SAMIKSA

Journal of The Indian Psychoanalytical Society

On the Psychoanalytic Idea of Time CHARLES HANLY

The Psychoanalytic Legacy of ANNE-MARIE SANDLER

Some Thoughts on Attention FRED M. CEVIN

Death Drive, Negative Narcissism, Disobjectalising Function ANDRE GREEN

Transference- Enactment in Successful Clinical OWEN RENIK

The True God and the False God NEVILLE SYMINGTON • The Black Hole : Terror and Dread in Confusional Psychosis MANEK-PHIROZ BHARUCHA

Evolution of the Concept of in Psychoanalysis BANi PAIN • Book Reviews

VOLUME 51 1997 ANNUAL J SAMIKSA CONTENTS

JOURNAL OF THE INDIAN PSYCHOANALYTICAL SOCIETY Journal of On the Psychoanalytic Idea of Time Samiksa is published annually. The annual subscription payable in advance is Rs.150/ The Indian by Charles Hanly 1 - (Rupees One Hundred and Fifty) for inland subscribers and U.S.$ 30.00 (Thirty) for Psychoanalytical overseas subscribers. Subscription should be sent to Indian Psychoanalytical Society, Society 14, Parsibagan Lane, Calcutta-700 009, India. Drafts should be made payable to "Indian The Psychoanalytic Legacy of Psychoanalytical Society". Anna Freud by Anne-Marie Sandier 11 Volume 51, 1997 MANUSCRIPTS Some Thoughts on Attention Manuscripts of articles should be sent directly to the Editor and must be in English, by Fred M. Levin 23 All editorial communications should be addressed to the Editor, Samiksa, Indian Editor Psychoanalytical Society, 14, Parsibagan Lane, Calcutta-700 009, India. , Negative Narcissism, Hironmoy Ghosal Contributors are requested to submit four clear copies — must be typewritten on bond Disobjectalising Function paper with at least 1 V2 inch margin on all four sides. All parts must be "double by Andre Green 31 spaced" including references, footnotes and extracts. Footnotes are to be numbered Jt. Editor sequentially and should appear at the foot of the page where they are cited; footnote Mallika Akbar -Countertransference numbers should be typed one space above the line without punctuation or parentheses. Enactment in Successful Clinical Initial footnotes referring to the title of the paper, or the author do not carry a number' Psychoanalysis Asst. Editors Author's address and affiliation should appear following the reference list at the end by Owen Renik 39 of the paper. Bani Pain Sarala Kapoor Full reference to all works cited in the text should be given in the list of references at Varsha Bhansali The True God and the False God the end of the paper. Reference list must be typewritten double spaced. Author's by Neville Symington 55 should be listed alphabetically and their works chronologically by date of publication (when several of the author's works are referred to). When an author has published The Black Hole : Terror and several works in the same year, the date is followed by a, b, c, etc. Authors' names are Editorial Board Dread in Confusional Psychosis not repeated in the reference list; they are indicated by a line. References should only Rafael Moses by Manek-Phiroz Bharucha 65 include works cited in the text. Dhirendranath Nandi Hironmoy Ghosal Evolution of the Concept of For books — give tittlr, place of publication, name of publisher and year of publication Bhupendra Desai Anxiety in Psychoanalysis of the edition cited (if different from the original publication date). When referring to Saradindu Banerji by Bani Pain 77 the writings of , cite only the Standard Edition, e.g. S.E. Mallika Akbar Sarosh Forbes For articles - give title, abbreviated name of the journal, volume number, and inclusive Book Reviews 85 page numbers. Varsha Bhansali Reviewers : References in the text should be given by quoting the journal, volume number, and Moinak Biswas, Mallika Akbar, Dr. Gouranga Banerji, inclusive page numbers. 14, Parsibagan Lane Dr. M.M. Trivedi References in the text should be given by quoting the Authors' name followed by the Calcutta - 700 009 year of publication in parenthesis. It should be arranged in alphabetical order following standard rule, e.g. ON THE PSYCHOANALYTIC IDEA OF TIME Charles Hanly

Psychoanalysis shares an underlying episteinology (theory of knowledge) with the natural and human sciences. A psychoanalytic concept of time must be consistent with what physics has to teach us about its nature. Therefore, psychoanalysts, when thinking about time, must take into account the concept of time and of temporality found in contemporary physics as articulated by Hawking. Freud grounded the human psyche in the human body and, hence, in physical time. However, Freud's hypothesis of an archaic inheritance, based on acquired species memories, was potentially a breach of natural time. But , including the universality of the Oedipus complex can survive the abandonment of Freud's Lamarkianism. I have also argued that Freud's flirtation with Kant's sub- jective idealist concept of time is not logically or conceptually required by anything essential to Freud's discoveries. More importantly, it can be shown that Freud's attribution of timelessness to unconscious psychic contents and processes does not imply any breach in natural time. Detailed considerations of psychoanalytic data are developed to analyse the meaning of Freud's attribution of timelessness to the unconscious. I conclude with psychoanalyticaily informed philosophical reflections on time as one measure of the fmitude of human existence.

Philosophically there are two basic questions time, "What then is time? If no one asks me, about time. One is ontological: what is the I know: if I wish to explain it to one that asks, nature of time? One is epistemological: how I know not" (p. 262). do we know what the nature of time is? The Philosophy, by itself, cannot answer ques- order of these questions already has philosophi- tions about the nature of time. Philosophy must cal implications. The order in which I have rely on the natural sciences to shed light on posed the questions is realist in the way in time, space, substance, natural history and which natural science or Aristotle is realist. other aspects of reality. Thus, Augustine's As Aristotle said, "That nature exists who can question can now be answered in so for as doubt". The reverse order is idealist in the physics has been able to shed light on the fashion of Descartes, Hume or Kant. The nature of time. Hawking (1988) describes time, knowability of nature is cast in doubt and according to relativity theory, as a dynamic philosophy turns the mind inward upon itself property of the universe which is influenced to seek the conditions for knowledge. by proximity to mass and by velocity and 1 have chosen the realist ordering of the which in conjunction with space influences questions because Freud premised psychoa- the way in which bodies move and forces act nalysis on scientific realism which remains the in nature. "Space and time are now dynamic dominant school of philosophical thought in quantities: when a body moves, or a force acts, the English speaking world. Augustine (397) it affects the curvature of space and time — succinctly posed the problem of the nature of and in turn the structure of space-time affects

Charles M.T. Hanly, Ph.D., Training and Supervising Analyst, Canadian Psychoanalytic Society, Toronto Psychoana- lytic Institute; Emeritus Professor of Philosophy, Univetsity of Toronto.

SAMIKSA CHARLES HANLY ON THE PSYCHOANALYTIC IDEA OF TIME

the way in which bodies move and forces act" It is not difficult for psychoanalysis to lo- (Hawking, 1988, p.33). Newton's absolute time cate man's psychic life within the physical been transmitted genetically. The central hy- esis of modern genetics had left no room in which allowed for unique fixing of .simultane- time of nature revealed to us by physics pothesis of Totem and Taboo, which Freud evolutionary theory for such an inheritance. ous events because he assumed that time is Shakespeare's evocation of the ages of the (1913) called a scientific myth, is an attempted The elements of Freud's archaic heritage are unaffected by the movement of bodies and the individual life by Jaques in Ax You Like It is reconstruction of the events that resulted in unquestionably acquired characteristics. All at- action of forces in nature. Newton's concept one to which Freud would have taken no ex- the formation of homo sapiens. The crucial tempts in biology to demonstrate the of time has been replaced in relativity theory ception. reconstructed event is the first parricide which, inheritance of acquired characteristics have by a simultaneity that is relative to the loca- according to the myth, brought about the trans- failed. Modern Freudians have abandoned the "All the world's a stage, tion and motion of the instruments used in its formation of pre-human hordes into the earliest hypothesis but not without consequences for identification. The acceleration of a body, And all the men and women merely play- totemic humans and which, Freud hypoth- psychoanalytic theory. ere; esized, is unconsciously remembered in the whether it be an atom or a living organism, The hypothesis that the Oedipus complex life of each individual where it takes the form alters the rate at which it ages by comparison They have their exits and their entrances; and the super-ego are an archaic heritage had of the instinctually originated Oedipus com- with identical bodies moving at lesser veloci- And one man in his time plays many parts, the advantage that it accounted for the univer- plex. The Oedipus complex and the formation ties because the rhythm, for example of the His acts being seven ages." (II, vii) sality of the Oedipus complex. The universality of the super-ego, consequent upon its resolu- heart slows down relative to the rhythms of of the Oedipus complex is important to psy- The individual psychic life, as Freud con- tion, were thought by Freud to be an archaic- the hearts of organisms moving at lesser ve- choanalytic theory because of the crucial role ceived of it, is finite and historical; its origins heritage. This hypothesis roots the individual locities. That the relativity theory of time is the resolution of the Oedipus complex has in and destiny are in nature. Psychic life depends life in the history of the species. It provides true, or, at least, is a closer approximation to the formation of mature, civilized personality upon the physical life of the body, comes into for pre-personal memories that go beyond the the truth, can be shown experimentally as well as well as in . Either the centrality of existence with it and is extinguished by its memories of the events even in the earliest as by predictions of the location of satellites the Oedipus complex in civilized character death. The psyche develops out of the body life of the individual and reach far back in and the planets of the solar system that are formation must be abandoned and some other through stages that depend upon stages in the time to the beginnings of human existence. more accurate than the predictions of explanation found to account for the capacity life cycle of the body. This inclusion of the Jung's hypothesis of a racial unconscious, Newtonian physics. for moral and epistemic deliberation and self- human psyche in the physical time of nature which became part of the foundation in his criticism in man or a different explanation of is grounded in Freud's (1895) hypothesis that psychology for his religious beliefs and his Hawking (1988) also argues that time has the universality of the Oedipus complex must neurones that can store memories and neu- conviction of psychic immortality, was an a direction because of at least three arrows of be found. In fact, an alternative account of the rones that can form perceptions to be elaboration and transformation of Freud's idea time. "First there is the thermodynamic arrow universality of the Oedipus complex that is remembered differ in that the former are du- of an archaic heritage. Jung's version of the of time, the direction of time in which disor- consistent with current knowledge about evo- rably modified by the excitations that pass archaic heritage, the racial unconscious, clearly der or entropy increases. Then, there is the lution is available. In any case, the rejection through them whereas the latter persist un- involved a breach in natural time through psychological arrow of time. This is the direc- of the hypothesis of an archaic heritage by modified by the excitations thai activate them. which the human psyche can pass, as it were, tion in which we feel lime passes, the direction contemporary Freudians has removed even this Psychic life and its specific functions such as into timelessness or eternity. But is there not in which we remember the past but not the hint of a psychic a-temporality from psycho- memory and perception are grounded in the also a hint in Freud's archaic heritage of Pla- future. Finally, there is the cosmological ar- analytic theory. Further, Freud's postulate of structure and functioning of the brain. Thus, to's (Meno) idea of knowledge as row of time. This is the direction of lime in an archaic heritage did not introduce any al- the psychoanalytic understanding of psychic reminiscence? Is there not an implication of, which the universe is expanding rather than teration in the direction of time, transcendence life stands opposed to the Platonic notion of at least, trans-generational organizing elements contracting" (p. 145). He argues that the psy- of time or teleology. It only assumed that el- the soul or the Cartesian notion of a mental at work in the mind, if not intimations of a chological direction of time is determined by ements of the psyche are immune to the substance. We are born, live and die, natural kind of immortality? It is claimed that crucial the thermodynamic arrow because, on anal- passage of time in the way in which naturally creatures in nature's time. events in the lives of ancestors are genetically ogy with computer memory, "we must selected genetic mutations remain stable over inherited as memories that cause themselves remember things in the order in which en- Nevertheless, a number of questions arise generations. Moreover, there is no indication to be re-enacted and relived by contemporary tropy increases" (p. 147). Human temporal within Freud's work that appear at least to that Freud, unlike Jung (1938), ever supposed descendants. orientation with respect to past, present and qualify Freud's adherence to a scientific view that the inheritance of crucial formative expe- future and memory, which allows us to be- of time. Freud thought that, contained in the riences of our ancient ancestors in the form of come aware of the passage of time, is constitutional endowment of each person, there There can be no question of Freud's com- pre-personal memories involved any ontologi- determined by the brain's obedience to the are remnants of memories of crucial develop- mitment to a Lamarkian inheritance of acquired cal break in nature and, specifically, in time. laws of thermodynamics. mental experiences of ancestors which have characteristics. Jones found him impervious The process of inheritance, as Freud conceived to the argument that genetic mutation hypoth-

SAMIKSA SAMIKSA CHARLES HANLY ON THE PSYCHOANALYTIC IDEA OF TIME of it. is a part of nature. Fox (1980) has re- stimuli. Freud supposed that this process could thought is inconsistent with the scientific re- tion in Kant, we are entitled to substitute minded us of how sophisticated was Freud's account for the mind's projection of special alism on which Freud grounded "duration" for "extention" which would allow understanding of the processes and events and temporal relations on the objects and psychoanalysis. Freud's effort to incorporate the statement to express Freud's doubts about which, he believed, lie at the origins of the events of nature. Kants idea of the nature of time into psychoa- the Kantian notion of time. first human societies. Freud's primal horde nalysis would have been much more difficult But the most intriguing question remains. After 1929, with the completion of her theory described the origin of humanity as than he imagined. As we have just seen, What was Freud getting at when he described analysis, Marie Bonaparte became one of though it were a single occurrence at one time Freud's argument based on processes of pro- unconscious processes as "timeless"? Does Freud's valued colleagues. Bonaparte further and one place; but his "scientific myth" delib- jection does not provide evidence for Kant's this attribution imply, as it seems to do, that stimulated Freud's interest in Kant. However, erately and explicitly abbreviated time and argument that time is a condition for any unconscious processes exist outside of the Freud did nothing further to integrate Kant's compressed location in order to capture, in a possible internal perception. Processes of pro- temporality of nature contrary to the empiri- idea of time into the psychoanalytic theory of simplified formula, the essence of processes jection, as Freud correctly says, are caused by cist view of psychic reality outlined above? mind than to make the above unconvincing that unfolded in various renditions over long fluctuating levels of unpleasure caused by Is the unconscious after all in the tradition of argument. Kant's idea of time as a pure form periods of time in different places in a hetero- internally originated excitations. But this proc- the Platonic, or at least, the Aristotelian psy- of inner-perception (space is the pure form of geneous and accidental way. It is natural to ess is much too haphazard to meet the che? Does the unconscious escape from the outer-perception) which the mind imposes on human narcissism to wish for a way out of requirements of a Kantian pure form of intui- dependency on the contingent, mutable and nature is itself counter-intuitive enough. time but Freud, unlike Jung, did not take his tion. Nor did Freud appreciate that Kant's idea finite brain that certainly exists in time with Freud's psychoanalytic explanation of the archaic inheritances to be an intimation of of time as a pure form of intuition restricts the rest of the body and on which conscious genesis of time as a form of intuition renders immortality. Freud's hypothesis of an archaic time to our experience of nature and removes ego functions depend for their existence? the idea even more counter-intuitive. Kant had inheritance was an error. However, its errone- it from nature itself as a physical property ot detached time as a pure form of inner-sense Here is a crucial text. ousness did not involve a mystification of time. objects and events. The idea that time is a from psychological influences. Freud accounts psychic structure imposed by the mind on "There is nothing in the id that could be But did Freud not abandon scientific for time precisely in terms of the psychologi- nature is not consistent with the hypothesis of compared with negation; and we perceive with thought about the nature of time and, finally, cal economics of instinctual demands upon relativity theory which makes time relative to surprise an exception to the philosophical prefer a philosophical view of it? Freud (1920) psychic functioning and the influence of the the velocity of matter and not to human sub- theorem that space and time are necessary announced in Beyond the Pleasure Principle stimulus barrier. This idea is highly problem- jectivity or to Kant's conditions for any forms of our mental acts. There is nothing in that "as a result of certain psycho-analytic dis- atic. Since the painfulness of instinctual possible experience. Even a pure form of in- the id that corresponds to the idea of time; coveries, we are to-day in a position to embark demands fluctuates according to their force- tuition, an organizing element of what Kant there is no recognition of the passage of time, on a discussion of the Kantian theorem that fulness, the defences mobilized against them thought of as a "pure psychology" cannot act and — a thing that is most remarkable and time and space are 'necessary forms of and circumstances, the projections they might as an influence upon the behaviour of matter awaits consideration in philosophical thought thought' " (p. 28). Freud uses the word cause would also vary. If Freud's conjecture required of time as well as space by relativity — no alteration in its mental processes is pro- "thought" which strictly speaking should have were correct, there would be, in addition to theory. Einstein (1921), with whom Freud duced by the passage of time. Wishful impulses been "intuition" but it is clear from his subjective fluctuations in the sense of the corresponded at the end of his life, was highly which have never passed beyond the id, but elaborations that by "thought" Freud meant passage of time, fluctuations in time itself. critical of Kant for removing the concepts of impressions, too, which have been sunk into "inner-perception" which is what Kant meant Since these fluctuations in the painfulness of space and time to the Olympian heights of the the id by repression, are virtually immortal; by "intuition". The evidence of which Freud instinctual demands are themselves located in a priori where they were no longer subject to after the passage of decades they behave as is thinking is a differentiation he had noted in time, time cannot be accounted for by the empirical and experimental study. That Freud though they had just occurred. They can only the action of external stimuli on the mind as hypothesized tendency of the mind to project (1941) was occupied with Kantian ideas to be recognized as belonging to the past, can compared with the action of internal intolerable increments of unpleasure outward the end of his life and that he had worked his only lose their importance and be deprived of excitations. External stimuli are modulated by on to nature in order to seek the relief of the way toward a similar conclusion is suggested their cathexis of energy, when they have been a stimulus barrier, whereas internal excitations stimulus barrier. Moreover, instinctual de- in the second last extant fragment of his made conscious by the work of analysis, and are not. However, when internally originating mands may give rise to pleasure without pain. thought, "Instead of Kant's a priori determi- it is on this that the therapeutic effect of ana- excitations become so strong as to cause an On Freud's account this circumstance would nants of our , psyche is lytic treatment rests to no small extent" (Freud, intolerable unpleasure, the mind tends to cause a cessation of time itself and not merely extended; knows nothing about it" (p. 300). 1932, p.74). project them onto the external world so that a subjective impression of a timeless "eternal Freud is thinking here of space but, given that they can become subject to the stimulus bar- now". both space and time are pure forms of intui- We notice that the passage begins with rier that protects against excessive external Kant. We also notice that Freud is declaring Kant was a philosophical idealist whose

SAMIKSA SAMIKSA CHARLES HANLY ON THE PSYCHOANALYTIC IDEA OF TIME

gled efforts to get rid of the intruder had never that the id (the instinctual unconscious) is not up of contents — memories, phantasies, think- and of feeling himself or herself to be the happened. We have been imagining the life of subject to Kant's universal and necessary form ing by means of images, desires, aversions unique object of his or her mother's love. a girl. Gender difference does not immunize of intuition which implies, although Freud does and fears — which have agency or motiva- When a sibling arrives, the newborn appears boys from the same experiences and conse- not seem to have grasped it yet, that time as tional efficacy on account of sexual and to the child, if she is a girl, to have taken from quent difficulties in life. a form of intuition is neither universal nor aggressive drives. We have already had rea- her the love of the mother that vouchsafes necessary as Kant had thought because a major son to find that certain contents which Freud these pleasures, pleasures that have nourished A personality is formed that does not take segment of psychic life takes place in sublime took to be an archaic heritage are finite and her well being and have been the means of this important episode into account and which indifference to time. temporal. The father whom a small boy wishes her survival. The child's profound anaclitic experiences as alien within itself the haphaz- to kill is not the echo of the primitive father attachment to her mother is disturbed and may ard manifestations of destructive aggression I shall argue that a failure to recognize time of the primal horde who was killed at the dawn be traumatically disturbed. Even the efforts at in phantasies, dreams and play. If the latency by unconscious psychic processes presents no of history; he is the real father or his surro- separation and autonomy of a two-year-old are child finds that the parents take pleasure in particular puzzle once we acknowledge that gate. But what of the phantasy father, the father grounded in the mother's love, which when a some activity of the younger sibling, the older time is an empirical concept derived from our who is symbolized by a dangerous monster in new baby arrives can seem to have been lost one may shy away from engaging in it be- experience of nature and perfected by math- an unconscious phantasy against whom, in a to the rival. It is not surprising under these cause of a vague anxiety about being in ematical and physical reasoning. Unconscious further phantasy elaboration, the boy pits him- circumstances that a two-year-old would de- competition with the sibling even though it is thought processes are indifferent to reality self in a test of strength? This father and his velop an ambivalent attitude of love and hate an activity which the older child enjoys. When, testing and logic. A phantasy about an event symbolic substitutes are not in the real world, toward the baby. The child's destructive hate in adulthood he marries and has a child of his is not differentiated from a memory of an event although certain symbolic substitutes may be thrusts her into a painful dilemma. The child own, he may find himself beset with in the unconscious. Unconscious thought proc- in the world of movies, comic strips or litera- hates the baby because she recognizes that the obsessional thoughts about being guilty of esses involve a magical indifference to reality. ture. What of the phantasy mother represented mother loves the baby as she so recently loved some terrible crime. Although he knows that Therefore, since time is a natural reality, it is by witches? What of the princess who sym- her and fears that the baby will take away the he has not committed a crime in reality, he not remarkable that unconscious mental proc- bolizes the small girl who is rescued by prince mother's needed love. Thus the child becomes feels himself to be a criminal. He is horrified esses are not ordered by a sense of real time. charming from the toils of the cruel step- anxious lest the mother who loves the new by thoughts that he might push the carriage After all, even the conscious sense of time mother? Are these contents of unconscious baby will hate her for hating the baby. An with his infant son in it into the path of a car finds natural time as it is known by relativity processes a-temporal, immune to time and internal conflict is generated within the child. on the road when he is taking his newborn for physics paradoxical [see Infeld (1950), Hawk- mutability? What is the meaning of Freud's One way of resolving it is to psychologically a ride in the carriage. This father may find ing (1988)]. Our natural (experientially but not assertions that unconscious processes are im- deny his or her hatred for the baby by inten- himself becoming overtly upset when an older mathematically or experimentally tested) idea mune to the passage of time and that repressed sifying his or her affection for and child behaves aggressively toward a younger of time is Newtonian, Just as the sun still memories and phantasies possess a virtual identification with the baby. The reaction for- child as though he feared that some terrible appears in our experience of it to move across immortality? mation has the effect of repressing the memory violence, was about, lo erupt. Children, he be- the sky daily, so absolute simultaneity of events of the hostile, destructive feelings for the baby lieves, are supposed to only love and care for in nature is self-evident to our unreflective Freud differentiates two types of uncon- and all the phantasy and real experiences to younger siblings as he proudly remembers and physically unsophisticated experience of scious contents, those that have always been which they had given rise. Henceforth, the having cared for his younger brother. time. Since the recognition of time depends unconscious and those that have been con- jealous child is only able to experience affec- upon self-aware perceptions of real motion and scious and then have been removed from tionate feelings toward the baby. A precarious In this history we have evidence of the change in artificial or natural clocks by means consciousness by repression. Repression relief from the jealousy will have been continuing activity of the warded off memo- of which we are able to identify time's pas- renders an experience unconscious by con- achieved. Relations with the baby will become ries, impulses and feelings from childhood. It sage and measure its duration, and since neither structing a barrier against its recall. The more peaceful. The child may well become was this sort of evidence that Freud had m self-awareness nor perception of reality are memory of the experience succumbs to amne- mother's helper in caring for the baby. The mind when he spoke of the virtual immortal- characteristic of unconscious processes, un- sia. Let us consider a representative example child's destructive hostility will no longer be ity of repressed memories. Defensive conscious thought activity will have no means of such an occurrence. A typical calamity of experienced as such. The pleasure that the processes, in this case , reaction-forma- for recognizing time. childhood is the birth of a sibling, especially parents take in this development reward it. tion and repression, neither obliterate when a child is under three years of age and For the child it is as though the painful epi- memories and phantasies nor annihilate the But the recognition of time is one thing remains very close to the special pleasures of sode with its tantrums, sulks, regression to motivational efficacy of the affects bound up and the nature of unconscious processes them- infancy: the oral pleasures of breast feeding thumb sucking, difficulties with sleep, bun- with them. Consequently, unconscious wishes, selves is another. These processes are made and the narcissistic pleasure of being the baby

SAMIKSA SAMIKSA CHARLES HANLY ON THE PSYCHOANALYTIC IDEA OF TIME

memories and phantasies persist unchanged. Analysts have often noted the subjective nature as a law of the formation of any pos- inconsistent with Freud's psychological expla- They are separated off, by the repression, from fluctuations in the sense of time. In depres- sible experience implies that the mind nation of the origins of an ethics of duty in being subjected to the processes of reality sion time seems to be without a future; interest transcends nature. In submitting to time one is the resolution of the Oedipus complex. There testing, modification, maturation and adapta- in the future is swallowed up in the misery of only submitting to the informing influence of is no transcendental ontological freight in tion to reality that conscious wishes continually the encumbered present in which nothing one's own mind which transcends nature by Freud's thought. His introduction (Freud, 1923) undergo. As a result, repressed memories of a changes or can be changed. Children typically this and other (among them space, causality of a Kant's Categorical Imperative as an calamitous sibling rivalry in childhood can experience time passing slowly — an experi- and substance) acts of legislation. To be sure equivalent for the psychoanalytic concept of cause an adult to be obsessed with the thought ence, possibly formed by longing to be adult Kant believed that pure reason falls into con- the super-ego was no less a blind alley, incon- of.being a criminal, a murderer, despite his in the fond belief that adults are able to do as tradictions when it tries to think sistent with the basic tenets and empiricist knowing that he has committed no such crime. they please. An afternoon waiting for a satis- transcendentally as, for example, in trying to spirit of psychoanalysis, than his interest in The incriminating scenes are not part of the faction can assume the aspect of an endless prove the immortality of the soul. However, the Kantian idea of time. The fundamental person's real life and time, they are not lo- time. Youth, at its best, experiences time Kant also believed that moral law (his categori- teaching of psychoanalysis is that human well- cated as an episode in the sequence of events manically. The future appears to offer endless cal imperative) demonstrates the reality, being and knowledge are best advanced not in his life in so far as he is aware of it. On possibilities. The years of life are numbered substantiality and immortality of the soul be- by the idea that nature must submit to the laws account of the repression, he cannot say to acording to the logic of the small child who cause he took moral will to be evidence of of the human mind but by the realization that himself with regret or shame that he had can count to seven and identify classes of seven man's noumenal existence. And just as Kant's the human mind must submit to the laws of a wanted to kill his baby brother and, thereby, things correctly but who also uses "seven" to idea of time is inconsistent with the psycho- natural world into which it is born and to which know both cognitively and affectively that he connote any number of anything greater than analytic idea of time, so Kant's idea of duty it must return. Time measures the finitude of was innocent of the crime since his brother six, however great. Middle age, brings us, at for duties sake (the categorical imperative) is human individual and colledive existence. still lived. It was to these phenomena that last, close enough to average life expectancy Freud was pointing when he described uncon- to be able to count our years less delusionally. References scious processes as being "virtually immortal" This realism is aided by encounters with limi- and "unchanged by time". When, in the course tations among them the passage of time, STINK (c. 397). The Confessions of St. (1932). New Introductory Lectures of analysis, the memories of the events that accidents and adult helplessness in a largely Augustine, trans. E. B. Pusey. : J.M. on Psychoanalysis. SE. 22, p. 74 were calamitous for the child are remembered satisfying Hie giving rise to the experience that Dent and Sons, 1907. (1941). Findings, ideas, problems. by the adult, the traumatic scenes and the feel- time has accelerated as the seasons rush by EINSTKIN. A. (1921). The Meaning of Relativ- S.E. 23. 299-300. ings of envy, anxiety, rage, despair and until it slows again with the declining ity: Four Lectures Delivered at Princeton HAWKING, S. (1988). A Brief History of Time. desolation which they caused return with un- strengths, increasing vulnerabilities and not University, trans. P. Adams. London: Toronto: Bantam Books. mistakable clarity. And when the adult who infrequent depression of old age. However, Methuen, 1922. thus remembers in analysis is able to mourn these subjective fluctuations in the sense of INR-XD, L. (1950). Albert Einstein: His Work his losses, the symptoms their repression has the passage of time are just that; they do not Fox, R. (1980). The Red Lamp of Incest. New and its Influence on Our World, New York: caused will resolve into adaptive and useful correspond with anything real in time itself. York: Dutton. Charles Scribner's Sons. mature activities. The memories will not lose They are psychologically meaningful and psy- FREUD, S. (1895). Project for a scientific psy- JUNG, C.G. (1938). Psychology and Religion, their clarity, but they will have ceased to be chologically relative i.e. they vary with human chology. S.E. 1, 281-391. New Haven: Yale University Press. pathogenic because the and aggression moods and stages of life. This relativity must (1913). Totem and Taboo. S.E. 13, KANT, I. (1781). Critique of Pure Reason, trans. bound to them will have moved forward to not be confused with the relativity of the real sustain adult life. The old grievance will be time of nature which is not relative to man but 1-161. Norman Kemp Smith. London: Macmillan, eased by present gratifications. The memories, to the velocity of matter and the constraints of (1920). Beyond the Pleasure Princi- 1950. while stil! retained and now accessible, are no mass. To confuse these relativities is to sub- ple. S.E. 18, 1-64. (1788). Criikjue of Practical Rea- less mortal than the life in which they have mit thought to the dominion of narcissism (1923). . S.E. 19, son, trans. Thomas Kingsmill Abbott. played such an important part. What can be rather than to the demands of reality. Freud 1-62. London: Longmans, Green, 1948. remembered need not be repeated. The id does did not appreciate how profoundly antitheti- not recognize time but its contents and proc- cal Kant's idea of time as a pure form of esses are no less temporal than the natural intuition is to the spirit of his own thought. To Prof. Charles Hanly world to which they belong. believe, as Kant did, that time is imposed on 27, Whitney Ave. Toronto. ONT M4W 2A7 CANADA

SAMIKSA SAMIKSA THE PSYCHOANALYTIC LEGACY OF ANNA FREUD * Anne-Marie Sandier

This paper was written to commemorate the 100th anniversary of Anna Freud's birth. She was the youngest daughter of Sigmund Freud, and dedicated her life to the study of the psychoanalysis of children. This paper attempts to highlight her considerable contribution to psychoanalytic theory and practice. After discussing the innovations brought about by her book The Ego and the Mechanisms of De- fence, the author maps out Anna Freud's lifelong interest in detailed and psychoanalytically-informed direct observation of young children and babies. Anna Freud's approach to direct observation was deeply rooted in a developmental point of view and led to her important concept of 'Development Lines'. The author then describes how Anna Freud's constantly reiterated view that one has to move from what can be observed to what was intrapsychic, led to the creation of the 'Diag- nostic Profile', an important toot for psychoanalytic child diagnosticians. The paper ends with a reference to Anna Freud's book Normality and Pathology in Childhood, and comments on a differentiation between neurotic and developmental disturbances in children, a different clinical and technical approach being needed for each of these disturbances.

In this paper I should like to present some metapsychology. This identification was con- aspects of Anna Freud's work in a way which sistent and unwavering. Yet she nevertheless is rather different from the conventional ac- managed to make substantial and original con- counts of her contributions. What I propose to tributions of her own. She was able to do this do is to speak of some of the factors which by her skilfuJ capacity to maintain her adher- have, in my view, led to her particular contri- ence to classical theory as well as taking bution to psychoanalytic theory and practice fundamental steps forward in theory and tech- — inevitably with special emphasis on her nique. work with children. In looking back at Anna A good example of this is the innovative Freud's work from the vantage point of today, way in which she explored and described the it is clear that she was, as Robert Wallerstein activities of the ego in its dealings with the once put it, a radical innovator as well as a id, the superego and the outside world in her staunch conservative. 1936 book, The Ego and the Mechanisms of In order to understand Anna Freud's con- Defence. There Anna Freud discusses the many tribution fully, a number of dominant aspects variations and diverse manoeuvres the ego of her professional life have to be taken into can use to protect itself from danger arising account. We are all aware of her very strong from both inside the individual and from identification with her father and with his outside. She describes how the excessive use

Anne-Marie Sandier, Lie. es Scs., Training and Supervising analyst, British Psychoanalytical Society; President, British Psychoanalytical Society; former President, European Psychoanalytical Federation; European Editor, Interna- tional Journal of Psychoanalysis and International Review of Psychoanalysis.

Paper presented to the British Psychoanalytical Society on 6 December 1995.

