Drawing on 15 years of experience teaching psychoanalytic theory and therapy primarily from an object relations perspective to Chinese psychotherapists onsite and online, the authors present their learning about Chinese culture, social history, and philosophy, and the Chinese way of communicating about emotional experience. Their essay is imbued with the Chinese use of metaphor and psychosomatic symbolization, particularly involving the heart. They elaborate on the Chinese concept of Empty Heart Disease, comparing and contrasting it to Western concepts from literature, sociology and psychoanalysis, namely spleen, anomie, dead mother, and schizoid, empty, false, and narcissistic self-states. They expand upon and extend the empty heart concept to various age groups and symptom presentations in China, illustrated by a vignette from individual psychoanalysis with a woman and three vignettes from applied psychoanalysis of a couple with no intimacy, a child with an obsessive psychosomatic symptom, and an adolescent school dropout who was self-harming and suicidal in response to academic pressure. Having emphasized the connection between symptom presentations and social life and times, they discuss the impact of trauma, its transgenerational transmission in China, and the impact of unprecedented economic growth and social change on individuals, couples and families.

The contributions to this Psychoanalytic Controversies section explore the question of what psychoanalysis may be able to contribute to thinking about some of the challenges currently confronting humanity and how such communications can be made effectively. This introduction to the section frames the debate with some reflections on anxieties that have been expressed about the application of psychoanalytic ideas beyond the clinical context, the risks of insularity, the need for appropriate humility, and the reality of the embeddedness of analytic practice, in particular social, cultural, and historical contexts. Contributions from Claudia Frank, Sudhir Kakar, Eli Zaretsky, Michael Rustin, Pratyusha Tummala-Narra, Magda Khouri, and Sally Weintrobe are introduced.

King Lear is a timeless exposition of humankind\'s attempt to find meaning amidst the ceaseless turbulence of existence. This entails navigating the disintegrating pulls of nature and harmful human action that exist alongside affiliative, life-promoting gestures shown toward one another. As the predictability and safety afforded by social and two-dimensional psychic constructs collapse, several characters in this play are forced to reckon with the untamed, less organized realms of the mind and natural world. This leads to movements toward psychic paralysis and disintegration, as well as toward growth and interpersonal healing, dynamics that hinge on the characters\' internal structuring.

This article reflects on the transmission of clinical practices based on psychoanalytic theories and methods in care institutions. It examines the issues raised by these practices and the impact on therapists in the French social, scientific, and economic context. We attempt to identify the factors that promote the implementation of a process of reflection on established practices and their evolution.Our hypothesis is that any process of transmission of psychoanalytic practices in institutions implies thinking about the institution as an object of psychic reality, and grappling with potentially persecuting elements of change; these include the upheaval of values and ideals underlying the practices, as well as generational transmissions and their potential for conflict. The possibility of working on these internal objects raises the question of the institutional capacity for containing conflict; it also involves thinking about the nature and function of institutional spaces.Three points in particular are developed: the organizational modes of structures and their impact; the history of the structure and its intergenerational transmission; and the place of third parties in the process of historicization and transmission. These three points define the objects that are collectively elaborated, and the method that promotes the evolution and creativity of psychoanalytic practices in institutions.

Despite Tennessee Williams\'s genius as a playwright who could represent his inner emotional struggles in his art, psychoanalysis was unable to free him from the powerful \"blue devils\" within him. Williams\'s inability to engage with psychoanalysis presents an opportunity to discuss ways that contemporary thinking about brain structure and function might guide our understanding and treatment of patients such as Williams. One of the core defensive behaviors that made analysis difficult for Williams was his avoidance of painful emotions through compulsive writing, sex, alcohol, and drug-addictive behaviors. These pre-mentalized reactions became Williams\'s habitual procedural body response, which occurs below the level of the self-reflective brain. Within a relatively traditional ego psychological frame, Lawrence Kubie, Williams\'s analyst in 1957, attempted to prohibit the compulsive behaviors to be able to process the underlying painful affects in the analysis. However, given that this level of mind and brain functions was Williams\'s chief means of regulation, Williams could not engage in the psychoanalytic process and left the treatment after one year. I propose that Williams was operating in brain circuits below the level of \"higher\" reflection or interpretation-receptive circuits and therefore he was unable to make use of a traditional ego psychological model. A review of these brain circuits seeks to encourage therapists to utilize simplified brain explanations for patients, which can destigmatize the pathologic behaviors and enhance engagement in the treatment process.

