On Freud's "The question of a Weltanschauung" – a world of perpetual transformation?
In this concluding chapter, I want to explore the question of whether the ideas and concepts adumbrated here, as well as their clinical applications, suggest a new and additional Weltanschauung for psychoanalysis; a world view that emphasizes constant change, evolution and growth. To be sure, the contemporary world around us is rapidly changing and it often seems like the pace of that change is itself accelerating. Psychoanalysis cannot escape the effect: as our psychoanalytic world has grown more "flat" (Friedman, 2005): there has been an infusion of new perspectives from around the world that have in short time deeply affected our theory and technique. Just as gourmet food emporia offer a wide array of global tastes, so now the analytic world is a sampling of various schools of thought ranging from conservative to cutting edge theories and practices. What does it mean to be a contemporary psychoanalyst? Recently, a colleague in another city teaching at a "contemporary" institute assigned some papers on the Oedipus Complex to a class on development and was roundly criticized for promoting "out-moded" ideas that some found disturbing. One would hope, especially in an institute that calls itself "psychoanalytic," that there would be an openness to all ideas, just as the analyst ought to have the welcome mat out for a variety of possible emotional experiences, both pleasant and painful.
In my view, a contemporary psychoanalyst is one who, as Carl Jung stated, “considers nothing human is alien to himself.” This is particularly true if the analyst is going to work with deeply troubled patients and, indeed, help neurotic patients reach the deeper regions of their suffering. Sean (Chapter 9) needed me to have the capacity and courage to dream the nightmare of the life-threatening bear in order to begin a process of transformation that helped enable him to move on with his young life. Another aspect of what I believe is central to a contemporary psychoanalyst is the capacity for reverie, dreaming (while awake and asleep) and to trust one’s unconscious as an assistant, guide and oracle in our clinical practice. It’s the Obe Wan Kenobe school of psychoanalysis: “Trust your feelings, Luke.” Far be it from me to challenge a Jedi Knight, but our emotions are often misleading and we may not have the necessary self-analytic skills to fully comprehend what our subjective experiences are telling us. I think Erikson’s concept of “disciplined subjectivity” strikes an excellent balance between wild and excessively constricted use of one’s private reactions in the clinical hour. One of the analysts I spoke with who had been supervised by Theodor Reik (Chapter 5) told me that a female patient of Reik’s entered his office and noticed that a book on the shelf was upside down. Reik interpreted that the woman was pregnant and she responded with surprise, “How did you know?” This seems like analytic folklore and also an example of un disciplined subjectivity; however, it seems true to me that as analysts mature they become more secure in using their private reactions as “an instrument of the analysis” (Freud, 1912).
Note that I have referred to Carl Jung, Theodor Reik, and Freud (and Obe Wan Kenobi!) in answer to the question of “what does it mean to be a contemporary psychoanalyst?” In addition to being open to a wide variety of evoked affects from our patients and the capacity for dreaming and reverie, I strongly believe that a contemporary analyst ought to have a grounding in the sweep of analytic history – the development of its ideas and the important figures. I find it sad that analytic candidates would be dismissive of some conversation about the Oedipus Complex and apparently lack the curiosity about what Freud was attempting to understand. Since studying Bion’s (1965) theory of transformations, my interest in the development of psychoanalytic thought has been enhanced by his statement that
The theory of transformations is intended to illuminate a chain of phenomena in which the understanding of one link, or aspect of it, helps in the understanding of others.
(p. 34)
For example, we may trace the roots of analytic field theory to Kurt Lewin’s work in Gestalt Psychology in Germany ↔ to England in WWII where Rickman and Bion blended Klein’s ideas of unconscious phantasy and Trotter’s (1916) observations about the “herd instinct” to form modern group theory ↔ to Uruguay where the Barangers formulated the concept of the shared unconscious fantasy of the couple ↔ to Italy for Ferro and Civitarese to impregnate the Barangers’ work with Bion’s theories of transformations and dreaming ↔ to American elaborations (Cassorla and Ogden emphasizing dreaming; Brown on intersubjective analytic field). I have used the ↔ symbol in order to emphasize that each of these links is bidirectional. In the forward direction, we trace the development of field theory over the years as it was transformed from its earliest iteration in Lewin’s work to subsequent links, each one deepening our understanding of the phenomenon. However, moving in the reverse direction helps us to understand more fully the richness of the earlier link that has inseminated later ones. For example, Ogden’s clearly written papers on reverie/dreaming cannot be fully appreciated unless one knows Bion’s theory of dreaming and, conversely, familiarity with Ogden’s work helps us to understand Bion’s contributions more deeply.
