CHAPTER TITLE I

ON FREUD’S “INHIBITIONS, SYMPTOMS AND ANXIETY” CONTEMPORARY FREUD Turning Points and Critical Issues Series Editor: Gennaro Saragnano

IPA Publications Committee Gennaro Saragnano (Rome), Chair; Leticia Glocer Fiorini (Buenos Aires), Consultant; Samuel Arbiser (Buenos Aires); Paulo Cesar Sandler (São Paulo); Christian Seulin (Lyon); Mary Kay O’Neil (Montreal); Gail S Reed (New York); Catalina Bronstein (London); Rhoda Bawdekar (London), ex-officio as Publications Officer; Paul Crake (London), IPA Executive Director (ex officio)

On Freud’s “Analysis Terminable and Interminable” edited by Joseph Sandler On Freud’s “On Narcissism: An Introduction” edited by Joseph Sandler, Ethel Spector Person, Peter Fonagy On Freud’s “Observations on Transference-Love” edited by Ethel Spector Person, Aiban Hagelin, Peter Fonagy On Freud’s “Creative Writers and Day-Dreaming” edited by Ethel Spector Person, Peter Fonagy, Sérvulo Augusto Figueira On Freud’s “A Child Is Being Beaten” edited by Ethel Spector Person On Freud’s “Group Psychology and the Analysis of the Ego” edited by Ethel Spector Person On Freud’s “Mourning and Melancholia” edited by Leticia Glocer Fiorini, Thierry Bokanowski, Sergio Lewkowicz On Freud’s “The Future of an Illusion” edited by Mary Kay O’Neil and Salman Akhtar On Freud’s “Splitting of the Ego in the Process of Defence” edited by Thierry Bokanowski and Sergio Lewkowicz On Freud’s “Femininity” edited by Leticia Glocer Fiorini and Graciela Abelin-Sas On Freud’s “Constructions in Analysis” edited by Thierry Bokanowski and Sergio Lewkowicz On Freud’s “Beyond the Pleasure Principle” edited by Salman Akhtar and Mary Kay O’Neil On Freud’s “Negation” edited by Mary Kay O’Neil and Salman Akhtar On Freud’s “On Beginning the Treatment” edited by Christian Seulin and Gennaro Saragnano ON FREUD’S “INHIBITIONS, SYMPTOMS AND ANXIETY”

Edited by Samuel Arbiser & Jorge Schneider

Series Editor Gennaro Saragnano

CONTEMPORARY FREUD Turning Points and Critical Issues First published in 2013 by Karnac Books Ltd 118 Finchley Road London NW3 5HT

Copyright © 2013 to Samuel Arbiser and Jorge Schneider for the edited collection, and to the individual authors for their contributions.

The rights of the contributors to be identified as the authors of this work have been asserted in accordance with §77 and 78 of the Copyright Design and Patents Act 1988.

All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the publisher.

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ISBN 978–1–78049–097–7

Edited, designed and produced by The Studio Publishing Services Ltd www.publishingservicesuk.co.uk e-mail: [email protected]

Printed in Great Britain www.karnacbooks.com CONTENTS

CONTEMPORARY FREUD IPA Publications Committee vii

ACKNOWLEDGEMENTS ix

EDITORS AND CONTRIBUTORS xi

Introduction Samuel Arbiser 1

PART I "Inhibitions, symptoms and anxiety" (1926d) Sigmund Freud 9

PART II Discussion of "Inhibitions, symptoms and anxiety" 101

1 The correlation between anxiety and danger: vicissitudes of mental functioning Horacio Rotemberg 103

v vi Contents

2 On the complex, relational nature of Freud's thinking on primary anxiety in Inhibitions, Symptoms and Anxiety: differences from and ties to Klein Rachel B. Blass 119

3 Winnicott and Kohut: their theories of anxiety Kenneth M. Newman 133

4 Primordial anxiety, drive, and the need for the progressive movement Luciane Falcão 142

5 Clarifications and comments on Inhibitions, Symptoms and Anxiety from a Lacanian perspective Leonardo Peskin 155

6 Psychoanalytic theory of anxiety: proposals for reconsideration Edward Nersessian 172

7 Traumatic seduction and sexual inhibition Elsa Schmid-Kitsikis 185

8 Freud's writing in the twenties: theory construction and clinical research in Inhibitions, Symptoms and Anxiety Giovanni Foresti 200

9 The death of an adult child: contemporary psychoanalytic models of mourning Jorge Schneider 219

10 An unexpected clinical experience: rethinking affects Samuel Arbiser 231

REFERENCES 243

INDEX 253 CONTEMPORARY FREUD

IPA Publications Committee

This significant series was founded by Robert Wallerstein and subse- quently edited by Joseph Sandler, Ethel Spector Person, Peter Fonagy and lately by Leticia Glocer Fiorini. Its important contributions have always greatly interested psychoanalysts of different latitudes. It is therefore my great honour, as the new Chair of the Publications Committee of the International Psychoanalytical Association, to con- tinue the tradition of this most successful series. The objective of this series is to approach Freud’s work from a present and contemporary point of view. On the one hand, this means highlighting the fundamental contributions of his work that constitute the axes of psychoanalytic theory and practice. On the other, it implies the possibility of getting to know and spreading the ideas of present psychoanalysts about Freud’s oeuvre, both where they coincide and where they differ. This series considers at least two lines of development: a contem- porary reading of Freud that reclaims his contributions and a clari- fication of the logical and epistemic perspectives from which he is read today. Freud’s theory has branched out, and this has led to a theoretical, technical, and clinical pluralism that has to be worked through. It has therefore become necessary to avoid a snug and uncritical coexistence

vii viii Contemporary Freud of concepts in order to consider systems of increasing complexities that take into account both the convergences and the divergences of the categories at play. Consequently, this project has involved an additional task—that is, gathering psychoanalysts from different geographical regions representing, in addition, different theoretical stances, in order to be able to show their polyphony. This also means an extra effort for the reader that has to do with distinguishing and discriminating, establishing relations or contradictions that each reader will have to eventually work through. Being able to listen to other theoretical viewpoints is also a way of exercising our listening capacities in the clinical field. This means that the listening should support a space of freedom that would allow us to hear what is new and original. In this spirit we have brought together authors deeply rooted in the Freudian tradition and others who have developed theories that had not been explicitly taken into account in Freud’s work. “Inhibitions, Symptoms and Anxiety” is without a doubt one of the most important theoretical writings of Freud’s. Written in 1925, it contains the seeds of virtually every development psychoanalysis would achieve in the following years. Samuel Arbiser and Jorge Schneider, the editors to whom goes our gratitude, have collected here a series of articles from well distin- guished psychoanalysts who put Freud’s work in perspective, and add to the depth and solidity of our shared theoretical-technical foundations. Special thanks are therefore due to the contributors to this volume which enriches the prestigious Contemporary Freud series.

Gennaro Saragnano Series Editor Chair, IPA Publications Committee ACKNOWLEDGEMENTS

In publishing this book, we would like to express our gratitude to all those people who collaborated in making it possible. First, all the contributors who have provided material that we are sure the reader will find enjoyable and stimulating. Moreover, our gratitude goes to our colleagues on the Publications Committee from whom we received continual support and wise professional advice, and in particular to the former and current chairs, Leticia Glocer de Fiorini and Gennaro Saragnano. Special mention should also go to Rhoda Bawdekar who, with a keen eye and diligent manner, ensured that the project did not stray from its set objectives. Finally, thanks also to our publishers, Karnac Books.

Samuel Arbiser & Jorge Schneider

ix

EDITORS AND CONTRIBUTORS

Samuel Arbiser is a Medical Doctor, a Full Member, with didactic role, of the Buenos Aires Psychoanalytic Association, a Lecturer at the ApdeBA Mental Health University Institute (IUSAM), Member of the Committee of Publications of the IPA, and author of various articles in Spanish, English, French, Italian, German, and Portuguese. Rachel Blass is a member of the British Psychoanalytical Society and a member and training analyst of the Israel Psychoanalytic Society. She lives and practices in London where she is Professor of Psychoanalysis and of Psychology of Religion at Heythrop College, the University of London and a Visiting Professor at University College London. She is on the board of the International Journal of Psychoanalysis, and is the editor of its “Controversies” section. Rachel Blass has published and lectured widely on the conceptual, episte- mological, and ethical foundations of psychoanalysis and their rele- vance to contemporary thinking and practice, focusing on Freud’s work and its evolution in Kleinian psychoanalysis. Luciane Falcão is a psychoanalyst; Full Member of the Psychoanalytic Society of Porto Alegre (SPPA); representative of the SPPA at the Psychoanalytic Congress of the French Languages and Member of the Editorial Commission of the Psychoanalytic Review of the SPPA.

xi xii Editors and contributors

Giovanni Foresti, MD, PhD, is a full member of the IPA and of the SPI (Società Psicoanalitica Italiana). In the latter organisation, he is part of the national Executive Committee and functions as scientific secretary. He is also member of OPUS, London, and of IL NODO group, Turin. He lives and works in Pavia.

Edward Nersessian is a clinical professor of psychiatry, Weil-Cornell medical college training and supervising analyst, New York psycho- analytic institute co-founder and co-director, Philoctetes Center for the Study of Imagination distinguished life fellow, American Psychiatric Association, and co-founding editor of the Journal of Neuropsychoanalysis, and co-editor of Textbook of Psychoanalysis.

Kenneth Newman received his medical degree from the University of Toronto, Canada. He received his training in psychiatry and psychoanalysis in Chicago. He is presently a training and supervising analyst at the Chicago Institute for Psychoanalysis. He is a former Dean of the Chicago Institute and is the co-author, with Howard Bacal, of the book Object Relations; A Bridge to Self Psychology. He is also author of articles on Winnicott and on the topic of “usability”.

Leonardo Peskin is a medical doctor, psychoanalyst, IPA full Member and supervising training analyst. APA seminar professor since 1982 to present. API full member. Member of the first APA Ethics committee. Professor at graduate and doctorate courses at multiple universities. Scientific advisor. Reviewer of articles for many psychoanalytic publications. Frequent participant in panels, round tables, conferences, symposiums, and congresses in different psycho- analytical institutions and hospitals in Argentine and other countries. Published numerous works in different psychoanalytic magazines and chapters in books. Author of the book: The Origins of the Subject and His Place in the Psychoanalytical Clinic reprinted in 2008.

Horacio N. Rotemberg is a psychoanalyst. Full member, with didactic role, of the Asociación Psicoanalítica de Buenos Aires (APdeBA [Buenos Aires Psychoanalytic Association]) Full Professor of Freudian Psychopathology at the APdeBA’s Instituto Universitario de Salud Mental (IUSAM [University Institute of Mental Health]). Full Professor of Special Psychopathology I at the APdeBA’s IUSAM. Editors and contributors xiii

Full Professor of Structuring of Subjectivity at the Facultad de Psicología y Psicopedagogía [Faculty of Psychology and Psychopeda- gogy] at Universidad del Salvador (USAL). Full Professor of Adult Psychopathology in the Facultad de Psicología y Psicopedagogía at USAL. Author of Estructuras Psicopatológicas e Identidad [Psychopathol- ogical Structures and Identity], published by Editorial Universitaria de la Universidad de San Luis and Estructuración de la Subjetividad [Structuring of Subjectivity], published by Ediciones del Signo. Former Academic Vice-rector for IUSAM.

Elsa Schmid-Kitsikis, Emeritus professor of Geneva University, is a training member of the Paris Psychoanalytical Society and the Swiss Psychoanalytical Society. She is the author of several books, most of them translated in Spanish, Italian, Greek, Portuguese, and Rumanian.

Jorge Schneider, MD, received his medical degree from the University of Buenos Aires, Department of Medicine. He took his psychiatric and psychoanalytic training in Chicago, Illinois, USA. He is presently a training and supervisory analyst at the Institute for Psychoanalysis, Chicago, and Assistant Professor of Psychiatry, Northwestern University Medical School. Former Dean of the Institute for Psychoanalysis, Chicago. Past President of the Chicago Psychoanalytic Society and Past President of the Chicago Society for Adolescent Psychiatry.

ON FREUD’S “INHIBITIONS, SYMPTOMS AND ANXIETY”

CHAPTER TITLE 1

Introduction

Samuel Arbiser

Besides constituting a fundamental milestone in contemporary Western thought, Sigmund Freud’s monumental corpus of work laid the theoretical–technical foundations on which psychoanalysts based the construction and development of the comprehensive edifice in which they abide today. This edifice, so varied in tones, so heterogeneous, even contra- dictory at times, has stood strong because of these foundations. Indeed, this book attempts to show, through its various chapters written by psychoanalysts from different parts of the world and sustaining varied paradigms, this enriching heterogeneity coupled with the invisible thread which strings together the diversity lent to it by the Freudian foundations. One of the characteristics of the Freudian opus that I intend to highlight in this context is the fact that when we are able to study it in perspective, it is possible to glimpse a path of incessant improve- ment, where ideas and concepts are reformulated and become more complex as clinical facts and methodological and epistemological resources call for it. The book Inhibitions, Symptoms and Anxiety is the irrefutable proof of this affirmation. This characteristic is probably not unrelated to some personal traits of the creator of psychoanalysis himself. There is no doubt that

1 2 Samuel Arbiser

Freud was motivated in his undertaking by a certain awareness that he was playing a leading role in an innovative mission that, in order to be accomplished, would require an unshakeable will to overcome the resistance from that which was already known and accepted. To achieve his end, he counted upon a broad humanistic education fuelled by a precocious curiosity and avidity for reading of both the classic writers and authors of his time. It suffices to recall that in his early adolescence, together with a young friend, Edward Silberstein, he founded in Vienna his own Spanish Academy to accomplish the reading of Don Miguel de Cervantes Saavedra’s Don Quixote de La Mancha in the original language. Thus, thanks to this unquenchable thirst for knowledge, he became familiar with the most sordid hidden corners of human nature, as well as with the most exalted. The spirit of the rigorous researcher is yet another component of his personality that transpires in his opus. A quality forged in the labo- ratories of Brücke and Meynert, where he trained and carried out research in his capacity as a neuro-physiologist. Both laboratories were regarded as the stellar expression of the scientific positivism of his time. Although Freud is considered one of the “masters of suspicion”, the forerunners of post-modernism, of the twentieth century, in my personal opinion he never lost his epistemological Modernist ratio- nality and critical spirit. Many psychoanalysts would not agree with this statement, inasmuch as the discovery of the unconscious would question the rational conscious mind. To my knowledge, this decisive finding does not question or dethrone the need for the conscious mind and, even more so, for intelligibility to attain conceptual and theoretical elaboration. His theory of anxiety, perfected in his book Inhibitions, Symptoms and Anxiety is, as so many other of his theories and formulations, an expression of this persistent loyalty to that rational and critical spirit, as well as of his being convinced of the provisional status of the truths he laboriously elaborated through the years; thus, his first incursions into the subject of anxiety can be traced back to his correspondence with Wilhelm Fliess in 1893, continuing in numerous works that covered almost forty years and extending to the New Introductory Lectures on Psychoanalysis of 1932– 1933 (Freud, 1933a). One of the early works of great importance, which is also paradigmatic of the pre-psychoanalytic medical style of his time, is the one in which he separates “anxiety neurosis” from Introduction 3

“neurasthenia” (Freud, 1895) and where, in the section devoted to etiopathogeny, he formulates his first theory of anxiety, defining it as the psychological incapacity to process the excesses of somatic sexual excitement as a result either of insufficient psychological capacity or of accumulation of this excitement. Here, sexual arousal finally transforms into anxiety. It is also worthwhile remembering from this brilliant text, the origin of his dispute with his friend Leopold Löwenfeld, the semiological refinement which maintains full validity in the diversity of clinical cases characterised by anxiety, and which modern psychiatry includes under the term “anxiety disorders”. In those early years, almost inadvertently, he gradually passed from “somatic sexual excitement” to the more psychological “libido”, and it is this libido, not channelled to the appropriate sexual behaviour, that turns into anxiety. The first Freudian psychopathology that differentiates “actual” neuroses from “psychoneuroses” is based on this transition and division of sexual excitement into “somatic” and “psychic”. In his meta-psychological works on “repression” (Freud, 1915) and the “unconscious” (Freud, 1915e), the libido, as a “free quantity” separate from its “represented—representative” product of the repressive process, has various possible destinations, one of which is the transformation into anxiety. And in this way it inter- weaves with diverse classic psychoneuroses, implying that it incurs both into the field of meta-psychology and that of psychopathology. Very soon, in the 25th Lecture of his Introduction to Psychoanalysis (Freud, 1916–1917) he expounded, in a clear and concise style more fitting to a lecture addressed to the general public, on the assemblage of findings obtained to that date which can be considered the climax of his first theory of anxiety: anxiety is the product of transformation of the libido and this “free libido” is a consequence of the repression which separates “quantity” from “representation”. Here, for the first time, he deals not only with “neurotic” anxiety, but also with “real” anxiety, and the relationship between both; this leads him to develop the subject of “danger-situation” in both situations. He also formu- lates his general theory of affects, among which he includes anxiety, proposing the hypothesis of “hysteria of the species” and opening up the way to the biological significance of this affect. At the next stop on this brief tour we already find Inhibitions, Symptoms and Anxiety (Freud, 1926d), which is in truth the primary subject of this intro- duction. On reading this book, it is hard to avoid feeling amazed at 4 Samuel Arbiser the vigour and determination of a man who, at the age of seventy, makes such a radical overhaul of his own previous theories. The theory of “structural identifications”, the introduction of the “death drive”, and even more importantly the “structural theory of the psychic apparatus”, no doubt forced him in that direction—but nevertheless, this fact does not render his actions less courageous. Contrasting with the clear style of the 25th Lecture mentioned above, in this book the author presents, chapter after chapter, state- ments, rectifications, and uncertainties, leaving unfinished lines that force him to draft an addendum to partially overcome these difficul- ties. Although he leaves a gap concerning “actual neuroses”, he emphatically states that anxiety is produced by the ego, and in this way he abandons his first formulations of transformation of the libido into anxiety, using the metaphor of the chemical transforma- tion of wine into vinegar as a basis. Nor is anxiety a consequence of repression, but rather it is anxiety that promotes repression that, it is worth stating, by the way, is only one among the many defence mech- anisms. His second theory of anxiety has now been formulated. With these drastic changes accompanied by brief annotations, this book represents the culmination of various aspects of the psychoanalytic conceptual framework. Indeed, it is possible to distinguish, on the one hand, a theoretical trend, and on the other, a revised synthesis of his psychopathology, and in addition a bridge acting as a link with modern neuroscience, inasmuch as it affirms the biological signifi- cance of affects, both in human phylogeny and in animal life. As mentioned at the beginning of this introduction, the current psychoanalytic edifice presents a varied façade resting upon those Freudian foundations. The authors who have made contributions in this book were selected precisely on the basis of geographic diversity and diversity of current paradigms. Horacio Rotemberg’s chapter contends that Sigmund Freud reshaped his theoretical convictions throughout his work, in accor- dance with the impositions of his clinical exercise and some of his essays are clear proof of the moments that epitomise his changing theoretical thinking. This can be seen especially in the essay Inhibitions, Symptoms and Anxiety. There, his previous points of view are included within the new theories presented. The aim of the author of this chapter is to focus in Inhibitions. . . on its theoretical intricacy on the basis of the new concept of anxiety that Freud Introduction 5 synthesises in that essay. From this perspective, he remarks, we can find in Inhibitions. . . theoretical elements that help us build a psycho- analytical nosology adapted to our time. Rachel Blass, in her chapter, offers a close examination of Freud’s formulations of the primary source of anxiety in Inhibitions, Symptoms and Anxiety and of how Klein diverges from these formulations, particularly in relation to the role of the fear of death. Through this examination her contribution challenges common accounts of Freud’s and Klein’s theories of anxiety and of the reasons for the theoretical differences between them. In this process, new light is shed on the analytic discourse on anxiety and on unappreciated dimensions of both Freud’s and Klein’s thinking that together provide a framework for an in-depth understanding of the complex nature of man’s most basic fears. For his part, Kenneth Newman states that, in the theories of Winnicott and Kohut, the locus of interest shifted from the centrality of drives in conflict with the superego to disturbances in the rela- tionship with primary care-takers. The emphasis is on the failure to achieve a secure sense of self as a result of failures in the environ- ment (Winnicott) or in the parental self-objects (Kohut). The source of anxiety is actually two-fold: the internalisation of faulty or noxious objects results in a vulnerable or fragmentation-prone self; in addi- tion—and equally importantly—the self-objects are unable to hold the affects associated with faulty care-taking and therefore the child’s structure is constantly threatened by disruptive emotions that are never securely integrated. Meanwhile, Luciane Falcão, in her chapter, proposes to raise understanding of what Freud referred to as primordial anxiety through the comprehension of instinctual movements—of life and of death. She understands this act of the impulse of death to be a force which is capable of provoking an imbalance that will in turn lead to a regressive path, or a return to primordial anxiety: When the Self experiences a pain which doesn’t stop, or a necessity for which one cannot find satisfaction, the economic situation is the same: the bodily abandonment will find its expression in the psychic abandon- ment. Therefore, she states, a disentangled libido, which does not bind but that waits incessantly for linkage without obtaining it, will empty the Self of narcissistic libido, as with a haemorrhaging, placing itself at the mercy of death. Thinking with Freud, she understands 6 Samuel Arbiser that if primordial anxiety does not go through a process of trans- forming itself into signal anxiety, it will remain as an experience simi- lar to abandonment, suffering the deed of the impulse of death, that would place an obstacle in the progressive route. Next, Leonardo Peskin writes that, in Inhibitions, Symptoms and Anxiety, Freud reorganises previous theories and makes contribu- tions on diverse theoretical and clinical issues. Following Freud’s ideas, Lacan provides hierarchy to the axis that shapes the title: Inhibitions, Symptoms and Anxiety. In this axis he sets the different possible positions of the subject in front of the “objet petit a”, which causes anguish. For Peskin, in contrast with Freud, Lacan states that anguish does not lack an object, but rather the object is the “objet petit a”. Anguish, therefore, is for Lacan the feeling or fundamental emotion that does not deceive. Based on the aforementioned con- cept, Lacan sets a universe of possible affections emerging when his three registers (Imaginary, Symbolic, and Real) are solved. The “objet petit a”, his invention, refers to the object of drive and is the object that is the cause of desire. This conception orientates Lacan’s clinical work and Peskin emphasises briefly these issues in every heading of Freud’s text. Edward Nersessian in his chapter argues that Freud’s thinking on anxiety went through different stages until, in Inhibitions, Symptoms and Anxiety, he settled on the notion of signal anxiety. Viewing symp- toms—from the beginning of psychoanalysis—as the result of con- flict, the idea of signal anxiety best described how a defence was initiated and a compromise was accomplished. This fundamental idea will be re-evaluated in light of modern neuroscientific findings. In her chapter on Freud’s considerations on what links inhibition and anxiety, Elsa Schmid-Kitsikis holds that they were already at work in the context of his first theory on seduction and his discover- ies concerning hysterical psychic functioning (1894, 1895). She writes that Freud introduces a certain number of hypotheses which prefigure his subsequent theoretical elaborations. With Dora’s case (1905e), he points out the importance of perceptive activity which can produce a traumatic effect, such as inhibition and anxiety. The case of Miss E. presented in this text illustrates Freud’s remarks (1926d) about inhibitions which represent the relinquishing of a function, such as a sexual function that, if exercised, would create anxiety. The analytical work led to a focus on the place and meaning Introduction 7 of perceptive activity and on the resulting transference and counter- transference difficulties while she looks at Freud’s reflexion that two reactions seemed to regularly confront each other in the course of the patient’s associations in relation to traumatic seduction: that of anaesthesia linked to an excess of perception that led to disturbed spatial-temporal references experienced as fascination, and that of a collapse of psychic limits. In his chapter, Giovanni Foresti states that the work he carried out aims at finding a balance between continuity and discontinuity. The title, “Freud’s writing in the twenties: theory construction and clinical research in Inhibitions, Symptoms and Anxiety, suggests the necessity to consider both the result of Freud’s work (his corpus of writings) and the process of their elaboration (reading the writings, we see a man who is writing). In order to obtain this result, the present author has read anew the books that constitute the institu- tional tradition he himself belongs to. Freud’s 1926 essay is then reconsidered, via a close reading of its conceptual structure. The result is based on the distinction between at least three dimensions of writing: Freud as a politician (the man who struggled to hold the psychoanalytic movement together); Freud as a theoretician (the man who worked to defend continuity and to develop his theories); Freud as a clinician (the man who used his personal sufferings as a tool to understand himself and others). Jorge Schneider’s chapter takes the view that, in Inhibitions, Symptoms and Anxiety, Freud raises the question of when the loss of an object creates anxiety and when it brings about mourning. It is the prelude of his paper “Mourning and melancholia”. In “The death of an adult child: contemporary psychoanalytic models of mourning”, Dr Schneider uses a clinical vignette to explore how contemporary clinicians think about this phenomenon. There seems to be a consen- sus that in the death of an adult child, contrary to Freud’s postulate, the subject of the loss does not give up the cathexis to the bereaved child, who instead remains internalised as an object that is continu- ally missed and remembered. Finally, my own chapter, the updated English version of a 2004 paper published the Apdeba journal, examines the casual discovery of a silent congenital vascular brain tumour in a patient presenting phobic symptomatology as providing the opportunity to reconsider the genesis and function of the tools directed at detecting danger. 8 Samuel Arbiser

Based on the analysis of anxiety and affects as psychic mechanisms necessary to orient our behaviour in the world, the continuity and the discontinuity of such mechanisms in the animal world are discussed in this paper. The hypotheses are that anxiety would be a central affect inherent to biological survival and that all the complex- ities that life in a civilised society imposes upon the human being stem from that biological matrix. However, the issue of how much of the animal world is lost and how much is retained, and whether it adjusts or not to conceptual laws, has not been studied in depth. In this respect, the knowledge derived from neuroscience associated to psychoanalysis is promising. Thus, I intend to emphasise my own line of thought, one which centres the definition of psychoanalysis on the fact that it focuses on humankind and inevitable suffering as life develops in a socio-cultural ecosystem. PART I

“Inhibitions, symptoms and anxiety” (1926d)

Sigmund Freud

CHAPTER TITLE 11

11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99

CHAPTER TITLE 101

PART II

Discussion of “Inhibitions, symptoms and anxiety”

1

The correlation between anxiety and danger: vicissitudes of mental functioning

Horacio Rotemberg

Introduction

Sigmund Freud reshaped his theoretical convictions throughout his work, in accordance with the impositions of his clinical exercises. This way of conducting his research allowed him to develop vari- ous explicative models of the mind, all deriving from the same point of view: metapsychology. He gradually expanded the meaning of the underlying economic base—psychic energy—in these models and elaborated on their structure and psychic dynamics. Some of his essays are clear proof of the moments he could epit- omise his changing theoretical thinking. This can be especially seen in the essay Inhibitions, Symptoms and Anxiety (Freud, 1926d). In this paper, the new structural model “ego-id-superego” relates to the issue of narcissism through situations that threaten subjective integrity. Also included in Inhibitions. . . are the unconscious processes that characterise the new elements of personality, promoting con- nections and interaction between them outside the conscious level of awareness. The topos of the unconscious, now more complex, still supports the Freudian view. The tension between Eros and Thanatos surrounds the dangers that threaten the ego. Moreover, this piece

103 104 Horacio Rotemberg clearly presents external reality as an unavoidable reference of the psyche, comparable to a fourth element of personality. Our aim is to specify, in Inhibitions. . ., its theoretical intricacy on the basis of the new concept of anxiety that Freud synthesises in that paper. We see that the articulation between anxiety and the situation of danger indicates a novel epigenesis for this emotional state, related to modifications in the conscious states of the ego. The issue of anxiety appears during the processes of fixation of certain experi- ences, which will influence different structural destinations for different psychopathological conditions. From this perspective, we can find in Inhibitions, Symptoms and Anxiety theoretical elements that help us build a psychoanalytical nosology adapted to our time. Freud himself attempts in his paper a reassessment of the transference psychoneuroses, based on the Oedipus complex and castration anxi- ety ascribed to it. Our task is to resume this construction and compare it to the effect that other situations of danger have on the determination of psychotic manifestations, as well as on structures proper to our time, as is the case of borderline structure. In this introduction, we would like to clarify the meaning attrib- uted to the term epigenesis. We consider epigenesis as the process through which the experience affects the constitutional disposition of the subject propitiating a series of transformations that generate the psychic structure. Contextual effects successively affect the previ- ously established and fixated structure, paving the way for poten- tially new manifestations. Erikson introduced this word to psycho- analysis terminology in his theorisation on stages of development (Erikson, 1982). Our use of the term is influenced by the Bionian conception of transformation in conjunction and contrasted to the Freudian construction of primal repression–fixation–disavowal of experience (Bion, 1965). In the next section we will use this theoretical resources to articu- late the epigenesis of anxiety to the psychic structuring process, incorporating Freud’s contributions in Inhibitions, Symptoms and Anxiety to the rest of his contributions throughout his work.

The epigenesis of anxiety Anxiety, among all affects encompassed in psychoanalysis, is a para- digmatic emotional state. In his early career, Freud defines affect and The correlation between anxiety and danger 105 representation as representing the drives in the psychic structure. From a metapsychological point of view, affect is basically charac- terised, though not exclusively, by the economic dimension. Freudian considerations define it as a tendency to discharge. This definition, ultimately combined with the idea that affects are phylo- genetic reminiscences—Fragment of an Analysis of a Case of Hysteria (1905e), poses the problem on the origin of the quantities that have an effect on mental functioning. In Project for a Scientific Psychology (1895a) the energy stimuli are already internal as well as external. The former are subsidiary of what will then become the drive. The latter, when they exceed certain intensity, will originate the concept of psychic trauma. In the Freudian work “On the psychical mechanisms of hysterical phenomena: preliminary communication “ we find (1893d, p. 6) this definition for psychical trauma: “Any experience which calls up distressing affects—such as those of fright, anxiety, shame or psychi- cal pain—may operate as a trauma of this kind” (my italics). This early definition establishes a clear articulation between anxi- ety and psychical trauma. Anxiety is an existential expression of the disturbing emotional impact certain external stimuli generate on the psyche, and not only the affective expression of a disconnected endogenous energy. These Freudian considerations find a new field of realisation in Inhibitions, Symptoms and Anxiety. This paper bridges the dispute with Rank over the trauma of birth and its possible repetition during states of anxiety, taking this event as the first of a series in a chain linked through another series of events that confront the subject with various painful experiences. It is not the original trauma that is repeated in each cycle. New contextual conditions feature and advance renewed traumatic impacts on the subject. The elements in this series are over-determined by both structural factors as well as linked environmental factors. The path of this series involves acknowledging the current narcissist dimension and its successive transformations; the renewed perceptual and instrumental capacity of the ego in its relationship with itself and the environment, and the threatening conditions anticipated by the ego in its perceptual contact with exterior reality. This perspective will allow us to address two types of anxiety provided for in Inhibitions. . .: automatic anxiety and signal anxiety— 106 Horacio Rotemberg the latter being a product of the instrumental transformation of the former. Automatic anxiety directly corresponds, in this new theory, to the psychic trauma defined in the “Preliminary communication”. In Inhibitions, Symptoms and Anxiety, Freud indicates that in early infancy the individual is not really equipped to master psychically the large sums of excitation that reach him whether from without or from within. This condition results from the psychic helplessness typical of the premature state characteristic to the breastfeeding baby. In this context, the experience of birth is archetypical; it provided a model to grasp the consciousness’s labour that, in the economy of its narcis- sistic libido due to the afflux of large sums of excitation crowding in on it, can only register pleasure and pain in the beginnings. It is in his work “Project for a scientific psychology” (1895a) where Freud specifies that the traumatic experience is fixated as an unpleasant experience of pain that, if reinvested, arises as an inner source for potential psychic catastrophe. This disruptive energy movement, directly derived from experience or re-activated through experi- ence, is what defines automatic anxiety. We understand that this development enables the comparison, in the same fashion as Freud, between the automatic anxiety and the experience of horror, of nameless terror, yet with an underlying pattern, paraphrasing Bion’s formula. The psyche is immersed in a situation that overwhelms him/her, that drags him/her to a state of intolerable, horrendous, painful, and distressing tension of narcissistic catastrophe. This type of automatic anxiety, when fixated, is registered as representation primarily repressed and conserves its potentiality throughout the entire subjective transformation. This consists of the fixation of a deconstructing experience that annihilates subjectivity and is ascribed to the death drives in its disin- tegrative tendency. Representation and discharge are thus tied in a destructive affec- tive tendency. This tendency, potentially present from the early stages of devel- opment—in that stage that Freud will later on call undifferentiated ego/id—will be counteracted by the integrating libidinal flow ascribed to Eros. The first desiderative ties in the structure will result from this flow and will simultaneously consolidate the primary defence against the traumatic experience. The correlation between anxiety and danger 107

In this attempt to formulate a theoretical integration of different Freudian contributions, we would like to highlight the following bias. This desiderative libidinal flow occurs in the original narcissism, that narcissism of disorganisations which proceeds to strengthen, gradually, around the auto-erotic activity as conditioned by the erogenous zones. The desiderative goals aim to find once more those moments of plenitude of pleasure that fend tensions off and bring about the transitory and gradual cohesion of the subject within that initial, disorganised state. The sum of those experiences, the set of stably cathected mnemic traces, according to the definition Freud features in his “Project for a scientific psychology”, shapes the ego as it is the potential base of its future thoughts regarding the object. The ego, within that original anarchic movement, enables a constitutional ability of Gestalt comprehension and acquires, thus, selfness. The ego features comprehensive unity the moment it estab- lishes a totalising bond of affect, prior to all relation to the object, with the image of the peer. According to Freud, this liaison is exclu- sive to the mechanism of primary identification and is initially referred, in the boy, to the prehistoric father (Group Psychology and the Analysis of the Ego (1921c)) and in the girl, to the pre-edipic mother (“Femininity” (1933[1932])). This mechanism is, to our understand- ing, the promoter of the new psychic act of libidinal narcissistic inte- gration noted by Freud in “On narcissism: an introduction” (1914c), and, as a consequence of its results, is the first structuring crossroad of importance that the subject is confronted with. This imago is assimilated in the ego and allows it to consider itself as an object of love. Various schools of psychoanalytic thought have gone back to these Freudian concepts and elaborated on them: Lacan with the mirror stage (1949), Winnicott with the mother’s face as precursor of the mirror (1971), and Kohut with the mirror transfer (1984). The ego becomes one entity, and from there on, it evolves and expands its abilities and functions. The perceptual identity starts giving rise to the thought identity; the associative, magical, and omnipotent thinking coexists with the discrimination characteristic of judicious thinking. The attributive judgment is complemented with the existential judgment. The pleasure principle will change into the principle of reality. The ego, in that movement, defines itself and loves itself. It perceives the object and constructs with the object 108 Horacio Rotemberg a complex dialectic in which it starts to recognise it in as much as it recognises itself and, concomitantly, it perceives the dangers that threaten its own existential continuity. Due to these successive and complex transformations, the auto- matic anxiety, which is triggered with no previous warning and inval- idates the ego, gradually gives rise to signal anxiety at the service of the ego. This signal anxiety can anticipate and eventually avert the traumatic danger situation that threatens the ego. This signal anxiety will set the pace to the capacity of conscience of the ego. The conscious begins to perceive a register other than the one that revolves around the pleasure–displeasure dimension. The ego, while functioning with bound energy and being able to inhibit the hallucinatory consubstantiation with the object of plea- sure, starts to detect that, in order to safeguard its integrity and subsistence, new resources must be brought into action. Learning through experience indicates it that there are times of tension and discomfort that it cannot resolve on its own. There is something that is not ego that supports it and completes it. Hate is not the only path to the object. This learning process can be disturbed by experiences of abandonment and of horror that expose the breastfeeding child, once again, to the unhindered break- through of automatic anxiety. The fixation of these painful experi- ences, in which the outer support does not properly resolve the vital and emotional insufficiencies, leads to the exposure of the subject, when these experiences are reproduced, to feelings of violence, hopelessness, and eventual psychic death. These are potentially tempestuous times when psychic helplessness may become more acute: times under the threat of cumulative traumas by repetition that may disturb the new discrimination and prevent the strength- ening of that basic identity that, as a narcissistic reassertion, would bring about the maintenance of existential continuity. This transfor- mation regressively imprisons the subject inside the environment of automatic anxiety, with its thanatic charge. Fortunately, that is not the only possible vicissitude. The factual implementation of the signal anxiety in the face of danger arisen by absence of the object provides the evidence to the existence of a narcissistic solidity of an ego that registers the threat that occurs by delay of satisfaction in which the threat does not acquire the intensity and extension proper to a devastating trauma. The correlation between anxiety and danger 109

