There is a widespread opinion that by now, over eighty years after the Freudian discovery, analysts speak such very different languages that they can hardly understand each other anymore. In inventing psychoanalysis, Freud, according to this view, somehow gave us our “natural language,” and this original language then became differentiated into as many languages as there were theoretical advances, with the result that analysts, new inhabitants of a Babel of the unconscious, can no longer understand one another. From here it is just a short step to the belief that these foreign languages have given rise to psychoanalytic populations with totally different customs. I would not wish such a fate on our discipline, nor would I want us to have to leave it up to a linguist of the future to assess what we have in common.
Although we speak different languages they are nevertheless not foreign to each other, since we share the same method of deciphering the unconscious that was established by Freud, and we use this method to deal with the sufferings and the demands of our patients. But is it then the case that we are all talking about the same thing, only with different analytic languages? Certainly, when we study the various theories that have arisen in the analytic domain since Freud, we cannot fail to observe that on many points the very same theoretical issues appear under different names. We can only wonder at the tendency to make a great fuss about discarding certain concepts when we find that they continue to exist, under a different name and in a different guise, sometimes in the very same theoretical field. If we think of the fate of certain controversial notions such as the death instinct or penis envy, which some analysts have abandoned resolutely the better to bring them back under other names, we have before us an interesting project in analytic epistemology that we might well approach from a psychoanalytic point of view!
And yet it would be doing an injustice to the majority of great psychoanalytic thinkers to suggest that they have merely reiterated the Freudian discovery, appropriating it in their own words. To do so would also represent a denial of any theoretical progress in our discipline. For there are advances, and theories that attempt to give them shape, and analysts to put them to good use in their clinical work, and also, sometimes, associations of analysts that are formed to defend these advances. When we speak of theoretical advances in the analytic domain we must acknowledge that, just as in the domain of scientific discovery, certain concepts may be abandoned for good or bad reasons, leaving as our sole guide clinical results that it can be difficult to evaluate.
Is there any other way to think of the contributions that different theories have to offer? It seems to me that what would allow for a set of psychoanalytic concepts is not so much positing a unique, immutable “truth” about the human subject; it is offering analysts who use that set as their theoretical base a field of decision. Let me explain. The analyst’s activity is one of intense decision making: whether he remains silent, intervenes, or interprets, he is at the intersection of unconscious, sometimes contradictory or paradoxical force fields to which he opens himself as he listens and as he receives into his own unconscious the material his patients address to him.
Deep inside this field of forces the analyst is anything but neutral, since he is the site of an intense effort of decision and hence of orientation. In contrast to the ordinary, well-intentioned listener, the analyst is sustained in his task by the body of theory to which he subscribes. We do not, perhaps, analyze in the same way if we are Kleinians, Kohutians, Lacanians, Winnicottians, and so forth, because the creation of certain analytic concepts marks out and delimits a certain field of decision, sometimes in a very narrowly prescriptive fashion (something for which the Kleinians, for example, have been criticized). What makes the task a bit harder is the fact that there are a number of analysts who profess loyalty to a given theoretical movement but who, when we look at their actual practice, turn out to adhere to an entirely different decision-making schema. And the issue becomes even more complex when we consider that the field of decision in which certain treatments are conducted can combine theoretical orientations, sometimes outside of our awareness.
And so we can only be very grateful to those who, like Anna Ornstein, describe their clinical practice in an effort to illustrate the field of decision in which they work. There can be no doubt that analyses proceed—and proceed successfully—with very different analysts representing very different conceptual configurations. Nevertheless, in emphasizing the field of decision as defined by each of these configurations, I want to stress the fact that a decision is judged by its consequences. In looking at the way an analysis proceeds, we can assess the consequences of the aspects of decision that governed the analyst’s efforts: How far could the treatment advance within this field of decision; or, if we have reached an impasse, might another field of decision have been more effective? And so forth.
