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Psychiatric Times. Vol. 29 No. 3
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VANGUARD ISSUES IN PSYCHIATRY 

Who Was Karen Horney?

How Her Ideas Can Help Clinical Practice

By Douglas H. Ingram, MD | February 28, 2012
Dr Ingram served as Dean of the American Institute for Psychoanalysis, founded by Karen Horney, and from 1992 to 2000 served as the Editor of The American Journal of Psycho­analysis, also founded by Karen Horney. He is Clinical Professor of Psychiatry at New York Medical College, Valhalla, NY. Dr Ingram reports no conflicts of interest concerning the subject matter of this article.

These moves are interpersonal as well as intrapsychic. The intrapsychic correlates (which encompass the traditional concept of transference) of what begin as interpersonal moves account for a rich understanding of psychic process. When the child suffers from excessive insecurity, these moves—toward, against, and away—become increasingly fixed and rigid. Generally, one move is elevated above the others. The entire spectrum of attitudes, beliefs, needs, qualities, and sensitivities that is consistent with the strategy selected becomes rigidly organized and excessively valued.

The person who learns that security is achieved and basic anxiety allayed by moving toward others comes to overvalue love, charity, kindness, self-sacrifice, and intimacy. He may show kindness even when it is evident that the object of kindness sees generosity as a clear sign of weakness and stupidity. The person who feels secure only when in overt control may come to value strength, power, money, and prestige. Such a person sulks or rages when he fails to win yet another award or when a spouse does not jump to his every wish, even those unspoken. The person who feels safe when detached comes to value freedom and serenity. He may care about a certain issue but does not want to “get involved.”

(MORE: Are Animal Models Relevant in Modern Psychiatry?)

When the neurotic process is under way, restrictions are imposed. Ways of feeling, thinking, and acting that are experienced as at odds with the primary solution are automatically and unconsciously rejected, but they do not disappear. They remain alive in the unconscious and constantly struggle for expression against the primary move.

The pressure created by these 3 orientations provides the dynamics that is so crucial to understanding the person in clinical context and making sense of inconsistencies. Hence, for example, the person who rigidly moves against others and endorses strength is likely to experience softer feelings as threatening. The person rejects such feelings and is alienated from them. Yet they continue to operate unconsciously and result in behaviors, dreams, and errors in daily living that seem very much at odds with the person’s preference.

These opposing strivings generate much of the inner unconscious conflict that surfaces as the basis for psychopathology. The self-effacing person, for example, may unknowingly exert considerable control by inducing guilt in others. Or, the person seeking to control his or her feelings may be alarmed by their sporadic eruption. The internal conflict generated by these opposing strivings that have become not only rigid and fixed but also insatiable, compulsive, and indiscriminate is what Horney called basic conflict. In addition to the defensive operations, such as projection, denial, rationalization, and dissociation, Horney added idealization.

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Also in this Special Report

Introduction: Controversies and Evolving Issues

Condemning Torture and Abuse: A Call to Action

A Delicate Brain: Ethical and Practical Considerations for the Use of Medications in Very Young Children

Who Was Karen Horney?

Antipsychotics for Behavioral Disturbance in Dementia? A Clinical Conundrum

Neuroscientific Mirages: Are We No More Than Our Brains?

Are Animal Models Relevant in Modern Psychiatry?

Enlightenment and Dimmed Enlightenment

VANGUARD ISSUES IN PSYCHIATRY

Introduction: Controversies and Evolving Issues

Condemning Torture and Abuse: A Call to Action

A Delicate Brain: Ethical and Practical Considerations for the Use of Medications in Very Young Children

Who Was Karen Horney?

Antipsychotics for Behavioral Disturbance in Dementia? A Clinical Conundrum

Enlightenment and Dimmed Enlightenment

Are Animal Models Relevant in Modern Psychiatry?






 
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