This instrumental nature of the anxiety, in favourable conditions, emerges from an ego capable of attributing a negative meaning to a certain event and simultaneously keeping the confidence in a provi- dential alternative that would compensate for the insufficiency. In these circumstances, it is the conjunction of an optimal frustration with the evocation of a satisfactory resolution from experience that brings about a painful affective manifestation that alerts and encour- ages the ego to endure until the object appears again. Bion has theo- rised on the mother’s decoding capacity that is able to bring sense to the movements of the realistic projective identification she receives from the child, and thus provide the latter with a capacity of reverie of his/her own. In this process there is successive discharge and accu- mulated experience that modulates the discharge. What Freud calls phylogenetic resource is, from this standpoint, the disposition of the human being to learn, from experience, to moderate and blend the affective discharge. The affects are modulated and bound, and acquire various experiential connotations during what would be called the start of sublimated sensations that favour intersubjective communication. These sensations would be the product of a human- ised pulsional energy that creates selfness and otherness. A primary indication in this process is the ego’s acquisition of the signal anxiety in the face of the threat of loss of object. The object to be lost is, at first, a partial object at the service of the ego. The danger of the loss spreads around the object and it is there that it is recog- nised. It is also around this partial object that the possessive domina- tion takes place in a game of self-assertion that involves a gradual recognition of the otherness (this movement is epitomised by Freud through the cotton-reel game and theorised by Winnicott by concepts such as transitional space and phenomenon). In this movement of subjective consolidation, the narcissistic love tied to a partial object will be joined by the anaclitic love for a total object, which is recognised in its existence and upon which there will be a loving emotional dependence. This event generates a new operative dimension for the ego: the danger that threatens it and triggers the sign for anxiety acquires a new meaning. This meaning is ascribed to representations that create mnemic symbols corresponding to a renewed psychic reality. The meaning of the threat is no longer the loss of the object; it is now the threat of loss of love from the object. The construction of this 110 Horacio Rotemberg total single object brings about a narcissistic dual dialectic in the ego, a source of both pleasure and anxiety. At this stage, and from there on, the ego’s dependence and anxi- ety will be directly correlated to the object’s amorous disposition in relation to the ego. Extremely important transformations take place throughout this process. Many experiences that once were a source of pleasure are not anymore, because of directives introduced by the object that set limits and produce changes to previous dynamics; these limits imply frustrations that need to be assimilated with the least narcissistic impairment possible. Weaning, sphincter control, family codes, the gradual delimitation of the thirdness, and the birth of siblings, test the ego and its tolerance to frustration, confidence in the amorous disposition, and strength of its narcissistic base. Language as a code is acquired during this process, which enables the word presentation to bring forth the pre-conscious. The primal repression, whose action is conditioned by certain states of discomfort, is the mechanism in charge of reorganising the psyche by building dams in order to divide horizontally certain disturbing contents from the pre-conscious area of the ego. This process significantly feeds the contents of the id. Motions of desire that were originally, but have ceased to be, a source of pleasure will be placed in the corresponding topos of the unconscious, as primar- ily repressed due to the change of meaning in the ego. The original meaning underlies in the unconscious. Those painful original expe- riences that have been fixated and are a potential source of discom- fort also subsist in the unconscious. The signal anxiety is triggered by certain attitudes of the object that create in the ego experiences of amorous rejection and abandonment. If these experiences acquire a traumatic intensity, of inassimilable collapse, a new mechanism can start operating to structure the mind: disavowal. This mechanism causes the ego to split vertically. Once this complex transformation takes place—across secondary oral psychosexual development stages and both anal stages, during which different transformations exclusive to the relationship with the object are established, with various structural consequences— then the subject finally arrives at the Oedipal dilemma. This event determines a great number of effects; such as the new type of signal anxiety that will be implemented in psychism. The relationship with the object now includes the incorporation of a third The correlation between anxiety and danger 111 party into the dual relationship. The recognition of the thirdness opens a complex universe of relationships and emotions that expose the subject to a new traumatic dimension: one that derives from the castration complex. The acquisition of the notion of thirdness sets a stage where the ego relates through intense love–hate relationships. These relation- ships are established between the ego and essential total objects and are supported by desiderative movements organised by a phallic drive foundation. The phallic dimension, that pervades the ego, brings a traumatic sense to the anatomical sexual difference. These are times when research on childhood sexuality and concomitant sexual theories cannot account for that difference, as experience imposes the idea of one single genital, the male genital. In this terri- tory, there is a symbolic inability that the ego cannot resolve on its own. The threat of castration or the fantasy of a perpetrated castra- tion trigger the signal anxiety in the face of the danger of becoming- being subjectively mutilated. During this stage, the phallus represents the narcissistic integrity as a whole; thus, there is a poten- tially ominous sense to the threat. In the Oedipal passional drama—where the boy’s libidinal possession of the object is confronted by a threat of castration ascribed to the father; while in the case of the girl, the expectation of a possible libidinal realisation with an object is opposed by the humil- iation of perceiving herself castrated by her mother’s blame—estab- lished primary family bonds become tense. The degree of trust previously acquired by the ego and the level of parental containment during this stage will influence its final outcome. (These ideas have been widely explored by Kohut (1977).) Parental symbolic capacity will have to compensate for and comple- ment the symbolic insufficiency of the child. (This perspective has been thoroughly developed by Lacan.) In the Oedipal resolution within real bonds there is an interaction between a set of determining factors, such as specific parental role along with different identification images that will or will not con- tribute to the appropriate resolution of the Oedipus crossroad. Also contributing to this resolution are the factors that derive from the primarily repressed amorous libidinal prehistory. The set of painful and pleasant experiences that has been fixated, partially transformed into character traits, and partially sublimated, is once again subjected 112 Horacio Rotemberg to tension and re-elaborated in this experiential–existential crossroad characteristic of the Oedipus complex. The relational context sup- ports and enables the different structural alternatives. The variant influence of these factors determines that the resolu- tion of the danger faced with the threat of castration be processed in psychism through three possible ways: a) by using the structuring mechanism of primal repression, which at this point gives rise to the apparition of the element of superego-ego ideal within the structure; b) with the impairment, the new intervention of the disavowal mech- anism as a possible compensation to the ego to conquer the difficulty of assimilating the trauma of castration, reinforcing the vertical split in the ego (Freud, 1940b,c[1938]); c) the inability to elaborate this traumatic contingency due to a radical symbolic incapacity that prevents as well the resignification and integration of the traumatic events characteristic of the previous stages. In these circumstances the ego projects itself onto a precarious psychic continuity and remains exposed to the threat of deconstruction in the presence of subsequent triggering factors. In the next section we are going to deal with these three alternatives and their relation to the various psychopathological destinies. To conclude with the topic of these paragraphs, we are going to refer to the new danger the ego will confront if the Oedipal resolu- tion is conducted according to the first of the three ways detailed above. The resulting instauration of the superego places this element in the presence of the ego as an internal reference of moral impera- tives and ideals to be reached (Freud, 1923b). This agency regulates by estimation the world of personal meaning, the feasible overall perspective. The danger occurs in the presence of possible devia- tions, inconsistencies, or flaws in the ego. The threat is derived from those outcast senses still in force in the depths of the unconscious that could make an impact on the official perspective; from the diffi- culties present in the reality that prevent the achievement of certain ideals, in particular when they have an absolute bias; from the ambivalence present in the ego that refuses the inner submission without being able to avoid it. This way, the signal anxiety becomes neurotic anxiety framed in a psychoneurotic disposition. Equivalent sufferings for this anxiety are the feelings of inferiority, fear to expo- sure and failure, and fear of authority. The correlation between anxiety and danger 113

The psychopathological structures

The epigenetic vicissitudes as explained above determine the various psychopathological structural destinies (Rotemberg, 2006). The different phenomena allow us to formulate a psychoanalytical nosol- ogy—from the basis of a Freudian metapsychology—whose articulat- ing factors are the prevalent constructive mechanisms and the predominant type of anxiety. In the text above we referred to two constitutive crossroads that, in our opinion, imply meaningful changes to the narcissistic realign- ment and the consolidation of the ego (Rotemberg, 2010). The first crossroad, supported by the primary identification, refers to what is known as the mirror stage, and is what gives origin to a new psychic act that generates the selfness and creates all dual narcissist dialectics with the object. The second crossroad is the Oedipal complex. Its resolution restructures the dual narcissism and establishes the superego as heir to the previous narcissism; this enables the symbolic regulation of the inbreeding relationships and an outbreeding way out for future amorous relationships. These crossroads allow us to conceptualise three structural dimensions that can be named after the transformations of narcis- sism they feature and the nosological perspective brought about: a) Original narcissistic stage: before the mirror crossroad. This stage is anarchic and auto-erotic and its structural origin can be found in the undifferentiated ego/id, without self and without object. The representation, weakly fixated, is adrift and at the mercy of the drive. Pleasure and pain determine a psychism regulated by the laws of the primary process. b) Secondary narcissistic stage: it is a result of the effect of the primary identification which includes the imago of the self as referent of the self in the structure. This event fixates the image of the self and then gives rise to the inclusion of the other in the area of the conscious as correlate of the delimitation to the object’s representation in psychism as product of successive secondary identification. These events encourage the gradual establishment of the subjective affective world and the gradual rule of the laws of the secondary process. 114 Horacio Rotemberg c) Post-Oedipal narcissistic stage: it is related to the outbreeding realignment and implies the delimitation of the sexual identity and the definite sexual objects. During this stage, the systemic representative intergame allows for the free circulation of the sense, its signification being characterised by a conscious with further judicious capacities, discriminative of the self and the other even when overwhelmed by conditions imposed on that signification by the ego/superego ideal. The laws are imposed upon the moral conscious.

The correspondence we find among these three stages and the noso- logical dimension is as follows: a) Psychotic states such as autism and schizophrenia are produced by a fixation–regression to this first stage. Autism is a psychosis related to a developmental disorder. Reality is severely rejected in this condition. The autistic child maintains his/her subjectivity in as much as he/she is able to stay centred around his/her own sensations. For this reason he/she creates a perceptive world restricted to a specific cut of reality. The stereotyped repetition of stimuli guarantees a controlled rhythm for the subject to live in. These stereotypes appear to provide a source of pleasure. The very rhythmic body movement generates sensorial series that substantiate the somatic. Simultaneously, the autistic child cen- tred on him- or herself tends to reject any sign that relates him/ her to a human presence that would take him/her away from this isolation. This incapacity to build a consensual human reality comprehensively shapes the autistic subjectivity. As the mirror crossroad has not been properly resolved, the structure of the mind still features the original narcissistic stage. The primary identification mechanism has failed, the image of the self has not consolidated, and the subsistence of glimpses of subjectivity depends on these transient integrations provided by the sensorial stimuli. In the autistic structure, the word cannot anchor the thing presentation and as it is inarticulate with the objectal bonds it becomes a vehicle for prodigious calculation and memory games with no emotional foundation and no construction of relations. The autistic sensorial balance bursts into repeated crisis when the requirements of the environment oppose the The correlation between anxiety and danger 115

established rhythm of the subject. In this type of subjective configuration there is no stable substance integrated in the structure. Thus, the autistic subject cannot categorise anxiety. Anxiety is here an unblemished form of suffering, sheer auto- matic anxiety, pure affective explosion, and pure rejection of the otherness. This embryonic subjectivity is different from the one that emerges from the wreckage of the schizophrenic episode. The schizophrenic psychotic structure, after resolving with difficulty the mirror crossroad, faces the following experiential experi- ences typical of the secondary narcissism with limited resources. The resulting subjectivity, different from the one in autism, does not include a proper cleavage between the image of the self and that of the objects necessary for its self-assertion. The complex relational exchanges characteristic to this stage precariously support the subject, who cannot find a differentiation from the other. Anxiety, as a form of extreme suffering, bursts in when that precarious balance is overpowered by the hyper intense drive typical of puberty or by the disruption of the previous and precarious containment. The pubertal emergence changes into psychotic outbreak in so far as the frail identificatory support fails, not being Oedipally processed, in its function to bring bondage and outlet to energy. The resulting deconstruction pushes the subject into anarchic times of primary narcissism. This regressive movement has a catastrophic impact on the subjectiv- ity and the flustered subject, amid chaos, witnesses that collapse. The schizophrenic person, as opposed to the autistic, has constructed along his/her process of transformation an existential sense that makes room for the other within his/her boundaries, without establishing any differentiation between them. The delimitation is a source of extreme suffering and promotes self- annihilation. As a counterpart to the autistic isolation, delusional schizophrenic behaviour seeks to restore the lost fusional sense transforming experienced nameless terror into hallucinatory and delusional projective categorisation of the ill they suffered. Violence takes form in self-punitive and hetero-punitive actions. Aggression is an emotional state equivalent to the intolerable anxiety. 116 Horacio Rotemberg b) The second stage allows us to keep the Freudian nosological denomination of narcissistic neuroses, as opposed to the psy- chosis of the previous stage and to the transference psychoneuro- sis typical of the following stage. In this group we include a range of psychopathological conditions that feature a variety of subjec- tive phenomenic manifestations with a common structural foun- dation (borderline conditions—eating disorders—addictions— perversions—psychosomatic disorders). This common founda- tion is given by the prevalence of splitting processes of the ego due to the occurrence in the psychic construction of the disavowal mechanism. This mechanism gives structural shape to the trau- matic relational vicissitudes that emerge in the secondary narcis- sistic stage. The occurrence of these traumatic events is mitigated by disavowal, a mechanism that generates disjunctive areas in the mind which can potentially and alternatively emerge into the level of the conscious disclosing conflicting contents, contents that cannot be identified or integrated. Discomfort here promotes a behavioural shunt, resulting from the passage from one field of conscience to another with an expulsive movement that goes from over adaptation to violence. According to Green (1986) the anxiety signal, related to the feelings of intrusion or emptiness, triggers an evacuation mechanism that enables extemporaneous behaviour that is later on denied. As a result of this type of func- tioning, the learning from experience is disturbed. There is no recognition of the depth of certain subjective suffering or the negative consequences of that fluctuating disposition, typical of “as if ” personalities, and therefore actions cannot be axiologically categorised. The moral imperative does not integrate the ego. What perverse amorality and behavioural chaos of the borderline patient have in common is that they both devalue the sense of evil and make the suffering circular through the relational networks woven by these subjects. Thus, personal suffering loses consis- tency; even when subjective catastrophe should be always present in these subjects. c) Transference neuroses include various clinical structured entities as well, all of which are based on the primal repression mecha- nism. This mechanism organises the representational–affective psychic base, enabling learning through experience; it delimits The correlation between anxiety and danger 117

the pre-conscious building dams supported by identificatory mechanisms. These processes guarantee a consensual exchange code where the basic identity is not threatened and a potential conflict with reality does not imply the elimination of the objec- tal–objective characteristics of the other. The characterological balance is supported by a personal search within the circulation of sense that reassures the identity of gender from the objects that replace the primary objects, in a competitive context regulated by the ego ideal. This movement consolidates the personal affective world. When certain frustrations, in certain subjects, reveal a faulty dimension in this process of structural elaboration, it returns to the repressed. Suffering, discomfort, and anxiety are indicative of the relative inconsistency of the identity of gender achieved. This identity does not properly channel the desires at the genital level and is exposed to danger that arises from the castration complex once again activated or from the superego. The axiological nominalisation of the signification within signifi- cant networks is modulated by the cultural code adopted. This factor obstructs the emergence of delusions even if it does not reduce the level of cruelty and banality that may emanate from the moral vision of the obsessive person or the unjustified fear typical of the phobic person. In the neurotic structure, as it main- tains the reality principle, transferential elaboration processes are possible, both positive and negative.

Conclusion: psychopatholgical outlines a) In certain psychotic entities, disturbance in the constitution of a basic identity due to failures at the mirror stage gives rise to certain psychopathological restorative developments in the ego, with strong thanatic charge: paranoid delusions that, through projections, maintain the ego with a revindicating belief in the presence of a threat to its integrity that arises from the environ- ment; the shadow of an object that, in melancholy, falls upon the ego due to an introjective movement that consolidates a void by means of an image of self-destructive power. b) Anxiety signal is not the only affect-guide conditioning the ego. The ego present in the narcissistic neuroses is affected by various 118 Horacio Rotemberg

sensations that condition evacuation responses in the subject: the tedium that precipitates different kind of behaviours, the exas- peration as a prolegomenon of disruptive behaviours, the condi- tioning perplexity of psychosomatic manifestations. 2

On the complex, relational nature of Freud’s thinking on primary anxiety in Inhibitions, Symptoms and Anxiety: differences from and ties to Klein

Rachel B. Blass

In this chapter I point to the limitations of common accounts of the differences between Freud’s ideas about anxiety, as he expressed them in Inhibitions, Symptoms and Anxiety (1926d), and Klein’s later formulations of anxiety. This leads to the clarification of Freud’s complex and changing ideas on the nature of primary anxiety in Inhibitions, Symptoms and Anxiety and the Kleinian nature of his thinking in this regard. This clarification serves as a first step towards developing a better understanding of the grounds and signifi- cance of the actual differences between Freud’s and Klein’s views of anxiety.

Common attempts to account for differences between Freud’s and Klein’s views of primary anxiety

Melanie Klein was greatly influenced by Freud’s thinking on anxiety and especially by the way he developed his thinking in Inhibitions, Symptoms and Anxiety. As Hinshelwood (1989, p. 112) notes, Klein “repeatedly returned to [that text] . . . to help her with her own theo- retical formulations”. Despite this direct influence, Klein’s significant

119 120 Rachel B. Blass innovations not only advanced Freud’s thinking on anxiety—they also directly opposed it on one crucial point. This regards the role that the fear of the death instinct plays in anxiety’s emergence. Klein’s opposition to Freud on this point is expressed most directly in her discussions of Inhibitions, Symptoms and Anxiety. Klein (1948) sees the fear of the death instinct as the fundamen- tal source of anxiety: “I put forward the hypothesis that anxiety is aroused by the danger which threatens the organism from the death instinct; and I suggested that this is the primary cause of anxiety” (p. 28).1 For Freud, however, the “unconscious seems to contain nothing that could give any content to our concept of the annihila- tion of life” (Freud, 1926d, p. 129). As a result, he holds that anxiety cannot have as its primary source the fear of the ultimate danger posed by the death instinct. Although Klein considers her hypothesis to be a derivative of Freud’s thinking on the death instinct, she explicitly acknowledges that her views depart from those held by Freud in this regard. In the secondary literature, this departure from Freud is noted by Klein’s supporters and critics alike. Following Klein’s own views of this departure (Klein, 1948), her differences from Freud are often seen to be the result of her more general emphasis on the death instinct and on aggression, with authors divided on the validity of this emphasis (Brenner, 1950; Compton, 1972; Glover, 1945; Hinshelwood, 1989; Money-Kyrle, 1955; Spillius, Milton, Garvey, Couve, & Steiner, 2011; Yorke, 1971; Zetzel, 1956). Supporters, again following Klein, point to the clinical findings that shaped Klein’s position; but they also make reference to broader theoretical considerations. In particular, they point to Klein’s concern with the content of anxiety rather than with its economic determinants, which are regarded as central to Freud’s view (Hinshelwood, 1989; Spillius, Milton, Garvey, Couve, & Steiner, 2011). It is claimed that, although Klein valued the views on the contents of anxiety that Freud began to develop in Inhibitions, Symptoms and Anxiety, she eschewed his thinking on the energetic conditions underlying anxiety. De Bianchedi, Scalozub de Boschan, de Cortiñas, & de Piccolo (1988, p. 360) consider this to be a metapsychological difference between the natural science perspective of Freud and the human science perspective of Klein. On the complex, relational nature of Freud’s thinking on primary anxiety 121

These explanations of the divergence between Freud and Klein in regard to anxiety are limited. Different clinical material and theo- retical predilections could explain why Freud might downplay the death instinct’s role in anxiety. However, these differences could not, as it is claimed, explain his categorical rejection of the death instinct’s involvement. In other contexts, Freud was very willing to ascribe a causal role to the death instinct. To explain his rejection of it in this context, an argument for the impossibility of the death instinct’s involvement in anxiety is necessary. Moreover, Klein’s thinking is not opposed to Freud’s in the way that many writers suggest. For example, like Freud, she discusses economic factors in anxiety: she writes of the importance of consid- ering “the quantity of anxiety from inner sources”, a point that she notes “Freud repeatedly referred to” (Klein, 1948, p. 40). She also concurs with Freud’s conclusion that “in young children it is unsatis- fied libidinal excitation which turns into anxiety” (ibid., p. 26). A new account of Klein’s divergence from Freud with respect to the role of the death instinct in anxiety is therefore needed. This chapter takes the first step toward such an account by offer- ing a close reading of Inhibitions, Symptoms and Anxiety. Freud’s con- cerns are shown to be very different from the concerns commonly ascribed to him in discussions of his differences with Klein. This lays the groundwork for a radical revision of our understanding of the sources of Freud’s and Klein’s differences on primary anxiety.

Freud’s struggle with defining primary anxiety: castration, birth, and separation

It is well known that in Inhibitions, Symptoms and Anxiety Freud intro- duced a major modification into his theory of anxiety, adopting what is commonly referred to as his second model of anxiety (e.g., Moore & Fine, 1990; Sandler, Holder, Dare, & Dreher, 1997). While he had originally held the view that anxiety is a transformation of libidinal pressure, in this text Freud puts forth the idea of the “signal of anxi- ety” (Freud, 1926d, p. 125 et passim). In his earlier theory, anxiety is the consequence of a defence that prevents the more direct ex- pression of libidinal pressure; instead, that libidinal pressure is expressed in the form of anxiety. In his new theory, anxiety signals 122 Rachel B. Blass an impending danger situation that calls defensive manoeuvres into effect. Klein (1948) saw Freud’s theoretical modification as an addition to, and not a repudiation of, his earlier theory. Some writers object to the idea that Freud continued to maintain his early ideas on anxiety, and they consider Klein’s recognition of this continuity to be misleading (e.g., Brenner, 1950, p. 609). Others think that Freud’s early model continued to play such a dominant role that the devel- opments put forth in Inhibitions, Symptoms and Anxiety were relatively limited in scope (de Bianchedi, Scalozub de Boschan, de Cortiñas, & de Piccolo, 1988, p. 361). The situation is actually more complex. On the one hand, Freud, indeed, never discarded his first theory of anxiety. He continued to maintain that, under certain circumstances, direct transformations of libido into anxiety do occur. The prototypic circumstance for such transformations is the trauma of birth: the baby’s response to his/her bombardment with internal and external stimuli, and to his/her helplessness in the face of these, will take the form of anxiety. In fact, Freud’s second theory of anxiety rests on the first, since the signal anxiety is in fact a repro- duction in miniature of the anxiety transformed in the state of trauma. As Freud explains:

Thus we attributed two modes of origin to anxiety in later life. One was involuntary, automatic and always justified on economic grounds, and arose whenever a danger-situation analogous to birth had established itself. The other was produced by the ego as soon as a situation of this kind merely threatened to occur, in order to call for its avoidance. (Freud, 1926d, p. 162)

On the other hand, despite continuity with his earlier ideas, the shift that took place here was significant. Freud is now concerned with delineating the danger situations that set off the signal anxiety, and is explicitly less concerned with the idea of transformation of libido (ibid.). Some consider the significance of this shift to lie in Freud’s move away from a biological model focused on energetic factors towards a model of content and meaning (Hinshelwood, 1989, p. 113). But this assessment cannot be quite right: from his earliest analytic models onwards, Freud always theorised contents that served to meaningfully explain anxiety. Fears of the consequences of forbidden wishes (e.g., Oedipal ones) are typical examples of this. On the complex, relational nature of Freud’s thinking on primary anxiety 123

Moreover, the kinds of contents that Freud refers to in Inhibitions, Symptoms and Anxiety are not new. Fears of losing the love of the object, of castration, and of the superego were all integral to his thinking in earlier texts. What is new is the way that Freud regards these contents and meanings. This goes beyond the technical fact that in Freud’s new model of anxiety the role of the contents shifts from explaining the transformation of libido to explaining the appearance of signal anxi- ety and consequent defensive acts. Rather, Freud is now particularly concerned with the relationship between different anxiety arousing contents and with how and why they are anxiety arousing. He aims to specify not only the states and phenomena that we fear, but also a single essential quality on account of which those states and phenom- ena are anxiety arousing. His basic questions are: (a) what is the ulti- mate danger facing man; and (b) what goes on psychically that causes the experience or anticipation of that danger to be felt as anxiety? In other words, what is innovative in this text is not Freud’s concern with the contents of anxiety per se, but rather his focus on their ulti- mate source and meaning.2 Understanding Freud’s contribution in this context lays the foundation for a better appreciation of the centrality of the fear of death and the role of the death instinct in Klein’s formulations of anxiety. In the course of Inhibitions, Symptoms and Anxiety, Freud focuses on several contents. These include the following danger situations: psychical helplessness, loss of the object, castration, and fear of the superego. He also speaks of the trauma of birth, separation, and the loss of the object’s love. His views of these various sources of anxiety shift implicitly in the course of his brief book. In struggling to grasp their inter-relationship, Freud only gradually comes to a compre- hensive perspective. But even then, a basic tension in his thinking regarding the essential nature of danger-situations remains, one that renders this comprehensive model forever unfinished. I will draw this tension out by examining the evolution in this text of Freud’s ideas about what constitutes a danger situation. Here, as well as in many earlier writings, Freud stresses the importance of castration. After developing his new theory of anxiety, Freud takes another look at this danger-situation. He inquires into the internal, unconscious source of this danger (rather than the external objective one), which he believes must be there for the 124 Rachel B. Blass neurosis to have its force. “Castration”, he now suggests, “can be pictured on the basis of the daily experience of the faeces being sepa- rated from the body or on the basis of losing the mother’s breast at weaning” (Freud, 1926d, pp. 129–130). According to Freud, this suggestion has dramatic consequences and “places the question of anxiety in a new light” (ibid., p. 130). Pointing to the connection between repeated object losses, the ego’s expectation of castration, and the fact that in anxiety “the danger is so often one of castration” (ibid.), he says that one could rightly con- clude that anxiety is not only an affective signal of danger, but that in its essence it is also a “reaction to a loss, a separation” (ibid.). Recog- nising possible objections to this view, he tries to bring evidence in its favour. In doing so, he begins to elaborate a web of connec- tions between the different forms of anxiety—birth, separation, and castration: [We] cannot but be struck by one very remarkable correlation. The first experience of anxiety which an individual goes through (in the case of human beings, at all events) is birth, and, objec- tively speaking, birth is a separation from the mother. It could be compared to a castration of the mother (by equating the child with a penis). Now it would be very satisfactory if anxiety, as a symbol of a separation, were to be repeated on every subsequent occasion on which a separation took place. (ibid., 130) Freud’s attempt to find the grounds of castration anxiety in the loss that it entails and to understand this loss in terms of a primary anxi- ety, that of birth, is indeed a dramatic move. At this point in the text, however, he feels compelled to reject the connection between birth and separation. He does this on the grounds that the foetus, which is unaware of the mother’s existence as an object, cannot subjectively experience its birth as a separation from her. As a result, birth cannot be the primary experience of separation that structures and under- lies all future anxiety situations. After a brief detour, however, Freud returns to support the connection between birth, separation, and anxiety. To do this, he takes the following six steps. First, he reiterates the idea that he put forth earlier in the book—namely, that birth is the prototypic ex- perience of the state of excitation and discharge found in anxiety. Second, he delves further into the question of what kind of danger birth could be on a psychological, subjective level and concludes: On the complex, relational nature of Freud’s thinking on primary anxiety 125

It can only be aware of some vast disturbance in the economy of its narcissistic libido. Large sums of excitation crowd in upon it, giving rise to new kinds of feelings of unpleasure, and some organs acquire an increased cathexis. . . (ibid., p. 135)

Third, he wonders what kinds of situations would remind one of the experience of birth and thus conjure up such excitation as a sign of imminent danger. Fourth, he turns to childhood experiences of anxiety for an answer, and this leads him back once again to the idea that it is separation from the object that is perceived as dangerous. He writes:

Only a few of the manifestations of anxiety in children are comprehensible to us, and we must confine our attention to them. They occur, for instance, when a child is alone, or in the dark, or when it finds itself with an unknown person instead of one to whom it is used—such as its mother. These three instances can be reduced to a single condition—namely, that of missing someone who is loved and longed for. (ibid., p. 136)

Freud considers this step, too, to be a dramatic one, and says that it provides the “key to an understanding of anxiety and to a reconcili- ation of the contradictions that seem to beset it” (ibid., p. 137). However, he does not yet explain in what sense it resolves the prob- lems. This requires step five: he quickly elaborates on the child’s state of longing and how it is transformed into anxiety, which is now recognised as “an expression of the child’s feeling at its wits’ end, as though in its still very undeveloped state it did not know how better to cope with its cathexis of longing”. (ibid., p. 137). Finally, through this notion of longing, Freud can return to the connection between castration and birth:

Here anxiety appears as a reaction to the felt loss of the object; and we are at once reminded of the fact that castration anxiety, too, is a fear of being separated from a highly valued object, and that the earliest anxiety of all—the “primal anxiety” of birth—is brought about on the occasion of a separation from the mother. (ibid., p. 137)

This, however, leads back to the problem that arose earlier: accord- ing to Freud, birth cannot be subjectively experienced as a sep- aration. 126 Rachel B. Blass

The key to the resolution of this contradiction is the idea of “long- ing”, which Freud introduced in reference to childhood anxieties. The term “longing” (“Sehnsucht” in the original German) permits a shift in emphasis from the “experience of loss” to “unsatisfied need”. It is longing in this latter sense—that is, a lack of satisfaction entailed by loss—that is the meaning and foundation of the experience of longing in the former sense. Freud sums up his argument thus:

[A] moment’s reflection takes us beyond this question of loss of object. The reason why the infant in arms wants to perceive the presence of its mother is only because it already knows by experi- ence that she satisfies all its needs without delay. The situation, then, which it regards as a “danger” and against which it wants to be safeguarded is that of non-satisfaction, of a growing tension due to need, against which it is helpless. I think that if we adopt this view all the facts fall into place. The situation of non-satisfaction in which the amounts of stimulation rise to an unpleasurable height without its being possible for them to be mastered psychi- cally or discharged must for the infant be analogous to the expe- rience of being born—must be a repetition of the situation of danger. What both situations have in common is the economic disturbance caused by an accumulation of amounts of stimulation which require to be disposed of. (ibid., p. 137, italics in original)

Freud concludes, “It is this factor, then, which is the real essence of the ‘danger’ “ (ibid., p. 137). Thus, he links the two situations of separation—birth and castration—by ascribing to them not the same content of loss, but similar experiences of stimulation. Freud does not rest here, however, and, as the text progresses, an unresolved tension in his thinking becomes apparent. He seems unsatisfied with his conclusion about the real essence of the danger and is quick to remind us that, in all post-uterine situations, it is the danger of the loss of the object per se that is central, not the economic implications of that loss (ibid., p. 138). In this context, Freud describes castration in a more object-related way than ever. The danger of separation from one’s genitals is conceived in terms of the fact that “that organ is a guarantee to its owner that he can be once more united to his mother” (ibid., p. 139). But then Freud once again reverts to the idea that the ultimate danger is an economic one of needs. Being deprived of one’s penis amounts to a separation from one’s mother; but this, Freud explains, “means being helplessly On the complex, relational nature of Freud’s thinking on primary anxiety 127 exposed to an unpleasurable tension due to instinctual need, as was the case at birth” (ibid., p. 139). Then he returns again to the object- related stance as he describes how castration anxiety develops into moral anxiety: the danger in this case is the fear of losing the love of the superego, the introjected parental objects. Towards the end of the book, Freud proposes that the various danger situations he describes—helplessness, loss of the object, castration, and fear of the superego—are appropriate to different developmental periods of life, although they need not replace each other. In this context he reminds us not to overestimate the influence of the castration anxiety, despite its apparently dominant role in the neuroses. The prevalence of hysteria among women, he says, should counteract any such inclination. Here, Freud offers one further permutation of the danger underlying anxiety in the direction of relatedness. He writes: All we need to do is to make a slight modification in our descrip- tion of their determinant of anxiety, in the sense that it is no longer a matter of feeling the want of, or actually losing the object itself, but of losing the object’s love. . . . [It] appears probable that, as a determinant of anxiety, loss of love plays much the same part in hysteria as the threat of castration does in phobias and fear of the super-ego in obsessional neurosis. (ibid., p. 143)

Freud’s views on the fear of death as a source of anxiety Despite Freud’s deliberations and shifts regarding the nature of the danger situations underlying anxiety, he was quite firm on the fact that the fear of death was not among them. In Inhibitions, Symptoms and Anxiety, he first raises the issue of the fear of death immediately after drawing his conclusion that anxiety is a reaction to a situation of danger. He writes: If anxiety is a reaction of the ego to danger, we shall be tempted to regard the traumatic neuroses, which so often follow upon a narrow escape from death, as a direct result of a fear of death (or fear for life) and to dismiss from our minds the question of castra- tion and the dependent relationships of the ego. (ibid., p. 129, italics in original) He quickly rejects this temptation, explaining, “it would seem highly improbable that a neurosis could come into being merely because of 128 Rachel B. Blass the objective presence of danger, without any participation of the deeper levels of the mental apparatus” (ibid., p. 129). The fear of death, according to Freud, simply does not exist on such levels. This is the crucial point: “the unconscious seems to contain nothing that could give any content to our concept of the annihilation of life” (ibid., p. 129). He contrasts this with castration anxiety, which is known to us through daily experiences with the separation of faeces and the loss of the mother in weaning. “But nothing resembling death can ever have been experienced” (ibid., p. 130). In other words, we can never directly experience our non-existence because it requires our being there to experience it. He suggests that the closest that we could come to such an experience is in the state of fainting. Instead, Freud argues that the deeper psychic meaning of the ostensible fear of death should be understood as fear of castration and as the ego’s experience of “being abandoned by the protecting super-ego—the powers of destiny—so that it has no longer any safe- guard against all the dangers that surround it” (ibid., p. 130). In other words, it is the danger of the loss of the object and its loving protection—a danger conceivable through experience—that finds expression in the fear of death. Freud returns to this matter a few pages later in his inquiry into the nature of the danger experienced by the foetus in birth. He acknowledges that in birth there is a real danger to life, but affirms that the foetus cannot possibly have knowledge of its life being potentially destroyed. What it experiences is rather “some vast disturbance in the economy of its narcissistic libido” (ibid., p. 135). Here we see an economic stimulation account of the fear of death. This account is similar to the one given of anxiety in general, which Freud explains in terms of both loss and massive stimulation met by helplessness. In the danger situation of death, as in anxiety gener- ally, loss and massive stimulation are the fundamental experiences. In a deep psychic sense, there is no fear of death per se.

Discussion of the theoretical considerations underlying Freud’s position on primary anxiety

In Inhibitions, Symptoms and Anxiety, Freud is trying to discover the essence of anxiety. For example—and this is his main example— On the complex, relational nature of Freud’s thinking on primary anxiety 129 having recognised long beforehand that anxiety is associated with the idea of castration, Freud now wishes to know what it is about castration that is frightening. He does not take anything for granted in this regard. He first concludes that, at bottom, we fear a loss, a physical separation such as the one we experienced at birth. But this is not sufficient: he feels he must still investigate the reason that such loss is a source of anxiety. Similarly, he must give an account of why the separation of birth, “the first experience of anxiety” (ibid., p. 130), is so terrible. We can offer seemingly self-evident explanations in terms of injury and potential damage; but Freud is concerned with discovering what this can possibly mean on the deepest psycho- logical level. What does our unconscious mind know of such dangers and how, in terms of the workings of the mind, does this knowledge find expression in anxiety? In attempting to answer this question, Freud is very attuned to matters of early immediate experience. For a danger to cause anxi- ety of the kind associated with neurosis, for it to have the force to pervert both thinking and the perception of reality, he claims that an unconscious determinant must be involved. Otherwise the danger would arouse only fear and aversion. Given the nature of the form and contents of the unconscious, the danger state would have to be immediately experienced and present early on, not something consciously learned about later in life. When one attempts to under- stand the origin and meaning of a certain fear (e.g., castration), one must therefore look for an analogous event that the subject, as an infant, could have actually subjectively experienced. The analogous, subjectively experienced event is the ultimate, unconscious danger behind the fear. Again, Freud suggests that the loss of the object is known to the infant from the infant’s bodily experience of being separated from his/her faeces and from the breast. Loss of the object therefore seems like an early experience that could account for anxiety. According to Freud, however, one must look beyond such experiences of loss for the very first source of anxiety. This source would provide a more comprehensive explanation of how and why these losses come to arouse the specific feeling of anxiety. Separation from the mother at birth seems like a possible source, but Freud argues that the foetus could not subjectively experience the loss of the mother whom it cannot yet recognise. What the foetus does psychologically 130 Rachel B. Blass experience, says Freud, is the state of being overwhelmed by stimu- lation. He concludes that this helplessness in the face of overwhelm- ing stimulation is the origin and ultimate meaning of the loss of the mother and that this is what is felt as anxiety. Because Freud seeks to explain all the specific danger situations with reference to a single originating experience, the various losses involved in these situations also come to be explained in terms of helplessness in the face of over-stimulation. In explaining them thus, Freud shifts from the description of relational experiences (of loss) to a description of the inner dynamics (helplessness and stimulation) that are associated with these relational experiences. By tying different fears to one ultimate psychic danger, Freud not only finds a coherent explanation of anxiety in terms of content, but also explains why the feeling called up by danger situations is specif- ically that of anxiety. The situations provoke anxiety because the experience of anxiety, which is an experience of excitation that one is helpless to control, directly corresponds to the state of overwhelm- ing stimulation of the psyche that emerges in the ultimate danger situation. Freud further develops these ideas, once again shifting from a focus on the content of loss to a focus on the economic state of high stimulation, in his examination of the state of longing, which expresses both a loss and an intensifying state of need. Despite its relative tidiness, Freud finds the economic solution unsatisfactory because, being focused on inner dynamics, it does not fully capture the relational factor in anxiety. He therefore vacillates between this solution and understanding anxiety in terms of object loss. His account of the danger of castration—the fear of losing the possibility of uniting with the mother—is a notable instance of this. Freud’s rejection of the fear of death as a source of anxiety may be understood in this complex theoretical context. According to Freud, no early subjective experience of death can be found. Therefore, the fear of death cannot be unconscious in a primary way. Rather, there must be some other unconscious danger state that underlies it. He suggests that this may be castration as well as the loss of the protection of the superego, which are known to the uncon- scious through early experiences of loss. Moreover, castration and loss of the superego’s protection account for the specific feeling of anxiety and the tension that is associated with it. The fear of death, however, has no psychic correlate that could account for this feeling. On the complex, relational nature of Freud’s thinking on primary anxiety 131

In rejecting the fear of death as a basic determinant of anxiety, Freud does not ignore the fear of death; he knows that people feel this fear strongly and that death is objectively an ultimate danger. He postulated an instinct of self-preservation and he mentions the temp- tation to explain anxiety in terms of the fear of death. But, realising the theoretical limitations of such an explanation, he feels compelled to recognise that underlying the fear of death there are more funda- mental psychic states—experiences of loss and stimulation—that give anxiety its form and meaning. Nor does Freud reject the death instinct or limit its role. Although in Inhibitions, Symptoms and Anxiety there is more reference to libidinal factors than to inherently aggressive ones, it is consistent with Freud’s thinking in this text that aggressive drives would be a source of anxiety, and he refers to their involvement in the Oedipus complex, for example. Thus, according to Freud, the individual’s destructive tendencies, like his libidinal wishes, may arouse anxiety. But Freud’s questions in Inhibitions, Symptoms and Anxiety are about the origin and meaning of anxiety. He wants to discover the root of the experience of anxiety, the ultimate danger that one hopes to avoid, that which finds expression in the state of anxiety. This, he argues, cannot be the fear of death.