I also believe that a contemporary psychoanalyst ought to have a comprehensive understanding of the unconscious and specifically of the nature of unconscious work, which I said in Chapter 1 is the “beating heart” of the analytic process. Psychoanalytic treatment occurs on two levels simultaneously: the “timelessness” of the analytic process that unfolds slowly, seemingly at its own pace, and the parallel unconscious work that is instantaneously “dreaming the analysis” (Bion, 1992); constantly at work to give meaning to emotional experience which is subsequently reconfigured, redreamed and re-represented. This is the unceasing work of alpha function, the “engine of transformations” (Chapter 3), that like a busy newsroom is sifting through a constant inflow of data, writing and rewriting the news in a never-ending effort to find meaning in an ever-developing story.
These thoughts bring a memory to mind of doing the research for my dissertation and the excitement I experienced at being able to have the university computer available for the required statistical analyses. It was a huge behemoth of a machine for which one had to create data cards that were fed into its mouth, followed by a long process of metallic gurgling that finally yielded many pages of a printout. A dozen or so years later my latency age daughter and I built our first desktop computer with the assistance of a more knowledgeable friend; a bulky and noisy contraption that seemed to take hours to get online via a dialup connection and then there was little of interest to access. Now my Lilliputian cell phone is gigantic in its capacity to connect to nearly endless sources of information in mere microseconds. These associations to the ease and rapid flow of information at one’s fingertips underscore a theme that has been central to the psychoanalytic Weltanschauung I have suggested in this book: the incredible capacity of the mind to process emotional data and to create intricately fascinating ways of representing these emotions in the fraction of a second. Another component of this viewpoint is a sense of humility in the face of recognizing the incredible output of one’s mind: how alpha function working hand in hand with condensation creates an endless parade of dreams, reveries, characters, quips, etc., that represent the varied emotional currents of a particular situation.
In the last chapter of New Introductory Lectures on Psycho-Analysis, Freud (1933) raised the question of whether psychoanalysis offered a new Weltanschauung, or world view, in addition to existing perspectives, such as those promoted by religion and philosophy. Although he might have mentioned just a few of the ways in which his work profoundly altered established beliefs, instead he simply said that psychoanalysis was one of the sciences and therefore was devoted to “the truth and the rejection of illusions” (p. 182). Freud was especially critical of approaches that he regarded as illusory or based on intuition and in contrast stated that science is limited to
what is at the moment knowable and by its sharp rejection of certain elements that are alien to it . . . [and contains] no knowledge derived from revelation, intuition or divination.
(1933, p. 159) [italics added]
It strikes me that Freud’s insistence that psychoanalysis was a science contributed to his vitriol toward religion and also was a reflection of his “limited attitude to illusion” (Blass, 2004, p. 619); indeed, so much of what is dealt with in analysis is illusory and ephemeral and so his outright rejection of “revelation, intuition and divination” remains puzzling. However, in my view the acceptance and clinical utility of the analyst’s reveries, intuitions and oneiric experiences lies at the center of contemporary psychoanalytic theory and technique. As mentioned previously, there are two analytic concepts that I (Brown, 2009b) find capture this current point of view: Erikson’s (1964) notion of “disciplined subjectivity” and Bion’s idea of “speculative imagination” (1997b), two concepts that speak for themselves. Put another way, the contemporary psychoanalyst must have the capacity to reside in a place between illusion and the truth, fully understanding that sometimes we need a lie to help us begin to bear the truth.
A recent article in the New York Times (Schrope, 2015) contains within it some further elements of what I consider a contemporary psychoanalytic perspective. One of the world’s oldest books is an eleventh-century book of prayers written on pages of animal skin in Syriac, an ancient dialect of Aramaic in which many early Christian books were written. It was discovered that the text was a palimpsest that covered over an undertext that had been scraped away to “recycle” the pages on which the prayers were later written; however, through the application of spectral imaging the hidden text was revealed. That undertext, likely written in the ninth century in Syriac was itself a copy of the first Syriac translation in the sixth century of Galen’s classic medical text, On the Mixtures and Powers of Simple Drugs, which he wrote in the second century in Greek. That first (sixth century) translation from the Greek by a Syriac physician and priest was exceedingly tedious because “ He had to create vocabulary to find Syriac words to correspond to this Greek medical vocabulary” (Schrope, 2015) [italics added]. Thus, Galen’s original second-century text written in Greek underwent many subsequent transformations: a sixth-century translation into Syriac, the creation of new Syriac vocabulary words for some original concepts, a ninth-century retranslation into Syriac and its final form as a prayer book. In addition,
As texts went through multiple rounds of copying, they underwent significant changes.
