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922 KARNAC
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First published in 2007 by
Karnac Books Ltd
118 Finchley Road
London NW3 5HT
ISBN-13: 978–1–85575–467–6
www.karnacbooks.com
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7222 Dedicated to the memory of Harold Stewart
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7222 CONTENTS
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5222 ACKNOWLEDGEMENTS ix
6 ABOUT THE EDITOR AND CONTRIBUTORS xi
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8 Introduction 1
9 Lesley Caldwell
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1 1 A theory for the true self 8
2 Christopher Bollas
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4 2 Destructiveness and play: Klein, Winnicott, Milner 24
5 Michael Podro
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7 3 On humming: reflections on Marion Milner’s contribution
8 to psychoanalysis 33
9 Claire Pajaczkowska
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1 4 Being and sexuality: contribution or confusion? 49
2 Lesley Caldwell
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4 5 Clinical experience with psychotic mothers and their
5 babies 62
6 Alain Vanier
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8 6 On holding and containing, being and dreaming 76
922 Thomas Ogden
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viii CONTENTS
INDEX 174
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7222 ACKNOWLEDGEMENTS
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5222 e wish to thank the following for permission to reuse
6 earlier publications:
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9 The editors of the International Journal of Psychoanalysis for their
20 permission to republish:
1 Thomas H. Ogden. On holding and containing, being and dreaming.
2 International Journal of Psychoanalysis, December 2004, 85: 1349–64.
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4 Christopher Bollas for permission to republish:
5 A Theory of the True Self. In: Christopher Bollas, Forces of Destiny:
6 Psychoanalysis and Human Idiom. London: Free Association Books,
7 1989.
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9 Extracts from D.W. Winnicott’s works reproduced by arrangement
30 with Mark Patterson and Associates on behalf of the Winnicott
1 Trust, London:
2 Winnicott D.W. Psychoses and Child Care. In: Through Paediatrics to
3 Psycho-Analysis. London: Hogarth Press, 1987.
4 Winnicott D.W. On the contribution of direct child observation to
5 psycho-analysis. 1957. In: The Maturational Processes and Facilitating
6 Environment. Madison, Wisc.: IUP, 1965.
7 Winnicott D.W. The effect of psychotic parents on the emotional
8 development of the child. 1959. In: The Family and Individual
922 Development. London: Routledge, 1999.
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x ACKNOWLEDGEMENTS
Winnicott, D.W. Ego distortion in terms of true and false self. In: The
Maturational Process and the Facilitating Environment. London:
(reprinted by) Karnac Books, 1991.
Winnicott, D.W. Playing and Reality. London: (republished by)
Routledge, 1991.
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7222 ABOUT THE EDITOR AND CONTRIBUTORS
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Editor
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6 Lesley Caldwell is psychoanalyst of the British Psychoanalytic
7 Association (BAP) in private practice. She is the editor of the
8 Winnicott studies monograph series, and was the director of
9 the Squiggle Foundation from 2000–2003. She is an editor for the
20 Winnicott Trust, for whom she is writing a book on Winnicott with
1 Angela Joyce in the New Library of Psychoanalysis teaching series.
2 She is Senior Research Fellow in the Italian department at University
3 College London where she co-directs the seminar series, Rome, the
4 growth of the city.
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Contributors
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8 Julia Borossa is a Senior Lecturer in Psychoanalysis in the School of
9 Health and Social Science at Middlesex University. She has a PhD
30 in the History and Philosophy of Science and her publications include
1 Sándor Ferenczi: Selected Writings (Penguin, 1999) and Hysteria (Icon,
2 2001). More recent writings on psychoanalysis, politics and culture
3 have appeared in The Journal of European Studies and Lost Childhood
4 and the Language of Exile (edited by Szekacs-Weisz and Ward; Karnac,
5 2005).
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7 Christopher Bollas is a member of the British Psychoanalytical
8 Society, a patron of the Squiggle Foundation, and the author of many
922 books.
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xii ABOUT THE EDITOR AND CONTRIBUTORS
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ABOUT THE EDITOR AND CONTRIBUTORS xiii
122 (1998); until recently he was Chairman of the Trustees of the Squiggle
2 Foundation.
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4 Margret Tonnesmann is a psychoanalyst of the British Psycho-
5 analytical Society and a Fellow and senior member of the British
6 Association of Psychotherapists. She was a consultant psychothera-
7222 pist (now retired), and she is a lecturer and seminar leader on Freud
8 and object relations theorists to various institutions in London,
9 Germany and Switzerland. She is in private practice.
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1 Alain Vanier is a psychoanalyst and psychiatrist, full member of
2 Espace Analytique (France), Professor of Psychopathology and
3 Psychoanalysis at the Université Paris 7-Denis Diderot, and director
4 of the Psychoanalysis and Medicine Research Centre (C.R.P.M.) in
5222 the same university. His most recent books are Lacan (trans. S.
6 Fairfield, New York: Other Press) and Éléments d’introduction à la
7 psychanalyse (Paris: Armand Colin).
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9 Ken Wright is a psychoanalyst and psychiatrist in private practice.
20 He trained with the Independent Group of the British Psycho-
1 analytical Society, and at the Tavistock clinic and the Maudsley
2 hospital. He is the author of Vision and Separation: Between Mother
3 and Baby (1991) which won the 1992 Mahler Literature Prize. His
4 interests include the development and use of symbols and the
5 relationship between creativity and the life of the self. He is a patron
6 of the Squiggle Foundation.
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7222 Introduction
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5222 lthough this collection does not represent a comprehensive
6 engagement with the intellectual history to which Winnicott
7 contributed so significantly, it does propose that using his
8 work to think about themes of importance to practitioners now is
9 also a way of thinking about some of the present preoccupations
20 of psychoanalysis. How certain themes assume an importance
1 and develop at certain times often resonates with debates of the past,
2 and to encounter them in the present almost always offers some-
3 thing new. Theoretical and clinical ideas are produced in particular
4 conditions and in response to, or as part of, a certain intellectual and
5 socio-cultural context; how they have come to be understood and
6 how they have their effect also involves that wider world and its
7 interests.
8 As in a close engagement with any thinker, a close engagement
9 with Winnicott’s work highlights recurring concerns, and in the
30 first five chapters, Christopher Bollas, Michael Podro, Claire
1 Pajaczkowska, Lesley Caldwell and Alain Vanier begin from familiar
2 themes—the true self and how it can be encouraged, the value of
3 art, creativity and the symbolic function, the links between being and
4 sexuality, the institutional care of psychotic mothers. In each case
5 the writer starts from a basic idea which is then used to develop
6 something different. This process, the process of intellectual work in
7 any area, encourages a new (theoretical) object to emerge through
8 the mental and psychological process of destroying, and then
922 restructuring the originating thought, so as to take it further. Such
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2 INTRODUCTION
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INTRODUCTION 3
122 too, the arts exemplify that creativity of mind that derives from the
2 initial mother-child relation, and what it enables in terms of a sense
3 of self. Claire Pajaczkowska also uses Milner to think about humming
4 as a liminal activity where the self, while being consciously absent,
5 is present as bodily acoustic frame. She, too, is impressed with
6 Milner’s attention to the centrality of feeling and affect in mental life,
7222 and discusses this through the concept of the framed gap and the
8 theory of symbol formation.
9 Lesley Caldwell describes the insights to be gained in looking at
10 records of Winnicott in the consulting room and at his clinical acu-
1 men, but she considers his attempt to develop an idea of difference,
2 based on sexual difference and its manifestation in the transference,
3 less convincing than his discussion of the growth of the self through
4 the encounter with an other—the mother or the analyst—elaborated
5222 through a distinction between being and doing.
6 Alain Vanier’s major influences, Lacan and Dolto, seem to sit easily
7 with what he sees as Winnicott’s fundamental contribution to his
8 own work with psychotic mothers in institutional care. He assumes
9 Winnicott’s sense of mirroring as a supplement to Lacan’s emphasis
20 on misrecognition, but it is through his comprehensive under-
1 standing of Winnicott’s “holding,” and what he regards as its
2 indispensability, that he approaches the place of the institution and
3 his own team in organized care.
4 The papers by Thomas Ogden on Bion, Vincenzo Bonaminio on
5 Anna Freud, Miera Likierman on Klein and Margret Tonnesmann
6 on Balint, explicitly discuss a complementarity between another
7 theorist and Winnicott, while also emphasizing specific differences
8 in their theoretical accounts that argue for differently inflected
9 approaches to some common fundamentals.
30 Ogden, like Vanier, finds “holding” an essential conceptual tool
1 for approaching clinical work. In the paper reproduced here from
2 the International Journal, he sees its complementarity to Bion’s
3 “container-contained” as representing different developmental
4 possibilities, and relating to different understandings of time and its
5 place, both in the growth of the human infant and in the analytic
6 situation. Ogden thinks that different clinical situations call forth
7 these concepts as ideas to be used, but each requires different mental
8 tasks of both analyst and patient. He illustrates this with two pieces
922 of clinical material that show the different needs of the patient and
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4 INTRODUCTION
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INTRODUCTION 5
122 rather different phenomena. She also wonders what is implied for
2 the infant’s own strength as a person by Winnicott’s account of the
3 early incapacity to exist without the mother.
4 Margret Tonnesmann undertakes a detailed account of the
5 approaches of Winnicott and Michael Balint to the issue of regression
6 in analysis, which outlines their differences and argues for its
7222 importance. While both argued for a conceptualization of infantile
8 development in terms of classical theory and object relations, and
9 specified an area—the basic fault, false self—that is organized by a
10 two-person relation situation, where the pre-verbal is paramount
1 and the treatment involves acting out, their accounts of the dynamics
2 of regression in terms of either primary narcissism (Winnicott) or
3 secondary narcissism (Balint) involve different theories of early
4 development. Tonnesmann also proposes that their very different
5222 personalities may well have contributed to further differences in
6 approach. Like the final two papers, this paper also locates the
7 historical importance of serious disputes in psychoanalysis and their
8 continuing relevance for debates about technique, training, and the
9 way individuals view the analytic endeavour.