Conclusions

The clarification of Freud’s ideas in Inhibitions, Symptoms and Anxiety points to the problems with the common accounts of the differences between Freud and Klein in regard to anxiety and, more specifically, primary anxiety. Freud’s rejection of the fear of death is based on experiential considerations—primarily the fact that the fear lacks an early experiential source—that are in line with Klein’s kind of think- ing. Like Klein, Freud is clearly concerned with content and rela- tionship (e.g., the phantasies of loss that underlie neurotic anxiety). Like Freud, Klein appreciates the role of quantitative factors (see Blass, 2012). Both thinkers see the two factors as being in a complex kind of interplay. Given these similarities, one may now wonder, how is it that Klein can postulate an unconscious fear of death, and what considerations do actually ground this divergence from Freud? The close reading 132 Rachel B. Blass above shows that their divergence is not based on incidental clinical material, personal preferences for certain kinds of theories, or other superficial and stereotypical differences. Rather, their differences centre on questions about the fundamental nature of anxiety and its primal source. Oriented to the problem in this way, we can attempt a new answer to the question of why Klein differs from Freud on such a fundamental issue. In a future article, I will answer this question through pointing to fine but significant differences in the way Freud and Klein conceive of the relational reality of the psyche. Both are concerned with inter- nal phantasised relationships—but they differ in their conceptualisa- tions of such relationships. Recognising this difference allows us to shed new light not only on the nature of anxiety, but also on the essential natures of Klein’s and Freud’s respective metapsychologies.

Notes

1. It should be mentioned that in some other texts Klein notes that “other important sources of primary anxiety are the trauma of birth (separation anxi- ety) and frustration of bodily needs” (Klein, 1946, p. 100). 2. This innovation is part of Freud’s decades-long effort to uncover the ultimate sources of neurosis that lie beyond the real seductive encounters to which he attributed neurosis in his very early analytic work (see Blass, 1992, p. 175; Blass & Simon, 1994, p. 690). 3

Winnicott and Kohut: their theories of anxiety

Kenneth M. Newman

Introduction

Winnicott, writing in the forties and fifties, and Kohut, who entered the scene primarily in the sixties, shifted the focus of disturbances in the self from drive-centred fixations to arrests in development. The emphasis included a shift to earlier environmental failure and faulty parental attunement to the emotional needs of the child, and there- fore required different explanations for the nature and causes of anxiety. That meant that the sources of anxiety would be located at the time of structural formation, when the infant’s dependence on maternal care-taking to provide the atmosphere of security and the foundation for a safe internal environment was of central impor- tance. Traditional explanations central to the structural model and ego psychology, that stressed the individual infantile drives in conflict with the superego, became somewhat subordinate. Since the pathognomonic points of fixation were now located in the prestruc- tural period, the Oedipus and the conflicts attendant upon its faulty solution were no longer the focal point for anxiety. Since Winnicott alludes to anxiety as emerging from an environ- mental failure situated within the early mother–child dyad, we will

133 134 Kenneth M. Newman try to amplify how disruptive affects emerging within this matrix become chronic problems, and contribute to the formation of patho- logical character restitutions. To this end, we will briefly consider his views on healthy outcome, and then see how, when the environment fails due to faulty maternal adaptation, the results become inter- nalised with disturbances in self and object. As stated above, the good-enough adaptation to need, expressed in Winnicott’s terminology (1958) as responsiveness to the child’s gesture and need for the illusion of control over the object, is essen- tial for the building up of an enhanced, imaginative self. It is the basis for a burgeoning sense of agency, confidence, and individuality and, in Winnicott’s view, the facilitator of the “true” self. The accrual of these positive experiences leads to an increasing sense of reality testing accompanied by the recognition that there is an object outside of the infant’s “omnipotent sphere” that provides nutritional and emotional sustenance. This decisive maturational achievement is the nidus for true dependence (a good thing) and “usability” (also a good thing). But to reach these nodal points, more must be navigated between parent and child. More explicitly, during the early phases, even with opti- mally gratifying experiences, there are disruptions and inevitable failures in care-taking. These frustrations cause varying degrees of infant distress registered as dysphoria, tension, anxiety, and reactive rage. At this point, a second and equally important care-taking func- tion is required, that is, the capacity to aid in “holding”. Parents provide this holding in two major ways. The first, as already described, involves accepting and facilitating the child’s early compe- tence, his/her illusion of control over the object. The second is the capacity to help manage affects, especially the unruly and negative ones linked to frustration. This vital dimension, when successfully employed, means that feelings mobilised by disruptions and breaks in attunement can be absorbed and integrated by the child. In the face of disappointments and misunderstandings, the care-taker can withstand the affects, survive destruction, and help the child’s psyche remain intact. The good-enough availability of these two dimensions of need—attunement to the phase-appropriate omnipotent gesture and containing affects associated with temporary environmental fail- ure—permit the crucial shift whereby the child places the object outside the self, making it “usable” (Newman, unpublished). Winnicott and Kohut: their theories of anxiety 135

I offer the above preamble because I believe that, to give a more fully developed explanation for Winnicott’s views on anxiety, we must elucidate how environmental failure in both dimensions of need weakens the child’s psychic structure and renders it vulnerable to anxiety. In the face of excessive trauma, the child’s psyche is reor- ganised through both adaptive and pathological character defences to protect his/her ego from overwhelming affect states. Winnicott’s explanation of these unfavourable outcomes tends to be terse and rather pallid. His ideas about how environmental fail- ures lead to a chronic sense of dysphoria, a vulnerability to anxiety, and the need for structural reorganisation are much too understated for the kind of pathology and compromise that can unfold. He essen- tially focuses on the care-taker’s inability to respond optimally to the child’s need for the omnipotent gesture, played out for a time as the fantasy of controlling the object. Whatever interferes with this expe- rience (e.g., narcissistic, obsessional, intrusive, or overly critical parents), evokes “impingement” anxiety, which he describes as a seis- mographic disturbance in the child, a break in his/her “going on being”. While Winnicott was clearly aware of the negative feelings that accompany disruption, I believe he placed too little emphasis on the way the inability to “hold” affect contributed to derailment of development and became a major source of anxiety. He introduced one of the most crucial concepts in clinical theory—the parents’ “survival of destruction”—yet he does not amplify how it works. To say that care-takers’ incapacity to “hold” intense affects leads to emergency measures like splitting and “freezing” out feelings vastly underplays the role of affect management in the evolution of psychic structure. Let me try to elaborate then on how I see faulty navigation of the nodal developmental stages discussed above. In the face of a con- sistent failure of the environmental objects (care-takers), the infant begins to “live” with an internalised object that is essentially nega- tively charged and feared. While the quality and nuances of the toxi- city vary, the overall result of the failure in “good-enough” mirroring, attunement, and holding is the creation of a core experi- ence, an internalised dyad, in which the other (the parent) is seen as either critical, emotionally unavailable, excessively narcissistic, and/or intrusive. This internalised world of the infant can be visu- alised along the lines of Daniel Stern’s RIGS—responses internalised 136 Kenneth M. Newman and generalised. This leaves the infant chronically in fear of “bump- ing” into the hostile introject and the sense of abandonment and/or anxiety such contact would evoke. While the emphasis on this facet of environmental failure gives a more compelling explanation for Winnicott’s model of anxiety/depression, there is a need to add the second dimension of failure in order to complete the picture. As previously stated, the events that follow consistent frustration and disappointment in the objects are of vital importance in deter- mining how the care-takers are experienced in their required func- tion of “holding” intense affect states. Thus, when the same parents who helped create states of high emotional intensity through inade- quate provision are unable to respond to the child’s reactive rages and/or despair, we have the second dimension of object failure. This creates a compound dilemma for the child. Not only does he/she dread experiencing the effects of the not good-enough, unattuned, or unavailable parent, but he/she is also frightened of the terrifying feelings, magnified by lack of integration, that will be reactivated. I am then conceptualising the anxiety as heightened not only by repeated experiences of faulty needed responses, but exaggerated by the psyche’s weakened structure, which is unable to manage intense feelings.

Kohut and anxiety

Kohut’ theory of anxiety—like Winnicott’s—emerges from a devel- opmental period where the primary concern is the structuralisation and integration of the self. Again, like Winnicott, the anxiety is not essentially created by drive–superego conflict but is located within the experience of the self, and determined by the factors that enhance or weaken its integration. For both Winnicott and Kohut, the emphasis shifted from instinctually-fuelled sources to the way care-takers helped the child’s psyche to become strengthened and enlivened through good-enough attunement to developmental needs. While Winnicott spoke of good-enough maternal adaptation, Kohut introduced the term self-object to conceptualise the functions required by the infant to build a secure and imaginatively creative self. He saw the two major features of self-objects as performing mirroring or idealising functions. Winnicott and Kohut: their theories of anxiety 137

To highlight the way Kohut’s model diverged from the classical drive-centred model, let us briefly review his thinking. In The Restoration of the Self (Kohut, 1977, p. 102), he delineated two basi- cally different categories of anxiety. The first, more familiarly, related to those individuals in whom the cohesiveness of the self is intact, suggesting that earlier maturational experiences had been success- fully traversed and greater autonomy achieved. With these condi- tions satisfied, anxiety represented signals of different specific danger, circumscribed fears related to threats of abandonment, fear of loss of love of the object, castration, and superego reactions in response to pressures from infantile drives. While the instincts and their fantasy accompaniments could be linked to earlier libidinal stages, reflecting arrests, the central conflicts were seen to be related to the oedipal situation. The second category of danger entails the disintegration or frag- mentation of the self. The crucial factor determining this form of disturbance concerned the pre-consciousness of the self and the vulnerability of the self–self-object unit. In individuals susceptible to this kind of anxiety, the early building blocks necessary for structural integrity were never fully established. This resulted from inadequate environmental provision. The elaboration of how this vulnerability becomes a chronic concern requires some further examination of the two dimensions of self-object need (Kohut, 1971, 1977), i.e., the critical role of parental mirroring and the complex idealising func- tions. While we have generally assigned the anxiety states found in a disturbance of the self to a fragmentation-prone vulnerability, further exploration of the cause of these particular anxiety states might extend completion to the original model. Briefly, somewhat analogous to Winnicott’s explanations, anxiety arises from the re-experiencing of faulty responsiveness from others (care-takers, self-objects), together with the inevitable intense affect states that accompany such disappointments. As with the Winnicott model, the fact that the vulnerable individual has never fully inte- grated the intense feelings linked to failure contributes mightily to the internal threat to the self, and is the story of the second dimen- sion of self-object failure. Let me fill this out a bit. Marian Tolpin (1971) beautifully described the early idealising function of the mother as she facilitates the acquisition of the child’s skill in paradigms of tension regulation. 138 Kenneth M. Newman

She describes how optimal frustration serves the basis for the trans- formation of the mother’s regulating capacities with bit by bit shifts leading to the child’s accrual of structure. Much of this microscopic description addresses healthy transactions that lead to a strength- ened self, able to manage and integrate tension states. However, a more complete explication of the role of affects and the handling of aggression and negativity requires examining the issues that arise when parents fail to adequately serve their self-object function. Miliora and Ulman (1996) add to our understanding of the interplay between the parental role and the way the child’s inter- nal structure is crucially influenced. They emphasise how parents serve in both their mirroring and idealising functions to absorb, neutralise, and detoxify potentially disturbing emotions or disorgan- ised stimuli. They see this as adding to the child’s capacity to achieve differentiation within containment. They view the parental function as a superabsorbent sponge that soaks up excessive affects and sen- sations while the child’s self is still fragile. But the (relative) absence of the parents’ capacity for providing differentiation within contain- ment interferes with the child’s ability to create well demarcated boundaries. This failure can lead in later life to an inability to con- tain intense emotions, especially negatively-tinged ones, and can be the basis for spectrums of anxiety from diffusion anxiety, fragmenta- tion anxiety, or even panic. We should again underscore that the functions they detail could all be subsumed under the second dimen- sion of need which the “idealising” object either fulfils successfully or not. Socarides and Stolorow (1984) also emphasise the role of the idealising self-object in affect integration. Affects can be seen as organisers of self-experience throughout development, if met with accepting synthesising and containing responses from caregivers. An absence of steady, attuned responsiveness to the child’s affect states creates minute but significant derailments of optimal integration, and leads to a propensity to dissociate or disavow feelings because they threaten the precarious structuralisations that have been achieved. I believe we can see strong analogies between Winnicott’s implicit understanding of the holding function so necessary for affect containment and proof of the object’s survival, and Kohut’s second dimension of need mediated through idealising self-objects. If we Winnicott and Kohut: their theories of anxiety 139 then want to place anxiety at the centre, motivating the need for characterological adaptations/maladaptations, compromised object relations, and emergency symptomatology, we might synthesise it as follows: the child (later adult) vulnerable to disorganising anxiety due to earlier care-taking (self-object) failure, continues to require excessive responses from external others or their own archaic grandiosity achievements to guarantee safety. In the face of the threatened loss of these affirming containing responses and threats to omnipotent control, the self is exposed to a sense of weakness, inadequacy, and internal self-criticism, all of which initiate the state of anxiety cum fragmentation. Adding mightily to this state of affairs are the accompanying reactive affects—rage, despair, hopelessness— that, because they have never been adequately managed, now incre- mentally threaten the self with overwhelming anxiety. In summary: since the source of developmental arrest, anxiety- prone vulnerability, and pathological character rests on a twofold failure of care-taking or self-object functioning, I believe this can determine various directions for treatment. Often, the patient’s presentation will recommend an atmosphere that facilitates the emergence of repressed narcissistic strivings. At other times, it may become clear that the patient’s repetitive narcissistic solutions (pathologically defensive character) may lead us to help the patient reach back to feeling states that have been feared and walled off. By attending to these earlier in the treatment (Newman, 2007), we are attending to a significant facet of need that the patient cannot manage on his/her own. Here, then, we may engage the faulty inter- nal holding environment almost from the outset, thereby consider- ing affect management as the forward edge of need. This helps the patient to mobilise frozen feeling states and it may allow for the emergence of deeper, true self needs or narcissistic strivings, since the problem of affect regulation has already been made a central concern.

Therapeutic action

Since both the Winnicott and Kohut models locate the core distur- bance in developmental failures that, in turn, have weakened the structure of the self, the recommendations for treatment follow 140 Kenneth M. Newman directly from this assumption. The precepts upon which the under- standing of therapeutic action is based are as follows: many of the presenting features of adult patients, including adaptive/maladap- tive character, symptomatic behaviour, and compromised object rela- tions, can be attributed to the early environmental failures that interfered with firm and reliable structure building. The current presenting personality represents intermixtures of forward edge needs, often in hypercathected forms, as well as defences against retraumatisation. This means that, while much of the needs related to arrested development are carried forward and imbedded in the character, so too are the defences that help protect the psyche from affect states never adequately managed or integrated. Tracing the factors back to the faulty environmental conditions and stages where the parental objects (care-takers, self-objects) were so crucial in determining the way the psyche became organised means that a new reorganisation in therapy must include a new rela- tionship to objects. To this end, the analyst must become available for the deployment of transferential needs as the conditions of safety are provided to facilitate their mobilisation. In both theories, these, predominantly narcissistic transferences, are to be encouraged and accepted, with the understanding that what is being remobilised are needs rather than libidinal (implicitly infantile, and therefore illegit- imate) drives. Thus, one major dimension involves providing a needed relationship that serves as the scaffolding for the building of a new, strengthened self. While often the primary focus has been on reactivating dependency and mirroring needs, it is equally vital that the dimension of affect management be attended to. The reworking of early trauma that led to a weakened self should include not only how the capacity for self-esteem regulation was compromised, but also how the parents failed to help “hold” intense feeling states. Earlier in this chapter, I have described how anxiety and unman- ageable tension states are linked to these early care-taking (self- object) failures. Therapeutic action, for Winnicott, meant that, in the treatment situation, when a therapeutic regression had deepened, the patient and analyst would have to live through a repetition in the analysis of failures that echoed with the early environmental ones. For Kohut, much of the therapeutic action involved managing rupture and disrepair in the analysis. These issues become most useful when solid self–self-object transferences become engaged, and Winnicott and Kohut: their theories of anxiety 141 then suffer from inevitable failures of empathy or temporary losses (separations, etc.). The analyst’s grasp of these events, which includes recognising his or her role in a rupture, helps the patient feel both understood and contained. The ability of the analyst to bear the intensity of the feelings attendant upon a break in the self–self-object tie, has parallels with Winnicott’s concept of survival of destruction. This provision—meeting the need for holding and integration—contributes greatly to a strengthened self. As Marian Tolpin’s paradigm has suggested, the patient can, bit by bit, inter- nalise the therapeutic transactions when mounting tension states prevail. Gradually, the analyst’s understanding, forbearance, and calm can be transformed and accrued as new structure. 4

Primordial anxiety, drive, and the need for the progressive movement

Luciane Falcão

Inhibitions (Hemmung), Symptoms (Sympton) and Anxiety (Angst) is a complex text, but at the same time essential. We must read it now bearing in mind that the father of psychoanalysis had just proposed the second topic and that there were many consequences of that new psychic structure which still remained unclear. One of those consequences—the death drive theory—seems to me to stand out in this text from 1926 through its relation to what Freud called automatic anxiety, understanding that the action of death drive reinforces the experience of psychic chaos. Freud forwards the idea that, when connected energies become disconnected, it results in a detachment of the energy coming from the disconnected organ- isms. This self, or being, these organisms, turn against each other and there is a constant debate with the id and the external world. The resulting loss of structure of the libido is the first signal of danger and has as a consequence the emergence of a perception of the most primordial affect, anxiety. Therefore, I use the term primordial anxiety as a synonym for this traumatic anxiety, which is primordial in the ontogenetic sense. Freud examines that primordial anxiety in this text—the automatic anxiety is the original one, the one that floods the subject. On the

142 Primordial anxiety, drive, and the need for the progressive movement 143 other hand, by means of life drives, of Eros, the ego will have to develop itself to reach a signal anxiety capable of helping the subject in self-preservation. For any progredient movement there will be the necessity of the link to the narcissistic libido which will be revealed by a new liaison of the libido, for that moment transforming the libido into a narcissistic libido and an object libido (Freud, 1933a). But death drive acts in silence, in a retrogressive movement, towards a primordial anxiety or a previous state. Therefore, for my reflections on Inhibitions, Symptoms and Anxiety, I shall try to tackle the proximity between anxiety in its primordial state and a signal anxiety to life and death drives, respectively, as well as the relation between anxiety and the detachment of narcissistic libido from the ego.

Death drive: the first drive

In 1926, Freud approaches the issue of birth trauma as a model of anxiety, based on the disorganisation suffered by a system of organs libidinally associated at the time of birth and on the association of this experience with the primordial anxiety. But, in order to think about this anxiety, we have to go back six years in Freud’s writings and refer to Beyond the Pleasure Principle (1920g), where he describes his last theory on drives, introducing the concept of death drive. In this text, Freud will grant death drive the status of first drive. This has crucial implications in metapsychology. From then on, Freud will state that man has an innate component of rage, a trend towards aggression and destruction, and will propose that death and life drives coexist right from birth. He will then demonstrate that there is a new power, the death drive, that tries to dismantle every- thing. Eros and death drive are then considered the two opposite sides of psychic conflict. Under this new lens, Freud elaborates the hypothesis of the prox- imity of sadism and death drive, drawing support from the entan- glement and disentanglement of sexual drive, destination of the sadistic component of libido in its perverse form and its new objec- tive, destruction. The studies he carried out of the development of non-destructive sadistic libido highlight the effects of the so-called life drive that shelters under the defence of the ego. We could here 144 Luciane Falcão correlate the theory of Green on two types of narcissism—life and death—and we can then consider narcissism the core essence of life drives, as a protective vertex of the whole building of the ego; the only one, in that moment, capable of resisting in an organised way the death drives (Green, 1983). Green believes Freud has not fully detailed this and was satisfied in considering narcissism as the first connection between life and death drives. He then goes on to draw this course:

... at first something that cannot be distinguished (chaos?). Later, the first identifiable investments appear (libido connected to the body of the subject, eroticism of the body—auto time—by the first unification, etc). Later, constitution of the first unification phase: narcissism itself, autoeroticism that opposes the disappearance of the acquisition but that cannot resist time as such. Green, 2007a, p. 31 (my italics)

I understand that this chaos corresponds to the primordial anxiety, which is sustained by action of the death drive that hinders the investments necessary for the linking and, furthermore, leaves room for the libidinal haemorrhage when the first unification does not occur. For this first unification to exist, there must be investment. Green states that in continuing the course or, if we prefer, in the progressive movement (progrediente), there will be an intervention, an investment that precedes the object constitution. This investment is what will not only make the object intervene but will also oblige the psychic structure to develop.

Birth trauma

In the 1926 text, birth anxiety is the model for the traumatic fact, is the essence. Freud searches for the factor a priori, a feeling of phylo- genetic anxiety which will be resignified. Along this course, the ego will be threatened by many experiences of danger throughout its devel- opment: (1) loss of the mother; (2) loss of the love of the mother; (3) loss of the superego; (4) anxiety of castration; (5) loss of the love of the super ego. However, his thesis is that the physical discharge (excess heart beats, forced breathing, etc.) causes a libidinal disequilibrium that is Primordial anxiety, drive, and the need for the progressive movement 145 transformed into anxiety. This physical disequilibrium experienced as anxiety needs to be symbolised or, as he puts it, “we must not lay undue stress on it nor overlook the fact that biological necessity demands that a situation of danger should have an affective symbol, so that a symbol of this kind would have to be created in any case.” (Freud, 1926d, pp. 93–94). Freud makes clear in this text that anxiety is connected to the danger of a state of excitement in the infant and, as a consequence, of displeasure. This experience that happens at birth implies a trau- matic physical experience. The pleasure principle is absent in that moment. This, in my opinion, is crucial:

. . . anxiety is accompanied by fairly definite physical sensations which can be referred to particular organs. . . The clearest and most frequent ones are those connected to the respiratory organs and with the heart. . . . Analysis of anxiety-states therefore reveals the existence of (1) a specific aspect of unpleasure, (2) acts of discharge and (3) perception of those acts. . . . anxiety is based upon an increase of excitation which on one hand produces the character of unplea- sure and on the other finds relief through the acts of discharge already mentioned. (Freud, 1926d, pp. 132-133)

Freud continues this line of thinking in 1933:

What is fundamental at birth, as in every situation of danger, is that it prints to the mental experience an extremely intense state of excitement, which is felt as displeasure, and that is not possible to dominate by discharge. A state such as that, in face of which the efforts of the pleasure principle fail, we shall call “traumatic moment” . . . What is feared Ö is invariably the emergence of a traumatic moment which cannot be confronted by the regular rules of the pleasure principle. (1933a, pp. 117–118)

Freud will acknowledge the existence of a double origin for anxiety: one, a direct consequence of the traumatic moment, the other as a sign that threatens a repetition of that moment. The idea of an exces- sive libidinal demand allows us to think of what will become the experience of helplessness, since there is not an ego capable of dealing with this initial anxiety, that being the equivalent to talking about primordial anxiety. 146 Luciane Falcão

I believe Esther Bick (1968) and Winnicott (1969) helped us understand the Freudian ideas concerning this bodily anxiety and helplessness. Bick demonstrated this by means of the studies observ- ing infants, and the results of these studies were in complete agree- ment with this Freudian idea. For her, most things felt emotionally are, first of all, naturally felt by the body. The mental and physical state of the infant is a continuum (Bick, 1968). Recently (Falcão, 2010), I discussed this issue using the experi- ence of parent–infant therapies. During this practice, one has the opportunity of experiencing with babies this bodily anxiety which I call physical flash and that, in my opinion, is a form of pre-figurability. The anxieties can be perceived by means of the physical sensations experienced by the analyst during the session. Often in such treat- ments they could be understood, at first, to be hysterical identifica- tions with the baby. But I would rather think that those body sensations, or body acts, correspond to the anxieties the infant cannot express in words: there is no word, there is the body. The analyst may apprehend the sign of the anxiety that is overflowing from the infant’s psychism in the moment he/she physically feels the anxiety during the session. It is a body flash that we may understand as an alarm sign. When those babies are referred to us it is always because of physical symptoms. I then understand that, on mentioning hilflosigkeit, Freud speaks of a desperate baby who cannot talk, who screams, who cries, who wiggles, and who is not able to create any representation. Drive cannot create its course. It is the primordial anxiety. Freud insists on the idea of this anxiety being connected to birth anxiety. I would rather believe that he insists in thinking about the experience of help- lessness, and that this helplessness is the prototype of the anxieties lived by human beings. The conditions of helplessness at this particular moment are what will be experienced during development. Therefore, when the ego experiences a relentless pain, or a demand that cannot be satisfied, the economic situation is the same: the motor helplessness will find expression in psychic helplessness. Hence, a disen- tangled libido that does not link, but that endlessly expects linking without ever achieving it, renders the ego void of narcissistic libido, like a haemorrhage, leaving it at the mercy of the death drive. And so, the disentangled libido would be an announcement of the coming death. Primordial anxiety, drive, and the need for the progressive movement 147

Winnicott (1969), in turn, also refers us to the Freudian idea of helplessness when he describes the breakdown anxiety. He states that the ego cannot organise itself against environmental failure, since dependence is a fact of life. During the period of absolute depen- dence, when the mother has a role of auxiliary ego, the baby does not yet separate the non-ego from the ego. For Winnicott, the anxiety of breakdown is related to the anxiety of a breakdown that has already been expe- rienced, it is the anxiety of original agony. And it appears in the form of different anxieties: return to a non-integrated state, mise en abyme, loss of psychosomatic collusion, depersonalisation, loss of sense of reality, and loss of the capacity of relating to objects. This collapse settles in because, at the moment of catastrophic experiences, the ego is still extremely immature and does not count with an environ- ment that might help in the process of integration. Going further along our course to understanding the primordial anxiety, we have the birth trauma—experience of a libidinal disequilib- rium derangement without an ego capable of taking care of that— and we have a metapsychologic understanding of this moment: an act of the first drive, the death drive, as capable of leading to that derangement. Let us now think about the loss of the object.

Primordial anxiety and the loss of the object

Still on this singular text, Freud will say that the primary anxiety of birth would be the separation from the mother. I would like to quote once again, since it is in Freud’s own writing that we find the clarity of his ideas: . . . anxiety is seen to be a product of the infant’s mental helplessness which is a natural counterpart of its biological helplessness. . . . just as the mother originally satisfied all the needs of the foetus through the apparatus of her own body, so now, after its birth, she continues to do so, although partly by other meas. There is much more continuity between intra-uterine life and the earliest infancy than the impressive caesura of the act of birth would have us believe. What happens is that the child’s biological situation as a foetus is replaced for it by a psychical object-relation to its mother. But we must not forget that during its intra-uterine life the mother was not an object for the foetus, and that at that time there were no objects at all. (Freud, 1926d, p. 138 (my italics)) 148 Luciane Falcão

Freud then describes two origins for anxiety: (1) one involuntary, automatic, that appears every time a situation of danger similar to birth is produced; and another (2) produced by the ego as soon as such a situation threatens to occur, in order to avoid it—here the ego submits itself to anxiety as an inoculation, subsiding to a slight attack of the disease in order to escape from its complete power; it is the signal anxiety. In addendum C of the 1926 text Anxiety, Pain and Mourning, Freud will again consider the issue of loss of object perception as the first determinant of anxiety, and the loss of the love from the object, that comes later and exists from the moment experience teaches the child that the object may be present but may also be upset with it: The traumatic situation of missing the mother differs in one important respect from the traumatic situation of birth. At birth no object existed and so no object could be missed. Anxiety was the only reaction that occurred. Since then repeated situations of satisfaction have created an object out of the mother; and this object, whenever the child infant feels a need, receives an intense cathexis which might be described as a ‘longing’ one. . . . Pain is thus the actual reaction to loss of object, while anxiety is the reac- tion to the danger which that loss entails and, by a further displacement, a reaction to the danger of the loss of object itself. (ibid., p. 170) In my opinion we have here one of the paramount moments of the theory, since Freud shows us the need for work that will allow the transformation of a vestige of something neutral—as he himself stated—into a mother object. This transformation is what will render possible the creation of what will become such an object. From the traumatic experience and the repetitions in the presence–absence rhythm there will exist possibilities for the psychic apparatus to create the representations of the object. There is here what we understand as specific action that creates meaning for the psyche. This specific action is the expression of Eros. This experience, of satisfac- tion and helplessness, will allow the birth of the other, a crucial element for the psychic work to create the representations. If drive is born from the body, in order to exist it also needs an encounter with the object, it is the intra-psychic and the inter-subjective at play (Green, 2002). We then have the specific action as creator and it needs the other to do the work. Primordial anxiety, drive, and the need for the progressive movement 149

But we must understand that it will not be one experience alone, one single moment of disequilibrium derangement that will be deci- sive but, instead, the repetitions of the model, that is, all the times the infant feels intensively the absence of the mother (while not consti- tuted as separate from it), every time movements are repeated away from tolerable rhythms, every time the haemorrhage of the libido occurs, and when traumatic experiences repeat themselves; we will then be able to talk of repetition of the traumatic model that constitutes the psychic helplessness.

Primordial anxiety, de-objectalising function, and self destruction

As we know, for the symbolic capacity to exist, biological experience has to be lived by means of the psyche. What was experienced by the body will have to cover a progressive movement (progrediente) that begins in the body, finding an object, passing by the barriers of the unconscious, pre-conscious, and conscious, and assuming a status of representation. We all agree that this would be the course to be covered when the conditions for psychic development are achieved. But what happened when this course is blocked? Which power blocks it? Which retrogressive movement will the psychic travel? Freud will say:

If it is true that—in some incredibly remote time and in a way we cannot imagine—life originated from inorganic matter, there- fore, according to our supposition, there must have aroused a drive that tried to eliminate life again and re-established the inor- ganic state. If we recognize in this drive the self-destructiveness of our hypothesis, we may consider self-destructiveness as an expression of death drive that has to be present in every vital process. (1933a, p. 133)

If, thinking as Freud, we understand that primordial anxiety has not covered a course to be transformed into a signal anxiety, it will remain as an experience equivalent to helplessness, suffering an action of death drive, which blocks the progrediente movement. I understand that, for Freud, death drive has at its origin an internal orientation, and it has to be deflected outwards in the form of an active aggres- sion, acting externally as a way of guaranteeing internal survival. 150 Luciane Falcão

At the same time, we may think that the failure of the movement or not-movement outwards turns it back inwards as a threat of mental destruction. André Green proposed a complement to Freudian ideas on destruction drive through his concept of the deobjectalising function, a concept that I consider basic for the understanding of the retrogressive movement, as well as the experience of primordial anxiety. To understand this idea of Green’s we must always include the issue of investments and the issues of life drives as well as death drives. He defines the latter in regard to the deobjectalising function, that is, in regard to the disinvestment of any structure that might have value as object. His core idea is that the ego cannot live away from the exchanges with the objects. This object is in a course that not only transforms the objects that exist as such, but rather adds the product of an object-creative evolution that then joins the earlier ones. This evolution constitutes the product of this movement of subjectivity, something that is reversed in deobjectalisation (Green, 2007b). At the same time, Green says that the deobjectalising function, due to its detachment, allows for the understanding that it is not only in rela- tion with the object that is attacked, but also all objectal substitutions: the ego, for instance, and the fact of investment itself, that has suffered the process of deobjectalisation (Green, 1984). For Green (2007b), the self destruction, as described by Freud, arises from the effects of the refusal to, or the impossibility of, leaving free room for erotic libidinal demand, where death drive is present by means of guilt conscience, masochism, and negative therapeu- tic reaction—states that are created by the effects of arresting the erotic life drive, implying a change of the references to pleasure in favour of another function to be satisfied: pain. Those three states (guilt conscience, masochism, and negative therapeutic reaction) are, in sequence, the first signs of the intervention of death drive and the prelude to the largest devastations, carriers of self-destruc- tive obsession. Probably Freud would say: the trends towards re-establishing an earlier state. For André Green, here a differentiation must be stated not only in regard to pleasure, but also in regard to the evolution of the drive activity that will allow for Primordial anxiety, drive, and the need for the progressive movement 151

. . . the transformation of functions into objects, suffering a change that no longer connects the object to its primary qualities (object of the drive), but being a destination of the drive, in which evolutionary transformations will have as a goal not only to trans- form the patrimony of drives—by means of sublimation, for instance—, but proceed into a definitive mutation that will stiffen the many possessions of the ego, by the failure of the processes that will allow it to climb to an independent object state. (Green, 2007b, p. 61)

Green states that “deobjectalising is to proceed with an action that causes evolution of drives to lose what in it is apt to deal with the most singularizing characteristics of the objects” (ibid, p. 62). Green draws a parallel between this idea and Freud’s hypothesis in Beyond the Pleasure Principle (1920g), where he grants death drive the role of being the first drive which aims at the destruction of the first invest- ments of the object. In 1924, in “The economic problem of masochism”, Freud mentions that another part (a part of death drive) does not partici- pate in an outwards movement, but rather it remains in the body, and there it is libidinally connected to the encouragement of sexual co-excitement. It is in it that we recognise the original erogenous masochism.

