproex 250mg on-line

The very existence of the two other classes medications you can give your cat purchase divalproex with amex, and especially the third treatment 7 february buy divalproex 250 mg amex, is difficult to 714x treatment for cancer buy discount divalproex 250mg line reconcile with the hypothesis of the innateness of inversion symptoms 5dpo discount divalproex generic. This explains why those who support this view tend to separate out the group of absolute inverts from all the rest, thus abandoning any attempt at giving an account of inversion which shall have universal application. In the view of these authorities inversion is innate in one group of cases, while in others it may have come about in other ways. The merit for bringing about this change is due to Bloch (1902-3), who has also laid stress on the occurrence of inversion among the civilizations of antiquity. Three Essays On the Theory Of Sexuality 1469 the reverse of this view is represented by the alternative one that inversion is an acquired character of the sexual instinct. This second view is based on the following considerations: (1) In the case of many inverts, even absolute ones, it is possible to show that very early in their lives a sexual impression occurred which left a permanent after-effect in the shape of a tendency to homosexuality. In view of these considerations it is even possible to doubt the very existence of such a thing as innate inversion. Havelock Ellis) that, if the cases of allegedly innate inversion were more closely examined, some experience of their early childhood would probably come to light which had a determining effect upon the direction taken by their libido. This experience would simply have passed out of the subject’s conscious recollection, but could be recalled to his memory under appropriate influence. In the opinion of these writers inversion can only be described as a frequent variation of the sexual instinct, which can be determined by a number of external circumstances in the subject’s life. The apparent certainty of this conclusion is, however, completely countered by the reflection that many people are subjected to the same sexual influences. We are therefore forced to a suspicion that the choice between ‘innate’ and ‘acquired’ is not an exclusive one or that it does not cover all the issues involved in inversion. In the former case we must ask in what respect it is innate, unless we are to accept the crude explanation that everyone is born with his sexual instinct attached to a particular sexual object. In the latter case it may be questioned whether the various accidental influences would be sufficient to explain the acquisition of inversion without the co-operation of something in the subject himself. Science, however, knows of cases in which the sexual characters are obscured, and in which it is consequently difficult to determine the sex. The genitals of the individuals concerned combine male and female characteristics. For it appears that a certain degree of anatomical hermaphroditism occurs normally. In every normal male or female individual, traces are found of the apparatus of the opposite sex. These either persist without function as rudimentary organs or become modified and take on other functions. These long-familiar facts of anatomy lead us to suppose that an originally bisexual physical disposition has, in the course of evolution, become modified into a unisexual one, leaving behind only a few traces of the sex that has become atrophied. It was tempting to extend this hypothesis to the mental sphere and to explain inversion in all its varieties as the expression of a psychical hermaphroditism. All that was required further in order to settle the question was that inversion should be regularly accompanied by the mental and somatic signs of hermaphroditism. Three Essays On the Theory Of Sexuality 1471 But this expectation was disappointed. It is impossible to demonstrate so close a connection between the hypothetical psychical hermaphroditism and the established anatomical one. A general lowering of the sexual instinct and a slight anatomical atrophy of the organs is found frequently in inverts (cf. The truth must therefore be recognized that inversion and somatic hermaphroditism are on the whole independent of each other. A great deal of importance, too, has been attached to what are called the secondary and tertiary sexual characters and to the great frequency of the occurrence of those of the opposite sex in inverts (cf. Much of this, again, is correct; but it should never be forgotten that in general the secondary and tertiary sexual characters of one sex occur very frequently in the opposite one. They are indications of hermaphroditism, but are not attended by any change of sexual object in the direction of inversion. Psychical hermaphroditism would gain substance if the inversion of the sexual object were at least accompanied by a parallel change-over of the subject’s other mental qualities, instincts and character traits into those marking the opposite sex. But it is only in inverted women that character-inversion of this kind can be looked for with any regularity. If the belief in psychical hermaphroditism is to be persisted in, it will be necessary to add that its manifestations in various spheres