Hope and Grief: The Introduction of an Emotional Language

  • Tamara McClintock Greenberg


Throughout this book, I have attempted to describe various aspects of emotional experience related to the process of aging and illness. Although the patients whose case histories I have discussed portray varied levels of psychological functioning, different personalities, character structures and defenses, there is one major theme that is common to all of them: the difficulty in accessing an emotional language due to the concrete demands of bodily illness or concrete focus on the body.

While I have described how ageism, and the fear of illness or death on the part of therapists may explain the hesitation of traditional psychoanalysts in addressing the needs of medically ill and older patients, the challenges that these patients bring to the therapeutic setting in talking about their internal and mental experiences creates unique difficulties for working with this population. In this chapter, we will revisit the concept of alexithymia; I will suggest that this idea can be expanded and applied to our work as clinicians, but without the pejorative connotations that are often associated with the dilemma of lacking the right words to describe feelings, or the assumption that illness is psychosomatic. I have argued that traditional approaches are not useful for many medical and aging patients; I will also describe how we might understand aspects of the therapeutic encounter with this population. Finally, I will contextualize the hope and grief our patients face, with a focus on the resilience of the elderly and medical patients, as these individuals often want to learn ways they can expand their emotional landscape towards a more nuanced and developed internal dialogue. The quest for meaning and insight in these patients implores us to continue to find ways to connect with and help this growing population.


Emotional Experience External Reality Intense Emotion Emotional Suffering Psychodynamic Theory 
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  1. Alpert, J. L. (1994). Analytic reconstruction in the treatment of an incest survivor. Psychoanalytic Review, 81, 217–235.PubMedGoogle Scholar
  2. Bion, W. R. (1962). Learning from experience. London: Tavistock.Google Scholar
  3. Bion, W. R. (1970). Attention and interpretation: A scientific approach to insight in psychoanalysis and groups. London: Tavistock.Google Scholar
  4. Bouchard, M. A, Lecours, S., Tremblay, L. M., Target, M., Fonagy, P., Schachter, A., et al. (2008). Mentalization in adult attachment narratives: Reflective functioning, mental states and affect. Psychoanalytic Psychology, 25(1), 47–66.CrossRefGoogle Scholar
  5. Breuer, J., & Freud, S. (1957). Studies on hysteria (J. Strachey, Ed & Trans.). London: Hogarth Press. (Original work published in 1895)Google Scholar
  6. Ferro, A. (2002). In the analyst's consulting room (P. Slotkin, Trans.). New York: Taylor & Francis.Google Scholar
  7. Fonagy, P., & Target, M. (2000). Playing with reality III: The persistence of dual psychic reality in borderline patients. International Journal of Psychoanalysis, 81, 853–873.PubMedCrossRefGoogle Scholar
  8. Glucksman, M. L. (2000). Affect dysregulation: Defense or deficit? Journal of the American Academy of Psychoanalysis, 28, 263–273.PubMedGoogle Scholar
  9. Gill, M. M. (1984). Transference: A change in conception or only in emphasis? A response. Psychoanalytic Inquiry, 4, 489–524.CrossRefGoogle Scholar
  10. Guttman, S. R. (2006).Hysteria as a concept: A survey of its history in the psychoanalytic literature. Modern Psychoanalysis, 31, 182–228.Google Scholar
  11. Jaques, E. (1998). Death and the mid-life crisis. In E. B. Spillus (Ed.), Melanie Klein today: Developments in theory and practice (Vol. 2, pp. 226–248). London/New York: Routledge.Google Scholar
  12. Joseph, B. (1983). On understanding and not understanding: Some technical issues. International Journal of Psychoanalysis, 64, 291–298.PubMedGoogle Scholar
  13. Klein, M. (1940). Mourning and its relation to manic-depressive states. International Journal of Psychoanalysis, 21, 125–153.Google Scholar
  14. Krystal, H. (1997). The trauma of confronting one's vulnerability and death. In C. Ellman & J. Reppen (Eds.), Omnipotent fantasies and the vulnerable self (149–185). Northvale, NJ: Jason Aronson.Google Scholar
  15. Krystal, H. (1988). Integration and self-healing: Affect-trauma-alexithymia. Hillsdale, NJ: The Analytic Press.Google Scholar
  16. McDougall, J. (1980). A child is being eaten, I: Psychosomatic states anxiety neurosis, and hysteria. Theoretical approach II: The abysmal mother and the cork child- a clinical illustration. Contemporary Psychoanalysis, 16, 417–459.Google Scholar
  17. McDougall, J. (1989). Theaters of the body. New York: Norton.Google Scholar
  18. McDougall, J. (1984). The “dis-affected” patient: Reflections of affect pathology. Psychoanalytic Quarterly, 53, 386–409.PubMedGoogle Scholar
  19. Miller, M. L. (2008). The emotionally engaged analyst I: Theories of affect and their influence on therapeutic action. Psychoanalytic Psychology, 25(1), 3v25.CrossRefGoogle Scholar
  20. Mitchell, S. A. (1993). Hope and dread in psychoanalysis. Cambridge: Harvard University Press.Google Scholar
  21. Nemiah, J. C. (1973). Psychology and psychosomatic illness: Reflections on theory and research methodology. Psychotherapy and Psychosomatics, 22, 106v111.PubMedCrossRefGoogle Scholar
  22. Rickles, W. H. (1986). Self psychology and somatization: An integration with alexithymia. Progress in Self Psychology, 2, 212–226.Google Scholar
  23. Renik, O. (1996). The perils of neutrality. Psychoanalytic Quarterly, 65, 495–517.PubMedGoogle Scholar
  24. Schore, A. (1994). Affect regulation and the origin of the self: The neurobiology of emotional development. Hillsdale: Erlbaum.Google Scholar
  25. Schore, A. (2002). Advances in neuropsychoanalysis, attachment theory, and trauma research: Implications for self psychology. Psychoanalytic Inquiry, 22, 433–484.CrossRefGoogle Scholar
  26. Schwartz, J. M., & Stolorow, R. D. (2001) Trauma in a presymbolic world. Psychoanalytic Psychology, 18, 380–387.CrossRefGoogle Scholar
  27. Seligman, S. (2000). Clinical implications of current attachment theory. Journal of the American Psychoanalytic Association, 48, 1189–1194.CrossRefGoogle Scholar
  28. Sifneos, P. E. (1973). The prevalence of “alexithymic” characteristics in psychosomatic patients. Psychotherapy and Psychosomatics, 22(2), 255–262.PubMedCrossRefGoogle Scholar
  29. Winnicott, D. W. (1965). The maturational process and the facilitating environment. New York: International Universities Press.Google Scholar
  30. Zackheim, L. (2007). Alexithymia: Expanding the realm of research. Journal of Psychosomatic Research, 63, 345–347.PubMedCrossRefGoogle Scholar
  31. Zinberg, N. E. (1964). Psychoanalytic consideration of aging. Journal of the American Psychoanalytic Association, 12, 151–159.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  1. 1.Department of PsychiatryUniversity of CaliforniaSan FranciscoUSA

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