Primordial anxiety and the extinctive regressiveness (regrediente)/signal anxiety and the progrediente movement

As we have seen, Freud has demonstrated that primordial anxiety is what floods the subject preventing its psychic development. Bernard Chervet (2008) dedicated himself to the study of the metapsychology of the après-coup1 (also mentioned by Freud in the 1926 text) and talked about the extinctive regressiveness that, in my opinion, is crucial for the understanding of primordial anxiety. Extinctive regressiveness is the drive trend towards going back to a previous state (be it by returning to the inorganic by means of death drive, or due to an extension to the infinite by Eros)—it is the orig- inal and endogenous traumatic source that the mechanism of après- coup must treat in a mandatory way. The capacity of the psychic apparatus for treating this silent drive shock passes by its capacity of 152 Luciane Falcão transforming this shock into perceptive data constructed in the psyche. Without this metamorphosis, it would remain in a state of non- transformable faults. Such transformation is essential. Without it, the psychic apparatus would remain trapped in the experience of an anxiety beyond the pleasure principle—I believe this idea has its origin in what Freud (1920g) called automatic anxiety and what I relate to primordial anxiety. Therefore, there is a need for a second time composed by the need for the production of a progredient material. The role of this second time is anti-traumatic in the sense of making the apparatus progress towards the access to quality (affect or thing representa- tion). This processual imperative has the mission of removing psychic activity away from the primordial anxiety in order to give it life. The access to traumatic quality itself is done by the transposition of the silent internal threats over the situations of danger, which would generate a detectable anxiety, the signal anxiety. This is how gender differences and the murder of the father appear among the lever- ages of the action of this processual imperative (Falcão, 2009; Kahn, 2009). The extinctive regressiveness–processual imperative dyad is totally embedded in the shades of Freudian dialectics. If there is a trend towards negativeness—extinctive regressiveness—there will be another one—processual imperative—which sustains existence. Thus, the processual imperative obliges the trend to inscribe psychically what tends to disappear. The notion of fractualité (Chervet, 2008) appears here and it has to do with the progredient movement and the psychic process. This fractualité highlights the procedure which is not linear; where there is a fracture at the same time it contains an idea of the similar. We then see that the extinctive regressiveness/proces- sual imperative dyad lays the foundations for the process of après-coup. Here, the ideas of Chervet are crucial. We need them to work with our patients when they are submerged in the deadly drive- world. By means of transference, we will be experienced as objects that will tend, in their experiences of the psyche, to deobjectalise by repetition, by extinctive regressiveness. How then are we going to perform our difficult task as analysts? How should we deal with our primordial anxiety? I understand that we must include the well known ideas of Bion on maternal reverie (Bion, 1962), of the work on the Primordial anxiety, drive, and the need for the progressive movement 153 negative by Green (Green, 1993), of Private Madness (Green, 1990a), and of the work as a double and of psychic figurability (Botella & Botella, 2001) all of which are fundamental. And I understand that if regres- siveness is void, it will be during the session that the possibility of any excitement will exist. The mixture of regression and excitement that occurs during analytical sessions is capable of creating something through the other, in this case, the analyst. The body of the analyst is also called into this process, who will also have to put into words what could have been silent. Often the analyst will have to launch, inaugu- rate, or create a language when the patient does not have one. In constructing this work there will also be the need for a game (in the Winnicotian sense (1965, 1968, 1969, 1971)) of representations, that is, the need for these representations to interplay amongst themselves and have a functional value (Falcão, 2008). There is the need for linking, for what is possible to be exchanged, for what is allowed to be exchanged, and that has to do with the drive-worlds of the analyst and of the patient. There is something there that allows us to access the movement that passed through the unconscious and can also pass through the body of the analyst. For this game to occur, we have to understand that regression will take place there—within a con- tinuity—that may catch both players, both protagonists of this process: the analyst as well as the patient. The transformation is, therefore, much more complex than we may think. We are here thinking of the progrediente movement cradled by Eros. But when Eros effaces, we will see the action of death drive appearing. Such action will follow the retrogressive movement, or, as Chervet said, will cause the extinctive regressiveness (Chervet, 2008; Falcão, 2009). I believe that in this course there is the need for the presence of Eros, as well as the need for transformation to become a fundamental psychic being. In other situations there are moments comparable to an explosion in the body, with no psychic meaning (I would compare them to nonsens as Green speaks of it). Depending on the intensity, the ingredients of this explosion may become psychic or not. They may remain with no significance (it is the failure of representation without the symbolic). If there is psychisation there will be a work- ing-through that may become stronger and more lively and that will allow for a regression as well as an excitement. This is the material we work with in our offices. 154 Luciane Falcão

Note

1. Nachträglichkeit is the noun for the unconscious psychic process. Nachträglich, après-coup, adverb of temporality, has its place in Freud’s ques- tions on aetiology and introduces the discontinuous temporal notion of return. From 1917 on, Freud abandons the use of the noun Nachträglichkeit (porter vers avant, a posteriori), that he had coined in 1897 (letter to Fliess n 146 on Nov 14, 1897, and letter no. 169 from June 9, 1898 (Freud, 1895)) since he recognises the value of regressiveness in the process of après-coup. 5

Clarifications and comments on Inhibitions, Symptoms and Anxiety from a Lacanian perspective

Leonardo Peskin

Up to now we have been living in anxiety, now we are going to live in hope

Tristan Bernard, the day he was arrested to be taken to the camp in Danzig, cited in Lacan (1953, p. 477, free translation)

Introduction

Inhibitions, Symptoms and Anxiety is a text written by Sigmund Freud (1926d) in the maturity of his thought. This involves a series of theo- retical reconsiderations that are embodied in this work with the typi- cal Freudian style of giving “a new twist” on old ideas, enriched with new proposals without abandoning those that came before. Some of the themes reformulated in this book are: the two theo- ries of anxiety, both topical, the introduction of narcissism as a new concept of ego, different theories about the drives, the theoretical system of resistances in relation to the psychic models, and, in particular, the three clinical dimensions in the title: inhibitions, symptoms, and anxiety.

155 156 Leonardo Peskin

I will outline some of the main points of the text guided by the Jacques Lacan’s proposals, who has the greatest merit of having promoted the return to Freud’s work, reviewing it while formulating his own productions, both in the Seminars he gave and in his Écrits (1966–1967) over more than forty years. With his interest he pro- moted the French translation of Freud’s work and the creation of valuable essays and dictionaries about Freudian terms and concepts, such as Laplanche and Pontalis (1967), which remains an important reference. He also made a detailed examination and criticism of Freud’s case histories that form the foundation of the Lacanian clinic, which is based in a nosographic sense on Freudian categories—neurosis, perversion, and psychosis—as the basic entities. Clearly there is a universe of clinical presentations that exceed the nosography and in which psychoanalysis has made progress, trying to address them. However, these advances in Lacan’s ideas do not lose sight of the Freudian horizon at any time, although several proposals appear to go beyond that limit. He also stressed the role of desire, drive, trans- ference, repetition, and the unconscious itself. Always reviewing and respecting Freud’s claims, but reinterpreting them in light of his own categories, which try to lead psychoanalysis closer to other disciplines such as philosophy, linguistics, mathematics, and others, reopening the epistemological debate whether or not psychoanalysis is a science or if it is a practice. Lacan starts with a metapsychological concept based on what he calls the three registers: the Imaginary, the Symbolic, and the Real. While we see them appear at the beginning of his work, he progres- sively emphasises and expands their qualities. This differentiates historical moments where the emphasis is placed on each of these parameters; however, they can be thought of only as coexisting, and all human phenomenon should be considered from these three per- spectives. When we apply these registers to the reading, it becomes apparent how they interplay, interdefine, and limit each other. The Imaginary is in a certain sense a synonym of psyche, as the very basis of the beginning of psychic functioning. Without the imag- inary operative, no reality can be built, and when its function is altered significantly we find the “clinic of emptiness”; the absence of affection and of the notion of existence. This of course happens in more severe illnesses, such as psychoses, autism, or melancholy. And where this dynamic is most evident is in the infans (without language). Clarifications and comments from a Lacanian perspective 157

The ego (moi) for Lacan is mainly imaginary, but it is worth noting that such a register exceeds the case of the ego. The ego is config- ured as it springs forward as an imago, linked from the beginning with the drive as Real, and the beginning operative of the Symbolic supported by the speech of parents and culture, that holds the configuration of that ego. Let us not forget that the “new psychic act” of Sigmund Freud’s (1914c) “On narcissism: an introduction”. The ego believes that “it is” in the specular image1 that is created; it is an incorrect shape that it believes itself to be and to be able to do from this idealisation of itself. Whenever the ego operates, it does so with its reflection in an other that accompanies it. It is continuously in an other (maternal) as the baby is seen and wants to be seen; if this is lacking, it feels, in a very disturbing manner, that it has disappeared. What would make it possible to endure beyond this alienation in the other is no longer part of this register, it requires from the Symbolic that, when operating, it symbolises and conceives an absence and an eventual recovery. Let us remember the reel game in the famous Freudian “fort/da” (Freud, 1920g). “Fort/da” would be the signifiers from which the subject can be constructed, the absence may be nomi- nated, and it can be played with. The paradox is playing a role in that game, which Freud highlights; in this paradox, starting with this conquest, absence is sought more than presence. This brings us to Beyond the Pleasure Principle (Freud, 1920g). When we refer to the Real later, we will add something more about this important paradox that revolutionises Freudian thought as it introduces Thanatos to the scene. It is clear that this description of the ego is related to what Freud proposes in relation to narcissism: the ideal ego and the pleasure ego (Freud 1914c, 1915c); including the relationship that narcissism has with death, by being so directly linked to the drive and search for a full release. For Lacan this is the only form of functioning for the ego and raises it as an instance of ignorance and denial; he does not consider it as a dependable ally in the analytic task. Nevertheless, it is quite evident that it is unavoidable in any description and clinical approach of any human production. In view of this difficulty of completion of the image of the ego, phenomena of aggression appear and any experience of frustration is ascribed to this style. This is how many clinical events of aggression, which should not be 158 Leonardo Peskin confused with violence or hatred because they have other roots, are conceived. This order of aggression is not related clinically to the death instinct or a desire of destruction, which corresponds to other registers. They cannot always be separated, but in clinical ego, aggression is passionate and fleeting. Hatred requires organisation supported by a symbolic desire and, when it comes to the drive in its thanatic aspect, it can have sinister muteness of direct damage, or the unrelenting violence such as are found in some psychosomatic conditions, or destruction of an other or of him- or herself, as s/he operates in the passage to the melancholic act of suicide or paranoid homicide. The Symbolic is based on the organisation of language that assists the human during situations of radical lack of instinct. Language as symbolic organisation comes from what Lacan called the Other (in capital letters, “Big Other”) to distinguish it from the other (lower case, “small other”), which is imaginary. The symbolic universe where the human is set up stands in for the lack of possibilities for adaptation and survival that the species has. The unconscious is seen as the way in which this Other crosses everything to become a subject. The so-called Name-of-the-Father is a product of the pater- nal function as the orderer of the signifier and repression; its absence, called foreclosure, determines the psychosis by not being able to stabilise the subject in relation to the signifier, since it cannot find a place in the Other. Subject is a fundamental theoretical name that characterises the symbolic realisation of the human as subject of the unconscious. This unconscious is a symbolic–imaginary organisation closely related to the structure of language. The unconscious itself would be struc- tured as a language and consisting essentially of signifiers. The Real as the third register is that which is neither Symbolic nor Imaginary, highly connected to the drive and particularly with the proposal: that the drive would seek as its theoretical invention called “objet petit a”. In the Freudian categories, we would be working with the object of the drive and the way it operates to cause the desire, depending on how the Symbolic, the signifier, responds to the push of the drive. For this reason, one of the definitions of “objet petit a” is being the cause of desire. With these complex parameters merely outlined, let us say that anxiety is considered a primordial affection or emotion linked to the Clarifications and comments from a Lacanian perspective 159 direct actualisation of the Real, without Symbolic–Imaginary attenu- ation. The rest of the affections and emotions result from the posi- tions that the subject adopts within the symbolic branch in comparison to the real of the drive. The ego provides an emotional imaginary version of the facts. It is the sensitive emotional pole, both for experiencing anxiety as a psychological manifestation, and to be happy, sad, moody, angry, or other emotions, according to how the subject manages to compose its symbolic location against the desire and/or the drive. From this we deduce the different psychic agencies as: the ego as an emerging imaginary, that is different from the subject that mirrors the operative of the unconscious as a symbolic support, and the drive, connected to the Real, that would regulate the psychological reaction in any experience. Repression is a founding aspect of the unconscious and the symbolic mechanism princeps (most important); it would derive from the possibility of symbolisation as the Oedipus complex is resolved. The constitution of the subject and all degrees of otherness, symbolic and imaginary, are the balance of how these three registers were resolved and the respective theoretical and clinical instances: the subject, the symptom, the phallus, the “objet petit a”, and others, are some characteristics of these configurations, which I will mention. In Seminar X, ‘Anxiety’, Lacan (1962–1963) ordered axes inside a box that serves to theorise the possible subjective locations in relation to the drive, particularly in relation to the “objet petit a”. Anxiety occurs when this drive object is present (see Figure 1).

Peskin (2008a, p. 182). This graph takes concepts from Jacques Lacan’s Seminars X (1962), XIV (1966), and XV (1967). It describes the diagonal of transference and places the “objet petit a”. 160 Leonardo Peskin

As the subject moves away from anxiety and, depending on how it acts, actions appear, alternatives of other emotions or symptoms and inhibitions. In this system, anxiety is the closest to the Real, this is an “intol- erable” position for the ego and the subject, they will find an outcome by way of actions or the formation of symptoms. And further from anxiety, depending on how it is located, other feelings or emotions and the “quietness” of inhibition appear. Note that transference, which is linked to the analyst’s position at the clinic, refers to the “objet petit a” and anxiety, therefore the analy- sis should raise a certain amount of anxiety. Acting out and passage to the act deserve a separate chapter. Lacan directly links them to anxiety, with two outlets seeking relief from the urgency of the drive by way of motion. Acting out is quali- fied as a staging of “unconscious thought” and the passage to act as alienation in the id. They are significant clinical alternatives because they complicate the transference direction and yet would be expected, to some extent, in every treatment. The analysis always involves transference in the analyst, but the ideal conditions of subjectivity that avoid these off axis transferences are not always provided. The axis of the transference as shown in the graph goes from the repetition and emphasis of the Real, to the sublimation as a way out through symbolic transference treatment. Let us consider that acting out and passage to act divert that way, as well as, in some cases, threatening the analysand. With these guidelines I will comment on Freud’s text. The Roman numerals of the following headings are those of the sections in Inhibitions, Symptoms and Anxiety.

I

Sigmund Freud raises the inhibition and avoidance of conflict by the ego. From the Lacan’s perspective, the ego would not be the central character but rather a reflection of subjective alienation of the cause that makes up the drive, because this causes anxiety. The ego attitude before the structural consequence would be the denial of the conflict, but the dynamics of withdrawal or avoidance is intended more as an intensification of repression by symbolic operations; this makes the Clarifications and comments from a Lacanian perspective 161 formation of the subject farther from the drive or desire. The ego could join this distance by “becoming disinterested” in that psychic operation. It is evident that the central role of the ego, for Lacan, is always secondary to the solution achieved by the symbolic device. It is not that the ego has no influence, because it is what suffers the anxiety, but it would not have its own resources to cause structural changes. What is theorised in Lacan is that the operation is significant, which is how the unconscious works, and produces changing mean- ings as it is organised in such a way. The result is that what is inter- esting is how the signifiers are articulated to produce a meaning.

II

In the second chapter, Freud returns to the relationships between anxiety and repression. There he suggests: “the ego is the actual seat of anxiety” (Freud, 1926d, p. 93). For Lacan, repression is what establishes the possibility of psychic functioning in what he called the significance of the phallus. This means that the primordial categories of absence and presence were established as a condition of access to symbolisation. He fol- lows the Freudian ideas in which admitting to having or losing the phallus in the resolution of the castration complex is the foundation of all other symbolic operations. Without that primordial signi- ficance, nothing could be given up on and desire could not be constructed. One aphorism associated with the appearance of anxiety in neurosis is that this is present when “lacking is lacking”, as it is a structural requirement that has a lack and if it is not perceived, it interrupts the real as something where nothing is lacking and that is monstrous. A clinical example is the maternal excess in anorexia, which is crippling as it does not give place for the desire of the child because she is not desiring but driven in her ways. Lacan will say that anorexia is the desire “to eat nothing”.2 We return to the need for a paternal operative as one that limits the maternal excess. As for the idea that anxiety is an inherited pre-existing state and activated by the current circumstances, this would be considered as though the register of the Real always pre-exists, that always exists as 162 Leonardo Peskin a dimension to be resolved. The Real that overflows the symbolic– imaginary possibilities from the very origin of the subject, was shown both in the subject’s history from its birth as well as in the origins of the culture; it is placed as the thing that lurks or returns as disturb- ing untamed. It would be a way of understanding one aspect of Freudian protofantasies by thinking of their biological genetic source as a predisposition, given the biological feature of absence of instinct; then a task will always be left to be resolved, in every culture and every individual, which is that of ordering a reality that limits and conceals reality and the Real of the gap. Any form of anxiety would be the “imaginary face of the Real” (Peskin, 1988). Freud places anxiety before the formation of the superego; it is also interesting that he gives it a relative value in the dynamics of repression. This is significant in terms of locating anxiety and repres- sion as a fact of structure, in particular the primordial repression, independent of the formations of the second topic; these would operate in relation to both anxiety and repression, but could be considered as autonomous, as proposed by Lacan.

III

In this chapter, the symptom is considered as something that does not belong, a product that must be resolved. Since the ego and the id are both described as the same strain—and to some extent in this order we could place the superego in this range—the differential nature of the symptom could be considered in relation to these other categories. One way of thinking is that the symptom is a subjective net production derived from the unconscious meaning. This means that we see the intersection between the two topics, as Freud himself outlined in the 31st Conference: “The decomposition of the psychic personality” (1933a). The ego, id, and superego as an approach to narcissistic organisation, at an intersection with the impact of the symbolic Other that is culture, the source of repression. The ego as we anticipated is the psychic function in imaginary form trying to resolve the onslaughts from reality, the id which is the real of the drive and the superego as the balance of these arrangements or disorders. But what addresses the possibility of this meeting between the drive of the body and emerging psyche is the Clarifications and comments from a Lacanian perspective 163 assumption of the symbolic codes on the basis of primordial repres- sion. The complexity is not easy to reduce to its different compo- nents, because they interplay and interdefine, setting up a dialectic of multiple elements, from different origins and rules of operation. Some of these combinations have a previous logic state and this step determines that other elements appear that did not previously appear. For example, the superego is mixed derivative, whose sources are the id as Real, that can be defined only when the uncon- scious operates from primal repression. When operating, repression becomes the Law that is the symbolic order and this Law interplays with the installation of the ideal of the ego by transformation of the ideal ego. The superego then ends up being made up of the Real of the drive (“objet petit a”), the Symbolic with the very particular way it took in the Law (Law meaningless for being partial), and the ideal of the ego as the imaginary guide that spurs the ego to follow it passion- ately. The superego would have a very conflictive make-up that is configured with everything unresolved, which as partial tendencies tug at the ego and propose outlets that in the best cases are neurotic and in others, such as melancholy, are psychotic, or even “pure culture of the death drive” (Freud, 1923b). As for the symptom, even though we need to solve it, as it is intended as an expression of subjectivity, the idea arises that it is in its transformation that the changes achieved are observed. At the start of analysis, the symptom is installed in the transference and it is in that line that it is possible to operate in the subject’s relationship with desire, repression, and drive, to the extent that transference is defined as “the enactment of the reality of the unconscious” (Lacan, 1964). The expectation is that in the course of analysis a transforma- tion of the symptom is going to be reached and there emerges a new concept: the Sinthome (Lacan, 1975–1976). Very briefly, this would be that the subject takes the symptom, identifies him- or herself by accepting it but having transformed it so that it is no longer refrac- tory, inconsistent, and ego-dystonic. Rather, it would become a new instrument of conflict between the trends that originated it in the service of the possibility of a change in the reality where the sub- ject lives, thus leading to sublimation from this new “creation” that the analysis promoted, or generally a subject, overcoming the conflict, even without analysis. The most classic examples become artistic productions, but may be inventions that a subject finds so 164 Leonardo Peskin that their conflict addresses some solution embedded in the reality he/she inhabits. This is how the symptom is transformed into a Sinthome.

IV

In this chapter Freud raises two paradigmatic cases of phobia, Little Hans and the Wolf Man. Here, for the same symptoms and similar treatment of anxiety, there is a very different clinical make-up. The first theory of anxiety arising from the impediment of “driving” excitement (current neurosis) or the unresolved drive (automatic anxiety, anxiety neurosis, hypochondria) are still possible, although there is a strong emphasis on the second theory, of signal anxiety subject to castration. I shall synthesise the position that the subject assumes the symbolic perspective to process its sexuation. The subject is consti- tuted as another signifier within the symbolic chain of signifiers in the Other. It is thus positioned in relation to a series of theoretical elements, including the phallic, that are to be put into play to define its sexual orientation. We must emphasise that this definition is made in the interplay of the narcissistic axis that includes the ego, the ideal, and the drive (“objet petit a”) interlaced with the symbolic chain that is ordered based on the signifier of the Name-of-the-Father. This makes the subject approach identification within an alternative as a man or woman, regardless of their biological condition, and placing as phallic or other object of desire of other that plays this attribution. These optional places lead it to play the rest of the masquerade, but the determinant of those positions has more to do with the choice of object and orientation of jouissance. These relativities make it so that homosexuality as an alternative is not itself a structure, but as Lacan says, the way the speaker is located in one or another position within the logical alternatives, regardless of their biological condition (Lacan, 1972–1973). Later we will see the symbolic–imaginary oper- ations resulting from this clearly unconscious choice. This would be the way that castration, understood as a sym- bolic operation, at the same time as it promotes the founding repressive bar of the unconscious, sets the rules about male–female difference. Clarifications and comments from a Lacanian perspective 165

V

As for the symptom, it is an attempt at a symbolic arrangement to compensate for the failure of repression and this arrangement involves the ego as an imaginary substitution against symbolic fail- ure. If the subject emerges as obsessive, it is in this arrangement that desire is suggested as something that is impossible to be realised, yet it is still sustained through a mechanism that Lacan ranks as procras- tination. And the ego attempts to hold as being able to appear to resolve this conflict, at the expense of showing a certain concealing poise. In short, the obsessive, with “beautiful words” of the ego, justi- fies the postponement as a way of saying that the “desire is impossi- ble”, yet has neurotic, anal pleasure for the control of the situation. Thus the progressive restriction of the ego can be understood at the service of the symptomatic increase, where the primary benefit obtains the maximum gain. In the prominent role of the superego, highlighted in other articles by Freud, we see that what is being enjoyed is the drive via the superego, instead of the subject or the ego (Freud, 1915c). The term “jouissance” is one that Lacan uses in relation to usufruct, power, or dominance. If this is governed by the drive, it is different than if it reaches the desire or other degrees of symbolism, so a plurality of jouissances is proposed. Jouissance is inconsistent with or independent from pleasure; in its “pure” forms it would be the expression of the drive in its Thanatos aspect, by being tied to the symbolic–imaginary it is involved in all forms of human production.

VI

There is a different central role of the ego in different clinical enti- ties, such as in obsessive syndromes the ego is an active concealer, offering itself to appear to compose something that has no genuine fix due to the lack of symbolic resources, as the ego is purely imagi- nary. The symbolic failure refers to some degree of repressive inef- fectiveness of the paternal function in the neuroses. All neuroses would be characterised by that failure in the Name-of-the-Father function as orderer and modulator of the operation of the subject, however, in each syndrome, the mode of the failure and the solution 166 Leonardo Peskin for the establishment of the subject are different. In the obsessive, the ego presents itself as very involved essentially in a parody of rationalisations that give the impression of something symbolic whose purpose is to an imaginary disguise. In hysteria, the ego seeks to weaken as a strategy of passivity, as a different mode of removing itself from the responsibility in the face of its inability to resolve the conflict. In the obsessive, we see an eventual paralysis of the ego, as emphasised by Freud, but by excess of rumination with no way out, giving the appearance of dealing greatly with resolving a conflict that it does not resolve. In hysteria, paralysis is in the form of the belle indiférence or a passivity acting out as overacting of suffering, or any way that it manages to mask the absence of a solution. This approach later changes in Lacan; the ego continues to be only one narcissistic imaginary instance, but it takes on the value of possible substitution of symbolic functions, especially for the impor- tance of acquiring the imaginary in general to offset what it cannot solve symbolically. On the other hand, as we shall see also in Freud, he states that the conflict not only depends on the symbolic uncon- scious instances, but also on the qualities and relative intensities of the id. This will end up being thought of by Lacan as forms of knotting of the three registers, considering that each one has its own impor- tance and prominence. Thus in this form the point of theoretical overvaluation is no longer the symbolic, as it had been in an earlier period.

VII

Here he raises what would be a situation of danger and its relation to the loss of object and castration. Anxiety presents a facet related to the traumatic interruption of the Real, which could be an objective traumatic event like the trauma of birth. But also in Freud’s think- ing, the drive is traumatic itself, since it haunts the ego, which is unable to run away. This pressure without any original meaning takes on significance in so far as it becomes part of the psychic appa- ratus by activating desires. The symbolic system gives different meanings to the onslaught of drives, as it is introduced at different times in the constitution of the subject. The oral, anal, gaze, voice, or Clarifications and comments from a Lacanian perspective 167 combinations thereof will be the forms that can reach as having phal- lic meaning as this meaning is established through the Oedipal tran- sit. Anxiety serves as witness to the trauma and simultaneously is a sign of the transformations that seek to resolve the destination of the drive. Anxiety is part of the different categories of potential meaning in the series of risks of losses as a background to what ends up as castra- tion anxiety. The meaning given by the ego goes from the fear of psychological helplessness, then the loss of the object or love of the object, to castration anxiety when it is located and in the phallic meaning. What would overcome the series of anxieties in the subject that succeeded in resolving the neurosis would be the “trial of condemnation”. Lacan ranks the phallic theme, radically decoupling the phallus from the penis. The phallic is a conceivable value to the extent that the symbolic is installed, and that value is attributed to that which would provide pleasure for the wonderful and illusory completion of the narcissistic image. He introduces it by attaching the name agalma, taken from the Greeks, to locate in a certain place the idealised object that would fill the ego and refers to the phallic mean- ing in the imaginary plane. In particular he considers it in the ideal- isation of the analyst in the transference. That agalmatic shine lights up the object of the drive, “objet petit a”, which would be the same object, without the symbolic–imaginary veiling, that would arouse anxiety. The phallic signifier is what governs the scope of the imagi- nary slip as to what that value is given; it is a symbolic operator like the Name-of-the-Father or the concept of Freudian Law. This symbolic element would regulate the limits by avoiding exaltations of mania or the complete disappearance of this agalmatic object in melancholy. The importance of this symbolic orderer is that it manages to provide stability to the ego, from being able to place the object of the drive (“objet petit a”) under repression. Then the “objet petit a” operates as a cause of desire and not as a disturbing object. If the drive succeeds in being led by the “ravine of the signifier”, that is, repression operating in an appropriate manner, it is expressed by means of the desire, and if this is legislated, it may be a driver for the acts carried out without extreme conflicts. When this path is com- plicated by problems in the interplay of the drive with adequate repression, the superego emerges as an epiphenomenon that, while 168 Leonardo Peskin intended to order, ends up more at the service of complicating and martyring. It is a regressive figure that can be qualified as “perverse Name-of-the-Father” (Glasman, 1983), as an individual failure of the Name-of-the-Father that does not neutralise the development of the superego. Perversion is theorised as the mode of subjectivity where the imaginary creates values at the expense of the denial, authorising paths of satisfaction that are prohibited in the neurotic. We empha- sise that we call the superego perverse, not necessarily the subject who is sadistically treated by this instance. Let us also say that sadism is the mode of paradigmatic perversion for Lacan, as it seeks to take over the role of “objet petit a” to make a martyr of the other. After he would say masochism is more paradigmatic than sadism for this purpose. Lacan proposes to cross the Freudian “bedrock” of castration anxiety trying to bring the subject’s relation to the drive beyond the limitations that the configuration of the Name-of-the Father has established. This is generally seen as going beyond the Father. This proposal is different from that posed by Freud in “Analysis terminable and interminable” (Freud, 1937c).

VIII

At this point Freud “sexes” anxiety in the case of women, “loss of love plays much the same part in hysteria as the threat of castration does in phobias and fear of super-ego in obsessional neurosis” (1926d, p. 143). The castration complex is very different in men and women and must be disengaged from the biological condition, men and women, posing it as male–female in speaking beings, regardless of biological sex (see Section IV). He does not differentiate between anxiety as a signal and the objective danger of the subjective, and this led Freud to formulate that anxiety does not guide the subject properly in terms of reality (Freud, 1917e), especially the neurotic. It is a signal related to the way that the subject’s fantasies were built, in some way related to more universal fantasies of that culture. The concept of fantasy is emphasised by Lacan, which is nor- mally referred to as fantasy3, to refer to the distance that the subject keeps with the object of the drive (“objet petit a”). By being able to enshrine this object in the fantasy, the object can be expressed in a Clarifications and comments from a Lacanian perspective 169 way that is liable to be conceived by the subject, adapting it to a symbolic–imaginary character related to desire. We can say that human reality is organised with the logical rules of fantasme, insofar as it is built to monitor the Real of these objects that are included in that reality. The subject would approach and move away in one continuous motion by being linked with the drive, in a coming and going that would achieve a relationship not too close or too far from what it determines. This can be stabilised to the extent that it medi- ates the symbolic order, through the unconscious; when this does not happen, the subject gets too close to the drive (anxiety, bodily expressions, grief, hypochondria, melancholy, and others) or too far (manic experiences, feelings of unreality, feelings of loss of sense, among others). To some extent in the course of analysis, effects are sought for altering the relationship the subject has with the “object”, this is called “vacillation of the fantasy”. It is assumed that during the analysis, the logic of that relationship is deciphered or built and this is called “traversing the fantasy”. This gives rise to a logical construct that is grammatical in nature, the way to “A child is being beaten” (Freud, 1919e), which places the subject in an action in relation to its objects and, depending on how it is configured: it can be oral, anal, scopophilic, etc.

IX

By locating the symptom as a substitutive formation, Freud opens the possibility to categorise it as a metaphor. Lacan takes the metaphor of Linguistics and makes it interplay with metonymy, and so he named respectively the Freudian condensation and slipping. Metaphor is substitution, a signifier for another (word for word) and metonymy is the part for the whole (word by word). Repression as a system is based metaphorically, as the metaphor of the Name-of-the- Father replaces the Desire of the Mother. It is in this understanding that the resolution of Oedipus that the nomination as symbolic signi- fier operation replaces what had been defined as the Thing (Peskin, 2001), as the lost object that will continue to exist as the cause of desire. Both sides of the symptom that Freud describes would refer to the fact that the “objet petit a” is held under repression by the symp- tom, managing to extract the ego from the anxiety thanks to the 170 Leonardo Peskin symbolic solution of the symptom that reinforces the repression that had failed at its moment. But just as it is described, what is repressed is seen by us as distorted. The symptom is part of a discourse, in which the clinical entities are defined: phobia as “prevented desire”, hysteria as “unsatisfied desire”, obsessive neurosis as “impossible desire”, perversion as “apparent willingness of enjoyment”, and psychosis as “push for the woman” (understanding this as a wordless pleasure that delirium tries to fence in). All these modes will be evident in the words of the subject, in its symptoms, unconscious productions, and associations.

X

This chapter introduces repetition as a tendency for the drive to Thanatos. In a first approach, Lacan (1955–1956) defines repetition as repetitive qualities of the symbolic apparatus, drawing on de Clérambault who described the so-called “mental automatism” as a tendency to repeat the automatic repetitive operation of the symbolic apparatus. This is relatable to the automatism mentioned by Freud. Later it is referred to the insistence of the Real “which continues to not register”. As for the quantitative factor, rather than being accepted as objective force in the form of physics, is proposed as a logical interplay of factors within the hypothesis of knotting of the three registers. In that regard, the complementary series and cogni- tive restructuring are highlighted as important concepts for under- standing facts.

XI

Freud says: “Anxiety [Angst] has an unmistakable relation to expecta- tion: it is anxiety about something. It has a quality of indefiniteness and lack of object.” (1926d, pp. 164–165, italics in original). Post-Freudians tend to emphasise this “absence of an object”; Lacan on the other hand will focus on “in the face of something” as the presence of the “objet petit a”. The anxiety produced by the disappearance of the current object of reality refers to the fact that the drive is present in that place and Clarifications and comments from a Lacanian perspective 171 it ‘calls for’ the symbolic-imaginary presence of what is lost. In so far as what was lost is taken on, sadness sets in and the pain brought on by the work of grief. In the years 1958–1959, Lacan stated:

In other words, the hole in the Real, caused by a real loss, this kind of loss that is intolerable for humans that causes, in mourn- ing, that hole in the Real, is found, for the same function, in this relationship that is the inverse of the one that I promote before you under the name of Verwerfung. (Unpublished)

On mourning, a specific development could be made that exceeds the limits of this comment, but briefly it would centre around doing an unconscious work of circumscribing the hole that opens into the real through the symbolic creation of a failure. It is very important that it characterises what the function of the subject was in relation to what was lost. In particular, if the mourning is in regards a death, what signified the subject had in mourning as “objet petit a” for what is no longer there.

Notes

1. Lacan draws on the experiences of Henry Wallon (1965) who describes the specular phenomena in young children. 2. Lacan (1956–1957), Seminar IV, Class 11, “is not about not eating, but not eating anything, which means eating nothing.” 3. In French, “fantasme” corresponds to the English “fantasy”. Lacan uses the term to refer to both “fantasy” in its colloquial use, and to designate the Freudian concept of fantasy, as well as to name the new notion of “fundamen- tal fantasy”, which he describes with a grammatical logic. Usually when he says fantasme it is refers to the latter meaning. 6

Psychoanalytic theory of anxiety: proposals for reconsideration

Edward Nersessian

It is important to keep in mind that from its inception, psycho- analytic theory has been about unconscious conflict. From early on, in Studies in Hysteria (1895d), Freud writes, “The patient’s ego had been approached by an idea which proved incompatible, which provoked on the part of the ego a repelling force of which the purpose was defence against the incompatible idea.” While his understanding of the adversaries involved in conflict changed, and he repeatedly modified the concept of anxiety, psychic conflict remained the central most important element of Freud’s theory. Similarly, the proposition that a symptom is the outcome of a strug- gle between opposing urges and the establishment of a compromise dates back to the early days of Freud’s discoveries. By 1900, with the publication of The Interpretation of Dreams (1900a), he essentially laid the foundations of a theory based on conflict, defence, and compro- mise, using dreams as a template for all mental functioning. Even as he tried to understand and explain the data from his consulting room, Freud remained preoccupied with the larger epis- temological questions of the functional relationship between the mind and the brain. His papers on metapsychology were his last attempt to create an overarching theory that would explain the basic

172 Psychoanalytic theory of anxiety: proposals for reconsideration 173 workings of the mind and brain, including such fundamental prop- erties as perception, consciousness, and memory. At the time, however, there was insufficient knowledge about the workings of the brain, and his project could not be successfully pursued. Instead, he abandoned this effort and in 1923, with the publication of The Ego and the Id (1923b), shifted his focus exclusively to the functions and structure of the mind. In order to untether the mind from the brain, he created a virtual model of the mind with a tripartite structure which he labelled the id, ego, and superego. By creating this virtual apparatus, Freud found a way to study all aspects of mentation and freed himself from any reliance on the neuroscience of his day which was inadequate to explain his find- ings. Since he began with a theory of unconscious conflict, however, the new apparatus had to be designed to provide a virtual explana- tory model for a mind in conflict. This theory was designed to explain not only symptoms, but also character traits, pathology, and normality, and it has persisted with well-known elaborations, expla- nations, and modifications for nearly ninety years. This is how Freud described it in the summer of 1938:

We assume that mental life is the function of an apparatus to which we ascribe the characteristics of being extended in space and of being made up of several portions—which we imagine, that is, as resembling a telescope or microscope or something of the kind. We have arrived at our knowledge of this psychical apparatus by studying the individual development of human beings. To the oldest of these psychical provinces or agencies we give the name of id etc. (Freud, 1940a[1938])

Following the publication of the Ego and the Id, and especially after Freud’s death, much of the focus was on the ego, with Anna Freud’s Mechanisms of Defense (A. Freud, 1966), Waelder’s “Principle of multi- ple function” (Waelder, 1936) and Hartman’s delineation of ego functions contributing to this trend. The “id” did not get the same level of attention, and as the following quote from Freud (1940a [1938]) shows, it is indeed a problematic concept:

There can be no question but that the libido has somatic sources, that it streams to the ego from various organs and parts of the body. This is most clearly seen in the case of that portion of the libido which, from its instinctual aim, is described as sexual 174 Edward Nersessian

excitation. The most prominent parts of the body from which this libido arises are known by the name of “erotogenic zones”, though in fact the whole body is an erotogenic zone of this kind. The greater part of what we know about Eros—that is to say, about its exponent, the libido—has been gained from a study of the sexual function, which, indeed, on the prevailing view, even if not according to our theory, coincides with Eros. We have been able to form a picture of the way in which the sexual urge, which is destined to exercise a decisive influence on our life, gradually develops out of successive contributions from a number of component instincts, which represent particular erotogenic zones.