20 Julia Borossa argues that both Ferenczi and Winnicott are
1 uncomfortable figures for psychoanalytic orthodoxy, but figures
2 whose willingness to pursue the implications of their chosen careers
3 still provides a fundamental reference point for psychoanalytic
4 discourse today. She describes the challenges offered by Ferenczi’s
5 detailed thinking about the interaction of patient and analyst, but
6 she herself questions the demand of training organisations that the
7 analyst must herself be analysed, as implying an identification
8 between analyst and patient that, subsequently, has to be hedged
9 about with restrictions. The requirement to be analysed, that is, to
30 be a patient, and for ongoing education through discussion and
1 supervision with colleagues, is not only the prerequisite of a
2 professional life spent analysing others, it addresses the bases of what
3 constitutes that practice, and the bases of the expertise and training
4 of its members. Borossa writes of Margaret Little’s differing
5 understandings, at the time of the analysis, and retrospectively, in
6 the course of her own analytic career, of the interpretation made
7 by Little’s training analyst, Ella Sharpe, about her patient’s success,
8 and why she made the interpretation she did. In doing so Borossa
922 is describing how and why Little came to recognize her analyst’s own
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6 INTRODUCTION
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INTRODUCTION 7
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CHAPTER ONE
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t is next to impossible to account for what transpires in a
psychoanalysis. Although clinicians collect vignettes, remember
interpretations that make sense, and isolate important psychic
themes, the sheer unconsciousness of a patient-analyst relationship
makes it a difficult occasion to describe. How do I talk about the
qualities of silence in an hour? How can I describe the mix of tonal
stress and narrative content that constitutes the analysand’s
unconscious emphasis of the emotional reality of a session? How
shall I ever be able to narrate my inner dialogue with myself as I
silently shadow the analysand, agreeing, disagreeing, querying,
wondering, co-imagining? If it is possible for me to state precisely
why I choose a particular interpretation, why in that moment? Why
do I allow clear themes to pass without comment, only to pick up
something else the patient says?
Some people find themselves incapacitated by the question “What
did you get out of your analysis?” Pressed to be specific, often by a
friend who is on the verge of seeking an analyst but still needing
some clear evidence of accomplishment for the considerable
investment of time and money, the friend may want to know details
of what was found out that was previously not known. The reply of
the analysand will often be most unhelpful. “It changed my life.” “I
was very confused and it helped me out.” The unanalysed cannot
be blamed for considering this a mystifying reply.
What does happen in an analysis? How can we discuss the
unknown benefits of our intervention?
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A THEORY FOR THE TRUE SELF 9
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A THEORY FOR THE TRUE SELF 11
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A THEORY FOR THE TRUE SELF 13
122 when he linked the true self to the id and the ego to the false self.
2 He intended to emphasize the true self’s representation of instinctual
3 life, but in so doing failed to convey the organization of person that
4 is the character of the true self. If the true self is the idiom of
5 personality, it is therefore the origin of the ego, which is concerned
6 with the processing of life. Naturally instincts are a part of the ego,
7222 and without delving into psychoanalytic metapsychology, I will only
8 add that there is no reason in Freudian theory why we cannot hold
9 that the energy of the instincts is intrinsic to and inseparable from
10 the economics of ego life. But the drives are always organized by the
1 ego, because this true self that bears us is a deep structure which
2 initially processes instincts and subjects according to its idiom.
3 If the ego is synonymous with the true self at birth, then the
4 infant’s negotiation with the mother and father establishes mental
5222 and organizational structures that subsequently become part of
6 the ego, but are not equivalent to the true self. The unthought
7 dispositional knowledge of the true self inaugurates the ego, but
8 increasingly the ego becomes an intermediary between the urges of
9 the true self (to use objects in order to elaborate) and the counter-
20 claims of the actual world. (This distinction is very similar to that
1 made in classical psychoanalysis where the ego is seen as a derivative
2 of the id, increasingly differentiated from the id as it manages the
3 child’s relation to the outside world.) We are still addressing the issue
4 of process and not of mental representation. A part of the ego
5 processes the demands of environmental reality, and its structure
6 changes according to the nature of the interaction with the object
7 world. When this dialectic is thought about, the thinking occurs in
8 the psyche, where that which is thinkable from true self experiencing
9 is represented in the internal world.
30 Perhaps the primary repressed unconscious consists originally of
1 the inherited potential and then those rules for being and relating
2 that are negotiated between the child’s true self and the idiom
3 of maternal care. These rules become ego processes and these
4 procedures are not thought through, even though they become part
5 of the child’s way of being and relating. They are therefore part
6 of the unthought known and join the dispositional knowledge of
7 the true self as essential factors of this form of knowledge. Freud’s
8 letter to Fliess of 6 December 1896 suggests that he knew there were
922 unconscious registrations of experience not unlike theories of being
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A THEORY FOR THE TRUE SELF 15
122 first thought about by the patient. In some respects, then, it is the
2 paradigm potential of the transference-countertransference category
3 that elicits unconscious rules for being and relating, and trans-
4 forms these lived processes into mental representations. Indeed,
5 the analyst’s countertransference is often just such a journey of
6 transformation from the object of the patient’s process to the affective
7222 and ideational representation of the process.
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In-formative object relating
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1 If unthought knowledge begins with inherited dispositions, the
2 infant will soon know about the laws of interrelating through the
3 relation to the mother, and this then will also become a feature of
4 the unthought known. Such knowledge is composed of all those
5222 “rules” for being and relating conveyed by the mother and father
6 to the infant (then to the child) through operational paradigms
7 rather than primarily through speech or representational thought.
8 In other words, the child learns theories for the management of
9 self and other through the mother’s mothering. As the mother’s
20 transformational idiom alters the infant’s and child’s internal and
1 external world, each transformation becomes a logical paradigm
2 replete with complex assumptions which no infant or child can think
3 out. These are meant to be the rules of this infant-child’s existence,
4 and they are determined by the mother’s presentation of them to her
5 infant, in interaction, of course, with his unique idiom.
6 As infant and mother are mutually in-formative, they act upon
7 each other to establish operational principles derived from inter-
8 relating. Of course, the mother forms an internal object representation
9 of her infant. But she is also in-formed by the infant’s true self, so
30 that her unconscious ego is continuously adapting to her infant. And
1 to a far greater extent the infant is given form(s) by the mother’s logic
2 of caretaking. Object relations during the first years of life are always
3 in-formative, so much so that such conveying of information could
4 be termed in-formative object relating, to identify object relations that
5 sponsor ego structures. In-formative object relating can refer either
6 to the alteration of ego structure or to the contents of psychic life or
7 to both. As the mother transforms the child’s self states, she may
8 induce significant ego alterations, a change in the child’s processing
922 of self and other, that may yield only minimal mental representation
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122 awkwardness or irritation will be evoked by such a false self act and
2 this may complement the patient’s own discomfort.
3 Perhaps a patient becomes highly articulate, evoking the analyst’s
4 capacity to interpret unconscious communications. The analyst then
5 is used for his ability to concentrate and bring his analytic intellect
6 to bear on the task. This could constitute a movement of true self as
7222 it uses the object.
8 On another occasion a patient, perhaps after reporting a dream
9 and its associations, searches for the analyst’s sense of intellectually
10 creative freedom. He inspires the analyst’s free associations. Such
1 associative freedom might be warranted one moment in working on
2 a dream and then not be correct on another occasion when the patient
3 wants the analyst to “hold” the dream and its associations, needing
4 the analyst to be in a quiet and reflective state.
5222 The aim of these reflections is to suggest an important clinical
6 differentiation in the patient’s use of the analyst. True self use of an
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analyst is the force of idiom finding itself through experiences of the object.
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Although at times such idiomatic use of the analyst may reveal
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patterns of personality, the analysand’s aim is not to communicate
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a child-parent paradigm script but to find experiences to establish
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true self in life. At other times, however, a patient does indeed create
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an object relation to convey some rule for being and relating derived
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from his relation to the mother or father.
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As I have argued that the ego is the unconscious organizing
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6 process—the logic of operations—its choices will ultimately reflect
7 both the innate true self (an organization that is its precursor) and
8 the subsequent structures developed out of partnership with the
9 mother and father. Therefore any ego operation in adult life will
30 inevitably be some kind of mix of true self and true self’s negotiation
1 with the world. There is no pure culture of true self, just as there is
2 no unmediated presence of the mother’s structure of caretaking.
3 Clinically, however, we see uses of the analyst substantially more
4 on the side of true self movement which will override our immediate
5 consideration of any related ego structure. The meeting point of the
6 two factors in an analysis (of true self and internalized object
7 relations) is often when true self movement is arrested by some
8 paradigmatic diversion (or distortion) that is represented in the
922 transference.
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How does the analyst know how to distinguish a true self use of
him from a paradigmatic use? The clue, I think, rests in the internal
information provided in the countertransference. When an analyst
is used to express a paradigm derived from an object relation, he is
coerced into an object relation script and given a certain sustained
identity as an object. He is “set up” to play a part in the completion
of a role that has become an ego operational paradigm. When,
however, this does not occur, when an element is elicited in him to
be used by the patient and then abandoned (with no aim to set the
object up as part of the logic), then in my view this is more likely to
be a true self movement to its experience through the object.
Are these systems of knowledge always distinguishable? I think
not. As the mother operationalizes the infant’s true self into the
infant-mother object relationship, true self becomes part of the
dialectic of interrelating. A true self idiom move will become part of
a relationship. But in the first months of life, a good enough mother
facilitates the infant’s true self, so he experiences object-seeking as
useful. If, on balance, a patient’s use of the analyst is useful, where
transference experience is sought in order to elaborate the core of
the self, then the clinician will not attend to the self-object paradigms
latent in any segment of such use. Only when a pattern establishes
itself, when a complex of uses is repeated, does the analyst shift
attention to consider the laws implied in this category of unthought
knowledge.