II SAMlKSA ANNE-MARIE SANDLER THE PSYCHOANALYTIC LEGACY OF ANNA FREUD

of certain mechanisms of defence can distort a group of mechanisms which had the com- could no longer be seen as simply the repeti- to learn and to test psychoanalytical ideas in reality and impoverish the ego, and intro- mon feature that they involved an interaction tion of instinctual cathexis from an infantile an active programme of day care. In January duced a number of new defences on the basis between the individual and others in his world. object to the person of" the analyst. Years later 1937 she wrote to Jackson, "They laugh at me of acute and perceptive clinical experience. For instance, after commenting that identifi- Anna Freud, in discussing her book on de- at home, because I think and talk of babies In this she continued and extended the cation is "one of the ego's most potent weapons fences, remarked that continually and because I lead a sort of dou- emphasis that her father had come to place • in its dealings with external objects which ble life at the moment." A month later, in a "What I point out in the book is the use on the role of the ego and on the need to arouse its anxiety", she went on to describe further letter to Jackson she commented, "Af- of the analysis of defence to discover analyse the patient's resistances to the ana- the specific mechanism of identification with ter a week the children seem to have made the ingrained defensive methods of the lytic process, particularly to the transference. the aggressor, in which the child copes with themselves much at home, there is very little ego... the idea of the transference of In her book Anna Freud elaborated the link the fear of an external figure by transforming crying, much activity, they eat much better, defence was not common knowledge at between resistances and the mechanisms of himself "from the person threatened into the and they now have stools — the first week the time.... It was really a new aspect" defence, but her ideas were not immediately person who makes the threat." And, in her not a child had a stool. I am sure that it is a (Sandier & Freud, pp.41-42). acceptable to all her analytic colleagues. description of what she called 'a form of al- sign that they now feel at home. However, Thirty-six years later, in discussing her book, truism', Anna Freud showed how one can Quite apart from Anna Freud's delineation they do not look well, probably a result of the Anna Freud was to comment that surrender ones own impulses and wishes in of the mechanisms of defence, a major aspect strain the adaptation meant for them" (Young- "It is perhaps not quite easy for those favour of another person. This was a mecha- of her work from the beginning was her in- Bruehl. 1988, p.221). who read the book today to grasp the nism which, she said, represented a sistence on the importance of direct child Then, during the war, having moved with atmosphere in which it was written... combination of identification and projection, observation with a psychoanalytic eye. She her father to England, Anna Freud and Dorothy these were the years when the introduc- and she viewed it as a way in which one can was not content to develop psychoanalysis in Buiiingham took responsibility for caring for tion of the ego as such into consolidate one's relationship with others. She the consulting room, nor to approach develop- at times over 100 children aged between birth psychoanalytic discussion or into the lit- saw this mechanism as typically showing it- ment through the reconstruction of childhood and five years, in residence at what was known erature was suspect to most analysts... self in the form of 'living through another experiences only on the basis of the patient's as The Hampstead War Nurseries. As she once There was quite a big body of opinion person', exemplified by the self-sacrificing analytic material: she insisted on the impor- put it, "It provided an opportunity to maintain very much hostile to any attempt to deal governess who satisfied her own desires by tance of the interaction between child a close connection between theory and prac- with the ego or with ego activity as such. helping and encouraging members of the fam- observation and psychoanalytic theory. Her ob- tice, to check constantly our theoretical ideas This was never the case in my father's ily for whom she worked to gratify these same servations were, of course, coloured by her by practical application and to widen practical writings, but it was very much so in the wishes in themselves — she attained satisfac- psychoanalytic point of view, but at the same handling and practical measures with the minds of the other analysts. I remember tion by proxy, so to say. Today both these time they had repercussions on the way in growth of theoretical knowledge." Helcne Deutsch... saying that I will fin- mechanisms could be subsumed under the which they in turn influenced her psychoana- ish myself with analysts forever with heading of projective identification. lytic understanding of both developmental All the staff working in the War Nurseries that book because I dealt with the ego pathology and technique. Throughout she was took notes about the children's behaviour. Clearly the interpretation of such mecha- and not with the id. Of course, this is concerned, not only with the hypothetical psy- These notes were copied and filed themati- nisms as identification with the aggressor and not true because I dealt with the rela- choanalytic child within the patient in the cally at the end of the day, and were then used so-called altruistic surrender had the greatest tions between the two" (Sandier & consulting room, but also with what she could as source material for discussion, and this importance in the analysis of children as well Freud, 1985, pp. 6-7). learn from the observation of children. method is still employed today at the Anna as adults, and influenced analytic technique Freud Centre Nursery and the Toddler Groups. In addition to the profound clinical impli- considerably, particularly in increasing the em- As is well known, Anna Freud trained and cations of her 1936 book on defences, we can phasis on the analysis of resistances as an practised as a teacher before she started to see Anna Freud's approach to child observa- detect Anna Freud's increasing interest in con- essential part of the analytic process. In this child and adult patients in analysis, and her tion was deeply rooted in a developmental structing a systematic developmental view of connection Anna Freud spoke of the 'transfer- interest in education continued throughout her point of view. When she observed a child she pathology. Thus she found it important to dis- ence of defence' and pointed out how in this life. In 1937, when still in Vienna, Anna Freud not only thought of the child as she observed tinguish so-called primitive defences from form of transference analytic attention must and some colleagues were given the chance, it in the present, but she was equally con- more sophisticated ones, which require more be focused on the ego rather than the instinc- through the generosity of an American friend, cerned with the history of the child's mature levels of ego functioning. One of the tual drives and the wishes associated with Edith Jackson, to open an experimental nurs- development, and with the significance of what striking features of Anna Freud's work on de- them. This represented a clinically important ery for underprivileged children under the age she saw for the child's later normal or patho- fences was her description and elaboration of extension of the concept of transference, which of two. She saw (his as a unique opportunity logical development. This preoccupation was

12 13 SAMFKSA SAMlKSA ANNE-MARIE SANDLER THE PSYCHOANALYTIC LEGACY OF ANNA FREUD

reflected in her statement in 1965 that sition gave her a degree of freedom and inde- equately fit the development of aggression in action to environmental influences, i.e., pendence, while at the same time she could "It is one thing for the child analyst to the child, nor were they entirely suitable for a between maturation, adaptation and retain her identification with her father's reconstruct a patient's past or trace back developmental categorisation of the child's structuralisation. Far from being theo- metapsychology. She was prepared — and said symptoms to their origins in earliest object relationships; and they were certainly retical abstractions, developmental lines, so specifically -— to move from one frame of years, and quite a different one to spot an insufficient basis for understanding the in the sense here used are historical . reference to another as she found it conven- pathogenic agents before they have done complexity of ego and superego development. realities, which, when assembled, con- ient. She moved easily between the their work; to assess the degree of a From the point of view of pathology, it was vey a convincing picture of an individual topographical and structural theories when it young child's normal progress; to pre- increasingly evident that not all disturbed child's personal achievement or, on the seemed appropriate, resisting the pressure of dict developments; to interfere with the children suffered from neurotic pathology, that other hand, of his failures in personal- her American ego-psychological colleagues to child's management; to guide his par- is to say, from the consequence of a drive ity development" (1965, p.64). encompass all psychoanalytic propositions ents; or, in general to work for the resulting from unresolvable Oedipal conflict, As a prototype of a developmental line within structural theory. At the same time she prevention of neurosis, psychosis and with the subsequent formation of symptoms Anna Freud described a sequence leading from found no contradiction between using the dissociality. While the recognised train- as compromise formations between revived the newborn's utter dependence on maternal framework of psychosexual phases, on the one ing for psychoanalytic therapy will pre-Oedipal instinctual wishes and unregressed care to the young adult's emotional and mate- hand, and simultaneously using other devel- prepare the child analyst for the former ego and superego constraints. rial self-reliance. Other lines described by opmental frameworks which took account of tasks, no official curriculum has been Anna Freud had to do with bodily independ- different aspects of mental growth as observed Anna Freud's awareness of the limitations devised so far to equip him for the ence, and delineated the progression from in the child. of the classical psychosexual theory of devel- latter. suckling to rational eating, characterized by opment led her to put forward what can be For decades Freud's schema of psycho- the following steps: being nursed at the breast Concern with problems such as predic- regarded as a brilliant solution to the problem, sexual phases, as spelled out in his Three or bottle; being able to tolerate weaning; the tion or prevention leads inevitably to a by introducing in the early sixties the concept Essays on the Theory of Sexuality (1905) had transition from being fed to self-feeding; the study of the normal, as opposed to the of lines of development (see A. Freud, 1965). provided the essential and fundamental frame- use of the spoon and fork, and so on. Further study of the pathological mental proc- These, while not contradicting the idea of li- work for the psychoanalytic theory of lines were from dependency to emotional self- esses, or the... transitions between the bidinal phase development, allowed it to be development. Freud's approach had been from reliance, from body to toy and from play to two states with which the analyst of supplemented in a way that avoided the re- the side of the libido and he had taken the work, from ego-centricity to companionship, adults is concerned" (pp.54-55). strictions inherent in the classical view. view that the neurosis in adults was the nega- from wetting and soiling to bladder and bowel When the Hampstead War Nurseries closed tive of the perversion, i.e., the outcome of the The developmental lines were based on the control, and from irresponsibility to responsi- after the Second World War, Anna Freud set revival so-called 'perverse' sexual wishes central idea that detailed observation of the bility in body management. Although the steps up the Hampstead Child Therapy Course and which had their origin in childhood, and which child's behaviour, the careful study of surface in each of the developmental lines were de- Clinic (now The Anna Freud Centre) in order represented impulses from early psychosexual phenomena, were intended> to allow the scribed much more fully than I have time to to provide a formal and comprehensive train- phases. These had, during (he course of the analytically-trained professional to make in- do here, their relation to discrete observational ing in psychoanalytic work with children. Here individual's development, become unaccept- ferences about the functioning of the child's phenomena was clear. The developmental lines again, from the inception of the Clinic, she able and a source of the conflict which led to inner life. Anna Freud constantly reiterated were not limited in number, and other lines saw the clinical services and the training as neurosis. Psychoanalysts had tended to see the that one had to move from what could be can be added as our experience in linking sig- having to be rooted in the careful observation libidinal stages — oral, anal, phallic-Oedipal, observed to what was intrapsychic, and this nificant surface phenomena to the depths of children of all ages who showed normal as and so on, as being the appropriate phases approach is exemplified in her use of the idea increases. well as pathological behaviour. She was in- relevant to the normal and pathological proc- of steps in development which could be used Anna F^eud showed how through the use sistent on her view that observation of the esses in all areas of child development. For as surface markers of normality or pathology of the developmental lines we can see the in- child's behaviour, the careful study of surface many, the psychosexual phases represented the in the developing child. In this connection teractions and interdependence between phenomena, would allow the analytically- psychoanalytic theory of development, and she Anna Freud commented, maturational (internal) and environmental (ex- trained professional to make inferences about became increasingly aware of the inadequacy "Whatever Jevel has been reached by ternal) determinants and how each interference the child's psychic life. of the libidinal phases as a framework for any given child in any of these respects will leave its mark on the individual's person- Anna Freud always claimed that she was viewing all aspects of development and pa- the developmental lines represent the ality. The developmental lines provide us with not essentially a theoretician and, with the thology in childhood. It was clear, for example, results of interaction between drive and a series of predictable, interlocking, overlap- benefit of hindsight, we can see that this po- that the classical libidinal phases did not ad- ego-superego development and their re- ping, unfolding lines which are characteristic

14 15 SAMIKSA SAMIKSA ANNE-MARIE SANDLER THE PSYCHOANALYTIC LEGACY OF ANNA FREUD

for each child's development. in the developmental processes, we have age-appropriate readiness for formal learning. self; peer relationships are frequently dis- no reason to believe that the same thera- turbed; their capacity for awareness of other The developmental lines enable the psy- In most cases these problems disappear in the peutic measures will be equally effective people and their needs is deficient — for ex- choanalytic diagnostician to look at a specific course of development, especially if the envi- for both. We are on familiar analytic ample a child may see others as there only to cnild and, with the addition of the Diagnostic ronment handles these upheavals in a 'good ground with the conflictual-neurotic pa- fulfil his wishes. Self-esteem is a particular Profile, another instrument devised by Anna enough' manner. They can be regarded as a thology where interpretation lifts problem. Their self-representations may be Freud, to try to assess the normal as well as temporary response to conflict between the repressed or otherwise defended mate- damaged, often having been distorted by de- the pathological components in that child's child and the external world, well within the rial into consciousness and helps the fensive grandiosity; further, their capacity for mental and physical life. Briefly, the Profile limits of normality, and thus would, in Anna child's ego to find solutions for his in- self-object separateness may well be flawed was an organized set of headings which, apart Freud's view, not require treatment for the ternal struggles, which are no longer and inadequate. They may show problems in from some factual data, was essentially a set child — mother guidance could be envisaged based on anxiety, panic and infantile cognitive functioning such as magical think- of metapsychologicaliy-framed assessments. in certain cases. misapprehensions of reality.... But so far ing, limited attention span, memory problems, As Anna Freud put it: as the developmental process itself is The diagnostic picture in cases of persist- and distorted perception of causality. Verbal "In the analyst's mind, the whole bulk defective or unbalanced due either to ing developmental disturbance is very different understanding and the experiencing as well as of material collected during the diag- innate or to environmental conditions, from what can be observed in 'normal' tran-" the communication of emotions often seem to. nostic procedure organizes itself into we cannot expect interpretation to undo sitory upsets. Anna Freud was particularly be faulty; moreover awareness of an emotional what may be called a comprehensive the damage, even if it clarifies the past aware of the consequences of unevenness in capacity in others may be impaired, and may help the child towards better development, and frequently stated that devel- metapsychological profile of the child, On the surface the symptoms of these chil- ways of facing and coping with its con- opmental disharmonies provided fertile ground i.e., a picture which contains dynamic, dren sometimes resemble those which we are sequences. If, in spite of that, children for enduring psychological disturbances. genetic, economic, structural and adap- used to seeing in severely neurotic children also profit from analysis in this respect, 'tive data. This can be seen as the Anna Freud placed children with develop- — we can think here of such neurotic symp- such success may be due not to the truly analyst's synthetic effort when dealing mental arrest at the other end of the spectrum toms as phobias and other forms of heightened analytic work but to admixtures to the with disparate findings, or, conversely, of developmental disturbances, that is, bor- anxiety, obsessional manifestations, specific technique such as new positive object as showing his diagnostic thinking bro- derline children, children with psychotic or avoidances and inhibitions, and regressive attachment, new superego identification, ken up analytically into its component autistic features, and children presenting atypi- behaviour. But while the neurotic child will suggestive influence, or even corrective parts" (1965, pp. 139-140). cal symptoms. A further group of children, tend to respond positively to a classical ana- emotional experience which with the who have been the victims of exceptional lytic approach, we have found that the children Once a systematic profile of a child had very young can set arrested developmen- environmental conditions, such as abuse or with developmental disturbances do not, and been constructed, a developmental diagnosis tal lines going again" (1974, p. 72). could be made. Anna Freud differentiated very other traumatic experiences, also frequently that we have consequently to modify our tech- clearly between childhood neurosis and de- show signs of developmental disturbance. All nical procedures. As Anna Freud put it in Anna Freud always underlined the view that velopmental disturbances, and believed that these children seem to suffer from deficient Normality and Pathology in Childhood in the diagnostic heading 'developmental distur- the same technical approach was not always structuralisation of their egos, from poorly 1965, 'As we move away from the conflict- bance' relates to a wide spectrum of entirely suitable for both groups of disturbance. defined mental representations and from diffi- based neurotic disorders to the arrests, defects, pathologies, from the normal to the most dis- In her 1974 paper on 'A psychoanalytic view culty in distinguishing phantasy from reality. and deficiencies of development, the thera- turbed1. We are all aware that young children of developmental psychopathology' she clearly They are often overwhelmed by affects, they peutic process changes its nature...' (p. 227). go through transitory developmental upsets, says, lack internal sources of safety, and suffer And, as late as 1978, in her paper 'The prin- particularly in the areas of feeding and sleep- from poor frustration tolerance and impulse cipal task of child analysis', Anna Freud made "If we accept the view that childhood ing. Quite a number of young children present control. It should be emphasized, however, it clear that she did not yet feel confident that psychopathology has a twofold causa- delays in motor development, in speech, in that for the most part they show a combina- appropriate methods had been devised for the tion, one rooted in the conflicts, defence the achievement of cleanliness, in the appro- tion of developmental disturbance and neurotic analytic treatment of children with develop- and compromise formations, the other priate control of aggression and in reaching pathology. mental disorders. She wrote, "The study of purely developmental as- 1 For a number of years a group of colleagues at the Anna Freud Cenlrc, led by Peter Fonagy (and, before his death, Many children with developmental George Moran) has been preparing a manual of child psychoanalytic technique for purposes of outcome research. disharmonies tend not to have age-appropriate pects has not been taken up very Particular emphasis has been placed on the presenting symptoms, psychopathology and variations in technique object relationships, and have difficulty in ac- seriously in child analysis so far. At appropriate to the treatment of developmental disturbances. quiring object constancy and a stable sense of least, it is still waiting to advance from

16 17 SAMlKSA SAMIKSA ANNE-MARIE SANDLER THE PSYCHOANALYTIC LEGACY OF ANNA FREUD

the realm of mere observation and de- questions regarding the interpretation of ag- or chaotic level, the analyst will need much to benefit from the analyst's understanding scription of facts to their application to gression and aggressive phantasies as opposed ingenuity in trying to establish contact with through identification and internalisation. Fur- the technique of treatment.... To the to ego-supportive handling, and it seemed clear them. Sometimes very simple games of the thermore, the analyst's understanding of the extent to which developmental harm can that the real question was one of balance and sort that mothers use with infants and toddlers child's non-verbal communication, and the ver- be undone belatedly, child analysis may timing. Consider the following case reported will open the way to more viable forms of balisation by the analyst of such accept it as its next duty to devise meth- by Rosenfeld and Sprince (1965). communication. Sessions five times weekly are communications are important in helping the ods for the task" (p. 108-109). "Pedro, aged six-and-a-half, initially en- appropriate for these children as the analyst child to comprehend his own mental states. Throughout her writings Anna Freud made acted his feelings of helplessness by needs to become a predictable, safe and reli- The analyst acts as a model for the very think- it-clear that certain technical procedures which identifying with a train engine, which able figure. Such frequency of sessions is ing capacity the child lacks, by verbalising it were not strictly analytic had their place in he saw as the most powerful vehicle in intended to help the development of an inti- as well as by relating to it. mate relationship with the analyst, a new object child analysis, especially for children with non- existence, and which was immune from In recent years at The Anna Freud Centre of particular importance to the child. The neurotic disorders. She did not hesitate to all danger. The engine was never to be we have come to think increasingly that in a analyst aims to function as the child's auxil- advocate the use of educational methods with allowed to run dry, so Pedro drank large number of children with developmental dis- iary ego in helping him to control his impulsive children whose egos are easily overwhelmed, quantities of water throughout the hour turbances, the development of specific mental behaviour, and to give meaning to events and and who would often misunderstand interpre- and urinated freely in the session. To processes has been defensively inhibited by actions. Clarifications and interpretations will tation as an invitation to act out. In such cases prove that the engine remained power- the child in an attempt to cope with unman- encourage a discrimination between reality and Anna Freud had very early on spoken of the ful he climbed on to the window sill ageable environmental pressures or unbearable phantasy, and the introduction of appropriate special difficulties posed to the child analyst, while whistling shrilly like an engine. inner states (Fonagy & Moran, 1991; Fonagy language to describe states of mind is aimed presenting a view which she never entirely He pulled down the curtains and said ct al, 1993). The therapeutic approach will at controlling affect, facilitating reasoning and relinquished, though it came to be greatly that he was going to jump through the thus need to be aimed at freeing the inhibition the understanding of causality. The disentan- modified in respect of purely neurotic chil- window. The therapist thought that of the relevant mental processes. The main gling of fantasy and reality is particularly dren. She said, 'the analyst accordingly Pedro might carry out this threat, since thrust of the work is to give content and important in work with children who have combines in his own person two different and he appeared not to acknowledge dan- meaning to the children's feelings and phanta- experienced actual abuse. Abuse may serve to diametrically opposed functions: he has to ger, and insisted that his powerful train sies by creating a coherent narrative, and by exacerbate frightening fantasies, which analyse and educate, that it to say in the same could never be damaged. The therapist labelling their mental states, their emotions heighten the child's anxiety to a point that his breath he must allow and forbid, loosen and introduced the idea that the really pow- and thoughts, whenever possible. To achieve capacity to regulate affect is diminished or bind again' (1926, p. 49). She also acknowl- erful engines have brakes, and that this the analyst will also at times spell out her overwhelmed. edged that developmental help at times strength meant being able to use these own thought processes and feeling states con- involved praise, suggestion and reassurance. brakes to stop and start whenever the The aim of the analytic work with such cerning events in and around sessions, and engine wanted to. Gradually Pedro's which relate to the child himself. Thus chil- Let me present a vignette to give some fla- patients may not be the provision of insight, game changed to one in which he would dren who have difficulty in acquiring the vour of the approach those working with Anna but rather one in which it gradually becomes turn his brakes on and off and stop at notion of mutuality may be helped by hearing Freud took. There was much concern about safe for the child to begin to understand him- stations to let people in and out. This the analyst verbalise her own thoughts and the acute anxiety that many of the children self and others and to experience affects provided welcome intervals during feelings of, for example, being excluded, ig- with developmental disturbance displayed, par- without being overwhelmed or forced to carry which the therapist could start giving nored or teased in a game. This is then later ticularly at the beginning of treatment. Their them over into action. However, if negative the explanations and interpretations. The presented to the child as relating to his own impulsive, aggressive and often dangerous and are not interpreted early, hostile engine game was elaborated by the in- feelings as well. All such measures represent provocative behaviour did not respond to in- affects may quickly become overwhelming, troduction of a mechanic who wanted attempts to provide the child with a structural terpretation. What was needed, it seemed, was threatening the new relationship. The inter- to understand how the train worked so development directed towards putting certain an adult who could be seen and felt as being pretation of the transference is essential that he could prevent breakdowns and derailed thought processes back on the rails, willing and able to protect the child from ex- because of the excessive projection character- damage". so as to increase the chances of further, more ternal dangers and from the blind acting out istic of these patients. It is the combination of normal development. of impulses. The thought was that only when Since many children with developmental containment of projections through transfer- there was a sense of safety can interpretative disturbances have problems in communicat- ence interpretations and the relative safety of Anna Freud was very much against the work begin. There were, however, always ing with others and do so on a very primitive the alternative relationship to the analyst which blind application of a technique for work with together creates the opportunity for the child children which simply mirrored adult psycho-

18 19 SAMlKSA SAMIKSA ANNE-MARIE SANDLER THE PSYCHOANALYTIC LEGACY OF ANNA FREUD

analytic technique. For her, what was most or less automatic avoidance of the disa- edge, both clinically and theoretically. Let me theories of emotion, and a project on mental appropriate was that which offered the great- greeable, and after all why should we mention some of these groups. One was for representations in young children who have est hope for restoring the child to the path of have disagreeable experiences? The ego the study of adopted children and their par- an abusive or disrupted background. An ex- normal development. She has stimulated us to feels that there are other things that one ents. Another was for the study of clinical and tensive project is under way on the analysis of examine more closely the specific elements of can do instead" (Sandier & Freud, pp. theoretical concepts. There were groups for a number of young adults with severe difficul- psychoanalytic technique necessary for the 359-360). the study of pre- and early adolescence, for ties in achieving the transition from treatment of an individual child, and inevita- adolescence to adulthood. The notion of ego restriction is well exem- the study of congenitally blind children, for bly this has prompted us to look more closely the study of borderline and atypical children, plified by remarks which Anna Freud once I should like to end this presentation by at the technical implications of analytic work, for psychoanalytic psychiatry, for working on made in a seminar. She recalled from her own saying that I belong to a generation of ana- not only with children, but also with adults. the Diagnostic Profile. There was also the experience a boy whose aggressive and com- lysts who have been profoundly influenced in One of the conclusions we can draw is that substantial project known as the Hampstead petitive tendencies, especially in games with their psychoanalytic understanding and clini- there is no hard and fast dividing line, neither Jndex, which had a variety of specific sub- other boys, and a little later on the football cal practice by the work of Anna Freud, and in the analysis of children nor of adults, be- groups attached to it. The techniques evolved field, were inhibited by enormous fears of hurt. who have been able to build on the founda- tween pure interpretation and developmental in these research groups have found applica- So he turned towards intellectual activities, tion she gave. The practical humanity with help. tion elsewhere, as for example in a study of which became highly developed, and through which she approached each patient was al- trauma conducted at the Sigmund Freud Institut It is worth singling out for special mention which he felt able to be competitive, without ways impressive, and shone through in the way in (Sandier et al, 1991). A special an aspect of development which may or may having to face the same anxiety as on the she dealt with the problems presented in the group was concerned with emotional problems not be regarded as pathological, but which is football field. Anna Freud added that she did analyses of children at the Clinic. relevant to the evaluation and treatment of not think he ever, in spite of analysis, restarted in children with chronic diabetes. In recent adults as well as children. This relates to what the physical activities he had given up; the years the research tradition has continued at Anna Freud referred to, in The Ego and the capacities involved were not actively inhib- the Anna Freud Centre. Thus our current projects include research on the efficacy and Mechanisms of Defence, as ego restriction. In ited but became merely unused. Acknowledgements Anna Freud's view this mechanism, which su- outcome of child psychoanalysis, on the study perficially resembles a neurotic inhibition or This experience from child analysis has im- of attachment in parents and children, in which Many colleagues at the Anna Freud Centre phobic avoidance, is in fact something quite plications for analytic work with adult patients, the nature of the relationship the parents are have contributed suggestions and ideas for this different, and represents what is in many ways as it underlines the importance of differentiat- likely to develop with their child during the paper. I have drawn on their work and should a normal developmental process which may ing between neurotic inhibition, phobic first eighteen months of its life is being inves- like to express my gratitude to them for their or may not lead to pathology. Restriction of avoidance and ego restriction. There are parts tigated. There is a group working on children's help. the ego is a consequence of the child giving of the personality that even the best conducted up interest or participation in certain areas of analysis cannot reach. activity because they are not pleasurable, and In this paper I have only been able to touch References turning instead to areas which are more grati- on some of Anna Freud's contributions to fying. As Anna Freud put it (1985), psychoanalysis. However, there is one signifi- FONAGY, P., EDGCUMBE, R., MORAN, G., FREUD, A. (1965). Normality and Pathology in cant area of her work which has to be KENNEDY, H. & TARGET, M. (1993). The Childhood. New York: Int. Univ. Press. "Restriction of the ego deals with emphasized. 1 refer here to her role both as a roles of mental representation and mental unpleasurable affect that is aroused by teacher — and in this regard she was quite processes in therapeutic action. The FREUD, A. (1974). A psychoanalytic view of external experience. The idea is that outstanding — and as a promoter and Psychoanal. Study Child, 48:947 developmental psychopathology. In The after the child has once had the experi- facilitator of psychoanalytic clinical and con- Writings of Anna Freud Vol. VJII. New FONAGY, P. & MORAN, G.S. (1991). Understand- ence that such an affect can be aroused, ceptual research. From the very inception of York: Int. Univ. Press, 1981. ing psychic change in child analysis. Int. J. the easiest thing for him is not to enter the Hampstead Clinic, Anna Freud set up and FREUD, A. (1978). The principal task of child into the same situation again... this is Psychoanal., 78:15-22. encouraged research groups which met weekly analysis. In The Writings of Anna Freud, by no means a neurotic mechanism, but FREUD. A. (1926). The Psycho-Analytical Treat- to consider special topics; and these groups Vol. VIII. New York: Int. Univ. Press, 1981. really one of the mechanisms which help continued for years and produced a remark- ment of Children. London: Imago, 1946. us to build up our different personali- able number of contributions to the FREUD, A. (1936). The Ego and the Mecha- FREUD, S. (1905). Three Essays on the Theory ties. From the earliest time there is more psychoanalytic literature, advancing our knowl- nisms of Defence. London: Hogarth. of Sexuality. SE. 1.

20 21 SAMlKSA SAMIKSA ANNE-MARIE SANDIER

ROSENFELD, S. K. & SPRINCE, M. P. (1965). SANDLER, J., DREHER, A. U. & DREWS, S. (199^ Some thoughts on the technical handling SOME THOUGHTS ON ATTENTION An approach to conceptual research in psv of borderline children. The Psychoanal choanalysis illustrated by a consideration Study Child, 20. Fred M. Levin of psychic trauma. Int. J. Psychoannl 18:133-141. " aL> SANDLER, J. & FREUD, A. (1985). The Analysis Everyone has experiences with fluctuating attention; some, however, much more of Defense: the Ego and the Mechanisms than others: for example, those with attention deficit hyperactivitv disorder (ADHD). of Defense Revisited. New York: Int. Univ. YOUNG-BRUEHL, E. (1988). Anna Freud: a Bi- However, not much has been written about the vicissitudes of selective attention Press. ography. New York: Summit Books. and psychoanalysis. This paper attempts to introduce the subject by describing the anterior and posterior attentional systems, which together form an executive con- trol network (ECN), and the various brain structures which constitute "extensions" Anne-Marie Sandier to the ECN which it uses to expand or contract its capabilities. Consciousness is 35, Circus Road a complex function of the anterior cingulate cortex, which accomplishes many London NWS 9JG tasks, one of which is the overall control or selective override of low level process- ENGLAND ing of attention. The search for what to attend to is an active process that also follows our unconscious needs. Some of the research bearing on the ECN is noted and the various "extensions" are described (amygdalar and hippocampal systems, corpus callosum, cerebellum, etc.). In a final section, consideration is given to how possible derailments of these brain components or their system relationships might impact on analysands and present themselves within psychoanalysis. This paper is meant to build upon earlier papers in Samiksa by the same author, but because of the complexity of the subject readers are referred to a more comprehensive review, now in progress, which is expected in 1998 (see Levin, EM., In: (eds.) Wilson and Levin, In Press).

A young driver suddenly comes to a screech- An analyst listens to a patient freely asso- ing halt as he realizes that his car has entered ciate and is surprised to find herself thinking an intersection against a red light and is per- of the very last time she spoke with a dying ilously close to pedestrians. The surprise on friend. Returning from this reverie, however, his face makes him look like he just awoke she recalls that at the beginning of this same from a bad dream. session the patient had innocently mentioned in passing the name of a particular friend he A self-employed business man fires his sec- might visit on an upcoming trip. The analyst retary and gradually discovers that he is unable knows that this close friend of the patient is to stay organized and properly attend to many suffering from cancer. The analyst comments accounting details which begin to seriously on her own associations, and with this the overwhelm him. patient gets more in touch with his current A grammar school student with an other- fears about losing his friend to cancer. He had wise nice disposition becomes surly with her been aware of these thoughts earlier in the parents after realizing that once again she has session, but was defending against them. forgotten to turn in a homework assignment, and will not get academic credit for her ef- Each of the above situations concerns se- forts. lective attention, a variable that quietly

Fred M Levin, M.D., Training and Supervising Analyst, Chicago Institute for Psychoanalysis; Assistant Professor of Clinical Psychiatry, Northwestern University Medical School, Chicago, Illinois; Faculty, Department of Neurology and Department of Psychiatry, Chicago Medical School.

