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Falling Out of the World: Traumatic Shock, Strangeness, and Afterwards (Alfred Margulies, MD - Boston)

  • 21 Nov 2021
  • 11:00 AM - 1:00 PM
  • Virtual meeting


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The center does not hold. The ground gives way, and we are lost and falling. The ancients knew about the sudden overturning of the order of things: “Catastrophe” derives from the Greek, from “down” and “turn over”. We lose the world we took-for-granted, and the familiar turns strange or uncanny. Sometimes it is the surprise of recall that overturns us. How is it that some memories remain dormant, as if waiting, returning with a shock of awareness, overturning us with new significance? How come the past won’t die? Why do certain experiences resist assimilation to our worldviews?

Here psychoanalytic and existential perspectives illuminate one another, and in this talk we will explore the transforming of awareness and its everyday grounding in the world. We’ll look at Freud’s conception of “deferred action” (Afterwards, Nachträglichkeit, or Après-coup)—and existential conceptions of the familiar and the strange. Some experiences continue to change us as we change them, mutating and co-evolving even as we do. An old memory’s new significance heralds a newly emerging person who remembers—and who may now suffer and change—in an evolving spiral of transformation.


Alfred Margulies, M.D., is a Training and Supervising Analyst at the Boston Psychoanalytic Institute. Among his many awards and accomplishments, he is a recipient of the Harvard Medical School Faculty Prize for Excellence in Teaching; the Cambridge Havens Award for Excellence in Teaching; and the 2013 Outstanding Psychiatrist Award for Clinical Psychiatry, Massachusetts Psychiatric Society.  Author of The Empathic Imagination, his recently published paper in JAPA is based on his APsA Plenary, “Falling Out of the World—and the Longing for Home,” reflecting his long interests in the construction of time, self, memory, meaning—and existential shock and dislocation, experiences that disrupt the coherence of worldview, and leave one falling.

About his attraction to this topic and field he says, “Looking back, I’ve always been drawn to the opening of awareness of our world and our place in it. The natural world sparked an adolescent wish to become an oceanographer; later, the creative arts opened my eyes—especially the visual and literary—as I encountered creative visionaries who saw the world as if new. These paths came together for me in medical school in my first rotations in psychiatry, and extraordinary encounters on the wards, finding a deep commonality. The healing arts became a calling, and psychoanalysis became foundational. Public sector has been essential, and I consult, supervise, and teach in many different settings. My practice spans a range of problems and treatments (including the biological, psychotherapy, and psychoanalysis). The natural world grounds me; Maine is a second home with its soulfulness and indescribable beauty. Side by side, anchoring everything, are love of family, friends, and now grandchildren and the unfolding of new life."

Learning Objectives 

At the end of this presentation participants will be able to:                                

1) To define “deferred action” (Nachträglichkeit or Après-coup) and its relationship to memory and awareness.  

2) To describe a continuum of awareness from existential authenticity to traumatic dissociation.  

3) To integrate understanding of deferred action, existential authenticity, and traumatic dissociation into an assessment of treatment process and outcomes.  

Associated Reading

Margulies, A. (2016). Hidden in Plain Sight on Locked Wards: On Finding and Being Found.  Michael Garrett, ed. Psychotherapy of the Psychoses. American Journal of Psychotherapy, 70 (1):101-16. PMID: 27052608 

Margulies, A. (2018). Illusionment and disillusionment: Foundational illusions and the loss of a world. Journal of the American Psychoanalytic Association, 66:289–303        

Margulies, A. (2020). Falling Out of the World-and the Longing for Home. Journal of the American Psychoanalytic Association, 68:1127-1136. PMID: 33439680; DOI: 10.1177/0003065120981823

Laplanche, J. (2017). Après-coup. (J. House, Trans.) NY: The Unconscious in Translation.                               


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