Internal World Research Articles

Exploring indigenous adoptees’ stories of reconnection after adoption through the lens of the indigenous connectedness framework

The Indigenous Connectedness Framework (ICF) describes mechanisms that help or hinder Indigenous children’s development of family, community, environmental, intergenerational, and cultural/spiritual connectedness, or belonging, and healthy identity. It has been applied in considerations of child welfare system-involved youth and alumni and studies of Indigenous mental health, but not yet to Indigenous adoptees who may not have experienced child welfare involvement prior to adoption and are reconnecting to their origins as adults. Although various factors influence the extent of (re)connectedness, Indigenous adoptees’ reunification with biological family, community, land/place, ancestors, and culture is generally linked with increases in their senses of connectedness, or belonging, and Indigenous/Tribal identity. To gain initial insights into the suitability of the ICF to describe components of Indigenous adoptee (re)connectedness, this study used a Two-Eyed Seeing approach with Indigenous storytelling and narrative inquiry methodologies to explore experiences and perceptions of reunification with four Indigenous adults who experienced adoption by non-Indigenous families as children and were raised in non-Indigenous communities. Stories about reconnection with family, community, and land/place after adoption, as well as stories of perceived supports for, and challenges of, reunification were obtained during conversational interviews conducted via Zoom or phone and then mapped onto the ICF. Disconnectedness mechanisms, (re)connectedness mechanisms, and themes related to adoptees’ internal worlds and resilience, relational identity development, and contributions to intergenerational connectedness were revealed. Suggested pathways for social work to support (re)connectedness or belonging for Indigenous adoptees and implications for future research are provided.

Evaluating state-based network dynamics in anhedonia

Anhedonia is a transdiagnostic clinical syndrome associated with significant clinical impairment. In spite of this, a clear network-level characterization of anhedonia does not yet exist. The present study addressed this gap in the literature by taking a graph theoretical approach to characterizing state-based (i.e., reward anticipation, rest) network dynamics in a transdiagnostic sample of adults with clinically significant anhedonia (n = 77). Analyses focused on three canonical brain networks: the Salience Network (SN), the Default Mode Network (DMN) and the Central Executive Network (CEN), with hypotheses focusing on the role of saliency-mapping in anhedonia. Contrary to hypotheses, no significant relation was found between the SN and anhedonia symptom severity. Exploratory results revealed a significant association between anhedonia severity and DMN reorganization from rest to reward anticipation. Specifically, greater anhedonia severity was associated with less reward-related reorganization. This finding suggests that anhedonia severity may be associated with DMN hyposensitivity, such that individuals with more severe anhedonia may have a difficult time disengaging from their internal world in the context of potentially rewarding experiences. Although preliminary, this finding challenges the centrality of the SN in anhedonia severity and suggests the importance of the DMN. Clinical implications and future directions are explored.

The conductor model of consciousness, our neuromorphic twins, and the human-AI deal

AbstractCritics of Artificial Intelligence (AI) posit that artificial agents cannot achieve consciousness even in principle, because they lack certain necessary pre-conditions present in biological agents. Here we highlight arguments from a neuroscientific and neuromorphic engineering perspective as to why such a strict denial of consciousness in artificial agents is not compelling. Based on the construction of a co-evolving neuromorphic twin, we argue that the differences between a developing biological and artificial brain are not fundamental and are vanishing with progress in neuromorphic architecture designs mimicking the human blueprint. To characterise this blueprint, we propose the Conductor Model of Consciousness (CMoC) that builds on neuronal implementations of an external and internal world model, while gating and labelling information flows. An extended turing test lists functional and neuronal correlates of biological consciousness that are captured by the CMoC. These correlates provide the grounding for how biological or artificial agents learn to distinguish between sensory activity generated from outside or inside of the brain, how the perception of these activities can itself be learned, and how the information flow for learning an internal world model is orchestrated by a cortical meta-instance, which we call the conductor. Perception comes with the distinction of sensory and affective components, with the affective component linking to ethical questions that are inherent in our multidimensional model of consciousness. Recognizing the existence of a blueprint for a possible artificial consciousness encompasses functional, neuronal and ethical dimensions, begging the question: How should we behave towards agents that are akin to us in the inner workings of their brains? We sketch a human-AI deal, balancing the growing cognitive abilities of artificial agents, and the possibility to relieve them from suffering of negative affects, with a protection for the rights of humans.