It is possible then to say that much of what occurs in an analysis
has not been articulated or thought before. Indeed, it is perfectly
natural that this should be so as until the intervention of psycho-
analysis (as far as I am aware), there was no cultural space for the
articulation of the unthought known in quite this careful manner.
While I think it is possible for the psychoanalyst to understand and
interpret those theories of being and relating that typify an
analysand’s approach to life, it is difficult, in my view, to see the
journey taken by the true self in the analysis. Of course, there are
many times when we sense that we are being used to process
an idiom move, we know that some of our interpretations have a
particular transitional function for the patient but such lucidity,
significant though it is, is a derivative of that deep, silent, profoundly
unconscious movement taken by the true self and effected, with equal
unconsciousness, upon ourselves. We can analyse the rules for being
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A THEORY FOR THE TRUE SELF 19
122 and relating when they are recreated in the transference and its
2 countertransference, but we cannot analyse the evolution of the
3 true self. We can facilitate it. We can experience its momentary use
4 of our self. We can identify certain features. But we cannot “see” it
5 all of a piece, in the way that we “see” what unconscious meaning
6 there is that lies hidden in the narrative text. To some extent this is
7222 because it exists only in experience and is contingent upon the
8 nature of experience to trigger idiom moves. Perhaps we need a new
9 point of view in clinical psychoanalysis, close to a form of person
10 anthropology. We would pay acute attention to all the objects
1 selected by a patient and note the use made of each object. The
2 literature, films and music a person selects would be as valued a part
3 of the fieldwork as the dream. Photos of the interior of the
4 analysand’s home, albums chronicling the history of domestic object
5222 choice, dense descriptions of their lovers, friends, enemies might
6
assist us in our effort to track the footsteps of the true self. But I fear
7
we should know only a bit more than we otherwise would were no
8
such effort made, as the choice of object tells us little about the private
9
use of the object. It is possible for an analyst to note how he has (or
20
has not) been used by a patient, and to comment on how a patient’s
1
very particular use of the analyst, at a moment in the session,
2
expressed a feature of this analysand’s true self.
3
Although Winnicott’s theory of an inherited disposition is related
4
5 to Melanie Klein’s theory of instinct (1952) as possessing an innate
6 knowledge of the relation to the object (as for example the relation
7 to the breast), his use of the concept to identify the inner originating
8 source of the spontaneous gesture and my view that the true self
9 exists through the use of an object suggest a different emphasis. The
30 concept of idiom, to specify the unique personality potential of each
1 individual—a potential that is only partly articulated through the
2 experiencing of a lifetime—emphasizes the innate factor as a
3 personality theory rather than simply as universal phylogenetic
4 knowledge. I agree that such phylogenetic knowledge of the breast,
5 perhaps of the face, perhaps of the father, does exist, but it is more
6 accurate to say that such phylogenetic knowledge is only a part of
7 the inherited factor, as I think infants inherit elements of their
8 parents’ personalities by virtue of the genetic transmission of genetic
922 structure.
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20 CHRISTOPHER BOLLAS
Essential aloneness
Something of what Winnicott (1963) means by the isolate that we
are is determined by this true self. Shadowing all object relating is
a fundamental and primary aloneness which is inevitable and
unmovable. And this aloneness is the background of our being;
solitude is the container of self.
In his book Human Nature (1988), Winnicott poses the following
question: “What is the state of the human individual as the being
emerges out of not being? What is the basis of human nature in terms
of individual development? What is the fundamental state to which
every individual, however old and with whatever experiences, can
return in order to start again?” (p. 131). He replies: “A statement of
this condition must involve a paradox. At the start is an essential
aloneness. At the same time this aloneness can only take place under
maximum conditions of dependence” (p. 132).
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A THEORY FOR THE TRUE SELF 21
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22 CHRISTOPHER BOLLAS
Note
1. I do not propose that instinctual life does not exist. I simply do not give
it that primacy that it holds for Freud. Somatic urges work all the time
upon the mind. The drives of the id do demand expression, a task
performed by the ego. But each person organizes the id differently and
this unique design that each of us is is more fundamental to the choice
and use of an object than the energetic requirements of the soma which
themselves express the idiom of the true self.
22
A THEORY FOR THE TRUE SELF 23
122 References
2
Balint, M. (1968). The Basic Fault: Therapeutic Aspects of Regression. London:
3
Tavistock.
4
Bion, W.R. (1962). Learning from experience. London: Karnac, 1984.
5
Bollas, C. (1987). Shadow of the Object: Analysis of the Unthought Known.
6
London: Free Association Books.
7222
Freud, S. (1887–1902). The origins of psychoanalysis. Letters to Wilhelm Fliess,
8
drafts and notes. E. Mosbacher, J. Strachey (Trans.), M. Bonaparte, A. Freud,
9 E. Kris (Eds.). London: Imago, 1954
10 Freud, S. (1915). The Unconscious. SE 14. London: Hogarth.
1 Laplanche, J. & Pontalis, J.-B. (1973). The Language of Psycho-Analysis. New
2 York: Norton.
3 Milner, M. (1969). The Hands of the Living God. London: Hogarth.
4 Winnicott, D. W. (1954a). Metapsychological and Clinical Aspects of
5222 Regression within the Psycho-Analytical Set-Up. In: Through Paediatrics
6 to Psycho-Analysis. London: Hogarth, 1958.
7 Winnicott, D.W. (1954b). Withdrawal and Regression. In: Through Paediatrics
8 to Psycho-Analysis. London: Hogarth, 1958.
9 Winnicott, D.W. (1960a). Ego distortion in terms of true and false self. In:
20 The Maturational Process and the Facilitating Environment. London: Hogarth,
1 1965 [Karnac, 1990].
2 Winnicott, D.W. (1988). Human Nature. London: Free Association Books.
3
4
5
6
7
8
9
30
1
2
3
4
5
6
7
8
922
23
CHAPTER TWO
T
hirty years after The Interpretation of Dreams, literary criticism
reabsorbed—reclaimed—Freud’s use of poetics in his analysis
of wit and the dream work; it reclaimed the sense of conflicting
meanings or condensed meanings and their expressive possibilities,
pre-eminently in Britain with William Empson’s Seven Types of
Ambiguity. The core of their shared thought was that the mind, in
making and responding to poetry (to keep to poetry for the moment),
moved between two psychic functions: that which observed rational
stringencies and conventions and, in contrast to it, a regression that
loosened those stringencies, allowing the play of ambiguity,
disrupting conscious and consistent thought to open the way for new
kinds of awareness. One should perhaps still observe that this
“regression” had, as in wit and the dream work, its own structuring
capacity.
Subsequently, in the mid-century, there had been a bifurcation in
psychoanalytic thinking that might be represented by the difference
between two notions of disruption and destructiveness. Melanie
Klein and those under her influence saw the underlying scenario
within mental life as constituted by the fantasies of aggression
towards the loved maternal figure and the struggle to escape the
remorse that this produced; this re-enacted itself as a conflict between
egotistical imperiousness as opposed to a sense of personal limitation
and concern for others. In the literary criticism under Klein’s aegis,
this is taken to be the subject matter or the thematic material of art,
even giving to art the rationale of symbolizing the restitution of the
24
DESTRUCTIVENESS AND PLAY 25
25
26 MICHAEL PODRO
26
DESTRUCTIVENESS AND PLAY 27
27
28 MICHAEL PODRO
28
DESTRUCTIVENESS AND PLAY 29
122 to realise the limits of the body, when beginning to make marks
2 on paper, all the anxieties about separation and losing what one
3 loved could come flooding in. [ibid., p. 57]
4
5 This intimates Milner’s sense of a relation to objects of physical,
6 even sexual, possessiveness. The business of painting involves
7222 absorbing the object into its own procedures and these in turn are
8 felt as an extension of one’s body. If at this point one reached for
9 some set of rules to bring the anxiety and anger under control, “the
10 very reliance on rules” would perhaps “stultify the very thing one
1 was seeking to achieve”. And the very idea of such enveloping might
2 fail partly on account of “that subtle secret possessiveness which,
3 under the guise of loving consideration, can hardly allow the other
4 to be itself at all” (ibid., p. 57). As Milner speculated about her sense
5222 of inhibition and disappointment she came to think of the problem
6 as both a fear of letting go, a fear originating in bodily letting go,
7 and, by the same token, a reactivation of the infant’s anxiety to adapt
8 to social living, as if learning to paint were like bringing instinctual
9 process under control. Milner is not describing technical difficulties
20
but difficulties about the very state of mind that she had invested in
1
the business of painting, even before a mark has been made.
2
Her solution was to make what she called free drawings. This
3
involved making a mark or gesture and letting this suggest to her
4
what to do next, how to respond to what she had already put down
5
by elaborating upon it within the picture. The response was not only
6
a matter of graphic additions but of developing a story, turning the
7
image into imagery, an adaptation of psychoanalytic free association.
8
In the to-and-fro of visual mark and verbal narrative there was no
9
clear consciousness of the priority of one over the other.
30
1 Milner did not, I think, see her free drawing as achieved works
2 of art, but they intimated what it was that the committed artist must
3 be able to do: “To an established painter, who knows that he can
4 successfully bring what he has taken inside himself back to life in
5 the outside world as a painting, there may be less anxiety in this
6 act of spiritual envelopment in order to paint; but for those of us
7 who have no such knowledge it might seem much safer to make
8 the spirit firmly keep itself to itself and not venture out on any
922 enveloping expeditions” (ibid., p. 63). But even if the position of the
29
30 MICHAEL PODRO
30
DESTRUCTIVENESS AND PLAY 31
122 the work of art as symbolizing and itself constituting a way of making
2 (inward) reparation; in this sense the destructiveness is something
3 prior to the working of the artist, something the work of the artist
4 puts right. But the other sense of destructiveness is part of a relation
5 to what is external and is brought about by the artist as artist;
6 overcoming the alienness of the external world as something already
7222 complete. Here Milner’s explicit argument invites expansion. A
8 mode of representation that is already complete appears to the artist
9 as alien because it is complete despite her. It is only by breaking down
10 her subject matter, and that means breaking down the way it has
1 previously been represented, that the relation to the external world
2 can become remade for oneself, become the construction of one’s own
3 thought. This can only be done when one is sufficiently aggressive
4 and not merely receptive. (One recalls here Winnicott’s positive role
5222 for aggression towards the loved object in infant development as
6
opposed to the false self of compliance.) Milner sees in an art’s
7
inventiveness, its reaching out to the external world and receiving
8
back suggestions from it, an extension of the earliest reciprocity
9
between the receptive and constructive capacities of the mind. What
20
makes her contribution to the debate fifty years ago so distinctive
1
and also highly pertinent to the present, is that it makes the relation
2
of internal and external world thematic, and not merely a condition
3
of symbolizing an internal development; and, in doing this, it begins
4
5 to make intelligible the sense of urgency that drives the making of
6 any work of art, the existential urgency springing from the need to
7 be a participant and not a bystander of one’s own world. “To make
8 experience sing”—to take up Rilke’s phrase from Ken Wright—is to
9 remake it.