Defining the essential mechanism of the change that we can expect from treatment, and locating herself in the tradition of Kohut, Dr. Ornstein emphasizes the need for the patient to feel profoundly and nonjudgmentally understood. Now no one would deny that a patient has a need to feel understood by his analyst; the problem is that feeling understood can be something of a paradoxical process. It is quite difficult to know how a patient feels understood when we do not rely only on the manifest content of what he says, since the patient may wish to please his analyst to the point of asserting full agreement with him. Is this compliant submission or genuine agreement?
Without pushing the paradox too far, we must keep in mind that certain patients may also resort to a hostile transference in order to provoke the analyst into verbalizing a limit to the violence that courses through them without their recognizing its origin. Through this type of transference they call on the analyst to utter the words that they were too defenseless to muster in their childhood in the face of what they experienced as a destructive bond forced on them by a parent (Searles 1986). Occasionally such patients will wait until the end of their analysis (or even until long after that) before they can risk acknowledging that they were understood by the analyst. It can certainly be narcissistically trying for an analyst (especially before his colleagues) to put up with being a figure, or rather a place, to which nothing but criticism is directed. And yet….
Now you may well reply that there are signs by which the analyst can be confirmed in his feeling that he is conducting the treatment properly, even though the patient claims the opposite, but then again how deeply worried an analyst can become if he is not covered with an armor of paranoiac convictions! ls it useful to consider that, if a given patient cannot part with this symptom made up of complaints and reproaches, he is not analyzable or analysis will not help?
There are in fact some patients—not typical, perhaps, at the border of analyzability, no doubt, but can we forget them in a conference on borderline conditions?—who are unable to live unless they surround themselves with a solid carapace of suffering that they cannot relinquish too quickly without danger. (Incidentally, we might do well to ask ourselves what “suffering” means in such cases.) A subject consults an analyst because he is suffering, surely, but note that his suffering allows him to say “I” in the phrase “I’m suffering,” and therefore he is not the mere plaything of his unconscious determinants. With this “I” he breaks through the alienating discourse that traverses him. Other patients are unable to say what they are suffering from: they cannot represent their suffering. When a patient says “I’m suffering” from this or that, he is stating that he seeks to enter upon the path of representation of the cause of his suffering so that he will no longer have to be its passive instrument. This desire is the foundation of any treatment. Following Lacan, we use the term jouissance for what stands outside of representation—for example pain in its raw state that has not been able to become a suffering expressed by a complaint that “I” am suffering. This jouissance, referring to what is outside the system of representation, belongs to the category that Lacan calls the Real, which is distinct from the reality in which we live, the reality made up of words, images, narratives. At most we can say that jouissance refers to what has no form, since a form is a minimal organization.
The fact that we are endowed with the capacity for language, that our cerebral functioning increases through connections to other people, shows that we have a need, one that is as vital as breathing and eating, to superimpose onto this Real a grid of images and of words, the Imaginary and the Symbolic. For Lacan, the grid of the Imaginary and the Symbolic is tied to the Real in order to make livable the relation we maintain to our reality as sexually differentiated, separate, and mortal individuals. What is at stake in any treatment is reweaving the gaps in this symbolic grid. Lacan conceptualized the relationship of the Imaginary, the Symbolic, and the Real in terms of the Borromean knot, which consists of three rings interlaced in such a way that if one of them is broken the other two will come apart. He thereby tried to express, without a priori assumptions, the extraordinary diversity of the ways in which a subject reconnects with his foundational signifiers, and these distinctions are of essential interest to anyone concerned with the processes that are at play in a psychoanalytic treatment. If Lacan (1964) also said that the unconscious is structured like a language, this in no way implies that our everyday language is that of the unconscious, but rather that the unconscious is organized by signifying elements that the analyst can try to decipher.