A scribe might remove parts that seemed unimportant or add material based on new knowledge.
(Schrope, 2015)
In this regard, the “Galen Palimpsest” (the Syriac prayer book that contained the translation of Galen’s book) was “ much further removed from the original ” (Schrope, 2015) [italics added] Greek manuscript.
This example may be viewed through several alternating analytic lenses, none of which is more “correct” than the other. The first is a traditional psychoanalytic model in which the discovery of the undertext of Galen’s book in the eleventh-century hymnal is analogous to making the unconscious conscious: a submerged (repressed) “truth” is unearthed. A second vertex is a model of the analyst’s role in the process of revealing this hidden truth, just as the scribes altered the texts, in which there are “fingerprints” of the analyst’s personality affecting what is discovered. A third lens is inventing a vocabulary for what is unknown (i.e., representing): that just as the original translators of Galen’s work had to invent new Syriac words to give meaning to some Greek concepts, so there are experiences that affect the analyst and analysand for which they do not have words, e.g., Mr. 72’s absorption into a black hole (Chapter 9). A final perspective is the theory of transformations (Bion, 1965; Chapter 4) that asserts understanding one link of a chain of phenomena helps in the understanding of other links in that sequence. The beginning of this linkage may fade as further connections are created, yet there is an origin, O, that is often unknown, like the hypothetical East African woman, Lucy, from whom we have all descended. Similarly, the process of transformation from Galen’s original Greek to the eleventh-century prayer book occurred over a period of approximately 1,000 years; thus, we are speaking about an evolution that proceeded at a snail’s pace and the end point of this progression was far removed in time and meaning from the original manuscript. Thus, the Syriac edition is an approximation, that is, a representation, “much further removed from the original.” I think all four vertices are part of the armamentarium of the contemporary analyst one might deploy as needed to understand the depth of the analysand’s communications.
In retrospect, I’ve come to regard Chapter 8, “Three unconscious pathways to representing the analyst’s experience: reverie, countertransference dreams and joke-work,” as one of the central chapters in this book that captures some of the essence of how one’s mind can receive, represent/dream (in the Bionian sense) and give meaning to one’s emotional experiences almost instantaneously. In the clinical situation, I believe this is among the most important processes for the analyst to try and comprehend. Bion urged the analyst to adopt a mindset of negative capability (Mawson, 2015) in order to be maximally receptive to the manifold ways in which we are affected by our analysands. I imagine by now the reader knows how important one’s receptivity is in how I think and practice, but I have come to appreciate in recent years how these processes occur in the blink of an eye. It requires us to train ourselves to listen to ourselves, to be somewhat solipsistic regarding what is happening inside of us when listening to our patients. There’s a joke about the difference between a Kleinian and a Freudian analyst: in a Freudian analysis, the analyst could die and the analysis would continue (because the patient is used to a silent analyst); whereas in a Kleinian analysis the patient could die and the analysis would continue (because the analyst is so focused on the countertransference). Perhaps we could say that in a Bionian oriented treatment the analysis would die if the clinician’s imagination or disciplined subjectivity were brought to a halt?
This joke underscores the importance of being maximally receptive to projections coming from the patient and to the impact these have upon one’s psyche as discussed in Chapter 5, “The analyst’s receptivity: evolution of the concept and its clinical application.” In that chapter, one’s receptive stance is linked with having trust in one’s intuition that is rooted in Freud’s recommendation we keep our minds as open as possible without any predetermined agenda as to the outcome of the session. Reik adopted this attitude very seriously; however, this faith in one’s intuitive processes as an invaluable tool in the treatment fell by the wayside theoretically with the ascendancy of ego psychology (primarily in the United States) in the 1930s and 1940s, which deemed intuition as “unscientific” (Brown, 2011a; Lothane, 2006). However, it is my impression based on supervisions I have had with some analysts trained in the heyday of ego psychology that they paid great attention to their associations to the analysand’s free associations and considered these as relevant to the patient’s “material.”