30
1
2
References
3 Empson, W. (1930). Seven Types of Ambiguity. London: Chatto & Windus.
4 Klein, M. (1929). Infantile anxiety situations reflected in a work of art and
5 in the creative impulse. In: The Writings of Melanie Klein, I: Love, Guilt and
6 Reparation and other works 1921–45. London: Hogarth, 1975.
7 Klein, M. (1963). Some Reflections on the Oresteia. In: The Writings of Melanie
8 Klein, 3: Envy and Gratitude and other works 1946–63. London: Hogarth,
922 1975.
31
32 MICHAEL PODRO
Milner, M. (1950). On Not Being Able to Paint. 2nd ed. London: Heinemann,
1957.
Milner, M. (1987). The Suppressed Madness of Sane Men. London: Routledge.
Williams, M.H. & Waddell, M. (1991). The Chamber of Maiden Thought.
London: Routledge.
Winnicott, D. W. (1958). Through Paediatrics to Psycho-Analysis. London:
Hogarth.
Winnicott, D.W. (1960). Ego distortion in terms of true and false self. In: The
Maturational Process and the Facilitating Environment London: Hogarth,
1965 [Karnac, 1990].
Winnicott, D.W. (1971). Playing and reality. London: Tavistock, 1971.
[Routledge, 1982]
Wright, K. (2000). To make experience sing. In: L. Caldwell (Ed.), Art,
Creativity, Living (pp. 75–96). London: Karnac.
32
122 CHAPTER THREE
2
3
4
5
6
7222 On humming: reflections on
8
9
Marion Milner’s contribution to
10 psychoanalysis
1
2
3
Claire Pajaczkowska
4
T
5222 here is a state of mind in which things are found. It is an
6 experience of finding something that already exists, but which
7 had not yet been discovered. This capacity for finding is
8 something that is made from within. Marion Milner was particularly
9 alive to the dynamic of making and finding, and how this can be
20 experienced as great joy. In this article I discuss Milner’s distinctive
1 contribution to psychoanalysis and show how it might be used today
2 to think about culture as a frame for finding and making objects.
3 Like doodling, humming exists in a space that links inner and
4 outer, subjective and objective realities; the visceral resonance of
5 sound that vibrates through muscle, tissue and bone is also the sound
6 wave that is heard through the ear and reaches out to some external
7 object or other. It is this state of liminality that makes humming so
8 interesting, and Milner’s work offers the means of understanding
9 experiences of liminality and transitional space.
30 Milner—child, adolescent and adult analyst, and author—enjoyed
1 professional and popular recognition. Herbert Read described her
2 work as having the “force of a sudden illumination”. Following her
3 death in 1997, she is particularly remembered for her significant
4 contribution to theories of culture, creativity and the visual arts.
5 As well as being the friend and colleague of Donald Winnicott,
6 Milner was a founder member of the Independent Group of British
7 Psychoanalysts in the 1950s. Her contribution to psychoanalysis
8 is noted by historians Eric Rayner (1991), Gregorio Kohon (1986),
922 D. Goldman (1993) and F.R. Rodman (2003). The distinctive nature
33
34 CLAIRE PAJACZKOWSKA
34
ON HUMMING 35
35
36 CLAIRE PAJACZKOWSKA
Symbol formation
This concept was prominent in Milner’s own practice and theory,
and “The Role of Illusion in Symbol Formation”, the paper she
wrote for an issue of the International Journal in honour of Melanie
Klein (1987 [1955]), is, in some ways, a response to the debates that
“framed” psychoanalytic theory at the time. For example, she writes
from the premise that symbolism is something other than regressive
36
ON HUMMING 37
37
38 CLAIRE PAJACZKOWSKA
38
ON HUMMING 39
122 use of object as signifier, and Lacan’s work revolves entirely around
2 this understanding of the centrality of the signifier in the construction
3 of the subject, although he does not have Milner’s facility for intuiting
4 feeling or for understanding the corporeal.
5 The ludic as an undiscovered dimension of the real was undoubt-
6 edly the empire of Donald Winnicott and Marion Milner, and yet
7222 neither they nor their colleagues ever tried to claim “ownership” or
8 mastery of this empire, understanding it as the privilege of childhood
9 and their work as the privilege of perceiving and understanding it.
10
1
E-merging
2
3 The third concept, the emergence of self from not self, or the
4 significance of the “pre-oedipal” to oedipal structures of subjectivity,
5222 is related to the two concepts discussed above. The framed gap is,
6 in a sense, a symbol of the process through which a subject emerges
7 from the state of being merged, but for this to make any sense, there
8 needs to be an understanding of Milner’s emphasis on the process
9 of emergence, which is often described as part of Milner’s clinical
20 practice, but not limited to it. For example, writing about her friend,
1 mentor, analyst and colleague Donald Winnicott for a memorial
2 meeting at the British Psycho-Analytical Society in 1972, Milner said,
3 “During the war I had shown him a cartoon from the New Yorker.
4 It was of two hippopotamuses, their heads emerging from the water,
5 and one saying to the other, ‘I keep thinking it’s Tuesday.’ It was
6 typical of him that he never forgot this joke” (Goldman, 1993, p. 117).
7 Years later, Milner reflected that the shared joke conveys many of
8 the preoccupations of her work throughout her life, “the threshold
9 of consciousness, the surface of the water as the place of submergence
30 or emergence”. Of course Winnicott’s capacity for understanding the
1 wordless dialogues of infants and mothers was the product of
2 decades of systematic observation as hospital paediatrician, not just
3 of the pursuit of the Zen-like “absent-mindedness of reverie”, but
4 Milner also writes of the need for a “space for absent-mindedness”,
5 a kind of thinking that, having mastered realism, can nevertheless
6 disengage from it and enter a space in which thought does not
7 depend on a marked separation between subject and object, or
8 different types of object, such as days of the week. For analysts, the
922 named days of the working week are perhaps even more significant
39
40 CLAIRE PAJACZKOWSKA
than for other workers as the names can signify the “frame” of the
setting that, at times, may be the only demarcation between psychosis
and reality. Following patients as they regress to dependence can
exert pressure or strain on the boundaries of the analytic setting,
which is in place precisely to offer the analyst and analysand protec-
tion from the fear of becoming merged.
The joke and its image also anticipate another aspect of Milner’s
contributions to the theory of art and culture: her concept of a
medium as the third term which enables the co-existence of two
different realities. The meeting of inner and outer worlds in play
takes place through the medium of the toys; the meeting of conscious
and unconscious thoughts in art takes place through the medium
of the materiality of the artwork: narrative, words, song, musical
sound, paint, clay or other material is simultaneously substance and
communication. For Milner, the concept of medium has some of the
meaning of Winnicott’s concept of culture as transitional space, a
third term enabling triangulation and the co-emergence of ideas of
one, two and three.
According to Milner, the state of mind that exists when emergence
is taking place is not only one of mental structuration, such as the
dawn of self consciousness, or the birth of the subject; it is also
one of distinctive emotion and feeling. This she describes as ecstasy,
the emotional experience of sudden discovery of inner space and
limitlessness, and an intense capacity for concentration. She traces
the minute transformations and fluctuations in the quality of
concentration in her child patients as they move through different
predicaments, and intuits a pattern in the quality of concentration.
Interestingly, she does not then classify this quality into different
“types” of, say, libidinal genres, obsessional, hysteric, paranoid, and
so on, but is interested in what the state of mind means to the subject
as a unique experience.
Milner’s work does include references to schizophrenia, especially
in her case study of “Susan”, the young woman Winnicott asked her
to analyse, but the classificatory system of psychoanalysis is also
something Milner wanted to subject to analysis. She writes in 1987
that if she were to write another paper, it would be on the use and
meaning of the word “mad” as it is used colloquially and clinically.
Milner’s concern for exactness in using concepts impelled her to
research the psychoanalytic accounts of mysticism, a discourse in
40
ON HUMMING 41
122 which the concept of ecstasy is also used. Her essay includes an
2 interesting review of Bion’s writing on the concept of “O”, which is
3 not unlike the idea of the “framed gap”, and she is able to distinguish
4 her thoughts from his on the grounds that whereas Bion equated
5 mysticism with genius, Milner thought that while genius may share
6 some characteristics with mysticism, the two are not synonymous.