Several authors, in particular Piera Aulagnier (1975), have attempted to set forth a theory of different stages of the elaboration of this unconscious language that organizes the tensions affecting the psyche, a process in which the Imaginary, the Symbolic, and the Real become linked. To envision this more concretely, consider the ordinary night terrors of a small child who sees, as if it were real, a man in his room who threatens him when the light is turned off. The child is so frightened that he fears impending death. That the man turns out to be his father has no bearing on the status of this apparition. Our interpretation should not focus on the oedipal imaginary without taking into account the fact that although, to be sure, the child hallucinated a “father,” this was a “Real” father, part of whose import remained without symbolic meaning for the child but was brought to him by a hallucination in the imaginary register along with the affect of terror. Seeking out the elements pertaining to the Real enables us to separate it out, in our handling of the transference, from what is based on the Imaginary or the Symbolic. This is the only way to conceptualize the resolution of the trauma by trying not to replicate it and thereby to perpetuate its activity in the unconscious.
We can easily imagine how, in the huge task that awaits him at the beginning of his life, the human child meets up with obstacles that are a function of his parents’ unconscious representations, representations that concern various elements essential for his individuation. A paradox of the human condition, the language the child hears from birth on, even before he can understand its meaning, conveys—in what is unsaid as well as in what is said—the best and the worst, the possibility of naming the world and the encounter with the unnamable, the possibility of a representation and its destruction. There can be no doubt that the way in which a child undertakes his task of individuation involves violence, since every child, in order to exist, must make his own what has been given to him, and he does not do so through some innate malice as Melanie Klein has suggested. If this necessary violence comes up against massive prohibitions, the child is then inhabited by the history of his family without being able to get hold of himself, see himself, represent himself in this torrent of meanings in which he is assigned a place that is sometimes impossible to live in. Isn’t this the case with Dr. White? We can therefore better understand why it is that representing oneself as suffering can be a true breakthrough in what has stood outside of representation.
It can also happen sometimes that treating a patient compels the analyst to adopt a certain violence, the violence that must be exerted against Thanatos, the antilife forces that lurk inside each of us and that can become fixed within the unconscious representations of our parents’ murderous desires. It is for the analyst to discover, in and through the transference, the multiple strata of the self. Dr. Ornstein speaks of early traumas and the failure of caretaker responsiveness. According to self psychology, the people around the child must maintain an empathic stance towards him, one that will differ according to his age and will therefore be more or less adequate and appropriate. Kohut’s theory of the development of the self also has the clinical aim of restoring to the subject the means by which he can reconstitute a self that is more cohesive, more flexible, better able to face the rejections and disappointments encountered in everyday life. But doesn’t this view place too little emphasis on what the child does with this environment that is or is not empathic and appropriate, is or is not good enough, the environment with which he will struggle with his resources, the signifiers and the ideals of those close to him (and those less close), which will give him the chance to take hold of life? Analysis, as Freud said, is not a therapy of love aimed at repairing the damage each of us has undergone in this area, but rather a treatment uniquely specific to the human subject who, because he speaks, has the opportunity throughout his entire life to try to symbolize the elements of the Real in his history that were unsymbolized at an earlier time.
Let us look at Dr. Ornstein’s case to see how this theory allows for the exploration and the reconstruction of the self in the course of treatment, but with the question in mind of whether the scope of the theory is not limited by definition. Is it possible to separate the domain of narcissism from the rest of the formations of the unconscious without running into major theoretical and clinical difficulties? Is it right to think that there could exist in the human psyche nonconflictual areas that guide the practice of the transference? And, finally, doesn’t the issue of the self refer in a restrictive manner to a fundamental, much larger issue that Freud (before he abandoned the term) called self preservation, and that Lacan left unexplored when he merely indicated the conditions for the linkage of the Real, the Symbolic, and the Imaginary with no further commentary? This is an issue that haunts psychoanalysis. In short, doesn’t self psychology lead the analyst to guide the treatment in such a way as to repair developmental damage by supplying the empathy the patient lacked, in so doing avoiding the necessary and sometimes risky confrontation with conflicts that can be unpleasant, disagreeable, or disturbing to each of the protagonists?