Preventive developmental guidance programmes have been applied on a large scale for several decades now in many western countries. But how do we adapt these programs to families with very different ethnic backgrounds? How can we concretise the concept of cultural sensitivity into that context? The plea of von Klitzing, the former President of the World Association for Infant Mental Health, for further reflection on the concretization of cultural sensitivity in the context of infant mental health care is the main source of inspiration to this article. von Klitzing speaks out against the point of view in which universal children\'s rights or conditions that are seen as promoting a child\'s development all around the globe, are criticized as being only western conceptions and thereby culturally biassed. Following this kind of reasoning, a culturally relativistic stance on what a facilitating environment is, should be adopted. Such a discussion in terms of universalism versus relativism, though, as argues von Klitzing, is an old antagonism that cannot inspire us for the adaptation of early health care practices or developmental guidance programs that are fitting in to the needs of families and their babies that are living in multicultural contexts. Although it could be interesting to think about how certain universal principles of good-enough child care can be formulated or embodied in an intercultural variety of ways, these variable expressions of the worldwide agreed upon principles of good early mental health care will only be culture-specific translations of these universal principles. They can\'t in any way be seen as an argument against the universality of these principles, as argues von Klitzing, who is describing another way of solving the problem of the cultural relativist criticism on the universality of principles of good infant mental health: culture sensitive infant mental health services. But, to make the principle of cultural sensitivity work in practice, we need to fill it with content. This article is mainly on what it concretely means to work in a culture sensitive way in our preventive practice within the FIRST STEPS program, a Belgian project for immigrant and exiled mothers and their children from zero to three.

Historian and philosopher John Forrester argues that psychoanalysis is characterized by a style of scientific thinking and reasoning that he coins \"thinking in cases\". Since Freud, case studies have been used as a medium for sharing, demonstrating, discovering, expanding, consolidating and \"thinking\" psychoanalytic knowledge. In this paper, we seek to clarify and enrich Forrester\'s idea of thinking in cases. We first attend to issues around the lack of definition for thinking styles, and we propose a more detailed description for what might constitute a scientific thinking style. Second, we outline how thinking in cases differs from other kinds of thinking styles. In doing so, we argue that some of the criticisms directed at case studies are the result of a confusion between statistical and experimental thinking styles and thinking in cases. Finally, we propose that there is more than one way of thinking in cases. We distinguish between cases as exemplars for analytic generalization, cases as exemplars for analogical learning, and cases in the service of empirical generalization. By making these implicit thinking styles explicit, we seek to demonstrate the importance of case studies at all levels of psychoanalysis: clinical, research, training and teaching.

Cultural products such as films or TV series can be understood as articulations of socio-political fantasies that contain conscious and unconscious elements. At first glance, Game of Thrones, a fierce medieval show full of violence and sex, appears to offer hardly any topical references. Psychoanalytic examination, which unveils the series from its unmistakable vesture, reveals essential elements and their relations that bear remarkable parallels to prevailing socio-political fantasies. The circumstances on the fictitious continent Westeros provide a diagnosis of a descending culture whose rulers are completely absorbed by intrigue for power and influence. They refuse to notice anything that does not serve in retaining their power. The North, cut off from Westeros by a tremendous wall, can be considered a repository for the repressed side effects of their own doing. These effects threaten their own existence in the long run. The distant continent Essos stands for the hope that there may be a shift or an alternative world. Psychoanalysis can not only contribute to the understanding of the unconscious content of TV series with its method, but can also theoretically explain how such series are individually received and mentally processed. For this, object relations theory from Winnicott is used. His concept of transitional space offers the possibility to understand mental processes that take place while watching television. The article concludes with general remarks about the meaning of television series as cultural phenomena and the object of research of psychoanalysis.

This study examines André Green\'s use of the negative and employs it to interpret works of art that provide a visual representation of absence and loss. Green identified the negative in all of Freud\'s basic assumptions and developed his work of the negative from an erudite reading of Freudian theory. By filling in what he identified as gaps in Freud\'s work, Green produced a contemporary psychoanalysis that yields new discoveries on each reading. His work on the negative describes a dialectics of absence and presence in the human condition and highlights the human endeavour to cope with loss/lack. The concept of the negative is applied to works by the contemporary sculptor, Berlinde de Bruyckere. This artist demonstrates a profound knowledge of art history and religion, as well as an intimate relationship to the human and equine bodies in her sculpture. Studying her work, like reading Green, is a dense and multi-layered experience. Both artist and psychoanalyst offer the body as a site of feeling and meaning-creation. In both, absence and loss are protagonists that lead either to an endlessly repeated cycle of suffering and pain or to the risk of an encounter that promises renewal and change.

Alluring and fertile, the flower connotes a locus of desire. The floral metamorphic myths narrated in Ovid\'s Metamorphoses (AD 8a) thematize the price of desire--the shame, grief, and rage of rejection and rivalrous defeat--and symbolize the generative transformation that frustrated desire and competitive loss can promote. In the deceptively beautiful painting Realm of Flora of 1631, Nicolas Poussin enlists these myths as allegories of his own great creative leap, an aesthetic metamorphosis that followed shattering defeats. Extending the association between creativity and object loss to competitive loss, Poussin holds a mirror to our powerful drive to prevail and create anew from the ashes of loss.