Within that broad group of patients who suffer from something more than a neurosis, the so-called narcissistic character disorders and borderline states, one can discern a subgroup whose main complaint is that their lives are empty, futile, and meaningless. It is not only that they perceive their lives to be empty; they also experience their sense of self to be empty and dead and express the fear that if one probes beneath the surface one will discover that there is nothing there. André Green (1986) has referred to this phenomenon of emptiness as a blank psychosis; in extreme cases this represents the equivalent of a psychic suicide that has already occurred. As you know, Fairbairn (1952) some years ago correctly associated the sense of futility and emptiness with the schizoid personality. I would not limit this symptom to the schizoid or the privately psychotic, as I believe that it is present in a broad spectrum of personality disturbances.
To be able to find meaning in life is equivalent to being psychically alive. To be more precise, the traumatized person finds meaning in life but the meaning is invariably a constricted one. For, in massively traumatized individuals, experiences in real time are invariably invested with old meanings; the possibility of novelty is subverted through the imposition of old meanings upon new experiences. There is evidently a selective process at work that disavows any percepts that are at variance with the original traumatic affective experience. In these severe cases, life becomes monotonous and extremely boring and invariably unhappy.
This inability to discover emergent meanings may have devastating consequences. If one is psychically dead, the affective core of the self is experienced as a “black hole,” as if one’s self has psychically imploded. In some cases such individuals are not suicidal for the reason that they simply do not care whether they are alive or dead—nothing matters.
We know that a given symptom may be arrived at by more than one pathway, for you will have recognized that the complaint that life has no meaning is also characteristic of depression. But the psychopathology and neurophysiological disturbances of depression are different from those of the narcissistic disorders and as such represent a separate subject that I will not consider here. Of course we know that depression may coexist with severe narcissistic disturbances.
As psychoanalysts we are, in our daily work, continually confronted with the problem of meaning and psychic aliveness, although we may not think in those particular terms. As we listen to our patients we are automatically attuned to what is meaningful. Meaning in a psychoanalytic context is different from the concept of meaning in philosophy and linguistics in that psychoanalysts search for private meanings. As you know, the relation between private and public meaning has been a problem for philosophers for centuries, but as psychoanalysts we are concerned with private meanings and private significance. Meaning in psychoanalysis always refers to what is significant for the analysand. Even when such meanings are arrived at through shared, that is, intersubjective experiences, they are always referred back to the analysand. This is not to suggest an identity or symmetry of meaning in these shared experiences, but the analyst’s private experiences are placed in the service of the treatment. What gives an item significance (for both participants) in a psychoanalytic treatment is the extent to which speech or other forms of behavior are invested with feeling.
The analyst listens to the patient’s speech and in addition observes the totality of the patient’s behavior, including his posture, bodily movements, and silences. From these elements an affective charge is communicated that directs the analyst’s attention and interest to what is meaningful to the patient. We customarily think of the analyst’s empathy as analogous to a perceptual instrument, but in order to activate this instrument a certain quantum of affective charge is required. (I have discussed this topic in Psychoanalysis in a New Context [Medell 1984].) If the patient does not communicate feeling in speech, gestures, or other forms of behavior, the analyst is unable to enter into the patient’s experience. Without the affective inflections of speech, all words become of equal significance and are shorn of their personal meaning.
Thus as we listen to our patients we select that which is meaningful because of the affects that are communicated to us. This paraverbal communication has been described as a metacommunication. We can assume that, automatically and unconsciously, we constantly monitor and select affective valences of speech. When meaningful communication is absent, we become bored, sleepy, or indifferent, so that boredom is a clue to psychic deadness. Of course it can be argued that the analyst’s boredom may reflect the analyst’s own internal psychic economy, such as a lack of interest that may have nothing to do with the patient. But, on the other hand, the analyst’s boredom may reflect the fact that the patient is psychically “not there.” If patients are completely walled-off within their private space, this invariably induces a counteraffective response in the analyst. We feel that such patients are not in the room with us. It would be unthinkable to have no response if one is in the continued presence of another human being who does not relate to us. This is not a question of the patient’s being uncooperative or defiant, but it is an indication of the automatic defensive measures introduced in order to preserve private space. When our patients are encased within their private selves, their endopsychic experience is that of being in a cocoon or a plastic bubble. This may be a wonderfully safe retreat or a prison from which there is no escape.
We have arrived at the subject of Winnicott’s false self, a defensive formation in which the individual is estranged from his or her central affective core, this inner core of the self that Winnicott (1971) has called the true self and that I have referred to as the private self (Modell 1993). The importance of this affective centering has long been noted. Its absence has been described as an alienation from the self, a decentering, a failure of indwelling. It is affective centering that enables one to feel real and alive, to feel that he or she is an entity with continuity in time and existence in space.