Dr. Ornstein shows in a very striking way how her patient, Dr. White, constructed a solid wall against his emotions; even his anorexia was a way of treating himself with the same indifferent harshness shown by his father, an unconscious accomplice to the mother’s mistreatment of her son. It is remarkable to see how this patient exactly reproduced, in his anorexia, his father’s behavior towards him (prohibition against going into the kitchen, maniacal attention to the amount of food ingested, the special value placed on excessive physical activity), so that we may wonder whether this anorexia comes under the heading of the type of sadomasochistic behavior that the analyst emphasizes in other contexts. The fact that the patient retained an undistorted body image, that he knew he was dangerously thin, would support this conjecture. In true anorexia the body image is most often completely unreal if not unrealistic; patients in the full throes of their anorexia do not perceive themselves as thin, but on the contrary they ceaselessly try to effect the real castration of their body that their image never satisfies.
In the history of patients presenting in adulthood with sadomasochistic behaviors, it has been observed (Enriquez 1984, Stoller 1975) that they had a parent who, because of an illness of the child’s, was passionately attached to a part of the child’s body. This strange investment of one part of the body at the expense of the rest of the child’s identity, a part often associated with the idealization of a stoic heroism imposed on the child, had, in the case of Dr. White, the result of silencing every expression of the child’s suffering. It led him to idealize, in imitation, the annulment of all his legitimate experiences of refusal, of rage, of revolt. From that time on he had no way of symbolizing his illness and his pain in a mode of suffering that could potentially be recognized by an other, even if it could not be shared in reality.
The consequences of denying the rage that such a child can rightfully feel extend to every affect that poses a danger to the narcissistic equilibrium constructed with such difficulty. Isn’t this what is going on with Dr. White? He must have felt doubly abandoned: he lost his father as a witness against the abuse inflicted by the mother and he lost “a” father when the latter proved to be a torturer in his own right. He had no choice but to treat himself with the same—and even more—severity if he were to retain any sort of bond with “a” father who would protect him against the even greater threat of the loss of bodily boundaries. This is the paradoxical function of the symptom, what Freud called a compromise formation and Lacan the sole means of access to the Real. Dr. White’s symptoms represent the Real of the father (his traumatic and senseless role) behind the imaginary, grotesque, and torturing father, so that in spite of everything, the patient could give himself a phallic limit in the face of a threat of disintegration that was even greater. When one part of the body attracts all the erotized attention of a parent while the rest of the child’s expectations are left unheeded, the child experiences this as a deep contempt for his feelings and a complete absence of meaningful connection with others. If later on a masochistic perversion develops, it represents an attempt both to master and to reverse, through erotization, the suffering that has been denied. This scenario takes the place of the lost suffering (Khan 1979).
In what we are told of Dr. White, however, no distinction seems to have been formulated between sadomasochistic behavior and a corresponding fantasy. It makes an essential difference, both in understanding what the patient says and in handling the transference, whether we approach the problematics of a subject through fantasy or through what led him to adopt a given behavior. If we speak in terms of sadomasochistic behavior, we are in the register of an identification, indeed an imitation, which does not take into account the fact that the entire reality of these behaviors is motivated and determined by the elaboration of fantasies whose purpose is to protect the subject from madness, from non-sense, from the loss of bodily boundaries.
This difference in approach to the conduct of an analysis is fundamental enough to warrant our stopping to look at it more closely. The term “behavior” refers to a way of acting that, as we observe in the analysis of Dr. White, may be borrowed from the behavior of an other (his father or mother), reducing it to being merely a bit of inert matter into which the wishes of an other are stamped and which is then replicated in an entirely passive manner. The Freudian discovery has surely taught us that the human subject must surrender to the omnipotence of words, the words, spoken and unspoken, conscious and unconscious, of the others who receive us into the world, words that we apprehend before we understand them, in such a way that Lacan was able to say that we are spoken by these signifiers of desire that come to us from a place that seems external to us and is yet deeply ours. If the human subject were the pure reflection of the omnipotence of words, nothing would be his own; he would be merely a machine proceeding in a straight line, as Freud said, in the shortest path towards his death. Through his life instinct every subject resists this course, taking hold of the elements that program him and arranging them in the stable forms we know as fantasies. Isn’t the narcissistic retreat behind a “wall” against emotions, which seemed to keep Dr. White safe, a rampart in the battle against affects that were too dangerous—a threat that also extended to his space for fantasies and language?