Psychoanalysis and homosexuality: The relevance of homophobia and shame for all sexualities

This article will describe some contemporary developments in psychoanalytic thinking about sexuality, from a post‐heteronormative standpoint. Psychoanalytic theorising of homosexuality had been generally homophobic for decades, reflecting society stereotypes. Previously, many analysts prescribed treatment to convert “the homosexual patient” to “healthy heterosexuality”, which Freud had regarded as likely to be unsuccessful. The author argues that psychoanalysis, having been part of the “disease” of homophobia, and the lengthy shadow cast by shame, can also contribute to its “cure” by promoting a broader understanding of the conscious and unconscious nature of desire and identity. The author considers the central role played by the superego in maintaining shame’s dominance and explores the impact of shame on time and temporality, including shame’s unique après coup nature. The struggle for acceptance of non‐heteronormative sexuality is discussed and contemporary developments in theorising desire, internalised homophobia, and Oedipus are explored. Drawing on fictional composite clinical vignettes, the author describes current challenges that clinicians face in relation to homophobia and shame, illustrating the central importance for clinicians to address where shame and homophobia lie within their own internal worlds and object relationships.

Lung cancer after the genomic turn: From the biopolitics of ‘lifestyle’ to the transcorporeality of breath

The lungs serve as a site of interchange between the bodily and environmental, an interface between the internal and external world, enacted through breath. We draw on the primacy of this exchange to explore the complexities of living with lung cancer amidst the enduring social challenge of stigma and the advent of ‘targeted therapies’ at the cutting edge of precision medicine. Lung cancer’s association with smoking and resulting stigmatisation of those with lung cancer has been well documented – positioning those with lung cancer as failed subjects of a biopolitics of lifestyle. However, recent developments in ‘precision medicine’ have drawn attention to alternate, genetic causes of lung cancer, disrupting easy equivalences between deviant cells (malignancy) and deviant conduct (smoking). Despite this, and drawing on interviews with 32 people receiving targeted therapy for lung cancer in Australia, we identify enduring resonances of deviance and stigma which still foreground individual lifestyle and blame, even for those – like many participants in this study – who have never smoked. Even in the context of uncertain causal origins and genetic mutations, the stigma of lung cancer and the figure of ‘the smoker’ as an object of abjection and disavowal persists. We find Alaimo’s concept of transcorporeality instructive for moving away from this biopolitics of lifestyle, toward greater recognition of the collective, though unequal, conditions of ‘carcinogenic capitalism’ in which we all must live and breathe. In turn, our analysis of the specificities of lung cancer may inform broader sociological approaches to tackle stigma at a structural level.

Positive events in psychotherapy: What do adolescents and young adults say is helpful?

Background The significant challenge in adolescent and young adult therapy lies in the fact that research in this field does not provide many clinical indications. This study addresses domains contributing to the establishment and sustenance of engagement, satisfaction, and progress among adolescents and young adults in their treatment by delving into the impact of events that, from the perspective of clients, have positively influenced their therapeutic process. Methods Employing a qualitative research approach, we conducted semi-structured interviews with 13 adolescents and young adults undergoing therapy, recounting positive and constructive events during their treatment. Results A structured thematic analysis revealed six primary domains of positive events: events linked to the management of the setting, events shaping the definition of therapy goals, occurrences tied to the therapist’s active role, collaborative events between therapists and clients, and events associated with both clients’ external and internal worlds. Conclusions The findings suggest that working with adolescents shares similarities with psychotherapy involving adult clients but demands specific attention to adolescents and young adults’ families, surrounding environment, and rapidly changing needs.

Umwelt-A New Strategy for Mentalizing Patient Experience.

There is an inevitable limit to understanding the internal experience of patients with whom therapists work in psychotherapy. The farther their experience is from that of their therapist, the more challenging this endeavor can be. Accepting that therapists cannot exactly know a patient's internal experience invites them to explore novel ways of appreciating another person's way of perceiving relationships, deriving meaning from them, and using their experience to motivate behavior. The concept of umwelt can be used as a metaphor to help therapists imagine the internal world of their patients, as shaped by patients' developmental, interpersonal, and traumatic experiences. Umwelt refers to the unique worldview created by a species' idiosyncratic perceptual organs and survival strategies. This first Psychotherapy Musings describes the concept of umwelt, applies it to the case of a patient with difficult-to-treat mental health problems, and explicates the benefit of this novel perspective.