7222 In this study she notes her interest in Lao Tzu’s Zen writings, the
8 Tao Te Ching:
9
10 He who knows the masculine and yet keeps to the feminine
1 Will become a channel drawing all the world towards it,
2 And then he can return to the state of infinity,
3 He who knows the white and yet keeps to the black
4 Will become the standard of the world. [Milner, 1987, p. 262]
5222
6 Milner is interested in the mystical Zen ideal of “absolute vacuity”,
7 whether or not this is equivalent to a state of massive denial,
8 and whether Bion’s idea of letting go of “memory and desire” is an
9 appropriate one for the analytic setting. My sense is that the reference
20 to the philosophy of the Far East functions as a way of reframing the
1 Western philosophical tradition’s conception of gender difference.
2 As a way of reframing the constrictive definitions of masculinity and
3 femininity inherent in the Freudian conceptual apparatus, the
4 “otherness” of another culture enables Milner to reconceive gender
5 without having to become confrontational or adversarial in relation
6 to canonical thought. Both Milner and Winnicott went on to make
7 some extraordinarily fertile and generative insights into the primary
8 femininity of creativity, and their thinking about the play of sexual
9 difference in creativity could not have been formulated within the
30 Freudian framework of western binary differentiation.
1 In the references to black and white Milner refers to her
2 analysands’ use of black paint in their art, differentiating between
3 the bad black and the good black. There is a sense in which the colour
4 black connotes death and another boundary or framed absence
5 which is also fertile and generative. There are, she maintains, levels
6 of experience described in mysticism that closely correspond to
7 states of mind encountered in analysis, and that are not adequately
8 described in the scientific literature. The reformulation of femininity
922 beyond the conventions of rather normative, pre-feminist authority
41
42 CLAIRE PAJACZKOWSKA
42
ON HUMMING 43
43
44 CLAIRE PAJACZKOWSKA
case with the child’s actions and speech, adding Klein’s comments
on the significance of the child’s behaviour. The supervisor’s
comments were directed to the analyst, and they show a single-
minded focus on Klein’s idea of what is taking place in the child’s
unconscious phantasy. This appears, even then, as existing in tension
with Milner’s own intuitive method of following, empathically, the
child’s experience of inner conflicts, and of her changing states of
mind. Not insensitive to Klein’s ideas, Milner, like Winnicott, was
able to integrate an understanding of the significance of early infancy
and the child’s relation to its mother, in reality and in phantasy, as
a central component of her method and her understanding.
There is still a wide readership for her early books On Not Being
Able to Paint (1950) and An Experiment in Leisure (1937), both of which
are written for a wide readership, without explicit reference to
psychoanalytic theory, but with much implicit use of the experience
of being in analysis.
Milner is used today in order to understand creativity as a primary
activity, neither derived from cultural conventions nor sublimated
instincts or unconscious impulses. The understanding of the primacy
of object relations as part of human maturation and psychological
development means that the human need to draw, write, sing, dance
and communicate is seen as something directed to an “other”, but
also—and equally—to a self. In fact the need to communicate is a
product of the space that gradually emerges as being experienced
as a space “in between”, neither self nor not-self. And it is the
formulation of the meaning and significance of this space “in
between” that is characteristic of the contribution of Marion Milner
to the British psychoanalytic tradition. Like Winnicott, there is a
constant recourse to the inner connection of certain kinds of
emotional and psychological truths learned from years of meticulous
clinical work, and a special interest in the space “between” what they
are experiencing in their work and what is written up in “the litera-
ture”. Through reading Milner the reader wonders if it is possible
to speak or write of an experience that is always before and beyond
words, and it is something in the quality of Milner’s writing that
makes this question possible for the reader.
In her most popular book, Milner speculates on the meaning
of not being able to paint and invites readers to recognise the
significance of spontaneously making symbolic or cultural forms for
44
ON HUMMING 45
45
46 CLAIRE PAJACZKOWSKA
46
ON HUMMING 47
47
48 CLAIRE PAJACZKOWSKA
and its creativity cannot be sought, it can only be found. And that,
paradoxically, is what Milner was saying.
References
Freud, S. (1917). Introductory Lectures on Psychoanalysis. SE, 16. London,
Hogarth.
Goldman, D. (1993). In: One’s Bones: The Clinical Genius of Winnicott.
Northvale, NJ: Aronson.
Kohon, G. (Ed.) (1986). The British School of Psychoanalysis: The Independent
Tradition. London: Free Associations.
Mannoni, M. (1970). The Child, His Illness and the Other. London: Tavistock.
Milner, M. (1937). An Experiment in Leisure. London: Chatto & Windus.
[Virago, 1988]
Milner, M. (1950). On Not Being Able to Paint. 2nd ed. London: Heinemann,
1957.
Milner, M. (1987) The Suppressed Madness of Sane Men. London: Routledge.
Rayner, E. (1991). The Independent Mind in British Psychoanalysis. London: Free
Associations.
Rodman, F.R. (2003). Winnicott: Life and Work. Cambridge, MA: Perseus
Publishing.
48
122 CHAPTER FOUR
2
3
4
5
6
7222 Being and sexuality: contribution
8
9
or confusion?
10
1 Lesley Caldwell
2
3
4
I
5222 n her early book, Psychoanalysis and Feminism (1974), Mitchell
6 argued for psychoanalysis as a theory able to explain the process
7 whereby men and women come to internalize difference as
8 oppression. In tackling this equivalence she was stating one of the
9 problems facing feminist theorizing of that time and arguing for
20 psychoanalysis as offering a way into why this might be so. In her
1 opening remarks at the Freud Museum conference that celebrated the
2 book’s twentieth anniversary, she said, “What we as feminists asked
3 of Freud’s theory was the same question Freud was asking as a
4 male hysteric: What is a woman? What is the difference between the
5 sexes?” (1995) This was a reasonable and relevant question to ask,
6 especially since it was the one that allowed Freud “to formulate the
7 Oedipus complex and the castration complex as a sort of ‘answer’”.
8 But Mitchell went on to make a distinction between what can be asked
9 as a feminist, an activist, a theorist, and what can be asked as a
30 clinician, a position she identified as involving a technique of listening
1 and hearing in a particular way. Such a practice gives rise to different
2 questions. This discussion of Winnicott and, by extension, the
3 psychoanalytic world we have all inhabited, recognizes the questions
4 that were not, or have not been asked, of and about sexuality as it
5 manifests itself in the consulting room, and in clinical papers and
6 debate, and their implications for practitioners; it offers a tentative
7 engagement with the questions that can and must be asked.
8 In much of Winnicott’s clinical material, especially in The Piggle
922 (1977) and other examples of his work with children, in the extended
49
50 LESLEY CALDWELL
50
BEING AND SEXUALITY: CONTRIBUTION OR CONFUSION? 51
51
52 LESLEY CALDWELL
52
BEING AND SEXUALITY: CONTRIBUTION OR CONFUSION? 53
122 the derivative problem: born from different or born from the same.”
2 His account insists that not only Sophocles but Freud should be
3 included among all the recorded versions of the Oedipus myth (1977,
4 p. 217). “Although the Freudian problem has ceased to be that of
5 autochthony versus bisexual reproduction, it is still the problem
6 of understanding how one can be born from two: How is it that we
7222 do not have only one procreator, but a mother plus a father?” (ibid.,
8 p. 217) In this chapter, Lévi-Strauss acknowledges the shared
9 problems of human beings and their various attempts to find answers
10 to the unanswerable conditions of their existence.
1 In the bibliography compiled by Harry Karnac, twenty-one
2 volumes of Winnicott’s work, including Rodman’s edition of his
3 collected letters, The Spontaneous Gesture (1987), are listed. There are
4 two titles using psychiatry and clinical disorders and four including
5222 paediatrics and psychoanalysis, that is, six titles that include the
6
fields of professional expertise with which Winnicott was concerned
7
and that elucidate central areas of a research practice focused on
8
consultation and the consulting room. Two mention the outside
9
world, three explicitly link mothers and babies, one mentions parents,
20
five child or children, one home, three family, two development, one
1
deprivation and delinquency. The titles that explicitly mention
2
development link it with the family (The Family and Individual
3
Development [1965a]) and with the combination of environment,
4
5 individual and emotions (The Maturational Processes and the Facilitating
6 Environment: Studies in the Theory of Emotional Development [1965b]).
7 They form the foundations of an interest in development that is both
8 psychoanalytic and social. Then there are two titles calling up the
9 wider field of human existence, Playing and Reality (1971) and Human
30 Nature (1988). While titles do not necessarily denote a specific field,
1 taken together they are indicative, and it is the less technical titles,
2 grouped around “home”, “family” and “outside world”, that allude
3 to the areas Winnicott so stoutly insisted also had their place in
4 psychoanalytic practice and thought. It is easy to underestimate now
5 what was then almost certainly contentious in this extension of
6 psychoanalysis to the domain of everyday life, and his insistence on
7 its appropriateness and its necessity.
8 In the extensive historical, sociological and anthropological
922 scholarship on the “family”, families always involve relationships
53
54 LESLEY CALDWELL
that extend, possibly with different meanings and forms, across the
generations and across the sexes. They always involve more than one
person and imply a series of relationships, though those relations
may have been understood and lived differently in different eras.
Even in the late modern world, where a family may comprise single
sex parents who have adopted a child of the same sex, the intractable
facts of human existence demand that somewhere the biological
contribution of two sexes has been necessary. This further means that
at some time, for any and every child, the question of origins arises,
and of that child’s roots in a world which has preceded it. In the
psychoanalytic literature, and in that of the human and cultural
sciences, origins implicate bodies and bodily processes, but psy-
choanalysis insists upon the psychical implications of this state
of affairs and its centrality for any account of human subjectivity or
personhood. Fantasy, imagination, narrative and myth also provide
ways into wrestling with the big questions of human existence.
In the paper “Creativity and its Origins” (1971), reproduced with
extra clinical material as Chapter 8 of Psycho-Analytic Explorations
(1989), Winnicott sets out a statement about creativity in the section
entitled “The split off male and female elements to be found in men
and women” (my italics throughout):
Here Winnicott mixes, slips between registers: the basic division, sex,
and the ascription of sex to the two classes of humans, male and
female, is indicated first in the heading; then there are the actual
representatives of these two classes of humans, men and women;
then he introduces the adjectival form, masculine. There is no
necessary equivalence between these terms. In the clinical example
he reports, one of startling interest and insight, he further says:
“Something has been reached which is new for me. It has to do with
the way I am dealing with the non-masculine element [another,
different qualifier] of his personality” (p. 73). This is explained by
his interpretation and the exchange that follows.
54
BEING AND SEXUALITY: CONTRIBUTION OR CONFUSION? 55
122 DW: “I am listening to a girl. I know perfectly well that you are
2 a man, but I am listening to a girl. I am telling this girl: You
3 are talking about penis envy.”