I think this apparent paradox – rejecting the value of one’s intuition theoretically yet employing one’s private associations clinically – reflects the absence at the time of a sophisticated way of understanding unconscious work, which I see as the lifeblood of the analytic process. The notion of unconscious work derives from Bion’s proposal of alpha function (Chapter 3, “Bion’s discovery of alpha function: the engine of transformations”), which grew out of his elaboration of Freud’s theory of dreaming, that includes the seminal idea that we are always dreaming, while awake and asleep. Put another way, unconscious work and free associations, whether in the analyst’s or the patient’s mind, are dreams in the sense that these are in vivo transformations of affective experiences that are alive in the here-and-now of the clinical hour. Thus, when I mentioned the paradox of the previous generation of analysts diminishing the importance of intuition yet valuing their associations to the analysand’s “material,” I think this was due to the absence of a more comprehensive (Bion’s) theory of dreaming. It is my impression, and likely a controversial one, that many of the classical analysts were more at home with using their associations as a pathway to understanding the patient than some present-day clinicians who focus excessively on the factual realities of the analyst/patient interactions.
To dream in Bion’s view is to transform an emotional experience into a variety of different manifestations: a night dream, an ordinary thought, a reverie, a countertransference feeling, the “meaningless” thoughts that meander through our minds during a session, etc. He has suggested that we consider the analytic session as if it were a dream. Why? I think he was emphasizing that every element in a session has unconscious meaning and that we ought to treat each of these elements as if they were dream symbols.1 To orient one’s listening in this way underscores the potential unconscious meaning of everything that occurs in the analytic hour. To have an intuition that such-and-such is occurring at a certain point in a session is to have a dream, i.e., a waking dream thought in Bion’s parlance.
Related to Bion’s expansion of what it means to dream is his Theory of Transformations (Chapter 4: “Bion’s Transformations and Clinical Practice”), another foundational chapter of this book. It is the third of Bion’s four major books2 – notoriously the most challenging to understand – and I had put off reading it for quite a few years, fearful of getting lost in an endless labyrinth without an Ariadne’s thread to find my way back. However, I was pleasantly surprised to discover that the book was essentially clinically oriented, despite his musings about mathematics and obscure philosophical questions. His elaboration of the concept of O, the emotional essence of a session or, more generally, the thing in itself (Kant), is the critical emotional “stuff” that is transformed into a representation, i.e., a dream, reverie, free association, etc., by the activity of the patient’s and analyst’s respective alpha functions. Thus, every association of the patient and each thought that passes through our mind is the momentary endpoint of a process of transformational dreaming, which will continue from that point forward. These thoughts and associations arise from the process of unconscious work that has been quietly on-going internally as well as intersubjectively through unconscious communications between analyst and patient. Furthermore, to the extent that one’s reveries are representations (by the patient and/or the analyst) of the emotional climate in the clinical hour, these may also be regarded as potential or fully formed interpretations.3 The joke my analyst told me in the beginning of Chapter 8 came to his mind spontaneously and was a condensation of many themes active at that point in treatment. Though he offered it as casual comment, it proved to be an effective interpretation that is still with me years later.
I have been discussing the complementary bilateral movement in analytic work that is both incrementally slow, yet also astoundingly rapid; a process that occurs within the boundaries of the analytic setting (or frame). The concept of an analytic frame or setting has been central to clinical thinking from Freud’s (1912, 1913) original writings onward and in Chapter 6 (“Ruptures in the analytic setting and disturbances in the transformational field of dreams”) the focus was on the psychic coordinates of the setting as a place of mutual dreaming that transformed the emotions enlivening that setting. We also saw in that chapter a unique kind of transformation by which primitive emotional material too powerful for the analytic pair to deal with in the on-going analytic process was relegated to “non-process” (Bleger, 1967/2013) and then “stored” in the analytic setting until the patient/analyst dyad was capable of managing the powerful affects without being overwhelmed. The nature of that transformation into non-process (and then back again) remains unclear, but the analytic frame holds this primitive material that is rendered into a sort of “freeze dried” state (Brown, 2015c), perhaps analogous to what in information technology is referred to as “the cloud,” a place that is not palpable in which material that is potentially accessible is stored; however, when in the cloud (or in the setting) it is inactive. Bleger (1967/2013) was clear in warning us that when the setting is disrupted a “crack” (p. 235) may develop through which a “phantom world” (p. 230) of archaic emotions floods the analytic process as we saw in the analysis of Mr. R. in Chapter 6.