‘An experiment with the self’: sensory experience, self-analysis, and object relations theory in Oliver Sacks’ A Leg to Stand On (1984)

ABSTRACT In 1974, neurologist Oliver Sacks was hiking alone in the Norwegian mountains when he severely injured his leg running from a bull. Better known for documenting his patients’ disorders and recovery processes, in the autobiographical A Leg to Stand On (1984) he instead maps the ensuing “chaos” of his own changed body and mind as he grapples with the alteration of core sensory experience and its impact on his sense of self. In this article, I showcase Sacks’ self-analytic narrative, demonstrating the value of reading accounts of sensory experiences of ill health via the lens of psychoanalytic object relations theory. I argue that this this approach can not only help us to see sensory and material experience as intimately tied up with one’s internal object world, but also allows us to understand illness narratives themselves as psychical objects in which authors, readers and critics may have complex investments.

Examination of a case of "treatment failure" in long-term psychoanalytic psychotherapy for treatment-resistant depression.

Randomized controlled trials have reported psychoanalytic psychotherapy to improve longer-term post-treatment outcomes in patients with treatment-resistant depression. In this case study, we examine the therapy process of a female trial participant diagnosed with treatment-resistant depression. Structured clinical assessments indicated that the patient's level of depression remained unchanged during and after treatment. Over the course of the therapy, she repeatedly broke away from important others and finally also from the therapy itself, which we linked to the impact of earlier experiences of abandonment on her internal world. In the discussion, we present a variety of reflections that were put forward by the authors during a series of case discussion meetings. Some of these reflections relate to how the inner world of this patient might have triggered a negative therapeutic reaction and a destructive pattern of repetition. The interpretative stance, in which the therapist interpreted this reaction as indicative of a psychic conflict and linked this conflict to the therapeutic relationship, seemed to be experienced by the patient as unhelpful and persecutory. Other elements that were brought up include basic distrust, lack of symbolization and trauma in the patient, as well as the constraints of the research context.

The "Fact of the Matter": A Model for Working with Activated Internal Object Relations in Psychodynamic Couple Therapy.

Extensive clinical scholarship has described the application of object-relational principles, particularly the operation of projective identification, to psychodynamic psychotherapy with couples. The author explores the way in which a more complete depiction of projective processes, one that incorporates each partner's intrapersonal management of multiple internal object relations, interacting interpersonally in the couple therapy process, can explain the escalating cycles of conflict between couples that are elaborated in the family-systems literature, and be helpful in understanding the object-relational substrate of chronic conflict in couples more generally. A description of how to map each partner's internal object world through the identification of these cycles in the early couple therapy process is elaborated in a theoretical model and illustrated with case material.

A model linking emotional dysregulation in neurodivergent people to the proprioceptive impact of joint hypermobility.

Emotional feelings are putatively ascribed to central representation of bodily states in the context of expectation and uncertainty in both internal state and external world. Neurodivergent people are more likely to experience co-occurring mental health challenges, although mechanistic insights underpinning this association are scarce. We therefore undertook a study to test whether imprecise processing of proprioceptive error signals may underlie the connection between neurodivergence and emotional dysregulation. In a cohort of people with complex chronic conditions, including chronic pain/fatigue, and complex trauma, and in a comparison group, we assessed presence of neurodivergence, variant connective tissue manifested through joint hypermobility, and emotional dysregulation. We present a data-informed conceptual model showing that variant connective tissue determines whether proprioceptive surprise is linked with emotional dysregulation in neurodivergent individuals. We suggest that future research in this area may have important clinical implications for the interaction of mental and physical wellbeing in neurodivergent people. This article is part of the theme issue 'Sensing and feeling: an integrative approach to sensory processing and emotional experience'.

In search of a common basis for the diversity of approaches to the study of reflection in psychology

The article attempts to find a basis for combining a large number of currently existing concepts of reflection in psychology. Today, there is an awareness of the importance of the role of reflection in our knowledge of the world around us, but there is no sufficiently clear definition that would most consistently express its essence and contribute to the unification of the entire variety of existing approaches to the study of reflection. The article suggests that this state of affairs is largely due to the long-standing philosophical tradition of contrasting the subjective reality of a person with the outside world. The influence of this philosophical tradition is also felt in attempts to scientifically describe reflection. It is traditionally understood as the ability to think about our thoughts and is contrasted with human sensations and perceptions. It is assumed that this approach can and should be questioned, since it contributes to the creation of a large number of disparate concepts. It can be concluded that there are no separate, independent processes of cognition of the external and internal worlds, but there is a single process of constructing our consciousness, in which reflection always participates.