4
The immediate effect was intellectual acceptance, relief. Then
5
the patient said, “If I were to tell someone about this girl I would
6
be called mad.”
7222
8
Winnicott took it further, which, he says, clinched the matter.
9
10
DW: “It was not you who told this to anyone; it is I who see the
1
girl and hear a girl talking when actually there is a man on my
2
couch. The mad person is myself.”
3
4 The patient replied that he felt sane in a mad environment.
5222
6 Winnicott explains that while this material tallies with work they
7 had already done, he begins thinking about it in a different way. At
8 the following Monday session, the patient reports that he made love
9 with his wife on Friday, and got an infection on Saturday. Winnicott
20 reports that he understood this as an invitation to interpret at the
1 psychosomatic level (an evasion of the psychic structure revealed in
2 the previous session). It is here, and in the following discussion, that
3 the complexity of the mental configuration referred to on the Friday
4 is elaborated.
5
6 “You feel as if you ought to be pleased that here was an
7 interpretation of mine that had released masculine behaviour.
8 The girl that I was talking to, however, does not want the man
9 released, and indeed she is not interested in him. What she
30 wants is full acknowledgment of herself and of her own rights
1 over your body. Her penis envy, especially, includes envy of you
2 as a male.” I went on: “The feeling ill is a protest from the female
3 self, this girl [my italics], because she has always hoped that the
4 analysis would in fact find out that this man, yourself, is and
5 always has been a girl (and “being ill” is a pre-genital pregnancy).
6 The only end to the analysis that this girl can look for is the
7 discovery that in fact you are a girl.” Out of this one could begin
8 to understand his conviction that the analysis could never end.
922 [1971, p. 75]
55
56 LESLEY CALDWELL
56
BEING AND SEXUALITY: CONTRIBUTION OR CONFUSION? 57
122 the female element, which does not seek, because the conditions of
2 seeking (awareness of and desire for the other, absence and loss) are
3 not yet in place; there is no separateness that makes this possible.
4 While this may be a further elaboration of his ongoing interest in the
5 development of the self, the attachment of these states to ideas of
6 “male” and “female” seems to fall into a cultural truism and a further
7222 endorsement of a theory of the need to be able to be before doing.
8 Winnicott seems to be trying to describe two attitudes, two ways
9 of relating to an object—and two ways that exist in sequence: first
10 being, then doing. One can be the object—Winnicott likens this to
1 primary identification—or one can do something for it: one can be
2 absorbed, immersed, or one can use it for some purpose. And the
3 object, of course, can be a person, or indeed a work of art. To call
4 these female and male elements may be neither here nor there:
5222 they do not need to be gendered, perhaps, to be of interest (Phillips,
6 2000, p. 44).
7 The real issue seems to me, here, to be how such an element,
8 whether pure or “contaminated” (but by what?), has played its part
9 in the evolution of the sexuality of the patient, and how this is
20 demonstrated in the ongoing dynamics of transference. With his
1 interpretation of himself as a mad mother, seeing a girl where, biolog-
2 ically and socially, there is a boy, Winnicott captures the complexity
3 of identifications at stake in this man’s first relationship, and their
4 grounding in the mental representatives of confused bodily images
5 developed through the gathering in, introjection and projection of
6 an initial imposition of desire, an unconscious message which, in the
7 world that cuts across both analysis and real life, registers around
8 sexuality, even when that sexual difference is harnessed in relation
9 to a model that proposes a different set of priorities for the neonate.
30 In the case discussed, the confusion of identities, of elements, of
1 the parts of the person called “girl” and “man”, and especially the
2 strength of the girl, and her desire to triumph, seemingly has little
3 to do with being and the female element, and everything, initially, to
4 do with the external and internal environment produced by the
5 mother, a woman who could not, or would not, see a baby boy, and,
6 even more, could not therefore relate to her baby’s early needs. To
7 think further about the implications, for the adult man on the couch,
8 of Winnicott’s recognition of his internalization of the wish of the
922 mother for something that he is not, and the strength of that “girl”,
57
58 LESLEY CALDWELL
and her desire to triumph, does open up a debate about the power
of the mother as caregiver in structuring the unconscious of the child,
and the adult, and its transferential implications.
To recognize the fundamental impact of the parents’ own
unconscious worlds on the child’s development links Winnicott
with Ferenczi and Laplanche, through the consistent, if differently
inflected importance each attributes to the parents’ unconscious
messages and the child’s attempts to make sense of them; this is the
importance, unconsciously, of the parents (in this case the mother)
as sexual. While Ferenczi and Laplanche overtly address the
importance of transgenerational transmission, the mother’s pathol-
ogy, and the impact of the parental unconscious for the possibilities
open to the infant, these issues are also there in Winnicott, as the
bedrock of a seemingly innocuous discussion of home and family.
The famous phrase “there is no such thing as a baby” may have
changed our thinking about babies, but it also invites some consid-
eration about the situation of the other/mother, for whom the
notion that there is no such thing as a baby (without a mother) may
potentially contain all kinds of emotions, many of them anxiety-
provoking and anything but reassuring. Useful and striking though
this idea has been, what it enables in thinking about babies, it may
correspondingly hamper and close down in thinking about mothers
(and by extension, practitioners).
A tentative step might be to say that, if Winnicott’s main concern
with women is with their status as mothers, and perhaps also, with
the implications for them, but more particularly, and certainly, for
their babies, of their immersion in that role, the sexuality of the
mother is overlooked. In the records we have, or at least those that
I know, the analysis of a mother does not appear; women as mothers
do not appear or speak as analytic patients, and women patients do
not discuss this status and its attendant problems—possibly because
they are not mothers. And yet the mother is almost never absent, is
indeed rather doggedly present in most British psychoanalysis.
“In terms of baby and mother’s breast (I am not claiming that the
breast is essential as a vehicle of mother-love) the baby has instinctual
urges and predatory ideas, the mother has a breast and the power
to produce milk and the idea that she would like to be attacked
by a hungry baby.” This statement from “Primitive Emotional
58
BEING AND SEXUALITY: CONTRIBUTION OR CONFUSION? 59
59
60 LESLEY CALDWELL
60
BEING AND SEXUALITY: CONTRIBUTION OR CONFUSION? 61
122 References
2
Adams, P. (1986). Versions of the Body. m/f, 11–12: 27–34.
3
Freud, S. (1923). The Ego and the Id. S.E., 19. London: Hogarth.
4
Laplanche, J. (1987). New Foundations for Psychoanalysis. Oxford: Basil
5
Blackwell.
6
Lévi-Strauss, C. (1977). The structural study of myth. In: Structural
7222
Anthropology (pp. 206–231). Harmondsworth: Peregrine.
8
Mitchell, J. (1974). Psychoanalysis and Feminism. London: Penguin.
9 Mitchell, J. (1995). Psychoanalysis and Feminism: 20 years on. British Journal
10 of Psychotherapy, 12: 73–77.
1 Phillips. A. (2000). Winnicott’s Hamlet. In: L. Caldwell, Art, Creativity, Living
2 (pp. 31- 48). London: Karnac.
3 Rodman, F.R. (Ed.) (1987). The Spontaneous Gesture: Selected Letters of D.W.
4 Winnicott. London: Karnac.
5222 Rose, J. (2004). On Not Being Able to Sleep. London: Vintage.
6 Winnicott, C., Shepherd, R., & Davis, M. (Eds.) (1989). Psycho-Analytic
7 Explorations. London: Karnac.
8 Winnicott, D.W. (1958). Through Paediatrics to Psycho-Analysis. London:
9 Hogarth, 1975.
20 Winnicott, D.W. (1965a). The Family and Individual Development. London:
1 Tavistock. [Routledge, 2006]
2 Winnicott, D.W. (1965b). The Maturational Process and the Facilitating
3 Environment. London: Hogarth. [Karnac, 1990]
4 Winnicott, D.W. (1966). The split off male and female elements to be found
5 in men and women. In: C.Winnicott, R.Shepherd & M.Davis (Eds.),
6 Psycho-Analytic Explorations. London: Karnac, 1989.
7 Winnicott, D.W. (1971). Playing and reality. London: Tavistock. [Routledge,
8 1982]
9 Winnicott, D.W. (1977) The Piggle: An Account of the Psychoanalytic Treatment
30 of a Little Girl. London: Hogarth.
1 Winnicott, D.W. (1986). Holding and Interpretation. London: Hogarth.
2 Winnicott, D.W. (1988). Human Nature. London: Free Association Books.
3
4
5
6
7
8
922
61
CHAPTER FIVE
T
he effects of maternal psychosis on babies and on their further
development have been widely studied since Winnicott’s
seminal article, published in 1959, and a number of studies
have contributed useful information (Anthony, 1969; Bourdier, 1972;
David, 1981; Lamour, 1989). In my hospital experience with patients
and their babies, I have been confronted with several questions:
Can an institution play a role in this type of therapy? What are the
effects of the type of psychosis involved? Is it useful, in terms of a
prognosis, to identify the psychic structure? What metapsychological
perspectives are opened up by this type of work?
“Institution” here is not to be understood only administratively
or legally, but rather as a symbolic organization (the “field of speech”,
as Maud Mannoni defined it, referring to José Bleger), a framework
in which the interventions of various protagonists take place and
have their meaning. It is obvious that the operation of the institution
in this sense cannot be reduced to the organization of a group of
health workers. An institution must be produced and a number of
discursive elements define it: utterances, signifiers, and the history
of the institution itself determine the place and actions of the various
protagonists. It cannot be defined merely as the model of the
Freudian crowd.