If we speak of decentering and alienation of the self, this assumes that at an earlier developmental stage the self has been more centered. When my patients declare that they are empty and have nothing inside of them, they also remain skeptical when I indicate to them that they really do possess an authentic self waiting to be found. My confidence in this assertion rests on the knowledge that most patients will establish better contact with their private self in the course of psychoanalytic treatment. If there were not any prior existence of an authentic self, it would be a nearly magical expectation to believe that the therapeutic process could bring it about.
Infant research suggests that the sense of agency of the self is related to an affective centering. Most infant observers believe that centering of the self is reinforced by the process of affective attunement or affective mirroring that occurs between the mother and child (Stern 1985). The mother who is able to match the infant or child’s affects also enables that child to process his or her own affects. Conversely, a mother who is out of attunement with her child’s affects may impede this process. If the mother’s response mirrors the child’s affects, this serves as affirmation of what the child is feeling. This is equivalent to the mother’s naming the child’s affects; the mother reaffirms the meaning of the child’s affective state.
I believe that psychoanalysis may, in some cases, provide a second chance to repair a developmental deficit in this area, should one exist. There are some patients who require that the analyst identify, that is to say, name, the patient’s affects. With regard to negative affects some patients experience only a vague sense of dysphoria—they are unable to name what they are feeling. By means of countertransference perceptions the analyst is able to identify affects that are unconsciously communicated by the patient. In such cases it is the psychoanalyst who names what the patient is feeling: “You are angry,” “You are feeling anxious,” “You are sad,” and so forth. The therapist is in effect teaching such patients to name their own feeling states, and through this provision of meaning those affects are brought within the domain of the self.1
The question then arises: How did the self become alienated from itself? Where the child’s private space is habitually violated, vital defenses are erected, such as the noncommunication of authentic affects. It seems, unfortunately, as if the defenses used against the intruder are turned upon the self. In accordance with Fairbairn’s principle that traumatic relationships between self and others are re-created within the self, the means employed to protect private space against intrusion by others is also re-created within the self. These individuals become estranged from their own affective core and are as false and inauthentic within themselves as they are with others. In the struggle to preserve private space they thus achieve a tragic pyrrhic victory. Ironically, the fight to protect the private self continues even after the individual has lost contact with it. It is as if a householder maintained a burglar alarm long after misplacing the jewels. In closing oneself off from others, one inadvertently closes oneself off from oneself.
If psychic aliveness requires this contact with one’s inner affective core, then it is apparent that psychic aliveness is intimately connected with an internal communication of affects: one must be able to read one’s own signals. Of course affects can be communicated unconsciously, as occurs in cases of projective identification. The conscious communication of affects is an aspect of object seeking. You will recall Fairbairn’s aphorism that libido is object seeking it is also true that if affects are communicated they are object seeking. Conversely, those patients who do not communicate authentic affects attempt to create the illusion that they are without desire, that is to say that they are self-sufficient. Winnicott thought this to be a sign of mental illness. When he was asked by mental-health counselors, “How do you distinguish someone who is mentally ill from someone who is basically healthy but only needs some counselling?” his reply was: “If a person comes and talks to you, and, listening to him, you feel he is boring you, then he is sick and needs psychiatric treatment. But if he sustains your interest, no matter how grave his distress or conflict, then you can help him alright” (1986, p. 1).
The communication of affects refers not only to object seeking but also to an internal scanning process that selects what is of interest in the world, what is needed, what is valued. In severe narcissistic disorders we may discover that such patients hate the world and everything in it. To express an interest in something may be felt to be dangerous: desire is experienced as enslaving, and accordingly one becomes panicked at the recognition of one’s own interests and desires. As a consequence of such inhibition of desire the world becomes empty and boring. This sense of boredom and emptiness in the world is reinforced by a decentering from one’s inner affective core. If one is out of touch with one’s affective experience, one is unable to select what is desired, and as a result all thoughts are shorn of their affective content and thus become equally indifferent. If all thoughts have an equal affective valence one is unable to choose one thought in preference to another. Such patients not infrequently remark at the start of an hour that they have nothing to say. In extreme cases they experience a pervasive sense of blankness, as if their brain were damaged.
It is evident that what is of interest is meaningful and what is meaningful is of interest. Meaning and interest are reciprocal and driven by desire, which in tum determines what it is that is selected. Let us, for the moment, put to one side the repetition compulsion and the seeking of pain, and consider only positive interests; then interest in people and things can be thought of as a form of loving. This is only to repeat Freud’s familiar concept of libidinal investment: what one invests with libido one invests with meaning. This equivalence of interest and love extends not only to persons but also to things, ideas, and activities—nearly anything can be invested with passionate interest. Thus in a larger sense the inability to find meaning in the world represents a withdrawal of love.