In speaking of a subject, when we locate ourselves in a theoretical context that takes fantasy elaboration into account (and in so doing we are following Freud as well as Lacan), we are setting out to explain the activity of every subject who must deal with trauma. No individual is exclusively a passive victim in the face of even the most major traumas. He is also an agent of his own survival, in that he makes use of a variety of fantasies that enable him to safeguard his subjective integrity and his integrity as some one of a given sex. Suffering is put into words in the language of these sin gular images that are fantasies. Actively constructing fantasies is one of the ways in which the human subject is able to articulate his traumas in language, traumas that are sometimes unspeakable, sometimes inevitable and inherent in the human condition that forces us to be monosexual, mortal, and abandoned to loneliness. It is a lengthy task to reveal, in the course of an analysis, the most archaic of these fantasies, since they are sometimes buried like a treasure in the wall of narcissistic defenses. Bringing them to light enables the patient to take up once again the path of fantasmatic elaborations that had gotten stuck around fragile archaic fantasies in which the subject was partially confused with an other and hence threatened in his identity, his uniqueness. But bringing them to light also involves interrogating the non-symbolized Real that produced them and to which they bear witness and give access.
Dr. Ornstein’s interpretation of her patient’s feel-sorry-for-me behavior enabled her to separate out, and hence to detach from the patient, a set of signifiers that was strictly determinative of his relations with others who could serve as transference objects. This behavior is common to many patients who state that they never succeed in communicating their suffering as well as they would wish to. These patients, always greedy and dissatisfied, demand that the analyst share their psychic life closely. For a long time, the time it takes for this type of transference to unfold, they are not aware that they have a need to show their suffering in a passive and accusatory way. It is interesting to see how the transition takes place, in the treatment of Dr. White, from the position in which the patient, confined in the reiteration of his utterances, can only show and hence merely demonstrate without genuine communication what he knows, to an entirely different position in which his suffering becomes his own. In isolating a feel-sorry-for-me complex, Dr. White’s analyst made it possible for him to recognize himself in a kind of potential fantasy and thus to gather together the fragments of this fantasy that had been scattered in all his behaviors.
At the same time as he gave up his greedy and accusatory demands, Dr. White explored with his analyst the various configurations of the feel-sorry-for-me behavior, all the subjective positions concealed by this set of signifiers, until finally the poem about how no one is able to understand the depth of another person’s suffering enabled him to represent for himself what he could now risk letting go of: the illusion of needing to be merged with someone else in order to be understood. Dr. White could allow himself to give up an illusion of completeness in order to achieve, on the symbolic level, another form of wholeness. What was at stake in his analysis was the possibility of representing himself as being understood by an other and of accepting the loss of the illusory register in which he wanted to be totally confused with an other in the hope of being totally understood. In such cases the analyst, too, runs the risk of getting lost in an imaginary (and omnipotent) transference in which he seeks to meet all of his patient’s expectations.
What happens to the concept of the self when the processes at work in the patient are derived from splits or even from fragmentations of identity? For when it is said that, because of the indirect way in which he expressed his sadism, Dr. White was rejected by those whose accepting responses he most needed, aren’t we dealing with the Kleinian concept of projective identification? The issue which then arises is knowing how the concept of the self does or does not allow us to take splitting into account (is the Kleinian concept brought in under the table?) and knowing how “the development of the self” does or does not presuppose the reduction of the splits in the guise of the concept of integration. These are not just academic distinctions. What is it that is split and fragmented? The fundamental problem in the treatment of these patients must then be knowing how these different parts speak and how to bring them together, to integrate them, since we are told that the treatment gives new impetus to movements towards the integration of the self. When Dr. White feared that his wife might see him “feeling good” because, as he put it, “presenting myself as a failure is the best way to communicate my despair,” should we, with Dr. Ornstein, take this literally? Or would we instead do better to think that he feared leaving this theater of unhappiness in which he had taken refuge, and in which he continued to bring onstage the father who had abused him?
