(A French analyst): I’ve come across patients who have nothing to say, whose deficits are so great that they can’t say anything. What interests me in Dr. Modell’s talk is that he offer an explanation for why this might be the case, and I found that valuable.
(A French analyst): If I understood Dr. Modell correctly, he is presenting a revised theory of trauma, though one that has a precedent in Ferenczi. These are traumas that can befall any of us at any time of life and that cause ruptures in symbolization. I’d like to say that in Nicolas Abraham’s theory of the psychoanalytic symbol, as in Freud’s first theory of symbolization, there isn’t a neo-linguistic division into verbal language, vocality, physical gestures, and the potentiality for action. After all, we do have a global theory of the psychoanalytic symbol that integrates these four poles, don’t we?
I regret the recent tendency in France to neglect the importance of affectivity in psychoanalysis, what André Green calls living speech, which includes what patients don’t say along with what they say and takes into consideration emotions, feelings, affects. I grant that the interest in verbal language and the theory of the sign, the signifier, and the symbol has been an entirely positive trend, but I don’t think we can separate off from psychoanalysis what belongs to affect and sense impressions. There is a sensori-affective-motor way of thinking that is in place from the outset and operates throughout life even though it is entirely transformed by verbal language. And as Dr. Modell suggested, even in the case of verbal language analysts pay just as much attention to vocal quality, tone, rhythm, intonation, and pauses as to the verbal content.
In connection with the transgenerational traumatic effects that Dr. Modell discusses, I want to add that many analysts of various theoretical persuasions in France are taking a look at this type of effect in the tradition of Nicolas Abraham and Maria Torok.
Daniel Widlöcher: I like the contrast you make between repetition compulsion and con textualization. But in contextualization there isn’t only the anti-traumatic effect; there’s also the secret of pleasure (jouissance). It’s through contextualization and retroactivity that jouissance becomes linked to trauma, but when do these lead to jouissance and when is their effect anti-traumatic? I don’t think we can set these over against each other. On the contrary, we have to ask ourselves whether, in these empty patients you mention, the emptiness isn’t also the result of the fact that this contextualization by means of jouissance has somehow eluded them. And if so, Dr. Dor would object that this isn’t something that we see only in major personality disorders, but that it’s a psychopathological feature that we encounter all the time in our work.
Anna Ornstein: I understand that both affect and language are in the service of communication. And if we accept that, then for me, affect is the first form of communication. It retains its power, when we learn language, only to a certain degree. We know that language expresses as much as it hides; I think this is what I’m learning from the Lacanians. This is the reason why we have to analyze language, because it goes both ways. However, instead of seeing both language and affect as forms of communication, it seems that the Lacanians have given some kind of priority to language as communication, and then affect, naturally, would have a secondary place.
Did I understand correctly that Dr. Dor meant that we actually have to listen for what is being said, rather than look for what is being hidden? Because in that case there is a similarity between self psychology and the Lacanian position. We too believe that our path, our route, to the unconscious is not through learning the language of the unconscious, and therefore guessing at what the manifest language exposes, but through following the patient’s lead with the manifest. That is the quickest way to the unconscious.
Paul Ornstein: I loved the passion with which Joël Dor approached the paper. It allows us to be more intense than we might otherwise have permitted ourselves to be.
I had the feeling that Arnold Modell was showing us not a new category but a way of cutting across categories that would enable us to get a deeper understanding of the phenomena he described. I missed a reference to the transference as a guide to understanding meaning, so in that regard I have some questions for Dr. Modell. Regarding Joël Dor’s lack of comfort with empathy, I would like to ask: How do we know what we know in psychoanalysis? What is our way of finding out? What is the method whereby we can get, imaginatively, into the experience of the other and know how the other feels, if not via empathy?
Arnold Modell: I’ll try to respond to Joël Dor’s comments. I’m not talking about a syndrome, or a new group; I’m talking about an aspect of life that’s present in all of us.
His comment about my “pragmatic” approach raises a question about my metapsychology. I’d say my own metapsychology is in transition. I have thought of myself as a Freudian. I no longer believe in Freud’s theory of drives. My own work and interest at this point is trying to integrate some work in neurobiology with psychoanalytic concepts, and I think this may be very off-putting to many people in the audience who don’t believe that psychoanalysis should have a biological underpinning. But that’s a separate issue.
With regard to affect: affect, clearly, cannot be separated from speech. It is part of language. We all know Strachey’s classic paper on the therapeutic effects of interpretation. He said that a transference interpretation is effective when it’s given at the point of affective urgency. This means that there has to be some affective bond at the precise moment that the interpretation is given. So this role of affect in speech is part of our heritage.
Joël Dor: As a clinician listening to patients and as a researcher, Freud was initially interested in what the patient didn’t say, what was hidden, what was manifest and what was latent. And Freud pursued this investigation quite far, only to realize that he could not sustain it. Even as he was continuing to explore this issue he found that what we really have to attend to as we listen is what the patient is saying. And what the patient is saying is not the meaning but the way in which the meaning is brought forth.
It’s obvious that what is said by someone isn’t necessarily exclusively verbal. I’m not reducing signifying or symbolic expression solely to an effect of language. The dimension of the symbolic isn’t simply the verbal, the linguistic, the signifier, and the signified—it’s really something a bit more important. It’s a problem of representation. Freud saw this right away. This means that the question confronting the analyst at a given moment in his transferential relation to the patient is the relation he has not only to his own representations but to those that are evoked for him by the patient in verbal, or extra-verbal, or infra-verbal forms (to use these convenient and fashionable terms).
Now to come back to that classic issue, of course it’s possible to caricature what is called Lacanian psychoanalysis, or Lacanians themselves. For my part, I appreciate Dr. Modell’s explanation of the way he goes about freeing a patient from “psychic death.” And until proved otherwise, even if I go about it differently I also have this concern. Though it’s not easy, there are surely different ways of unlocking the process with this kind of patient (as with the kind of patient who says nothing), or in this clinical situation. I use these terms as opposed to “clinical profile” or “state,” because I’m not quite sure that we are even dealing with a state—a situation, yes; pathological, certainly; but a state is something much more systematic. I’d just like to say that what Dr. Modell proposes in the name of empathy or affect raises some difficulties for me, quite apart from the terrorism of the silent Lacanians, which is something in which I don’t recognize myself.
Arnold Modell: Let me be clear. I’m thinking about a severe state which is not a passing sense of having nothing to say. This is a state of deadness of the self, where nothing means anything and nothing gives pleasure, and so forth. It’s a characterological issue. We call this a symptom, but it’s also a problem of character.
Joël Dor: I’m completely in agreement with you there.