I am writing this segment about the setting/frame two days after the provocative and violent marches by neo-Nazis, KKK members and other fascist groups wreaked havoc in Charlottesville, Virginia, which underscored for me the importance of the setting in situations outside the confines of the analytic office. Suddenly, Bleger’s assertion about the release of a “phantom world” into the analytic process when the setting is disrupted took on a fresh and frightening relevance to what had happened that weekend. Freud’s (1930) observation, too, comes to mind about the thin veneer of civilization, which directly relates to the absolute necessity for a social framework to be intact in order to keep potential incursions of destructive elements from flooding the everyday rhythm of normal activity. The maintenance and enforcement of the societal setting depends on our leaders to transform behavior inimical to society by strengthening the framework; incarcerating, so to speak, the phantoms to a position in which they are neutralized in a “cloud-like” setting. Indeed, from the perspective of transformational processes, we can say that one of the responsibilities of leadership is to contain the emotions that confront the group (analytic couple, corporation, municipality, nation) and transform these into a narrative that renders the toxic affects more manageable.4 Of course, if the leadership class regards the usual framework as worthy of demolition and allows or encourages the disruptive emotions in the society to seismically rattle the political setting, then chaos will surely follow.
I hope at this point the definition of the analytic process I gave in the Introduction and discussed further in Chapter 6, which I called “quite a mouthful of psychoanalytic theory, dense and tightly woven,” is more meaningful than it was at the outset of this book:
The active here-and-now process of continuous transformations of affects arising in the intersubjective field to create new meaning, which is achieved through a perpetual, unconscious, joint process of dreaming and Nachträglichkeit (après-coup), made possible through the linked alpha functions of patient and analyst – all of which is enabled by, and depends upon, a stable analytic setting/frame.
But I cannot end here and there is one last point I wish to make and that is about the importance of maintaining what Bion (1965, 1970) calls a “binocular” view, that is for the analyst (and patient) to have the capacity to see one phenomenon from multiple perspectives. For Grotstein (2009a, 2009b), one aspect of binocular thinking is that the conscious and unconscious personalities work collaboratively, rather than in opposition as Freud stated, to create a stereoscopic perspective in one’s object relations. Grotstein’s comment about “resistance” is characteristic of his often pithy way of considering a concept through a binocular point of view:
When one considers the analysand’s utterances and behavior from the dramatic vertex, resistance as a concept and as a phenomenon seems to vanish. Put another way, the analysand is always cooperative in the analysis as long as he is attending sessions.
(Grotstein, 2009a, pp. 98–99) [italics added]
With many patients, especially those who are more disturbed, the analyst is frequently challenged by the analysand speaking in different “tongues,” each of which may organize their emotional world – and the mood of the analytic hour – through different frameworks. For example, I began in Chapter 9 by relating Mr. B.’s state of mind as governed by an autistic transformation that was dramatically and structurally different from his usual mode of experiencing himself. These sorts of situations require the analyst to be familiar with different pathways to representing emotions and varying channels of communication that are employed. My analytic work with Ms. G. demanded this sort of flexibility.
In his recent book, The New Analyst’s Guide to the Galaxy, Ferro (2017) addresses what he sees as folly in the psychoanalytic genuflection to past theories:
We’re like a family that has not emptied its closets for 200 years, that hoards as certain psychotic individuals do: hoards and hoards so that we have concepts that are part of the history of psychoanalysis, but have outlived their usefulness. For this reason, a travelling analyst is followed by twenty-four carriages full of trunks, that is no longer useful.
(p. 47)
This year, for the first time, I unexpectedly took off the entire month of August to recover from a mild concussion and some friends invited my wife and me to visit with them for a few days on Cape Cod. Upon telling my patients of my up-coming absence, one said, “Now you’re a real psychoanalyst taking all of August off; I guess you’re going to Wellfleet5 on Cape Cod.” I had to laugh and said, “Guilty as charged.” Despite the tongue-in-cheek humor in Ferro’s comment, I think he is making an important point about how often we analysts define ourselves as analysts by taking on the accoutrement of certain prescribed markers to confirm our identity and be part of the group, like a secret handshake. Ferro wisely cautions us to eschew the supposed necessity of, for example, beginning each paper by quoting Freud. Bion, on the other hand, discouraged others from identifying themselves as “Bionian” so that we might instead become our own psychoanalyst that evolves from our in-born predilections, experiences in our families and with teachers, through a process of entelechy (Grotstein, 2009b) by which we become our inner potential.