The very term communication used by Dr. Ornstein and her patient is perhaps problematic and subject to misunderstandings. This was the case when we found communication and projection assimilated to one another, and it is even more true when we are in the presence of actors on the psychic stage who are unaware of each other’s existence. Can we really speak of direct communication, complete unto itself, when we hear in the utterances of certain patients a dialogue of identity fragments that are lost among several generations and that address one another? Let me explain. Searles (1986) describes how borderline patients evoke countertransferential feelings of rage or destructive envy in the analyst to the extent that they themselves did not feel entitled to experience these feelings in childhood, or perhaps because they were not even able to create a space within themselves in which to accommodate these affects that could undo their fragile narcissistic equilibrium. The analyst, then, must accommodate within himself the slow process of giving these excluded affects form in words and representations, and he must provoke, often by a kind of detour into angry countertransferential acting out, the patient’s recognition of the intensity of his own inner life. These kinds of affects can sometimes originate with a parent who has no means of representing them, and who transmits to the child the burden of keeping the affect alive—to the child’s detriment, of course, since the parent is transmitting only his jouissance.
To be sure, different modalities of transferential enactment may indicate intersections and differences among various theoretical fields of decision. Doesn’t receiving into oneself affects and representations that are, as Winnicott would say, still formless amount to serving the patient as a transferential selfobject, which, according to Kohut (1984) involves essential communication between analyst and patient? Once again we encounter a problem with regard to the concept of the selfobject and what it entails. Whereas Searles, in a manner that seems to be unique to him, tries to conceptualize the way in which excluded or forbidden representations can emerge in the transference, the notion of the selfobject transference in its diverse manifestations (reflecting damaged ambitions, ideals, or skills) involves privileging the aspect of reparation in a way that restricts the scope of the transference. Although an analyst has no choice but to sustain the type of imaginary transference chosen by the patient, among which the mirror and idealizing transferences are just a few aspects among many, does this mean that he must believe that each area of imaginary transference completely sums up the patient’s expectations? As Lacan and others have emphasized, the reparative aim is not absent from the analyst’s intentions, but reparation does not occur only in the synchronic dimension of the here-and-now of the imaginary transference; it comes about chiefly through the process of discerning the ways in which the different registers of the Real, the Symbolic, and the Imaginary are connected.
One of the most fundamental problems separating different schools of psychoanalysis is the way in which the role of the generations is theorized. Conceptualizing it in the three registers of the Real, the Symbolic, and the Imaginary obliges us not to restrict ourselves to only one of these registers, which is something that always occurs in our theories when we ignore one of them and especially that of the Real. The Real, the site of traumatic chaos that escapes representation and meaning, bears witness to a defect in the symbolic transmission to which the so-called paternal function summons every man and every woman.
In what place was Dr. White put by his father? What unspoken question did he have to formulate for himself, in his father’s place, towards what was addressed to him by another generation? I’m reminded of a patient, severely abused by her mother, who caught herself repeating inwardly “Forgive me! Forgive me!” We might think that she was addressing her mother, but the analysis uncovered a much more complex situation: the repeated “Forgive me!” was in fact directed to her maternal grandmother. The abuse my patient’s mother inflicted on her was intended, in this woman’s unconscious scenario, to prove to her own mother that there was a child who was worse than she was. In choosing her daughter to be this “bad” child, she exculpated herself in her mother’s eyes. “Bad” by definition, my patient was always unsatisfactory; she had to devote her own life to relieving her mother of guilt, and in so doing she took upon herself all the evil in the world. Very early on, a child feels the need to relieve the caretaking parent of the unbearable part of that parent’s psyche, and to his own very great disadvantage he dedicates himself to keeping that part active. The unconscious begging for forgiveness that her mother could not allow herself to formulate on her own behalf, lest she collapse, was uttered by my patient, who one day hallucinated the presence of her mother in my office. Thanks to the transference, an element of the Real of my patient’s mother began to enter into a linguistic process and to take on meaning. We can see here how the model that each of us uses to conceptualize the relationship among the generations has a direct influence on the conduct of the treatment.