22 SAMIKSA 23 SAMIKSA FREDM. LEVIN SOME THOUGHTS ON ATTENTION

functions behind the scenes of most lives so attempts to delineate attention from an inter- perceptual defence, that is, the idea that hu- tasks are then added to the primary task. These long a.s it does so successfully. When this disciplinary perspective. This paper also builds mans in general are not ready to accept what tasks involve such things as counting back- function fails, however, the seamless experi- on two previous papers written for Samiksa they see, hear, touch, etc. unless it fits with ward from a fixed digit or monitoring a series ence of life itself can begin to unravel, (Levin, 1995, Levin and Gunther, 1996). It their inner needs. Put differently, reality like of spoken words for the appearance of a tar- sometimes disastrously. It behoves us to ex- does not, however, attempt to elaborate on the memory is a highly filtered construct. Each get word. To help differentiate the primary amine carefully what exactly attention is and relationship between psychoanalytic learning experience recreates reality or the memory of from the secondary tasks using scanning, only the primary task requires a movement as a what factors may influence the shape of its and attention per se. Those interested in this it. Thus denial, disavowal, projection, etc. response. Posner and Raichle learned that the deployment. After examining this subject I subject should consult Levin (1995 and I997d). allow us to adjust the current perception of secondary tasks essentially delay the time re- shall return to the specific examples given to reality according to our momentary psycho- Some definitions may help at the outset. quired for the primary task. They interpret this make some further comments about each case. logical needs. It should be clear from this Attention refers to our conscious awareness as indicating that "visual orienting requires description of mental processing, that in our Psychoanalysts, of course, have their ideal of what is happening in the here and now. access to fan]...executive network" (p. 177), effort to wrestle with what generally underlies of so-called "evenly hovering attention"; how- Selective attention refers to the fact that when- that is, to an overarching system which pays shifts in attention, we are engaging a new ever, although there is well documented ever we chose to focus on some things we attention generally and not just visually. As subject: the need to create and preserve a evidence that both the patient and the analyst leave out others, depending presumably upon we shall see the anterior cingulate gyrus and privately useful reality, or a •'private self can learn to pay attention to the fluctuation of what is of interest to us at the time (that is, basal ganglia play a crucial role in providing their thoughts, it certainly doesn't appear that depending upon our motivation). Put differ- (Model 1, 1993). these functions. the result is ever "even" or "regular". In this ently, signals compete for our attention. But this paper must be careful not to at- sense the ideal would appear to be a theoreti- Motivation refers to the idea that perception, tempt to review the bulk of psychoanalytical There is a second important variation of cal fiction, although a useful metaphor action, and thinking tend to follow deeper level theory, for example, theory about the uncon- their original experiment. When they use as nevertheless. Maybe the best one can hope for priorities which are set according to some inner scious or about self experience. Rather, our subjects patients with damaged parietal lobes regarding attention is that during each analy- hierarchy of goals. Thus, if our brain decides purpose is the more limited goal of updating on the primary task alone, as expected delays sis the participants (that is, both analyst and that the time to eat is approaching, instruc- our thinking about how unconscious cognitive in the primary task occurred, especially when analysand) will feel free enough to comfort- tions are relayed to our various sense organs mechanisms provide selectivity of attention, the target to be tracked appeared in the visual ably experience their own and each other's to begin to investigate the availability of food. and how this manifests itself in our patients. field opposite to their lesion and at a location attentional shifts while simultaneously observ- other than where the subjects were attending ing and remaining curious about when and Consciousness obviously plays some role For this purpose it will help to review some (that is, in a part of the visual field controlled how these shifts occur. In addition, of course, in the ensemble of activities which I am at- recent work in the area of the so-called execu- by the parietal cortex). This is because pari- both parties need to appreciate the significance tempting to describe; somewhat surprisingly, tive control network, a terminology which etal lobe damage is known to interfere with of these "resonances" for such things as their however, understanding the role of conscious- denotes the highest level system of the brain the ability to detach from things which have ongoing transference relationship. ness in brain design is much more complex which enables us to establish and maintain than it appears. Those interested readers who control over mental processing in an efficient captured our interest. What was unexpected, Attention also bears important relationships wish to pursue this aspect of the problem will manner. As with my earlier contributions to however, was that when these same parietal to learning. For example, what I will later de- need to look beyond this discussion (for ex- Samiksa some detour into neuroanatomy and damaged patients were engaged in the com- scribe as the anterior attentional system relates ample, Levin, 1997a). Motivation is another physiology is inevitable, but hopefully this will bined (primary and secondary task) directly to what has been called explicit learn- complex topic which is beyond any brief dis- help some readers better appreciate how things experiment, their reaction times were slowed ing (memory) and is blocked by distraction; cussion but has been ably reviewed by are done in the brain, that is, how brain makes only very slightly and they were not slowed at all when images appeared on the side control- while what I shall call the posterior attentional Lichtenberg (1989). Fortunately, leaving these mind, rather than add a level of complexity to led by their lesion! From this second system relates to implicit learning (which is topics out, however, will not detract too much an already difficult subject. learning without being necessarily the recol- from the present discussion which is concerned experiment and its unexpected result Posner lection of the experience that one is learning) principally with shifts in attention, their role II. The Core Executive Control Network and Raichle concluded that "not only does visual orienting require access to the execu- and this is not blocked by distraction (Posner in information processing, and their meaning Posner and Raichle (1994) describe an ex- and Rothbart, 1994). for clinical psychoanalysis. tive network...but operations performed by the periment in which subjects must attend to a executive network are quite different from These brief introductory remarks should Perception is the process of taking in expe- particular location on a TV monitor and press those performed by the visual orienting net- highlight the importance of attention to life rience by means of particular sensory a key when a specified target appears. We will work" (p. 177). In other words, the more and to analysis. The remainder of this paper modalities. Of help is the Freudian notion of call this the primary task. So-called secondary

24 25 SAMIKSA SAMIKSA FREDM. LEVIN SOME THOUGHTS ON ATTENTION

general system for executive control is obvi- III. The Enlarged System for Executive gyrus. The reader may be confused by the psychological development. ously capable under certain circumstances of Control current literature on working memory which taking over for the visual system. The reticular activating system has long varies from author to author somewhat. But Having described the basic components of been known to play a role in general arousal. most researchers seem to agree with Posner One final comment about this experimen- the executive control network, I wish to add This contributes to the precise control executed that the anterior cingulate and frontal cortical tal paradigm. These researchers also some complicating facts. In addition to the by the anterior cingulate in forming systems areas (including orbital frontal cortex) are both discovered "...[that] if a target is detected in anatomical structures twted in the basic net- tuned for specific cognitive tasks. In essence, decisive. (one] stream of information, the chance of work, it is important to note the presence of the cingulate's job involves recruiting an ex- detecting a simultaneous target in the other other structures which contribute decisively The basal ganglia are well known to pro- ecutive control network which is matched to stream is greatly reduced" (p. 178). It appeared to executive control. You may think of these vide control over movements and ideas, and the task at hand, including the necessary data- to them that what they were studying in these components as an extended system that is for recognizing the appearance of redundan- bases of the brain bearing on this task. Along various experiments was what is usually meant available to the anterior and posterior parts of cies (meaning recurrent thoughts and actions) the way the executive control network creates by consciousness, "at least in the form of focal the executive control network: in essence, they and for setting limits when necessary in their the felt experience of self awareness (con- awareness" (p. 178). are extensions of the basic system without cycling within mind and brain. I am referring sciousness), cohesiveness, intentionality and which the basic system could not accomplish to the research on obsessive compulsive dis- autonomy (see also Levin, 1997c). Posner and Raichle divide the executive much that is interesting or important. order (OCD) (Baxter, 1994; Schwartz, Stoessl, control network into anterior and posterior Baxter, Martin, and Phelps, 1996), and also to First let me name these structures, then say IV. Some Clinical Applications: The components. The anterior involves the ante- recent research on childhood Group A beta a word about some of them. I note the follow- Executive Control Network At Work rior cingulate gyrus and basal ganglia, and is hemolytic streptococcal infections where in- ing: the cerebellum, corpus callosum, responsible for selecting objects of interest, jury to the caudate may contribute to OCD At the outset of this essay I introduced vi- amygdalar and hippocampal systems (on both zooming in on these, and for overall attentional clinically as an "interval clock" mechanism of gnettes relating to selective attention. I will sides), the basal ganglia, the orbital frontal control. The posterior system is made up of make some brief comments on these cases, cortex, the left posterior parietal cortex near the brain gone awry (Baker, 1996; Morell, the superior parietal cortex, pulvinar, and su- the angular gyrus, the reticular activating sys- 1996). If we cannot compute time duration and then attempt to describe how I believe perior colliculus. This system enables subjects tem, and the left frontal cortex near Broca's perhaps this is when we need to repeat. problems with the executive control network to detach interest and move on to new inter- area. may demonstrate themselves in the clinical ests. Detailed descriptions of the sub-functions The corpus callosum is not just the band situation (analysis or psychotherapy)- The first of next, scan, name, zoom, etc. are covered in I have described the amygdalar and hip- of neurons connecting the hemispheres but is vignette was of a young man whose car Posner and Raichle's book, and the numerous pocampal systems in a recent review (Levin, true associative cortex. Sperry, Trevarthen, screeched to a halt narrowly missing some pe- bibliographic references they cite therein. 1997b) and will not elaborate on these sys- Levy and others have demonstrated that it plays destrians. As psychoanalysts, we naturally tems here. a role in matching hemispheric systems (some would think of a mix of conscious and uncon- lateralized, some not) with task at hand, Posner and Raichle cite evidence that sup- scious impulses that could generate such Working memory, according to Posner (per- through what they call "metacontrol". It also ports their conclusion that consciousness as behaviour. What needs to be added, however, sonal communication, 1997) involves two brings together non-verbal and verbal intelli- focal attention requires the activity of the is that it is possible for an individual's atten- major components. There is a content specific gence with affect and knowledge systems anterior cingulate. First, in a semantic moni- tive behaviour to fail because of physiological component and an executive control. Posner (Levin, 1983, 1991). toring task the anterior cingulate shows disturbances in the executive control network. believes that the content specific information stronger activation as the number of targets Only examining the detailed history, physical is present in the left lateral frontal and left The cerebellum, does much more than regu- increases, without corresponding increase in and mental status of a person will tell us the posterior parietal cortical areas, perhaps sepa- late movement; its prime function "...is to learn task difficulty. Second, the anterior cingulate extent to which specific behaviour is deter- rate for different domains. For example, he to predict and prepare for imminent informa- activates when subjects are asked to evaluate mined by conflict or by other factors. In my believes verbal material requires the left fron- tion acquisition, analysis, or action" (Allen, multiple target attributes, such as form, col- experience a significant number of learning tal area near Broca's area a,s well as the left Buxton, Wong, and Courchesne, 1997). This our, and motion. Third, feelings of effort in disabled children grow into learning disabled posterior parietal area near the angular gyrus. recent research confirms pioneering studies in visual target detection coincide with those adults. Some of these individuals suffer from But.as noted above, Posner feels that overall the late 70's and early 80's by Heath and oth- times when the anterior cingulate is activated, attention deficit disturbance with or without control of working memory is not domain ers on patients with cerebellar damage, by Itoh whereas clearing one's thoughts is associated hyperactivity (ADHD). This population may specific and this involves the medciat frontal on the vestibulocerebellar reflex, and by Frick with deactivation of the anterior cingulate. show clear-cut evidence of brain damage on cortical system, namely, the anterior cingulate and myself on the cerebellum and neural con- trol in relationship to learning and neurological examination; it most certainly

26 27 SAMIKSA SAMIKSA FREDM. LEVIN SOME THOUGHTS ON ATTENTION

shows problems with such variables as short- Now I would like to finish with some brief edly assisting the patient in making transi- sense of omnipotence, or some deep seated term memory and selective attention on suggestions as to how disturbances in aware- tions in thinking. masochistic impulse. In this case, the problem neuropsychological testing. ness/attention might present themselves in may stem from an executive malfunction in A third example might be classified as a treatment. I will, obviously, be employing the integrating the various components of the con- The self-employed businessman with diffi- disturbance in metacontrol, following perspective of the executive control network trol network, say a disturbance in the cerebellar culty tracking accounts was seen in treatment Trevarthen and Levy's terminology. This kind described above. The first example concerns module, which ordinarily improves the han- and tested by an expert in learning disabili- of patient will be relatively unable to match a patients with disturbances of consciousness. dling of thoughts with the same agility that it ties. The diagnostic impression of his analyst, particular task at hand with the optimal men- Gedo (1996), reviewing a lifetime of psycho- orchestrates movements. In this instance, the confirmed by psychological testing was that tal/brain machinery suited for such problem analytic work, describes patients who analyst's interventions (interpretations) may he definitely suffered from an attention deficit solving. This decision requires an intact cor- demonstrate disturbances of consciousness have the function of simplifying the overall disorder without hyperactivity. The history pus callosum, under the guidance of the during their analysis, something which is ac- cognitive task by such measures as reducing confirmed his symptoms started during his anterior cingulate gyrus. Here the analyst's at- tually quite rare (3 out of 70). Interestingly, the patient's memory load, thus freeing the childhood, and all DSM-IV criteria for the tention will be drawn inexorably toward each such patient had experienced disturbing patient to concentrate more effectively on how diagnosis of ADHD were met. Treatment with questioning the nature of patient's approach trauma during their first year of life that con- to best arrange the elements in mind into a stimulants resulted in immediate significant to particular problem solving. Of course, the tinued for significant periods thereafter. coherent pattern. This may be accomplished, gains in his ability to concentrate. In addition, analyst will need to be careful not to over- Howard Shevrin (1992) has indicated that one for example, by reminding the patient in timely he selected to continue his psychotherapy in diagnose executive control problems. For mechanism that may play a role in such cases and gentle ways of important related material order to sort out the significance of this new example, we might start to quickly dismiss as is that proper perceptual tags are not attached from preceding sessions. Please note, I am diagnosis for his sense of self. inappropriate a patient's surprising thoughts to such experience, so that memory becomes merely suggesting one set out of a large or approaches as if these are pathological per The grammar school student who got into unreliable. That is, such traumatized patients number of possibilities of intervention, but I se just because they are unexpected. On the trouble with homework, a common enough become unable to differentiate properly be- think this example (and the others above) one hand, some patients will just be unusually problem, is being observed by her parents and tween what is a memory of thought, of a real should give some idea of what I mean when creative. On the other hand, analysts cannot not in treatment. Her psychological testing is event, of a wish, etc. For Shevrin such catego- I suggest that the executive control network help but observe that some patients are likely currently inconclusive. The probability remains rization of experience is the principal function deserves the attention of psychoanalysis. In to have problems with analyzing because they that there is some developmental delay which of consciousness (attention) and is required fact, it seems probable that analysts are al- consistently approach certain problem domains is showing itself as at least transient dysfunc- for the proper organization of memory, and a ready thus addressing both neurophysiological from the wrong perspective. Gedo refers to tion of the executive control network. Unless number of self-related functions. and conflict-related difficulties through the such patients as apraxic; it should be noted she would be in psychotherapy or analysis it tactful subtlety of their interventions. After that this does not imply that learning cannot would be difficult to make any further charac- A second example would be an analytic all, the mind/brain does not change just be- occur with profound effects. Obviously, the terization. patient with a non optimally functioning pa- cause we shift our orientation at times between diagnosis and facilitation of learning difficul- rietal lobe. Such posterior attentional pathology psychoanalysis or neuroscicncc. The example of the analyst whose atten- would require special care in helping the ties is a very challenging part of the work of psychoanalysts. tion drifted to a reverie of being with a dying patient to properly detach their interest from I thank Samiksa for this opportunity to friend was given to remind us that our ana- subjects or objects of interest. This kind of One final example. Consider a patient who present my ideas on the interface between lytic listening involves fluctuating attention as difficulty would need to be distinguished from consistently attempts to accomplish too much biological and psychological issues in the a normal event which we learn from. Such ADHD or with obsessive compulsive behav- at once, but not because they are driven by a context of teaching and learning in psychoa- ego capacities are sometimes surprising in their iour. Put differently, such symptoms as pathological need to achieve, a narcissistic nalysis. depth and range. Most importantly, they can difficulty in distracting oneself from compel- be improved if we become aware of and prac- ling subjects may result from a variety of tise them, and if we discuss with each other pathological mechanisms, including our focus the data of our scientific observations and the here, a malfunction of the parietal system References ways in which we use analytic data to make which ordinarily allows smooth transitions BAKSIR, B. (1996). OCD, tics follow strep throat various inferences. In fact, the very scientific from one interest to the next. The analyst in ALLKN, G., BUXTON, R.B., WONG, E.C., and in some children, Clinical Psychiatry News, status of psychoanalysis depends, to a signifi- such a patient with parietal lobe pathology COURCHI-SNH, E. (1997). Attentional activa- March issue, p. 16. cant extent, on such matters as how we collect, would therefore make use of the fact of tion of the cerebellum independent of motor utilize, and test our evidence. observing himself or herself subtly but repeat- involvement, Science, 275:1940-1943. BAXTI-R, L.R. JR. (1994). Positron emission

28 29 SAMlKSA SAMIKSA FRED M. LEVIN

tomography studies of cerebral glucose AND GUNTHER, M. (1996). The psy- DEATH DRIVE, NEGATIVE NARCISSISM, DISOBJECTALISING metabolism in obsessive compulsive choanalytic approaches to the FUNCTION * disorder, Journal of Clinical Psychiatry, 55 neuropsychiatric patients, Samiksa, Journal Suppl., 54-59. of the Indian Psychoanalytical Society. Andre Green GEDO, J.E. (1996). Epigenesis, regression, and LICHTENBERG, J.D. (1989). Psychoanalysis and The concept of the death-drive is highly controversial in contemporary psychoa- the problem of consciousness, The Annual Motivation. Hillsdale, N.J.: The Analytic nalysis. The author examines the different aspects it conveys in Freud's work. The of Psychoanalysis, 24:93-102, The Analytic Press. question of the representative of the death-drive is considered, and its main clinical Press: Hillsdale, N.J. MODELL, A. (1993). The Private Self Cam- applications. Objects and drives are coupled. The object is the revealer of the LEVIN, F.M. (1983). Psychoanalysis and the bridge, MA: Harvard Univ. Press. drive. The hypothesis of an objectalising function is raised as a process of trans- two cerebral hemispheres, The Annual of formation of psychic cathexes into objects through binding. Similarly a Psychoanalysis, Int. Univ. Press, New York. MORELL, V. (1996). Research news: Setting a disobjectalising function unbinds the products of the objectalising function, by (1995). Psychoanalysis and inter- biological stopwatch, Science. 271:905-906. destroying the links. This process ends in a condition called negative narcissism as an aspiration of the ego to the zero level. For the author this conception could disciplinary research: An introduction to POSNER, M.I. AND RAICHLE, M. (1994). Images be a possible alternative to Freud's theory of the death-drive more in harmony with the integration of neuroscience and the psy- of Mind. New York: Scientific American clinical facts. choanalytic theory of learning, Samiksa, Library. Journal of the Indian Psychoanalytical I. The discussion on the concept of the death- these two preceding aspects, the linkage lead- Society, 49:1-12. AND ROTHBART, M. (1994). Chapter ing to the insertion of the concept of the 3, Attentional regulation: From mechanism drive should be, nowadays, centred around two (1997a).In Press, Why conscious- death-drive into a theoretical mode of the psy- to culture. In International Perspectives on orders of thoughts. ness? J, Amer Psychoanal Assn. chical apparatus — second topographical Psychological Science. Vol. 1. Leading 1. The retrospective interpretation of what model whose creation closely follows the last (1997b). Abstracts: Neuroscience Themes, eds. P. Bertelson, P. Elen, and G. Freud meant to designate or signify by this theory of drives. At this level arises the ques- Section. The amygdala, hippocampus, and d'Ydewalle, Hillsdale, N.J.: Lawrence concept, lately introduced in his theory. This tion of the place, the function and the economy psychoanalysis, Psychoanal, Q., Vol. 16(3): Erlbaum Associates, pp. 41-55. interpretation demands the distinction of three of the death-drives in the psychical apparatus, pp. 555-568. aspects at work whose relationships should be SCHWARTZ,, J.M., STOESSL, P.W., BAXTER, L.R. so as to say, of its heuristic value in the en- intertwined. _ _ (1997c). The experience of con- JR., MARTIN, K.M., AND PHELPS, M.E. (1996). deavour of a theoretical representation of the sciousness and its relationship to the Systematic changes in cerebral glucose The progressive teachings of clinical expe- psychical functioning. executive control network, Prepared for metabolic rate after successful behaviour rience which has led to a re-evaluation of the 2. The contemporary interpretation of what presentation to the Gedo Festschrift Sym- modification treatment of obsessive com- basic mechanisms supposed to be at the foun- Freud designates and means by death-drive, posium planned for October 18, 1997 in pulsive disorder, Arch. Gen. Psychiatry dation of psychopathology. which poses the problem of its preservation Chicago, Illinois. 53(2):109-113. The thinking about the present and past or replacement. This interpretation depends on (1997d). In Press, Transference: the SHKVRIN, H. (1992). Subliminal perception, cultural phenomena and about certain factors numerous facts. phenomena, J. Amer. Psychoanal. Assn. influencing their determinism, at a distance memory, and consciousness: cognitive and The modification, by psychoanalytic expe- from observable facts on the one hand and on ,— Consciousness and the executive dynamic aspects. In Perception Without rience, of the configuration of the clinical field the other, the metascientific speculation on control network. In A Fusion of Humanity, Awareness: Cognitive. Clinical, and Social which served as the basis for the theoretical natural phenomena which are the object of Science and Art: Essays in Honour of John Perspectives, eds. R.F. Bornstein and T.S. elaboration of Freud. The overall picture which biology. E. Gedo. eds. A. Wilson and F.M. Levin, Pittman, Guilford Press: New York, pp. emerges from the present practice forces us to Jasaon Aronson Press, New York. 123-142. The linking of the hypotheses born out of take into account the importance of factors

Fred M. Levin Andre Green, M.D., Training and Supervising Analyst, Past Director Paris Psychoanalytical Institute, Past President 11 IN, Wabash Avenue Paris Psychoanalytical Society, Past Vice-President of the IPA, Past Freud Memorial Professor at University College Suite 1022 London. Chicago, Illinois 60602 * Paper presented at the Mascilles Symposium of the European Federation 1984 and reproduced in "Lctravait du U.S.A. Negaty" Paris Ed Minnit, 1993.

30 31 SAMIKSA SAMIKSA ANDRE GREEN DEATH DRIVE, NEGATIVE NARCISSISM, DISOBJECTALISING FUNCTION

connected with narcissism and destructivity terpretation of clinical facts and the theories but with life-drives. He will call it later on life-drive or love-drive. What we know about conjointly with whatever falls into the domain postulated for understanding them, every psy- Eros or love-drives (Freud, 1940). This slight it with the greatest certitude is its possible al- of the fixations of object-libido. choanalyst agrees on the fundamental postulate semantic shift leads Freud to talk no more of liance with the death-drive in sado-masochism. But we have also the deep feeling that there The breaking up of the post-Freudian theo- of psychical conflict. Disagreements appear sexual drives but of sexual function as a means are forms of destruction which do not consist retical field following diverse reformulations only when we have to state the nature of the to know Eros from which it is distinct. On the of this mode of intermixing of two drives. Its of his theory. Out of them, many are not sim- .elements in conflict, the modalities of the lat- other hand, Freud acknowledges that we do clear examples are serious forms of depres- ple complements to the Freudian work or ter and the consequences which follow from not possess any sign analogous to what repre- sion leading to suicide and psychoses showing simple developments of such and such aspect it. From this, we have arrived at a situation sents the libido for the sexual function, in order a disintegration of the ego. I need not go as of his thought, but rather, complete theoretical where we cannot say any more that a consen- to know the death-drive in such a direct way. far as these extreme pathological forms. The alternatives. Regarding the death-drive, let us sus would be established about the hypothesis III. Since the drive is knowable for us only contemporary psychoanalytic psychopathology notice that none of the post-Freudian theoreti- of the innate conflict opposing two principal by its psychical representatives, which we no has no problem in spotting non-intermixed cal systems adopts Freudian theory to the letter. types of drives as the expression of the primi- longer confuse with the ideational representa- forms of destructivity, more or less apparent This is even true for the Kleinian system which tive and originally psychical forces. tives, we shall hypothetically draw the in severe neuroses, and character-neuroses, openly accepts the hypothesis of its existence. In fact, one of the arguments, the most conclusion that the sexual function and its narcissistic personality structures, borderline Besides, we know that if the role of aggres- frequently used by the opponents of death- manifestation, the libido, is the representative cases etc. We must observe that in all these sion is held as fundamental in many of these drive, maintains that we do not see well how of the Eros, the life-drives or love-drives, pro- clinical configurations, the dominant mecha- systems, the theoretical frame into which it is to apply good characteristics in the death-drive, vided we understand that this function of nism which is frequently called upon, is the conceptualized differs from that of Freud. which have been described for the sexual-drive representative does not always possess all the impossibility to overcome mourning and the The conception of the general theoretical (source, drive, aim, object). In a more radical attributes of Eros binding, cohesion which, in defensive reactions it incites. Finally, in the model of the psychical activity, i.e., the psy- way the present psychoanalytic literature parenthesis, poses many clinical and series of painful affects, described in the above chical apparatus of Freud, is no longer accepted presents various stances, either against the idea metapsychological problems regarding the re- mentioned relevant entities besides other well- unanimously. Sticking to essential, let us say that drives represent the most basal element lationships between Eros and sexuality. known forms of anxiety, we observe that the present apprehension about what of the mind, or in the extreme, to emphasize The real question reverts to attempt to of- catastrophical or unthinkable , fear of should be the nature of such a model, tends to the inadequacy or uselessness of the concept fer an answer to the enigma left open by Freud: annihilation or break-down, feelings of futil- make the object, in its double status of exter- of drive. What is not held by most of the crit- what would be the function which could have ity, of devitalization or of mental death, nal and internal, play a constituent role in this ics is that the thesis of the fundamental drive the corresponding role of a representative of sensations of abyss or unending hole of chasm. One can rightly ask oneself to know whether functioning. Besides, the theory of the ego conflict fulfils, for Freud, a requisite; that of the death-drive? And we must remember that all these manifestations correspond, partly or witnesses the birth of complementary concepts, giving an account of the fact that the conflict for him, self-destruction is its fundamental entirely, to what Freud designated as innate, such as the self, the subject, the I etc. is repeatable, displaceable, transposable, and expression, whereas hetero-destruction consists that its permanance resists all the transforma- primary masochism whose status was, for him, The elimination of some of the sources of only of an attempt to release the internal ten- tions of the psychical apparatus (intersystemic endopsychical, prior to any externalization. the Freudian thought from the discussions is sion, a point of view rejected by many or intrasystemic conflicts, or between narcis- However it is true that no clinical argument due to complex reasons: the metabiological post-Freudian theories. So far as I am con- sistic and objectal libido, or between agencies constitutes a proof in favour of a death-drive, speculation and the reflection on cultural phe- cerned, I fully adhere to the hypothesis that and external reality, etc.). It is this acknowl- because, the entire clinical picture is suscep- nomena are no more included into the debate. the self-destructive function has the same role edgement which forces Freud to theoretically tible to diverse interpretations and cannot be One of these reasons might be the outcome of Cor the death-drive as, the role of the sexual postulate an original, fundamental and primary a direct expression of drive functioning. The the contradiction between what is in agree- instinct for Eros. However, unlike Freud, I do conflict involving the most primitive forms of problem stemming from clinical experience, ment with the hypothesis of Freud on the social not believe one should defend the idea that psychical activity, which explains his refusal remains theoretical. In this regard, I agree with scene where the impressive advancement of this self-destructive function would be ex- to modify his views on (he drive dualism. .1. Laplanche. means of destruction is more and more alarm- pressed primitively, spontaneously or ing (action of men towards nature and in their automatically. relationships between them), and what, till The theoretical boldness of the Freudian IV. The hypothesis that I would like to hypothesis on the death-drive led analysts to The difficulty concerning the death-drive formulate includes two presuppositions. now, invalidates this hypothesis in biological crops up from the fact that we cannot attribute sciences, lacking any evidence to support it. passionate debates about it and turned their attention from the fact that Freud does not put to it, with the same precision, a function cor- 1. It is impossible to say anything about II. Whatever be the divergences in the in- it any more in opposition with sexual drives responding to that of sexuality in relation with the death-drive without any reference to the

32 33 SAMlKSA SAMIKSA ANDRE GREEN DEATH DRIVE, NEGATIVE NARCISSISM, DISOBJECTALISING FUNCTION other term of the pair that it forms with the function is not limited to the transformations life-drive in an indissociable conceptual cou- of the object, but can let befall in the rank of In this regard, destructive manifestations projected reflection of the primary object. pling. This has for its corollary the fact that in object that which does not possess any of the of psychosis are much less linked with projec- These remarks are not outside the subject of order to have a more precise idea of death- qualities, properties and attributes of the object tive identification than with what accompanies the discussion in so far as we try to define the drive, we are forced to go further in the provided, a single characteristic is maintained it or follows it, the impoverishment of the ego primary manifestations of the death-drives Freudian theory of life-drives or love-drives. in the accomplished mental work: the meaning, given over to the withdrawal of cathexis. In and their bond with the object (primary). In 2. If we do not lose from our sight that the ful cathexis. Hence, the apparent paradoxes of spite of the considerable contribution of the this regard, we have to be aware that the theory of drives belongs to the order of con- the classical theory where the ego can itself ideas of to the understanding good enough mother (Winnicott) implicitly cepts and is therefore never entirely provable become an object (of the id) or consequently of psychosis, the latter has been partly deny- contains the bad enough mother, in order to by experience, the aim of these concepts is to which allows certain theories to speak of self- ing her own ideas by forgetting that the get out of the impasse of the idealization- clarify the experience and cannot be sepa- objects. The process of objectalisation is not schizoparanoid phase was schizo not in the persecution relationship and to promote rated from it. This leads us to affirm that confined to transformations concerning forma- sense the term made allusion to splitting mourning preserving the objectalising func- even if one sets forth the drives as primary tions which are as organised as the ego, but (schizo) into good or bad, but in the sense that tion. The effects of these observations on and fundamental entities, i.e., innate nonethe- may concern modes of mental activity in such — paranoid cathexis was opposed to schizoid technique are important. less, we have to admit that the abject is the a way that to a certain extent it is the cathexis withdrawal of cathexis. We can refer, regard- revealer of the drives. It does not create them itself which is objectalised. This leads there- ing this, to one of the most troubling The disobjectalising function is found and of course we can say that, at least, in fore to distinguish the object from the paradoxes of the psychoanalytic experience, dominant in some clinical pictures other than part, it is created by them — but it is the objectalising function, where naturally the the fact that the disobjectalising function, far the melancholia, like, infantile autism of non- condition of their coming to existence. And it binding, coupled or not with the unbinding from being synonym with mourning — is the paranoid form of chronic psychosis, mental is by this existence that it will itself be cre- comes into play. This justifies the attention most radical device to oppose the work of anorexia and diverse expressions of somatic ated by already being there. Such is the given to the theories of object-relations, whose mourning which is at the centre of the proc- pathology of the works of the psychosomatic explanation of Winnicott's idea of found and fault, however, lies in not having clearly no- ess of transformation typical of the school of Paris. (P. Marty: operating thought, created". In terms of these two remarks, we ticed the objectalising function for having objectalising function. Regarding melancho- essential depression, regressive desublimation, must keep in mind the idea of Freud that the< attached too much importance to the object lia, Freud opposed the strong fixation (oral) to progressive disorganisation, pathology of the principal mechanism described by him as typi- stricto sensu. This explains that the sexual the weak cathexis of the object. (Freud, 1917). ) form a very valuable contribu- cal of life-drive and death-drive are binding function and its sign, libido, would be the way tion to the reflection on the question we are In my opinion, it is in this manner that and unbinding. This idea is right but insuffi- to know Eros. But the latter is inconceivable discussing. They seem to corroborate the hy- should logically explain the transition from cient. Life-drives can very well accommodate without including in it the object. And this pothesis of the withdrawal of cathexis and the conception of the conflict between nar- into it the existence of these two mechanisms, clarifies the classical theory of narcissism the disobjectalising aim of death-drive. cissistic and object-libido to the last theory of binding and unbinding. In the same way, it which should however be completed. can absorb into it a share of the death-drive drives: Eros and destructive drives. This is V. The against anxiety which is thus transformed by it. Manifesta- On the contrary, the aim of the death-drive what has induced me to support the hypoth- and the other painful disorganizing affects may tions that occur out of it are not interpretable is to accomplish as much as possible a esis of a negative narcissism as an aspiration equally be reinterpreted in the light of the in terms of what is typical of the death-drive. disobjectalising function by the unbinding. to zero-level, expression of a disobjectalising thoughts on the conflicts between life and On the other hand, the death-drive consists This qualification helps understand that it is function which does not focus on objects or death-drives. One must in this perspective dis- only of unbinding. We still have to clarify not only the relation to the object which is their substitutes, but on the objectalising proc- tinguish before hand between primary and from what? being attacked but also all the substitutes of ess itself applied to the ego itself. secondary defences of the ego. Primary de- the latter, the ego for example, and even the The central point concerning the fences constitute a category of which We are proposing the hypothesis that the fact of cathexis at the extent to which it has objectalising function is that its theory has to repression is the prototype (Verdrangung). The main aim of life-drives is to fulfil an undergone the process of objectalisation. Most take into account a contradiction which is latter was subsequently enriched by the dis- objectalising function. This does not only mean of the time, we are in presence, in fact, only inherent in it, as we know that the role of the covery of other analogous mechanisms, such that its role is to create a relation to the object of the concurrent functioning of activities in primary object is decisive in it and that there as the disavowal related to splitting (internal and external), but that it shows a relation to the mixtures of the two groups of is always more than one object. But we are (Verleugnung), foreclosure (Yerwerfung), ne- capacity to transform structures into objects instincts. But the manifestation, specific to the not, as such, allowed to think that the second gation (Verneinung), whereas the other even when the object is not any more directly destructivity, of the death-drive is in the with- object, the father in (the Oedipus-complex) defences should be considered as secondary, involved. To put it differently, the objectalising drawal of cathexis. can be given secondary role in importance just aiming at strengthening or improving the task as in time. Neither can we consider it as a of these primordial mechanism.