show only slight signs of being mutually determined. Moreover the same is true of somatic hermaphroditism: according to Halban (1903),fi occurrences of individual atrophied organs and of secondary sexual characters are to a considerable extent independent of one another. Three Essays On the Theory Of Sexuality 1472 the theory of bisexuality has been expressed in its crudest form by a spokesman of the male inverts: ‘a feminine brain in a masculine body’. There is neither need nor justification for replacing the psychological problem by the anatomical one. Krafft-Ebing’s attempted explanation seems to be more exactly framed than that of Ulrichs but does not differ from it in essentials. According to Krafft-Ebing (1895, 5), every individual’s bisexual disposition endows him with masculine and feminine brain centres as well as with somatic organs of sex: these centres develop only at puberty, for the most part under the influence of the sex-gland, which is independent of them in the original disposition. But what has just been said of masculine and feminine brains applies equally to masculine and feminine ‘centres’; and incidentally we have not even any grounds for assuming that certain areas of the brain (‘centres’) are set aside for the functions of sex, as is the case, for instance with those of speech. In the first place, a bisexual disposition is somehow concerned in inversion, though we do not know in what that disposition consists, beyond anatomical structure. And secondly, we have to deal with disturbances that affect the sexual instinct in the course of its development. As long ago as in January, 1884, he published a paper, ‘Les aberrations de l’instinct sexuel’, in the Revue Philosophique. It is, moreover, noteworthy that the majority of authors who derive inversion from bisexuality bring forward that factor not only in the case of inverts, but also for all those who have grown up to be normal, and that, as a logical consequence, they regard inversion as the result of a disturbance in development. Krafft-Ebing (1895, 10) remarks that there are a great number of observations ‘which prove at least the virtual persistence of this second centre (that of the subordinated sex). Arduin (1900) asserts that ‘there are masculine and feminine elements in every human being (cf. Hirschfeld, 1899); but one set of these according to the sex of the person in question is incomparably more strongly developed than the other, so far as heterosexual individuals are concerned. Weininger, the philosopher, who died at an early age, and who made the idea the basis of a somewhat unbalanced book (1903). The particulars which I have enumerated above will be sufficient to show how little justification there is for the claim. An inverted man, it holds, is like a woman in being subject to the charm that proceeds from masculine attributes both physical and mental: he feels he is a woman in search of a man. But however well this applies to quite a number of inverts, it is, nevertheless, far from revealing a universal characteristic of inversion. There can be no doubt that a large proportion of male inverts retain the mental quality of masculinity, that they possess relatively few of the secondary characters of the opposite sex and that what they look for in their sexual object are in fact feminine mental traits. If this were not so, how would it be possible to explain the fact that male prostitutes who offer themselves to inverts to-day just as they did in ancient times imitate women in all the externals of their clothing and behaviourfi It is clear that in Greece, where the most masculine men were numbered among the inverts, what excited a man’s love was not the masculine character of a boy, but his physical resemblance to a woman as well as his feminine mental qualities his shyness, his modesty and his need for instruction and assistance. As soon as the boy became a man he ceased to be a sexual object for men and himself, perhaps, became a lover of boys. In this instance, therefore, as in many others, the sexual object is not someone of the same sex but someone who combines the characters of both sexes; there is as, it were, a compromise between an impulse that seeks for a man and one that seeks for a woman, while it remains a paramount condition that the object’s body. Thus the sexual object is a kind of reflection of the subject’s own bisexual nature. In all the cases we have examined we have established the fact that the future inverts, in the earliest years of their childhood, pass through a phase of very intense but short lived fixation to a woman (usually their mother), and that, after leaving this behind, they identify themselves with a woman and take themselves as their sexual object. That is to say, they proceed from a narcissistic basis, and look for a young man who resembles themselves and whom they may love as their mother loved them. Moreover, we have frequently found that alleged inverts have been by no means insusceptible to the charms of women, but have continually transposed the excitation aroused by women on to a male object. They have thus repeated all through their lives the mechanism by which their inversion arose.

Cheap divalproex 500mg online. Useless ID - Borrowed Time (BLACK COFFEE SESSION).

order 500mg divalproex overnight delivery