The emphasis on the ego and the various ways it fends off forbid- den impulses put the focus on anxiety, since in its signal function it indicated impending danger whether libidinal or aggressive in nature. In psychoanalysis, affect and anxiety have often been used inter- changeably; therefore, a brief review of Freud’s theory of affect can serve as a starting point for a consideration of anxiety and its role, especially as described in Inhibitions, Symptoms and Anxiety (1926d). Three phases can be seen in the evolution of Freud’s thinking about affect. In the earliest phase, still very much impressed by the effect of catharsis in alleviating hysterical symptoms, Freud consid- ered drive and affect as synonymous. Under this schema, a build up of affect or drive was responsible for the symptom, and a discharge of the quota of affect was seen as therapeutic. But by the time he wrote the Interpretation of Dreams, ideas also began to assume an important role. A wish was not just a drive but could also be an idea. This ushered the second phase in his thinking, wherein both affect and idea were manifestations of drive, and affect was no longer the same as drive. Additionally, affects became a way that the energy from the drives could be discharged. In the paper on “The uncon- scious,” Freud (1915d) most clearly elucidated the difference between affects and ideas:

The whole difference arises from the fact that ideas are cathexis ultimately of memory traces, whilst affects and emotions corre- spond to processes of discharge, the final expression of which is perceived feeling. In the present state of our knowledge of affects and emotions we cannot express this point more clearly. Psychoanalytic theory of anxiety: proposals for reconsideration 175

It is important to keep in mind that at this point, Freud still strongly argued about the unconscious nature of affects, which he deter- mined were mere potentialities and therefore different from ideas that existed in an unconscious form. The last phase in this evolution, and the most enduring and comprehensive, was ushered in with the important work Inhibitions, Symptoms and Anxiety in 1926, following the creation of the virtual mind mentioned above. In this work, he no longer maintained that affect is unconscious and furthermore, he gave it a signal function. As Rapaport (1953) described, an affect charge that is prevented from discharge or repressed does not exist only as a potentiality but is “structuralized”. In this new theory, smaller amounts of affect— which are now anxiety—are discharged in order to prevent a more massive discharge. The small amounts acting as a signal can thus mobilise defence by the ego. In addition, in this new conceptualisa- tion, Freud somewhat categorically stated that the ego becomes the seat of anxiety, and there is no longer an “anxiety of the id”. The ego not only produces anxiety and feels anxiety, but in this schema, it also starts the defensive processes. If we look closely at this particular function of the ego, however, we will see that it poses a thorny theo- retical dilemma: if the ego is the agency that defends against the emerging impulse, why does it also have to produce a signal? Why would the same agency need to produce a signal to then mobilise defence? Why should it not just mobilise defence? It may be that Freud himself was not completely happy with this formulation, because in New Introductory Lectures on Psychoanalysis (1933a), he made the following abstruse statement:

The ego notices that the satisfaction of an emerging instinctual demand would conjure up one of the well remembered situations of danger. The instinctual cathexis must therefore be somehow suppressed, stopped, made powerless. We know that the ego succeeds in this task if it is strong and has drawn the instinctual impulse concerned into its organizations. . .. Thus the ego antici- pates the instinctual satisfaction of the questionable instinctual impulse and permits it to bring about the reproduction of the un- pleasurable feelings at the beginning of the feared situation of danger. With this automatism of the pleasure-unpleasure princi- ple is brought into operation and now carries out the repression of the dangerous instinctual impulse. 176 Edward Nersessian

With these words, Freud appears much less clear about the ego being the seat of anxiety, and seems to imply that it is the instinctual impulse that is the source of the unpleasurable feelings. The ego, therefore, uses the instinctual impulse to promote defence. This reasserts the role of the pleasure–unpleasure principle, which is fundamental to the proposals in Inhibitions, Symptoms and Anxiety and an essential notion in psychoanalytic theory. Conflict, defence, and compromise can only be conceptualised within this principle and a close re-examination of it is therefore in order. Given the state of scientific knowledge and the centrality of the theory of homeostatis at the time that Freud was writing, the idea that pleasure and unpleasure were inextricably paired in an on-going reciprocal attempt to achieve mental equilibrium seemed natural and intuitive. In early psychoanalysis, if the tension of the drives increased, it led to unpleasure and when these same tensions were discharged, it led to pleasure. Even though this early view was later significantly modi- fied, it needs to be recognised that the principle itself is a product of its time, namely of very broad generalisations about mental func- tioning that were modelled after a similarly rudimentary physiology and neuro-physiology. As the twentieth century progressed, however, and especially beginning in the late nineteen fifties, discoveries about the workings of the brain started gaining momentum, and by the latter part of the century, neuroscience had become a multifaceted discipline that included neuro-anatomy, neuro-physiology, neuro-biology, and neuro-psychology. Discoveries were made at a relatively rapid rate, and it became evident to some psychoanalysts that these could help advance psychoanalytic theory. Research findings in early infant development, in memory and memory systems, and in emotions specially fear and anxiety, became recognised as areas that could contribute to the ongoing refinement of the fundamental tenets of theory, and broad generalisations could be parcelled out and studied in more detail. In fact, already based on his clinical findings, even Freud had problems with the principle, which he later set about to resolve in Beyond the Pleasure Principle (1920g), as well as in works such as “The economic problem of masochism” (1924c) and “Analysis terminable and interminable” (1937c). In the light of current scientific knowledge, it is easy for us to recognise that pleasure and unpleasure are complex feelings, Psychoanalytic theory of anxiety: proposals for reconsideration 177 emotions, and sensations that are distinct and not necessarily related. An oscillating U-shaped tube view of psychic balance based on poorly delineated principles called pleasure and unpleasure is no longer valid. Obviously, this does not mean that there is no relationship at all between pleasure or unpleasure, but there are numerous instances where pleasure and unpleasure are present simultaneously and other situations where unpleasure motivates one to seek plea- sure, thus underscoring the complexity of the relationship between the two. It is important to remember that pain, fear, and anxiety, and especially anticipatory anxiety, are warning systems that inform us of danger or threat to bodily integrity; these systems are protective and are essential not only for survival, but also for the maintenance of health. As counter-intuitive as it may seem on the face of it, we need unpleasure in order to have pleasure, for without our fear and anxi- ety systems, we would be at risk, exposed to harm, and unable to attain pleasure. With this in mind, the assertion of the prominent psychoanalyst Charles Brenner in 2008 that “the mind is motivated by a need, desire, or tendency to achieve pleasure and to avoid un- pleasure. . .” and that “at a certain age rather early in childhood and from then on, both normal and pathological mental functioning are largely motivated by both needs acting together” can only be seen as both too global and overly simplified. Importantly, in my reading of Brenner, I am inclined to think that he confuses motive and outcome; the fact that some acts or impulses can be pleasurable does not explain their fundamental raison-d’être. In fact, his version of the functioning of the mind relies too heavily on the verbal report of patients—which, though important, is an incomplete source of data when the problem is understanding the fundamental principles governing the mind and the brain. One final word on this subject, specifically about what are, on the one hand, broad and overly generalised definitions of pleasure and unpleasure, and, on the other, definitions that are overly limited and limiting. For example, when Freud and Brenner refer to pleasure this denotes sexual and aggressive pleasure, but there are other plea- sures needed for survival. Furthermore, sexual pleasure itself is a complex phenomenon involving desire, attraction, responsiveness, sexual behaviour such as foreplay, sexual intercourse or stimulation, and orgasm all of which involve complex hormonal and other 178 Edward Nersessian biological interactions. Similar comments apply to aggression and I will deal with them presently. The idea of aggression as a drive, as a component of conflict, and as a source of pleasure, begins with Freud. But neither Freud, nor those who followed him within psychoanalysis, attempted to more clearly delineate and differentiate the various types of aggression we encounter in our everyday life (Panksepp, 1998). What we term aggression includes a heterogeneous admixture of behaviours, including self-protection or protection of offspring on the one hand, and murder, torture, maiming, on the other. In between these extremes, we also lump together diverse actions such as boxing, wrestling, fighting, humiliating, ridiculing, revenge, rage, playful teasing, as well as feelings such as anger, frustration, irritation, and annoyance under the rubric of aggression. My discussion of this concept cannot be comprehensive or nuanced enough, given all the complexities involved; instead, I will focus on those aspects of aggression crucial to Freud’s last theory of anxiety, namely, signal anxiety. As he developed the concept, signal anxiety warns of danger and mobilises defence. This is what he had to say in Inhibitions, Symptoms and Anxiety: “A defence against an unwelcome internal process will be modelled upon the defense adopted against an external stimulus, that the ego wards off internal and external dangers alike along simi- lar lines” (p. 92). Furthermore, he continues, just as when faced with real danger the “organism has recourse to attempts at flight”, when faced with internal danger it has recourse to defence. As compelling and logical as this argument may be, it omits any consideration of the fight response, which is an equally important and ubiquitous reac- tion to danger. Any theory that does not include the role for aggres- sion in self-preservation and preservation of offspring, kin, territory, and so forth is partial and incomplete and in some way compromises the robustness of its explanatory powers. Furthermore, for aggression to be elicited there must be a threat, namely a danger from which we need to protect ourselves. Understood in this light, it cannot be the emergence of aggression that causes anxiety, but rather it is fear or anxiety—which are indica- tors or warning signals of danger—that arouse aggression. Naturally, when such aggression is aroused, there immediately and often, instantaneously, follows an evaluation about its appropriateness, its Psychoanalytic theory of anxiety: proposals for reconsideration 179 intensity, and its object. For survival, however, it is imperative that this evaluation be subsequent to its arousal. In sum, what I am proposing here is that the actual situation is the opposite of the usual way this is understood in psychoanalysis; namely, that danger elicits fear or anx- iety that then arouses aggression. While the suppression of aggres- sion needs to occur at some point or in some instances, it is not the first step. More fundamentally, aggression is not aroused sponta- neously due to drive pressure which then leads the ego to signal danger and to mobilise defences; instead, when faced with danger, either real or imaginary, the person adopts a psychological posture of self-protection and mobilises aggression to defend itself. In this con- text, danger could take various forms, including pain, frustration, and distress. This change in theory obviously has theoretical and clinical implications, which are beyond the scope of this paper. Another important and related idea expounded by Freud, Brenner, and others is that aggression leads to pleasure. I believe the evidence for this is very weak; if anything, clinical experience reveals that a person in a state of anger or rage is a person in a state of stress and discomfort. If one accepts the notion that aggression is a source of pleasure, one must explain how it is that humanity has survived. Once again, the distinction needs to be made between the role of aggression and the rewards that may be needed in order to achieve the desired goals. In conceptualising aggression as a response to danger, a danger indicated by fear or anxiety, I have not made a very strong distinc- tion between fear and anxiety, and in psychoanalytic theory, we often find the two used interchangeably. Positing some hypothetical situa- tions highlights this lack of clarity. For example, when a one-year-old sees a stranger and becomes distressed, is that fear or anxiety? If a boy of six is afraid of damage to his penis, should we call it fear or anxiety? Or, to take yet another example, if someone has been in a serious car accident and subsequently is distressed in a car, is that fear or anxiety? The usual distinction that fear refers to external danger and anxiety to internal danger is not so clear-cut. Ledoux (1996), who has done some of the most significant work on fear describes the differences in the following way: Anxiety and fear are closely related. Both are reactions to harm- ful or potentially harmful situations. Anxiety is usually distin- guished from fear by the lack of an external stimulus that elicits 180 Edward Nersessian

the reaction—anxiety comes from within us, fear from the outside world. The sight of a snake elicits fear; but the remem- brance of some unpleasant experience with a snake or the antici- pation that you may encounter a snake are conditions of anxiety. Anxiety is also described as unresolved fear. Fear in this view is related to the behavioral acts of escape and avoidance in threat- ening situations, and when these actions are thwarted, fear becomes anxiety.

As is clear from this quote, even in neuroscience, there is no clear distinction between fear and anxiety. Assertions that fear comes from outside and anxiety from inside do not stand up to scrutiny, since obviously both fear and anxiety are within the person. Instead, one could argue that the triggers may be outside or inside, though even this assertion is debatable. At present, it can be said that there is no consensus on the differ- ence between fear and anxiety. For example, Davis, Walker, Miles, and Grillon (2009), draw the following line between the two:

Although the symptoms of fear and anxiety are very similar, they also differ. Fear is a generally adaptive state of apprehension that begins rapidly and dissipates quickly once the threat is removed (phasic fear). Anxiety is elicited by less predictable threats, or by those that are physically or psychologically more distant. Thus anxiety is a more long-lasting state of apprehension (sustained fear).

Another frequently used definition of anxiety stipulates “it is a state of apprehension and high arousal in the absence of an immediate threat”. For the most part, it seems that these and other definitions all suffer from the lack of precision needed to fully differentiate the two. For the purpose of my proposal regarding aggression, however, it does not matter whether the danger is external or internal—that is, whether it is real, or fantasised, or imagined, nor whether it is phasic or sustained; neither is it of any consequence whether we call it fear or anxiety. In proposing a modification of our familiar way of thinking about aggression and anxiety, the question arises regarding the rela- tionship between anxiety and sexuality. How does it happen that sexuality and fear become connected? Clearly from a biological perspective, it makes no sense for sexuality to be a source of fear. As Psychoanalytic theory of anxiety: proposals for reconsideration 181 a significant source of pleasure as well as a requirement for the creation of offspring and propagation of the species, it would appear logical that mainly reward—that is, pleasure—should be important regarding sexuality. We know clinically, however, that this is not always so. Could it be that it is not sexuality that is a danger itself, but only its consequences? Consequence implies the capacity for reasoning, evaluating, and judging, that is, what Freud called the reality principle, and therefore implies a more important role for the higher mental functions. Obviously, consequence is also important in regards to aggression, although again, there may be other as yet unknown inhibitory mechanisms in the expression of sexual impulse that by pass higher centres, just as empathy is in regards to aggression. Regardless, I do not think that the basic, primary relationship I have described regarding aggression, fear, and anxiety exists regarding sexuality. Instead, the situation has already been recognised as consider- ably more complex. For example, there is some evidence including clinical psychoanalytic observation that certain situations of fear are accompanied by sexual arousal, primarily on a physiologic level, which is unusual since in many situations anxiety has an inhibitory effect on sexual desire. From a biological perspective, and more to the point, from the vantage point of self-preservation, it seems reasonable to assume that fear and possibly aggression would have some overlapping circuits with sexuality. In a given situation, the decision is between whether it is safe for sexual behaviour or it is dangerous; in the latter case, aggression should be mobilised. Recent research with rodents has shown that faced with an unknown female, the activation of sexual circuits has a dampening effect on the aggressive circuits. Interestingly, Hartman, (1964; Hartman, Kris, & Lowenstein, 1949), using the vocabulary of his time, made a similar observation when he stated, “the unmodified aggressive impulse threatens the existence of the object and the investment of the object libido acts as its protection”. By speaking about sexuality in this way, I am narrowing the focus much more than Freud did when he wrote about libido and Eros. I think aggregating all the various properties we attribute to libido or Eros under one rubric is inaccurate, and that the notion of “sexual” is used too indiscriminately in current psychoanalytic theo- rising. When we speak of the libidinal investment of a mother in her 182 Edward Nersessian baby, for example, we acknowledge the sensuous aspects of that relationship without deeming it sexual. It would be more useful to keep the sexual for the sexual and to study the other properties of mind that pertain to relationships and to the need for others sepa- rately, while being mindful that there are always interactions between these various properties. Attachment is one such property, but there are others. From a brain perspective, the play of hormones presumably is different when we are talking about sexual motivation versus attachment, and I believe there is evidence that supports this assumption. Another subject in Inhibitions, Symptoms and Anxiety that is impor- tant to reconsider and which also relates to anxiety is the superego. Classical psychoanalysis has assembled together under one agency morality, prohibition, and punishment. As heir to the Oedipus complex and through the process of identification, the superego becomes the agency that threatens punishment for wrongdoing. The most significant instances of doing wrong involve hurting others or transgressing certain sexual taboos. While the concept of the super- ego has had its usefulness, I think the time has come to differentiate and delineate the many attributes or properties we lump together under this heading. Morality and the capacity to tell right from wrong, such as has been derived from biblical injunctions is one area in need of study. Areas that involve others, however, and many of the prohibitive acts do, are dependent on other capacities that have nothing to do with punishment. Empathy, which I have already mentioned, is one such domain that has received a great deal of attention in recent times. Research on theory of mind has focused on the development of empathy in the child around the age of three. The terrible twos occurs prior to this stage, and most parents or close observers have surely witnessed the nonchalance with which a frus- trated child expresses its aggression prior to the age of three (+ or –). After that age and over time, with maturity, the child becomes better able to control such aggressive actions, aided in large part by the social environment, which includes parents, nursery teachers, older siblings, etc. Empathy is also central in this maturational process, and as Simon Baron-Cohen (Baron-Cohen, 2011; Baron- Cohen, Tager-Flusberg, & Cohen, 2000), Donald Pfaff (2007), and others have described, empathy works to control the expression of aggression towards others. In this sense, the action of empathy in Psychoanalytic theory of anxiety: proposals for reconsideration 183 controlling rage and destructive wishes is akin to the function Freud attributed to fear of superego. This is not to imply that the fear of punishment is not an important deterrent in controlling aggression, but it is mostly learned and not infrequently works on a conscious level. A discussion of guilt though is relevant but is beyond the scope of this chapter. To summarise: Freud’s ground-breaking work, Inhibitions, Symptoms and Anxiety along with the Ego and the Id have been founda- tional to psychoanalytic thinking for almost ninety years. While there is much in both works that remains valuable to this day, a study of anxiety and fear encompassing findings from neuroscience offers another perspective which can be useful in advancing psychoanalytic thinking. The views I have presented here, relying primarily on psychoanalytic vocabulary, have findings from neuroscience as their underpinnings and question/modify some of the tenets presented in the above two works. These modifications are as follows:

1. Freud saw unconscious conflict from the beginning of his clinical observations, and the theories he proposed all served the purpose of explaining conflict. 2. Aggression does not arise spontaneously, requiring defence, rather it is a response to a perception of danger. Therefore, aggression does not arouse anxiety but is aroused by fear and anxiety. 3. The aspect of aggression we have been most interested in is not a source of pleasure. 4. The pleasure–unpleasure principle represents a way of looking at the mind that relies on late nineteenth–early twentieth physiology and does not adequately account for the working of the mind. As a corollary to this, the notion of signal anxiety that is closely related to this principle is no longer adequate to explain mental phenomena. 5. The superego as it is currently understood encompasses too many properties which need to be addressed and understood sepa- rately.

These ideas inevitably bring into focus the concept of the dynamic unconscious, since it is so firmly rooted in the notion of conflict. 184 Edward Nersessian

Therefore, a critical study of this concept also will need to be under- taken, especially in light of recent findings on memory, memory systems, memory consolidation, emotional memory vs. memory of emotions, as well as dissociation and suppression. Additionally, the relationship of the so-called cognitive unconscious with the psycho- analytic dynamic unconscious will need to be clarified, but again, this is beyond the scope of the present chapter. It seems increasingly evident that progress in psychoanalytic understanding of the mind can no longer ignore the ever-increasing findings from the neuro- sciences and this chapter represents an early effort in this direction. The aim here has not been to present any definitive conclusions, but instead to point to areas that need to be revisited with the assistance of current neuroscientific findings, in the hope of creating a higher degree of correspondence between psychoanalytic discoveries and hypotheses, and neuroscientifc findings. 7

Traumatic seduction and sexual inhibition

Elsa Schmid-Kitsikis

I now watch from a distance the symptomatic reactions that are accompanying the introduction of psycho-analysis into the France which was so long refractory. It seems like a reproduction of something I have lived through before, and yet it has peculiarities of its own. Objections of incredible simplicity are raised, such as the French sensitiveness is offended by the pedantry and crudity of psycho-analytical terminology. . . . Another comment has a more serious ring (a Professor of Psychology at the Sorbonne did not think it beneath him): the whole mode of thought of psycho-analy- sis, so he declared, is inconsistent with the génie latin.

Sigmund Freud, An Autobiographical Study, (1925d, p. 62)

From the very beginning of Inhibitions, Symptoms and Anxiety (1926d), Freud recalls the obsession and phobic acts in relation to sexual and traumatic experiences. He writes: “Some inhibitions obviously represent a relinquishment of a function because its exercise would produce anxiety. Many women are openly afraid of the sexual func- tion. We class this anxiety under hysteria, just as we do the defensive

185 186 Elsa Schmid-Kitsikis symptom of disgust which, arising originally as a deferred reaction to the experiencing of a passive sexual act, appears later whenever the idea of such an act is presented. Furthermore, many obsessional acts turn out to be measures of precaution and security against sexual experiences and are thus of a phobic character” (p. 88, italics in original).

Affect inhibition and psychic functioning

Miss E, one of my patients, complains about different psychic states during which she feels petrified and anaesthetised. These different states make her feel a psychic lifelessness, a feeling of dissolution. She gives the impression, through transference, that she is fighting against a state of fascination, due to too much perceptive activity which muddles space-time markers and produces a falling-away of her psychic limits. She recalls these feelings with a mixture of terror and sensual pleasure that seem to connect to a seductive experience full of excitement. Unable to contain such excess, she fails in her attempt to elaborate infantile sexuality and is overwhelmed, obliging the ego, as Freud underlines, to defend itself by considering the “irreconcilable” representation1 as “unreachable”. The traumatic aspects of such a seductive experience take refuge in a sort of intense eroticism grounded in great perceptive activity, feeding automatic repetition without restriction. The intense eroticism, accompanied by much excitement, seems to prevent access to affect and acts as a last resort in helping the patient overcome unbearable psychic pain. The question which still remains open concerns the state of anaesthesia. It reminds us of psychic narcosis which hinders psychic elaboration and confronts us with ego dependence, the one under- lined by Freud concerning the hysteric ego and its unconscious guilt (1923b). If such is the case, another question arises concerning my patient, which has to do with the nature of the falling-away of her psychic limits. Is it in some way connected to the one described by D. W. Winnicott, as the only possible psychic outcome in the face of an unsymbolised past event? Or does it concern the frequent falling- away as experienced by the young child in the context of an in- adequate environment unable to contain and metabolise psychic limits? In such circumstances the only psychic outcome will be the Traumatic seduction and sexual inhibition 187 maintenance of a continuous source of excitement in an effort to disavow any affect susceptible to creating pain. Consequently, the outcome would prevent the ego from drawing the conclusion which is, according to Freud, to see “itself deserted by all protecting forces and [it] lets itself die” (1923b, p. 58).

Freud and anaesthesia: from somatic innervations to the discovery of transference

Freud’s considerations about what links inhibition and anxiety were already at work in the context of his first theory about seduction and his discoveries on hysterical psychic functioning. He introduces a certain number of hypotheses which prefigure his subsequent theo- retical elaborations. Relying on clinical work, these hypotheses take into consideration his theory on conversion and integrate his doubts concerning, and his questioning of, a probable equation between body activity and somatic innervations. Freud queries, among others things, in relation to the case of Fräulein Elisabeth von R., the sub- stitution process involved, admitting the possibility of a purely symbolic conversion without any organic dysfunction. Freud writes:

I also expressed my view, that the patient had created, or increased, her functional disorder by means of symbolization, that she had found in the astasia–abasia a somatic expression for her lack of an independent position and her inability to make any alteration in her circumstances, and that such phrases as “not being able to take a single step forward”, and ‘not having anything to lean upon’, served as the bridge for this fresh act of conversion. (Breuer & Freud, 1895d, p. 176)

The problem of paralysis had retained his attention since 1893, in the context of his work on hysteria and on the fundamental role played by representation in relation to affect. He stresses the exces- sive aspects of hysteria, as well as the existence of absolute and profound anaesthesia, with its weak link to any organic lesion. He concludes that hysteria and some other manifestations, act, in such circumstances, as if anatomy were unknown or nonexistent. At this point, one might wonder if what Freud calls representation in the context of hysteric functioning has to do with a figurative 188 Elsa Schmid-Kitsikis action as his future research on the subject—as well as on dream activity—will show. The patient seems to seek, through his or her symptoms and their excesses, a way to figuratively designate the object of desire, similar to a game with images and sensations, in order to be able to endure the consequences of its absence. Two years later (1895), Freud moves on to the problem of anxiety neurosis and its paralysing effects. He seems interested both by “co- ordinatory vertigo” and by the vertigo in “oculomotor paralysis”, and their specific discomfort such as “sensations of the ground rock- ing, of the legs giving way and of its being impossible to stand up any more; while the legs feel as heavy as lead and tremble or the knees bend” (1895b, p. 95). As this vertigo, adds Freud, never leads to a fall, it may be replaced by a profound fainting fit, or by virginal anxi- ety, as experienced by the adolescent or young married woman, whose first approaches to sexual activity provoke a psychic anaes- thetic state. Thus, inferring an intimate relationship between anxiety neurosis and hysteria, Freud writes:

it is not to be wondered at that hysteria and anxiety neurosis regularly combine with each other, as is seen in “virginal anxi- ety” or in “sexual hysteria”, and that hysteria simply borrows a number of its symptoms from anxiety neurosis, and so on. (p. 115)

Furthermore, it is probably at this time that Freud starts wondering if there is a necessity to consider the symptom as part of our under- standing of hysterical phenomena. To a certain extent the hysterical body, its dramatisation and symptoms do not fascinate Freud that much; he seems more interested in the paradox present in the body of the hysterical patient. The case of Dora (1905e), “a small hysteria with banal somatic symptoms”, will become, in that respect, exem- plary. Freud seems to question the significance of acts such as those found in his patients who suck, bed-wet, or masturbate while “listen- ing” to their parents’ sexual intercourse. Following Freud’s interpretations of such phenomena, which are usually organised through intensive imagery made of absence and exclusion, I wonder to what extent the patient lets him- or herself be fulfilled with fixed and static images in order to deny painful absence. One of my patients, who could not see her father because of her parents’ divorce, and who pretended to be totally indifferent to Traumatic seduction and sexual inhibition 189 the situation, discovers during her analysis the link between the absence of her father and the static images which concern him and invade her while she masturbates. During this same period, Freud becomes more and more inter- ested in clues which concern not only motor difficulties. The body is no longer synonymous with motor innervations. The sensorial sphere is privileged, and even though it remains under the control of the sense organs, Freud gives a new direction to his theoretical construction. The body’s functions will be considered from now on, with its pleasures and displeasures, as a territory for desire and for symbolic travesty. His friendship with W. Fliess, will stimulate his interest in the sense of smell,2 as developed in the report concerning the case of Miss Lucy R. (1888), in which Freud explicitly supports the idea that the traumatic effect of an event is due to an affect conflict and that the olfactory sensation attached to it, remains as the symbol of a traumatism. But it is his interest in what connects one sense to another that guides his theoretical investigations in the field of perception/fantasy links. For Freud, a new element of uncon- scious production appears. He draws the so-called “architecture of hysteria”, describing the subject’s aim to arrive back at the primal scene. He affirms that if in a few cases this can be achieved directly, in other cases a roundabout path via fantasies is necessary. These fantasies “combine things that have been experienced and things that have been heard, past events (from the history of parents and ancestors) and things that have been seen by oneself ” (1892, p. 248). This new approach to psychic functioning lessens the power of the conversion theory. Indeed, from then on, Freud’s examples of suppression and inhibition mechanisms in relation to anaesthetic or paralysis phenomena emphasise the prevalence of sensorial activity. He suggests that a sensorial function that is not associated to another sensorial function may lead, because of its overbearing percep- tive power, to a point of breakage or fixation, excluding the neces- sary space for representation activity. The risk is that the latter succumbs to an “overcharged organ” or to a “displeasured organ” producing the same inhibition as the one which is due to fascination or petrifaction. With Dora’s case, Freud confirms his lack of interest in somatic symptoms and his greater interest in the destiny of affect. He points out the importance of perceptive activity (Herr K’s sex erect against 190 Elsa Schmid-Kitsikis her), acting as a fascinating object which can produce a traumatic effect: shock, lack, attraction, displacement, and inversion of affect, inhibition. From now on the body plays a role in transference. Freud is conscious of this reality, all the more so since he admitted his lack of attention to it during Dora’s treatment. He writes:

I have been obliged to speak of transference, for it is only by means of this factor that I can elucidate the peculiarities of Dora’s analysis. Its great merit, namely, the unusual clarity which makes it seems so suitable as a first introductory publication, is closely bound up with its great defect, which led to its being broken off prematurely. I did not succeed in mastering the transference in good time. Owing to the readiness with which Dora put one part of the pathogenic material at my disposal during the treatment, I neglected the precaution of looking out for the first signs of transference, which was being prepared in connection with another part of the same material—a part of which I was in ignorance. (1905e, p. 118)

The particular position, the one occupied both by the analyst and the patient, will be explored by Freud after his proposition of a second topography (1920). In his work Group Psychology and the Analysis of the Ego (1921c), he analyses once more the ego’s extreme psychic posi- tions, its impoverishment because of submission—as in the case of a person in love—in order to evoke how in such circumstances the hypnotist’s power occupies the ego ideal’s place as a unique object. Consequently, Freud thinks that paralysis arises from the relation- ship between a too-powerful person and a powerless and defenceless one. He points out the manner in which a patient can be abused during a psychoanalytical treatment.

Traumatic seduction and psychic inhibition

The complexity of the analytical work is very often due to the variety of seductive situations. The scenario and the seductive scenes recounted by our patients offer a polysemy of what is “seen and heard but half understood” or what remains ambiguous because of caresses, slight touches, or psychic abuse, and therefore becomes a source of overwhelming excitement defensively transformed into different inhibition patterns. These patterns do not always signify Traumatic seduction and sexual inhibition 191 hysterical functioning and do not always end up in a motionless psychic position even if they are part, as Joyce Mc Dougall points out, of the traumatic nature inherent in normal sexuality. Nevertheless, the effects of the most violent scenarios usually lead up to the so- called “psychic commotion” described by Ferenczi, a sort of psychic shock resulting in a feeling of terror and self annihilation. On the other hand, Paul Denis’s work (1997) concerning vulner- able patients underlines the fact that, traumatic or not, seduction has always to do with power and ascendancy. Even though seduction does not always have a purely sexual quality, it nevertheless submits the child to a particular type of relationship with one of his/her parents, usually the mother. The struggle against affect, by way of defence mechanisms, becomes a priority so as to avoid suffering. Freud writes in Moses and Monotheism (1939a, p. 76), about “negative reactions” transformed in “defensive reactions”, that their principal expression are what are called “avoidances”, which may be intensi- fied into “inhibitions” and “phobias”. However, as a last resort, another outcome is possible which I have experienced with my own patients: the defensive use of recur- rent perceptive images. Freud, in the work just quoted, tells us that images do not appear spontaneously, but relate to

impressions which impinge upon a child at a time when we would have to regard his psychical apparatus as not yet completely receptive. The fact itself cannot be doubted, but it is so puzzling that we may make it more comprehensible by comparing it with a photographic exposure which can be developed after any inter- val of time and transformed into a picture. (p. 126)

This type of image which can reappear suddenly in the absence of diachronic time and space for representation constitutes, for a while, an efficient protection against psychic distress.

Psychic compulsion and sexual inhibition

Miss E, previously referred to, is a young woman who grew up in a backward and stifling environment. Her endless waiting for repara- tion of what had been missing during her childhood, intrusive maternal care, the father’s inertia, and excessive tolerance created 192 Elsa Schmid-Kitsikis strong anxieties3 that overwhelmed her so suddenly and so intensely that only psychic anaesthetic states, hours of sleep, and frenetic and interminable hours of useless intellectual work could give her the illusion of some sort of calm out of which she arose, paradoxically, physically and emotionally exhausted. She relates during the sessions the first years of a difficult life. Her arrival as a “desired” child so as to avoid her parents’ divorce and the place she occupied among brothers and sisters already adolescents. She emphasises somatic complications: breathing, sleeping, and motor difficulties but above all she describes how, when she was four, her legs suddenly became paralysed and how, a few months later, they suddenly returned to normal. As Freud’s writes (1926d, p. 89),

In hysteria there will be a paralysis of the motor apparatus, or this one special function of the apparatus will be abolished (abasia). Especially characteristic are the increased difficulties that appear in locomotion owing to the introduction of certain stipulations whose non-observance results in anxiety (phobia).

She says: “My mother never wondered why paralysis appeared and disappeared so suddenly. It’s her lack of interest that hurt me and not so much the physical pain”. She speaks of all these difficulties without any emotion, with no affect. She expresses her emotions through a myriad of images and details underlining her mother’s power and ascendancy over her. As for me, I do not feel her emotional pain, but I feel her permanent sensation of exhaustion which “fascinates” me, but which also makes me feel uncomfortable. My listening capacity is invaded by theoretical knowledge. I feel obliged to fight against this tendency, against a tendency to establish a comfortable pathological diagnosis, one about hysteria, and forget my work as an analyst. In such circumstances, I feel unable to think and since I feel she denies me the right to experience my concern and my maternal preoccupation, experiences she fears as potentially too infused with warmth and excitement, my space for intervention becomes increasingly restricted. As things moved along, I wondered if her tendency to feel anaes- thetised or close to a falling-apart state was due to the different scenarios which pursue her. It appeared to me more and more plau- sible, that these scenarios constituted the basis on which quasi-hyster- ical functioning developed defensively. For a while, I felt imprisoned Traumatic seduction and sexual inhibition 193 in her decision to talk about these recurrent crude fantasies which overwhelmed her when certain events took place: the announce- ment of a future birth was felt by her to be an emotional catastrophe which could provoke a collapse; she was subject to obsessive images, such as a baby sucking at a breast that suddenly turns into a penis and makes her feel nauseous; a routine gynaecological check-up provokes intense anxieties and the desire to vomit; she fantasised that a medical assistant in a gynaecological office occupied by male physicians, had to fulfil their sexual desires. She recalls: “The other day I was in a library. I opened a book by chance and saw a woman taking a penis in her mouth. I was petrified. I couldn’t move or leave. I see the scene over and over again”. All these scenarios appeared to me as if her fascination for the penis, a source of disgust, had something to do with the type of intel- lectual activity she developed at times. Even though she was a bril- liant university researcher, she evoked periods of her life subject to so much frenetic and useless intellectual work that she would vomit and then fall asleep for interminable hours. She then felt as if her creative capacities were ineffective. Freud writes the following about inhibition in work (1926d, p. 89):

the subject feels a decrease in his pleasure in it or becomes less able to do it well; or he has certain reactions to it, like fatigue, giddiness or sickness, if he is obliged to go on with it. If he is a hysteric he will have to give up his work owing to the appearance of organic and functional paralyses which make it impossible for him to carry it on.

And he adds

. . . and with what tenacity the ego clings to its relations to reality and to consciousness, employing all its intellectual faculties to that end—and indeed how the very process of thinking becomes hypercathected and erotized—then one may perhaps come to a better understanding of these variations of repression. (p. 119)

She invades me with all these fantasies and descriptions, never followed by free associations, as if she wanted to avoid my interven- tions. She only mentions anaesthesia, petrified states which did not, happily, avoid a discrete entrance in the field of desire in its reversed form, disgust. This opening towards the expression of affect, even 194 Elsa Schmid-Kitsikis though it intensified her uneasiness, showed how these anaesthetic states and psychic conflicts due to “blank” or overly invasive images, served a psychic protection. The psychic protection needed to be all the more efficient since her unsatisfied infantile curiosity remained intense. But at the same time this excessiveness did not help the organisation of a symptomatic functioning that could have protected the ego from suffering, from being subjected to huge responsibilities such as containing and delimiting, and with the help of despair investments, anxiety which tended to overflow. The memories which emerge make her realise that she not only feels repulsed but also attracted by these scenarios. She wonders what attracts her since she feels so horrified. She wonders if she has been abused as a child. She says: “It’s an impression, but I remember a sort of uneasiness when I got close to my father, when my mother would tell me to get down from my father’s knees while at the same time I had to take a bath with him”. She gets angry, she feels as if her mother steals or excites her driving energy. She says: “At home my mother didn’t let us close the doors. Even when we had to go to the toilet we had to leave the door open. My mother would enter my room without knocking and it is still the case today. I always felt as if I were doing something wrong. I never got to know what the meaning of intimacy was”. She adds: “My mother has always been unexpected. The only way for me to protect myself was to pretend I didn’t exist, as if I were dead. When my boyfriend penetrates me I do the same. I let him do so because I am afraid of being abandoned. I feel the same when you intervene, as if your interventions were unexpected. It is a terrible moment, an hour of non-existence. I can’t think anymore. For a while I feel noth- ing just like the day when my boyfriend entered the bathroom. I was under the shower and felt paralysed, I could no longer feel the difference between warm and cold water”.