Enhancing interoceptive sensibility through exteroceptive–interoceptive sensory substitution

Exploring a novel approach to mental health technology, this study illuminates the intricate interplay between exteroception (the perception of the external world), and interoception (the perception of the internal world). Drawing on principles of sensory substitution, we investigated how interoceptive signals, particularly respiration, could be conveyed through exteroceptive modalities, namely vision and hearing. To this end, we developed a unique, immersive multisensory environment that translates respiratory signals in real-time into dynamic visual and auditory stimuli. The system was evaluated by employing a battery of various psychological assessments, with the findings indicating a significant increase in participants' interoceptive sensibility and an enhancement of the state of flow, signifying immersive and positive engagement with the experience. Furthermore, a correlation between these two variables emerged, revealing a bidirectional enhancement between the state of flow and interoceptive sensibility. Our research is the first to present a sensory substitution approach for substituting between interoceptive and exteroceptive senses, and specifically as a transformative method for mental health interventions, paving the way for future research.

Observation as a gateway: using Anna Freud’s ‘double approach’ to understand the child and parent

ABSTRACT Anna Freud’s groundbreaking use of child observation gave rise to the ‘double approach’, an innovative methodology that combined direct child observation with psychoanalytic reconstruction. This method of gathering and understanding data resulted in Anna Freud’s developmental theory that encompassed both normative and pathological child development. Anna Freud became convinced of the need to work with the parent and child and of the power of early intervention and prevention. This paper describes the use of the ‘double approach’ during a year-long observation of a therapeutic parent-toddler group, an early intervention and prevention approach that included parents and their toddlers. The observations demonstrate the valuable role of how intervening early in the toddler’s life facilitated her processing of trauma, leading to her developing the capacity to explore and play and to form strong relationships. It underscores the invaluable role of close observations in gaining insights into the child’s behaviour and internal world.

Understanding the use of metaphors by parents of children with cancer in blogs: a qualitative analysis

Parents of children with cancer, who face significant financial and psychological burdens, often employ metaphors to convey their distinctive experiences and inner realms. However, these metaphors have received scant attention in prior research. Therefore, this study seeks to investigate the utilization of metaphors in blogs authored by parents of children with cancer, aiming to shed light on this understudied area. This study collected data from blogs authored by 33 parents of children with cancer spanning the period from 2019 to 2022, yielding a total of 181 metaphors. Drawing upon Conceptual Metaphor Theory, the method of qualitative content analysis was employed to analyze how parents of children with cancer utilize metaphors. This study found that “Game”, “War”, “Journey” and “Plant” metaphors were the most commonly used by parents of children with cancer. Game and war metaphors occupy a dominant position, followed by journey and plant metaphors. Additionally, these parents frequently employ mixed metaphors. The use of metaphorical language enables these parents to effectively articulate their distinct experiences and emotions. The use of metaphors may serve as a means for parents to articulate their feelings and motivate their children to actively fight cancer. By recognizing the metaphors embraced by these parents, we can gain a deeper understanding of their internal world and potentially offer support through both online and offline channels to mitigate their stress levels.

Must The Show Go On? A Qualitative Study Exploring Barriers And Enablers To Manual Therapists’ Care Of Dancers

Introduction: Dance Medicine is a growing discipline, and healthcare for dancers requires appreciating particularities of their artistic craft. Manual therapists (MTs) are often dancers’ first choice when seeking care. Whilst dancers’ experiences of injury and healthcare have been extensively researched, little is known of MTs’ perspectives of caring for them. Aim: This study aimed to gain an understanding of MTs’ perspectives of caring for dancers. Communication, treatment strategies and obstacles to a successful therapeutic alliance were examined to broaden knowledge and improve care. Methods: This was a qualitative study using Grounded Theory as a framework for data collection and analysis. A purposive sample of 8 participants was recruited—physiotherapists, chiropractors, and osteopaths with 2+ years’ experience of treating dancers. Data collection was conducted via semi-structured interviews, which were transcribed verbatim, anonymized, member checked, and later analyzed. Results: Data analysis constructed 3 categories which described the range of participants’ experiences. Two categories were identified—(i) A Strangled Industry and (ii) Be-all End-all Patients—and found to culminate in a core category: (iii) Beyond Hands-on, which exemplified MTs’ attempts to address clinical challenges. Conclusions: MTs experience several challenges when providing healthcare to dancers. These encompass psychosocial aspects relating to dancers’ internal world and the dance industry environment. It suggests that caring for dancers demands comprehensive, collaborative, and psychologically informed approaches. Emphasis should also be given to developing and implementing dance-specific pain science for all stakeholders.