34 SAMlKSA 35 SAMIKSA DEATH DRIVE, NEGATIVE NARCISSISM, DISOBJECTALISING FUNCTION ANDRE GREEN

References However, nearer we are to the repression It appears also to take part in the couple of in the proper sense of the term, more the binding-unbinding, as well as it has something (1917). Mourning and melancholia polarity of binding-unbinding is accompanied of the nature of the sole unbinding, as Freud FREUD, S. (1940). An Outline of Psychoanaly- by a re-binding in the unconscious, thanks to had already pointed it out. sis. S.E. 23. S.E. 14 other mechanisms (displacement, condensa- tion, the turning around the self or into the These remarks require our attention. They contrary etc.). Further we move away from show how the characteristics, which mark the Dr. Andre Green repression, the more we notice the work of modes of action of drives (binding-unbinding), 9, Avenue De L'Observatoire 75006, Paris other primary types of defence (splitting, fore- can be found again at the level of the ego. FRANCE closure) that the unbinding tends to Either the latter carries in it their stamp of predominate, by restricting or preventing the origin, or again, it imitates the binding func- re-binding. Thus, to mention only a single case, tioning revealed by the object. Will it be too so much discussed in psychoanalytic litera- much if we say an identification of the ego ture, that of projectivc identification, its with the drive functioning? Or with the ob- function seems to be that of strengthening the jects of the latter? splitting which induces the disobjectalisation, VI. The conception of mental apparatus, in spite of the apparent objectalisation at- according to Freud, survives the re-evaluation tempted by the projection and the identification that we have just initiated. But it will be bet- with the projected parts. However destructive ter off being clarified by the conflict of be its action, it is above all in an attack on objectalisation-disobjectalisation. linking (Bion, Lacan) that its fundamentally disobjectalising withdrawal of cathexis mani- The joint use of the two topographic mod- fests itself in by the extinction of projectivc els shows itself as necessary, provided, the activity which is above all expressed by the essential difference between Id of the second feeling of mental death (negative hallucina- topography and the unconscious of the first is tion of ego). Sometimes, it just precedes the understood. The unconscious appears then as threat of loss of external and internal reality. the most protective organization of the An interesting parallel has been maintained objectalising function. between foreclosure and radial rejection sup- posed to be at the ground of psychotic It is clear that the hypothesis of the structures and a corresponding mechanism objectalising function could have been more supposed to be at the foundation of severe advanced than I did here. Had I done this, the somatic disorganisation (P. Marty) which discussion on the death-drive would have been would be the expression of a disruption of decentred on life-drives. This is what people mental functioning characterised by the pov- have very strong tendency to make in the erty of psychical activities or the deficiency exchanges that revolve around such a difficult of their cathexis. Of course, we are, here, talk- theme. But I shall content myself with a sin- ing about asymptotic functionings which testify gle but fundamental point: the major less the accomplishment of the aim than its consequence of the objectalising aim of life- orientation towards the pursuit of its ultimate drives or love-drives is to accomplish, by the goal: the objectalising withdrawal of cathexis. mediation of the sexual function, the symboli- sation (Bion, Lacan, Winnicott). Such The negation, which is expressed through accomplishment is the warrant of the inter- language, occupies certainly a particular place mixing of the two groups of drives. Their in this category, as it appears to cover the axiomatics is, for me, indispensible for the entire field occupied by each of the other terms. theory of the psychical functioning.

37 36 SAMlKSA SAMlKSA TRANSFERENCE-COUNTERTRANSFERENCE ENACTMENT IN SUCCESSFUL CLINICAL PSYCHOANALYSIS * Owen Renik

The author proposes that it is useful to consider the sequence of events in a clinical analysis from three complementary perspectives: as an unfolding process of inter- pretation, as a continuing transference-countertransference enactment, and as a series of corrective emotional experiences. He suggests that a conception of clini- cal technique which directs the analyst to substitute countertransference awareness for countertransference enactment is misguided because some form of enactment of emotionally-charged responses always precedes awareness of them. Some of the most important things analysts do, they do unconsciously. The author discusses the problem of how to protect patients from exploitation, and underlines the impor- tance of better defining what might be called "analytic conscience." Clinical examples are given.

Introduction In Forty-two Lives in Treatment (1986), Wallerstein reported data gathered in a long- I hope to inquire into the psychoanalytic proc- term, prospective study that did not support ess, the sequence of events characterizing a the contention that psychoanalysis and psy- successful cHnical analysis. I have always been chotherapy are easily and clearly a bit leery of the term structural change itself, distinguishable from one another on the basis because I think concrete and material conno- of methods employed and results achieved. tations of the word "structure" dispose toward One reason for the overlap might be that the reification. For me, psychic structure is sim- mechanism of action of clinical psychoanaly- ply a convenient way to refer to the clinical sis has more in common with the mechanisms inference that a group of psychological activi- of action of other treatments than we have yet ties appears to be relatively stable and realized. Possibly some of our assumptions functionally interrelated. The case example I have caused us to exclude from our theory will present portrays structural change and also important elements of the psychoanalytic proc- illustrates how in a psychoanalytic process we ess, even to mistakenly regard them as inimical learn about psychic structure at the same time to analytic work. With this point in mind, I and by the same means that we alter it. would like to turn to the topic of The specific focus of my discussion will countertransference. be on the role of countertransference enact- ment in the psychoanalytic process. Clinical Countertransference Enactment and observation and reflection lead me to question Awareness of Countertransference a widely held view of the consequences of Few of us any longer regard the existence countertransference enactment. I will propose of an analyst's varied, even powerful, emo- an alternative. tional responses to his patient in the clinical

Owen Rcnik, M.D., Editor-in-Chief, The Psychoanalytic Quarterly; Chairman, Programme Committee, American Psychoanalytic Association; Training and Supervising Analyst, San Francisco Psychoanalytic Institute. * A previous version of this article was published in Psychic Structure and Psychic Change, M. Horowitz, O. Kernberg and E. Weinshel, eds. Connecticut: International Universities Press, 1993.

39 SAMfKSA OWEN RENIK TRANSFERENCE-COUNTERTRANSFERENCE ENACTMENT

situation to be a hindrance to analytic work. scious of a countertransference motivation. The might ask ourselves whether such instances curs without being preceded by On the contrary, an analyst's sequence of events in which awareness fol- show us with unusual vividness what is regu- countertransference enactment. However, ex- countertransference reactions are by now lows enactment is generally conceptualized as larly the case, whether these "errors" differ perience indicates otherwise. Even the slightest generally considered a rich and crucially less than optimal — though, of course, per- from the majority of our preliminary nuance of disposition influences how an ana- useful source of information. fectly expectable, given human limitations. countertransference enactments only in that lyst hears material, whether he decides to be Nor is it expected that an analyst will al- I think we have maintained, without realiz- circumstances conspire to bring them explic- silent or to intervene, how he expresses him- ways be immediately conscious of his ing it, an unsubstantiated theory that fantasy itly and dramatically to our attention, making self if he does make a comment, etc., all of countertransference responses. A burgeoning can become conscious without having been disavowal of them more difficult. which is of the greatest importance, as we literature concerning the analyst's self-analy- expressed at all in action. According to Freud's know. For example, Jacobs (1986) describes We have little difficulty regarding transfer- sis shows us how subtly countertransference (1900) early reflex-arc model of mental func- how his particularly rapt, silently attentive ence enactment as a necessary prelude to can manifest itself in action, how easily tion, motivations are envisioned as impulses listening in a certain treatment was motivated transference awareness for an analysand. We countertransference enactments can be ration- that can take either one or two quite separate by his admiration and hostility toward the expect an analysand to begin by playing out alized as appropriate technique, and how paths: the efferent, leading to motor activity, patient, who reminded Jacobs of his father. his transferences within the treatment relation- countertransference is often acted upon for or the afferent, leading to fantasy formation This vvas an extremely consequential ship, and eventually to become aware of what some time before being recognized (e.g., via stimulation of the sensory apparatus from countertransference enactment, even though it Jacobs, 1986). The contemporary analyst within. Every clinical analyst has had the he is doing; it seems we find it difficult to did not involve grossly aberrant behaviour by strives to be completely aware of his opportunity to confirm Freud's later (1914) suppose that the same is true for an analyst the analyst, arid it went unnoticed con- countertransference reactions, but realizes that observation that conscious awareness of an with respect to his countertransferences. At sciously, at least — by the analysand. this is an ideal that can never, in practice, be irrational fantasy and of the motivations that the same time, we regularly observe that suc- achieved (Abend, 1986), Furthermore, he produce it can put an end to enactment of the cessful analytic work unfolds via a process of As it stands, our theory of technique indi- knows that it is often possible to turn a fantasy; but I know of no empirical validation continuous mutual active embroilment between cates that an analyst should strive to minimize countertransferentially motivated technical for Freud's early proto-neurological analyst and analysand, and continuous effort his countertransference enactments in order to error to good account, once it has been iden- conceptualization of thought and action as on the part of both to become aware of and maximize his countertransference awareness. tified, by exploring the analysand's reaction mutually exclusive activities. clarify the nature of the embroilment. Sandier However, if countertransference enactment is to what has transpired (Panel, 1986). (1976) speaks of the analyst's "free floating a prerequisite for countertransference aware- On the contrary, there is every reason to behavioural responsiveness" and his post facto ness, then elimination of countertransference I think it is fair to summarize the current conceptualize thought and action on a con- awareness of its countertransference determi- enactment is not only unattainable as a prac- consensual view as follows: an analyst's tinuum, thought being a form of trial action, nants. Boesky (1990), for example, has tical technical goal, but it is misconceived even awareness of his countertransference is an based on a highly attenuated form of motor concluded that "If the analyst does not get as a technical ideal toward which the analyst asset that contributes to analytic work, while activity. Darwin pointed out — and Freud emotionally involved sooner or later in a should strive. While countertransference sat- expression of his countertransference in ac- (1926) agreed with him — that a physical re- manner that he had not intended, the analysis isfaction is clearly not an objective to be tion is a liability that limits analytic work. In sponse lies at the core of every affect. The will not proceed to a successful conclusion." pursued, in and of itself, in making technical other words, countertransference enactment is data of introspection favour William James' (p. 573). decisions, neither does the presence of considered inevitable, and by no means dis- (1890) formulation that awareness of emotion countertransference motivation constitute a astrous, but not desirable per se. How does an arises from one's observation of one's actions. Countertransference Enactment and the contra-indication to a given course of action. analyst become aware of his It seems likely that if we could always Psychoanalytic Theory of Technique This would seem to be a point worth em- countertransference? We usually assume, it is closely examine the sequence of events by The self-observation that leads an analyst phasizing since analysts tend to be quite best if a countertransferentially motivated fan- which an analyst becomes aware of his to awareness of his countertransference can conscientious, so that interferences with an tasy claims the analyst's attention, i.e., if he countertransference motivations, we would be of behaviour on the very finest scale of analyst's functioning arise at least as frequently imagines acting in relation to the analysand in find that it invariably begins with his noting magnitude — a subtle kinesthetic tension. It from constraining inhibitions and reaction some way. However, it is commonplace for an how he has put them, sometimes almost im- is tempting to believe that such microactivity formations designed to guard against enact- analyst first to become aware of some way perceptibly, into action. We are familiar with remains essentially private to the analyst and ment of counterlransference urges (perhaps that he has, in fact, been behaving in the clini- finding ourselves able to profit in the clinical has no significant impact on the treatment with eventual breakthrough) as from direct en- cal situation, and then, through consideration situation from post facto investigation of our relationship, so that, for all practical purposes, actment of countertransference urges per se. of what he has been doing, to become con- countertransferentially-motivated errors. We countertransference awareness sometimes oc- In my experience, the technique of novice

40 SAMIKSA 41 SAMIKSA TRANSFERENCE-COUNTERTRANSFERENCE ENACTMENT OWEN RENIK

contract. This is the point, I believe, that Bird think there has been an awareness on the part analysts tend to suffer more from stiffness than countertransference enactment, what of any means to address in the passages I have cited, of many that if we do not continue to try to from an excess of spontaneity. immediacy would there be to analyze? In fact, and what Freud (1915) had in mind when he understand the importance to the analytic proc- Bird goes on to say, referring to the need for We have come to realize that analytic work emphasized that a patient's "transference love," ess of non-interpretive aspects of the real conflict between analyst and analysand, is not furthered by preventing a patient from though lacking the freedom of love occurring interaction between analyst and patient — "In order for this to happen, I am tempted to "acting out," but rather by helping him be- outside an analytic treatment relationship, is which Alexander and French labelled "correc- believe the analyst's own transference involve- come as completely aware as possible of the every bit as genuine. One of the most familiar tive emotional experience" and addressed, ment is necessary" (p.235, my italics). various motivations for his actions. Similarly, and potent resistances to the analysis of trans- though ultimately in an unproductive way — an analyst can aim at maximum awareness of then we will have thrown out the baby with Certainly, there is a distinction between the ference is precisely when a patient maintains, the elements of countertransference enactment the bath water. Thus, some theories of the role of the analyst and the role of the analy- sometimes quite subtly, the conviction that that motivate his technical conduct, without analytic process suggest that the analyst is a sand in the analytic process; but it is hard to events taking place within the treatment situ- assuming that gratification of a new object, providing new experiences that see how that distinction can be made on the ation are less than completely real. countertransference urge in the clinical situa- permit development to go forward (e.g., basis of the degree of either party's actual tion necessarily opposes the analytic process. Loewald, 1960; Settlage, 1989); others em- involvement, i.e., the extent to which either The "Corrective Emotional Experience" phasize the mutative role of empathic one expresses emotional responses in action. It may be a bit disconcerting for us to admit Transference-Countertransference responsiveness (Kohut, 1971); others concep- Rather, it would seem that the difference be- that an analyst's awareness of Enactment tualize the analyst as passing tests so as to tween an analyst's participation and an countertransference, like an analysand's of disconfirm the patient's pathogenic beliefs Having considered the idea that analysand's has to do with the agreed-upon transference, is always retrospective, in the (Weiss and Sampson, 1986); and so on. countertransference enactment contributes use- purpose of the partnership (to increase the sense that it is preceded by an enactment of fully to an analyst's participation in the analysand's self-awareness), and the intentions which he has been unaware; but by this ad- Our difficulty comes when we try to rec- psychoanalytic process, just as transference en- of each in relation to it. Thus, for example, mission we gain a way of understanding how oncile these formulations with our other ideas actment does to an analysand's, I would like what is revealed to the analyst in the course an analyst becomes sincerely involved in the about analytic process and technique. If psy- now to look at the interaction between trans- of the work about his countertransference re- emotionally-charged encounter that is the choanalysis is a corrective emotional ference and countertransference enactment. mains private to him, whereas what is revealed substrate and text of every successful clinical experience, then a systematic theory of ana- Freud pointed out that the treatment rela- about the analysand's transference is a matter analysis. Aside from the authenticity of the lytic technique should direct the analyst how tionship is the arena in which definitive for joint consideration. Also, while the patient engagement between analyst and analysand, best to provide a corrective emotional experi- learning about transference takes place, "For can and should strive to verbally express him- there is another aspect of the analytic encoun- ence for the analysand. We immediately come when all is said and done, it is impossible to self as freely as possible, the verbal expressions ter that we know to be crucially important: for up against, in one form or another, the very destroy anyone in absentia or in effigie" (1912, of the analyst, because he functions as "con- an analysis to proceed the interactions between same problems raised by the recommendations p. 105). This famous comment resonates with science of the analysis" (Calef and Weinshel, analyst and analysand have to be such that the of Alexander and French: What is incorrect? our clinical experience. Any number of in- 1980), are limited by his need to keep the latter is able to recreate and master crucial Of what should correction consist? And who vestigators have noted that the analysis of goals of the enterprise continuously in mind. pathogenic experiences. This observation decides these matters? It is presumptuous for transference requires actual engagement by the brings up the vexing problem of the concept an analyst to take it upon himself to decide analytic couple. Bird (1972), for example, puts The proposition that transference- of corrective emotional experience. Is clinical where a patient's psychological development it this way "...the analyst...must somehow countertransference enactment forms the psychoanalysis a corrective emotional experi- went astray and how the defect can be rem- enable the patient to extend his intrapsychic required text for clinical analysis leads to a ence? If so, how is this taken into account in edied. Furthermore, contrived role-playing conflict to include the analyst. Whereupon the very different conception of the psychoana- our theory of technique? within the treatment relationship is hypocriti- analyst becomes protagonist and the patient lytic process than is implicit when the cal. Such presumption and hypocrisy contradict Analysts who have studied the historical antagonist, or vice versa, in a real conflict treatment relationship is spoken of as an "as what most of us understand to be the essence development of our thinking about technique within the analysis..." (p.235, my italics). if" or "transitional space" in which transfer- of the psychoanalytic clinical collaboration. ences emerge and are investigated. Far from (e.g., Friedman, 1978; Lipton, 1977) agree that How else does the authentic engagement being not-quite-real, the analysis of transfer- one of the most important shaping trends of One effort to resolve this dilemma has been Bird regards as a sine qua non take place but ence depends on a very real relationship, no the last forty years has been a reaction against through the claim that ordinary psychoanalytic via the playing out in action of a transference- different in its reality from any other, taking the technical innovations introduced by Alex- procedure, the neutrality of the analyst and countertransference drama? Without the place within the protective limits provided by ander and French (1949). At the same time. I his commitment to the investigative task, in analytic text of transference- the agreed-upon ground rules of the analytic

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itself provides the required corrective emo- peutic alliance," maintenance of which by the off and self-indulgent exploitation of the ana- him, and his associations suggested that re- tional experience (e.g., Chused, 1982). It can analyst is distinguished from psychoanalytic lytic situation by the analyst begins? Also, sentment toward a younger sibling in utero be argued that by interpreting resistances, the technique per se. This theoretical isolation how do we understand the difference between might be playing an important genetic role in analyst engenders a corrective emotional ex- keeps the concept of psychoanalytic process clinical psychoanalysis and psychotherapies generating his sadistic fantasies. He had a perience. This proposition captures an aspect free from contamination by the concept of a in which the therapist participates in correc- dream in which he was swimming around in of the truth. For example, some of our clinical . certain salutary, non-interpretative interaction tive emotional experiences without necessarily a pond, urinating, thus killing some young corn concepts can guide us toward providing opti- between analyst and analysand. However, re- knowing about it? I think the nature of the that was growing on the bottom. The dream, mal frustration-gratification sequences for our gardless of the categories we establish, we are analyst's conscience and the role it plays in in particular, made quite an impression on him. analysands (Renik, 1990). However, there are left with clinical reality and the observation the psychoanalytic process is the central issue He felt it confirmed the idea that he might elements of an analyst's activity, through which that it is necessary for corrective emotional raised by these questions; however, that sub- have been hostile to the arrival of a younger he provides the corrective emotional experi- experiences to occur if analysis is to proceed. ject might be easier to consider if we have an sibling, and he ransacked his mind — with ence required for a successful clinical analysis, How does the analyst arrange for them with- illustrative clinical vignette to use as a basis characteristic obsessive thoroughness — about that are not included in our description of out deliberately manipulating the analysand? for discussion. his feelings toward his six-year-younger sis- ordinary psychoanalytic procedure. ter, trying to dredge up memories of her birth, The conclusion seems unavoidable to me Clinical Example of his mother's pregnancy and his reactions, The interactive guidelines indicated by an that it is because an analyst's conduct in the etc. It all yielded very little, analytic stance, as it is usually enunciated, are clinical situation is partly determined by The patient was a young man who was very wide. At a given moment, how does an motivations outside his conscious awareness, terribly hemmed in by obsessions and com- This man had trouble sleeping, and from analyst choose from among the many possi- i.e., because countertransference enactment pulsions of all sorts. He spent the better part time to time made use of a mild sedative that bilities consistent with the concept of a neutral always precedes countertransference aware- of every day preoccupied with intrusive non- he got from his internist. When he first de- analytic investigation the one that he thinks ness, that it is possible for him to participate sense thoughts or executing various rituals. scribed taking the pills, 1 made some comment will facilitate rather than impede analytic in what could be called corrective emotional After two years or so, our analytic work to- about medicating his anxiety instead of progress? What are our specific intentions experiences, and to do so in a genuine and gether had come to the point at which we were analyzing it, such that he firmly associated me when we use what we call analytic 'tact" and unpremeditated way. I would say, in other able to understand that these activities served with the idea that renunciation was in order. "timing"? We invite our analysands to observe words, that aspects of effective analytic tech- to prevent him from being aware of violent, In fact, he came to take the pills less and less, themselves in ways that we judge they will be nique are inherently outside the conscious sadistic fantasies that would con e to his mind and would look to me for approval about his able to tolerate. For example, Poland (1975) control of the analyst — that many of the and disturb him very much. This timid and progress in this regard. It was not a major considers the need to avoid counterproductive most useful things we do, we do for reasons inhibited man was inwardly boiling with rage, point of investigation, but I did have the chance injuries to an analysand's self-esteem. Poland of which we cannot be aware at the time. Not often in response to apparently trivial events. from time to time to remark that not using the emphasizes that analytic tact takes place within only is every technical act inevitably a A female co-worker would close a window he pills seemed to be something he felt he was a two-person field. Inevitably, then, an ana- countertransference enactment, at least in part, had opened and he would imagine grinding doing at least as much for me as for himself. lyst's tact involves an effort on his part to be but it is useful for this to be so. Newman his heel into her face. Of course, 1 encouraged hiin to look into his regarded for the moment in one way and not (1988) suggests that an analyst makes himself fantasies about my investment in the matter. another — perhaps as respectful rather than into a "usable object" for an analysand by The question for us had become why he intrusive, or as accepting rather than punitive, virtue of unconscious countertransference in- was so prone to fury, especially to fury at On one such occasion he came in and an- or as helpful rather than competitive. We are volvement and subsequent self-analysis. women; and here we were stuck. He had cer- nounced that he had not taken any sleeping thrown back upon the problem that the ana- tain grievances toward his mother, and we had pills for a month. As usual, I did not con- lyst, as an aspect of good technique, seems to If we think of countertransference enact- gone over these. Something in his attitude gratulate him, and as usual he complained deliberately influence the way he is experi- ment by the analyst, along with transference toward me seemed relevant, a demandingness about this. In the course of exploring his re- enced by the analysand, which inns counter to enactment by the analysand, as a regular and thai was only thinly covered over by ingratia- actions to this familiar situation, he moaned our usual understanding. necessary aspect of the psychoanalytic proc- tion and compliance; but the transference that it was like being weaned from the breast, ess, we can see how inadvertent and authentic elements involved remained elusive. I couldn't realize how difficult it was. [ made Some theorists deal with the problem by corrective emotional experiences occur. How- the following comment to him: "It's as if you We just had not made much headway in sequestering all purposeful interactive aspects ever, while this conceptualization solves one feel like the only person who was ever weaned clarifying his chronic anger. of the analytic relationship under the separate problem, it poses others. How are we to say from the breast."' heading of the "treatment alliance," or "thera- where productive analytic technique leaves There were sometimes claustrophobic as- pects to the situations that seemed to provoke Now I think the content of this interpreta-

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tion was valid, and, as I will describe in a tion (pun very definitely intended). He blinked been consciously available to him. After the with his aunt. One aspect of his reaction to moment, it had very productive results. My and paused fractionally, obviously feeling the delivery of his still-born brother, his mother my interpretation, consciously passed over but interpretation called his attention to a particu- hostility I had expressed; but he did not ver- had suffered a severe post-partum depression. revealing itself through the slip, was that I lar fantasy, based on an implicit denial of the balize any reaction to this aspect of my remark; A dream revealed the patient's childhood un- was refusing the deal. I was insisting on being facts of life. It related to attitudes of entitle- and I, out of continuing denial of my derstanding of his mother's depression. In the an angry, rejecting mother instead of a grati- ment and a sense of injustice that was a central . countertransference motivation, did not ad- dream, his mother was squatting and had a fying aunt in order to punish him for the feature of his transference to me. All of this dress his avoidance. Instead, what happened miserable, dejected expression. Something was hostility and demands toward me that lurked was potentially useful information, and con- was that the patient took my interpretation at terribly wrong. A long lip of bleeding flesh beneath his surface good-patient pose. The veying it to the patient was consistent with face value and began to associate to the con- drooped from between her legs. He had a childhood theory had been that his devastated good analytic technique. tent of it. He thought about the fact that his strong urge to go toward her to help, but at mother had sent him away because his resent- own son had been weaned from, the breast However, I remember the state of my feel- the same time he dreaded touching her. ment of the frustrations he had to endure some years earlier. Compliantly, the patient during her pregnancy and his jealous rage ings at that moment very clearly. The general Fantasies about still-birth, his mother's reflected that what I had said about his not toward little Gary in utero had caused the still- context was my frustration with the treatment genitalia, and the loss of body products by being unique had been true. birth. seeming bogged down and my exacerbated excretion all had become confused and con- impatience with this man's hyperintellectual However, despite the patient's effort to keep densed in the child's mind into an impression As these concerns emerged and their ori- style and underlying whiny complaints. I had his sense of injury by me out of conscious that his mother was depressed because she gins were clarified, the patient's attitude toward been going to save him when many before me awareness — and despite my tacit collusion had lost something important. This impression women changed. He became less angry, and had failed. But now, after a successful initial with his effort — his warded-off reaction broke resulted in a conflict between the child's wish his preoccupation with sadistic fantasies di- phase of analytic work that confirmed our through, and in a form that made it possible to to substitute himself for what was missing in minished correspondingly. He developed more mutual idealizations, we were each feeling elucidate his transference even while con- order to make his mother once more loving comfort in his sexual life. For a time, he was disappointed in the other. Against this general sciousness of my countertransference and lovable, and his fear of having to sacri- tremendously excited by cunnilingus, and background of resentment toward the patient, enactment was being avoided by both of us. fice himself to restore her loss. In fact, noticing this, realized that he was counter- I was feeling sorry for myself; and when he As he spoke about recognizing that others had, throughout our sessions he had been express- phobically overcoming a longstanding horror essentially claimed that nobody knew the trou- indeed, been weaned from the breast, the pa- ing this conflict in his reports of the many and disgust toward the female genitalia. Frank ble he felt, my reaction was to review some of tient made a slip, substituting the name "Gary" dreams in which he would be irresistibly drawn confusion about women's anatomy came to the more difficult periods in my own past and for his son's name. When he claimed to know toward a boiling sea or into the eye of a storm. light. His sleep difficulty essentially disap- to ask myself who this guy thought he was, no one named Gary, I suggested it couldn't The conflict was revived during his latency peared and he discontinued sedative use telling me about suffering... have come from nowhere and that he seemed when his mother would, for ill-defined rea- altogether. Out of this not very admirable set of sen- reluctant to associate to "Gary." He shook his sons, join him in bed, and he could feel the Eventually, I did take up with the patient timents what I said to him was not entirely head and said, "No, the only Gary I can think warmth of her body close to his. his disavowal of my real lapses, and the way kindly meant, and therefore was not put.as of is the younger brother my parents told me The patient's mother's depression had been he avoided thinking about the possibility that gently as it might have been. My empathy about that was stillborn when I was a year and sufficiently severe that he had been sent away I could be angry at him and act on that feel- with him was harnessed to my own emotional a half old." (!) He couldn't believe he had to live with an aunt for six months. Early ing. His need to cling to an idealizing needs at least as much as to my analytic func- never mentioned it before. Obviously, it was experiences of rejection and abandonment had transference fantasy of mutual uncritical ado- tioning. Far from realizing that my own relevant to so much that we had explicitly been eclipsed in his memory by positive im- ration and his need to avoid conscious grandiose self-pity had been provoked by a puzzled about together over two years of analy- ages of the aunt in whose care he had been disappointment in me became significantly less similar state in the patient, and fashioning a sis. When he had been assiduously searching placed. There had been a kind of tacit collu- driven, though the amelioration was somewhat constructive interpretation on the basis of self- his memory for experiences about the birth of sion with the aunt throughout his childhood, limited by his fear of re-experiencing what analysis, I had competitively contended with a sibling that might illuminate the origin of beginning during the time his mother had been must have been an overwhelming infantile rage him for first place in a suffering contest — his sadistic preoccupations, his mother's preg- disabled. His aunt totally idealized him and and despair. although I did use truth as my weapon, and I nancy with Gary, and the subsequent stillbirth, was unconditionally accepting, in return for Dimensions of the Psychoanalytic Process remained within the realm of observation, both had never come to mind. which he did not contradict her fantasy that of which were important constraints. From here, our work led to retrieval of early he was actually her son. Part of the patient's The foregoing clinical vignette portrays a The patient was struck by my interpreta- childhood memories that had not previously transference to me was an expectation that he characteristic sample of the psychoanalytic could recreate the kind of collusion he had process. At the heart of it was an investiga-

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existed in all three dimensions. It was a tion of the patient's transferences to me, clari- operation the promise that I would be allowed came into my awareness after the fact. At the countertransference enactment; it was part of fication of which had an impact not only upon to succeed with him where all others had time I made my remark, I realized in a general a sequence that provided a corrective emo- our relationship, but upon the symptomatic way failed. An early phase of progress confirmed way that I was annoyed at the patient. I knew tional experience for the patient; and it was a he had been leading his life in general, and both our fantasies; but then, as the pace of that what I had to say would probably deflate useful psychoanalytic interpretation of resist- upon his view of his own history. This is what psychological discovery and symptomatic im- him, and that I would take some satisfaction ance that drew the patient's attention to a we expect from a successful piece of analytic provement slowed, mutual disappointment set in his discomfort; but I said it anyway, telling feature of his mental life that he had been work. For purposes of discussion, I would like in. In this context, my angry reaction to his myself that it was true and he needed to hear overlooking. to identify three dimensions of the psycho- complaining, which I expressed pointedly via it. It was not until later in the analysis that I analytic process illustrated by the vignette, and my interpretation of his grandiose self-pity over acknowledged to myself my outrage at the Psychoanalytic theory tends to treat as to consider the relations among them. discontinuing sleeping pills, vividly evoked his patient for treating me as if his experience of separate phenomena what might better be con- rejection by his depressed mother. deprivation were superior to my own. At that ceptualized as three dimensions of a single First, there was our work on the patient's point I could more fully appreciate the hostil- psychoanalytic process. It would seem that the resistances. By drawing his attention to spe- Our enactment of transference and ity of my motivation, which made it clear to completest, and therefore most accurate, pic- cific obstacles that he placed in the way of his countertransference preceded our awareness of me that since I had made my intervention I ture of what actually transpires in clinical self-awareness, and by inquiring with him into transference and countertransference at every had been colluding with the patient to avoid his motivations, I assisted the patient in en- step. When I made my deflating remark and analysis has to take account of all three. Every his perception that I could be angry with him productive technical choice is, in part, a larging his capacity for self-observation. This the patient responded to it, neither of us rec- and want to hurt him. aspect of our collaboration would be consid- ognized that he was experiencing me as countertransference enactment; and it involves ered by some theorists to comprise the whole punishing him in the same way and for the A third dimension of the psychoanalytic the analyst in a spontaneously occurring cor- of the psychoanalytic process. It is certainly same reasons he thought his mother had pun- process consisted of a corrective emotional rective emotional experience, an authentic what we usually conceive of as the distinctive ished him long ago. Later, this experience came experience — a series of non-interpretative encounter that then forms the text for self- essence of psychoanalytic work and the aim into consciousness; and the analytic work that interactions that permitted the patient to change conscious investigation. of analytic technique. From the point of view brought it into consciousness had, in turn, its misconceptions that had arisen in his traumatic Having presented a clinical example illus- of the interpretation of resistance, a success- own unperceived transference- past and remained with him since. First I joined trating this conception of the analytic process, ful intervention — one on which I have countertransference meanings: by finding a with the patient in a kind of mutual seduction; I would now like to address the two problems focussed — was the comment by which I ex- way to see the patient's entitlement and self- then, in reaction to my own disillusionment, I I mentioned earlier. First, the distinction be- posed to the patient compelling evidence of importance in a sympathetic light — as the wounded him; and finally, we struggled to- tween analytic technique and exploitive his passionately held but unrealistic image of consequence of a previously repressed child- gether to a workable rapprochement. He had self-indulgence, which requires a considera- himself as especially put upon. As we contin- hood trauma — we re-established the dealt with his traumatic childhood experience tion of the analyst's conscience alongside his ued to pull on this loose thread and follow its possibility for mutual idealization and quid by longing for and pursuing a cherished ide- countertransference; and then the distinction course, we learned a great deal about his past pro quo. Every experienced analyst expects alization of his mutually seductive relationship between psychoanalysis and psychotherapy, that he had been withholding from his own that today's authentic piece of analytic inves- with his aunt, while avoiding at all costs any- which bears upon the relation between correc- view, information that helped him understand tigation will very likely tomorrow be revealed thing that might resemble his catastrophic, tive emotional experience and analysis of and alter some important, longstanding atti- also to have been a transference- unbearable image of rejection by his mother. transference. tudes and behaviours. Thus, interpretation led countertransference enactment that was The sequence of clinical events described in to insight and change. unrecognized as it took place. Since each suc- my vignette corrected this schism by provid- Analytic Conscience cessful bit of analysis creates something new ing him with an opportunity to learn that A second dimension of the psychoanalytic Even when my unconscious to be analyzed, the analysis of transference disappointment can be tolerated emotionally, countertransference enactment was most process was the evolution of a transference- reminds me of Achilles' fabled effort to catch and that two imperfect people who care about prominent, other motivations played a part in countertransference enactment between the the tortoise — a project whose completion by each other can manage to sustain their rela- determining my technique. For example, my patient and me. Initially we duplicated in many its nature is impossible, and can only be ap- tionship in the face of mutual disappointment. interpretation represented a compromise for- ways, without realizing we were doing so, his proached asymptotically. childhood relationship with his aunt. He con- These three dimensions of the psychoana- mation in which conscientious urges had a role. strued my patient attention and therapeutic I want to emphasize that the lytic process describe the view from three At the same time as I indulged myself in optimism as evidence of an all-accepting love countertransference as well as the transfer- different angles of what, in nature, is a unitary expression of my own self-pity, competitive- for him; and I, in turn, saw in his eager co- ence significance of my interpretation only phenomenon. For example, my intervention ness and resentment, I felt a countervailing

