Ajase Complex

   What is psychoanalysis? Often it is described as "bringing unconsciousness into consciousness" or "getting insight into the resolution of conflict." In other words, through psychoanalysis one comes to understand the existence of psychic pain that was not perceived until then, and that understanding allows the person to begin resolving it. It is essential that the habits of feelings and thoughts (defense mechanisms) that lie behind psychic pain are taken up as resistance in psychoanalysis (in the therapeutic relationship) and are worked through. "Remembering, repeating, and working through" are basic principles of psychoanalysis.

   In the psychoanalysis of defensive states (slightly disturbed personality disorders), the therapist does not encounter difficult situations and treatment will not take a long time if it follows the above-mentioned therapeutic principles. But these basic principles are too vague in the treatment of pathological states (severely disturbed personality disorders) or psychoses. For example, it is necessary to bring unconsciousness into consciousness over and over again. As regards defense mechanisms, here we see very complicated nature of mind that are connected with one another. The therapist also encounters severe symptom formation protruding from defense mechanisms. As the therapist deals with resistance, he/she finds multiple kinds of psychodynamics close together. It is difficult in those situations to judge what and how he should work through them. That naturally increases the frequency of sessions and prolongs the treatment. The therapist cannot assess the future prospects if he/she goes only by these basic principles.

   Through trial and error, many psychoanalysts hace come up with models for treatment in these situations. Those of Otto Kernberg and James Masterson in the psychoanalysis of borderline cases are well known. Also widely known is the "separation-individuation process" of Margaret Mahler, a developmental theory often used in borderline therapy. Another is Heinz Kohut's psychoanalysis (self psychology) on narcissism. Kohut did not clinically deal with pathological states (severely disturbed personality disorders), but he brought forward the concept of narcissistic neurosis, which is different from Freud's concept of classical neurosis. Nowadays, these are generally known as narcissistic personality disorders in defensive states (slightly disturbed personality disorders). By the way, the work of borderline cases and narcissism in fact contributed to some progress in making prognoses in functional mental disorders. The substance of their researches is reflected in current strategies of therapeutic techniques. Because of such work, we know that interpretation is important in the treatment of borderline cases because management of aggression is so central in the therapeutic approach, and that empathy is important in the treatment of narcissistic neurosis.

   Thus, we have made some progress in psychoanalysis, but the ratio of cure in pathological states (severely disturbed personality disorders) nonetheless is actually still low. Certainly advances have been made in understanding mental disorders, but psychoanalysis comes to be more and more put into culture if it is unable to bring about cure of patients. These were the circumstances when I started a study of psychoanalysis. But I was fortunate to be able to study psychoanalysis under the supervision of Okonogi. One of Okonogi's concerns is the so-called Ajase Complex, developed by Heisaku Kosawa, Okonogi's teacher. It proposes two types of guilt; one is the punitive type, and the other is the forgiven type. The latter has its source in a "sense of penitence," which is Kosawa's concept discussed in a paper called "Two kinds of guilt−Ajase Complex" on the sense of penitence (forgiveness). I found the paper very interesting, and although I did not realize it until later, the study on forgiveness inspired a series of discoveries that I made.

   Fifteen years later, my radical treatment of several borderline patients was successful. Finding that forgiveness was the concept that held the key to my success in treatments, I studied the structure of forgiveness (what psychodynamics operated in forgiveness). I came to understand that not only rebellion but also apology is an important constituent factor in forgiveness. As regards the therapeutic technique of interpretation, specialists have studied well how to make effective interpretation, but they lack understanding of the nature behind interpretation. They understand little of how interpretation works as the rebellious object. My borderline patients formed the rebellious self through introjecting me as the rebellious object (not the punitive object) and identifying with it. Patients also introjected me as the apologetic object, and formed the apologetic self, which became the basis of perseverance. This is the formation of the loop of forgiveness. Finally clarifying this, I was able to explain the question of dealing with aggression apart from the topic of narcissism (taken up below), and to improve the borderline theory of Kernberg, which did not clearly distinguish the aggressive system and the fragile system.