Notwithstanding Ferro’s proscriptions in the previous paragraph, I had planned to approach the topic of “staying on one’s toes” by re-looking at one of my papers (Brown, 1996) from about 20 years ago (that I had not read in many years) in which I presented the analytic treatment (four sessions a week face-to-face) of a deeply troubled woman, Ms. G., who related to me in four distinct object relational patterns that appeared at various times, even within the same session. In rereading the paper, I was surprised that I had begun with a discussion of “dual consciousness,” an idea promulgated by Breuer and Freud (1893) in Studies in Hysteria; what we today would call different organizations; each perceiving, thinking, generating meaning and cordoned off from the other. Regarding each distinct consciousness, Freud said, “their ideational content can . . . reach a more or less high degree of psychical organization” (p. 12). I commented that
Thus, Freud’s first model of the unconscious referred to relatively independent selves dedicated to the illusion that the other did not exist, with each generating its own system of meaning. When external events were ripe, the second, hysterical consciousness ascended to become the dominant self, not unlike the sudden coming to political power of a well-organized government in exile.
(p. 22)
Today I would use very different terminology to describe Ms. G.’s alternating states of mind, but 20 years ago Freud’s notion of “dual consciousness” offered a scaffolding to understand the shifting interactional patterns in the treatment. Regardless of which psychoanalytic language I brought to characterize the rapid oscillation of varying states of mind in Ms. G. and their impact on me, at the heart of what transpired between us was an experience of O – the shared feeling of instability and uncertainty making “staying on one’s toes” difficult, but necessary – that might conceivably be transformed through a variety of psychoanalytic languages (i.e., Freudian, Lacanian, Kleinian, etc.). I think Ferro’s earlier hyperbolic quote is a warning to the analyst to consciously stay fresh and jettison what one has learned because those perspectives remain available in our minds as potential frameworks by which to transform the emotional essence of the clinical situation. The capacity for binocular (or multi-ocular) vision depends on the analyst having various transformational lenses available to give meaning to the shared O conjoining patient and analyst.
In working with Ms. G., it was never clear who was coming into my office: one presentation was a mature and thoughtful Ms. G. who freely associated, understood metaphors, formed various paternal and maternal transferences; put another way, a classically “neurotic” patient who early on introspectively said, “My father made me sad and my mother made me crazy.” On other days, and sometimes within the same clinical hour, a second Ms. G. would speak of feeling “drained” or “vacuumed out” while passively telling me that she wanted to die and then refused to leave my office at the end of a session. In Ms. G.’s mind, I had turned into – i.e., been transformed into – the abandoning mother who made her “crazy,” an image of her mother with whom I felt identified when I imagined throwing her out of my office. A third interactional pattern was expressed through puzzling and bizarre bodily experiences that accompanied her wondering whether she had been sexually abused by her father. In these states, Ms. G. reported feeling that
her arms and legs were on backwards, that her hands were her father’s hands, and that she was walking around with all her body parts clanging disjointedly inside of herself.
(ibid, p. 45)
A fourth kind of interaction emerged as she came to recognize how painful separations from me had become, and that
absences made her feel like what she had heard burn patients go through when new skin is grafted: that if the bandage is removed too soon the new skin will peel off adhered to it . . . [and] that she often felt as though she had neither an inside nor an outside, that she was ‘a face on a pane of glass’. . . like the Scarecrow in the Wizard of Oz whose insides kept falling out of him.
(ibid, p. 44)
When Ms. G. spoke these words, I had a chillingly empty feeling, different from my reaction to her fear of being “vacuumed out,” her refusal to leave my office or her description of disjointed body parts inside her. I found the image of “a face on a pane of glass” evoked a particularly frightening sense of being two dimensional, without any emotional depth – like a stamp on a postcard with no address. She also refused to leave my office and was filled with blind terror; a very different emotional state than the fear of abandonment in the second version of Ms. G.