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wish to be helpful and honest, so that, as I think it is helpful to see countertransference In our literature, I think we are beginning to fications of the type suggested by Alexander have already mentioned, even my hostile in- enactment as the ever-present raw material of see analysts point out that various and French, and most recently from a plethora tervention took the form of conveying a productive analytic technique, rather than a countertransference enactments can contribute of psychotherapies, psychoanalytically in- potentially useful truth to the patient. Further- counterproductive alternative to technique. In to an analytic process and therefore need not formed and otherwise. Unfortunately the effort more, I continued to do my job, remaining Boesky's (1990) description of how resistances be automatically rejected by a well-function- to preserve a special identity has sometimes interested in the patient's thoughts and feel- are "negotiated" between analyst and analy- ing analytic conscience. An excellent example led psychoanalytic theorists to concentrate ings, and this attitude on my part was crucial sand, there is the suggestion that technique is Chused's (1987) careful discussion of the exclusively upon those aspects of the psycho- to our negotiation of a rapprochement. I think can be conceptualized as arising from an in- benefits, under some circumstances, of an ana- analytic process that are unique to it, and to the many technical decisions that arose from teraction between countertransference and lyst's acceptance of being idealized. Kris neglect — even disclaim — aspects of the my original therapeutic optimism, as well as other components of the analyst's psychology; (1990) suggests that commitment to the method psychoanalytic process that can also be found from my subsequent disappointment were, "We have, since the dawn of our science, of free association, rather than abstinence, is in other therapeutic modalities. The result is a similarly, compromise formations to which learned so painfully that we must guard against the basis of analytic neutrality. picture of analytic process and technique that both countertransference and conscience con- the serious errors introduced by the is incomplete and therefore distorted — a pic- tributed. countertransference that we have failed to ture in which the special, best studied part is Psychoanalysis and Psychotherapy taken for the whole. I think we want to avoid I think we handicap ourselves if we con- appreciate that the conflict of the analyst can the mistake of the blind man who feels the ceptualize countertransference enactment as an lead to adaptive and useful outcomes as well, All well-intentioned therapists, regardless elephant's trunk and is convinced that col- impediment to effective technique. Rather, it As in any matter of conflict, it is a matter of of their theoretical orientations, tend to en- leagues who describe a foot, or a tail — parts seems to me, it would be helpful for our theory degree, and the quantitative aspect will deter- gage in countertransference enactment at the that are not unique to the elephant — must of technique to focus on the analyst's super- mine whether pathological countertransference same time as they try conscientiously to be have hold of some other kind of animal en- ego. We need to develop a more exact picture or creative subjectivity will be the outcome" helpful to their patients, so that inadvertent, tirely. It does not serve us well to say about a of its content and modus operandi in the clini- (p.578). therapeutically beneficial corrective emotional experiences are provided in many forms of corrective emotional experience, "That's psy- cal situation, of how other aims join with My impression is that the concept of con- treatment. Thus, while the occurrence of cor- chotherapy, not psychoanalysis," or, "That countertransference to produce the analyst's science and countertransference coming rective emotional experiences is an essential belongs to the therapeutic alliance — it has to contribution to a successful psychoanalytic together to form analytic technique accords feature of the successful psychoanalytic proc- be there, but isn't part of the psychoanalytic process. In the clinical moment, analysis of with what we can observe about analytic de- ess, it is not unique to the psychoanalytic process itself." countertransference is not always the analyst's velopment. The veteran analyst becomes more process. What is unique to the psychoanalytic immediate priority. Sometimes it is useful for comfortable and effective not so much because Since transference-countertransference process is the way in which therapist and an analyst to accept the need to act under the he has diminished the degree to which he acts awareness follows enactment, we can concep- patient work together toward conscious insight influence of countertransference motivations out of countertransference motivations, as tualize a successful psychoanalytic process as into the corrective emotional experiences that before they can be thoroughly investigated. because he becomes less defensive about his one in which a series of unpremeditated cor- do occur. In practice, clinical psychoanalysis How analytic conscience functions in that countertransference enactments and more con- rective emotional experiences comes to be depends upon commitment to a searching decision and how the operations of analytic fident that he will be able to investigate his examined and understood retrospectively (see examination of the treatment relationship it- conscience convert countertransference expres- patients' experiences of them. Panel, 1986, pp.707-708), and a successful self as the highest priority of the work. To the sions into useful analytic interventions is psychotherapeutic process, on the other hand, extent that conscious insight into corrective precisely what we need to learn more about. The example I have presented focuses on as one in which corrective emotional experi- emotional experiences is achieved — i.e., to Poland (1986) notes: "Evaluation of the pa- how an analyst's hostile countertransference ences take place, but remain largely outside the extent that successful analysis of transfer- tient's analyzing needs combines with the urge translated itself into a useful interven- the patient's — and perhaps the therapist's — ence takes place — the patient obtains a degree analyst's inner regressive signals to move the tion. I thought it would be a particularly conscious awareness. (Cf. Gill's [1984] view of self-awareness and autonomy, a pervasive- analyst to speak. Deeply rooted motivations relevant instance, inasmuch as acting with that a clinical psychoanalysis and a psycho- ness and durability of benefit, that is generally for analyzing provide the driving force. Tech- hostility toward a patient is so completely at analytic psychotherapy are best distinguished not available from other therapeutic methods, nical skill and self-knowledge shape the variance with what we usually consider pro- by the extent to which unwitting suggestion so far as I can tell. movement of that force" (p.271). fessional behaviour, let alone good technique. within the treatment relationship has been Obviously, all sorts of impulses — to sexually Psychoanalysis has always been at pains to analyzed.) If a purely psychotherapeutic proc- In order to study the workings of the ana- stimulate a patient, to reassure, to warn, etc. distinguish itself from other treatments — at ess at one pole, and an ideally complete lyst's conscience in the clinical situation, I — also can be expressed through technique. first from hypnosis, then from technical modi- psychoanalytic process at the other, define a

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RENIK, O. (1990). Comments on the clinical spectrum, most analytic treatments certainly find that a sequence of corrective emotional LIPTON, S. (1977). The advantages of Freud's analysis of anxiety and depressive affect, fall somewhere in between. experiences based on transference- technique in the Rat Man case. Int. J. Psychoanal. Q., 59: 226-248. countertransference enactment forms the Psychoanal., 58: 255-273. substrate of the treatment. I have the impres- LOEWALD, H. (1960). The therapeutic action of SANDLER, J. (1976). Countertransference and Conclusion sion this was true in the case I have presented psychoanalysis. Int. J. Psychoanal, 41: 16- role responsiveness, Int. Rev. Psychoanal., In Forty-two Lives in Treatment (1986), here. However, keeping in mind Wallerstein's 33. 5:42-47. Wallerstein demonstrated by careful empirical methodological cautions, it should be stated NEWMAN, K. (1988). Countertransference: Its SETTLAGE, C. (1989). The interplay of thera- investigation what many of us already sus- explicitly that the kind of anecdotal account I peutic and developmental process in the pected, that psychotherapy and psychoanalysis have offered in the form of a clinical vignette role in facilitating the use of the object. The Annual of Psychoanalysis, 16:251 -265. treatment of children. Psychoanal. Inq., are not as different as we sometimes like to is of negligible evidential value in support of 9:375-396. think. My main point of emphasis has been my point of view. I intend it only as an illus- PANEL (1986). Countertransference in theory that no matter where on the spectrum of thera- tration of an hypothesis that must be tested and practice. O. Renik, reporter. J. Amer. WALLERSTEIN, R. (1986). Forty-two Lives in pies we look, even if we examine a against more systematic observation if it is to Psychoanal. Assn., 34: 699-708. Treatment. New York: Guilford Press. well-conducted clinical psychoanalysis, we be either accepted or rejected. POLAND, W. (1975). Tact as a psychoanalytic WEISS, J. AND SAMPSON, H. (1986). The Psy- function. Int. J. Psychoanal., 56:155-162. choanalytic Process. Theory, Clinical (1986). The analyst's words. Observation and Empirical Research. New References Psychoanal. Q., 55: 244-272. York: Guilford Press.

ABEND, S. (1986). Countertransference, empa- FREUD, S. (1900). The Interpretation of Dreams. thy and the analytic ideal: The impact of S.E. 5. life stresses on analytic capability. (1912). Repeating, remembering and Owen Renik Psychoanal. Q., 5: 563-75. working through. S.E. 12. 244, Myrtle Street ALEXANDER, F. AND FRENCH, R. (1946). Psy- San Francisco choanalytic Psychotherapy. New York: (1914). Observations on transference California, 94109 Ronald Press. love. S.E. 12. U.S.A.

BIRD, B. (1972). Notes on transference. Uni- FRIEDMAN, L. (1978). Trends in the psycho- versal phenomenon and the hardest part of analytic theory of treatment. Psychoanal. psychoanalysis../. Amer, Psychoanal. Assn., Q., 47:524-67. 20:267-301". GILL, M. (1984). Psychoanalysis and psycho- BOESKY, D. (1990). The psychoanalytic proc- therapy: A revision. Int. Rev. Psychoanal., ess and its components. Psychoanal. Q., 11:161-180. 9 : 550-584. JACOBS, T. (1986). On countertransference CALEF, V. AND WEINSIIEL, E. (1980). The ana- enactments. J. Amer, Psychoanal. Assn., lyst as the conscience of the analysis. Int. 34:289-308. Rev. Psychoanal. JAMES, W. (1890). The Principles of Psychol- Chused, J. (1982). The role of analytic neu- ogy. New York: Henry Holt & Co. trality in the use of the child analyst as a new object. J. Amer, Psychoanal. Assn., KOHUT, H. (1971). The Analysis of the Self. 30:3-28. New York: Int. Univ. Press. (3987). Idealization of the analyst KRIS, A. (1990). The analyst's stance and the by the young adult. J Amer, Psychoanal. method of free association. Psychoanal. Assn., 35:839-60. Study Child, 45:25-41

53 52 SAMIKSA SAMIKSA THE TRUE GOD AND THE FALSE GOD Neville Symington

With close reference to and textual study of Judaism, Christianity and Islam, the author relates the socio-cultural construction of the true god and the false god to an individual's intra-psychic structural need to form such gods as perceived in his psychoanalytical journeys with his analysands. In the first half of the paper, the author discloses the hidden false god within the personality of an individual as the narcissistic object which has the "potential for embodiment". This "potential for embodiment" gets expelled from the self and finds external manifestation in figure (s), like trees, rivers, rituals and so on. However, this false god is revealed only "in a moment of ecstasy ". Contrary to this, the true god is attained through the thinking process. It is not only a thought-related, self-reflec- tive process for an individual hut also a deeply systematic and "sustained reflection in the nature of reality" for religion itself— like Judaism, Christianity and Islam. Unfortunately this phenomenon gets overshadowed by the false god. According to the author, Spinoza among the Western philosophers and the Upanishad in the Eastern philosophy have shown the deepest understanding of this true god. The paper finally concludes on the note of the "Absoluteness of Being" derived from the conceptual insight of the true god, which further branches off into two other aspects: (i) conscience and (ii) symbolism. Drawing parallels from his clinical experience, the author relates how these two aspects work at a fundamental level informing the false god and the true god within the analyst-analysand interaction.

A patient was late one day because snow on solves problems by obliterating them. the road had delayed her and she was angry. I mentioned this to Wilfred Bion in supervi- You may recognize in this portrait of God sion and he said to me : traits with which you are familiar from the reading of the Bible, the Torah or the Koran. "You must say to her that God has sent Embodied in these ancient texts are aspects of down that snow to get between you and this God that I have been trying to describe. her." There are also other aspects that I shall come There is a God that gets in the way of two to iater. This cultural expression is manifest people coming to know each other. There is a in the psychology of the individual. I can find God who interferes with my thinking; there is in myself and my patients traces of this God. a God who demands that I follow his instruc- This God is a narcissistic object seen from tions; there is a God who punishes me if I one particular angle. The narcissistic object is think for myself; there is a God who sanctions many-faceted and it is a part of the self which my sadism; a God who encourages my maso- has been expelled and embodied either in a chism; a God who hates my greed, who hates figure or figures outside. The outer figure is my envy, who hates my jealousy; a God who then enveloped by this part of the self in the possesses me but despises me; a God who way that Wilfred Bion describes :

Neville Symington, Deputy President, Training and Supervising Analyst, Australian Psychoanalytic Society.

55 SAMIKSA NEVILLE SYMINGTON THE TRUE GOD AND THE FALSE GOD

"Oh, you were analyzed by Hans Sachs, "The object, angered at being engulfed, form of worship unmercifully. The ferocity of This rests on a theory of Redemption whereby swells up, so to speak, and suffuses and their attack might give a psychoanalyst a hint the sin of Adam was an infinite offense to the were you ..." controls the piece of personality that that they themselves were subject inwardly to Almighty God who then sent His Son to make and then looking down his nose said, engulfs it ..."' such a worship. It is clear that the prophets reparation to God, His Father, for this infinite "You know I was analyzed by Freud." were trying to purify themselves and Israel of offense. We see here a God who is deeply These are the facets of the narcissistic an embodied God and substitute for this a wounded by an insult. This devotional atti- Analyst B was still offended thirty years object. The figure who is an embodiment of pure spiritual reality. However they never later and took revenge on analyst A quite regu- the narcissistic object is extremely sensitive tude gained great strength in the Middle Ages managed to cleanse Yahweh of all anthropo- larly year after year. to any hurt. This is the core of the narcissistic and still continues to-day in many Christian morphic elements. He always remained a object and is not immediately obvious to ex- communities, particularly within the Catholic The hurt only makes sense if you put in possession of the Israelites. It was a God who ternal perception. For instance when a patient Church. The Old Testament is also redolent the idea of a god-like ego : had chosen this race rather than those around installs the analyst as narcissistic object he/ with the theme of Yahweh who has been of- as his favorite son, "Do you not realize that you are insult- she perceives him as a God, as an elevated fended by Israel's infidelities. ing a royal personage? Did you not human being in his/her conscious "Is Ephraim my dear son? It is not difficult to see how this devotional know that you are insulting the Lord conceptualization but unconsciously registers Is he my darling child? attitude came about. It is the reification of a Himself?" the inner sensitivity to hurt. For as often as I speak against him, fundamental narcissistic attitude. It is typified when I am deeply wounded by the smallest So the extreme sensitivity to self-hurt and This narcissistic object gets established in I do remember him still. slight and nuvse this injury, down the years; A god-head are included in one another. this way. The first thing we infer is that this Therefore my heart yearns for him; man met a friend who said to him, God is present in the personality as a potential I will surely have mercy on him, says the I want now to look at another aspect of for embodiment. This God never exists as a Lord."3 "Good Lord John you are looking well this God. Knowledge of this God is not ar- spiritual reality but always as a God incarnate to-day. When 1 saw you last week I rived at through thought and reflection. This in a particular person or institution. The proph- So the God, as part of the narcissistic struc- thought you were very off colour..." God is revealed in a moment of ecstasy. The ets whose sayings are recorded in the Old ture, is ready for embodiment. But how does clearest example of this is the way in which He was deeply offended that his friend Testament continually chided Israel for chas- the embodiment take place? The answer is that Allah was revealed to Mohammed. In the midst should have said he was off colour. 'Me — ing after false gods : the figure or institution has to be a willing of an ecstatic trance the teachings of Allah host for such an embodiment. The host then off colour'— what an insult. He was so in- were revealed to Mohammed who dictated "Trouble is coming to the man who says has to demonstrate one of the elements of the sulted by it that it entirely wiped out the them and they were transcribed onto tablets to the piece of wood, 'Wake up!' to the narcissistic structure. I am going now to sketch encouraging statement that he was looking well which became the Koran. Mohammed himself dumb stone: 'On your feet!' (And that just one correlate of the God. God and this on this particular day. I remember an occasion was a slave in submission to the voice of Al- is the oracle.) Plated it may be with gold correlate arc just two elements of the narcis- when a friend of mine asked a Spaniard to lah. Thinking which is an inner creative and silver, but not a breath of life inside sistic structure though under the Principle of carry a letter for him to a friend in Spain where process was crashed under the force of the 4 it." "What is the use of a carved image, Inclusion , they are one reality with two mani- he was going. It used to be a gentlemanly ecstatic experience. In Judaism one needs only or for its maker to carve it at all? It is festations. custom in Spain that if you asked someone to to consider these two passages — the first a thing of metal, a lying oracle, What is deliver a letter by hand it was bad manners to So this correlate of God is a figure who is from the Book of Exodus and the second from the use of its maker trusting this and seal the envelope. My English friend, not well 2 hurt by the slightest criticism or neglect. In Isaiah : fashioning dumb idols?" up in this piece of Iberian etiquette, did not religious devotion this is seen most clearly in know it. The Spaniard was deeply insulted "Now at daybreak on the third day there False gods were gods embodied in statues, the Christian rite known as the Stations of the and would never talk to my English friend were peals of thunder on the mountain trees, rocks, or rivers: a type of religious ritual Cross where the devotee believes that Jesus, again. and lightning flashes, a dense cloud, and known as animism. The prophets attacked this who is God, is deeply wounded by every sin. a loud trumpet blast, and inside the camp The other aspect, already adumbrated, is all the people trembled. Then Moses led 'BfON. W.R. (1967/1993) Development of Schizophrenic Thought. In Second Thoughts p.40. London: William the people out of the camp to meet God; Heinemann Medical Books/Karnac Books. that the wound is tended and nursed as though ; and they stood at the bottom of the Habakkuk Ch.2 v. 1920. Jn The Jerusalem Bible (1966). London: Darton, Longman and Todd. it were the greatest treasure. Adam's sin was mountain. The mountain of Sinai was 3 Jeremiah Ch. 31 v. 20. In Revised Standard Version. (1962) London: Eyre & Spottiswoode. quite a long time ago now ... but I still hear entirely wrapped in smoke, because 4 The Principle of Inclusion stales that two psychic elements are one and the same but with two manifestations or people beating their breasts about it. Analyst Yahweh had descended on it in the form it can be conceptualized that one is contained in the other. A said to analyst B:

56 57 SAMlKSA SAMlKSA NEVILLE SYMINGTON THE TRUE GOD AND THE FALSE GOD

of fire. Like smoke from a furnace the These are all shamanistic experiences where What can be observed as happening in an who best represents this endeavour has been smoke went up, and the whole moun- a transcendent power is believed to have taken individual is writ large in the religions of rev- Spinoza. In the East the seers who are respon- tain shook violently. Louder and louder possession of the believer and in whose power elation, most particularly Judaism, Christianity sible for the school of thinking that produced grew the sound of the trumpet. Moses the priest, prophet or shaman becomes the and Islam. the Upanishads showed the first and deepest spoke, and God answered him with peals automatic translator of the godly message. 5 understanding of what I refer to as the True of thunder." Yahweh tells Jeremiah : I want to make it clear that this God exists God. God is not a term that is ever used by "I saw the Lord Yahweh seated on a high in all of us who have a narcissistic structure "There ! I am putting my words into these seers. They use the following terms: the within us. It is not confined to religious peo- throne; his train filled the sanctuary, your mouth,"8 THAT, the Absolute or just Reality. Wilfred ple. I have encountered many patients who above him stood seraphs, each one with Bion called this same Reality 0. Through con- and the Quran is a record of what are atheist in conscious belief but who are six wings: two to cover its face, two to templative thought these seers came to Mohammed said while in ecstatic states. enslaved to an ecstatic God within. cover its feet and two for flying." understand the absolute character of reality. Secularization has only changed the external And they cried out one to another in How is a psychoanalyst to understand this They also understood that reality is contingent. forms, not the inner structure. this way, "Holy, holy, holy is Yahweh phenomenon? I think what I have been de- How these two can co-exist is baffling to the Sabaoth. His glory fills the whole earth. scribing would be formulated by a The God I have been trying to describe I mind because they are mutually contradictory. The foundations of the threshold shook psychoanalyst as a split-off part of the self call a false god in that it deceives the believer Parmenides ran into this problem when he said with the voice of the one who cried out taking possession of the whole personality. I into trusting his dictates. He believes passion- that all change is illusion. If reality is absolute and the Temple was filled with smoke. think it occurs because in the narcissistic part ately in what the God directs. As I have tried then how can there be change ? Parmenides, I said : of the personality a wound has been incurred to illustrate this passionate belief cannot be determined that the human mind should not be and the God arises, having sustained, an infi- shaken with reason but it is more than that. declared inadequate to any reasoning task, 'What a wretched state I am in! I am nite insult and takes over the personality. The The presence of this God precludes the possi- declared that because reality is absolute and lost for I am a man of unclean lips and rest of the personality is utterly crushed by bility of thought. It is intrinsically antagonistic because change is incompatible with absolute- I live among a people of unclean lips, the overpowering God. An example comes to to thought. The inner correlate of the God is ness then change must be an illusion. Yet, and my eyes have looked at the King, 6 mind from an incident that a colleague de- a psyche which is gelatinous in nature with no common sense declares, that change does occur Yahweh Sabaoth.'" scribed : source of action within and therefore submis- in our world. Aristotle believed that he had Then within Christianity one need think sive to the God, There is no option other than solved this problem by saying that Reality The analyst had a moment of deep em- just of the Pentecost experience as it is de- to capitulate in total submission. The God and existed in two modes: Pure Act and Potency. pathic understanding of this woman's scribed in the Acts of the Apostles and also in gelatinous substance are two parts of an inter- By Pure Act Aristotle meant what the seers of deprived childhood. She conveyed this the same book what has become known as the locking system. So the action and speech of a the Upanishads meant by the THAT or the to the patient and there were a few Conversion of St. Paul on the road to Damas- person dominated by such a system is false in Absolute. Potency meant being in a state of moments of emotional 'togetherness' of cus where he was struck down onto the ground another sense: that what is said does not rep- being capable of coming to Absoluteness. a deep kind. Then the cruel event oc- and a voice spoke to him from the heavens resent the thought of a person. It is a pretend However, although Aristotle believed that he curred: the session, like an insensate and he was struck blind. An authority on Is- person standing for a person that could be had solved this problem, yet he had not. He executioner, came to an abrupt end. The lam has this to say about Mohammed : there but isn't. So this is the false god that had given an account of the two horns of the woman was hurt to the quick. The next exists in individuals governed by narcissism; dilemma and refused to deny either aspect but "From the books of tradition we learn day she would not come into the con- it is also the god that rules all religious ob- he had not solved the problem. that the prophet was subject to ecstatic sulting room, she declared with servances of a primitive or superstitious kind. seizures. He is reported to have said that emphatic certainty that there were hid- We are confronted with this problem: that when inspiration came to him he felt as den microphones in the room and no I want now to turn to the true God. This is our minds are not capable of grasping this it were the painful sounding of a bell. rational argument could dissuade her a God who is grasped through a supreme ef- conceptually. Kant emphasized the limitation Even in cold weather his forehead was from her conviction. An irrational God fort of thought; a God who is a triumph of the of our minds. We do not have the categories 7 bathed in sweat," had taken over. thinking process. Traces of this God can be necessary to be able to grasp the problem. found in Judaism, in Christianity and in Islam The progress of evolution may enable our 5 Exodus Ch. 19 vv. 16-19. In The Jerusalem Bible (1966). London: Darton, Longman and Todd. but it is largely overshadowed by Ihe false god. progeny millions of years hence to be able to ' Isaiah Ch. 6. vv. 1-5. In The Jerusalem Bible (1966). London: Darton, Longman and Todd. The true God is reached through a deep and solve this problem. What we need to acknowl- GUILLAUME, A. (1976). Islam, p.56. Harmondsworth, Middlesex: Penguin Books. Jeremiah Ch. 1 v.9. Ibid. sustained reflection on the nature of reality. In edge is that the human mind meets here a our Western tradition I think the philosopher limitation rather than trying to deny either the

58 59 SAMIKSA SAMIKSA NEVILLE SYMINGTON THE TRUE GOD AND THE FALSE GOD

Absoluteness or the contingency or change- So the Absoluteness of Being is a truth this embodiment. We are familiar in the psy- tion. Associated with the false god are words ability of Reality. arrived at through reflection. It is the product choanalytic world with the discipleship of one such as 'driven', 'obligated' or 'compelled' of thought. The thinking process has produced whereas conscience is an invitation within the This Absoluteness is arrived at through ra- analyst towards another; for instance Jung an intuition that penetrates through into the personality and following conscience is a free tional reflection and, I believe, probably towards Freud and Paula Heimann towards nature of Being. It is an insight that is grounded act. The ontological truth that the Absolute is requires mental discipline and virtue to achieve Melanie Klein. There is a period of intense in rational processes. I call the Absolute the in the contingent finds its subjective realiza- it. It is entirely different from the revelation submission and then a rebellion. The latter True God: I call the God revealed in the reli- tion in the free acceptance of the invitations of the Judeo-Christian-Islamic God which is occurs at the moment when the individual is gions of Judaism, Christianity and Islam a false of conscience. As the following of conscience through an ecstatic experience directly or by trying to break free from the narcissistic bond- god or rather a god who is a mixture of the is respecting the Absolute, in which I and you faith and tradition. The Absoluteness of Be- age. The rage towards the erstwhile mentor is true and the false. Within this religious tradi- share, then if I follow the promptings of con- ing is grasped through a personal act of insight. the projected hatred of the submissive act. It tion it has been the role of mystics to purify science it has to benefit me and you. Similarly, Although concentrated mental attention is nec- is the submissive act that is hated but it be- the revealed god of its anthropomorphic ac- if you follow the promptings of conscience it essary to achieve it, yet there is no experience comes projected and hypostasized in the outer creations. Due to the fact that they bear a has to benefit you and me. It follows too that here of a being outside of myself calling me object. It means that the attempt to achieve loyalty to their religious cult, they only achieve if I say 'No' to the prompting of conscience to obedience, submission or discipleship. The freedom has failed. The attempted liberation it on the basis of a split. I harm you as well as myself. What I have latter is the false god: the former is the true becomes perverted. True liberation requires realization that the enslaving principle is the said so far about conscience may be catego- God. The false god is part of the narcissistic sys- inner submissive act and total liberation re- rized as 'religious' but what I turn to now has tem. Other elements in that system are a Now, you may ask, does this have tiny quires an understanding that the enslaving a direct clinical application. denigrated object, a state of being merged with relevance to clinical work? I believe it does. principle is one element in the narcissistic the embodied God, a paranoia towards the em- The truth I want to draw your attention to I approach it in this way. The seers of the structure. is this: that every time a person follows Upanishads realized the Absoluteness of Be- bodied God, the psyche in a jelly-like state conscience,his or her ego is strengthened. You ing and that they participated in it. Their and absence of creative capacity. As Bion says The realization of the True God in the may demand my evidence for this. My answer realization that they were part of it or rather in his paper On Arrogance, this set-up is the personality is the product of an inner creative is that it is a conviction born of clinical obser- they were IT turned it from being a philo- living remains of a primitive catastrophe. It is act. This is in dire contrast to the presence of vation. I do not want you to believe this sophical truth into religious one. In other the fossil remains of a traumatic event, the False God which is through an act of sub- mission in which the individual psyche is because I have said it. Go and observe and see words, it rendered a piece of knowledge about I have referred to the effect of this godly whether what I assert is verified. Should your their own selves and this piece of knowledge crushed. The realization of the True God lays activity within the personality at the begin- observations not confirm this assertion of mine, had a consequence. Realization about the Ab- a foundation in the personality for respect for ning. The concept of embodiment is central to then I must ask you to describe the psycho- soluteness of the self necessarily has a the Self. I have spelt 'Self here with a capital understanding the effects. There is no think- logical processes that lead to strengthening of consequence, I say 'necessarily' because the letter because it is the THAT. I am IT. I am ing process within the personality but only the ego. I shall, however, stick to my assertion necessary is the essential attribute of the Ab- this necessarily so not through an act of sub- the appearance of such. There is substitution until I have evidence to the contrary. If what solute. This realization led the Buddha, who mission. There is no merger here. THAThood for it, the embodiment of the thoughts of the I assert is true then it must be crucial that the traced the emotional consequences of this re- is my nature, it is my being. The THAT de- god. The god is embodied within and his or clinician facilitate the following of conscience. alization, to stress that attachment to what is mands respect. The THAT in me and the THAT her thoughts are incorporated in the act of From what I have said it is clear that the cli- contingent, to what is passing, is to ignore the in you demands respect. An act that conforms embodiment. The embodied god is frequently nician cannot make the patient follow central character of our being. It is worth to that respect has of necessity to be benefi- a person though it can also be an institution. conscience. Such a statement is a contradic- noting however, that the Buddha also recog- cial to me and to you. It cannot be otherwise. Due to coalescence, person and institution are tion in terms, because following conscience is nized that to ignore or despise the contingent also frequently fused. The individual in whom I want to look at just two aspects of the a personal free act. There are two prescrip- nature of our being was to enact in the this narcissistic structure is operating is then True God: conscience and symbolism. Both tions for the clinician that seem to follow from religious-moral domain what Parmcnides con- in submissive identification with the god. of these are extremely relevant to clinical work. what I have said. ceptualized philosophically. The famous Through this identification the thoughts and Let us take conscience first. Conscience is the 'middle-way' of the Buddha is notoriously dif- thinking processes of the god are understood subjective evidence of the Absolute aspect of The first prescription is that the clinician ficult to achieve. It requires us to realize the and yet there is always distortion. However, our being. We feel conscience to be us, yet be encouraged to follow his own conscience. limitations of our minds at the same time as to the most important aspect is that the creative not us. We experience it as inviting us. To As we are listening to our patient a realization think continually. capacity in the individual is crushed through follow conscience is a free act, not an obliga- may come to the mind of the clinician. How-

60 61 SAMIKSA SAMIKSA NEVILLE SYMINGTON THE TRUE GOD AND THE FALSE GOD

ever I may find what has come to my mind if he is to assist his patient in the job of hatred against his own submissive activity; that God forbids suicide as He does murder and so extremely uncomfortable. The truth that has strengthening his or her ego. it is the embodying activity, the making of a on but then the person who says 'I don't be- come to mind may make it clear that I have false god, that is attacking of himself. Then as lieve in God' (i.e. the false god of revelation) I want now to turn to the relevance of what been going up the wrong path for months or one looks more closely at the self-damaging then the only arbiter of truth are my subjec- I have said about the Absolute to symbolism. perhaps years. I may prefer not to communi- activity, it is possible to see the subtle ways in tive feelings. If I want to commit suicide why I will start this topic thus : cate what I have understood to the patient. 'I which he attacks his own thinking processes. shouldn't I? If I want to murder why shouldn't won't,' I say to myself and have almost de- A patient is covertly attacking the ana- In fact it is mentality itself which has been I? In the latter case you might answer that if cided when conscience pricks me ... lyst and the analyst points this out. He severely damaged — to the extent to which I do I shall go to prison for life. I might an- Alternatively, I may find the truth that has has made a transference interpretation. the person is deprived of mentality. It has swer that I don't care. I can do as I please. My come to mind extremely painful for the pa- The question is, 'Why?' Is the patient become so confused and embodied that it is life is my own, it belongs to me. I can con- tient and wish to protect him from it and think not free verbally to attack the analyst? difficult to see that there is a mentality there tract AIDS if I want to, if I have AIDS I can I won't, then conscience pricks me ... That we What is the particular significance that at all. infect someone else with it. I can do entirely avoid making interpretations because they are makes the analyst decide to point this as I please. I can destroy my own mind if I Symbolism is the name we give to that disturbing I am certain. However, if we fol- out to the patient? want; it is my business. process whereby we recognize that an activity low the principle that I have adumbrated Of one thing I am sure. Very often the that is interpersonal, that is outer, represents This outlook at present is very pervasive above: i.e. that if I follow conscience it is implication is 'You have no right to be attack- what is inner. An ontological understanding in the developed Western world. It is unfortu- mutually beneficial to me and the patient, then ing me'. There are two points here. The first of the Absolute tells us why this should be so. nately the degenerated child of the it follows that if the clinician follows his or is that if this is the analyst's viewpoint then The True God then becomes not only the ra- Judeo-Christian tradition. It is an outlook her conscience, then this strengthens not only he or she is operating from the narcissistic tional basis of symbolism but also its creator. shared by most schools of psychotherapy. The his or her ego but also the ego of the patient. structure within him or herself. The second is The False God, on the other hand, is the de- chairman of that committee that I referred to that even if this is not so from the analyst's The second prescription is that the clini- stroyer of symbolism, the destroyer of the was a psychoanalyst of some eminence. Those point of view the patient will frequently view cian avoids smothering conscience. The prime inner. psychoanalysts and psychotherapists who do it with that viewpoint as his or her basic as- way in which the clinician does this is by not share his outlook are usually not able to sumption. It is a narcissistic principle that I I want to end this talk by making some acting in the persona of the false god. The ground their position in a convincing set of believe that the other is motivated by the same more general reflections about the significance false god persuades, the false god demands, arguments. There are certain schools of psy- principles as myself and therefore if I the of what has been said for the claim that there the false god says 'Do it my way'. The patient chotherapy whose very basis lies in a relativism patient would feel entitled not to be accused exists absolute truth. I will try to illustrate this invites me to be god; the patient installs me as of values such as this committee chairman or attacked I will also believe that the Other by giving you a vignette. Many years ago I god; the patient puts enormous pressure on espoused. In fact I believe that it is at present or the analyst is also so motivated. The nar- found myself in this situation. me to be god and act accordingly. It is my job only a small minority who challenge it. I be- cissistic reason then for pointing out to the as a clinician to avoid this pressure. The more A psychotherapist was presenting his lieve two consequences follow from this. One patient that he is subtly attacking the analyst I am able to avoid being a false god, the less work with a patient to a committee that is that under such a philosophy there can be is that he should not be doing this. What then is conscience smothered. The extent to which was trying to assess his work. In dis- no healing of a torn mind because there is no is the healthy reason for pointing it out? we fail to do this as therapists can, to some cussing his work it was clear that he concept of what a torn mind is and the other considered suicide as an evil to be is that psychotherapy itself exists as part of a extent, be measured by the degree to which in We can find the answer to this question if avoided. The chairman of the commit- narcissistic culture and therefore does not have the therapeutic world it is common to find we go back to our fundamental premise about tee said to him, "But don't you think the tools with which to heal narcissism. With- that a therapist follows the doctrinal position the True God: I am IT or THAT thou art. this patient was free to commit suicide out transforming narcissism any healing that of his or her own analyst or follows the school When the patient is subtly attacking me, the if he wanted to?" we produce is false coinage. It is not the genu- to which his or her own analyst belongs. I analyst, he is subtly attacking himself. In other believe that it is extremely difficult to avoid ine article. I believe we have a personal and words, what he is doing to me is a symbol of Under a false god morality, the only an- cultural task to address. smothering conscience. Following the voice what he is doing to himself. The purpose then swer to this question would be to say that of conscience always means experiencing pain of pointing out to him that he is subtly attack- and guilt. This has to mean that it is a path ing me is to bring him to an understanding fraught with difficulty and one that all hu- Neville Symington (hat he is attacking himself. The other way of 88b, Warrangal Road mans fight to avoid. However, it is this difficult reaching this is to realize that his paranoia Turramurra path that the clinician is being asked to tread directed towards the analyst is a primitive N.S.W, 2074

62 63 SAMlKSA SAMIKSA THE BLACK HOLE : TERROR AND DREAD IN CONFUSIONAL PSYCHOSIS Manek - Phiroz Bharucha

This paper is based on working with a five-year-old autistic boy in psychoanalyti- cal psychotherapy over a three-year period. This hoy's disturbance was obvious to the parents when he was two and a half-year old at the time when the parents had moved into a new flat and he was moved out of the parents' bedroom. Subse- quently, his illness erupted after the birth of a baby brother who occupied the parents' bedroom. At that time, his head banging resulted in dents in the wall of the flat. In the course of the therapy, it was possible to understand some aspects of this boy's terrifying internal world. At the core of the. terror was an experience of separateness and separation as being the source of catastrophic feelings. These feelings were akin to a grievous injury or wound that would not heal and would result in unending pain. Several defensive manoeuvres had developed in order to avoid these frightening feelings. These included the use of confusion to build up a world in which people and things are not differentiated in the usual way. There was a blurring of the sense of not-me objects. By creating autistic objects, he attempted to evade the painfulness of external reality — especially of experiences of new encounters and of changes in existing situations. In the therapy, he would attempt to elicit old familiar interpretations and indeed demand them from the therapist or repeat them himself, ad infinitum to the therapist. These interpreta- tions would then lose the value that they did have when they were fresh and new and the therapy would get bogged down and lose the forward momentum that it did have earlier. He would also twist external reality to suit his own needs. For example, thinking of it as the old one that had grown bigger blotted out the existence of a new table. He would move around the furniture in the room so that the therapy room became, for him, his bedroom. He believed that he could create at will, a mechanical version of the breast and thus remove painful experiences of loss. These defensive manoeuvres had replaced the more usual ways of conia'udtig anxiety and had seriously hindered the process of growing up. It is hypothesized that there was impairment in the ability of the parents to provide an adequate containment for this boy's feelings and to enable the process of psychological birth to take place.