In his concern not to confine the patient to an exclusively oedipal mode of relationship, in which everything reflects defenses against incestuous wishes, Kohut nevertheless does not really manage to get outside of the exclusively dual mother–child or father–child relation, and this restriction leads him to privilege, in the transference, a mode of imaginary reparation the failure of which is necessarily linked to the analyst’s lack of empathy. But to the extent that every subject is at the crossroads of a more archaic history, traversed by meanings and significations that he is not always able to conceptualize, the symbolic function is what each of us can reappropriate in order to put a stop to that which causes us to act without our knowledge. Dr. Ornstein has clearly shown how Dr. White was traversed by behaviors of whose meaning he was unaware, and how he sought in the work of analysis to construct a true identity in which he could experience his reality as a father, as a son, and as a man.
We may also wonder about the violence that Dr. White manifested towards his son. To be sure, he contrived a “theory” of the depressive state that had emerged in him when his son was born; he wanted to believe that his violence arose as an effect of the envy he felt of the intimacy that the baby, and later the child, could have with its mother. But must we believe him here, accepting as truth the theory he addressed to his analyst, who received it with much sympathy? He presented to his analyst a similarly imaginary elaboration of the reasons for the suffering that made him continue to blame his son. Note the intense shame that he experienced after giving in to his rage: Couldn’t very condensed identifications with his abusive mother have been manifesting themselves on such occasions? The shame that Dr. White experienced after his outbursts can in fact alert us to the complexity of what was besetting him. If this had been merely an expression of envy of the intimacy his son was enjoying with the mother, while the patient himself was deprived of such a relationship, there would be no reason for him to feel shame; he would be more likely to feel guilt. If there was shame, as distinct from guilt, this is a sign of the way in which he participated libidinally in what he lacked the most, in what he was suffering from. Like terror or fear, shame is a particular affect pointing to elements of an unsymbolized Real transmitted by previous generations. Like any child, Dr. Ornstein’s patient had interpreted his mother’s pathological behavior as though it were an enigmatic demand addressed to him, a demand he had to satisfy if he did not want to risk losing the loving bond that kept him alive better than any food. A child has no choice but to respond to the neurotic, psychotic, or perverse impasses of his caretakers and those around him, and he responds with the means at his disposal, sacrificing the boundaries of his body, of his thoughts, of his difference. The hate that can come over a child put in this position of sacrifice must, understandably, remain disavowed, banished, turned against the self and erotized as in masochism, but, as Enriquez (1984) has observed, this hate is also necessary in order to maintain and validate the suffering.
It is interesting to observe that suicidal thoughts erupted at these times. What did Dr. White want to kill in himself? Here we are at the heart of a very complex problem having to do with the narcissistic constitution of subjects like these. For Joyce McDougall (1985), while certain narcissistic pathologies lead to the formation of adored or hated selfobjects, others are characterized by the type of retreat we find in Dr. White, a retreat in the face of archaic libidinal demands that are too dangerous or unacceptable. In these cases the pathology is associated with the persistence of objects that are partial, primitive, overlapping, sometimes confused with the subject himself. In his fits of rage against a son, Dr. Ornstein’s patient may have been trying to confront, in a displaced manner, his inability to elaborate part-objects with which he would not be merged. His son seemed to arouse an insoluble conflict in this patient, while his daughter enabled him to get in touch with a more feminine, peaceful part of himself and thence to reconstruct a relationship with himself that was more tolerable, as a father and as a son.