“I can’t touch and I can’t be touched”

Sensual motion, the ego’s somatic search for satisfaction, has to perpetually fight against excitement and its overflow. During the object pleasure investment process, which leaves bodily traces, excitement has to find a sort of equilibrium in its relationship with Traumatic seduction and sexual inhibition 195 imagination, by regulating valence, texture and envelope, so that too much excitement does not become an obstacle to sensual feeling. When excitement tends to submerge the body, defensive splitting mechanisms appear and prevent the senses from functioning prop- erly thus increasing the risk of traumatic experiences. Miss E evokes during a session her “innocence” concerning sexu- ality because of the prudishness of her parents, the embarrassment of the nuns of the Catholic school she attended when she was adoles- cent, and the way the “old” doctor of about fifty years old gave her courses on sexuality. Sexually she feels as if her body were a hole instead of the femininity that she expected to feel. She permanently feels repulsed by her female body about which she knows nothing. She thinks that this permanent feeling has to do with the way she feels about her mother. She says: “When men started to look at me as a woman I felt my body empty, as if it were a hole”. She feels repul- sion, which she never links to her mutilating experiences. She refuses to use imagination, to use fantasy, being overwhelmed by strange and unknown feelings. She evokes love for her mother. She realises that she can’t live far from her, even though she also experi- ences strong negative feelings. She accuses her mother of not having helped her to construct good protective defences and the strong limits she needed and she still needs. She is convinced that she grew up in an environment which did not understand what a child desires and expects. Freud writes:

Since there is no doubt that hysteria has a strong affinity with femininity, just as obsessional neurosis has with masculinity, it appears probable that, as a determinant of anxiety, loss of love plays much the same part in hysteria as the threat of castration does in phobias and fear of the super-ego in obsessional neurosis. (1926d, p. 143)

Miss E is also convinced that her mother never really touched her when she was a baby. She says: “In the family, we don’t know what kissing means”. She mentions feeling suffocated and her profound and perpetual fear of being touched or to touch.4 She adds: “It has to do with this particular moment when an ordinary caress slides towards an erotic gesture. During this particular moment I can’t say yes or no. I just flatter, hypnotise myself. It is then followed by a sort of contagion, the same impression which lasts and repeats itself ”. 196 Elsa Schmid-Kitsikis

During a session, she announces that she and her boyfriend have decided to start horseback riding. This was followed by a period of intense elation. Miss E expresses her pleasure while trying to get in contact with and to master the unexpected movements of the horse. A new tendency towards the integration of a sensual bodily contact appears, but which also reactivates at the same time old traumatic experiences which she is able to more or less confront. Freud, concerning anxiety, asserts that in certain circumstances it is “not newly created in repression; it is reproduced as an affective state in accordance with an already existing mnemic image”. He adds:

Affective states have become incorporated in the mind as precip- itates of primaeval traumatic experiences, and when a similar situation occurs they are revived like mnemic symbols. I do not think I have been wrong in likening them to the more recent and individually acquired hysterical attack . . .. (1926d, p. 93)

She says: “Saturday I went horseback riding with my boyfriend. There was a dog wandering around. I was able to touch it, to caress it but it gave no sigh, it didn’t move. Suddenly it rubbed against me, lay on its back, lifted its paws as if to be caressed on its belly. I felt disoriented for it gave no sign if I could touch it or not”. I remember that I had listened to this account as if it were a dream. Through transference I had considered, at that time, the displacement of a sensual contact on a dog as an important change. It reminded me of how Miss E, at the beginning of her analysis, related to the couch. She was lying on it as if she were in levitation, even though she left traces, for the cover was upside down when she got up at the end of the session. It was as if excitement, despite every- thing, had ended up on the couch. A few days later she arrives at her session looking extremely moved. She says: “I was riding somebody else’s horse. It tried to grasp my sweater and bite me [I thought to myself: the sweater which hides her breast]. It took me some time to realise that it didn’t try to bite me but to play with me as a child”. She adds that even though she likes animals she can never be sure if they will attack her or not. A process seems in progress towards a better integration of infan- tile sexuality. Miss E’s fantasies are more and more connected to fears and anxieties about being touched or to touch, to be penetrated Traumatic seduction and sexual inhibition 197 or to penetrate. During a session, she looks prostrate. She says: “I can’t ride a horse anymore. I feel nauseous and terrified”. She adds: “It is as if I made love”. This traumatic scene represents a dividing line. Psychic figurability is from now on open to infantile sexual theory misconceptions. She evokes her sexual anxiety through a dream. She recalls: “I stand in front of a loose-box with three horses, a small one and two big ones. I have the impression that they are three mares. Suddenly, I realise that one of them is a stallion which sticks its penis in the adult mare. The mare continues eating as if nothing happened. I feel relieved. It wasn’t a catastrophe”. She continues: “When my mother is calm it always means a catastrophe. I have the impression that I can’t count on her love. I wasn’t the desired child. I am convinced that one day she will abandon me”. Several authors make a distinction between neurotic love which concerns the Oedipus conflict and addicted love which delegates to the object the magic power to repair or to avoid conflict and negative feelings. The so-called normal capacity to love has to do with loving and being loved. Such a capacity concerns the subject’s aptitude to develop and transform his/her narcissistic functioning, to question the prerogative of his/her ideal ego and ego ideal, and to confront the violence of his/her infantile sexual fantasies. It implies meet- ing the other who is ready to both receive and return love, in a way which avoids the alienation and mutilation of its own psychic functioning. Because of having a depressed mother, Miss E did not have the opportunity to be in contact with her mother’s body, skin, smell, voice, and eyes. The necessary connection with sensual experience was lacking, compromising therefore the construction of an object relationship and the integration of desire. Such a psychic state prevented the formation of bodily memory experiences, the recog- nition and integration of non-intrusive feelings of the somatic sensa- tions, leading to the capacity for auto-eroticism. Freud writes:

It is the fate of sensual love to become extinguished when it is satisfied; for it to be able to last, it must from the beginning be mixed with purely affectionate components—with such, that is, as are inhibited in their aims—or it must itself undergo a transfor- mation of this kind. (1921c, p. 115) 198 Elsa Schmid-Kitsikis

By way of a conclusion

Freud’s considerations about what links inhibition and anxiety were already at work in the context of his first theory about seduction and his discoveries on hysterical psychic functioning (1888, 1895b). He introduces a certain number of hypotheses which prefigure his subsequent theoretical elaborations. With Dora’s case (1905e), he points out the importance of perceptive activity which can produce a traumatic effect, such as inhibition and anxiety. The case of Miss E presented in this text illustrates Freud’s remarks (1926d) about inhibitions which represent the relinquishing of a function, such as a sexual function which if, exercised, would create anxiety. Indeed Miss E was regularly overwhelmed by feelings of terror and an impression of internal death. These psychic states were always followed by a threat of collapse which was persistent yet held some sort of attraction for her. She thought she could test her courage, through mutilating sexual experiences. The analytical work led me to focus on the place and meaning of perceptive activity and on the resulting transference and counter- transference difficulties. Two reactions seemed to regularly confront each other in the course of the patient’s associations in relation to traumatic seduction: that of anaesthesia linked to an excess of perception which led to disturbed spatial-temporal references expe- rienced as fascination, and that of a collapse of psychic limits that Miss E experienced with a mixture of fear and pleasure.

Notes

1. From now on I will use the word “representation” introduced by C. and S. Botella (2004), instead of “presentation”. 2. Freud reconsidered this point in his work Civilization and its Discontents (1930a), thanks to a debate about a certain change in psychic sexual excitation, and anal eroticism which succumb “in the first instance to the ‘organic repres- sion’ “. For Freud, the change seems to be connected with “the diminution of the olfactory stimuli”, their role being taken over “by visual excitations, which, in contrast to the intermittent olfactory stimuli, were able to maintain a perma- nent effect”. He adds, that the “diminution of the olfactory stimuli seems itself to be a consequence of man’s raising himself from the ground, of his assump- tion of an upright gait” (pp. 99–100). Traumatic seduction and sexual inhibition 199

3. Freud writes (1926d, p. 166), that anxiety is “on the one hand an expec- tation of a trauma, and on the other a repetition of it in a mitigated form”. 4. Freud writes (1926d, pp. 121–122) about “the taboo on touching”: “If we ask ourselves why the avoidance of touching, contact or contagion should play such a large part in this neurosis and should become the subject-matter of complicated systems, the answer is that touching and physical contact are the immediate aim of the aggressive as well as the loving object-cathexes.” 8

Freud’s writing in the twenties: theory construction and clinical research in Inhibitions, Symptoms and Anxiety

Giovanni Foresti

Can we succeed in understanding the differences between these various un-pleasurable affects? Freud, 1926d, p. 132

That my last book would cause a stir in the millpond was to be expected. After a while it will subside again. It does no harm for people to realize that we have not yet earned the right to dogmatic rigidity and that we must be ready to till the vineyard again and again. Freud to Andreas-Salomè, 13th May 1926; quoted in Gay, 1988

Reading Freud’s work is a process of interaction between the text and the reader, which is influenced by differing and sometimes excessive poles of interpretation. When we consider the debt we owe Freud, in fact, our thoughts tend to organise themselves in the middle ground between two extreme and contrasting attitudes: on the one hand, rev- erential for the continuity and consistency of Freud’s research; on the other, critical on account of the at times perceived contradictions and scattered conceptual aporias (Bollas, 2007; Derrida, 1987, 2007; Ferro, 2005, 2010; Grubrich-Simitis, 1997; Mahony, 1987, 2002;

200 Freud’s writing in the twenties 201

Quinodoz, 2004). The former attitude can result in theoretical recon- structions that are too systematic and tend both to minimise the con- ceptual discontinuity, and to ignore the open or unresolved aspects of Freudian theorisation. At the other extreme, the latter attitude can focus too closely on the author’s personal life or on the turmoil of the movement he founded and belonged to, and can therefore neglect the conceptual structure of the texts and their theoretical complexity and clinical meaning (Assoun, 1997; Civitarese, 2010; Momigliano, 1987; Ogden, 2009; Riolo, 1991, 2010). In this re-reading of Inhibitions, Symptoms and Anxiety (Freud, 1926d), I attempt to demonstrate the interpretative usefulness of some hypotheses concerning the dialectic between continuity and discontinuity within the psychoanalytic tradition. The most compre- hensive of those hypotheses is that the struggle between conceptual rigorousness (continuity) and clinical research (discontinuity) consti- tutes the living core of the psychoanalytic research. Within psychoanalysis, we all belong to groups and traditions of thought that strongly affect our conceptual perspectives. The first step towards analysing the text in question was therefore to identify the factors that determine the specific conceptual and institutional tradition I belong to. After deconstructing the interpretations inher- ited from previous generations, I tried to reconstruct the conceptual organisation of Freud’s essay by exploring the various emotional and conceptual dimensions that I think are discernible therein. Having distinguished Freud as clinician, from Freud as politician, and Freud as theoretician, I explore the role that his 1926 theories play in the conceptual models we now use to understand the inhibitions, symp- toms and anxieties that we currently study and treat (Bolognini, 2004, 2008; Ferro, 2002; Ferruta, 2011a,b; Foresti & Rossi Monti, 2010; Neri, 1998).

Interpreting the Italian psychoanalytic tradition

We can analyse how Inhibitions, Symptoms and Anxiety is interpreted in the Italian psychoanalytic tradition by comparing the books that have most greatly contributed to creating that tradition: the Treatise of Psychoanalysis published by Cesare Musatti in 1948, and the book bearing purposefully the same title edited by Antonio Alberto Semi in 1988 (Semi, 1988a,b). 202 Giovanni Foresti

Cesare Musatti edited the Italian translation of the works of Sigmund Freud, which were completed by a Turin publisher, Boringhieri, in the 1970s. In this series of books, Inhibitions, Symptoms and Anxiety appears in the 10th volume, along with all the other publications by Freud between 1924 and 1929. In the foreword to the text in question, Musatti wrote: “Despite some formal imperfec- tions due to the multitude of problems tackled in this relatively short summary, the text makes a fundamental contribution to psycho- analytic theory” (Musatti, 1978). He then describes the publishing history of the text,1 and goes on to contextualise the novelty of the ideas presented in 1926. He mentions the “profound transformation that took place in the early twenties” and argues that the work was written because “Freud felt the need to re-examine the problems of psychogenesis in neurotic manifestations on the basis of these new theoretical perspectives” 2. What insights can we generate by comparing Musatti’s Treatise and the namesake Semi edited forty years later? Here are my results.

Musatti’s Treatise Published just after the Second World War, Musatti’s offering is divided into two parts and makes reference to the first complete edition of Freud’s works: the Gesammelte Schriften. In his book, Musatti paid little attention to the chronological order of publication and reconstructed Freud’s theories into a conceptual order with the intention of making them more accessible to the reading public. Contrary to what he later claimed in the foreword he wrote in 1978, in his Treatise Musatti did not underline the theoretical turning point of the twenties, but instead gave an overall reconstruction of psycho- analytic theories, which he expounded as if they were the logical development of a progressive disclosure of the basic principles of psychoanalysis3. This theoretical scheme derives from the Hegelian combination of logic and history as re-elaborated by the most influ- ential Italian philosopher of the time, Benedetto Croce, and empha- sises the conceptual continuity of Freud’s theories. Yet Musatti’s Treatise does not create a completely imaginary Freud and it certainly does not ignore the novelty of the theoretical ideas published in the twenties. The paragraph that opens the chap- ter where Freud’s 1926 essay is commented upon, is called Weakness Freud’s writing in the twenties 203 and Dependence of the Ego. The first part discusses the aggressiveness of the superego, the sense of guilt, melancholy, and the psychogene- sis of suicide. By the time readers reach the discussion of Inhibitions, Symptoms and Anxiety, they have also finished reading The Repetition Compulsion and the Death Instinct (Chapter 20) and The Doctrine of Psychic Instances (Chapter 21). The length and richness of this commentary—thirty extremely well written pages divided into five different sections4—demonstrates the importance attached to Freud’s 1926 text by Cesare Musatti. Let us now consider the main characteristics of the second text.

Semi’s Treatise The conceptual choices Antonio A. Semi made when he edited his Treatise reflect a very different relationship with the psychoanalytic tradition and they are the result of a radically changed cultural context. At the time the book was published (Semi, 1988a,b), the psychoanalytic movement and its main institutional body, the International Psychoanalytic Association, had just officially recognised the inevitable theoretical pluralism of psychoanalysis (Wallerstein, 1988; 1990). Having held similar conclusions for quite some time, the Italian psychoanalytic community felt the need to take stock of the basic principles and developments of Freudian and post- Freudian psychoanalysis. Semi’s work is the visible result of this collective rethinking. The text is divided into two parts of around 800 pages each, and consists of contributions from more than thirty authors. The first part focuses on observations about theory and technique (Semi, 1988a), and the second part on clinical practice and treatment tech- nique (Semi, 1988b). The “Freudian model” is presented in the second chapter of the first part (Petrella, 1988), in between an open- ing section on Freud’s philosophical and scientific education (Funari, 1988), and a detailed bibliographical conclusion (Barale, 1988). The choice of the word “model” presumably reflects an indirect reference to Bion’s way of thinking, which was already highly influ- ential among Italian psychoanalysts at that time (Gaburri & Ferro, 1988; Neri, Correale, & Fadda, 1987). According to the author of Learning from Experience (Bion, 1962), scientific models are needed in order to make temporary connections between heterogeneous 204 Giovanni Foresti elements, thereby bringing order to observations that would other- wise be too chaotic. Moreover, the word “model” also reflects Bion’s concern that psychoanalytic theories can be used to avoid the emotions elicited by experience (–K) rather than to learn from them (+K) (Ferro, 2002, 2010). Use of the word “model” is then completed by recourse to the terms “function” and “factors”, as evinced by the following passage: “If the analyst observes functions and deduces the related factors from them, the gap between theory and observation can be bridged without the elaboration of new and possibly misguided theories” (Bion, 1962, p. 21). The contribution Fausto Petrella wrote for Semi’s Treatise, seems to go along the same lines. The author points out that there are different versions of the “Freudian model” that can be “extracted straight from Sigmund Freud’s writing” (Petrella, 1988, p. 41). The specificity of these reconstructions can only be identified correctly if you “examine which characteristics of Freud’s writing are needed to formulate and use models” (ibid.). In other words, we need to understand “the position and function Freud assigned to the model- ling” of the psychic object, and to pay particular attention to “the functional aspects and the practical needs” that have influenced the model’s construction” (ibid.). Petrella begins by analysing the difficulties involved in under- standing Freud’s writing. He then goes on to reconstruct the various stages of Freudian theory, mainly focusing on the early works (the Project for a Scientific Psychology, and the Interpretation of Dreams), which are considered to be crucial for the understanding of the origin of archaeological metaphors. Only after this initial reconstruction does Petrella address the issue of evaluating the value of theories and auxiliary constructions in Freud’s work. The organisation of the text reflects the belief that a Freudian theoretical definition is very difficult and even inappropri- ate, since it increases the risk that the theories can be treated as a real and concrete objects5. “If, as we think” he wrote (ibid., p. 100), “there is still life in Freud’s models and theories, it must be sought in an open and non-systematic theoretical development, in the endless game of argumentation and construction, and in the mobility of the discursive process.” The result of this interpretative exercise is very elegant. In this study of Freud’s texts, as is often the case in sophisticated studies of Freud’s writing in the twenties 205 this kind, Petrella finds exactly what his “model”—the model of all the other possible models—allows him to find. The study lacks a detailed investigation into each individual text because the different theories, in his view, collectively describe the general need to repre- sent the psyche and its functioning. In addition, some of the theories (such as the Oedipus complex, infantile sexuality, transference, and the dream-work) “are not theories, but evidence that can be estab- lished within oneself and in patients as they respond to the practice of analysis” (p. 103). For other theories, however (and the example Petrella chose is very interesting: “the idea of the death instinct”), one must recognise that the result is partial and disputable: “it is only a hypothesis, a possible way of seeing things or a requirement of the theory, and not a tangible object whose existence can be confirmed” (ibid.). In Petrella’s conclusions, Freud’s theories thus become, “a sort of mother liquor that contains different crystallization potentials”. The “Freudian model” of Semi’s Treatise is a coherent but somewhat elusive whole: “a protean, ever-changing being”, writes Petrella, “which tends to escape any unilateral and partial interpretation” (ibid., p. 104).

The dimensions of Freudian writing

Let us now try to free ourselves from traditional methods of reading and to use a method often claimed as necessary: the close reading of the Freudian texts (Grubrich-Simitis, 1993; Ogden, 2009; Riolo, 2010). Many authors have proposed the use of group reading and discussion in order to bring out neglected dimensions of Freudian writing (Anzieu, 1986; Ferro, 2005, 2010; Quinodoz, 2004). What I propose here derives from, and diversifies upon, this practice. I suggest that while reading these pages the author himself should be considered as animated by an internal group which affects the mental organisation of the subject. By reading the text from this perspective, one meets a multidimensional and plural subject, who is caught up in thinking thoughts that are still scattered, disorganised, and due to arrive (thoughts that are still searching for a thinker, as proposed in a well known formula by Bion). This is not a composed and harmonically coherent individual, but a Freud that fluctuates in disorderly fashion between analyses and syntheses, as he tries to 206 Giovanni Foresti construct hypotheses aimed at integrating clinical observations, political decisions, and theoretical needs. Let us see what hypotheses and what needs. Many illustrious readers of Inhibitions, Symptoms and Anxiety declare that their first reaction was one of bewilderment as they struggled to identify a conceptually unifying organisation (for instance, Servadio, 1951; Strachey, 1959). The work consists of eleven short chapters, in total about eighty-eight pages, and none of the chapters have a title: the chapters are simply numbered, as if they constitute a collection of notes rather than a text ready for publication. Chapters X and XI are the only chapters that to some extent satisfy the reader’s need to find the founder of psychoanalysis’s sure and convincing prose. The first of these chapters starts with an attempt to summarise Freud’s thoughts on the subject, and ends with a section, divided into three paragraphs, that highlights the impor- tance of the factors that must be considered in order to understand the origin of the neuroses. Chapter XI on the other hand immedi- ately differs from the preceding chapter and corrects it in terms of both theory and style. In Chapter X, the Freud we see at work thinks and acts as the leader of the analytical movement. After a peremptory beginning—an extremely short sentence: Die Angst ist die Reaktion auf die Gefahr, “anxiety is the reaction to fear” (1926d, p. 150), he moves on to examine “two attempts” that were made to discover which “factor” it is that enables some individuals “to subject the affect of anxiety, in spite of its peculiar quality, to the normal workings of the mind, or which decides who is doomed to come to grief over that task” (ibid.). The first attempt mentioned is the work of Alfred Adler, which is written off in a few lines—quite surprisingly, because the turning point of the twenties constitutes a recasting of drive theory that left space for the Adlerian hypotheses on aggression. Adler’s explana- tion, according to Freud, “sets aside the whole wealth of material that has been discovered by psycho-analysis” and must therefore be rejected (ibid.). But the real polemical object of these pages is Otto Rank, and in particular the birth trauma theory that he had published the year before. According to Freudian reconstruction, this theory sustains that birth is the first dangerous situation that the human being encounters. The emotional upheaval that this produces constitutes the prototype of the anxiety situation. Every Freud’s writing in the twenties 207 successive manifestation is none other than an attempt to “abreact” the first trauma of an individual’s life. At first, Freud writes that “it would be unjust to put his attempt on the same level as Adler’s”. Then he declares that “it is not our business to criticize Rank’s hypothesis in detail here” (ibid., p. 151); the theoretical positions of the former. A few lines later, however, he claims that the birth trauma theory “is highly disputable from a theo- retical point of view” and that it “floats in the air instead of being based upon ascertained observations” (ibid., p. 152). At the end of his criticism, Freud writes that “Rank’s theory completely ignores consti- tutional factors as well as phylogenetic ones” (ibid., p. 151) and seals his critical opinion with a few very terse sentences.6 As if dissatisfied with the conclusions, Freud then goes on to add another chapter, this time with a title: Nachträge (translated as Addenda). Having concluded the previous pages with what seems to be a conclusive remark,7 Freud unexpectedly reopens the discussion and re-examines themes that, he writes, had been set aside prema- turely. It is as if having completed the political task that he felt obliged to undertake, he feels compelled to examine the theoretical consequences of the modifications that he made to his positions. The person writing these pages is different from the one at work in Chapter X. Instead of making technically and theoretically limit- ing syntheses, the author’s interest here seems to concentrate on identifying those concepts that make further in-depth analyses possi- ble. This Freud is more a troubled thinker who hopes to reorder the categories he uses than a systematic theorist who vehemently fights the ideas of others. The first part of Chapter XI is entitled Resistance and Anticathexis and once again takes up the theory of repression, which is here reformulated through an insistence on the role anticathexis (Gegenbesetzung) plays in making repression more stable over time. This leads to a rethinking of the functions of resistances, which are initially indicated as the exclusive competence of the ego and subse- quently classified into five types (fünf Arten), that originate from three different parts (drei Seiten) namely id, ego, and superego. Freud then criticises the anxiety theory that he had always sustained (Anxiety from the Transformation of Libido) and brings it back to his interest, by this time outdated, in actual neuroses. He admits that this concept suffered as a result of the topical re-organisation of 208 Giovanni Foresti the psychic apparatus that came to light in the twenties. Given that— he observes en passant—the ego works mostly with desexualised energy, it is possible to propose a previously inexistent theoretical alternative: Ich-Angst oder Trieb-(Es-)Angst? Is anxiety produced by the ego or by the drives (and therefore by the id)? Without claiming to have completely understood the phenomenon, Freud writes, “I hope I have at least succeeded in making the contradiction plain and in giving a clear idea of the point in doubt” (1926d, p. 161). The section that is most reminiscent of the peremptory Freudian conclusions is the third section of the first part and is entitled Repression and Defence. Here Freud returns to the intuitions on psychic mechanisms described in Chapter VI, and criticises his previ- ous reduction of the defences to the mechanism of resistance. Without mentioning either isolation (das Isolieren) or undoing (das Ungeschehenmachen), Freud admits to having thought too often of repression as the only form of defence (in one of his most political texts, he had defined it as the Grundpfeiler, the pillar, of metapsy- chology; Freud, 1914). He then proposes to reactivate use of the notion of defence-process (Abwehrvorgang), one he had used in a long since published text (Freud, 1894a). As if compelled to reproduce the 3+2 schema he had recently coined to classify resistance, Freud then adds section B and section C to section A. In Section B (Supplementary remarks on anxiety) he attempts yet another synthesis that, however, once again fails to satisfy him because the imbalance he describes (imbalance between the subject’s psychic resources and the internal and external dangers) returns to the notion of trauma, and this in turn reopens complicated theoretical and possibly personal questions. In Section C (Anxiety, pain and mourning), only the last subject, mourning, which is discussed in the concluding eleven lines of the text, is one that “does not present any difficulties” (1926d, p. 172). Everything else (the complex relationships between anxiety, drives, threat of object loss, and psychic pain) leads back to the “change from narcissistic cathexis to object-cathexis” and constitutes a tangle of problems that are still difficult to define (ibid., p. 171). How can we explain all these difficulties and hesitations? I think our understanding will depend on a very careful reading of the first chapters of the essay. Freud’s writing in the twenties 209

Earlier chapters of Inhibitions, Symptoms and Anxiety

In the first chapter, Freud begins to reflect like a naturalist (i.e., descriptive psychopathologist, as we would say today), and he tackles the problem of distinguishing the functional inhibitions from the symptomatological productions. Although this path quickly takes him to the functions of the ego and their dysfunctions, which mani- fest themselves in various neurotic affections (a path of great interest, as we shall see in the next paragraph), the first page immediately presents a show of impatience. “But all this is really of little interest;” he exclaims angrily, “and the problem as we have stated it does not carry us very far.” (1926d, p. 87). This quotation is only the first of a lengthy series of criticisms that Freud directs at the text, at the substance of psychoanalytic theories and, in the end, at himself. At the conclusion of the second chapter, after having indentified a rather interesting contradiction between the ego as an active agent of repression and the ego as a weak agent (because it submits to the double influence of the superego and external reality—an issue of heated debate between European psychoanalysis and North American ego-psychology), Freud writes a long tirade against those who expect psychoanalysis to be an absolutely coherent conceptual system. Psychoanalysis is not, he writes, Fabrikation von Weltanschauung.8 The third chapter begins with a reappraisal of the value of psychoanalytic categories (“apparent contradiction is due to our having taken abstractions too rigidly and attended exclusively now to the one side and now to the other of what is in fact a complicated state of affairs”, ibid, p. 97) and ends with a frank admission of theo- retical inadequacy (“for we are not as yet in a position to consider the conditions in which the symptoms of obsessional neurosis, paranoia and other neuroses are formed”, ibid., p. 100). The fourth chapter revives the results of the analyses of Little Hans and the Wolf Man and concludes with the assertion that it is not easy to distinguish the anxiety originated by the ego from the anxiety originated from the repression of drives: “it will not be easy to reduce the two sources of anxiety to a single one” (ibid., p. 110). Despite the clinical and theoretical results, which are by no means banal (these pages contain the distinction between Realangst, automa- tische Angst, and Signalangst), the subject is still not clear enough for 210 Giovanni Foresti

Freud, who writes: “But this takes us nowhere. On the other hand, our analysis of the phobias seems to admit no correction. Non liquet.” (ibid., p. 110, italics in original). The most disconcerting statement is, however, at the beginning of the seventh chapter, where Freud returns to the study of phobias, after a two chapters detour on obsessive neuroses, and writes this decisively symptomatic sentence: “It is almost humiliating that, after working so long, we should still be having difficulty in understand- ing the fundamental facts” (ibid, p. 124). It is difficult to understand these self-critical statements without thinking of a Freud who is completely different from both the politi- cal and theoretical Freud who wrote the last chapters of the book. The Freud who wrote these long meandering passages is a clinical Freud, in at least two senses of the word. We know that the twenties were an extremely difficult period for the founder of psychoanalysis. After the First World War, Freud no longer lived in the capital of a great multiethnic Empire, but in a decadent and nostalgic city that would never again return to the splendour of the previous decades. The deaths of many people close to him (above all his daughter Sophie and adored nephew Heinerle; but also Anton von Freund and his niece Caecilie Graf, who commit- ted suicide at the age of twenty-three . . . “the best of nieces”) and the discovery of a cancer which accompanied him to his death, contributed to the states of depressive discouragement subsequently discussed at length by his biographers (de Mijolla, 2003; Gay, 1988; Major & Talagrand, 2006; Speziale-Bagliacca, 2002). Other painful events occurred in the year he wrote Inhibitions, Symptoms and Anxiety. Within a few months of Freud’s seventieth birthday, his most generous mentor Josef Breuer and his most faith- ful pupil Karl Abraham died. In February 1926 his health worsened and he suffered from an anxiety crises that greatly disturbed him (upon hearing of his problems, Ferenczi offered to go to Vienna and analyse him, an offer for which Freud thanked him but firmly refused). Thus, I imagine that the Freud in these pages is a “clinical” Freud, primarily because his interest in depression, obsessive defences, and anxiety was of immediate personal significance. Freud himself gives the most convincing proof in favour of this hypothe- sis. In the very first chapter of the book he writes one of those Freud’s writing in the twenties 211 crypto-autobiographical passages that abound in some of his texts (Grubrich-Simitis, 1997).

I came across an instructive example of this kind of intense, though short-lived, general inhibition. The patient, an obses- sional neurotic, used to be overcome by a paralysing fatigue which lasted for one or more days whenever something occurred which should obviously have thrown him to rage. We have here a point from which it should be possible to reach an understanding of the condition of general inhibition which characterizes states of depression, including the gravest form of them, melancholia. (1926d, p. 90)

As stated before, there is a second meaning we can give to the word “clinical”. We know that Freud was able to extract material for his reflec- tions from these states of mind. As he did during his first self-analy- sis, in this text too, the founder of psychoanalysis fluctuates between the study of himself and the study of the phemomena he observes in others (Anzieu, 1986; Grubrich-Simitis, 1997). By using writing both as a research tool and as therapy, Freud succeeds in doing what only the great writers can: he treats himself as another (Derrida, 1987, 2007, 2008; Mahony, 1987; Ricoeur, 1990). In this sense, the Freud who wrote the first chapters of the book in 1926, is a “clinical” Freud in the second sense of the word. The person writing these pages is a researcher who reflects upon the psychic disturbances of others and frees himself from the naturalism of contemporary psychiatry (contemporary both for him and us), thanks to a specific quid that is strictly psychoanalytic: the willingness to interpret the clinical mate- rial by using his own psychic resources to their utmost and by bring- ing his own person seriously into play.

Psychoanalytic models and clinical research

The aim of this contribution’s title—Freud’s writing in the twenties—was to direct the reader’s interest in two different but complementary directions. It is, in fact, both an indication of this study’s object (the early postwar writings of the founder of psychoanalysis), and a sentence that indicates the possibility of identifying with the author and of placing his contribution in its historical context. Freud is 212 Giovanni Foresti writing and as we read, we try to imagine how he lived and what he thought. So what have we obtained as we fluctuated between identification and historicisation, between immersion in the text and critical distancing from it? I think the best way to summarise the results is to show how close reading comparison with the ideas that we find in Freud’s work can enrich our understanding of clinical material. I will conclude this contribution, therefore, by discussing a case that requires both clini- cal attention, in the more traditional sense of the word, and the will- ingness to include one’s own psychic functioning in the field of observation. This latter meaning of the word “clinical”, already described at the end of the previous paragraph, develops the Freudian idea that psychoanalysis is an interminable process, that the analyst remains also an analysand and that the clinician, there- fore, has never ceased being a patient. Michela is a woman of around forty, whose symptoms are mainly inhibitory. She suffers from eating disorders, describes a persis- tent but seemingly well tolerated mal de vivre, and has severe diffi- culties in making important decisions in her life (to change work and to marry). Sceptical to the point of cynicism, she seems to live in an eternal and disappointing present that has no possible future. A few weeks after starting her treatment, she suddenly presented an anxiety that she had not previously suffered. We discuss this problem in the last session of the week: if psychoanalysis is a cure, she asks herself and me, why have I started to feel so bad? During the same session where she makes this point, Michela describes a dream. She finds herself on the island where her family have a house (her father died in this place when she was eight years old). In the restaurant where she is having lunch, she meets some famous people from the entertainment industry (the popularity of the island is increasing; the price of real estate is constantly on the rise: it would probably be the right time to sell, she says. . .). Among these VIPs, there is a television anchorman whom she doesn’t like because, she says, “he is too sarcastic”. They talk at length but she remembers only one line from their conversation. Freud’s writing in the twenties 213

Michaela knows that the house that this character bought, is large and very beautiful (a famous photographer is in fact the owner of one of the most elegant houses on the island). Her family’s house has, however, a priceless quality: compared to the anchorman’s, “my house is the closest to the sea”.

Among the factors organising the patient’s psychic functioning, the death of her father (he died at sea during a dive while his wife and daughter waited for him on the boat) certainly plays a fundamental role. The patient has elaborated this traumatic experience by resort- ing to effective mechanisms of negation, as described in Christopher Bollas’s formula “unthought known”. It is as if Michela both knows and does not know. The patient knows that her father’s premature death is still an unresolved problem for her: but at the same time she does not seem to know what consequences this death has had on her. In order to understand a clinical phenomenon like this, the rethinking of the defence mechanisms outlined in Inhibitions, Symptoms and Anxiety is still indispensable. The radical operations of rejection (Verwerfung), negation (Verneigung), and denial (Verleugnung) that Freud described in the twenties, are a conceptual development of the observations on isolation (das Isolieren) and undoing (das Ungeschenmachen) described in the 1926 work and discussed earlier in this text. These concepts can be used to analyse Michela’s psychic processes in more depth; but to this aim, it is also necessary to use the concept of the stabilising function of the anticathexis as well as the distinction between the primary and secondary processes of repres- sion (Freud, 1926d). Using these categories, we can imagine that the house on the seashore is part of a system of emotional investments that are the result of the precocious loss of the parental object. Their function was probably multiple: to guarantee emotional stability and create an imagined family security; to offer a material reality to the processes of identity organisation; and to avoid the problems posed by human relationships by turning to and putting into effect controllable, phys- ical certainties: the house as a substitute for the psychic home. In any case (and independently from the emotive scenarios that are highlighted as and when they occur by the clinical material), Michela’s sudden anxiety can be seen as an epiphenomenon: the result—the signal (Signalangst)—of transformation processes that 214 Giovanni Foresti occur both on the intra-psychic dimension and on the interpersonal level. The psychic phenomena that signal major transformational events, are the result of micro-transformation processes that take place over time in the analysis room (Ferro, 2005). When this does not take place, it is usually because the patient’s Grundpfeilers (the defensive pillars of his/her psychic functioning) have combined with the analyst’s repression and/or negation mechanisms, thus creating those tenacious forms of resistance à deux that we define as “ramparts” (Baranger & Baranger, 2008). In order to reduce the risk of this occurring, it is necessary to take what the patient says very seriously, and, in particular, to examine the structure of their bourgeoning storyline and the variations that the clinical dialogue introduces (Ferro & Foresti, 2008). The animating character of the session’s narrative is an over sarcastic anchorman. This interesting clinical fact can be interpreted in many ways. If we choose to interpret him as a transference figure, the problem is to understand his function and to interpret his appearance. An anchorman is a television presenter who knows how to keep his audience hooked to his programme. Just as his role is to bind together the whole programme, so this character can be a rather effective metaphor for the work that the analyst carries out to keep his/her patients “anchored” or, in other words, in contact with their psychic life. In Michela’s case, however, the allusion to the anchor and the bottom of the sea is, probably, also an indication that leads to her father’s death and to the inner depths of her buried affections. Whatever the case, it seems clear that the arrival of the analyst in the patient’s mental horizon (on the island) has happened and the anxiety that accompanied the landing demonstrates the relevance of the change. Michela is definitely interested in her interlocutor’s home, but she fights against this state of mind and determinedly affirms her loyalty to her old family home (the one which is “the closest” to the sea). But what does the chosen character’s sarcasm mean? Is he an unpleasant character simply because his job is hateful? Or is the patient’s dialogue providing an indication of something that disturbs her a great deal: for example, something that she does not like about the personal style of her analyst. Freud’s writing in the twenties 215

In this framework, how can the analyst intervene with the aim of changing the analytical couple’s dialogue and the psychic function- ing of the analysand? Is young Peter Pan, barricaded inside his island, finally ready to meet Captain Hook, or would it be better for her to prepare herself a bit more before facing him? Is it necessary to proceed with caution, and to make only those indirect and simple interventions that maintain the setting’s stability and gently keep the process moving? Or is it necessary to proceed with more active inter- pretations, ones that deal with the psychically problematic tangles more directly and more clearly? In short, is Michela distressed because the analyst is doing his job and pushes her to think? Or is her distress a signal that the analyst is not involved enough, that he is not on the same wavelength as her, and she finds him too detached and cold?

Concluding remarks

At the beginning of this contribution, I maintained that reading Freud’s work is a process of interaction between the text and the reader that treads numerous paths of interpretation—paths that often appear inevitable and sometimes become excessive. My work aims at demonstrating that it is possible, while digesting the psycho- analytic theories, to balance respect for the interpretative tradition with the search for the differing dimensions inherent to the psycho- analysts’ thinking and writings. “As a method of making something clear to himself ” Bion writes in Learning from Experience, (1962, p. 39) “the analyst needs his own book of psychoanalytic theories that he personally frequently uses together with page and paragraph numbers that make their identification certain.” With the Freudian theories, this suggestion is particularly useful because the conceptual bulk is such that the digestion can easily become a theoretical indigestion (Ferro, 2010; Kernberg, 1996; Wallerstein, 2005). Though difficult to fulfil, there are at least two sets of good reasons for engaging in such a work. As practising analysts, this issue is of inescapable clinical rele- vance: the new type of patients that we meet today (their/our narcis- sistic fragility; their/our reluctance to commit emotionally; their/our 216 Giovanni Foresti turbulent emotional instability) make it necessary to rethink anew where our knowledge is grounded and how our treatment tech- niques work. But tolerance for the internal diversity that we can discern in Freud’s writings is also important for the bettering of both training (to focus more on the method and the treatment process than on the theoretical conclusions that we need to reassure ourselves) and for the amelioration of the psychoanalytic institutes’ functioning and political life. Whether we like it or not, it remains true that “we have not yet earned the right to dogmatic rigidity and that we must be ready to till the vineyard again and again” (Freud to Andreas-Salomè, 13th May 1926, quoted in Gay (1988)).