Some years ago, I saw a little boy for psycho- The form of treatment used was psycho- analytical psychotherapy three times a week analytical psychotherapy. It may seem that the and was fortunate enough to have the oppor- notion of using a form of treatment devised tunity of supervision from Mrs. Francis Tustin. for adults is quite bizarre, inappropriate and James was five-years old when I started see- indeed inconceivable for children and even ing him and the treatment lasted for three more so for a five-year old child. There are so years. many different possible objections to such an

Manek - Phiroz Bharucha M.D., D.P.M., Psychoanalyst, Bombay, India.

65 SAMIKSA MANEK - PHIROZ BHARUCHA THE BLACK HOLE : TERROR AND DREAD IN CONFUSIONAL PSYCHOSIS idea. How can children be expected to com- noticed that the equivalent of such processes very repetitive ways. They appear shut off from the pavement on to the road. She was con- municate verbally and to free associate as in childhood lay in play (Klein, 1955). The the outside world, and may be thought to be vinced that something had to be done for adults do? How can they consider that there child represents his thoughts and phantasies deaf or subnormal. The confusional children James; and her persistence resulted in James would be any possible benefit from such treat- by enacting them in play situations, by mak- are different: they may be hyperactive, they being referred to the clinic by the general ment and co-operate with the demands of the ing cars crash into each other, by chopping off are not withdrawn and indeed there may be a physician. He was assessed as having a treatment when they could barely have a no- the heads of dolls or by drawing houses on period of apparently normal development. In confusional disturbance. In a sense, one can't tion of what the treatment is for? How can fire with smoke pouring out of the chimney. their play, these children equate inanimate and find fault with the parents for not being con- they form a rapport with the therapist when These play situations are a way in which chil- animate objects. They equate objects in the cerned about James earlier. Both the parents they are at a stage in their lives when they are dren express their anxieties and allow an outside world with their own things. A neu- are E.S.N., and James was their first child, a already so heavily dependent on their parents understanding of them. The mode of expres- rotic child would represent their daddy by a full term (though forceps) delivery. James had when 'the old edition has not been exhausted'. sion is different, the means of access is car; but for a confusional child, the car is their been an ideal baby — never cried and allowed The pioneer of psychoanalysis, Sigmund different in child and adult analysis. As Mrs. daddy. There is no make-belief quality to the mother to go to work, leaving James with her Freud, found that the analysis of adults led to Klein puts it, 'In it's play the child acts in- play. The relevance of studying these children own mother — with whom they were staying uncovering an infantile neurosis in childhood, stead of speaking. It puts actions which is that their difficulties throw light on difficul- for the first year of James' life. He fitted in He used indirect method to explore childhood originally took the place of thoughts in the ties in the origins of relationships. with the feeding schedule — bottle feeding psychopathology. He also observed children place of words: that is to say that acting out from the beginning (and took readily to Cow and encouraged his students to do the same. is of utmost importance for it' (Klein, 1975). Case Description and Gate I and then Cow and Gate 2), which He also used the opportunity to supervise a However, she also held that the difference be- he had for the first year. In fact it was only child's treatment which was conducted by the tween adult and child analysis was one of I would now like to give an account of the after Martin was born that mother realized boy's father. In 1909, Freud published the case technique and not of principle. Though play patient I have in mind. He was referred to a completely missing out on James's infancy; history of Little Hans, a five-year old boy that had its role as a means of communication, she child psychiatry department for head-banging he was so quiet that she didn't know he was had a fear that he would be bitten by a horse was also very clear that no analysis of a child, which was most severe at bed time; the neigh- there. The first sign of protest was when she (Freud, 1910). Freud successfully guided the whatever its age, can be said to be really ter- bours had made a number of complaints as tried to start him on solids. He was extremely boy's father to conduct the treatment and the minated unless the child has employed speech picture frames kept falling off their walls. In fussy about what he ate; and mother couldn't boy's neurosis abated. At that time, Freud in analysis to its full capacity; for language addition James had made dents in the bed- understand why he would reject certain foods thought that only the father should carry out constitutes the bridge to reality. Playing with room wall and also had been bleeding from like eggs just from the appearance and with- the treatment. In 1918, Freud published an toys as a means of communication can be his wounds. It needed this dramatic symptom out actually tasting it. He also had a number important paper on a patient called the Wolf symbolic. The toys can also provide a direct to bring James to the clinic. Looking back on of anxieties like having his hair washed, or Man (Freud, 1918). Freud showed how in means for representation of various themes, it later, things had been wrong with James for having his hair cut; and at night would cry out analysing the adult neurosis, he unearthed an such as playing mother and child, or mum- quite a while. But at the age of two and a half as if he had nightmares. It was gradually dawn- infantile neurosis. In discussing the possible mies and daddies, or doctor and nurse, or when the parents had moved from a one bed- ing on mother that all was not well; but she merits of direct and indirect analysis of child- shopkeeper. The therapist may be assigned room flat to a two bed-room flat in which did not know what it could be about, espe- hood psychopathology, Freud characterizes the certain roles too. However, some children do James had his own bed room, his difficulties cially as 'no one in the family had it'. At the former as being perhaps more convincing and not play in these ways. They may be inhibited had become obvious and disturbing. His age of two and a half, when he was put in the the latter as being more instructive. He does about playing and require interpretations to mother thought he was being naughty and nursery, she was told that he was very aggres- not at this stage lay restrictions for analysing free their capacity to play. However, in some would feel at times like killing him. She tried sive to the other children. In addition he had children. Though it was then considered highly cases, there are other interferences which restraining him, scolding him and when that a very intense relationship with a girl in the desirable to have more direct access to chil- manifest themselves in this manner. Psychotic did not work, evaded the issue by giving James nursery, would spend hours sitting with her dren, it remained inconceivable as to how this children fall into this category. Mrs. Tustin a 'treat'. That seemed to work sometimes. The and would be furious if someone intruded or would be possible until the further develop- separates out 2 important categories of child- final blow was when Martin was born and tried to separate them. At home he never ments from the work of Melanie Klein. We hood psychosis : encapsulated children and James was four years old. Martin occupied played with toys; though this only struck her hope that adults have a capacity to express confused children (Tustin, 1981). The encap- the parents' bedroom. The head-banging got when she saw Martin playing and James would themselves verbally and to speak about their sulated children are the more typical autistic much worse; he was also wetting his bed and come up to him and try to take his toys away thoughts. As Freud put it, 'too many words children. They do not speak, appear aloof, avert displayed ill-feelings towards his brother — or stop him from playing. James was becom- have to be lent to the child'. Melanie Klein their gaze and do not play with toys except in trying to push him out of his pram or cot and get in himself and trying to push his pram of ing quite a handful for mother, especially after

66 67 SAMIKSA SAMIKSA MANEK - PHIROZ BHARUCHA THE BLACK HOLE : TERROR AND DREAD IN CONFUSIONAL PSYCHOSIS

her own mother's death. At that time James also after arrangements had been made for of me as the frightening big elephant. That them directly from James — except on rare was four, which was just before Martin was James to be transferred to boarding school, to did tie up in that particular session with a occasions when there would be a catastrophic born. There was a strong feeling that he would stop the move, as it was counter-productive. I number of other similar anxieties, but, in sub- anxiety. On one such occasion, in the early have to go to a boarding school. He spent a think it is possible for parents, therapists, and sequent sessions he would repeat this sequence period of the treatment, after returning from a lot of his time rushing about in a mad flurry staff involved in the care of such patients to ad infinitum and use in a parrot like, 'you big break, he'd been banging his head fiercely to of activity — though appearing quite normal be entangled by this and unable to see the full elephant,' quite inappropriately and also at wipe out a painful awareness. I stopped him to outsiders to whom he would smile at and extent of the difficulties. If the active nature times try to elicit this interpretation from me. from doing it and he started shrieking — as if try to win over with his charm. Eventually, at of the manoeuvres that James employs in cre- When I would speak about his trying to get he was about to physically disintegrate and the age of five years he was sent rather half- ating this entanglement is not recognized, it is into me and getting me to say what he wanted could only hold himself together by holding heartedly to the same E.S.N. day school as his possible to overlook the extent of the difficul- me to, he would say the same old things again his arms and legs out stiffly. But despite this mother went to, however with very much the ties. Indeed, James had to be disentangled from and again; not letting me to tell him some- terror James had managed in the sessions, for feeling that it wouldn't work, but which in his first school before he could be transferred thing new which would make him furious and most of the time, without displaying even a fact it did. However, he would be very diffi- to the boarding school. shout, 'you say now, you big elephant.' In a bit of it and the ways in which he averted it cult at the time of leaving his mother in the similar way he has dealt with interpretations constituted the most prominent difficulties I morning to get on to the school coach. He James' Therapy about the anxiety of having a hole or about experienced with him, especially in the early would also be quite angry with her after school the roles he was making me enact with him period of therapy. One of the most frequently The therapy seemed to proceed in cycles finished and would bang his head quite re- —• 'friendly father that plays with him'. At used, especially at that time, was to twist — initially finding his material strange, diffi- peatedly. one point I rather generously thought that this external reality to suit his own need. Thus the cult to understand, challenging, full of latent repetition compulsion was only a way of otherwise alarming fire-alarm light on the ceil- meaning and also emotion; then getting a way The school described him as a boy who working over his anxiety, to try and make it ing became the familiar Pepsi-cola or in, feeling exhilarated that everything seems was making good though slow but with all something familiar and less frightening; but Coca-cola (from the name of the alarm Smoke much clearer, but then finding the cutting edge round progress and who was also fitting into there was no evidence of his having gained in tec). The existence of a new table is blotted of that insight being worn away, eroded, the school life socially. He was reported to have any sense from it — the opportunity to work out by thinking it was the old one that had life taken out of it and feeling quite hopeless a reading age of six years when he was chrono- it through was missingj.arid also, the thrust grown bigger. and really questioning the validity of my work. logically eight years. It was clear as the therapy forward was quite lacking. In a way it does Colours of objects were changed to suit proceeded that there was a marked divergence Over the course of time I had seen this seem that the wish to use me and my things to his needs. For example, looking out of the between the degree of difficulties noted • in happen repeatedly and it is possible to link help him grow or the expression of a needy window of the therapy room, he would change James' therapy and the degree of progress this to what he did to the understanding given part of himself were both quite lacking. the colours of the cars he saw and even their reported at James' school. In addition to the to him. It is striking that he created a misun- number. If I interpreted, 'That's a James' col- concern about the degree of containment James derstanding or made no sense of the words I To express it geometrically, the course of our\ he would start clapping and say, 'You're received at home, there was also the concern used for my interpretations — particularly the therapy could be represented not by a spiral in clever'. The strange 'frightening' therapy room about whether the school had a grip on James' more telling ones and my finding the emo- which after completing a cycle there would be became his own flat, he could speak to his difficulties. On these grounds, he was referred tional impact of the words being lost and their some movement, but by a circle. It does seem friends and carry on a conversation with them at the end of therapy to a special weekly board- being used as his play things; mimicked, re- that at a very fundamental level there is an on the phone; or call out to them in the court- ing school for autistic children. peated endlessly as if he felt it was a attitude of mind of not wanting to be disturbed yard; or see them playing football outside. I possession of mine that he had taken over, — not wanting to struggle or face frustration. He was described at the assessment to this was quickly changed into becoming his in- stripped it of its value and which now served For James there could not be a 'no' if he unit -as failing to score on the Holbom Read- tensely controlling and restricting mother or the purpose of proving how he could get into wanted something — and if I did dare say ing Test. There was doubt that he could the friendly father — at any rate I'm not a me, take me over, and try to get me to join 'no' he would immediately retort, 'but I say comprehend what he read. He could not say separate person. him in his game. yes'. I found myself quite often engulfed by when looking at pictures if it was a girl or a this state of mind of his, and I would say to His mother appeared in the session from lady. What was striking was the response of He would make my words into James' myself 'let him get on with what he's doing', time to time, fused with him, he mimicked her James' original school to the offer of therapy things. For example, I had at one stage spoken 'why bother', and I had to pull myself out of voice saying things like 'not funny' or 'kids' and the referral to the boarding school. There to him about how he felt very anxious of me it quite sharply. Also I had to be often re- or 'chucked things'. At other times, he would was a very strong response from the school because of my size and when he threatened minded of the degree of seriousness of his say, 'I'll tell you my news. I've got your baby' about the lack of necessity for therapy and me with a big elephant, I spoke of his anxiety difficulties — though I was rarely aware of and 'I've got titties', feeling his penis excit-

68 69 SAMIKSA SAMIKSA MANEK - PHIROZ BHARUCHA THE BLACK HOLE : TERROR AND DREAD IN CONFUSIONAL PSYCHOSIS edly. At times he sat in my chair and said 'I'm in them, that I got more of a grip on what was the major difficulties I have with James — of difficulties I had was, that he was extremely Dr Bharucha and you're James' and then or- happening. These sensations included those of his relying on the 'pom-pom' as a comforter sensitive to my innermost feelings, especially dered me around actually believing that to be the skin — uncomfortable prickliness; hard- and evading growth. in relation to my being angry or not adequately what I'm like. On one occasion, he looked at ness and softness; burning when inflamed as receptive to him. Mrs. Tustin described James' mode of me and shouted loudly, 'You'll bring me pud- it often is; inimical grittiness and the rare growing-up as being 'sideways', not trying to In addition, there was a very sly and ex- dings at Highwick' (Highwick was the name recognition of the catastrophe of the wound. approach it in a straightforward way — trying ploitative side of his that didn't hesitate to put of the Boarding School that he was due to go If he felt traces of sand on the floor of the to grow up in a devious way. The ways he the boot in. When I was murderously angry to). In this way, he attempted to get over his therapy room, he would avoid walking on the seems to use are to try and 'steal my height', with him, he would stand back and burst into anxiety of a new place by transferring me to floor by making bridges to cross across the to crash me down, to make me seem silly — laughter and clap vigorously. At moments he it. In the middle of the therapy, we had to room. Other sensations included the sensations to try and snatch away from me what makes perceived my anger and dreaded retaliation move to a new room as he was so distracted inside himself — powerful, bulging and big, me a grown up. Also, for James, growing up and tried to run away but my interpretations by what happened in the streets outside the or of bursting fullness or of the soft vulner- is a sudden transition from being small and about this were taken as reassurance and en- ground floor room. He didn't seem disturbed able front and the hard protective back. helpless to being big and powerful; something couragement to get at me again. This is a by the change for quite a while and in fact In the course of the session he doesn't play that can be achieved by getting onto a cup- problem that I want to touch on here; that altered the furniture in the new room to re- at being big, he actually becomes big by get- board or making a loud noise or sitting in a when I did interpret to him in very simple semble the position they were in the old one. ting on the cupboard and standing up there. big chair or getting into my chair. words it was difficult to prevent him taking It took me quite a while to get past the dis- He also believed that he could steal my height the words literally and concretely — either turbing quality of these experiences — that from me by knocking me over. Uncomfort- Underlying this, there was near the end of confirming or denying his suspicions. When there wasn't a shared sense of reality with able feelings were thus got rid of. His the therapy an awareness of the fact that I was for example I spoke of 'other babies' it was him — that his world was so far away from perception of objects too is altered by defin- a separate person and do have something to as if I was confirming their existence and I my own; that I could not rely on the most ing them on the basis of the most dominant offer, but that he could not or would not use had to labour strenuously at trying to set that fundamental assumptions that I had always surface quality. This then gets linked to or it — and that there are other children who can right. He would shout, 'don't say other ba- taken for granted. These included the sense of confused with a different object in an idiosyn- do so. This manifested itself in his wanting to bies', and would attack me if I said it. But in me/not-me and the immutability of perceptions. cratic way. The dead leaves in the courtyard destroy all the things I had, especially my a sense he has got an extremely concrete idea In short, he had a much more fluid sense of would be 'mummy's pooh-pooh'; the opening 'peace of mind' and 'my light', that is, my of inside of babies which he drew for me as himself and of the outside world. This search ability to think, but also the play material. of a drainpipe become 'mummy's wide-open the mummy with a bulge on her tummy or for meaning was particularly difficult when With great glee, laughter and clapping he enacted going behind the curtains or under the sessions didn't seem to have a thread run- mouth'; the clouds are 'someone smoking'; or would tear up the sheets of paper I gave him the carpet so that I could see the bulge but not ning through them and seemed to be 'mummy's pooh-pooh' covering the sum; the after first tantalising me saying that he wanted what lay behind it — his experience of the disconnected, meaningless bits of activity in- waste-paper basket spinning around becomes to write. There was something quite deliber- pregnant mother linked to his notion of there terspersed with an intensely powerful but 'mummy's mixer', producing the milk shakes ate about this. He also wanted to be with me being an existence somewhere that was so strange way of relating to me. The bits of that he likes to have — a 'breast-thing' or all the time or to come and see me every day. perfect and free from the threats of others — activity seemed to lack any emotional content 'pom-pom'. His notion of the breast accord- He said that if he had four or six hours more where he was the only one filling up the space, or fantasy content — it was as if the manoeu- ingly was a very mechanical one — a round in the session then by being with me he could where he could do whatever he liked ('yes — vres he carried out to avoid his own recognition smooth object that moved round and round ensure that the 'one who comes next' — a and shit and fuck'), run up and down the of terror were so effective that I myself found — something that he could very much make major preoccupation with him — wouldn't get stairs — go wherever he liked, no one would it difficult to sense the terror. At the end of and have for himself. This notion of the 'pom- anything. In a sense he made sure that I haven't stop him, could take off all his clothes that the sessions the bits of material would slip pom' and the anxiety that the other children anything left because often I did feel totally were an unnecessary restriction. away like quicksilver from my grasp — leav- could take it away and have it themselves has drained after seeing him. In the sessions he ing me with a sense of emptiness — a feeling been a central one in the therapy. was terribly taunting and provocative, finding In the sessions he tried repeatedly to get in that there was something quite insubstantial He had several ways of creating it, — one out my weak spots — what he was not meant — be the one inside with me, exclusively. For about him. of the most concrete ones being of the bowl to do and then setting about doing that ad example, he would go under the desk or in the of toys actually having milk in it. Sometimes, infinitium. He spent whole sessions spitting at sink unit or under my chair and then go ahead It was only by reconstructing his world and when he spits, it's as if to prove that he's me and all over the room, an inexhaustible and do all the things which I would not let recognizing that his world was rooted in physi- swallowed the 'pom-pom' and has an unend- source of this precious stuff. One of the major him do. He also tried to burrow his head into cal sensation and the emotions incorporated ing source of stuff inside him. This is one of

70 71 SAMIKSA SAMIKSA MANEK - PHIROZ BHARUCHA THE BLACK HOLE : TERROR AND DREAD IN CONFUSIONAL PSYCHOSIS

my tummy — trying to get back inside, which and I then spoke of how he had lost the 'pom- lost your wallet and feel your coat to find it It may be that their inability to think about is to that idyllic state where he was unsepa- pom' and felt a hole it its place. He ran not there, there is a sense of something famil- his needs abstractly rather than concretely con- rated from his mother. frantically around the room trying to get it iar missing. Or if you forget to put on your tributed to his sense of feeling uncontaincd. back. He then started attacking me extremely To complete this picture of James I would watch and find it missing, it feels strange not When asked in the assessment about his early fiercely and tore off the pocket of my shirt. I like to say that there have been rare but cru- to have it. If one has a tooth removed, one feeding history, they described it by saying felt very aware of the flap of my shirt being cial sessions in which he has been in touch keeps feeling the strange gap to locate the that he had Cow and Gate 1 followed by Cow like a bit of my flesh hanging out like an open with an unbearable sense of loss and broken tooth. The experience of moving home has and Gate 2. wound. An hour after the session was over at down — crying endlessly with a very painful some of these qualities. about 7.00 pm, James' mother returned to the James' father was rather depressed and scream. After his mother told him about the clinic saying that a bit of the dungaree button However, for a very small child, the expe- would not intervene to protect the family from plan to send him to a boarding school he was had got left behind and I found myself caught rience has a far more disturbing impact. It has James. It is possible that his parents were quite banging his head almost continuously in the up in this tremendous anxiety of something been hypothesized that following physical unable to stand up to the intensity of James' session and was quite out of reach. I stopped terribly important having been lost and hunted birth, there is a tremendous disruption of the manoeuvrings and were caught up in it. him banging his head, which was, as it truned all over the clinic before finally admitting that intra-uterine continuity with mother, the bliss- out, the last resort to actually stop himself Indeed, they were always trying to find it had been lost! The feeling I had with James ful state of being cocooned in the womb. The feeling the pain. He burst into tears— an end- ways to avert James' frustration, rather than is of his constantly keeping everything in the containment provided by parental nurturing less wail, only ending when he banged his facing it and modifying it. Such speculations clinic the same, including myself and the things helps to repair these wounds and gradually set head and fell asleep. I think it was as if he have to take into account the fact that the I say. He persistently asked questions over and in motion the process of psychological birth was then aware of a desperate sense of being current relationship between James and his over again, 'Am I coming tomorrow — what's (Tustin, 1981). As Winnicott expresses it, "The totally vulnerable to a catastrophic form of parents is not necessarily the one which ex- tomorrow — time to stop? — nearly? — not mother places the actual breast just where the separation. On another occasion he fell from isted at the time that his difficulties began. quite?' I feel under a considerable pressure to infant is .... to create and at the right moment" the cupboard and injured his gum. He thought James' parents have been considerably affected continue doing things with him in the same (Winnicott, 1958). If, however, this process (and also convinced me) that he had lost a by the intensity of James' disturbance and I old way — not wanting to say anything new has not taken place then the infant faces a tooth and was crying pitifully. I spoke of his had firsthand evidence of that in the course of — not wanting to make any change at all. barrage of terrifying not-me sensations and a feeling of opening up a hole in his mouth — the therapy. We did not have the opportunity feeling akin to an amputation. Autistic chil- to see James' parents at the clinic for psycho- a wound — where something had been torn However, I must say that his way of deal- dren have described these states when they therapy. Hence I would like to return at this from him and his feeling of needing to con- ing with changes in the setting has changed. are able to speak as being akin to falling in- stage to discussing the implications of James' stantly cover that up. He rushed to the window Though initially it would take him at least and started sucking the window handle. finitely or being immobilised at the point of manoeuvres. two to three sessions and a lot of prompting death or as a black hole — terrifying empti- from me to react to the difference, at the end This did produce quite a change in him in ness. Discussion of the therapy he did notice changes more the next session noticing much more what readily. In a sense, however, it is impossible It is possible in this way to understand the James' personality was dominated by this was absent in the room. But later he made use to work on the feelings of loss as they arc use made by confusional children of their structure that hated numerous aspects of real- of this concept in a rather mechanical way. very quickly covered up or else the loss U peculiar defensive structure. There are numer- ity. These aspects included separations, When I spoke about the hole or wound lie treated as such a concrete happening that it is ous hypothesis of why there is such an changes in himself and in the outside world, pointed to the handle and grinned as if to say difficult to think about it or to put it right. It experience of disruption of containment for differences between himself and others and 'That means that one.' He came for one of the does seem that all these defensive manoeu- these infants. At one time, the onus for such he would fight to keep out of his awareness sessions with an inflamed cut near his eye. In vres against catastrophic anxiety have replaced tragedies was placed squarely on the so-called such situations. He believed he could make the middle of that session his dungaree button the more usual ways of containing anxiety and autism generating parents. Such parents were them non-existent. Though others may have came off and he immediately put it into his have seriously hindered the process of grow- characterized as being cold, distant, intellec- to confront such issues in the course of their mouth and sucked ii. I feii he would swaiiow ing up. These manoeuvres are part of an tual and schizoid. This is not believed to be lives, yet he was immune to such pains as a it; I took it out of his mouth. avoidance reaction to deal with terrifying situ- invariably true and indeed the type of difficul- result of his unique armamentarium that could ties may be much more subtle mismatches easily evade such threats. There was another He immediately grabbed it back and again ations which are at first difficult to empathize between the infant's needs and the parental James that did indeed notice changes and reg- sucked it like a sweet. I then took it out and with. They come from a world in which there capacities. James' parents intended to provide istered them.He also asked questions to find put it in my pocket. He was terrified, rushed are the early precursors of feelings and emo- for him as best as they could. out what he could expect to happen in the at me to get it back, put his hand in my pocket tions, namely physical sensations. If you have

72 73 SAMlKSA SAMlKSA THE BLACK HOLE : TERROR AND DREAD IN CONFUSIONAL PSYCHOSIS MANEK - PHIROZ BHARUCHA

are a well-guarded secret i.e., they can be in- future. Yet, such attempts ware quickly inter- tic object is used to evade the sense of loss by However, that is of course only half the accessible to one part of the patient and also fered with by the James that took over and escaping from the not-me outside world. Such truth. The other half is the existence in all of to the therapist. These feelings are not obvi- dealt with the management of such issues. an object creates a barrier between the child us of a psychotic personality which has an ous in the countertransference and it is There was then a very considerable invest- and the nurturing caretakers. Such an object is intrinsic hatred of change and the differentia- important to look very carefully into the trans- ment in this sideways approach to issues and anti-life. On the other hand, the transitional tions implicit in separations. Understanding of ference implications of the patient's material the deal included freedom from black hole type object helps a child to wait until Mummy transference and countertransference manifes- to examine the patient's differing perspectives. experiences. returns, and is a bridge to the not-self mother. tations have to take into account the presence Perspectives, the implications of which Dr. In the context of therapy, the therapist can of psychotic and non-psychotic personalities The price that was paid for such an eva- Klein is speaking of, relate more to encapsu- become the next in the series of confusional in the patient and in the therapist. sion was loss of contact with a personality, lated children. The implications of work with objects — treated not as a separate human which, though it appeared solely as a source There is a considerable pressure on the confusional children relate more to aspects of being but as a thing that has to be relentlessly of unremitting, endless and overwhelming therapist to engage with such a patient in a the psychotic personality which believe that moulded and shaped into a me-thing. This pain, was also the key to the avenues of healthy way in which there is an acceptance of the by remaining in a permanent state of entan- could be accomplished by getting me to inter- growth and development. basic premise that the idyllic, harmonic, glement with one's objects, it is possible to pret in a predictable and reliable fashion, and conflictless state of undifferentiation has mer- escape the terrors of a separate existence. However, such possibilities were barred as when I didn't, he demanded that I did. An- its over the harsh world of reality. The patient long as there was a James that had the en- other way of doing this was to ask repetitive must not be considered to be the sole source Such entanglements can take the form of trenched view that it was possible to negotiate questions, the answers to which he already of such problems for the therapist. The other sexual relationships or phantasies in order to the vicissitudes of growing up without having had learnt from me. My capacity to think for source which needs to be looked into continu- avert isolation. However, there is frequently a to encounter painful feelings. Such a view myself was very much affected early on in the ously is in the therapist. sane personality which recognizes the futility could be substantiated by this James using the therapy by the trance-inducing capacities of of such action. If this situation is not worked various illusionary tricks and manoeuvres that I now wish to turn to look at the implica- his repetitive behaviour. In such a state, I was out in the transference, the grip of the psy- I described earlier in the paper. However, the tion of such phenomena in working with so very much drawn into James* mental world chotic personality remains unmodified. The reliance on such manoeuvres from such an and was no longer, for him, this terrifying not- called neurotic adult patients, a subject which devastating impact of such an entanglement early period of life had resulted in an accumu- self figure. has been well covered by Dr. Sidney Klein's may not be readily apparent because the thera- lated back-log of unfaced terrors that had paper on Autistic Phenomena in Neurotic Pa- pist functions for the patient as an autistic become bundled together into the experience A more concrete way of doing it was to tients (Tutsin, 1986), One set of relationship object, ie. not facilitating change but to main- of a black hole — unfaced and unfaceabie. actually fuse himself with me — by standing dominates the picture: an apparently moving against me and pressing his back against mine analysis, the regular production of dreams and tain the patient's status quo and equilibrium. The chief manoeuvre involves the use of so that we were joined up together. He would reports of progress. However, there are indi- The consequences of altering the balance can confusion in such a way that a world is cre- also try a more concrete way of detoxifying cations of another patient which are made appear as terrifying for the therapist as for the ated in which people and things are not my strangeness by spitting on me and all over clearer by references in a projected form. Such patient. The therapist can use old familiar in- differentiated in the usual way. For example, the room. It is important to clarify that these references could be to disturbances of an au- terpretations and ways of thinking in James would create a 'pom-pom' thing which acts actually modified James' sense of reality. tistic nature that the patient has noted in others. understanding the patient which are as famil- was for him the exact equivalent of mother's He was not building up a fantasy of having In addition the patient can also develop bodily iar to the patient as to the therapist. The patient breast: round, smooth, producing fluid. Such altered me. He actually believed that I was disturbances such as cysts at the time of holi- may elicit skilfully such interpretations from an autistic object is used by a child with a altered and such a belief could not be altered day breaks which function as autistic objects the therapist and the therapist may respond as confusional psychosis to avoid the experience by talking about the situation as if I was al- to deal with the separation. These are consid- required to. If such means do not work, the of missing his needed people. There is a blur- tered. For James the object actually gets patient may demand or threaten the therapist ring of the sense of 'not-me' objects. ered to be manifestations of an almost moulded by his actions. There is then danger impenetrable cystic encapsulation within the to use specific interpretations used by the Recognition and awareness of not-me objects of getting drawn further and further into the therapist before as James did when he said : results in the terrifying experience of a wound patient which serves to protect the self from child's world if one were to adopt a wait and the intense fears of death and disintegration 'you say now,' 'you big elephant.' in his flesh. watch style of approaching such a situation. caused by separation from the life giving ob- These phenomena are based on projective One could be moulded into becoming an au- It is important in this context to make a ject. identification. They are based on pressure put tistic object for the child and it would be very distinction between a transitional object and However, what is striking is that like with on the therapist in the session to do things in difficult to extricate oneself from the web that an autistic object. Both of them are used to James, the existence of the feelings of terror certain ways. The patient may not be listening deal with the sense of loss. However, the autis- is woven around oneself.