I have been discussing the experience of psychic aliveness in relation to affects and desire. There is a third component, which is of equal importance, and that is memory. From one perspective it can be said that the self is a structure whose function is to maintain a coherent model of past, present, and future. In health our memories of the past are continually updated and recontextualized, as Freud described by means of the concept of Nachträglichkeit (cf. Modell 1990, 1993). When one is psychically alive, one finds new meaning in experience, in contrast to the traumatized individual who cannot experience novelty and cannot recontextualize the original traumatic experience. When Freud still believed in the traumatic etiology of the neuroses, he had the deep insight that whether a traumatic event proved to be pathogenic depended on the individual’s capacity to retranscribe memory. In a letter to Fliess dated December 6, 1896, we find the following:
As you know, I am working on the assumption that our psychic mechanism has come into being by a process of stratification: the material present in the form of memory traces being subjected from time to time to a rearrangement in accordance with fresh circumstances—to a retranscription. Thus what is essentially new about my theory is the thesis that memory is present not once but several times over, that it is laid down in various kinds of indications…. I should like to emphasize the fact that the successive registrations represent the psychic achievement of successive epochs of life. At the boundary between two such epochs a translation of the psychic material must take place. I explain the peculiarities of the psychoneuroses by supposing that this translation has not taken place in the case of some of the material which has certain consequences…. [cited in Masson 1985, p. 207]
Pathogenesis thus represents a failure of translation from one developmental epoch to the next. Freud’s theory of memory here is one of cyclic time; health represents the capacity to retranscribe memory to form a model of past, present, and future. I believe it is unfortunate that Freud later deemphasized his theory of Nachträglichkeit. For, preoccupied as he was in later years with instinct theory, he attributed the repetition compulsion to the death instinct, suggesting a linear as opposed to a cyclic conception of psychic time.
Freud’s theory of Nachträglichkeit has recently received some unexpected support from contemporary neurobiology. It is very similar to a new theory of memory proposed by the Nobel Prize laureate Gerald Edelman (1992), who arrived at similar ideas independently in the course of proposing a global theory of the mind–brain relationship. His basic idea is that memory does not consist of a static record in the brain; instead it is a dynamic reconstruction that is context bound and established by means of categories. According to Edelman’s theory, long-term memory consist of categories of experiences awaiting activation. Although we do not yet possess firm scientific evidence concerning the way in which long-term memories are stored in the brain, Edelman suggests that what is retained in memory is not a replica of an event, something that has a precise correspondence with the original experience, but instead a potential to generalize or to refind the category or class of which the event is a member.
The clinical application of these ideas can be seen in cases of trauma resulting in a splitting and dissociation of parts of the self. Dissociation is different from repression, but the end result is the same in that portions of the self are outside of conscious awareness. The retranscription of memory, the translation or recontextualization of the past in the context of current experience, requires a relative coherence of the self. If portions of the self are split off from each other and noncommunicative, this means that aspects of an individual’s history are unavailable, and hence a retranscription of memory cannot take place. If we think of the self as what reorganizes our experience of time, then we can see how massive psychic trauma will result in a telescoping of the past into the future and an obliteration of present time. We know that in cases of massive trauma, experiences in current time are meaningful only to the extent that such experiences are congruent with the traumatic past. From this perspective the repetition compulsion represents a disturbance in memory and not, as Freud believed, a disturbance in instinct. We also know that the effect of massive trauma can be passed to the next generation by means of a form of cultural inheritance. For example, children of the survivors of the Holocaust will not uncommonly incorporate their parents’ experiences as if such events were part of their own past.
As Winnicott pointed out, the feeling of being psychically alive depends upon creative apperception or (in the language that I have used) upon the capacity to find new meanings in experience. This creative apperception, in turn, rests upon a measure of love of external reality and on the capacity to experience cyclic time. The opposite of creative apperception is psychic death. We know that there are some patients who actively seek psychic death as an alternative to the actual death of the body. These patients are among our most difficult therapeutic challenges. Therefore the more we understand of the processes that underlie their sense of emptiness and sense of futility, the more likely we are to be able to offer some help.
Edelman, G. (1992). Bright Air Brilliant Fire. New York: Basic Books.
Fairbairn, W. R. D. (1952). Psychoanalytic Studies of the Personality. London: Tavistock.
Green, A. (1986). On Private Madness. Madison, CT: International Universities Press.
Masson, J., trans. and ed. (1985). The Complete Letters of Sigmund Freud to Wilhelm Fliess. Cambridge: Harvard University Press.
Medell, A. (1984). Psychoanalysis in a New Context. New York: International Universities Press.
——— (1990). Other Times, Other Realities. Cambridge: Harvard University Press.
——— (1993). The Private Self. Cambridge: Harvard University Press.
Stern, D. (1985). The Interpersonal World of the Infant. New York: Basic Books.
Winnicott, D. W. (1971). Playing and Reality. New York: Basic Books.
——— (1986). Holding and Interpretation. New York: Grove.
1. It may be observed parenthetically that, according to linguists, in those cultures where there are no words to describe a specific affect state the individual cannot process that particular affect. For example, the Tahitians do not have a word for sadness, and consequently they have no way of coping with sadness and depression. They attribute sadness to something outside of the self and categorize it with sickness, fatigue, or the attack of an evil spirit.