I imagine that the reader has his or her own numerous associations and theories about the nature of Ms. G.’s pathology, its connections to her mother and father, its manifestations in the transference and countertransference, hypotheses about what I might have done differently, as well as other approaches. These are important conversations to have, but I want to focus on the nature of the transformations that are occurring, keeping in mind that
The psychoanalyst’s domain is that which lies between the point where a man receives sense impressions and the point where he gives expression to the transformation that has taken place.
(Bion, 1965, p. 46; Chapter 4) [italics added]
Simply put, this “domain” refers to having an emotional experience (“receives sense impressions”) and ascribing a meaning (“gives expression to the transformation”) to that emotional experience. Implicit in Bion’s statement, but not said, is the activity by which a “sense impression” has been transformed – unconscious work/dreaming/alpha function. This accounts for the process by which the transformation is effected; there are also different kinds of transformations, and I will turn to these now in the context of Ms. G’s four patterns of interacting with me.
In my view, each of the four interactional patterns in the brief clinical vignettes with Ms. G. are illustrative of different types of transformations: rigid motion transformations, projective transformations, somatic transformations and autistic transformations. Ms. G.’s initial “neurotic” presentation was a “rigid motion transformation” in that the transference and countertransference were seeded by the repetition of seemingly actual events from her past, which in classical analysis is the repeat of the infantile neurosis in the here-and-now of the transference and the analyst’s countertransference is considered a “neurotic” reaction to the infantile aspects of that transference. This scenario assumes a relatively high level of ego functioning including the capacity for representing emotional experience (intact alpha function), metaphorical thinking and communicative projective identification.
In contrast, the “second” Ms. G.’s interaction with me is an example of a projective transformation in which experiences of herself and her analyst were greatly shaped by her use of evacuative projective identification, which left her feeling “vacuumed out.” Perceiving that she had little left inside, Ms. G. felt empty, abandoned and enraged at me as her transferential mother and planted herself in my office, refusing to leave. This evoked a tendency to enact angrily toward her (throw her out) in response to her aggressive demands to remain after the session. Thus, I had become in phantasy (hers and mine) Ms. G.’s abandoning mother and I am quite certain that she sensed my strong desire for her to leave, which surely intensified her rageful passivity. Unlike the rigid motion transformation in which reality distortions are minimal, Ms. G.’s experiences of herself and me were greatly distorted by her evacuative projective identification that left her feeling empty, forgotten and with an analyst painfully like her abandoning mother. In such a patient, the analyst’s interpretations (his transformations of what appears to be occurring) need to address the transformational process (massive projections by Ms. G.) by which the patient’s distortions are created and, similarly, the ways in which perceptions of the analysand may be misrepresented by the analyst. Addressing the patient’s misperceptions is more easily said than done since the analyst’s interpretation may be felt as the clinician’s forceful projection back into the patient of what he or she had hoped to evacuate out.
I felt completely befuddled when Ms. G. appeared in the third iteration in which she experienced herself as a collection of disjointed body parts and was relieved when she linked this to possible sexual abuse from her father. Making this assertion helped things fall “together” rather than fall “apart” and we both were calmed by having discovered the “answer”; however, a few days later Ms. G. reported a dream in which she was hooked up to an IV in the hospital and the word “Mutilator” was written on the IV bag. When relating the dream to me her thoughts became disconnected and the feeling of her body being dismembered came back. I interpreted that it was as though her dream had alerted us to a force at work within her that was mutilating her thoughts, affects and body. She remembered that her mother would threaten the family that their anger toward her would make her collapse and she would have to be sent back to the State Hospital where she had previously been admitted several times.
These sessions with Ms. G. occurred at the time when the sexual abuse scandal was breaking news in Boston and so I was unsure whether she was in fact abused by her father or perhaps it was a lie 6 that was unconsciously spun. The fact that both Ms. G. and I were relieved when she attributed falling apart to the alleged abuse from her father suggests that this possible “lie” helped organize her and calmed me. However, what I found most striking and difficult to understand was her experience of being broken apart into pieces internally. Now, 20 years later, I am not so convinced that my “mutilator” interpretation was on target: there was a transformational process occurring that oscillated between Ms. G.’s body experienced as dismembered and, only moments later, she was sufficiently integrated to communicate verbally. Bion (1965) hinted at the notion of somatic transformations but did not develop this idea; however, he had earlier (1961) speculated that understanding “proto-mental” phenomena, which are primitive states that are neither physical nor mental, could help broaden the study of physical illness. In a related way, Andre Green (2010) conceptualized a somato-psychic frontier that is a dividing point between unrepresented somatic stimuli and those stimuli that have been represented in words and this seems to be a useful perspective from which to consider what Ms. G. was experiencing. Furthermore, I find Riccardo Lombardi’s (2011, 2013) ideas about somatic phenomena to be very helpful clinically: he emphasizes the importance of addressing the patient’s relationship to her body prior to offering a relational interpretation. In retrospect, if I had a time machine to return to that point in working with Ms. G., I would have tried to stay focused on her relationship to her body and to her not having truly crossed the somato-psychic boundary rather than attempting to formulate more standard types of interpretations.