75 74 SAMlKSA SAMlKSA MANEK - PHIROZ BHARUCHA

to the actual words used by the therapist, but employ various means equivalent to head- EVOLUTION OF THE CONCEPT OF ANXIETY IN may be absorbed by the physical and concrete banging to stop the patient ever considering PSYCHOANALYSIS nature of the experience — the feel of the change to be possible. couch, pictures on the wall, the sound of the Postponement of issues would be preferred Bani Pain therapist's words rather than their meaning and to even struggling with them. It is necessary other physical sensations. These aspects of the to have, as Bion puts it, binocular vision to Freud's conceptualisation of anxiety changed in tandem with modifications in his relationship to the therapist may have priority look into these issues. path-breaking theories on structure and instincts. The. writer here traces the route over the concurrent verbal interactions taking taken by Freud who began by seeing anxiety as transformed libido (1895) and place between the therapist and the patient. If then, as his own understanding of the mind deepened, changed his view point the therapist's words do impinge on this situ- Concluding Remarks accordingly until, eventually, he was able to state that anxiety was a signal that ation, the patient may fall asleep to avert such I would like to end this paper with a re- a feared traumatic situation might recur (1926). The views of subsequent analysts an impingement. minder of the utmost importance and difficulty who have elaborated on, modified or repudiated this theory are also assessed here for their ability — or lack of it — to fit into the larger canvas of primary psycho- Bion raises the important issue of looking keeping in mind the plight of the patient who analytical concepts, as of the unconscious. very closely into the patient's different per- would want there to be growth and develop- spectives — of the psychotic and the ment while on the other hand, the activity of One of Freud's seminal contributions was to Freud described "anxiety as an affective non-psychotic personalities (Bion, 1957). The the processes which would counter such de- state — that is to say, a combination of cer- non-psychotic personality may well seek velopments even at the cost of leaving the clarify the nature of anxiety and to assign to tain feelings in the pleasure-unpleasure series change and consider it fruitful to enter into individual apparently mentally subnormal. Use it a central role in neuroses. An early formu- with the corresponding innervations of dis- communication in order to bring it about. The of the manoeuvres outlined in this paper had lation was that anxiety was purely biologically charge and a perception of them, but probably psychotic personality could actively counter a devastating impact on the mental life of this conditioned. It occurred in neuroses because also the precipitate of a particular important such steps; prevent this being the kind of child and resulted in a considerable impair- undischarged sexual tension was directly trans- event, incorporated by inheritance — some- choice that could bring about change and ment of his development. formed into anxiety. This theory was influenced by Fechner's postulation of the thing that may thus be likened to an "principle of constancy" which states that the individually acquired hysterical attack" (Freud, References inherent tendency in the nervous system is to 1933, p 81). Earlier, he had said, "... realistic keep the quantity of excitation in it as low as anxiety must be regarded as a manifestation FREUD, S. (1909). Analysis of a phobia in a . (1986). Autistic Barriers in Neurotic possible or at least to keep it constant. of the ego's self-preservative instincts" (Freud, five year old boy. S.E. 10 1916, p.411). Patients. Karnac Books. In spite of theorizing that neurotic anxiety _(1918). From the history of an infan- KLEIN, S. (1980). Autistic phenomena in neu- was transformed libido, Freud was even then While analysing realistic anxiety, Freud said tile neurosis. S.E.ll rotic states. Int.J.PsychoanaL, Vol 61. aware of the close relationship between anxi- that anxiety develops out of "preparedness for ety arising from the apprehension of external anxiety" i.e. the state of increased sensory KLHIN, M. (1955). The Psychoanalytical Play WINNICOTT, D.W. (1958). Collected Papers: danger and the danger arising from within. attention and motor tension. Two possible Technique. In The Writings of Melanie Through Paediatrics to Psychoanalysis, Klein, Vol.III, Hogarth Press, 1975. outcomes are "Either the generation of anxi- Tavistock, 1958. This is clearly stated in his first paper on ety — the repetition of the old traumatic (1975). The Psychoanalysis of Chil- BION, W.R. (1957). The differentiation of the the anxiety neuroses (Freud, 1895, p.112) as experience — is limited to a signal, in which dren. Hogarth Press, 1975. psychotic from the non-psychotic person- "The psyche finds itself in the affect of anxi- case the remainder of the reaction can adapt TUSTIN, F. (1981). Autistic States in Children, alities. Int.J. Psychoanal. Vol.38. ety if it feels unable to deal by appropriate itself to the new situation of danger and can Routledge. reaction with a task (a danger) approaching proceed to flight or defence; or the old situa- from outside; it finds itself in the neurosis of tion can retain the upper hand and the total anxiety if it notices that it is unable to even reaction may consist in no more than a genera- out the (sexual) excitation originating from tion of anxiety, in which case the affective state Manek - Phiroz Bharucha within — that is to say, it behaves as though becomes paralysing and will be inexpedient for 125, Wodehouse Rd. it were projecting that excitation outwards". present purposes." (Freud 1933, p 82). Bombay 400 005 INDIA Bani Pain, Ph.D., Candidate, Indian Psychoanalytical Institute, Calcutta.

76 77 SAMlKSA SAMIKSA BANI PAIN EVOLUTION OF THE CONCEPT OF ANXIETY IN PSYCHOANALYSIS

Neurotic anxiety was observed in three hysteria gives rise to neurotic anxiety. cumulation of excitation, whether of external One fundamental factor about birth, as or internal origin, which could not be dealt about every danger situation, is that it evokes situations :- In neurotic anxiety what one fears is one's with. Later anxiety as a signal for help is the in mental experience a condition of these (a) freefloating anxiety, the general appre- own libido. The danger, in neurotic anxiety, is response of the ego to the threat that a trau- excitations which is felt as pain, and which hensiveness of anxiety neurosis; internal and not consciously recognized, matic situation might occur. Such a threat cannot be mastered by discharge. Such a situ- whereas it is external in objective anxiety. (b) phobias where anxiety is attached firmly constitutes a situation of danger. Internal dan- ation, in which the efforts of the pleasure to certain ideas, indicating a connection Freud's views on anxiety changed in the gers change with the period of one's life, but principle come to nothing, may be called "trau- with external danger; course of time. He soon saw psycho-neurotic they have a common characteristic : they in- matic". In this way by following the pattern anxiety as a response to a danger (signal volve separation or loss of a loved object, or of neurotic anxiety, objective anxiety and dan- (c) anxiety in hysteria and other severe neu- theory). What changed his view was the reali- a loss of its love — a loss or separation which ger situation, Freud arrived at a simple roses — this anxiety either accompanies zation that this theory had certain inherent might in various ways lead to a build up of formula: whatever my be feared, the object of symptoms or manifests itself limitations (Mack and Semrad 1967, p.282). unfulfilled desires and so to a situation of anxiety is always the emergence of a trau- independantly without any external ref- helplessness. Freud stated that certain specific matic factor which cannot be dealt with in erence. "First, it contradicts a basic aspect of psycho analytic concept of the psychoneurosis. Freud developmental occurrences are liable to pre- accordance with the norms of the pleasure Freud then raised two questions: What are postulated that in the psychoneurosis, anxiety cipitate traumatic situations : birth, loss of the principle. people afraid of in neurotic anxiety? And how is the result of sexual repression, which, of mother as an object, loss of the super-ego's It is only the magnitude of (he excitation are we to relate such anxiety with the anxiety course, implied that repression precedes anxi- love. And anxiety is now seen as the cause of which turns an impression into a traumatic felt in the face of external danger? Investiga- ety. But what causes repression? Freud had repression instead of the reverse, as Freud factor, which paralyses the operation of the tions revealed that the most frequent cause of also stated that repression arose in response to thought for many years. pleasure principle and gives significance to anxiety neurosis was undischarged excitation. unbearable affects, which would certainly in- ]n Inhibitions, Symptoms and Anxiety the danger situation. This view is supported by the prevalance of clude anxiety. This, of course, implies that (1926), Freud explained that symptoms were certain universal phobias among children. anxiety precedes repression and represents the Finally, in New Introductory Lectures, created to avoid a danger situation which is Being left alone or seeing strange faces stirs Freud concluded that there was no objection basic contradiction which was the source of signalled by anxiety. Anxiety arose originally up the child's longing for the familiar pres- to postulating a two-fold origin of anxiety: considerable controversy. Second, the theory as a reaction to a state of danger, and is repro- ence of its mother. It cannot control this first, as the direct effect of a traumatic factor did not take into account anxiety which arises duced whenever that state recurs. Freud knew Hbidinal excitation nor keep it in a state of and, secondly, as a signal that a traumatic in response to realistic danger, i.e. so-called that the child's anxiety when alone in the dark suspension, instead it turns into anxiety. Freud objective anxiety." factor of this kind threatens to recur. held that this phobic anxiety of children is not or with a stranger was linked with his missing In "An addendum to Freud's theory of objective, but must be classed among neurotic With the introduction of the structural a loved one. In this lies the key to anxiety. model of mental functions, Freud mostly dis- Anxiety" Charles Brenner (1953) held that, anxieties. Children's phobias and the anxious "The more the generation of anxiety can be carded the previous hypotheses. Anxiety was anxiety was an emotion (affect) which the expectation in anxiety neurosis are two exam- restricted to a mere signal, so much the more now an ego-function, affects were no longer anticipation of danger evoked in the ego. It is ples of one way in which neurotic anxiety does the ego expend on actions of defence safety valves but were used as signal by the not present as such from birth or early in- comes about i.e., through direct transforma- which amount to the psychical binding of the ego. He said, "the ego is the actual seat of fancy. In very early periods, the infant is aware tion of libido. repressed [impulse], and so much the closer, anxiety.... Anxiety is an affective state and as only of pleasure or pain as far as emotions are too, does the process approximate to a normal A second method by which anxiety origi- such can, of course, only be felt by the ego. concerned. As experience increases and ego working-over of it, though no doubt without nates is from repression, as in hysteria. But The id cannot have anxiety as the ego can; for functions develop (eg. memory and sensory attaining to it" (Freud 1933, p.90). there is an underlying unity between the two it is not an organization and cannot make a perception), the child is able to anticipate that methods. In hysteria and the like, it is the idea judgement about situations of danger". How- But why do people become neurotic? Some a state of unpleasure (a traumatic situation) is that is repressed; its associated affect.is al- ever, "processes take place or begin to take determinants of anxiety disappear; others do likely to occur. This ability of the child to ways turned into anxiety whether it is place in the id which cause the ego to produce not. Freud said that what was necessary was react to danger in advance is the beginning of aggression or love. This transformation of anxiety" (Freud 1926, p. 140). Anxiety is now some factor that would explain why some the specific emotion of anxiety which, in the course of further development, may become sexual energy due to infantile weakness of the seen as a signal from the ego to indicate that people were able to subject the affect of anxi- sharply differentiated from other unpleasant ego, as in children's phobias, or on account of there is danger ahead. Originally, in a trau- ety to normal control while others came to emotions. somatic processes in sexual life, as in anxiety matic situation, anxiety was a reaction to the grief in this process. Here he introduced the neuroses, or on account of repression as in helplessness of the ego in the face of an ac- quantitative factor to explain the difference. (1945, p. 192) said that "...if

78 79 SAMlKSA SAMIKSA BAN I PAIN EVOLUTION OF THE CONCEPT OF ANXIETY IN PSYCHOANALYSIS

/choanalysis succeeds in freeing a patient's attributes. There is an intimate relation be- lack full orgastic potency. He also believed which is limited in its manifestations and exists jressed sexual energies, but the external tween conflicts and anxiety but the anxiety that the existence of sexual energies required at an organic rather than at a psychological uation prevents him from finding an oppor- producing conflict can no longer be seen recurrent orgastic discharge which posed the level. Variations in the birth process may simi- lity for achieving the satisfaction of which simply as ego vs id. Any pride invested as- question of what happened to these energies larly increase the (organic) anxiety response is now capable, psychoneurotic symptoms pect of self that has subjective compulsive when they were not effectively discharged. An and heighten the anxiety potential, causing a ly again be replaced by actual-neurotic value may be endangered either by a contra- answer could be that they were experienced more severe reaction to later (psychological) es". This view was based on his own clini- dictory internal tendency or by disapproval as anxiety. Here Reich was following a line of dangers in life. Further where there is an in- 1 observations, but these have not been from without. Whether anxiety is present or thought begun by Freud, whose original theory crease in early anxiety, there is an increase in sorted in detail unfortunately. absent is not an absolute criterion of pathol- of anxiety was that undischarged libido is narcissism. This situation hinders the devel- ogy for several reasons. Firstly, anxiety may 'converted' into anxiety. This theory, which opment of a sense of reality and further In the Psychoanalytic Theory of Neurosis, be repressed due to excessive control, pride Freud himself abandoned in the 1920's, as- pre-disposes the development of esneciniiy nichel wrote that anxiety neurosis was an in serenity or some other neurotic attitude. It sumed that anxiety is a direct psychological severe neuroses or borderline states. tity which was the result of a state of height- may not even arise owing to feelings of al- result of repressed sexual tension, but the G. Bose (1921) links anxiety with repres- ed inner tension due to lack of satisfactory ienation or other emotions like rage, precise nature of the process of 'conversion' sion which arises owing to the conflict between stinctual gratification. As he said that if an humiliation or embarrassment, may replace it remained mysterious. opposite wishes: active and passive. Bose says stinctual need is not adequately satisfied, the in an apparent direct response to threat. Sec- According to M. Klein (1948), the first "The repressing force and the repressed force emical alteration connected with the gratifi- ondly all anxiety is not neurotic. Healthy, consequence of the operation of the death come to the consciousness respectively as a tion of the drive is missing, and disturbances constructive, normal anxiety may be gener- instinct is anxiety. Klein considered the ego to wish and a fear. As I have indicated above the chemistry of the organism result. Un- ated in response to positive movement or be the seat of anxiety, with anxiety constitut- wherever there is repression there is an inhi- scharged excitement and affects mean when genuine values are threatened and it is ing the ego's response to the expression of the bition of action. The conscious wish is ^normal quality and quantity of hormones essential for producing constructive activity. therefore an impotent wish to a certain extent. id thus alterations in physiological functions, death instinct. Anxiety is also reinforced by In all psychoneurotics that I have analysed, I sre alterations presumably constitute anxi- Anxiety is the focal issue in personality the separation caused by birth and by the frus- have always been able to find these two phases y neurosis. development for the neo-Freudians as it was tration of bodily needs. Anxiety becomes fear of the struggle. The wish with its pleasant for Freud himself. Like all other concepts of persecutory, objects and later through (1939) while tracing the reintrojection of aggression in the form of affective tone being impotent goes to form developed by Sullivan (1955), anxiety was mesis of anxiety and conflict, explained that internalized bad objects, the fear of outer and day dreams and fancies and other activities of seen as an interpersonal phenomenon and the child who is exposed to a rejecting parent inner persecutors. Inner persecutors constitute similar types. The fear with its unpleasant response to the disapproval of a significant ill react with vague feelings of loneliness, the origin of primitive superego anxiety. affect appears as an obsession. It has been adult. slplessness and fear of the potentially hostile customary to describe obsessional psychoneu- orld that surrounds him. This reaction is In large measure, Sullivan views personal- In Trauma, Growth and Personality, P. rosis as a separate disease entity, but in my died "basic anxiety". He avoids this anxiety ity development as a process of learning to Greenacre (1953) discusses anxiety in the opinion any demarcation of the different types / developing attitudes toward his parents handle anxiety with adaptive manoeuvres and prenatal period. She held that anxiety response, of psychoneurosis is more or less arbitrary hich are compulsively submissive, aggres- defensive tactics. Since anxiety stems from which is genetically determined probably and is only a matter of convenience. All psy- ve or detached. the feeling that one's needs are threatened manifested itself first in an irritable response choneurosis, including hysteria, show this essentially, these patterns are techniques for of the organism at a reflex level. This is ap- important trait of having an impotent wish on These attitudes have been called neurotic achieving security by gaining approval from parent in intra-uterine life in a set of separate the one hand and an obsession on the other; ends or drives. It is disputable whether ba- significant people. They are incorporated into or loosely constellated reflexes which may although the one or the other may be the more c anxiety alone can account for the the self-system which form the matrix of the become organised at birth into the anxiety prominent. Anxiety, fear, obsession & c, all henomenon of anxiety. Its precise nature personality structure of the individual. Sullivan reaction. How much this total reaction is po- belong to the same category and cannot be 3cds further research and elaboration, How- tentially present but not elicited before birth pointed out that it may also constitute a posi- differentiated one from the other" (pp. 59-60). vcr, once the neurotic trends are established, and how much birth itself may play a rein- tive force, propelling the individual towards nxiety is produced. The development of the forcing or an organising role, is not clearly learning new techniques and devices for deal- According to Spitz (1950), anxiety must eurotic superstructure extends the possible determinable at present. Certainly, however, ing with it. be considered in relation to the weakness of rea of emotional conflicts between opposing 'danger' does not begin with birth but may be the ego and the development of the object. He ends, the idealized and despised selves, con- W. Reich (1948) believed that all neurotics present earlier and provoke a foetal response enumerates three phases in the development adictory shoulds and real self and neurotic and, indeed, most civilized men and women

81 80 SAMIKSA SAMIKSA BAN) PAIN EVOLUTION OF THE CONCEPT OF ANXIETY IN PSYCHOANALYSIS psychoanalysis succeeds in freeing a patient's attributes. There is an intimate relation be- lack full orgastic potency. He also believed which is limited in its manifestations and exists repressed sexual energies, but the external tween conflicts and anxiety but the anxiety that the existence of sexual energies required at an organic rather than at a psychological situation prevents him from finding an oppor- producing conflict can no longer be seen recurrent orgastic discharge which posed the level. Variations in the birth process may simi- tunity for achieving the satisfaction of which simply.as ego vs id. Any pride invested as- question of what happened to these energies larly increase the (organic) anxiety response he is now capable, psychoneurotic symptoms pect of self that has subjective compulsive when they were not effectively discharged. An and heighten the anxiety potential, causing a may again be replaced by actual-neurotic value may be endangered either by a contra- answer could be that they were experienced more severe reaction to later (psychological) ones". This view was based on his own clini- dictory internal tendency or by disapproval as anxiety. Here Reich was following a line of dangers in life. Further where there is an in- cal observations, but these have not been from without. Whether anxiety is present or thought begun by Freud, whose original theory crease in early anxiety, there is an increase in reported in detail unfortunately. absent is not an absolute criterion of pathol- of anxiety was that undischarged libido is narcissism. This situation hinders the devel- ogy for several reasons. Firstly, anxiety may 'converted' into anxiety. This theory, which opment of a sense of reality and further In the Psychoanalytic Theory of Neurosis, be repressed due to excessive control, pride Freud himself abandoned in the 1920's, as- pre-disposes the development of especially Fenichel wrote that anxiety neurosis was an in serenity or some other neurotic attitude. It sumed that anxiety is a direct psychological severe neuroses or borderline states. entity which was the result of a state of height- may not even arise owing to feelings of al- result of repressed sexual tension, but the G. Bose (1921) links anxiety with repres- ened inner tension due to lack of satisfactory ienation or other emotions like rage, precise nature of the process of 'conversion' sion which arises owing to the conflict between instinctual gratification. As he said that if an humiliation or embarrassment, may replace it remained mysterious. opposite wishes: active and passive. Bose says instinctual need is not adequately satisfied, the in an apparent direct response to threat. Sec- According to M. Klein (1948), the first "The repressing force and the repressed force chemical alteration connected with the gratifi- ondly all anxiety is not neurotic. Healthy, consequence of the operation of the death come to the consciousness respectively as a cation of the drive is missing, and disturbances constructive, normal anxiety may be gener- instinct is anxiety. Klein considered the ego to wish and a fear. As I have indicated above in the chemistry of the organism result. Un- ated in response to positive movement or be the seat of anxiety, with anxiety constitut- wherever there is repression there is an inhi- discharged excitement and affects mean when genuine values are threatened and it is ing the ego's response to the expression of the bition of action. The conscious wish is abnormal quality and quantity of hormones essential for producing constructive activity. therefore an impotent wish to a certain extent. and thus alterations in physiological functions. death instinct. Anxiety is also reinforced by In all psychoneurotics that I have analysed, I Here alterations presumably constitute anxi- Anxiety is the focal issue in personality the separation caused by birth and by the frus- have always been able to find these two phases ety neurosis. development for the neo-Freudians as it was tration of bodily needs. Anxiety becomes fear for Freud himself. Like all other concepts of persecutory, objects and later through of the struggle. The wish with its pleasant Karen Horney (1939) while tracing the developed by Sullivan (1955), anxiety was reintrojection of aggression in the form of affective tone being impotent goes to form genesis of anxiety and conflict, explained that seen as an interpersonal phenomenon and the internalized bad objects, the fear of outer and day dreams and fancies and other activities of a child who is exposed to a rejecting parent response to the disapproval of a significant inner persecutors. Inner persecutors constitute similar types. The fear with its unpleasant affect appears as an obsession. It has been will react with vague feelings of loneliness, adult. the origin of primitive superego anxiety. helplessness and fear of the potentially hostile customary to describe obsessional psychoneu- world that surrourids him. This reaction is In large measure, Sullivan views personal- In Trauma, Growth and Personality, P. rosis as a separate disease entity, but in my called "basic anxiety". He avoids this anxiety ity development as a process of learning to Greenacre (1953) discusses anxiety in the opinion any demarcation of the different types prenatal period. She held that anxiety response, by developing attitudes toward his parents handle anxiety with adaptive manoeuvres and of psychoneurosis is more or less arbitrary which is genetically determined probably which are compulsively submissive, aggres- defensive tactics. Since anxiety stems from and is only a matter of convenience. All psy- manifested itself first in an irritable response sive or detached. the feeling that one's needs are threatened choneurosis, including hysteria, show this essentially, these patterns are techniques for of the organism at a reflex level. This is ap- important trait of having an impotent wish on These attitudes have been called neurotic achieving security by gaining approval from parent in intra-uterine life in a set of separate the one hand and an obsession on the other; trends or drives. It is disputable whether ba- significant people. They are incorporated into or loosely constellated reflexes which may although the one or the other may be the more sic anxiety alone can account for the the self-system which form the matrix of the become organised at birth into the anxiety prominent. Anxiety, fear, obsession & c, all phenomenon of anxiety. Its precise nature personality structure of the individual. Sullivan reaction. How much this total reaction is po- belong to the same category and cannot be needs further research and elaboration. How- pointed out that it may also constitute a posi- tentially present but not elicited before birth differentiated one from the other" (pp. 59-60). ever, once the neurotic trends are established, and how much birth itself may play a rein- tive force, propelling the individual towards anxiety is produced. The development of the forcing or an organising role, is not clearly learning new techniques and devices for deal- According to Spitz (1950), anxiety must neurotic superstructure extends the possible determinable at present. Certainly, however, ing with it. be considered in relation to the weakness of area of emotional conflicts between opposing 'danger' does not begin with birth but may be the ego and the development of the object. He trends, the idealized and despised selves, con- W. Reich (1948) believed that all neurotics present earlier and provoke a foetal response enumerates three phases in the development tradictory shoulds and real self and neurotic and, indeed, most civilized men and women

80 81 SAMlKSA SAMIKSA BANI PAIN EVOLUTION OF THE CONCEPT OF ANXIETY IN PSYCHOANALYSIS of the object: (a) the pre-objectal or objectless ment. There are four prototypical danger situ- stage (up to three months); (b) the stage of the ations of childhood which account for more Sullivan's explanation of anxiety as a re- tion of anxiety is based on controversial con- precursor of the object (three to eight months); familiar forms of anxiety. These are loss of sponse to the disapproval of a significant adult cept makes it unacceptable to many analysts. (c) the stage of the libidinal object proper the object, loss of the object's love, castration is similar to Freud's concept of anxiety aris- The anxiety owing to the loss of different (eight months on). It is only in this third stage, and loss of the superego's love. ing from the loss of love of the love object. objects is due to the fact that the ego or the he argues, that one can speak of anxiety about Sullivan views personality development as a self values it. Unless the ego and the self values separation from the mother, for it is only then But the nucleus of the patient's annihila- process of learning to handle anxiety with an object, there can be no anxiety even if it is that the infant is mature enough to be aware tion anxiety according to Kohut (1983), is his adaptive manoeuvres. It seems to over empha- lost forever. Thus all objects become signifi- of her presence and absence. This has become experience that his self is undergoing an omi- size the role of anxiety. Nevertheless, both cant because the ego or self attaches value to known as the eight-month anxiety, although nous change. Kohut says that often the four Homey and Sullivan provided new insight on them, livery loss is ultimately linked to the other authors variously place it anywhere from familiar forms of anxiety are but the patient's the positive connotations of anxiety. deeper unnamable dread experiences when he self. three months to one year. Spitz, Bowlby, Mahler, Winnicott and feels his self is becoming enfeebled or is dis- Therefore in the final analysis it can be Greenacre did not contradict Freud but tried In normal development, the infant moves integrating. said that every anxiety is an apprehension of to strengthen his theory. Greenacre focussed towards a state of object constancy in which the loss of the self either directly or indirectly. Freud's new theory of anxiety was accepted on anxiety in intra-uterine life. According to the internal representative of the caretaker This is also Kohut's finding as embodied in by some psychoanalysts; others stayed with Klein, the source of anxiety is the death in- (mother, essentially in our culture) remains, his concept of annihilation anxiety. What is constant even in her absence. Mahler places his earlier theory with certain modifications stinct which exists in every individual. For implicit in Freud has been made explicit by this in three years; other authors still earlier. and certain others discarded his theories alto- Klein, anxiety was the direct product of in- Kohut. As the object becomes increasingly internal- gether, formulating different views on anxiety. stinct. This might seem like an ised, anxiety regulation moves more and more But only Freud's new theory adequately ex- oversimplification of a complex phenomenon towards the internal rather than the external plained all the anxiety states. like anxiety. As anxiety is always a reaction Conclusion sources. of the ego, the ego's role in an anxiety-ridden Anxiety has two aspects: phenomenological Otto Fenichel explained anxiety neurosis situation must be accepted and clearly stated. and genetic. Phenomenologically, it can be said Consequently, separations from this inter- but not realistic anxiety. Charles Brenner One can agree with Klein that anxiety arises that anxiety is a state of tension which is nal source (introject, later superego) is always pointed out that Fenichel's presentation was from the death instinct only in so far as the unpleasure to the ego. It is the sense of appre- difficult. In fact, such separation always in- admirably clear and logical; unfortunately, ego is afraid of its own death instinct. There- hension of some impending danger. volves some intermediate object, usually a what he offered as facts were in reality as- fore in every anxiety situation the ego on the Genetically, it can be traced to five prototypes; person. The human being apparently cannot sumptions. Anxiety neurosis is not a one hand and the death instinct on the other birth anxiety, separation anxiety, castration leave one attachment figure without having well-established clinical entity and we know must play their part. Thus anxiety is not as anxiety, superego's anxiety and annihilation another available. The only apparent excep- very little about the relation between instinc- one sided as Klein envisaged it. anxiety. It can be said that no singular proto- tion is the "transitional object" described by tual gratification and alteration in the chemistry Secondly, the issue of the acceptability of type is sufficient to explain all varieties of Winnicott (1953), although there too the role of the body or whether undischarged excite- the death instinct is still debatable. Though anxiety. Anxieties are phase-basic. Therefore, of the father remains obscure. ment and affects do in fact produce abnormal Freud first introduced this concept, many of in order to explain different varieties of anxi- amounts of hormones, let alone qualitatively Accoiding to Bowlby (1973), in the earlier his followers including were not ety we are to take into account the five abnormal ones. When what is required is a stages, separation from the mother arouses favourably disposed to it. That Klein's explana- above-mentioned genetic prototypes. anxiety of the most intense kind, eventually psychological explanation of anxiety, Reich leading to a state of detachment. In this state gives only a physiological account. The men- the infant has given up all hope of ever deriv- tal state of anxiety may have a corresponding References ing giaiificuiiuii fioni other human beings. physiological state but they are not identical. Detachment follows upon protest and despair. Moreover Reich does not state whether his BOSE, G. (1920). The Concept of Repression. theory of anxiety. Int. ./. PsychoanaL, theory is verifiable. Kegan Paul, Trubner & Co., Ltd. London. 34:18-24. Kohut's (1983) psychology of self accounts pp.59-60 for psychopathology associated with annihi- Horney's concept of basic anxiety due to FENICHEL, O. (1945). The Psychoanalytic lation anxiety. For him, annihilation anxiety the child's helplessness in a hostile world is BOWLBY, J. (1973). Separation, Anxiety and Theory of Neuroses. W.W. Norton & Com- is an archaic pre-structural prototype of the the prototype of birth trauma as Freud envis- Anger. Vol. II Hogarth Press. London. pany Inc, New York. more familiar post-structural anxiety develop- aged it. BRENNER, C. (1953). An addendum to Frued's FREUD, S. (1895). On the grounds for detach-

82 SAMlKSA 83 SAMIKSA BANI PAIN

ing a particular syndrome from neurasthe- J. PsychoanaL, 64 (1). 59-69. BOOK REVIEWS nia under the description "anxiety neurosis". S.E. 3. MACK, J.E. & SEMRAD, E.V. (1967). Classical psychoanalysis. In Comprehensive Textbook LACAN AND LANGUAGE : A READER'S GUIDE TO ECRITS. BY JOHN P. MULLER AND WILLIAM (1916). Introductory Lectures on of Psychiatry, cds. Alfred M. Frccdman and J. RICHARDSON. International Universities Press, Inc. 1982, 1994. pp.443, $29.95 Psychoanalysis. S.E. 16. Harold I. Kaplan. Indian Edition, Scien- It is rather late for appraisal of a book that first to undertake what must have seemed to (1926). Inhibitions, Symptoms and tific Book Agency. Calcutta. was published in 1982, but a discussion of everyone as extremely ambitious — a full- Anxiety. S.E. 20. MAIH.I'R, M.S. (1969). On Human Symbiosis Muller and Richardson's Lacan and Language, length exigesis on Ecrits. Compared to their (1933). New Introductory Lectures. and the Vicissitudes of Individuation. Vol.1. A Reader's Guide to Ecrits would still be later joint venture, a book on Lacan's seminar S.E. 22 Hogarth Press. relevant in a context where one has just begun on Edgar Allan Poe's short story The Pur- GREENACRE, P. (1953). Trauma, Growth and REICH, W. (1948). The Function of the Or- a serious engagement with the thought of loined Letter called The Purloined Poe must Personality. London, Hogarth Press. gasm. Institute Press, New York. . The book appeared close in have been much more challenging. The reac- the wake of the publication of the English tions to the book have been mixed, but no one HORNEY, K. (1939). New Ways in Psychoa- Spitz, R. (1950). Anxiety in infancy: A study version of Lacan's Ecrits (1977), still the most would deny that it was a timely intervention nalysis. London, Kegan Paul, Trench, of its manifestation in the first year of life. daunting book that he wrote. A selection from in the effort to introduce one of the most start- Trubner & Co. Ltd. Int. J. PsychoanaL, 31:138-143. the French edition (1966), it contains nine of ling thinkers of this century to the English KLIEN, M. (1948). On the theory of anxiety SULLIVAN, H.S. (1955). The Interpersonal his papers including some of the earliest ones readers. Laplanche and Pontalis's The Lan- and guilt. In Developments in Psychoanaly- Theory of Psychiatry. N.Y. Norton: Lon- like The Mirror Slage as Formative of the guage of Psychoanalysis and essays by Louis sis. Hogarth Press. London. 1955 don: Tavistock. Function of the I and Aggressivity in Psychoa- Althusser, Anthony Wilden, Fredric Jameson nalysis. Malcolm Bowie commented that in and Malcolm Bowie have preceded Muller and KOHUT, H. (1983). In Annihilation anxiety: the WINNICOTT, D. (1953). Transitional objects and Richardson in the task and excellent work by experience of deficit in neurotic compro- the euphoric days of the first explosion of transitional phenomena. Int. J. Psychoanai, poststructuralist theory on the continent ac- a whole host of critics and analysts has come mise formation, by Helen K. Gediman. Int. 34:89-97. quiring a copy of the Ecrits meant buying a out since their publication (among whom one badge and an event, but it was and remains must mention Malcolm Bowie's Lacan and the most difficult text to penetrate among the Slavoi Zizek's Looking Awry) but that does formidably recondite body of work that Lacan not take the credit away from this attempt to Bani Pain produced. The best way to begin to approach situate the most opaque work of the French B K-108, Sector II theorist in a broad frame of reference. Salt Lake his thought is through his 'seminars', particu- Island No. 8 larly through the first, second and the eleventh The authors never lose sight of the fact Calcutta 700 091 one which are also readily available in Eng- that it is in no way possible or desirable to INDIA lish. In fact Lacan wrote very little; most of offer paraphrases of the tantalisingly involved his ideas were presented in the annual semi- statements of Lacan. Difficulty for him is the nars that he gave in Paris between 1953 and stuff that one has to make sense of, it should 1980. These are recorded in twenty seven not be made easy. If Lacan believed that the volumes by faithful students under the guid- unconscious and the human subject arc thor- ance of Jacques-Alain Miller (only once was oughly linguistic creations then the language this annual classic event interrupted — when that represents these entities must always turn Lacan stopped his lectures at the Ecole Nor- back upon itself, cross itself, erase, appear and mal Superieure in solidarity with the left withdraw. The only way tn enter the uncon- students' movement of May, '68). Muller and scious, he thought, was by already being inside Richardson, who have been publishing regu- it; as he would say — there is no way out larly essays in psychoanalysis and philosophy, other than the way in. And his writing mimics with a special focus on the structure of psy- this procedure, incorporates all the games that chosis, were among the early authors to take the unconscious plays with us. The authors up Lacanian theory for discussion and the very take it upon themselves only to relate the statc-

