By Prof. Levine & Dr. Salganik
Greetings to our readers,
The philosophical idea of substitution in the complex fabric of human thought, the concept of "substitute" emerges as both a practical and metaphysical entity. At its core, a substitute is what stands in the place of the other, a character entity or idea that fulfills, replaces or imitates the function of the original. However, to reduce the substitute to a mere placeholder is to ignore its profound implications in ontology, ethics, aesthetics, and epistemology.
Below we will explore the dimensions of the substitute, trace his philosophical genealogy and examine his resonance in contemporary thought.
The ontology of exchange
The substitute works in a dual mode: as a reflection and a deflection. In its reflective capacity, it reflects the essence of the source, striving to imitate its role or presence. However, in its deviation it symbolizes absence – a reminder of what is lost, incomplete or unattainable.
Heidegger's concept of "being" and "being-there" offers fertile ground for examining this duality. Substitution may be perceived as an attempt to restore or approximate an ontological presence, but at the same time it emphasizes the impossibility of complete replication.
For example, a portrait of a loved one. The portrait replaces his physical presence, evoking his essence but it also conspicuously marks his absence.
This duality invites reflection on the nature of reality and representation – an ancient discourse such as Plato's "allegory of the cave", in which the shadows serve as a substitute for the real, and confuse the boundaries between appearance and truth.
The ethics of substitute
Ethical considerations of substitute often revolve around the authenticity of the substitute and its consequences. Substituting one action, decision or entity for another is intrinsically value-laden, and carries implications about trust, responsibility and justice.
Emmanuel Levinas, in his reflections on alternatives and responsibility, touches on substitute through the ethical requirement to prioritize the other. Here, the substitute of the self with the other is not just a substitute but a deep ethical call – to stand by the other in his suffering or vulnerability.
However, ethical dilemmas arise when the exchange violates trust or diminishes the intrinsic value of the source. Replacing real relationships with business relationships, or replacing human work with automated processes, for example, raises questions about respect, autonomy and alienation.
These considerations invite us to examine the moral weight of alternative actions, and to demand a balance between necessity and irreplaceable respect.
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By Prof. Levine & Dr. Salganik
Greetings to our readers,
The human ability to perceive is not a passive reception of stimuli nor is it purely "mental theater". This concept stems from complex interrelationships between the senses and the internal models of the brain. In order to survive and thrive, we must accurately analyze what arises externally from what is created in our soul internally. This distinction underlies everything from threat detection to social interaction.
However, delusions, hallucinations, and confusion can occur when the neural processes that maintain this boundary go awry.
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By Prof. Levine & Dr. Salganik
Greetings to our readers,
Transitional objects, a term first coined by the British pediatrician and psychoanalyst Donald Winnicott, refer to physical objects used by children to ease the transition between dependence and independence, usually during the developmental stages of early childhood.
The following is a comprehensive overview of the definition, use, and theoretical implications of transitional objects as obtained by various researchers.
In addition, we will hypothesize about the neurobiological foundations of the phenomenon, and examine the areas of the brain involved in attachment and use of transitional objects. Through the synthesis of psychoanalytic theory, developmental psychology and neuroscience, we will try to contribute to a holistic understanding of transitional objects.
Donald Winnicott [197-1896]
Transitional objects play a significant role in child development, especially in facilitating the transition from initial dependence on primary caregivers to increased autonomy. The term "transitional object" was introduced by Donald Winnicott in 1953 and refers to an item, often a blanket or stuffed animal doll, that a child uses for reassurance and comfort when separated from their primary caregiver.
These objects serve as mediators between the child's inner world and external reality, and provide emotional regulation during key developmental transitions.
While Winnicott's conceptualization laid the foundations, later researchers built on and expanded the concept, exploring its psychological, developmental, and neurobiological dimensions.
Definition and use of transitional objects:
According to Winnicott, transitional objects are "first not me" objects that serve as a bridge between the infant's self and the world outside the mother.
They are used to help the child manage separation anxiety from their caregivers while providing comfort. Winnicott postulated that these objects embody a developmental transitional stage where the child's inner world of fantasy and outer reality begin to merge, allowing the child to explore the world independently.
Various scholars have expanded on Winnicott's work, offering different interpretations of the role and meaning of transitional objects. Bowlby's attachment theory, for example, sees transitional objects as representations of a secure base, providing emotional stability in times of distress.