Both the administrative conditions and the orientation of the care
provided influence clinical practice, and in the service that provides
the focus of this article the psychiatrist was asked to provide a
response in line with the elements of predictability, a forecast which
62
CLINICAL EXPERIENCE WITH PSYCHOTIC MOTHERS 63
63
64 ALAIN VANIER
64
CLINICAL EXPERIENCE WITH PSYCHOTIC MOTHERS 65
122 Authors who have dealt with these issues most often recommend
2 a very early separation from the child, given the deadly components
3 of the initial relationship. For Françoise Dolto, however, such mothers
4 have to be given support, and their children should be allowed to
5 see them: “They chose the mother they have. If mother and child hit
6 it off right, they can make do. Who knows if the observed behaviour
7222 isn’t in line with the potential inner development of the child?” What
8 is needed is support for the relationship. But the child also has to be
9 told: “You’re right. What your mother just told you, or just did, isn’t
10 good for you. But she acts like that because she’s sick in her head.”
1 Dolto stresses that although the child should see the mother, these
2 mothers should not be too present for the child because “even in her
3 motor reflexes such a woman mediates a deadly disorder”. That is,
4 the death drives of the psychotic are transmitted directly to the child,
5222 who serves as a continuous boosting mechanism for the mother, so
6 that the danger for the child of a psychotic (or neurotic) mother
7 is that the child may become the mother’s first psychoanalyst or
8 psychotherapist. The child pumps up the mother and very soon
9 becomes hypertonic trying to stimulate the mother who, because of
20 psychosis, depression or medication, is unresponsive and has too still
1 a face.
2 These are mothers who have a difficulty with separation (for
3 example, Winnicott’s Esther), but we can work with them either to
4 tolerate real separation, where the child goes to another institution,
5 or to accept symbolic separation: the baby is not a part of her.
6 The mother and child should be separated, since the mother’s
7 behaviour and care can be very dangerous for her child; but on the
8 other hand, it is just as dangerous for the child not to see its mother.
9 The child should “be told about the abnormality that makes it
30 impossible for it to be left with its mother. For this reason, the person
1 who provides care for the child must be sufficiently maternal to
2 agree to see a woman who, for example, does not acknowledge her
3 child” (Dolto, 1988/1993). These tensions are also reproduced in the
4 practices of the institution because the teams that take care of a
5 mother are not the same as those that take care of a child. There is
6 conflict between parts of the institution deriving from the various
7 identifications of the therapeutic staff.
8 Our work during the very first months after birth recognizes that
922 a stay in an institution can develop the link between the mother and
65
66 ALAIN VANIER
the child and allow for the work to be done that makes separation
possible. Separation takes place at several levels. If necessary, it can
be a real separation, or it can be a potential separation, allowing the
mother to tolerate the emergence of a difference, a subjective
recognition of the child inside its initial relationship. Whichever it
is, the separation is part of the link between mother and baby and
should not be confused with a complete break.
Ms H is an African patient sent to us by the home where she was
staying temporarily. She already had a four-year-old in care. She was
being treated on an occasional basis by a psychiatric team and by
the child-care centre which had taken in her older child. Ms H had
just given birth to a baby girl, who arrived with her. She gave the
baby her own first name, which meant that, since the baby had not
been recognized by the father, she bore exactly the same name as
her mother. From the outset, then, there was a confusion with respect
to the chronology of generations. We have been surprised by the
frequency of identical first names, by a familial identification through
first names more generally, which reveals the narcissistic basis of the
relation of mother to child, a narcissistic investment along the lines
of a total double. We could speak of a seamless mirror relationship,
lacking nothing, leaving no room for the recognition of otherness.
Such a mirror relationship is marked by a number of symptoms
involving the gaze.
The family name allows for an inscription in the register of
genealogical succession and thus for the staking out of a symbolic
place. In this respect, the name refers to an origin which could be
mythical, as in the case of the most famous French aristocratic
families. The Lusignan family, for instance, claimed descent from
the fairy Mélusine, the Bourbons from Hercules, and so on. On the
mother’s side, the biological side, there is no real bloodline in the
symbolic sense, the kind that dispels doubt through the bestowal
of a name. However, for the mother, the origin is certain, being
biological, and can be equated to a unicellular being. In the first
instance, we have an origin that can be expressed only as a myth; in
the second, we have a demythicized real. The first name, however,
does not play the same role as the family name. It allows for the
inscription of a different generation.
Just before being hospitalized, Ms H invited her own mother over
from Africa. Her mother returned to Africa once she was admitted,
66
CLINICAL EXPERIENCE WITH PSYCHOTIC MOTHERS 67
122 and once her baby was born, Ms H displayed a very ambivalent
2 relationship with her daughter, not wanting to be separated from
3 her, since this might invalidate her as a mother. From the first
4 meeting, Ms H’s behaviour was very erratic. She would make bizarre
5 statements, stop speaking for no apparent reason, and avoid looking
6 anyone in the eye. She could not look at us when she spoke, nor could
7222 she look at her baby. She would give her baby the bottle with a certain
8 aloofness: the baby would lie on her mother’s bed and the mother
9 would stand next to the bed, staring at the floor. She would give the
10 bottle with her arm stretched out straight, or she would prop the
1 child up with cushions, so she could drink from the bottle by herself.
2 The shutters would be closed and the curtains drawn all the time.
3 Ms H’s comments revealed the beginnings of a surveillance delirium.
4 Her baby would be wrapped naked in blankets. Most of the time,
5222 she would lie on the bed propped up against her mother, or in a crib
6 on the other side of the room. On the first day, the paediatric nurse
7 who took care of the baby wrote: “The baby does not drink much
8 from the bottle and sleeps a lot. I told the mother to watch the bottle
9 and not the baby, which she agreed to do, but she needs me to be
20 there.”
1 Right away, we asked Ms H to leave the child at the nursery. We
2 told her that the child could sometimes be with her in her room, but
3 we also asked her to come to the nursery to take care of her. This
4 meant that there would be a third party present, the paediatric nurse,
5 who could speak to Ms H with the baby present, and speak to the
6 baby with her mother present. To protect her baby from her murder-
7 ous feelings, Ms H began handing the child over more and more
8 often to the paediatric nurses, and the baby soon showed fewer signs
9 of what at first had been cause for concern. During her stay, Ms H
30 gradually began playing with the distance that she had created
1 between herself and her baby, but distance alone could not protect
2 her completely. Something more was needed. If creating a distance
3 had sufficed to regulate the relationship, we would have found
4 ourselves faced with a phobic solution for a problem that is at another
5 level altogether.
6 A month later, the paediatric nurse wrote: “I put the baby in her
7 arms with the baby facing her. She looks at the baby, speaks to her,
8 calls her ‘my honey bun’. The baby, who previously had slept poorly
922 and drunk little, now looks you in the eye and listens when you speak
67
68 ALAIN VANIER
68
CLINICAL EXPERIENCE WITH PSYCHOTIC MOTHERS 69
122 this actually happened. She did phone later but seemed to care very
2 little about the proceedings.
3 The second patient, Ms A’s, psychosis was diagnosed not as
4 schizophrenia but as paranoia. Rather than a lengthy description, we
5 will give only a few details of her case.
6 Ms A was over 40 years old, and this was her first baby. Her
7222 pregnancy was unexpected, but she seemed extremely happy about
8 it. She presented a significant persecution delirium, very systematic
9 and rather stable, which revolved around the government adminis-
10 tration where she had been employed. The delirium fed on intuition
1 and interpretations, but we did not observe any hallucinatory states.
2 Her stay at the hospital service, which began long before delivery,
3 took place in a near euphoric atmosphere: the space was well
4 protected; her persecutors could not get in. The future father was
5222 very present but also very odd. He recognized the child before its
6 birth but disappeared for a time when Ms A left the hospital.
7 After giving birth, Ms A no longer felt safe at the hospital. The
8 day after the delivery, she spotted a white truck in the car park.
9 There was no doubt in her mind that the truck belonged to her
20 persecutors, so the centre was not impenetrable and people could
1 get in. She went through a very agitated period in which she called
2 the police and had them come to the hospital and to her parents’
3 place because she felt that they too were in danger; this also related
4 to questioning her filiation. She barricaded herself in her room.
5 Although I was the only one she let in, she still kept up a satisfactory
6 relationship with the staff. She agreed that her baby should be in the
7 nursery as often as possible and even asked for this to be done, while
8 she herself remained barricaded in her room. In her mind, the baby
9 was not threatened by her persecutors.
30 At this point we might do well to consider the idea posited by
1 some authors about the involvement of a child in a delirium. In Ms
2 A’s case, the child was not totally excluded from it, but the danger
3 would appear only after puberty. The little girl stayed at the nursery,
4 and her mother started coming more and more often to take care of
5 her, something she did particularly well. The relationship was not
6 an especially affectionate one, but the care Ms A gave her child was
7 good enough for the child not to present any obvious problems. Ms
8 A explained her lack of affection by saying that she could imagine
922 her child only as a teenager. She began telling us about her numerous
69
70 ALAIN VANIER
fears concerning the future of her baby. She was worried about who
her friends would be, about what might happen during after-school
hours. She was worried about substance abuse, possible delinquency,
and, of course, what her persecutors might want to do to her.
Speaking about her baby in the here and now, she said, “She’s like
a toy poodle.” She expressed surprise that there was any point in
talking with her child, but she did it anyway; she was proud of her
baby and loved to show her off to everyone.
In this type of delirium, the child is not so much a double as an
ideal. This supposes that the ideal process, which does not happen
in all types of psychosis, is in place and functioning. The first name
that she chose for the child supports this. Her family name is the
same as that of a very famous actress, and Ms A gave her child
the actress’s first name. The only hitch was that since the father
recognized the child, the duplication of names became impossible.
To counteract this, Ms A said that she planned to have the father’s
name cancelled.
Depending on Ms A’s mood, the hospital provided more or less
adequate protection against her persecutors, whom she saw milling
around outside the entrance, in the car park, and so on. She was very
relieved the day she went to meet a family court judge to request
protection for herself and her daughter, and came back from the
meeting reassured that her child was no longer in jeopardy.
In the cases described briefly above, the institution functioned
as a third party that provided security first and foremost. When the
mother feels endangered, or becomes dangerous for the child, the
institution does indeed offer effective protection, but it also allows
for a possible readjustment of the situation. This starts with a gradual
distancing of the mother and child, but without depriving the mother
of her imagined control, since she can still control the child by issuing
orders to the staff.