 

Roots of the Integration Theory of Psychoanalysis

Narcissism

   If my discovery had been limited to forgiveness, I would have published my results in journals of psychoanalysis. But what I had finally understood led to a surge of insights that so overwhelmed me that it took me twenty years to complete the book, The Integration Theory of Psychoanalysis. Let me next relate my progress in understanding narcissism and its treatment.

   Conventional studies of narcissism have been placed in the category of paraphilia. Kohut extracted healthy narcissism which grew up due to empathy. This extraction was significant because psychoanalysis until then was influenced by Freud's theory of infant and his theory of sexuality. Deliberately moving away from Freud, Kohut made us notice the differences between healthy narcissism and pathological narcissism. I wonder whether "idealization" is the psychodynamics to make healthy narcissism or a sort of defense mechanisms, in short, pathological narcissism. (Let me say in passing that various opposing views have constantly appeared in conventional psychoanalysis. For example, the disagreement between Anna Freud and Melanie Klein is widely known. There are also disagreements about ego psychology and self psychology, and between self psychology and object relations theory.)

   The disagreement between healthy narcissism and pathological narcissism is a difficult problem. How can they be integrated? We should pay attention to the clinical cases Kohut and the Klein school focused on to frame their theories. Briefly, Kohut focused on neurosis centering around hypochondria, and the Klein school focused on schizoid personality disorders centering around withdrawal. Healthy narcissism grows up in neurosis, but it is difficult for healthy narcissism to grow up in pathological states (severely disturbed personality disorders). How can this gap be filled? Although Kohut's study was useful in some ways, I was compelled to turn elsewhere because it did not address the problems of severely disturbed personality disorders. I thought that something was lacking in Kohut's theory. At that time, I had already thought out a strategy against silence, which is important in the treatment of schizoid personality disorders. Because talking is used in psychoanalysis, the therapist gets anxious when sessions are routinely filled with silence. By its nature, silence can drive a therapist to his/her limit; he/she cannot cope with the silence without an accurate understanding of it. I realized that treatment for pathological narcissism required solely an awareness on the part of therapist of his/her limitations (sense of incapacity and incompetency). That was my discovery of the "weak object."

   In order to induce healthy narcissism, the therapist functions not only as the idealized object but also the weak object. Unless the therapist can become the weak object, he will instead become the ruler personifying perfection and absoluteness (of the grandiose object). When the patient goes beyond treatment, it is necessary for him/her to feel an urge to "get even" with his/her therapist, and it is also important that he/she discovers the weakness of the therapist. I concluded that a series of such psychodynamics is the key to creating healthy narcissism. That is the formation of the loop of help. Discovering how to make efficient use of silence and therapist limitations in treatments, I was also able to discover where Kohut's theory was deficient. At the same time I could see where Kohut had made a false step: it was in the psychodynamics of "mirror trandference." That is the psychodynamics of expectation.

   Thus, the discovery of forgiveness gave rise to the apologetic technique, and the discovery of the weak object produced the technique of inducing superiority in the object. It seemed to me that by adding these two techniques to interpretation and empathy, we could assure cure of psychosis.

                           Roots of the Integration Theory of Psychoanalysis

Finding the cause and establishing treatment for psychosis (schizophrenia and manic-depressive disorders)

   When I finally conceptualized and tested the loop of forgiveness and the loop of help, I had confidence that they were mechanisms of a healthy mind.  Then I asked, how is a pathological mind constructed? I had already made diagnoses and designed treatment for many patients at the Nitta clinic. While many researchers begin with the mechanisms of a pathological mind, I began by laying out the mechanisms of a healthy mind. I had thought all along that we should first define a healthy mind and then should study a pathological mind. This course of study was natural for me because I had already helped many patients to cure. For example, the fruit that I made the borderlines (borderline personality disorders) cure leads to a conclusion that their cause is the defects of "relief to be forgiven and gratification of forgiveness." Thinking carefully about this conclusion, I went ahead with symptom formation and disorder formation, and buckled down to the difficult task of formulating the treatment process. I went through the same progress for psychosis―schizophrenia and manic-depressive disorders. To me, nothing is more rewarding than to clarify the cause and to establish the treatment for disorders of unknown etiology. But, such a task demands more than ordinary ideas and efforts.