Other developmental psychologists have emphasized the role of these objects in promoting emotional regulation and fostering a sense of security and continuity in the absence of a caregiver.
A teddy bear as a transitional object
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By Prof. Levine & Dr. Salganik
Dependent personality disorder is a common psychological condition characterized by an excessive need to depend and lean on others leading to submissive and clingy behavior.
Dependent personality disorder is defined by the DSM-5 as a personality disorder from the C disorder cluster characterized by an extensive and excessive need to depend on another manifested in early adulthood and present in a variety of contexts.
DSM-5 criteria:
According to the DSM-5, dependent personality disorder is diagnosed based on the presence of a pervasive and excessive need for dependence leading to submissive and clingy behaviors and fears of separation, as characterized by at least five of the following:
1. Difficulty making daily decisions without excessive advice and reassurance from others.
2. Needing others to take responsibility for most of the main areas of their lives.
3. Difficulty expressing disagreement with others because of fear of losing their support or approval.
4. Difficulty initiating projects or doing things independently due to a lack of confidence in self-judgment or self-abilities.
5. The person makes excessive efforts to receive nurturing, approval and support from others, to the point of volunteering to do things that are not pleasant to him.
6. The person feels uncomfortable or helpless when alone because of exaggerated fears of not being able to act on their own.
7. The person urgently seeks another relationship as a source of affirming nurturing and support when an existing close relationship ends.
8. The person is unrealistically preoccupied with fears that will make them worry about themselves.
Etiology
The etiology of dependent personality disorder is multifactorial, involving genetic, environmental and psychological factors. Early childhood experiences, such as overprotective parenting or conversely neglect, may cause people to develop dependent behaviors. Cognitive theories offer maladaptive schemas about self-worth and interpersonal relationships as contributing factors.
Genetics
While specific genetic markers for dependent personality disorder have not been adequately identified, family studies suggest the existence of a hereditary component. Twin studies suggest that personality traits associated with addiction, such as neuroticism and agreeableness, may have genetic underpinnings. Genetic research continues to identify specific sites and their role in dependent personality disorder in the genome.
Epidemiology
Dependent personality disorder is relatively rare, with an estimated prevalence of 0.49% to 1.5% in the general population. It is diagnosed more often in women, although this may reflect gender biases in diagnosis. Cross-cultural studies indicate variation in prevalence, perhaps influenced by social norms regarding dependence and independence.
Clinical manifestations
People with dependent personality disorder exhibit:
• Difficulty making daily decisions without excessive advice from others and reassurance.
• Tendency to allow others to take responsibility for key areas of their lives.
• Fear of abandonment and separation Urgent search for new relationships when a close relationship ends.
• Difficulty expressing disagreement from the other for fear of losing support.
• Inability to initiate projects or do things independently due to lack of confidence in personal ability.
• Tendency to exert too much effort to receive nurturing and support, even volunteering for unpleasant tasks.
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By Prof. Levine & Dr. Salganik
Greetings to our readers,
Psychological sensitivity refers to a person's heightened ability to perceive, experience, or respond to internal or external stimuli, especially those involving emotions, relationships, or social cues. This is a concept that can vary greatly between people and is influenced by personality, education, cultural factors and even biological predispositions.
Below are some dimensions of psychological sensitivity: [when we note that some of them demonstrate partial overlap].
Emotional sensitivity [sensitivity regarding emotional expression to an issue]: the ability to feel deep and intense emotions. It is possible to include in this also the ability to have a strong awareness of the emotional states of the person and others. This sensitivity is often associated with traits such as empathy and emotional intelligence.
Cognitive sensitivity: [see expansion below]. Increased awareness of nuances in information, such as language, tone or context, this includes sensitivity to criticism, feedback or ambiguous situations. This may correlate with reflective thinking or a tendency to overanalyze.
Interpersonal sensitivity: acute perception of social cues and non-verbal communication, such as body language or tone of voice. Often associated with a strong desire to maintain harmony and prevent conflict. can make people adept at navigating complex social dynamics, but can lead to vulnerability in challenging interactions.
Physiological sensitivity: the interrelationship between psychological states and physical sensations, such as a physical sensation affected by mental stress. This may include heightened sensory processing, such as being easily overwhelmed by bright lights, loud noises, or chaotic environments.