In discussing Dr. Ornstein’s case I must once again emphasize the value of the real concern underlying the work of Kohut and his followers, namely that they do not confine the patient and his utterances to an interpretative system dominated by a forced “oedipalization,” and they do not hear everything the patient says as the expression of a system of defenses that the omniscient analyst can decipher, as it were, without letting himself be guided by the transference. In his discussion of the case of Mr. Z, Kohut (1979) clearly shows the impasses that analyst and patient can arrive at if watchwords govern the analyst’s listening. But can we therefore conclude that there is a development of the self separate from that of the remaining formations of the unconscious, without running into even greater theoretical and clinical difficulties?
The notion of fantasy seems to be absent from the theory of the development of the self, and this has its effect on the conduct of the treatment. Even if we acknowledge the real concern of analysts following this theoretical model to remain as close as possible to their patients, we must still point out a fundamental difference in the very conception of what a fantasy is. Fantasy is not only a defensive system whose interpretation is open to challenge; it is also a crucible of images, memories, condensed experiences, and communicable verbalizations that serve to confront the traumas encountered in our past. Fantasy is a way of expressing in language the interpretation the child was able to put on his relationship with his·caretakers. For, right from the start, a child enters into contact—for the pleasure of the exchanges between himself and adults and for all the other modes of exchange to which he is exposed—with the unconscious representations of his parents. He weaves his partial drives in this field of representations, and he elaborates fantasies to articulate his relation to this field that is so alien and at the same time so intimate because it predates the baby’s even having a body of his own. Can’t we understand the unfolding of the treatment around the need to help the self to evolve and to become integrated as also entailing an attempt to remobilize the more advanced elaboration of what had been fixed primitive fantasies?
Similarly, it is clear that Dr. White’s narcissistic mortifications had very touching origins. When Lacan (1964) emphasized that we must think of the process of becoming a subject in conjunction with a new conception of otherness, he was trying to give a radical meaning to the fact that a child at first has to deal with an other from whom he receives everything and expects everything, and through whom he interprets everything, even before he is able to think of himself as separate from this other. The child responds, in effect, to what he believes to be the demands of the other, first with his body—his earliest language—and then with the elaboration of a differentiated system of objects, representations, and fantasies. He can be induced to sacrifice this system more or less completely, leaving himself vulnerable to losing his “I” because he has no barrier against the alienating discourse of those around him.
In other words, perhaps there is more to be gained from trying to theorize the way in which the development of the self is bound up with other formations of the unconscious that lead to conflicts than there is from setting these two approaches against one another as though they were entirely divergent analytic undertakings. Likewise, there is more to be gained from trying to understand as thoroughly as possible the ways in which our unconscious determinants are expressed, the ways in which they are inscribed as they pass through us, and the psychic space in which this inscription occurs1 than it is to consider that the problem of the transmission of our determinants and our actions has been solved.
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Freud, S. (1923). The ego and the id. Standard Edition 19:3–59.
Khan, M. (1979). Alienation in Perversion. London: Hogarth. Kohut, H. (1979). The two analyses of Mr. Z. International Journal of Psycho-Analysis 60:3–27.
——— (1984). How Does Analysis Cure?, ed. A. Goldberg. Chicago: University of Chicago Press.
Lacan, J. (1964). The Four Fundamental Concepts of Psycho-Analysis, ed. J.-A. Miller, trans. A. Sheridan. New York: Norton, 1981.
McDougall, J. (1985). Theaters of the Mind. New York: Basic Books.
Searles, H. (1986). My Work with Borderline Patients. Northvale, NJ: Jason Aronson.
Stoller, R. (1975). Perversion: The Erotic Form of Hatred. New York: Pantheon.
1. Freud (1923) envisaged the existence of a third unconscious in order to account for the presence of elements not repressed within the ego.