   Conventional studies on treatment of psychosis include that of Wilfred Bion on psychosis and that of Harold F. Searles on schizophrenia, and Edith Jacobson's work on manic-depressive disorders, among others, are widely known. But I could not cite them in The Integration Theory of Psychoanalysis. I first wrote a paper citing a study by Searles. But as I continued to develop my ideas in increasingly greater detail and depth, his study became useless to me and I put it aside. I believed that psychosis must have some continuity with the pathology of pathological states (severely disturbed personality disorders), and I read about their psychodynamics as they were revealed through treatments for psychosis in practice. At last, I found that the psychoses of schizophrenia and manic-depressive disorders consist of a continuum of two pathological states: pathological states of the aggressive system like borderline personality disorders and pathological states of the fragile system like schizoid personality disorders. I found that these psychoses are generated whenever pathological states of the aggressive system and pathological states of the fragile system overlap.

   I was able to discover this because I had already succeeded in bringing about cure of borderline personality disorders and schizoid personality disorders. To begin radical treatment of a psychosis without having successfully treated pathological states will result in poor work. I mention this point also in The Integration Theory of Psychoanalysis. How, then does one proceed to ensure cure? I obliged patients' families to participate and cooperate in my radical treatments from the outset. I treated patients on the one hand, and I counseled their families on the other. In addition, I administered treatment to patients in company with their families as time and circumstances allowed. Today there are new medications on the market and pharmaceutical companies are more aggressive than ever in pushing them. My patients and their families, however, did not want medications. Patients' parents hoped that their child would get better "while they are still in good health." I devoted myself to treating patients, responding to their parents' thoughts. However, the burden on families increased whenever the treatment approached a vital point, because patients' demands and dissatisfactions, dormant until then, grew stronger. I was greatly worried that the patients' families could not cope and would fall ill. There was often a tacit complaint:"Our child is worse than ever although we have been trying our best to help him get better."

   On these hopeless thorny ways, the ideas of patients as the following showed fresh hope;"If I can have one more doctor like you, I'll be able to cure easily." My patients said the same words many times. But another therapist on my level was not available. What should I do? After due consideration, I proposed "double" treatments. Some patients consulted other therapists with a letter of introduction from me, and others went to other therapists without informing them of their treatment with me. This produced certain results: If the therapist is trusted, the fragile system which is the loop of help applicable, but the aggressive system which is the loop of forgiveness is inapplicable. The reason for this result is that their therapists could not cope with the management of aggressions. Therefore, I came to the conclusion that both therapists should be specialists (psychoanalysts) when double treatments are done.

                             Roots of the Integration Theory of Psychoanalysis

Review work of conventional psychoanalysis

   Some patients passed through the crisis of treatments and outgrew treatments because their families corrected their own behaviors. I wrote two papers dealing with the treatment processes combined with the results of double treatment. They are "The formulation of the radical treatment of psychoses" and "The concrete formulation of the radical treatment of psychoses." Thus, for the first time in history, a treatment method for psychosis was established. Conventional psychoanalysis, which had been gradually losing direction, was no longer interesting to me because I had been concentrating my efforts on the new treatment. However, my methodology is undoubtedly psychoanalysis. How should my findings be published? I had not associated with others in my field before the completion of my work. If I had, I could not have finished it. I am convinced even now that I proceeded in the only way I could, but I also worried about difficulties to come, because I had in my writing broken utterly with conventional psychoanalysis. Nonetheless, this work is finally completed, and I am convinced that the fruit of my efforts will benefit many more patients and their families.