Cultural and contextual sensitivity: Awareness of how cultural or social norms shape interactions and emotional responses. Sensitivity to cultural differences or social injustices.
Illustration about increased sensitivity with the help of AI
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By Prof. Levine & Dr. Salganik
Greetings to our readers,
Obsessive-compulsive personality disorder (OCPD) is a common but often misunderstood condition that significantly affects people's functioning in various areas, including personal, social and occupational life.
Obsessive-compulsive personality disorder is a chronic and pervasive personality disorder characterized by an excessive preoccupation with order, perfectionism, and control. Unlike obsessive-compulsive disorder (OCD), obsessive-compulsive personality disorder does not involve intrusive and compulsive obsessions but rather a common pattern of inflexibility and rigidity in cognition and behavior. Obsessive-compulsive personality disorder affects over 2% of the general population and is associated with significant impairment.
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By Prof. Levine & Dr. Salganik
Hello to our readers,
The American diagnostic system DSM-5-TR divides personality disorders into cluster A, cluster B and cluster C. Each cluster encompasses a distinct group of personality disorders with common characteristics regarding symptoms, behaviors and basic psychological patterns.
Cluster A refers to personality disorders with odd or eccentric characteristics. These include paranoid personality disorder, schizoid personality disorder, and schizotypal personality disorder. Individuals within this cluster often exhibit social withdrawal, strange or paranoid beliefs, and difficulty forming close relationships.
Cluster B includes personality disorders with dramatic, emotional, or unstable behaviors. This cluster includes antisocial personality disorder, borderline personality disorder, histrionic personality disorder, and narcissistic personality disorder. Individuals within this cluster often exhibit impulsive actions, emotional instability, and challenges maintaining stable relationships.
Cluster C includes personality disorders with anxious and apprehensive characteristics. And these fears include avoidant personality disorder, dependent personality disorder and obsessive-compulsive personality disorder. People within this cluster tend to experience significant anxiety, fear of abandonment, or an excessive need for control or perfectionism.
Avoidant personality disorder (avoidant personality disorder) included in cluster C is characterized by a persistent pattern of social anxiety, heightened sensitivity to rejection, and pervasive feelings of inadequacy, along with an ingrained longing for meaningful connections with others.
AI-assisted illustration of an Avoidant Personality Disorder
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By Prof. Levine & Dr. Salganik
Greetings to our readers,
Obsessive-compulsive disorder in an intimate relationship (Relationship Obsessive-Compulsive Disorder or ROCD) is a subtype of obsessive-compulsive disorder (OCD) characterized by intrusive thoughts and compulsive behaviors centered on intimate relationships. We note that there is still no complete consensus as to whether such a type of OCD disorder exists or whether it can be included under the umbrella of the accepted diagnostic definition of OCD.
It is a chronic mental condition characterized as mentioned by intrusive thoughts (obsessions) and repetitive behaviors (compulsions) aimed at reducing anxiety (American Psychiatric Association [APA], 2013).
While traditional OCD symptoms often focus on contamination, symmetry, or harm, a subset of people experience obsessions and compulsions related to their romantic relationships, known as relationship obsessive-compulsive disorder (ROCD).
ROCD has received increasing attention in clinical research due to its significant impact on people's well-being and relationship satisfaction.
Definition and conceptualization of OCD in interpersonal relationships.
ROCD is characterized by persistent doubts and preoccupations about the quality of the relationship, the suitability of the partner, or feelings for the partner. These obsessions often lead to compulsive behaviors such as reassurance-seeking, testing, or mental rituals aimed at reducing uncertainty.
Two main themes are common in ROCD:
Obsessions focused on interpersonal relationships: doubts about the "righteousness" of relationships, compatibility or the presence of true love.
Partner-focused obsessions: Preoccupation with perceived flaws in the partner's appearance, personality, or other qualities.
Some cite a third type of ROCD focused on retroactive jealousy to previous partners of the intimate partner or this may be classified as a subtype of the partner-focused obsessions.
Prevalence and epidemiology
While exact prevalence rates of ROCD are not well established, studies show that relationship-related obsessions are relatively common among people with OCD. ROCD symptoms can appear at different stages of the relationship with the partner and are not limited to a specific demographic.