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merits to a broader context of theoretical prac- Marx, Derrida's return to Western metaphys- the human reality of language and they have psychoanalysis to ego-psychology. In analyti- tice, to other statements scattered over the texts ics and Foucault's critique of Enlightenment language-like structures. The Oedipus com- cal practice Lacan would demand a distrust and thus offer ceratin entry points to the argu- thought. For these thinkers 'reading' anew plex, for example, is the moment of passage when the patient says "I" because the dimen- ments. They list the allusions as far as possible what has been said is more important than into language for the child which places it in sion of the subject is what the analyst should so that the constant quibbles, puns, rhetorical saying altogether new things and linguistics what Lacan calls the Symbolic i.e. the inter- look for, not the dimension of the ego. twists that Lacan uses are a little more acces- serves all of them a major purpose. Lacan subjective network. The resolution of this sible to the reader. Steeped in the avant-garde Muller and Richardson offer a lucid ac- shares with all these thinkers the other com- complex can be seen as dissolution of the Parisian culture of the twenties and thirties, count of how Lacan comes to conceive the mon trait — a suspicion for the metaphysics dyadic bond between the child and the mother Lacan had friends like Breton, Picasso, Bataille unconscious as structured like language. Lacan of presence. It is no accident that the term through the introduction of a third term. The and Dali and contributed to the Surrealist jour- takes Freud's words about the dream being a 'absence' or 'lack' becomes so central to his phallus is the name of this third term; it does nal Minotaure; artistic and literary references 'rebus' {The Interpretation of Dreams, 1900) thought, he cannot take the human subject or not have any biological function, it stands in abound in his writing. On the other hand he quite literally; the unconscious is not given in reality as objective, immanent, self-identical, for the reality of absence and difference that was trained in philosophy from early on and the dream content but in the dream-work, pre- everything is in the process of formation and all human representation is marked with. In developed a classical bent of speaking in apho- cisely in the formation of the rebus. And the is being formed through an active exchange language something always takes the place of risms. Muller and Richardson have a dream-work is a linguistic operation based on between human beings. This exchange defines something else and a word is always the ab- convincing humility in the method they adopt metaphoric (condensation) and metonymic the essence of all that we have or do, all that sence of other words; it does not indicate any in unfolding the essentially non-linear argu- (displacement) activities. we are, its nature is like that of language and sure presence of the thing. As Saussure him- ments of Ecrits as they always keep the thus entirely social. Thus what appears to be self remarked that in language there are only For Lacan the unconscious is not only that interpretative options open. The sense of in- natural or biological in Freud becomes cul- differences; no positive terms. In their expli- which slips through speech, it is an obverse completeness and the gaps this method leaves tural in Lacan. A return to Freud, then, meant cation of the seminal essay on the mirror stage, formation of language that comes into being are partly unavoidable. for Lacan applying Freudianism to Freud — Muller and Richardson points out how Lacan as we cross the 'mirror stage' and enter the locating the directions in his thought which The authors situate Lacan in two contexts, makes the crucial distinction between the ego Symbolic. He would ask us to pay heed when he could not fully articulate but which cry out in the revolution in linguistic philosophy that and the subject. What is given to the pre-oedi- Freud says that symptoms are often literally for elaborations that would radicalise the very Ferdinand de Saussure and the structuralists pal child in reflection (real or metaphorical) is words trapped inside the body. He would show limits of his theory. Every thinker is circum- brought about and a certain tradition of an illusion of totality, an illusion that it is a how what he calls 'the agency of the letter' scribed by the paradigms of thought that his Hegelian thinking connects to Heidegger in a finite, defined, absolute entity. This is for (cf. chapter five in Ecrits) is operative in the age offers, for Freud a basic paradigmatic rather paradoxical way. Saussurian linguistics Lacan the reality for the ego, the "I" that one unconscious structure that Freud reveals ana- constraint was a positivist biology, a general comes to influence Lacan through the work of has always in mind when thinking about the lysing a case like that of the 'Rat Man'. Muller idea of science that has been thoroughly ques- the formalist critic Roman Jacobson and the conventional split between mind and matter and Richardson could have taken up the con- tioned in our times. He looks for bases in anthropologist Claude Levi-Strauss. When or subject and object — a Cartesian forma- cept of 'lack' in Lacan for further elaboration human nature, biology etc. of psychic forma- Jacobson maps the phenomena of aphasia or tion. It is only when the "I" becomes aware of along these lines. Once the pre-oedipal 'im- tions that are always constructed never given, speech difficulties along the rhetorical axes of something constantly missing from the pic- aginary' fullness of identity or perception is always in formation never absolute, always metaphor (selection of words) and metonymy ture in front of it, of the fact that there is lost to the subject it becomes marked with a inter-subjective never purely individual. Lacan (combination of word with word) he supplies always another dimension, another absent pic- gap — Lacan writes this subject with a barred had been arguing along these lines right from Lacan with a crucial tool of understanding the ture that subjectivity emerges. This S — and lives on in a continuous locomotion the thirties. In an article on The Family con- processes of condensation and displacement second-level reality is the Symbolic, while the of desire. Lacan makes an important distinc- tributed to the Encyclopedie Francaise in as metaphorical and metonymic activities re- first is the imaginary for Lacan. The third term tion between need, demand and desire: need Freud's life time (1938) he already indicates a spectively. Lcvi-Strauss's work on kinship in this schema is the Real : it is that which has an object, but desire does not have any. I project of revising the role of family com- structures showed him how the inter-subjec- slips through the net of language, resists need something, but as soon as I put it in plexes in the socio-cultural formation of the tive network in a society operates under laws symbolisation. That the perceived wholeness words or any other form of language I always individual. Thereafter he consistently questions that are ordered like language; how, moreo- of the "I" is a misrecognition, is the radical demand of someone something 'more' than the ontological basis of such Freudian things ver, a subject is hardly immanent but is always basis on which Lacan's notion of the subject what I need. The word can never match the as id, ego or super-ego, of need, instinct and given in a structure of relationships. Lacan stands and announces his total rejection of need, and what is more, words have already desire, or of castration, phallus etc. claiming 'returns to Freud' a little earlier but almost those Freudians who fail to make a distinction existed before me and formed their own mes- that they are phenomena which occur within simultaneously with Althusser's return to between the ego and the subject and reduce sages to some extent, they are not entirely

86 87 SAMlKSA SAMlKSA BOOK REVIEWS BOOK REVIEWS

neutral things to be used by me. In this gap thought and summary of the main argument. THE BABY AND THE BATH WATER. BY NINA COLTART. International Universities Press, Inc., between need and demand, desire is bom. The second section gives a map of the text Madison, CT 06443, pp.172, $35. Desire is as crucial to Lacan as libido or Eros just to help the reader find his/her path through is to Freud. the maze of formulations which of necessity Nina Coltart does not write like other psycho- partial protection the perversion gave, never- often gives the impression that things are left The authors have taken enough care to point analysts. There's an easy vigour and theless left him vulnerable and frightened. out. The third contains annotations to the text isn't-the-sun-shining air around her writing Much of his anxiety centred around the self- out Lacan's indebtedness to Hegel and the role where, apart from explanations of terms and Alexandre Kojeve's lectures on Hegel (1933- which are deceptive : they may mask the sen- imposed task of having to choose between his phrases the authors try to disentangle the daz- sitivity, conviction and skill which make her foster mother and real mother. Choosing ci- 1939) played in his formulations about desire. zling tapestry of references and allusions that It was Kojeve who illuminated passages from work and her description of it so special. ther was linked with terrible fear and guilt. Lacan's wide erudition has come to weave. Collurt's unravelling of the layers of meaning Hegel for Lacan where the German philoso- The essays here broadly cover the range of Much that is there has been better elucidated of the perversion is masterly. The patient tried pher investigates desire in relation to what has occupied her most in her chosen since and much is left for commentary but to deal with the problem by creating in fan- self-consciousness of man. Hegel argues that profession. "Ever since early childhood," Muller and Richardson do not fail to make tasy a third ideal object who incorporated all for the "I" to experience itself as self-con- use of whatever data was available at that Coltart recalls, "I could think of nothing that sciousness, the non-1 toward which its desire the good points in his mother and in his ana- point. The most useful thing in their painstak- gave me more intense enjoyment than listen- lyst and who was unaffected by his own is directed must be another self-consciousness, ing work is the attempt to link Lacan not only ing to people telling me their stories." But she i.e. another desire. Thus for Lacan desire is badness. In the ultimate analysis, the perver- to the lineage of structuralist thought and the is modest. Clearly any pleasure she gets out sion was a defence against castration anxiety. human only when it is a desire for the other's interrogation of the Enlightenment as conven- of psychotherapy owes much also to her ca- desire. In his writings the 'other' is a constant The hopelessness of his anger for the bad tion decrees but to the contemporary currents pacity to observe, to "listen with the third ear" mother object emerged in the transferential theme, denoted either by small 'a' or by capi- of psychoanalytical thought and other impor- and, ultimately, to strive to help her patients tal 'A' as the case may be ('a' standing for the need to also hold on, however bad the mother tant currents in French philosophical discourse overcome their suffering. was, for she was also his only source of hope. French 'autre'). The Hegelian connection of like existentialist phenomenology At crucial "The Man with Two Mothers," the first Lacan has recently been the subject of a se- points they have located Lacan's kinship with paper she ever wrote, is an account of a mid- A postscript added by Coltart in 1995 ac- ries of highly exciting investigations by the modernist artistic revolutions to which Paris dle-aged school teacher's active knowledged and accepted the 'limited gains' Slovenian philosopher Slavoi • Zizek (cf. his played the most generous host in the first four sado-masochistic perversion and the historic of the therapy. The patient had given up his The Sublime Object of Desire and Tarrying decades of this century. But most importantly factors, which re-emerged in the transference, perversion and had made significant strides With The Negative). Similarly inspiring work they have always kept us in focus on the which made the perversion a vital 'protector'. on the work front but he was unable to lead a on the broad semiotic implications of desire polemical coordinates of Lacan's writings, that The patient was the only child of two middle- normal sexual life or have a family, drawbacks has been produced by American scholars like they are often offered as repartees, interjec- class teachers who had married only because which he accepted with grace. Joan Conjee (cf. her Read My Desire). tions and correctives. Without an the woman was pregnant and who separated understanding of the very powerful refusal to "Why I Am Here" is a convincing reaffir- immediately after the son was born. When a Muller and Richardson devote a chapter understand what Lacan was saying, the initial mation of the many reasons which made month old, he was fostered to a loving, child- each to the nine essays of Ecrits and divide protracted resistance among the analytical Coltart choose to be a psychotherapist. Per- less couple but he continued to see his real them into three sections. In the first of these community to his thought and practice one sonal factors aside, she highlights the curiosity parents for a month each year until adoles- they present an overview of the context of the cannot prepare a useful approach to him. about other people which is an abiding char- cence. He was relatively 'normal' from the essay, its general significance in Lacanian acteristic of psychoanalysts. This curiosity is age of ten when he had a psychotic break- attributed to an "unworked through trauma" down, till he was thirty-six, year after his loved which is then used as a source of strength. foster father died. Moinak Biswas She is also one of the few analysts to have Senior Lecturer The perversion was a complex, violence- considered head on the frequent clashes among Department of Film Studies filled masturbatory ritual enacted with a girl analysts, ostensibly on theoretical biases. As Jadavpur University with whom he had no other link. Coltart quotes one who is comparatively new in this profes- Calcutta sion, I have often felt uneasy with the venom India Glover (1933): "Certain perversions are the negative of certain psychotic formations and and the need to exclude which persist in the help to patch over the flaws in the develop- guise of 'professional differences'. Is it unrea- ment of a reality sense" to then show that the sonable to hope that analysts, who must have

88 89 SAMIKSA SAMIKSA BOOK REVIEWS BOOK REVIEWS tis, eczema, anorexia nervosa and ulcerative tis. The analytic treatment served primarily to greater insight than most others into paranoia make her range of insights and knowledge of colitis) are multi-causal in origin, with genes allow him to move from a state of no feeling and envy, would be better able to reach con- theory seem effortless and almost incidental. and early environment being as important as to one in which he could truly experience the sensual decisions without rancour? Coltart Her application, for example, of Winnicott's internal conflict and emotional deprivation. For rage and sadness which had been a secret part quotes Neville Symington (1993) whose ex- concept of True Self/False Self in "A Philoso- Coltart, "One of the main areas of interest, of him since he was a little boy with a dying planation for this phenomenon is that a long pher and his Mind" courageously reveals the from the beginning, was the making of a clear mother. personal analysis, intrinsic to analytic train- hopelessness and helplessness which made this distinction between conversion hysteria and 'Buddhism and Psychoanalysis Revisited': ing, leaves the ego weaker and the narcissism brilliant philosopher live a life which was truly psychosomatic symptomatology. It was thought is daring because it goes beyond the antipathy stronger than they were when analysis began. unreal. "It is probably accurate to say that in that in the conversion hysterias — that is, towards religion which has traditionally been It is difficult to think of a better explanation some people extreme self consciousness ac- genuine neuroses...the body has lent itself and a hallmark of psychoanalysis. She not only for the curious amalgam in the analyst of great companies — or is even a synonym for — the its functioning to the mind to use in its serv- introduces the reader to the basic tenets of insight and depth of understanding in the ana- False Self. Furthermore, the self-conscious ice, usually to remove the self, or defend it, this religion and draws close parallels with lytic room and a childishness bordering on the mind is the creator and organiser of the False from a stress situation. In psychosomatic ill- psychoanalysis, she also does not hesitate to paranoiac outside it. Self. To be watched, ideally, in fantasy, with ness, then and now seen as more primitive state that, "It is my contention that the prac- loving admiration was such an important con- and more mysterious, the body seemed to do Today, when there are diverse and diverg- tice of psychoanalysis in harness with the dition of J's early precocity that he was its own thinking (Italics author's)... the illness, ing views on transference, it is reassuring to practice of Buddhism is not only harmonious, controllingly identified with the Watcher, and which would recur — and could be disabling be reminded that Freud said it all first, and but mutually enlightening and potentiating". in adult life he could not escape from the split to the point of death — seemed, in a way that that he is as relevant today as when he wrote and the subsequent state of mind that this "The Technique Papers" between 1911 and was at once obvious and mysterious, to be Coltart's greatest asset, to my mind, is the implies". The patient's mind was ever careful linked with the patient's personality and life gift of love. It is special because it is fun, 1915. In "Handling the Transference", a paper to never allow the experiencing of a true feel- written for students of psychotherapy in 1993, history... the body seems to be on a direct compassionate and able to reveal itself in most ing. At the same time, this mind was idealized short-cut circuit between the stress situation of what she does. Whether it is her supervi- Coltart delineates the basic aspects of trans- and relied on to impress the world and gain ference, always going back to Freud with and its pathological physical manifestation". sion of clinical work ("Something Completely its admiring 'love'. His insomnia, a symptom Different") or the way she sees death ("End- valuable guidelines on what to do to allow the for which he sought a cure, is seen to be linked Coltart skilfully uses her patient's early ings"), there is humour and understanding of transference to develop, to maintain the treat- with his use of the mind. On the surface, he history and pathologic identification with his ment alliance, and to cope with the difficulties others' and her own vulnerabilities. wanted very much to sleep. However, sleep- mother who died on him when he was nearly which occur in the transference relationship. ing was also linked with pleasing his parents. fifteen, after a long, painful and 'smelly' bout Somewhere in this book, Coltart describes She emphasises the virtues of working in an The need to not give them what they wanted with breast cancer to understand the rage and herself as an "armchair traveller". It has been atmosphere of abstinence and truthfulness and of him was clearly greater than the need to helpless grief which took "the mysterious leap both humbling and pleasurable to have briefly with a genuine desire not to exploit the vul- sleep. Sleep was, in addition, dreaded as a from the mind to the body" and became coli- accompanied her on her journey. nerable. merger with the admiring but also critical John Strachey's remark of 1934, that "only mother and the subsequent loss of self. The the transference interpretation is imitative," has equation of sleep with death, the longed for release from humiliating attacks and the ea- Mallika E. Akbar often been singled out as the definitive K 1553, Palam Vihar statement on transference cure. It has also been gerly sought reunion with a good mother was, however, what eventually proved truest for Gurgaon a source of anxiety for young analysts Haryana him. Four years on, the philosopher ended his struggling to make the 'right' interpretation. India Coltart has ably put this contentious issue in life. perspective by pointing out that Strachey had also reiterated the need for and value of extra- The study of psychosomatic illnesses has transferential interpretations to pave the way, not been extensive, as Coltart discovered when so to say, for the effective transference she began working with a patient who had interpretation. severe ulcerative colitis. Research work in the recent past has tended to show that Franz The clinical essays are classics in their Alexander's famous "Chicago Seven" (peptic genre. Coltart's superb skills in story telling ulcer, hypertension, asthma, rheumatoid arthri-

91 90 SAMIKSA SAMlKSA BOOK REVIEWS BOOK REVIEWS

both nature and nurture are involved in the THE SEED OF MADNESS : CONSTITUTION, ENVIRONMENT, AND FANTASY IN THE ORGANIZATION The author clarifies that adult schizophre- aetiology of schizophrenia and the formation OF THE PSYCHOTIC CORE, EDITED BY VAMIK D. VOLKAN AND SALMAN AKHTAR. International nia develops in individuals who carry a psychotic "seed". This is in other words, "the of a psychotic seed. An analyst should be more Universities Press, Madison, Connecticut, 1997, pp 213. infantile psychotic self. In pre-morbid state concerned about how the combination of biol- this infantile psychotic self is enveloped by a ogy and psychology create this condition The rapid growth of knowledge in biological ourselves how he developes his theme of "seed healthier self. Adult schizophrenia is initiated together. No doubt further research into in- psychiatry often pulls many of us to believe of madness" in the general framework of psy- when this encapsulated 'mad' core can no fancy will identify and loll us inure about both that we have already unravelled the secrets chodynamic theory and practice. longer be effectively controlled by the ego types of mental function potentials. of psychoses, particularly schizophrenia. The Recent researches on infants have re-em- mechanism of the healthier self. In a fully de- book under review will, I hope, wake them phasized the findings of earlier workers (e.g. The concept of the seed of madness or veloped case of schizophrenia the healthier up to the reality i.e. much is known yet much Spitz and Mahler) that, apart from infantile psychotic self as delineated in the self is replaced by a more primitive self hav- remains unknown. The book under review is psychobiological activities and potential, hu- first chapter of the book has been developed ing a primitive ego mechanism. Regression in a collection of scholarly papers about the man mind matures cohesively when and elaborated by many well-known analysts schizophrenia is the result of this replacement. depth of psychological understanding of psy- mother-child experiences function as its "in- and thinkers in the following six chapters This replacement is, however, not absolute. chotic persons. The uniqueness of the book cubator". Such interaction provides a symbolic through theoretical constructs, clinical descrip- That is why each adult with schizophrenia re- lies in the fact that it is not a reiteration of channel for the start of the self that is origi- tion and outcome of treatment by tains aspects of the healthier self. The infantile well-known concepts of psychoanalytical study nally undifferentiated. The author believes that psychoanalytical methods. psychotic self i.e. the "seed of madness" is of the psychoses and an integration of the the nature of this channel, as well as the in- formed during the early interaction of mother The last chapter of the book written by Dr. biological (genetic) and psyhological predis- gredients that pass through it determines and child or during marked regression in the Salman Akhtar (co-editor of the book) is a positions in the crucible of environment. whether the seed will be 'normal' and evolv- developmental years, caused by an unbearable conceptual follow up on ideas contained in the ing or 'mad' and fixated. In the exposition of first chapter contributed by Dr. V.D. Volkan. Some of the chapters in this book were trauma. early mother-child experience, the author uses Dr. Akhtar divided his presentation into three originally presented at the eleventh Interna- the term channel in a metaphorical sense and The formation of a seed of madness does sections viz. hereditary and constitutional fac- tional symposium for the Psychotherapy of assesses that what passes through this channel not necessarily lead to adult schizophrenia. tors; the environmental contributions and the Schizophrenia held in Washington DC, in June, includes biological determinants, psychologi- There are several outcomes of the infantile role of fantasy. While the first section forms 1994. Others were written specifically for this cal and environmental (cultural) variables. psychotic self. It may shrink and disappear as volume by prominent European and American the foundation of discussion on the biological These factors influence one another and min- the child grows. The second possibility is the (genetic) research, the other two sections are psychoanalysts having outstanding contribu- gle as they pass through the channel and appear opposite of the first. The childhood psychotic tions to the study of overt or dormant psychotic primarily based on psychodynamic formula- in the context of mother-child interactions. The seed may persist into adult life and prevent tions. He made a valiant effort at giving us an processes. The book is divided into three parts. strength and stability of such interactions make the development of mature ego functions. The integrated view of the basic dynamic concepts Part-I contains one chapter only. The first for either a smooth flow or for an incompat- person will exhibit childhood schizophrenia propounded in the book. editor of the book (Vamik D. Volkan) laid the ible mixture. In the beginning the seed of the or retarded mental development. There may ground work for the study of the seed of self is undifferentiated from the images of the be encapsulation of the infantile psychotic self Dr. Akhtar concludes that the constituents madness by a thorough exposition of the con- object (mother). Gradually it takes a shape of by the healthier self representation. When this of the psychotic core are indeed multifaceted. cept. Part-II the largest part of the book its own with separation of the self images and happens, the person exhibits a psychotic per- It takes into account the role of constitutional contains six chapters which describes the object images. After differentiation, integra- sonality organisation as an adult. The other factors, the environmental input and the dialec- theory, clinical illustrations and techniques of tion with libidinally and agressively invested two possibilities are the appearance of tran- tical play between them. Not to be overlooked management of psychotic conditions. Part-Ill self-images and representation takes place. The sient focalized bizarre behaviour and is the intrapsychic fantasy of the child as well comprises one chapter only. In this chapter self, now cohesive, is associated with more prototypical schizophrenia in adult life. as that of the parents in so far as the latter the second editor of the book (Salman Akhtar) mature ego functions. When this happens, we affects the psychic unfolding of the child. gives an erudite presentation of modem con- say that the development of the core is nor- Dr. Volkan feels the need to combine bio- cepts of biological psychiatry and makes a mal. If, however, the seed of self has not logical and psychological factors for the Treatment strategy, Dr. Akhtar emphasizes, valiant effort at relating these concepts with evolved, but remains undifferentiated and as- explanation of the aetiology of schizophrenia. must take into account these multifaceted de- the psychoanalytical constructs which is the sociated only with primitive ego mechanism, He asserts that there are no unified biological terminants of the psychotic core. To be brief, main focus of the book. we say that it is fixated as an infantile psy- theories explaining why madness occurs. treatment should be biopsychosocial, since the chotic self i.e. a "seed of madness". Along with Freud and Mahler he believes that fundamental nature of this pathology is Now, let us follow Dr. Volkan and see for

93 92 SAMlKSA SAMIKSA BOOK REVIEWS BOOK REVIEWS biopsychosocial. Pharmacologial and social This book will remind the votaries of bio- interventions therefore deserve a place of logical psychiatry, the folk tale of the blind "As I review this rich array of research, I find ers' affection and concern alone are not the importance in the treatment approach. At the men and the elephant. One should be aware thai there are questions about their relevance only corrective factors, a child's reflective self for my practice." And he accepts that the find- same time, it must be made clear that these that the great advancement of neurobiology functions have a lot to contribute in building ings "enrich" our grasp of the problems of modalities will be most helpful only when has sharpened our acuity of vision, but our "mental state constructs". science. He noticed : "Yet we all must admit psychotherapeutic help is available on an on- field of vision will remain narrow unless we The third part of the book, Outcome Stud- that there are no clean results that say this is going basis. In fact, it is the informed take into consideration the intrapsychic psy- ies, covers an account of a 30 year effort of the way to work..." He also says, "Science eclecticism coupled with the containing func- chopathology of man. The book under review the Psychotherapy Research Project of the should protect us from premature closure from tions of the analyst's countertransference that will surely rekindle new thoughts on psy- Menninger Foundation and also the San Fran- dogmatism and from zealotry." yields the best results in the treatment of the chodynamic interpretation of the origin of cisco project. A major conclusion according anguish associated with a psychotic core to psychoses. The second section, — Psychoanalysis and to Dr. Wallerstein is : "(the finding) from the the personality. Developmental Psychiatry and Psychology, (PRP) project was that structural change tra- from very important informative and interest- ditionally regarded as achieved only in insight — aiming expressive therapeutic modes..." Prof. Gouranga Banerjee ing articles, by Joy D. Osofsky, R. Peter Judy L. Kantrowitz notes that after 20 years Consultant Psychiatrist Hobson, Mary Main and Peter Fonagy. Hobson Girindrasekhar Clinic remarks, "Theoretical and empirical studies of of Boston research study the main outcome is: Calcutta - 700 009 early childhood autism and borderline person- "The impact of the patient-analyst match on India ality disorder illustrate the potential relevance the outcome of treatment may help to explain of such research in the field of developmental why some seemingly suitable patients have psychopathology." Further Osofsky emphasises unsuccessful outcomes and some seemingly unsuitable patients have favourable outcomes." RESEARCH IN PSYCHOANALYSIS : PROCESS, DEVELOPMENT, OUTCOME. EDITED BY THEODORE — "The need for a dynamic interactional Further both the Luborsky(s) have tried to give SHAPIRO & ROBERTN. EMDE. International Universities Press, Inc. 1995. pp. viii +447, $60. model in psychoanalytic theory..." And adds quoting Emde that "an affective core of self* answer to the key question on measurement of transference. They have developed a "Core Research in Psychoanalysis, edited by Shapiro Process', by Joseph Weiss — he aptly says : is necessary to provide the individual with a Conflictual Relationship Theme" (CCRT) with and Emde is a rich collection of some seri- "The research indicates that, in analysis, the sense of consistency about the other in the a lot of statistical data and tabulation. ously engaged minds of the world in this sci- patient sets the agenda and benefits from cor- environment.... She also calls attention to the entific discipline. It is divided into three parts: rective emotional experiences provided him mother's "mirroring function" by responding Whatever they have tried, seems to me like Process, Development, Outcome. The intro- when the therapist passes his test." He further to the infant with adequate emotional response. "throwing away the baby with the bath water" duction says, "as we approach the one hun- notes : "Finally, the research supports the idea Mary Main has mainly referred to the study — I believe with Bion that where one tries to dred year after the birth of psychoanalysis, we that the psychoanalytic theory of the mind and of human attachment organisation, founded measure a dynamic situation like transference take stock of our status as science." The idea therapy may be fruitfully studied by empirical upon the works of John Bowlby and Mary one is transforming a dynamic into a static of science is further specified as: "Science quantitative method." The next essay in this Ainsworth. Peter Fonagy emphasises the pa- situation and a lot of distortion is bound to get become that body of truths to be held tenta- section by Teller and Dahl, survey the psy- rental tendency to repeat their own childhood. in. But finally I do not think one can improve tively until newer hypotheses could be tested choanalytic process and researches in the He further remarks : "It is clear that while upon what Emde has said under the rubic : by accumulated empirical observations de- United States and the University of Ulm in certain individuals repeat adverse or abusive Quoting Heisenberg's principle he clearly con- signed to select among alternative theories." and conclude with a discussion on experiences with their own children, others cludes... The best that scientists can say is the difficulties and rewards that await any one are able to find a more adaptive resolution." that there is "probabilistic determinism". Re- This volume is dedicated to summarizing interested in pursuing a serious scientific in- Fonagy says that their investigation on moth- searchers are pragmatists. ilic work of some selected psychoanalytic in- vestigation into the psychoanalytic powers. vestigators and psychoanalytically informed H.Kachele and Helmut Thoma's intention can researchers who have been labouring to bring be conceptualised as : The introduction of the Dr. M. M. Trivcdi our science into parity with other scientific technologically sophisticated computer-based 2, "Sanket" Apt. clinical disciplines. analysis of the various texts opens up a wide Opp. Krutika Society In the first section of the book, the essay array of perspectives for study of the psycho- Paldi Gam on 'Empirical Studies of the Psychoanalytic analytic process. Further Shapiro observes : Ahmedabad 380 007 India

94 SAMlKSA 95 SAMIKSA FROM IV RULE 8 Statement about Ownership and other Particulars about the Journal

Place of publication The Indian Psychoanalytical Society 14, Parsibagan Lane, Calcufta-9 Periodicity Annual Printer Tarit Kumar Chatterjee Nationality Indian Address 112, Rammohan Sarani, Calcutta-9 Editor Hironmoy Ghosal Nationality Indian Address 1, Fern Place, Calcutta-700 019 Publisher Tarit Kumar Chatterjee Nationality Indian Address 112, Rammohan Sarani, Calcutta-9 The Indian Psychoanalytical Society - A Names and addresses of individuals who own the newspaper and Registered Society under the Societies partners and shareholders holding Registration Act XXI of 1860. 14, Parsibagan more than one per cent of the lane, Calcutta-9 total capital.

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Sd/ (TARIT KUMAR CHATTERJEE) Signature of Printer and Publisher of Samiksa Preud, A. (1936). The Ego and the Mechanism of Defence, London : Hogarth Press, 1937. ?reud, S. (1937a). Analysis terminable and interminable. ST.. 23. (1937b). Construction in analysis. S.E. 23. Wallerstein, R.S. (1972). The future of psychoanalytic education, ). Amcr, Psychtmiml, Assn., 21 : 561-606. Weiss, S. (1975). The effect on the transference of 'special events' occurring during psychoanalysis. Int. j. Psychoanal., bb : 69-75. Winnicott, D.W. (1960). Ego distortion in terms of true and false self. In The Maturational Processes and the Facilitating Environment. London. Hogarth Press, 1975 : 140-152. Quotations must be carefully checked for accuracy. It should be within inverted commas. Author's own emphasis in quotations must be indicated as ital mine. A brief abstract (not exceeding 200 words) must accompany each article. All accompanied works like charts, tables, figures, drawings and photographs are to be submitted in original. These should measure 22.5 x 14 cm. The editor reserves the right to alter the accompanied works (keeping its original form intact) suitable to the space available in the journal. The editor does not assume any responsibility for the opinions and statements expressed by the contributors. Articles published in the journal become the copyright of the Indian Psychoanalytical Society, and cannot be republished elsewhere either in the original or in any translated form without the permission of the Council of the Society. Every contributor will receive a copy of the issue of the journal in which his article appears along with 25 reprints of the article free of charge. The management regrets its inability to return the manuscripts of unpublished articles. Books for Review. The journal has a book review section. Two copies of each book may be sent to the Book Review Editor, Indian Psychoanalytical Society, 14, Parsibagan Lane, Calcutta-700 009.

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