   I will put the differences between conventional psychiatry/psychoanalysis and my practical theory in order, here. Conventional psychiatry and my practical theory differ the most sharply in diagnosis. Diagnosis means diagnostic method. Symptom diagnosis and disorder diagnosis are mixed in conventional diagnostic methods. For example, panic disorders, depression, dependencies, eating disorders, and some others are all symptom diagnoses. In contrast, manic-depressive disorders, schizophrenia, schizoid personality disorders, borderline personality disorders are all disorder diagnoses. They are enumerated on an equal level in conventional psychiatry. But, for instance, all symptoms often appear in borderline personality disorders and it is necessary to make many diagnostic labels. The marked symptom cluster is placed on diagnostic labels,but that means that diagnosis is composed only of superficial observations. Psychiatrists create diagnostic standards even on symptom diagnosis, and arrange them so as to prevent overlapping. But that arrangement does not eliminate that vagueness. Each one actually insists on a different opinion without the consistent treatment method on how to make patients cure. My radical treatments demonstrate very distinct treatment processes. It is easy to predict what symptom will appear and disappear at what stage, especially when the practitioner makes a success of the radical treatment of psychosis. It is then possible to distinguish between symptom formation and disorder formation. The diagnostic difference between conventional psychiatry and my practical theory depends on whether the formulation of treatment method is contained or not.

   There are many differences between conventional psychoanalysis and my practical theory. Readers may be interested in and can easily understand four of them. Four contains two structural theories, the theories on pleasure-displeasure principle and defense mechanisms.

   Freud's two structural theories are discussed in Chapter 15:"Just a dream, but a dream" in Digest version of the Integration Theory of PsychoanalysisThe classification of "id, ego, and super-ego" is now too vague to apply to the study of mind, given the appearance of recent brain research that gives us steadily growing understanding of the function of each brain area. I propose new, revised classification which lists "displeasing factors, defensive factors, and regulatory factors." This can be collated to brain research. The same classification can deal equally well with "defense, dissociation, and regulation." This new classification is easy to understand and practical.

   It is also necessary to reshuffle the classification of the conscious, the pre-conscious, and the unconscious. The greater part of our daily life is pre-conscious, and it can be always put into consciousness; if that is taken into account, it should be expressed as the preconscious, the conscious, and the unconscious. The ground of this classification is not so simple. Our psychic phenomena, which are generated by the relations between consciousness and self-consciousness, have been classified into "nine layers." This reshuffle can be presented according to this classification.

   It is also necessary to sharpen the distinction of pleasure principle and reality principle. No one asks whether auditory hallucinations in schizophrenia occur from pleasure principle or reality prenciple. They should be distinguished into pleasure-displeasure principle derived from animal brain and pleasure-displeasure principle derived from human brain. All psychic phenomena, which have been mysterious, come to appear clearly through this work.

   My practical theory, furthermore, explains the working of defense mechanisms dealt with in conventional psychoanalysis. Answering a simple question, "what defends what?" is suitable to clarify defense mechanisms. It can be said from this viewpoint that introjection, projection, identification, displacement, sympathy, intellectualization are not defense mechanisms. What are they? They can befully explained by the functional network of neural transmissions that I proposed.



                               Roots of the Integration Theory of Psychoanalysis

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The Integration Theory of Psychoanalysis is the revolutionary theory of psychoanalysis. It defines mental health & disease, and elucidates every psychological phenomena. Particularly, the cause of psychosis, schizophrenia & manic-depressive disorders, is clarified and their radical
treatment aiming complete recovery is established. The contents beyond all imagination, the elucidation of consciousness & self-consciousness, the way to enlightenment etc. are included in this book. Not only the expert in the field of psychoanalysis but also the persons who have interest in mind will be strongly affected by this book.