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By Prof. Levine & Dr. Salganik
Hello all
In our model, the self includes the elements of the human psyche. The model first assumes the existence of the "primary self", which is in fact the basic biological core consisting of several innate structures and subject to development during life, this self includes the instinctive emotional and cognitive parts of the person. The primary self uses the reservoirs and mechanisms of emotion, memory and cognitive abilities and it contains primary nuclei for the future development of other mental structures.
Let's first refer to the primary self (Biological Premordial Core): the primary self consists of innate biological structures and instincts that form the innate basis of the parts of the personality and it also included the cognitive processes and the emotional processes. This primary self has its own dynamics during a person's life and is subject to changes with age, following diseases, traumas, drug consumption, addiction, etc. Both the instincts and the basic needs in each and every person change according to different periods of development and aging – (hence their effect on behavior) and may change through drugs, trauma, diseases and more. Within the primary self there is the potential for instrumental abilities that are innate, but they can also be promoted, or on the contrary, suppressed through the influence of the reference groups. The primary self also has cognitive abilities that are partly innate and partly dependent on interactions with the environment during the first years of life. In addition, it includes the temperament and emotional intelligence that are partly innate and partly dependent on interactions with the environment in the first years of life. And finally, it includes an energy charge that is mostly innate but can be suppressed through the influence of the reference groups, as well as through various situational factors. The primary self also includes the six personal sensitivity channels: Individual Sensitivity Channels (ISC) which reflect our individual reactivity in response to stressors (both external and internal). So far we have identified six channels of sensitivity:
- Sensitivity regarding a person's status and position (status channel)
- Sensitivity to changes in norms (norm channel)
- Sensitivity regarding emotional attachment to others (attachment channel)
- Sensitivity to threat (threat channel)
- Sensitivity for routine changes (routine channel)
- Sensitivity to a decrease in energy level and the ability to act derived from it (energy channel)
From the initial self, they continue to develop from innate nuclei that constitute a primordial basis for development in the interaction of the baby and later the person during his life with the figures in his environment and the events of reality. Consequently, a number of superstructures is developed:
1] The reflective agency,
2] Three structures that together make up the secondary self or the social self, these include:
A] The group of internalized characters that we will metaphorically call the Board (or Directorate) of Internalized Characters,
B] Enemies’ group
C] A group of Me-representations.
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By Prof. Levine & Dr. Salganik
Greetings to our readers,
Stockholm syndrome describes the psychological state of the victim who identifies with the captor or abuser and their goals. Stockholm syndrome is relatively rare; A report by the FBI, the American estimates that the situation occurs in about 8% of hostage victims.
AI-assisted Illustration
The name of the syndrome is derived from a failed bank robbery in Stockholm, Sweden. In August 1973, four Sveriges Kreditbanken employees were held hostage in the bank's vault for six days. During the confrontation, an apparently inappropriate relationship developed between the captive and her captor. One of the female hostages, during a telephone conversation with Swedish Prime Minister Olof Palme, even said that she completely trusts her captors, but fears that she will die in a police attack on the building.
Below is a breakdown of the course of events at the bank from the article at https://www.history.com/news/stockholm-syndrome
On the morning of August 23, 1973, an escaped prisoner crossed the streets of Sweden's capital and entered a bustling bank, Sveriges Kreditbanken, in Stockholm's prestigious Norrmalmstorg Square. Under his jacket was an extendable object that he carried in his arms, upon entering the bank Jan-Erik Olsson pulled out a loaded submachine gun, fired at the ceiling, and disguising his voice to sound like an American, shouted in English, "The party has just begun!"
After wounding a police officer who responded to a silent alarm, the robber took four of the bank's employees hostage. It was Olsson, a safecracker who did not return to prison after a vacation during his three-year sentence for major fraud. Olsson demanded more than $700,000 in Swedish and foreign currency, a getaway car and the release of Clark Olofsson, who was serving a prison sentence for robbery and was an accomplice in the 1966 murder of a police officer.
Within hours, the police paid the ransom and even brought a blue Ford Mustang with a full tank of gas. Clark Olofsson was also released and joined Jan Olsson. However, authorities refused the robber's demand to leave with the hostages to ensure safe passage.