But what to make of the fourth version of Ms. G? I did not feel I was abandoning her when asking her to leave the session as was the case when I felt like tossing her out; instead, I felt protective of this fragile “face on a pane of glass.” Writing now, I think of Ms. G.’s experience as an autistic transformation (Korbivcher, 2005, 2014; Chapters 9 and 10) in which the self and affect are quite literally flattened out and the patient fears dissolving into non-existence. At the time, I had recently read Ogden’s (1989) paper on the “autistic-contiguous position” and realized her need to lean up against me, so to speak, in order to have a sense of an outer boundary that could offer depth and keep her insides from falling out of her. I said to Ms. G., “I know that there is something terrifying you right now that keeps you from leaving, something that has to do with being a ‘face on a pane of glass,’ that you or I don’t have words for.” She replied quickly and asked if I ever watched Star Trek. I said that I did and wondered why she asked and Ms. G. replied, “You know when they beam someone down to a planet or up from a planet, that the person getting beamed dissolves into something like a mist. That’s what it’s like for me to leave – that I’ll dissolve and there’d be no trace of me.”7 Ms. G. was able to leave the session after this exchange.
I use the term “staying on one’s toes” to indicate the necessary awareness of the constant unconscious work in which one’s alpha function is engaged to represent and give meaning to the emotions of the intersubjective analytic field of the moment. In addition, one must be alert to the various methods by which the emotions of the field are transformed – rigid motion, projective, somatic and autistic8 – and, depending upon which is being employed, the analyst must be ready to pivot, perhaps several times within the same session. In place of Bion’s types of transformations, I could employ Freud’s (1893/1895) idea of a “dual9 consciousness “[in which] their ideational content can . . . reach a more or less high degree of psychical organization” (p. 12) to explain the changes in Ms. G.’s interactions, which would account for much of the shifts in her perceptions of me and herself. But these are static ideas that require enrichment from Bion’s emphasis on how these perceptions change and evolve over the course of the session, and surely over the arc of an analysis. However, Bion’s types of transformations have given me a greater appreciation of what Freud was attempting to understand in his hysterical patients; simultaneously, familiarity with Freud’s concept of dual consciousness offered me a scaffolding from which to consider Bion’s transformations. This seems to me the essence of a contemporary psychoanalyst: being enriched by the past to understand the present more completely and the past more fully; that, like psychoanalysis itself, one is constantly expanding one’s horizons in the perpetual search for meaning.
1 Of course, it is impossible to analyze ev ery element in a dream, just as each segment of a session has innumerable associations that can never be fully explored.
2 Learning from Experience, 1962; Elements of Psychoanalysis, 1963; and Attention and Interpretation, 1970.
3 Discussed in greater detail in Chapter 10.
4 President Franklin Roosevelt’s timeless words about the attack on Pearl Harbor, labeling it as a “Day that will live in infamy,” and his earlier statement that “We have nothing to fear but fear itself,” are but two of many examples.
5 Wellfleet is a town on Cape Cod in Massachusetts rightly known as an August haven for Northeast Coast analysts.
6 A “lie” in the sense that Bion has discussed that serves a defensive purpose to organize and that may or may not be factually true; what he calls a Column 2 phenomenon in the Grid (see Chapter 4).
7 These anxieties of melting, vanishing, etc., are typical of Asperger’s children and adult patients with so-called autistic pockets.
8 Bion has hinted that there are additional pathways to transformation, but has left this to future generations to develop, such as Korbivcher’s (2005, 2014) idea of “autistic transformations.” I would add transformations in humor, examples of which were cited in Chapters 8 and 10 here.
9 Or in this case, “four consciousnesses.”