Notes

1. According to Musatti, the text was written in the summer of 1925, edited in December of the same year, and first published in February the following year (Musatti, 1978). The first edition was in 1926; it was then published for a second time in Gesammelte Schriften, Volume XI (1928), for a third time in Schriften zur Neurosenlehren und zur Psychoanalytischen Technik (1931), and finally in Gesammelte Werke (1948). 2. In the foreword to Inhibitions, Symptoms and Anxiety, Musatti writes that the founder of psychoanalysis “was mainly interested in the problem of anxi- ety and phobias” (Musatti, 1978). He returned to the hypotheses he engen- dered while studying obsessive thought, and tried to rethink psychological dynamics in an attempt to demonstrate how, “in addition to repression, other defence mechanisms supported neurosis” (ibid.). In the conclusion to his fore- word, Musatti pointed out that an earlier translation of Freud’s writing had already appeared in 1951 accompanied by a foreword by another important first-generation Italian psychoanalyst: Emilo Servadio. Musatti quoted Servadio in his foreword and a few sentences might be of interest. “Although . .. quite wavering, with some unclear moments and many unresolved questions, Freud’s discussion about anxiety is nonetheless extremely stimulating . . . “ (ibid., my italics). Servadio addresses the bewilderment felt by the reader of this text with the suggestion that: “We should perhaps look for a point in common between the numerous, different points of view expressed in the text by establishing early on an interior ‘dialectic’ at the heart of the psychic apparatus.” According to Servadio, “our life starts in a foetal phase of non-distinction, it then passes through a new phase of purely subjective non-distinction . . . which is then followed, in the first few months of existence, by phases of internal and exter- nal distinction.” (ibid., my italics). Freud’s writing in the twenties 217

3. In this reading, the “formal imperfections” and the “numerous, differ- ent points of view” that were subsequently pointed out (Musatti, 1978; Servadio, 1951) tend not to be noticed. The main aim of the reading is to understand Freud’s conceptual innovations as examples of removing-yet- retaining (Aufhebung), a concept hailed by Hegel as the logic of the progression of thought and history. The text that best illustrates this type of interpretation is probably the following. Musatti is trying to argue that the theories related to the second topic are not inconsistent with the hypothesis of the sexual origin of neurosis. “We have confirmed” he wrote (Musatti, 1978, pp. 394–395) “the sexual etiology of psychoneurosis, but together we have said that neuroses are produced by conflicts between the id and the ego, and to study how instincts function, we have used a dualist theory and distinguished between libidinal and aggressive instincts. This reasoning seems to be contradictory: either aggressive instincts compete with each other to determine the pathological conditions of psychoneuroses and thus the principle of a purely sexual etiol- ogy of neuroses collapses; or this principle is considered to be right and we should assume that the conflict between the ego and part of the id is the path- ogenic situation, and that there is not a generic conflict between the ego and the id.” Musatti believes that this conceptual difference can be explained in the following way: “This contradiction does not actually exist. Libidinal instincts and aggressive instincts are not two separate parts of the id, but are linked . . .. Therefore, both the principle of the sexual etiology of neuroses, and the fact that they are the result of a conflict between the ego and the id are equally valid” (ibid.). 4. Musatti’s text is organised as follows. How the ego defends itself from the id: a) inhibitions (§176), b) repression,, isolation and cancellation (§177). The problem of neurotic anxiety: a) the theory of the conversion of libido into anxiety (§178), b) neurotic anxiety and ego-defences (§179), c) anxiety and birth trauma (§180). Ego defences from neurotic symptoms (§181). 5. “To understand the meaning of ‘individual pieces of Freud’s theories’ “, Petrella wrote, “we need to recognize that the tension that animates the struc- ture of the texts comes from “two opposing forces in tense equilibrium: a) an imaginary moment that is present in the description and in the theoretical construction, b) in contrast, a moment that tends to restrain the imagination, both by postponing it to clinical-therapeutic practice and by consciously changing the perspectives where the material is received” (Petrella, 1988). 6. In the sentences that condemn the author of The Trauma of Birth, there are the following assertions: “I cannot identify myself with the view that Rank’s theory contradicts the aetiological importance of the sexual instincts as hith- erto recognized by psycho-analysis. For his theory only has reference to the individual’s relation to the danger-situation, so that it leaves it perfectly open to us to assume that if a person has not been able to master his first dangers he is bound to come to grief as well in later situations involving sexual danger and thus be driven into a neurosis.” (1926d, p. 152). And Freud continues: “I do not believe, therefore, that Rank’s attempt has solved the problem of the causation of neurosis; nor do I believe that we can say as yet how much it may 218 Giovanni Foresti nevertheless have contributed to such a solution. If an investigation into the effects of difficult birth on the disposition to neurosis should yield negative results, we shall rate the value of his contribution low” (ibid., italics in original). 7. Chapter X concludes with the words: “Further than this, I believe, our knowledge of the nature and causes of neurosis has not as yet been able to go.” (1926d., p. 156). 8. “I must confess that I am not at all partial to the fabrication of Weltanschauungen. Such activities may be left to philosophers, who avowedly find it impossible to make their journey through life without a Baedecker of that kind to give them information on every subject. Let us humbly accept the contempt with which they look down on us from the vantage-ground of their superior needs. But since we cannot forgo our narcissistic pride either, we will draw comfort from the reflection that such ‘Handbooks of Life’ soon grow out of date and that it is precisely our short-sighted, narrow and finicky work which obliges them to appear in new editions, and that even the most up-to- date of them are nothing but attempts to find a substitute for the ancient, useful and all-sufficient Church Catechism. We know well enough how little light science has so far been able to throw on the problems that surround us. But however much ado the philosopher may make, they cannot alter the situ- ation. Only patient, persevering research, in which everything is subordinated to the one requirement of certainty, can gradually bring about a change. The benighted traveller may sing aloud in the dark to deny his own fears; but, for all that, he will not see an inch further beyond his nose.” (1926d, p. 96 italics in original). 9

The death of an adult child: contemporary psychoanalytic models of mourning

Jorge Schneider

In Inhibitions, Symptoms and Anxiety (1926d) Freud discusses the phenomenon of mourning from two points of view. In the first, he attempts to differentiate inhibitions from symptoms. He defined inhibitions as restrictions of the ego due to the need for protection or the result of an impoverishment of energy. In mourning, the difficult and painful psychical task involved drains energy from the ego. In the second point of view, he addresses the origin of anxiety. He raises the question of when the loss of an object creates anxiety, and when it brings about mourning. For him, the infant missing the mother is traumatic, and therefore originates mourning when the infant feels a need that the mother is supposed to satisfy. On the other hand, if the need is not present at the moment, it turns into a danger situa- tion that originates anxiety. He further elaborates on the issue of mourning when he establishes that it occurs under the influence of reality testing. The ego demands from the bereaved person that he/she separate him- or herself from the object that no longer exists. This last formulation became the basis of his 1917 paper “Mourning and melancholia” (1917e). Parents who lose an adult child present special issues. As with any loss, a number of variables are involved such as, for example, the

219 220 Jorge Schneider personality structure of the parent and that of the child, the age of the child who died, and the response of the environment. It is my premise that, because of the special bond that develops between a parent and the adult child, mourning cannot be completed. For mothers, this bond may be particularly close. Hagman (1995) takes issue with the analysts since Freud who believed that the process and symptomatology of mourning are universal. From this point of view, the psychological and behavioural phenomenon of mourning is far more varied and multiform than that which is described in the psychoanalytic literature. For Hagman, variables such as culture, historical epoch, family, and individual psychodynamics influence how people mourn.

Freud’s paper “Mourning and melancholia”

Freud’s understanding of the psychological processes that differenti- ate mourning from melancholia—that we now call depression—was never superseded. It is remarkable that a paper published in 1917 still has such powerful clinical applications. As we well know, Freud thought of mourning as a normal process that starts when the indi- vidual faces the reality that the loved object has died. The demand that the libidinal attachment to the object be withdrawn creates opposition, and makes the process a slow and painful one. The mourning process is carried out “bit by bit”, involving memories and expectations tied up with the object. Eventually, the work of mourn- ing is completed when the ego becomes free, and the subject is ready to cathect a new love object. In melancholia, the situation is different. Freud tried to explain why there is such a high degree of loss of self-esteem in the melan- cholic patient. As he described it, (1917e, p. 246) “In mourning it is the world which becomes poor and empty, in melancholia it is the ego itself ”. He described what we usually see in depressions: the painful dejection, the cessation of interest in the outside world, the loss of the capacity to love, the inhibition of activity, and the lowering of self-esteem, accompanied by self-reproaches and self-revilings. He thought that, in melancholia, a different psychological process was involved. The loved object, instead of being slowly decathected from the libidinal investment, becomes a part of the ego through the The death of an adult child: contemporary psychoanalytic models of mourning 221 mechanism of identification. The conscience, later called the super- ego, sadistically attacks the lost object, now an aspect of the subject’s ego. In this way, Freud was able to explain the self-reproaches and the loss of self-esteem. In the unconscious, the subject was attacking the love object, now a part of the ego. But why does the subject need to attack the love object? Freud was not very clear on this point, other than to suggest that a regression to a sadistic phase of develop- ment had taken place. He did speculate on the possible reasons why certain persons become melancholic: there was a strong fixation to the loved object based on a narcissistic object choice, and/or the object was experienced in a strongly ambivalent manner. Children are often experienced as narcissistic extensions of the parent, espe- cially the mother. That the child is a part of the mother’s internal world very early on is described by Freud in his 1914 paper “On narcissism” (1914c). There he talks about narcissistic women, but we can now look at it as a normal phase of development. He stated: (1914c, p. 89) “In the child which they bear, a part of their own body confronts them like an extraneous object, to which, starting out from their narcissism, they can then give complete object-love”.

Two psychoanalytic models: contradictory or complementary?

In working with this group of patients, it was my impression that the difficulties in completing a mourning process were related to the strong narcissistic attachment and, to some degree, to the ambiva- lence that these parents had experienced toward their children. How does the narcissistic attachment manifest itself clinically? Usually by idealisation. These children were highly idealised by their parents. They were usually bright, accomplished, and socially adept. The adult child’s death also represents an injury to the parents’ omnipotence: they could not help the child remain alive. Freud described idealisation as the overvaluation of the object. It was related to the establishment of the ego ideal as the child struggles to give up his/her original narcissism or sense of perfection. Heinz Kohut started from the same point, but developed a different theory of narcissism. As he described it, the child attempts to save his/her original narcissism by giving it over to two psychological structures or fantasies: 1) a narcissistically experienced omnipotent and perfect 222 Jorge Schneider self-object, the idealised parent imago; and 2) a repository of grandiose fantasies, the grandiose self. In normal development and through phase appropriate frustrations and disappointments, these primitive psychological structures become integrated within the personality. Primitive forms of narcissism develop into mature forms of narcissism. In Kohut’s model (1971), narcissism has an indepen- dent line of development. In this way, he departs from Freud who described narcissism as evolving into object-love. When the child is faced with chronic traumatic experiences, these narcissistic structures are not integrated within the rest of the personality and remain in their primitive state. As an adult, the indi- vidual seeks an attachment to highly idealised figures or demands recognition and praise. In the clinical situation, Kohut referred to these reactivated needs as the idealising and mirror transferences. Although Kohut described the psychopathology of narcissism, he also emphasised the normal need of the child to have a parent s/he can idealise, and that his or her self be responded to with validation and admiration. In other words, for normal development to take place, the parent should allow him- or herself to be idealised. He/she also should be able to respond empathically to the child’s exhibition- istic needs. From this point of view, a certain degree of idealisation of the parent by the child and of the child by the parent is expected. Freud made this point too. Melanie Klein (1935, 1940) was another analyst who worked ex- tensively with the problem of mourning and melancholia. Like Freud, she used this clinical entity to develop a model of the mind and to think about normal development. Both Kohut and Klein were in- terested in preoedipal development. Both authors understood the origins of melancholia in this early phase of development. The dif- ference between the two was that, for Klein, the problem resided in primitive unresolved conflicts. For Kohut, it was an arrest in devel- opment due to poor environmental responses. I believe that these two models complement each other, and that the psychoanalytic under- standing of mourning and melancholia is a good example of that. Klein provides a better understanding of ambivalence, as it relates to depression, than Kohut does. On the other hand, I believe that Kohut’s understanding of normal and pathological narcissism gives us a better picture of what takes place in the narcissism realm of a par- ent when an adult child dies. The death of an adult child: contemporary psychoanalytic models of mourning 223

Melanie Klein’s theory of object relations involves two stages of development: the paranoid–schizoid position and the depressive position. It includes the vicissitudes of the good and bad objects and the mechanism of projective identification as the main tools for building psychological structures. It is a theory of internalised object relationships and, although different from Kohut’s model, some of the issues raised are intriguingly similar. For example, some of the developmental achievements of the depressive position are similar to Kohut’s description of the cohesive self. It is in the depressive posi- tion that the infant becomes aware of his/her ambivalence toward the object. At this crucial junction, the parent is perceived as a whole object (in the paranoid–schizoid position the object was a part- object), and the infant realises that he/she both loves and hates the same object. The fantasy of destroying by his/her aggression an object that the infant also loves, provokes states of mourning, depres- sion, and guilt. For Klein, this is a normal stage of development. It is partially resolved by the infant’s attempt at reparation and a variety of manic defences that include idealisation. For Klein, depressions usually originate in this phase of development. Contemporary Kleinian analysts have written about the difficulty to mourn. Kancyper (1997) described the struggles of ambivalence between love and hate. He felt that mourning was paralysed when resentment and remorse took over. He particularly wanted to differ- entiate the hateful feelings from the experience of resentment. When resentment takes over, there is a “passion for revenge”. In the state of resentment, disavowal, idealisation, and aggressiveness take over. It is an attempt to ward off the trauma and narcissistic griev- ance. We often see these dynamics in parents whose adult child committed suicide. They rage against the professionals who treated the child, threatening legal action, or actually engaging in costly and painful lawsuits. Steiner (1990) talks about pathological organisations within the personality that act as obstacles to mourning. These organisations result in a denial of separateness between self and object, and con- sequently prevent the patient from experiencing both frustration and envy. Splitting and projective identification result in a complex structure in which parts of the self become stuck inside the objects they invade. Separateness is prevented by the rigidity of the organi- sation. For Steiner, this organisation serves primarily as a defence 224 Jorge Schneider against unbearable guilt. The role of guilt, in this case, conscious guilt, plays a significant part in the difficulty of mourning in the patient I present in the clinical vignette below. Clinically, and depending on how the personality is organised, idealisation may play different roles at different times. It may be an aspect of a manic defence that includes disavowal and splitting, or it may represent the reactivation of an arrested need for the idealisa- tion and a developmentally appropriate de-idealisation of a parental imago. We often see the phenomenon in which the analyst is quickly overvalued or, on the other hand, we may see defences against this idealisation. The idealising transference that Kohut (1971) described is a subtle one and not always easily recognisable. He thought it set up the ideal conditions under which early narcissistic disturbances could be worked through in the analysis. This brief summary points to the difficulties in distinguishing normal from pathological narcissism. It is my contention that, in parents who lose adult children by death, both aspects are involved. Therefore, we have to find a third position between “mourning” and “melancholia”. These parents do become depressed; they also mourn, but they never completely give up the internal representa- tion of the lost child. Hagman (1995) thought that Freud believed that the basic goal of mourning was for the individual to separate from the lost object and recathect new objects. Instead, Hagman now proposes the following conceptualisation of mourning:

There is a restructuring of the inner object relationship that allows for a range of outcomes from complete psychological disengagement from the deceased to continued attachment despite permanent loss. The form of this structuring process will vary according to transferential factors and developmental needs, as well as societal prescriptions and restrictions. In most cases the resolution and restructuring of the relationship with the deceased is a long-term process, extending far beyond the period of mourning proper. (1995, p. 921)

Mourning and adaptation

Pollock (1961), writing from an ego-psychological point of view, thought of mourning as a process of adaptation to a significant loss. The task of mourning was to maintain the constancy of the internal The death of an adult child: contemporary psychoanalytic models of mourning 225 psychic equilibrium. He described two stages of the mourning process: the acute stage, which included shock, grief, pain, and reac- tion to separation, and the chronic stage during which various adap- tive mechanisms attempt to integrate the experience of the loss with reality. The end result of the mourning process may stop at various intermediate steps short of completion. Pollock wrote about the impact on the individual of the death of a significant other. He differ- entiated the mourning required in normal development from that which is activated by the actual death of an object. He reiterated the importance of understanding the significance of the object loss to the individual. The death of a parent in childhood differs from the death of a parent in adulthood. The death of a sibling in childhood differs from the death of one’s own child. He felt that the purest form of the mourning process occurs in mature adults. He thought that, even at this stage of maturity, the loss of a child could never be fully integrated and totally accepted by the parent. He quoted a letter from Freud to Ludwig Binswanger on the anniversary of his dead daughter’s thirty-sixth birthday: We know that the acute grief we feel after a loss will come to an end, but that we will remain inconsolable, and will never find a substitute. Everything that comes to take the place of the lost object, even if it fills it completely, nevertheless remains different. (Pollock, 1961, p. 353)

Clinical vignette Ann was a fifty-five-year-old woman, married to a lawyer, an en- terprising but difficult man. She had two grown children, a boy and a girl, both very bright, and successful professionals. She was the youngest of three children, two boys and a girl. Her father was a prominent businessman. She idealised him with some degree of ambivalence. He was always available when she needed directions about what to do in a particularly thorny situation. Her mother was described as more passive, always eager to follow her husband’s suggestions. Ann was a highly educated and creative woman who struggled to improve herself despite the constant crises that originated in her unstable marital situation. I saw Ann in psychotherapy for two years until the marriage situ- ation stabilised. 226 Jorge Schneider

Two years later, I got a phone call from her. She was despondent; she told me that something terrible had happened, and that “You are the only one who can help me”. Her daughter had killed herself. As she sounded deeply depressed on the phone, I made immediate arrangements to see her. I began seeing her three or four times a week, working around my busy schedule. I was taken completely by surprise because, based on the previous psycho- therapy, there was no indication that her daughter, a successful physician, was depressed. Slowly, as the treatment evolved, I was able to get a clearer picture of what had happened. Pat, Ann’s daughter, was thirty-two years old at the time of her death. At the hospital where she worked, she met a fellow physician with whom she had an affair. She thought this was a serious relationship, but the man was not ready for a commitment and left her. Pat became despondent, thinking that she would never get married. Ann was in constant contact with her daughter, making sure to be available to her. A week before Ann’s phone call to me, her daughter committed suicide by taking an overdose of pills.

When I began seeing Ann this time, she was in a state of deep depression. She looked painfully dejected, she had lost interest in the outside world, and there was an inhibition of activity with lowering of self-esteem accompanied by self-reproaches. She was very con- cerned about her body and, although these hypochondriacal pre- occupations are common in depression, it later became clear that they were characteristic of her personality. She found it very difficult to leave her house; she did not want to face the outside world. Still, she was able to come to her sessions, and she rarely missed one. The sessions were extremely painful for both Ann and myself. She grieved openly, as she recounted the last year of trying to help her daughter deal with her disappointment and anger with the man with whom she was involved. Ann was painfully troubled by her inability to help her daughter. She felt that she had failed miserably as a mother. The more guilty she felt, the more despon- dent she became. There was not much I could do other than to com- municate to her my awareness of her pain. Occasionally, when I could not stand Ann’s intense guilt, I suggested that she had limited responsibility for her daughter’s actions. She could not control Pat’s behaviour. The death of an adult child: contemporary psychoanalytic models of mourning 227

The sessions continued in this manner for the following two years. Slowly, she began to recognise how angry she also was with Pat: “How could she have done that to herself and to her mother?” This anger explained some of Ann’s guilt, along with her inability to help her daughter. The first two years of the treatment were “touch and go”. Slowly, her depression improved, but it worsened again at times of anniversaries and holidays. I had to be alert to Ann’s identification with her daughter’s destructive behaviour. At the peak of her des- pondency, she felt that life was not worth living, but she did not enter- tain suicidal thoughts. I became the idealised container of her despondency and anger, and also the person whom she asked for con- crete advice, a role that her father had played most of her life. I had suspected that I was going to function in that role when she told me over the phone: “You are the only one that can help me”. Initially, I was surprised because, during the period of psychotherapy, I never got the impression that Ann held me in such high regard. As her depression lifted, she was able to resume her normal life. She had kept a small group of friends with whom she met regularly. She also began to attend a variety of cultural events that gave her a great deal of pleasure. But, more importantly, she pursued her interest in art, becoming a well recognised painter. Her tendency to idealise her teachers made her feel like a lesser artist by comparison. At this point, I began to interpret her idealisation as a defence against her own ambition. In this regard, men—her father, I, and her teachers—represented strong masculine figures. Being a woman meant being weak and depreciated. Her daughter’s suicide was another example of feminine weakness. The following years of the analysis focused on her relentless drive to develop herself as a painter. She enjoyed her creativity, and her work was highly praised by her peers and teachers. Up to the present time and many years into the analysis, Pat is still intensely alive in Ann’s mind. Puzzled by this persistence, I explored further with the patient her relationship with her daughter. She missed her daughter a lot and felt very lonely without her. She felt angry with Pat for “leaving” her. She felt very guilty for feeling this way. It turned out that, despite Pat’s professional achievements, she was quite confused about relationships and what to do with her life. Pat was very inde- pendent but often got into despairing crises. At these times she would call her mother for help. They had long phone conversations. 228 Jorge Schneider

Ann enjoyed these conversations with her daughter. In the last year prior to the suicide, Pat withdrew from her mother, attempting to separate from her. Ann felt hurt and angry about her daughter’s detachment. This complex of feelings about her daughter was reac- tivated more intensely around holidays and anniversaries.

Discussion

Ann’s analysis exemplifies a variety of issues common to this group of patients. There is the initial shock and depression following the death of the adult child. The child is usually idealised as somebody very special with whom the parent had a very close relationship. What is usually not evident at the beginning of the treatment is the ambivalence for which the idealisation may serve a defensive pur- pose. The parent may identify strongly with the child and become suicidal him- or herself, a more serious melancholic outcome. The idealisation of the analyst has adaptive and defensive functions, and the technical intervention has to be adjusted accordingly. When it serves an adaptive function, the idealisation has to be respected. This idealisation may also represent the displacement of the dead child’s idealisation onto the analyst. Although some of these patients have the personality traits of narcissistic disorders, the literature suggests that any parent faced with the death of an adult child experiences a similar kind of response. More specifically, the lost adult child remains as an active presence in the parent’s emotional life. Pollock (1961), writing about pathological grief, stated that, when the object has been introjected without identification, it exists as an encapsulated image in the ego as the result of the lack of assimilation. This object is experienced as highly ambivalent. In this group of patients, the object is missed and its absence makes the patient feel extremely lonely. That this attach- ment persists after many years suggests that the adult child played a significant narcissistic function in the parent’s emotional life. We may here combine Freud’s formulation of the narcissistic and ambivalent origins of melancholia. I suggest that what we observe in this group of patients is prolonged or incomplete mourning. What remains unclear is whether this prolonged mourning is a stable emotional state in any parent who loses an adult child. The death of an adult child: contemporary psychoanalytic models of mourning 229

What is the role of analysis in treating these patients? They seek help for the intense pain they suffer. The analytic process helps them cope with the initial depression and work through the variety of feelings involved in the narcissistic injury and ambivalence toward the dead child. Hopefully, they can learn to adapt better with the ongoing mourning. A not unusual favourable outcome is the devel- opment of creativity.

The mourning–liberation process and creativity

Pollock (1982) was interested in how the resolution of the mourning process affects creativity. He wrote a paper on “The case of Kathe Kollwitz”. Kollwitz was a well-known painter and sculptor in Germany who lost one of her two sons, Peter, when he was killed at the beginning of the First World War, at the age of eighteen. Peter was studying to become a painter himself. Pollock described Kollwitz’s surge of new creativity:

After several months of acute grief, Kathe summoned his pres- ence to help her in her work; she believed that Peter had been denied the opportunity to do it himself. Struggling with an artis- tic promise that, with the death of her son, could no longer be fully realized by him, Kathe began to activate the seeds of a talent she feared would die with her menopause. Her renewed creativ- ity not only signaled a partial resolution of her bereavement; it further signified a liberation of energy through identification with the child who might have been creative if he had lived. (1982, pp. 342–343) In June 1926 Kathe and Karl Kollwitz traveled for the first time to the World War cemetery where Peter was buried. After the visit she sculpted the Mother and the Father for the memorial and was able to visualize how they would stand in the graveyard. It had taken her many years to plan, deliberate, and even incu- bate her ideas about the sculpture. It may be that only through her mourning of eight years was she able to sufficiently feel liber- ated to begin actual work on it. (ibid., p. 345)

Pollock concluded that, for mothers who have lost children, the mourning process is never fully completed; they feel they have not been able to adequately preserve their child’s life. 230 Jorge Schneider

Kohut (1971) considered creativity as one of the mature transfor- mations of narcissism. He thought that either a new-found ability to perform certain tasks with enthusiasm or the emergence of inventive artistic ideas might appear in the analysis of narcissistic personality disorders. For him, the creativity was related to the mobilisation of formerly frozen narcissistic cathexes, both in the area of the grandiose self and in that of the idealised parent imago. Ann’s interest in painting predated her daughter’s suicide. It was during the mourning process and during the analysis that this inter- est took the form of an intense pursuit. Contrary to Kollwitz’s exam- ple, it did not seem that this upsurge of creativity was related to continuing Pat’s creative life. It seemed more related to transforma- tions and new adaptations in her emotional life.

Conclusion

The loss of an adult child affects the parent in specific ways. The parent’s sense of omnipotence is threatened by not being able to protect the child. He/she feels responsible and angry with the child for deserting him/her, even when the cause is not suicide, as it was in Pat’s case. This induces guilt that may lead to depression. There is also the perception of an adult life interrupted on the verge of devel- opmental possibilities: career, family, and children. The parent may grieve the absence of grandchildren from this particular child. The mourning for the loss of an adult child is complicated and never completely finished. It demands from the parent a lifelong readjustment of values, expectations, and acceptance of the limited influence we have over other peoples’ lives. Contrary to Freud’s postulate, we do not give up the cathexes to the bereaved child, who remains internalised as an object we continually miss and remember. 10

An unexpected clinical experience: rethinking affects

Samuel Arbiser

Introduction

Psychoanalysis was born at the end of the nineteenth century, in the heyday of the microscope and of the promise of certainty offered by a medicine rooted in the positivist approach to science; it originated in the unexpected discovery of “ordinary unhappiness” (Breuer & Freud, 1895d), concealed behind a heterogeneous series of somatic symptoms known as “hysterical conversion”. Despite expectations, neither cellular lesions nor bacteria could explain these disorders (Freud, 1888). Therefore, it was not easy to categorise the afore- mentioned unhappiness within the framework of positivist science; rather, it was vaguely described as “the circumstances and events of one’s life” (Freud, 1895d). Very soon, a wide array of nosological entities with an evident organic incidence and an uncertain or unknown aetiology joined the ranks of ailments incorporated in the young science under the name of psychosomatic disorders. These successive steps led to drastic modifications in contemporary medical concep- tions which could not disregard psychoanalysis in the process of understanding not only the doctor–patient relationship but also its psychopathological explanations. Psychoanalysis, in turn, profited

231 232 Samuel Arbiser from the enriching experience derived from these new fields; and the scientific and philosophical debate on the nature of the mind and the psyche-soma relationship grew and was revitalised (Rabossi, 1995). However, while we trustingly move along this path which makes psychoanalysis increasingly encompassing, surprise may—some- times—lie ahead of us. Accustomed to the frequent finding of the “psychological explanation” that ultimately elucidates a somatic symptom, we are not always prepared for what, at least apparently, emerges in the opposite direction: a set of typical neurotic symptoms, a phobia, may eventually entwine with a serious organic pathology: in the case described in the present article, an asymptomatic congen- ital vascular brain tumour. Furthermore, we should not exaggerate our reaction. It is by no means a novelty or a rare case; simply, the forgotten concept of pathoneurosis introduced by Ferenczi (1917), revisited by Fenichel (1967), and developed in our milieu (Argentina) by Pichon Rivière (1948) is addressed with considerably less frequency in present-day psychoanalytic literature and in the fora for discussion of theoretical and clinical issues. This presentation contains the report of a clinical case which, loosely considered, could be included in the above-mentioned char- acteristics. Its reading invites us to share perplexities, pose questions and doubts, and engage in some speculation on the issues of the psychic awareness of danger, anxiety as paradigm of affect, and phobias. Consistent with this objective, the case will be presented in global terms, paying due attention to the aforementioned issue: the rela- tionship between tumour and phobia; at the same time, it will be a contribution to my recent reflections (Arbiser, 2003) on the specific object of psychoanalysis, that is, the inevitable suffering derived from the circumstances and events of man’s life as it develops in a socio-cultural environment. This would be consistent with the assertion that we share with the animal world a significant part of the generation of affects which, in Homo sapiens, would be the matrix upon which the historical (non-instinctive) part of affective life, now dependent on the learning process1 in the family and the socio-cultural milieu, is inserted. And in the context of the evolutionary perspective, this would be located in the prefrontal cortex, hyper developed in the most recent hominids that make up our species (Leakey, 1994) at the expense of the retrocession of the rhinencephalon (Netter, 1987). An unexpected clinical experience: rethinking affects 233

Clinical communication

More than a decade ago, a thirty-five-year-old married woman who was the mother of two boys under the age of ten came to seek consultation. She worked part-time as a sales representative, an activity from which she derived little satisfaction. She had been unable to complete her university studies and had attended an elite high school where she had not been an outstanding student. She said she had been a hard-working student rather than a bril- liant one, and that she had gone unnoticed in her relationship with her peers. The reason for her seeking consultation at that time was the pressure exerted on her by her family and her social environment for her to take her children on a visit to Disneyworld, which forced her to face her considerable fear of flying. She also had other phobic symptoms consistent with claustrophobia, such as the occasional impossibility of travelling by car, since she felt locked in and experienced anxiety and a feeling of suffocation; another symptom she related was her aversion to entering a swimming pool or bathing in the sea. As is usually the case with any typical phobia, the description of the symptoms associated to it was imprecise and confusing. The struggle between her neurotic restrictions and her tenacious will to overcome them, driven by her domestic, work, and family responsibilities, explained the lack of continuity in her symptoms. In other patients presenting similar symptoms, it is restriction which generally turns out to be the victor in that struggle, and consequently its regressive corre- lations of helplessness and deep depression prevail. Something like this had happened years before, when she was about to get married and was faced with the imminence of the event: she had a crisis that forced her to postpone the wedding and from which she recovered by resorting to psychiatric assistance. She managed time in an obsessive way, ritualising her everyday activities to the point of feeling that it slipped out of her hands. Among her organic manifestations, the patient reported frequent and annoying allergic rhinitis and conjunctivitis. She had always suffered from a selective dysphagia evidenced by difficulty in swal- lowing medicines in capsule or tablet form. These symptoms gave the impression that the circumstance of her premature birth had left the imprint of an inescapable physical and psychic fragility. 234 Samuel Arbiser

Diagnosis At that time (end of the 1980s), I concluded, at the psychopatholog- ical level, that this was a case of a phobic–obsessive symptomatic faÁade that prevailed over the defensive effort of transforming into a characteropathy of the same kind.2 The episode involving the mentioned crisis prior to her marriage could be understood as an apparent transient regressive decompensation undoubtedly trig- gered by the pressure of facing the responsibilities of matrimony. This made evident, in a dramatic and paroxysmal way, that which appeared in a more subdued manner in her everyday life: an incom- pletely accepted or acknowledged feeling of maturity-related incom- petence to meet the vital demands imposed by her social milieu and the emblems of her social and family upbringing. At the level of psycho-social diagnosis, an obvious discrepancy between the consumer aspirations characteristic of such sociocultural belonging and the patient’s limited economic possibilities of having access to them—as for example the coveted trip to Miami—was note- worthy. This marked, once again, a discrepancy between demands and resources (economic and psychic). At the level of motivational diagnosis, the patient’s egodystonic suffering did not became the motor for the curiosity to elucidate the internal causes of her profuse neurotic symptoms (psychoanalytic function of the personality) but only in the external conflict, ex- pressed as “real”, between the pressure to travel and the obstacle imposed by her phobia, a piece of information that, in my practice, is crucial when it comes to justifying the decision to embark on an analytic treatment. She saw a conflict in a situation that her analyst viewed as a mere setback. That is to say, her motivation originated mainly in the urge to actually solve the problem of her trip. It was not possible to arouse in her any interest to find out the meaning of her symptoms and solve them via psychoanalytic investigation. Thus, she behaved more like a classic psychiatry patient in search of the suppression of symptoms instead of a psychoanalytic patient questioning those symptoms.3

The haemangioma Based on my initial diagnostic impression of a phobic neurosis, the analysand had started therapy with a frequency of two weekly An unexpected clinical experience: rethinking affects 235 sessions, with the promise of complying with a third session in a few months’ time, as soon as her economic situation improved. Contrary to this expectation, a year after starting treatment she had to reduce the frequency to only one session a week as a result of the unfortu- nate ups and downs in her own and her husband’s work situation. Backed up by these conclusive facts, the obstinate “realism” of her convictions, both in the case of these misfortunes and of everything else, became consolidated. For this reason, and resigned to a change of strategy, I did not insist upon the usual resistance analysis more than was prudently advisable according to my common sense. Anyway, after six years of treatment, the analysand’s symptoms had shown marked signs of improvement, resulting rather from the qualified psychotherapeutic support and accompaniment than from the effects of insight. The analysand could finally fulfil her wish of taking her children to Miami, supported by her psychotherapy and with the help of anxyolitics. Despite this achievement, nonspecific dizziness— which apparently did not represent an alarming symptomatology— appeared among the varied physical manifestations that led her to seek consultation with her clinical doctor quite frequently. Curiously enough, and despite the little importance that doctors attributed to this manifestation, she insisted on having complementary clinical tests with an obstinate—and for me, unexpected—determination. These tests would finally culminate in the diagnosis of a sub cortical haemangioma the size of a cherry, located in the left temporo-pari- etal region. It was a skein of capillaries, small veins, and arterioles presumed to be extremely fragile. In sum: a bomb about to explode. This was, precisely, the issue that originally prompted me to submit the present clinical communication: without any knowledge of the fact, this person had a latent congenital anomaly that implied the possibility (although not the certainty) of spontaneous rupture, or rupture induced by an abrupt pressure change, and consequently travelling by plane, or diving in the sea or in a swimming-pool actu- ally entailed serious risk! Imagine my surprise when I learned that all the symptoms I had initially hoped to free her from through psychoanalytic treatment had been, over the course of her life and until that moment, a suffi- ciently effective protection from the bursting of her lesion. 4 And I was equally surprised when I observed the way in which, throughout the odyssey that led to her treatment and cure, she acted with an 236 Samuel Arbiser amazing intuition that gave the observer the impression that she was guided by a mysterious superior wisdom, a wisdom that enabled her to avoid the proposals of classical neuro-surgery, which implied true damage to the integrity of her brain in the process of gaining access to the inconvenient location of the tumour. Thus she finally came across a medical team that practiced a new, bloodless treatment tech- nique via therapeutic embolisation of the afferent and efferent blood vessels of the tumour, which could be reached through a vascular catheterisation; thus, by depriving it of irrigation, a retraction and a restitutio ad integrum healing was achieved. She underwent two successful procedures which chased away for good the risk of a cere- bral vascular accident—generally fatal. Parallel to these medical vicissitudes, another intriguing story associated to homes and removals began to develop. Since her marriage, the analysand had lived in an apartment with which she declared an absolute harmony. She loved it and had decorated it to her taste. As her sons grew up, she needed an extra room, so she decided to move. In the relationship with this second home, not only did she experience affective discomfort, but it was also plagued by mishaps: she hated the place. Remarkably, these mishaps turned out to be. . . plumbing problems! Pipes would constantly burst, or kitchen or bathroom floor drains would overflow. This made her desperate and increased her dislike of this ill-fated house. To make matters worse, when two years had already elapsed after the two medical procedures performed to cure her of her tumours, a violent explosion caused by a gas leak occurred in a neighbouring apart- ment upstairs. In the analysand’s apartment, the laundry and part of the kitchen were destroyed. Also, this terrible accident claimed the life of an unfortunate maid (the neighbours’ maid). The fact that the accident occurred in the early hours of the morning prevented the presence of any of her family members being near the epicentre of the explosion. The tragic reality (realism, once again!) of these events conducted me towards prudent interpretive approaches— avoiding the possibility of banalising the hard reality of that context—associating the problems of the apartment’s plumbing with the blood vessels in her body—the haemangioma—and the fatal consequences she avoided largely thanks to the competence with which she herself dealt with her diagnosis and treatment. I also inter- preted the projection on the young victim (the maid) of a possible An unexpected clinical experience: rethinking affects 237 personal fatal outcome. The casual incidence of these housing- related events offered a not-to-be-missed opportunity to address the representational and verbal processing of obviously traumatic episodes. Prior to these events, this same analysand had already told me, during the course of the session following the terrorist bomb attack on the Amia Jewish community centre in Buenos Aires (July, 1994), that she had spent the whole night watching on television (with the sound turned down, so as not to wake her husband up) the incessant repetition of the images of the explosion and its conse- quences. On that occasion, I had interpreted this as her attempt to digest that which overwhelmed her, whereas her husband, on the other hand, could carry out his digestion simply by dreaming. But on this occasion, I needed to be very prudent in my interventions, taking into account the brutal reality of these events and the grievous toll of human life. I believe that “clichéd” interpretations might have hurt her delicate sensibility as well as banalised the actual signifi- cance and the harsh reality of these events. However, the unexplain- able feeling of discomfort with no mitigating circumstances that the analysand experienced with respect to the second apartment prior to the emergence of this devilish and endless concatenation of cracks and bursts remains a disquieting question. In the course of my clini- cal experience, I had never observed such an evident love/hate affec- tive relationship with “places”, despite remembering Pichon Rivière’s insistence, as a teacher, on what he termed the ecological dimension (1965) on the basis of his clinical experience with psychotic or very regressive patients. He referred to the intense affective cathectisation of certain geographic environments as a result of their projection on the primitive relationship with the mother’s breast. In Argentina, this relationship between affect and place is present in the meaning of the words querencia or pago (home/homeland).