Life Philosophy: A Study on Western Ontology and Taoism of Form and Spirit Dualism

The paper, starting from the perspective of philosophical exploration of life, combines historical literature with ontology and dualism as the focal points, integrating features from various fields such as psychology, traditional Chinese medicine, and phenomenology. It conducts a comparative study on the similarities and differences between Western ontology and Taoist dualism of form and spirit. The article elucidates how the 'outward-extending material world and inward-purifying spiritual world' are unified in the principle of the amalgamation of 'human body.' It also provides specific methods and theoretical explanations for the discovery of the spiritual world in the East and West. The external world is defined as the material realm discovered by science, while the internal world is the spiritual realm revealed after the purification of the mind. Both idealism and materialism have tended toward extremes in two directions. Both Western ontology and Eastern Taoist dualism of form and spirit have discovered the phenomenon that 'the spirit can exist independently in this time and space through specific exercises such as meditation.' Taoism, with its unique medical foundation in the study of 'form,' recognizes the interaction of form and spirit, leading to the development of their respective religious, philosophical, and theological traditions. Interdisciplinary and cross-regional studies in religion, particularly in the field of mental and physical health, are expected to become significant trends in the future."

“Brutal by Temperament and Taste”

Abstract Central to the historiography of the First World War, scholarship on violence has focused on abstract and impersonal forms of violence between opposing forces or on more personal forms of violence between civilians and enemy combatants. In contrast, this article uses military justice archives to explore instances of serious interpersonal violence and sustained brutality between soldiers in the same combat unit. It provides a new vantage point to explore the complex entanglement of violence and camaraderie and how that played out in the specific context of France's multiethnic Armée d'Afrique. Unpacking the accusations, explanations, and justifications that emerge from multivocal military justice sources illustrates what it meant to commit and be criminalized for certain acts of violence in a context saturated with violence; how and where the line was drawn between acceptable and unacceptable conduct; and, most important, what violence reveals about individual combat experiences and relationships between comrades. Granting access to the perspectives and internal worlds of this diverse group of soldiers, many from racially and otherwise marginalized communities, military justice evidences a complicated and rich set of situational responses and social relationships that enhances our ability to reflect on the conflict's impact on the men caught up in it.

The poetics of the symptom

In contemporary psychoanalytic theory and practice, the patient’s and the analyst’s body are growing in importance. Over time psychoanalysis has become enriched by neurosciences, sociology, neonatal studies, philosophy, literature, and art. It is especially focused on what has not been represented and integrated within the mind, and on how to recover, represent, transform, and integrate these types of experiences, with the corporeal experience now acquiring more prominence. I will assemble those so-called “poetic” aspects in the formation and manifestation of the symptom, which come from embodied and non-symbolized experiences. I will start from the observation that poetry offers an embodied meaning, learned through the body before being understood in the mind. Similarly, the suffering world of our patients can resonate within the therapist like a poem or a piece of music. Through careful attention to the resonances in the body and in reverie, therapists can deduce the personifications inhabiting that internal world. It is as if the poetic experience is situated “on the border” between the sensorial dimension and the verbal dimension. After a brief review of the psychoanalytic literature on corporeal experience in psychoanalysis, a clinical vignette will clarify these statements.

PERSONAL PROPER NAME IN LITERARY TEXT TO DEPRESENT THE EXTERNAL AND INNER WORLD OF A PERSON

The article gives an interpretation of the term "proper name", defines the types of nouns in the literary text, and examines how the external and internal world of a person is described through the name of a person. Factual material -based on the works of Russian writers, describing a person's appearance through a personal name is an important element of Russian fiction. The analysis of Russian personal names in the texts taken from the works of Russian writers shows that carefully selected names of heroes can serve as an important tool in the development of the inner world, moral qualities and character.