The unfolding drama grabbed headlines around the world and played out on TV screens across Sweden. The public flooded the police headquarters with proposals to end the conflict, which ranged from a concert of religious tunes by the Salvation Army band to sending a swarm of angry bees to sting the criminals until they surrender.
At Olsson’s command, the kidnapped locked themselves in a crowded bank safe, and soon formed a "strange" relationship with their captors. Olsson draped a woolen coat over hostage Kristin Enmark's shoulders when she began to shake, soothed her when she had a bad dream and gave her a bullet from his pistol as a souvenir. The shooter comforted the captive Birgitta Lundblad when she was unable to make contact with her family by phone and told her: "Try again; don't give up."
When hostage Elizabeth Oldgren complained of claustrophobia, he allowed her to leave the vault attached to a 100-foot rope, and Oldgren told a New Yorker reporter a year later that even though she was strapped in, "I remember very well that I thought it was very kind of him to let me leave the vault."
Olson's benevolent actions aroused the sympathy of the hostages. "When he treated us well," said hostage Sven Sepstrom, "we could think of him as a god who appeared to us in an emergency."
On the second day, the hostages were already talking privately with their captor, and they began to fear the police more than their captors. When the commissioner was allowed inside to check on the health of the hostages, he noticed that the captives seemed hostile towards him but calm and cheerful with the gunmen.
The police chief told the press that he doubted that the gunman would harm the hostages because they had developed "a fairly relaxed relationship ".
Enmark even called Swedish Prime Minister Olof Palme, who was already busy with the upcoming general election and a deathbed vigil for the revered King Gustav VI Adolf, 90, and begged him to let the robbers take her with them in the getaway car.
"I completely trust Clark and the robber," she assured Palma. "I'm not desperate. They didn't do anything to us. On the contrary, they were very nice. But, you know, Olof, what I'm afraid of is that the police will attack and make us die."
Even when they were threatened with physical harm, the hostages still saw compassion in their captors. After Olsson threatened to shoot Sven Säfström in the leg to shock the police, the hostage told The New Yorker: "How well I thought he said it was just my leg that he was going to shoot." Enmark tried to convince her friend the hostage to "accept" the bullet: "But Sven, it's only by foot."
In the end, the kidnappers did not physically harm the hostages, and on the night of August 28, after more than 130 hours, the police poured tear gas into the safe and the attackers quickly surrendered. The police called for the hostages to leave first, but the four captives, who defended their captors to the end, refused. Enmark yelled, "No, Jan Olsson and Clark Olofsson go first – you'll shoot them if we go first!"
Police officers in gas masks escort 32-year-old Jan Erik Olsson from the bank.
At the door of the vault, the prisoners and the hostages hugged, kissed and shook hands. When the police caught the two gunmen, two female hostages shouted: "Don't hurt them – they didn't hurt us." As Enmark was carried away on a stretcher, she shouted to the handcuffed Olofsson, "Clark, I'll see you again."
The seemingly irrational connection of the hostages to their captors confused the public and the police, who even investigated whether Enmark had planned the robbery with Olofsson. The captives were also confused. A day after her release, Oldgren asked a psychiatrist: "Is there something wrong with me? Why don't I hate them?"
Psychiatrists compared the behavior to the battle shock displayed by the soldiers during the war, and explained that the hostages were emotionally indebted to their captors, and not to the police, for saving them from death. A few months after the failed robbery, psychiatrists called the strange phenomenon "Stockholm syndrome".
Even after Olofsson and Olsson returned to prison, the hostages paid visits to their former captors. An appeals court overturned Olofsson's conviction, but Olsson spent years behind bars before being released in 1980. After he was released, he married one of the many women who sent him letters of admiration while he was imprisoned, moved to Thailand and in 2009 published his autobiography, called "The Stockholm Syndrome".
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Prof. Joseph Levine, M.D. is an emeritus associate professor in the Division of Psychiatry, Faculty of Health Sciences, Ben Gurion University in Israel. Prof. Levine is a certified psychiatrist with clinical experience in controlled trials of adult psychiatric disorders and in psychotherapy. He was awarded a NRSAD independent investigator grant for the study of Creatine Monohydrate in psychiatric disorders -- mainly Schizophrenia. He resides and treats patients in Tel Aviv and all of central Israel.