Reflections

The reflection posed by this clinical experience compels us to re- examine Freud’s teachings regarding the concept of danger situation, anguish, and affects in a more general sense, and in the same order, the biological signification of the afore-mentioned, and the decisive imprint that human culture (Oedipus and language) imposes upon them. As has insistently been pointed out at the beginning of this 238 Samuel Arbiser presentation, the more recent works on neurosciences and psycho- analysis contribute a fresh perspective on these issues. One could therefore wonder: 1) Might phobic–obsessive symptoms—classically considered precau- tionary behaviours in the presence of pulsional pressures—also be considered precautionary behaviours triggered by the risk of a potentially dangerous anatomic lesion? 2) What is the explanation for the efficacy and determination with which the analysand conducted her diagnosis and treatment and the finding of a bloodless medical procedure culminating in total restitution? 3) How can we interpret the unexplainable—or only partially explainable on the basis of justifiable reasons—visceral dislike of her second apartment? Let us clarify, in the first place, the issue of the pathoneurosis that we mentioned at the beginning. If an attempt were made to relate this case with a pathoneurosis, an intrinsic relationship between organic and psychic pathology should be admitted, provided that this rela- tionship is not understood in the sense of the psychogenesis of such pathology, as Fenichel points out. Besides, the psychic symptoms should be more general and nonspecific, and it should be unlikely that they make up a systematised neurotic manifestation such as a phobia. But one should ultimately contemplate the possibility that psychism might be able to detect an “anatomic” danger and that besides discovering it and maintaining it out of reach of conscious- ness, it might be able to organise a series of symptomatic behaviours that wisely turn out to be “purpose compliant”. This would appear to be unconvincing in the extreme, and still the sources of profane knowledge, which Freud never disregarded, maintain the belief in the existence of a “sixth sense” 5. We should also attribute to this indefinable sense the skill with which she handled her diagnosis and treatment, and her mysterious feelings towards the houses. In any case, in our search for an explanation we resort to what Freud (1926d, 1933a) termed the “danger situation”, which primar- ily expresses the economic commotion of the psychic apparatus, called traumatic factor in 1933. But, as posited by this author, in order to be able to be an effective protector from danger, the mechanism of An unexpected clinical experience: rethinking affects 239 anxiety must precede the aforementioned economic commotion through the so-called anxiety conditions, namely: loss of the maternal object, castration fear, loss of love, fear of the superego, and anguish of moral consciousness and social anguish. All these conditions refer directly or indirectly to the loss of the object and they refer, likewise, to the fear of drives in terms of the external danger implied in their satisfaction. However, it seems that these conditions cannot explain the alleged detection of danger inherent in the lesion in this particular case, since these conditions involve the dangers associated with the human being in its cultural aspects (loss of the object) rather than in its biological aspect. Referring to the components of the circuit of affects, Regina Pally (1998) distinguishes between automatic affective responses (amygdala) and the changes in these responses implied by the intervention of the prefrontal cortex through the function of memory, proper to human beings.6 Going back to the field of psychoanalytic explanations, would it be possible to resort to what Freud (1917d]) called diagnostic dreams? It posits that, on its regressive path towards the primary narcissism of sleep, the libido invests itself in the representation of the body. The cerebral lesion supposedly configuring something similar to a day’s residue would require a cathexis reluctant to the withdrawal of the libido. However in this case its emergence, more or less masked, in the manifest content of dreams or, in some covert way, in the thoughts occurring during the state of wakefulness, would be explainable. It is more difficult to infer that it should appear under the guise of a typical neurosis, and it is even less credible that it should induce a concatenated series of extremely complex behav- iours culminating in an efficient handling of the analysand’s diagno- sis and treatment, leading her to choose the most convenient option that the cultural world—medical breakthroughs—had to offer. By way of conclusion, the simplest option appears to be to give credence to the hypothesis of a fortunate coincidence and grant to random- ness a greater importance than we usually attribute to it in our unquestioned adherence to “psychic determinism”.

Conjectures I would now like to mention a few ideas that originated during the drafting of this case, while underlining the prudence that any conjec- ture deserves. 240 Samuel Arbiser

The need to reflect on the question of the significance of affects in general, and of the mechanism of anxiety for the survival of the species in particular—and the vicissitudes of the processing that this specific affect would undergo along the path towards the humanisa- tion of our animal nature—became evident. In this line of thought, the works of Gioia (1996) revisit this Darwinian perspective, in addi- tion to offering valuable information on recent ethological studies, and they attempt to re-establish the biological continuity and discon- tinuity of affects, particularly of fear. To my mind, in the human being affects constitute foundation and primary components of the psychic functioning, and they provide, through the wide spectrum of the aes- thetic tonality they impose upon the conscience, a large part of the orientation of our behaviours in the world. Green (1973, 1990b), in his thorough psychoanalytic studies of affects, recognises the exis- tence of an extraordinary complexity in their genesis, a diversity of expressions that question the Freudian metapsychological status (quantity and representation), especially the assertion that all repre- sentations originate in perception. He therefore proposes an investi- gation along the lines of a primary symbolization, described as matrices of personal experiences responding to a primary functioning logic, which do not distinguish between affect and representation. With this in mind, it was tempting to explain the particularities of this case by invoking the idea—not at all foreign to Freud—of a phylogenetic memory: affects as hysterias of the species. By extending the scope of this concept beyond Homo sapiens, I am basing my inferal upon those remnants of wisdom inherited by the surviving species, typical of Darwin’s evolutionary perspective. In this respect, I recalled, from my days of medical training, the physiology laboratory experiment with small animals when their parathyroid glands, which regulate calcium levels in the body, were removed: in the pres- ence of two vessels containing milk, the mice deprived of their glands went without hesitation towards the one whose milk content had been enriched with the mineral. The well-known phenomenon of animals fleeing in terror moments before a natural disaster also comes to mind. In the same way that the newborn human infant loses its innate ability to swim after a few weeks of extra uterine life, a large part of the intrinsic affects in the animal world (at the service of self-healing, protection from predators and from natural contin- gencies) are relinquished in the process of the humanisation of our An unexpected clinical experience: rethinking affects 241 species. These losses are compensated, in terms of survival, by the high degree of complexity of our psyche, inextricably linked to the corresponding complexity of the cultural world; through the management of cultural assets, the human creature is relatively compensated for its characteristic helplessness as compared to other species. The biological foundation of affects must necessarily inter- weave with the new conditions of socio-cultural life implying an extraordinary sophistication with regard to the organisation, struc- turing, and management of the pulsional life (the Oedipus complex), which in turn is conditioned by the universe of language, introducing an extraordinary and infinite semantic diversity. Survival and successful reproduction do not depend solely on the natural world; they also depend on the mentioned production and management of cultural assets. As Freud always maintained, and as has recently been confirmed at the neurological level (Pally, 1998), neuroses apparently constitute the price and the inexorable imprint of this passage; and the precautions inherent in phobias in particular are a clear example of the displacement of fears as biological assets aimed at protection and their resignification to a human scale. To conclude, I would dare to risk the following hypothesis to explain the clinical case: this patient’s phobia had no intrinsic rela- tionship with the brain lesion, but the latter made use of the former, guided by a factor X that we attribute, as a conjecture, to some degree of persistence of the “biological wisdom” of self-preservation. Many enigmatic phenomena attributed to the popular and mysteri- ous “sixth sense”, such as the accident of the other young patient mentioned in endnote 5 or the attraction or aversion to certain places, might eventually fall within the scope of this explanation. In this respect, an interdisciplinary approach shared by neuroscience and psychoanalysis would provide greater scientific support to replace the romantic appeal made to this often-invoked sense.

Notes

1. “Learning process” in a wide sense, as opposed to “instinctive”. 2. Today, I would not disregard this diagnosis; I would only say that it does not form part of the axial aspects of her psychopathology. From my current perspective, the central aspect was her deficit in the process of repre- sentation capacity, characteristic of psychosomatic patients. 242 Samuel Arbiser

3. These reflections form part of the first version of this paper in which I justified my acceptance of a low frequency programme of sessions imposed by the patient. 4. Something similar happened to Oliver Sacks (1998), when ninety-year- old Natasha asked him not to cure her “Cupid’s Disease”, a neurosyphilis, since she thoroughly enjoyed the change it had produced in her, transforming her into a lively, “frisky” person, with the energy of a young woman. 5. Bearing these issues in mind as a result of the drafting of the present article, I remembered the following strong account from a young analysand: “. . . I was sleeping . . . it was around two to three in the morning . . . I don’t know, at first I thought it was a dream . . . I heard a noise like the one made by a door when it opens slowly . . . like a creaking sound, I raised my hand and deflected a large mirror which got loose from the upper door of the closet and was falling directly on my head . . . it fell on the ground and shat- tered into pieces . . . I shouted so loudly that my father came running in, in despair . . .” 6. “The amygdala activates automatic preformed responses. The prefrontal cortex, fully developed in human beings, may transform the amyg- dala’s automatic responses into decisions and choices based on previous expe- riences . . . Human anxiety may be the high price paid for the ability to anticipate danger . . . Inferior animals suffer the consequences of mistaken choices but they do not worry about this beforehand.” (Pally, 1998, p. 354). REFERENCES

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INDEX

abasia, 13, 187, 192 intense, 135 Abraham, K., 210 life, 232 abwehr [defence], 97 management, 135, 139–140 Adler, A., 74, 206–207 manifestation, 109 affect(ive), 3–5, 8, 17, 32, 35, 41, primordial, 142 44, 54, 56–59, 64, 71–72, 86, reaction, 50, 54, 89, 139 104–105, 107, 109, 116–117, regulation, 139 134–135, 138, 152, 174–175, relationship, 237 187, 189–191, 193, 232, 237, response, 239 239–241 signal, 50, 54, 124 anxiety, 71–72, 74–75, 85–86, state, 17, 56–57, 64, 86, 88, 142, 206 135–137, 140, 196 cathectisation, 237 suppression, 14 character, 41 symbol, 18, 145 conflict, 189 tendency, 106 containment, 138 theory of, 3 discharge, 109 transformation of, 15 discomfort, 236 unpleasurable, 56, 200 disruptive, 134 world, 113, 117 explosion, 115 aggression, 115, 120, 138, 143, expression, 105 157–158, 178–183, 206, 223 integration, 138 active, 149

253 254 Index agoraphobia, 33, 51 realistic, 50, 86, 89, 92 amnesia, 44 repression, 34 hysterical, 88 separation, 124, 132 anger, 64, 94, 159, 178–179, 194, sexual, 196 226–228, 230 signal, 5–6, 62–63, 65, 90, 105, Angst [anxiety], 89, 142, 170, 209 108–112, 116–117, anxiety (passim) 121–123, 142–143, -animal, 28 148–149, 152, 164, 178, anticipatory, 177 183 -arousing, 123 -situation, 60, 72 attack, 52, 68 social, 63, 69 automatic, 105–106, 108, 115, -state, 56, 58, 85–86, 105, 131, 142, 152, 164 145 birth, 124, 144, 146 -symptom, 25 bodily, 145 theory of, 2–5, 121–122, 136, breakdown, 147 155, 164, 178, 207 castration, 47, 49, 61–63, 67, traumatic, 142 104, 124–125, 127–128, Anzieu, D., 205, 211 144, 167–168 après-coup, 151–152, 154 childhood, 60, 126 Arbiser, S., 232, 243 conscience, 52–57 Assoun, P.-L., 201, 243 diffusion, 138 attachment, 48, 182, 222, 224, disorder, 3 228 ego-, 34, 64, 85 libidinal, 220 fragmentation, 138 narcissistic, 221 hysteria, 35 autism, 114–115, 156 -idea, 32 impingement, 135 Barale, F., 203, 243 initial, 145 Baranger, M., 214, 243 instinctual, 85, 92 Baranger, W., 214, 243 moral, 52, 63, 70, 127 Baron-Cohen, S., 182, 243 neurosis, 2–3, 34, 56, 65, 86, behaviour(al), 8, 22, 24, 28, 36, 89, 91, 112, 131, 164, 188, 39, 41, 44, 58, 69–72, 89–91, 217 93, 118, 178, 180, 226, 240 phylogenetic, 144 chaos, 116 primal, 61, 125 complex, 239 primary, 119, 121, 124, 128, destructive, 226 131–132, 147 disruptive, 118 primordial, 5–6, 142–147, extemporaneous, 116 149–152 normal, 44 -reaction, 75, 85, 89, 91 phenomenon, 220 real, 3 precautionary, 238 Index 255

schizophrenic, 115 intense, 94–95, 148 sexual, 3, 177, 181 libidinal, 34, 53, 87 shunt, 116 narcissistic, 95, 208 symptomatic, 140, 238 object-, 30, 48, 59, 67, 95, 208 Bick, E., 146, 243 sadistic, 49 Bion, W. R., 104, 106, 109, 152, unsatisfiable, 96 203–205, 215, 243–244 Chervet, B., 151–153, 244 –K, 204 Civitarese, G., 201, 244 +K, 204 Cohen, D. J., 182, 243 Blass, R. B., 131–132, 244 Compton, A., 120, 244 Bollas, C., 200, 213, 244 conscious(ness), 15–16, 19, 25, Bolognini, S., 201, 244 40–41, 43, 66, 83, 87, 89, 97, Botella, C., 153, 198, 244 103, 108, 113–114, 116, 129, Botella, S., 153, 198, 244 149, 173, 183, 190, 193, 217, Brenner, C., 120, 122, 177, 179, 238 244 guilt, 224 Breuer, J., 97–98, 187, 210, 231, ideation, 95 244 labour, 106 mind, 2 care-taker, 134–137, 140 moral, 114, 239 primary, 5 pre-, 16–17, 110, 117, 137, 149 case studies state, 104 Ann, 225–228, 230 Correale, A., 203, 250 Kathe Kollwitz, 229 Couve, C., 120, 251 Michela, 212–215 Croce, B., 202 Miss E, 6, 189, 191, 195–198 castration, 32, 47–50, 52–54, 63, Dare, C., 121, 251 66–67, 69, 71, 111–112, Davis, M., 180, 244 123–127, 129–130, 137, 164, death, 5–7, 53–54, 127–128, 166, 168, 195 130–131, 144, 146, 157, 171, anxiety, 47, 49, 61–63, 67, 104, 210, 213–214, 221, 224–226, 124–125, 127–128, 144, 228–229 167–168 drive, 4, 106, 142–144, complex, 32, 38, 47, 67, 111, 146–147, 149–151, 153, 117, 161, 168 163 fear of, 32–33, 39, 46–47, 52, fear of, 5, 53–54, 64, 123, 54, 63, 72, 128–129, 239 127–128, 130–131 cathexis, 7, 16–17, 23, 47–48, 59, instinct, 120–121, 123, 131, 61, 64, 95–96, 125, 174, 239 158, 205 anti-, 81–83, 88, 207, 213 internal, 198 ego-, 17 premature, 213 instinctual, 15, 175 psychic, 108 256 Index

De Bianchedi, E. T., 120, 122, infant, 176 244 mental, 60, 89 de Cervantes Saavedra, M., 2 needs, 136, 224 de Cortiñas, L. P., 120, 122, 244 normal, 222, 225 defence [abwehr], 97 of creativity, 229 defence, 6, 16, 24, 29, 35, 38, 42, period, 136 44, 47–49, 52, 70, 83, 87–88, phase, 70 97–98, 121, 135, 140, 143, preoedipal, 222 172, 175–176, 178–179, 183, psychic, 149, 151 109, 208, 223–224, 227 restorative, 117 concept of, 88 sexual, 40, 79 ego-, 217 psycho-, 110 hysterical, 13 stages of, 104, 106, 135, manic, 223–224 222–223 mechanism, 4, 39, 191, 213, diphasic, 37, 43 216 Dreher, A. U., 121, 251 obsessive, 210 primary, 106 ego (passim) process, 208 -anxiety, 34, 64, 85 protective, 195 -cathexis, 17 deliverance [Erlösung], 74 clinical, 158 de Mijolla, A., 210, 245 -defences, 217 Denis, P., 191, 245 dependence, 186 de Piccolo, E. G., 120, 122, 244 -dystonic, 163, 234 depression, 14, 136, 197, 210, function, 11, 13, 77, 173 220, 222–224, 226–230 hysteric, 186 deep, 226, 233 ideal, 157, 163, 197 discouragement, 210 non-, 147 position, 223 -organisation, 21–23 state, 211 pleasure, 157 Derrida, J., 200, 211, 245 psychology, 133, 209, 224 Desire of the Mother, 169 -resistance, 84 development(al), 28, 31, 40, 45, super, 5, 14–15, 18–19, 21–23, 48, 63, 65, 67, 72, 75–76, 79, 37–42, 45, 52, 54, 63–64, 127, 133, 135, 138, 144, 146, 66–67, 69, 71–72, 84, 103, 171, 173, 202, 221, 230 112–114, 117, 123, achievement, 223 127–128, 130, 133, arrest, 139–140, 222 136–137, 144, 162–163, child, 72, 223 165, 167–168, 173, disorder, 114 182–183, 195, 203, 207, empathic, 182 209, 211, 239 failure, 139 -syntonic, 79 Index 257

Erikson, E., 104, 245 Dora, 6, 91, 97, 188–190, 198 Erlösung [deliverance], 74 Draft L [Notes I] from Extract Eros, 46, 49, 103, 106, 143, 148, from the Fliess Papers, 189, 151, 153, 174, 181 246 Elisabeth von R, 187 Fadda, P., 203, 250 Fragments of an Analysis of a Case Falcão, L., 146, 152–153, 245 of Hysteria, 6, 15, 97, 105, fantasy, 111, 135, 137, 168–169, 188, 190, 198, 246 171, 189, 195, 223 “Group psychology and the fear [Furcht], 89 analysis of the ego”, 107, femininity, 67, 195 190, 197, 246 Fenichel, O., 232, 238, 245 Inhibitions, Symptoms and Anxiety Ferenczi, S., 63, 79, 191, 210, 232, (passim) 245 facsimile, 9–99 Ferro, A., 200–201, 203–205, “Instincts and their 214–215, 245, 247 vicissitudes”, 17, 30, 157, Ferruta, A., 201, 245 165, 246 Fine, B., 121, 250 “Introductory Lectures on first unification, 144 Psycho-analysis, Part III”, Fliess, W., 2, 15, 95, 154, 189 3, 24, 37, 89, 99, 246 Foresti, G., 201, 214, 245 Little Hans, 25–28, 30–32, fort/da, 157 48–50, 54, 164, 209 Freud, A., 173, 245 “Manuscript E”, 6, 99, 246 Freud, S. (passim) Miss Lucy R, 189 “A child is being beaten”, 169, Moses and Monotheism, 191, 246 247 “A meta-psychological Mourning and Melancholia, 7, 55, supplement to the theory of 93, 96, 168, 219–220, 246 dreams”, 51, 239, 246 New Introductory Lectures on An Autobiographical Study, 185, Psycho-analysis 247 “Femininity”, 2, 20, 99, 107, An Outline of Psychoanalysis, 173, 143, 145, 149, 162, 175, 247 238, 247 “Analysis terminable and “On narcissism: an interminable”, 83, 168, 176, introduction”, 95, 107, 157, 247 221, 246 Beyond the Pleasure Principle, “On the grounds for detaching 15–16, 18, 57, 89, 91, a particular syndrome from 94–96, 143, 151–152, 157, neurasthenia under the 176, 246 description ‘anxiety Civilization and Its Discontents, neurosis’”, 34, 56, 65, 99, 52, 198, 247 188, 198, 246 258 Index

“On the history of the Freudian psychoanalytic movement”, concepts, 107, 171 208, 246 considerations, 105 “On the psychical mechanism of dialectics, 152 hysterical phenomena: foundations, 1, 4 preliminary Law, 167 communication”, 105, 246 metapsychology, 113 “On the right to separate from model, 203–204 neurasthenia a definite protofantasies, 162 symptom-complex as psychopathology, 3 ‘anxiety neurosis’”, 3, 6, Freund, A. von, 210 154, 246 Funari, E., 203, 247 “Project for a scientific Furcht [fear], 89 psychology”, 105–107, 204, 246 Gaburri, E., 203, 247 Rat Man, 41, 43–44, 98 Garvey, P., 120, 251 “Repression”, 3, 15, 18, 33, 70, Gay, P., 200, 210, 216, 247 81, 246 Gioia, T. B., 240, 247 “Some elementary lessons of Glasman, S., 168, 247 psychoanalysis”, 112, 247 Glover, E., 120, 247 “Some points for a comparative Graf, C., 210 study of organic and Green, A., 116, 144, 148, hysterical motor paralyses”, 150–151, 153, 240, 189, 198, 231, 246 247–248 Studies on Hysteria, 17, 22, 57, grief, 32, 74, 76, 169, 171, 206, 97, 172, 187, 231, 244, 246 217 “The economic problem of acute, 225, 229 masochism”, 151, 176, 247 pathological, 228 The Ego and the Id, 19, 38, 54, Grillon, C., 180, 244 64, 79, 83–85, 112, 163, Grubrich-Simitis, I., 200, 205, 173, 183, 186–187, 247 211, 248 The Interpretation of Dreams, 51, guilt, 150, 183, 223–224, 172, 174, 204, 246 226–227, 230 “The neuro-psychoses of conscience, 150 defence”, 22, 37, 87, 97, 245 conscious, 224 “The splitting of the ego in the intense, 226 process of defence”, 112, sense of, 41, 84, 203 247 unbearable, 224 “The unconscious”, 3, 50, 64, unconscious, 186 70, 174, 246 Wolf Man, 29–31, 33, 37, 48, 63, Hagman, G., 220, 224, 248 164, 209 Hartman, H., 173, 181, 248 Index 259 helpless(ness), 61, 63, 65, 68, 78, libidinal, 40 90–92, 122, 126–128, 130, masochistic, 42 145–146, 148, 233, 241 passive, 30 admission of, 90 reprehensible, 15 biological, 62, 147 repressed, 17, 24–25, 32, 48, mental, 62, 96, 147 77–78, 81 motor, 92, 146 sexual, 79, 181 physical, 90 substitutive, 19 psychic(al), 65, 90–91, 92, 106, tender, 30, 49 108, 123, 146, 149 wishful, 26, 66 psychological, 167 instinct(ual), 15, 17, 40, 48–49, hilflosigkeit [helplessness], 146 53, 70, 72, 80–81, 90, 92, 98, Hinshelwood, R. D., 119–120, 136–137, 217, 241 122, 248 absence of, 162 Holder, A., 121, 251 aggressive, 217 hysteria, 3, 12–13, 37–39, 43–44, aim, 173 67, 81–82, 87–88, 98, 127, anxiety, 92 166, 168, 170, 185, 187–189, cathexis, 15, 175 192, 195, 240 component, 174 anxiety, 35 danger, 50–51, 69, 80, 89–90 conversion, 35–36, 46, 71, 87 death, 120–121, 123, 131, 158, sexual, 188 205 id, 14–16, 19, 21, 29, 34, 39–42, defusion of, 38 45, 48–49, 64–66, 68–70, 77, demand, 18, 50, 68, 79, 88, 79–80, 84, 88, 103, 106, 110, 91–92, 175 113, 142, 160, 162–163, 166, destructive, 48, 92 173, 207–208, 217 disagreeable, 27 anxiety, 64, 85, 175 id, 85 process, 34 impulse, 15, 18–19, 21–22, repressed, 78 26–30, 33–34, 39, 41, 49, impulse, 19, 26, 29–31, 33, 45, 48, 69, 77–78, 80, 85, 87–88, 66, 77–78, 83, 177 175–176 aggressive, 40–41, 48–49, 181 lack of, 158 conflicting, 27 libidinal, 217 death, 5–6 movement, 5 emerging, 175 need, 63, 92, 96, 127 forbidden, 174 non-, 232 genital, 29 process, 16, 69–70 instinctual, 15, 18–19, 21–22, regression, 29 26–30, 33–34, 39, 41, 49, rejected, 80 51, 66, 69, 77–78, 80, 82, representative, 17, 33 85, 87–88, 175–176 repression, 30, 51, 66, 82–83 260 Index

satisfaction, 15, 175 psychological, 3 self-preservation, 131 regression of, 41 sexual, 48, 76, 217 repressed, 33 stimulus, 94 sadistic, 143 theory of, 48 life, 5, 8, 20, 38, 59, 66, 70–72, 79, trend, 81 86, 91, 122, 128–129, 138, isolation, 44–45, 88, 114–115, 143–144, 147, 149–150, 174, 208, 213, 217 193, 204, 207, 212, 216, 218, 227, 229–232, 235–236, 240 jouissance, 164–165 affective, 232 animal, 4 Kahn, L., 152, 248 annihilation of, 53, 120, 128 Kancyper, L., 223, 248 creative, 229 Kernberg, O. F., 215, 248 difficult, 192 Klein, M., 5, 119–122, 131–132, drive, 143–144, 150 222–223, 248 emotional, 228, 230 on anxiety, 5, 119, 121, 123, erotic, 150 131–132 everyday, 53, 178, 234 theory of object relations, 223 fear for, 53, 64, 127 Kohut, H., 5, 107, 111, 133, genital, 38 136–140, 221–224, 230, 249 human, 237 Kris, E., 181, 248 intra-uterine, 62, 79, 147 mental, 66, 173 Lacan, J., 6, 107, 111, 155–171, normal, 227 249 personal, 201 Imaginary, 6, 156, 158 political, 216 Real, 6, 156–163, 166, 169–171 psychic, 186, 214 Symbolic, 6, 156–159 pulsional, 241 Lacanian clinic, 156 real, 78 Laplanche, J., 156, 249 sexual, 79 Leakey, R., 232, 249 socio-cultural, 241 Ledoux, J., 179, 249 longing [sehnsucht], 61, 94–96, libido, 3–4, 12, 29–30, 33–34, 125–126, 130, 148 37–39, 48–49, 65, 79, 85–86, Löwenfeld, L., 3 122–123, 142–144, 149, Lowenstein, R., 181, 248 173–174, 217, 239 disentangled, 5, 146 Mahony, P., 200, 211, 249 free, 3 Major, R., 210, 249 genital, 63 melancholia, 14, 95, 117, 156, narcissistic, 5, 59, 106, 125, 128, 158, 163, 167, 169, 203, 211, 143, 146 220–222, 224, 228 object, 143, 181 Miles, L., 180, 244 Index 261

Miliora, M., 138, 249 repetitive, 139 Milton, J., 120, 251 repressed, 139 Modernist, 2 satisfaction, 23 Momigliano, L. N., 201, 249 solidity, 108 Money-Kyrle, R. E., 120, 250 stages, 113–116 Moore, B., 121, 250 strivings, 139 mourning, 7, 14, 55–57, 93, 96, theory of, 221 171, 208, 219–225, 228–230 transference, 140 Musatti, C., 201–203, 216–217, women, 221 250 Neri, C., 201, 203, 250 Netter, F. H., 232, 250 Name-of-the-Father, 158, neurosis, 24, 27–28, 35–36, 38, 164–165, 167–169 40, 43–48, 50–51, 53, 60, narcissistic, 53–54, 63, 103, 107, 66–69, 72–73, 76–80, 83, 87, 110, 113, 135, 144, 155, 157, 89, 91, 97, 124, 127, 129, 132, 166, 221–223, 228, 230 156, 161, 164–165, 167, 199, attachment, 221 206–207, 209, 216–218, 239, axis, 164 241 catastrophe, 106 actual, 4, 33, 65, 85 cathexis, 95, 208, 230 anxiety, 2–3, 34, 56, 65, 164, dimension, 105 188 disorder, 228, 230 childhood, 72, 78 disturbance, 224 hysterical, 24, 57 dual, 113 narcissistic, 116–117 fragility, 215 obsessional, 23–24, 29, 36–46, function, 197, 228 52, 67, 69, 71, 81–83, image, 167 87–88, 98, 127, 168, 170, impairment, 110 195, 209–210 injury, 229 patho-, 232, 238 integrity, 111 phobic, 234 libido, 5, 59, 106–107, 125, 128, psycho-, 3, 65, 104, 112, 116, 143, 146 217 love, 109 transference, 116 neuroses, 116–117 transparent, 31, 54 object, 221 traumatic, 53, 65, 127 organisation, 162 Newman, K., 5, 134, 139, 250 original, 221 pathological, 222, 224 object (passim) pride, 20, 218 bad, 223 primary, 115, 239 -cathexis, 30, 46, 48–49, 59, 67, realignment, 113 95, 199, 208 reassertion, 108 constitution, 144 262 Index

dangerous, 16, 168 self-destructive, 150 external, 91, 123 symptoms, 37 failure, 136 Oedipal female, 31 attitude, 25 good, 223 conflict, 133, 197 idealising, 138, 167 dilemma, 110 internal, 135 passional drama, 111 libido, 143, 181 post-, 114 loss, 7, 54, 61–62, 66–67, 69, pre-, 222 75, 91–96, 109, 123–130, resolution, 111–112 147–148, 166–167, 208, situation, 137 219–220, 222, 224–225, 239 transit, 167 love, 46, 49, 67, 107, 123, 127, wish, 122 137, 167, 220–221 Oedipus, 169, 237 mother, 148 complex, 26, 30–32, 37–39, 46, narcissistic, 221 104, 112–113, 131, 159, noxious, 5 182, 205, 241 of drive, 6 negative, 48 parental, 127, 140, 213 positive, 31, 48 partial, 109, 223 crossroad, 111 perceptible, 61 Ogden, T., 201, 205, 250 presentation, 95 primary, 117 Pally, R., 239, 241–242, 250 protecting, 92 Panksepp, J., 178, 250 psychic, 204 paradigm, 1–2, 4, 104, 137, 141, -relations, 62, 82, 126–127, 164, 168, 232 139–140, 147, 223–224 paralysis, 13, 89, 166, 187, 190, self-, 5, 136–141, 222 192 sexual, 46, 114 motor, 35, 192 substitutive, 27 oculomotor, 188 transference, 140 of the ego, 166 valued, 61, 79 phenomena, 189 objet petit a, 6, 158–160, 163–164, Peskin, L., 6, 159, 162, 169, 250 167–171 Petrella, F., 203–205, 217, 250 obsession(al), 38, 44, 135, 185 Pfaff, D., 182, 250 acts, 12, 39, 68, 186 phobia/phobic, 13, 26–35, 46, ceremonials, 43 48–52, 67, 71, 82, 127, 164, idea, 41 168, 170, 191–192, 195, 210, neurosis, 13–14, 23–24, 36–46, 216, 232, 234, 238, 241 52, 67–69, 71, 81–83, acts, 185 87–88, 98, 127, 168, 195, agora-, 33, 51, 68 209, 211 animal, 28, 31–33, 48, 50, 69, 71 Index 263

character, 12, 186 Rabossi, E., 232, 251 childhood/infantile, 48, 59–60, rage, 14, 139, 143, 178–179, 183, 71, 92 211, 223 claustro-, 233 reactive, 134 hysterical, 101 Rank, O., 59–60, 74–76, 85, 105, neurosis, 234 206–207, 217 -obsessive, 234, 238 Rapaport, D., 175, 251 of heights, 92 Ricoeur, P., 211, 251 of horses, 25–27 Riolo, F., 201, 205, 251 person, 117 Rossi Monti, M., 201, 245 symptomatology, 7 Rotemberg, H., 113, 251 symptoms, 233 syphilido-, 72 Sacks, O., 242, 251 typical, 233 sadistic/sadism, 29, 49, 143, 168 undefined, 101 aggressiveness, 30 Pichon Rivière, E., 232, 237, 250 -anal, 37–39, 48 pleasure, 12–13, 16, 19, 49, 64, attack, 221 68, 86, 106–108, 110, cathexis, 49 113–114, 150, 165, 167, 170, component, 143 175–179, 181, 183, 189, 193, libido, 143 196, 198 organisation, 29 aggressive, 177 phase, 30, 38, 221 dis-, 108, 145, 189 Sandler, J., 121, 251 ego, 157 Scalozub de Boschan, L., 120, investment, 194 122, 244 principle, 16, 69, 107, 145, schizophrenia, 114–115 175–176, 183 sehnsucht [longing], 61, 94–96, sensual, 186 125–126, 130, 148 sexual, 177 self, 5, 23, 113–115, 133–134, un-, 12, 15–18, 24, 35–36, 136–139, 142, 222–223 56–57, 59, 64, 68, 85–86, -analysis, 211 96, 125, 145, 175–177, 183 -annihilation, 115, 191 Pollock, G., 224–225, 228–229, -assertion, 109, 115 250–251 cohesive, 223 Pontalis, J.-B., 156, 249 creative, 136 psyche, 104–106, 110, 130, 132, -criticism, 139, 210 136, 140, 148–149, 152, 156, -destructive, 117, 149–150 162, 205, 241 -esteem, 140, 220–221, 226 child, 134–136 -evident, 66, 93, 129 -soma, 232 -experience, 138 grandiose, 221, 230 Quinodoz, J.-M., 201, 205, 251 -healing, 240 264 Index

imaginative, 134 life, 79 -love, 23 lusts, 72 -ness, 107, 109, 113 motivation, 182 -object, 5, 136–141, 221 object, 46, 114 -preservation, 53, 62, 90, 131, orientation, 164 143, 178, 181, 241 phantasies, 14 -protection, 70, 178–179 pleasure, 177 -punishment, 14, 42 practices, 34 -punitive, 115 psycho-, 110 -reproach, 220–221, 226 significance, 13 -reviling, 220 stimulation, 177 sense of, 5 taboos, 182 strengthened, 140–141 temptation, 33 true, 134, 139 theories, 111, 197 weakened, 140 urge, 174 Semi, A., 201–205, 251 sexuality, 40, 53, 79, 97, 180–181, Servadio, E., 206, 216–217, 251 195–196 sexual, 182, 188, 191, 217 childhood, 111 abstinence, 65 homo-, 164 act, 12, 14, 186 infantile, 79, 186, 205 activity, 188 normal, 191 anxiety, 197 Silberstein, E., 2 arousal, 3, 181 Simon, B., 132, 244 behaviour, 3, 177, 188 Socarides, D., 138, 251 circuits, 181 Speziale-Bagliacca, R., 210, 251 danger, 76, 217 Spillius, E. B., 120, 251 desire, 181, 193 splitting, 21, 116, 135, 223–224 development, 40, 79 defensive, 195 difference, 111 psychical, 98 drive, 143 vertical, 110, 112 excitement, 3, 29, 34, 65, 85, Steiner, D., 120, 251 151, 173, 198 Steiner, J., 223, 251 experience, 12, 185–186 Stolorow, R., 138, 251 factors, 53 Strachey, J., 206, 251 fantasies, 197 subjectivity, 106, 114–115, 150, function, 6, 11–12, 174, 185, 160, 163, 168 198 autistic, 114 hysteria, 188 embryonic, 115 identity, 114 symbol(-ic), 18, 46, 54, 124, 145, impulse, 79, 181 153, 159, 161, 164–167, 189, instinct, 48, 76, 217 240 intentions, 70 affective, 18, 145 Index 265

apparatus, 170 136, 143–144, 148, 172–176, arrangement, 165 178–179, 203, 205–207, 217 branch, 159 birth trauma, 206–207 capacity, 111, 149 clinical, 135 codes, 163 death drive, 142 conversion, 187 dualist, 217 creation, 171 Freudian, 204 desire, 158 of abreaction, 75 device, 161 of affect, 3, 174 disguise, 36 of anxiety, 2–4, 50, 121–123, element, 167 164, 178, 207 failure, 165 of homeostatis, 176 function, 166 of mind, 182 inability, 111 of narcissism, 221 incapacity, 112 of object relations, 223 insufficiency, 111 of repression, 81, 207 location, 159 of seduction, 187, 198 mechanism, 159 of structural identification, 4 mnemic, 17, 57, 109, 196 of the instincts, 48 motor, 43 of the psychic apparatus, 4 operations, 160–161, 164 of unconscious conflict, 173 order, 163, 169 on conversion, 187, 189 organisation, 158 on seduction, 6 Other, 162 psychoanalytic, 172, 176, 179, perspective, 164 202 realisation, 158 sexual, 197 regulation, 113 Tolpin, M., 137, 141, 252 resources, 165 transference, 7, 152, 156, signifier, 169 159–160, 163, 167, 186, 190, solution, 170 196, 198, 205 substitute, 14 axis, 160 support, 159 counter, 7, 198 system, 166 direction, 160 transference, 160 factors, 224 travesty, 189 figure, 214 unconscious, 166 idealising, 224 universe, 158 mirror, 107, 222 narcissistic, 140 Tager-Flusberg, H., 182, 243 object, 140 Talagrand, C., 210, 249 psychoneuroses, 104, 116 Thanatos, 103, 157, 165, 170 resistance, 84 theory, 7, 59–60, 75–76, 106, 122, symbolic, 160 266 Index trauma(tic), 58, 75, 90–91, 94, Ulman, R., 138, 249 105, 140, 144, 166–167, unconscious(ness), 2–3, 39, 50, 53, 189–190, 197, 199, 207–208, 66, 77, 83–84, 95, 103, 110, 219, 223 112, 120, 123, 128–130, 149, anxiety, 72, 142 153, 156, 158–159, 161, aspects, 186 163–164, 169, 175, 221 birth, 54, 57, 59, 62, 65, 75–76, choice, 164 85, 105, 122–123, 132, 143, cognitive, 184 147–149, 166, 206–207, 217 conflict, 172–173, 183 contingency, 112 danger, 129–130 cumulative, 108 determinant, 129 devastating, 108 dynamic, 183–184 dimension, 111 fear of death, 131 disturbance, 60 form, 175 early, 140 formation, 15 effect, 6, 186, 189, 198 guilt, 186 episode, 237 meaning, 162 events, 112, 116, 166 mind, 129 excessive, 135 nature of affects, 175 experience, 17, 44, 90, 106, phantasy, 45 185, 195–196, 213, 222 processes, 103 factor, 238 productions, 170, 189 impact, 105 prototype, 83 intensity, 110 psychic process, 154 interruption, 166 symbolic, 166 model, 149 thought, 160 moment, 145 work, 171 nature, 190 neuroses, 53–54, 65, 127 Waelder, R., 173, 252 of castration, 112 Walker, D. L., 180, 244 physical experience, 145 Wallerstein, R. S., 203, 215, psychic, 105–106 252 quality, 152 Wallon, H., 171, 252 relational vicissitudes, 116 Weltanschauung, 19–20, 209, 218 reproduction, 18 Winnicott, D. W., 5, 107, 109, seduction, 7, 198 133–141, 146–147, 186, sense, 111 252 severe, 76 situation, 90, 92, 94, 108, 148 Yorke, C., 120, 252 source, 151 state of, 122 Zetzel, E. R., 120, 252