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Hamburg, P. (1987). Symptoms, Chaos and the Architecture of Psychotherapy. Mod. Psychoanal., 12(2):187-193.
    

(1987). Modern Psychoanalysis, 12(2):187-193

Symptoms, Chaos and the Architecture of Psychotherapy

Paul Hamburg, M.D.

I would like to explore certain parallel architectual metaphors in patients' symptom-structures and in psychotherapy, with the view to clarify some of the difficulties in maintaining a therapeutic space with some disturbed patients. Masud Khan (1978), Andre Green (1978), and Serge Viderman (1979) have all written about the concept of therapeutic space as the embodiment of illusion in the psychotherapeutic situation. The boundaries, constituents and limitations of therapeutic space as a potential environment for exploration and growth remain to be mapped. Beginning from a consideration of the symptom as a structural unit that mitigates chaos in the patient's inner world, I would like to examine the shape of the common space occupied by patient and therapist and the strains placed on that space by patients whose symptoms include severe limitations in their tolerance of illusion and play.

Psychiatric Disorder and Chaos

To name a set of psychiatric symptoms a “disorder” obscures even as it clarifies, by implying that symptoms replace order with chaos. The possibility of creating a taxonomic classification of disorders itself hints that something besides disorder is at stake in understanding symptoms. Be they obsessions, rituals, inhibitions or repetitions, psychiatric symptoms help organize a world as it threatens to become chaotic, even as they become names for that chaos.

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