But the institution intervenes as a third party on another level.
This third party is missing not only in reality—we are dealing very
often with single mothers, the father being unwilling to recognize
the child—but because of the mother’s pathology. It is precisely this
third element, needed for the structuring of a subject, that the mother
is unable to provide. In a way, the institution’s rules for everyday
life, along with the staff’s presence, provide a basis for something
which can function both as an intermediary and symbolic element
70
CLINICAL EXPERIENCE WITH PSYCHOTIC MOTHERS 71
122 for the child, and as a prosthesis of the ego, a narcissistic support
2 for the mother in the particularly difficult relation she has with her
3 child. Here we see the possibility of a real “holding” of the mother
4 and the child, organized very flexibly in the daily life of the clinic.
5 But the term “holding” does not suffice to account for everything
6 taking place, unless we give “holding” all of Winnicott’s meaning.
7222 Mediation is more than holding, more than what is seen in the ways
8 the child is held.
9 The time spent in the clinic does not necessarily end in separation.
10 Often the clinical environment seems to be a determining factor in
1 the future association of mother and child. The environment is
2 not only the maternal field, it also includes the mother; it is the
3 space within which the relations between the mother and child
4 are organized. Even when such an environment exists, the issue of
5222 separation is still crucial, so our work does not end with actual
6 separation. Sometimes the mother and child can return to the family
7 home, and our work has created a place where the third fundamental
8 element could inform the home environment. The period of
9 separation, that first, archaic attempt, was the determining moment.
20 Our experience shows that for psychotic mothers, birth, properly
1 speaking, does not in itself constitute a break; the actual separation
2 of bodies is not a separation in the symbolic sense.
3 There is a particularly difficult moment to negotiate in the mother-
4 child relationship. Winnicott remarks upon this in a paper in which
5 he talks about Esther. Esther’s mother, a psychotic, was taking care
6 of her child all alone during the first months of her life, and soon
7 started acting strangely. After a sleepless night, she began to wander
8 in a field near a canal, stopping to watch a retired police officer dig
9 a hole. She then headed for the canal and threw her baby into it.
30 Although everything here is of importance, we will not comment on
1 the police officer, but on the baby’s having been thrown, dropped—
2 it is relevant to note that the fact that the baby was “dropped” refers
3 us back to how a baby functions as an object, a special kind of object
4 that Lacan called the “object a”. Winnicott refers to the baby as an
5 object and remarks that if the baby is not held it will fall “infinitely”
6 (Winnicott, 1957). For Lacan, the baby has the status of an “object a”
7 for the mother. This includes separation, provided that the object is
8 phallicized, that is, referred to in terms of a lack. This supposes a
922 third position in the mother-child relation, a position that causes
71
72 ALAIN VANIER
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CLINICAL EXPERIENCE WITH PSYCHOTIC MOTHERS 73
73
74 ALAIN VANIER
References
Anthony, E.J. (1969). Clinical evaluation of children with psychotic parents.
American Journal of Psychiatry, 126: 177–184.
Bergès, J. & Balbo, G. (1998). Jeu des places de la mère et de l’enfant. Essai
sur le transitivisme. Ramonville Saint-Agne: Érès.
Bourdier, P. (1972). L’Hypermaturation des enfants de parents malades
mentaux. Revue Française de Psychanalyse, 36/1: 19–42.
David, M. et al. (1981). Danger de la relation précoce entre le nourrisson et
sa mère psychotique, une tentative de réponse. La psychiatrie de l’enfant,
24/1, 151–156.
Dolto, F. (1993). Conversation. Entretien avec C. Mathelin et A. Vanier. In:
L’enfant et la psychanalyse. Paris: Esquisses Psychanalytiques.
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CLINICAL EXPERIENCE WITH PSYCHOTIC MOTHERS 75
75
CHAPTER SIX
W
innicott’s concept of “holding” and Bion’s idea of the
“container-contained”—though often used interchange-
ably in the psychoanalytic literature—to my mind, each
addresses quite different aspects of the same human experience and
involves its own distinctive form of analytic thinking. To blur the
distinction between the two concepts is to risk missing what is most
original and most important to the psychoanalytic perspectives
created by Winnicott and Bion.
I believe that the confusion regarding the concepts of holding and
the container-contained derives to a considerable degree from Bion’s
penchant for using words in a way that invents them anew (Ogden,
2004a). In Bion’s hands, the word “container”—with its benign
connotations of a stable, sturdy delineating function—becomes a
word that denotes the full spectrum of ways of processing experience
from the most destructive and deadening to the most creative and
growth-promoting.
In this paper I delineate what I see as the essential features of the
concepts of holding and the container-contained, and by juxtaposing
the two, illuminate some of the differences between these sets
of ideas. Throughout the discussion, it must be borne in mind that
the concepts of holding and the container-contained stand not in
opposition to one another but as two vantage points from which to
view an emotional experience.
76
ON HOLDING AND CONTAINING, BEING AND DREAMING 77
77
78 THOMAS OGDEN
78
ON HOLDING AND CONTAINING, BEING AND DREAMING 79
79
80 THOMAS OGDEN
80
ON HOLDING AND CONTAINING, BEING AND DREAMING 81
122 depends upon the analyst’s being able to tolerate the feeling “that
2 no analytic work has been done”. Winnicott demonstrates in the way
3 he uses language what he has in mind. In saying “Sometimes we
4 must interpret this as the patient’s need to be known in all his bits
5 and pieces by one person, the analyst”, Winnicott is using the word
6 “interpret” to mean not to give verbal interpretations to the patient,
7222 and instead, simply, uninterruptedly to be that human place in which
8 the patient is becoming whole.
9 This type of holding is most importantly an unobtrusive state of
10 “coming together in one place” that has both a psychological and a
1 physical dimension. There is a quiet quality of self and of otherness
2 in this state of being in one place that is not a part of the infant’s
3 earlier experience of “going on being” (while held by the mother in
4 her state of primary maternal preoccupation).
5222
6
Internalization of the holding environment
7
8 The experience of transitional phenomena (Winnicott, 1951) as well
9 as the capacity to be alone (1958) might be thought of as facets
20 of the process of the internalization of the maternal function of
1 holding an emotional situation in time. In transitional phenomena,
2 the situation that is being held involves the creation of “illusory
3 experience” (1951, p. 231) in which there is a suspension of the
4 question “Did you conceive of this or was it presented to you from
5 without? The important point is that no decision on this point is
6 expected. The question is not to be formulated” (pp. 239–40).
7 Winnicott views this third area of experiencing—the area between
8 fantasy and reality—not simply as the root of symbolism, but as
9 “the root of symbolism in time” (p. 234). Time is coming to bear the
30 mark of the external world that lies outside of the child’s control,
1 while at the same time being an extension of the child’s own bodily
2 and psychological rhythms. When the child’s psychological state
3 (whether as a consequence of constitutional make-up and/or trauma)
4 is such that he cannot tolerate the fear evoked by the absence of
5 his mother, the delicate balance of the sense of simultaneously
6 creating and discovering his objects collapses and is replaced by
7 omnipotent fantasy. The latter not only impedes the development of
8 symbolization and the capacity to recognise and make use of external
922 objects, but also involves a refusal to accept the externality of time.
81
82 THOMAS OGDEN
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ON HOLDING AND CONTAINING, BEING AND DREAMING 83
83
84 THOMAS OGDEN
addresses not what we think, but the way we think, that is, how we
process lived experience and what occurs psychically when we are
unable to do psychological work with that experience.
84
ON HOLDING AND CONTAINING, BEING AND DREAMING 85
85
86 THOMAS OGDEN
86
ON HOLDING AND CONTAINING, BEING AND DREAMING 87
122 thinking. Bion elaborated the idea that thoughts may destroy the
2 capacity for thinking in his essays that are collected in Second thoughts
3 (1967), most notably in “Attacks on linking” (1959c) and “A theory
4 of thinking” (1962b). There he introduced the idea that in the
5 beginning (of life and of analysis) it takes two people to think. In
6 stark contrast to Winnicott—who is always the paediatrician—for
7222 Bion, his ideas/speculations concerning the psychological events
8 occurring in the mother-infant relationship are merely metaphors—
9 ”signs” (1962a, p. 96) —that he finds useful in constructing a “model”
10 (p. 96) for what occurs at an unconscious level in the analytic
1 relationship.
2 The metaphoric mother-infant relationship that Bion (1962a,
3 1962b) proposes is founded upon his own revision of Klein’s concept
4 of projective identification. The infant projects into the mother (who,
5222 in health, is in a state of reverie) the emotional experience that he
6 is unable to process on his own, given the rudimentary nature of
7 his capacity for α-function. The mother does the unconscious
8 psychological work of dreaming the infant’s unbearable experience
9 and makes it available to him in a form that he is able to utilize in
20 dreaming his own experience.
1 A mother who is unable to be emotionally available to the infant
2 (a mother incapable of reverie) returns to the infant his intolerable
3 thoughts in a form that is stripped of whatever meaning they had
4 previously held. The infant’s projected fears under such circum-
5 stances are returned to him as “nameless dread” (1962a, p. 96). The
6 infant’s or child’s experience of his mother’s inability to contain his
7 projected feeling state is internalized as a form of thinking (more
8 accurately, a reversal of thinking) characterized by attacks on the very
9 process by which meaning is attributed to experience (α-function)
30 and the linking of dream-thoughts in the process of dreaming and
1 thinking (1959c, 1962a, 1962b).
2
3
Relocating the centre of psychoanalytic theory and
4
practice
5
6 When the relationship of container (the capacity for dreaming, both
7 while asleep and awake) and contained (unconscious thoughts
8 derived from lived emotional experience) is of “mutual benefit and
922 without harm to either” (Bion, 1962a, p. 91), growth occurs in both
87
88 THOMAS OGDEN
88
ON HOLDING AND CONTAINING, BEING AND DREAMING 89
89
90 THOMAS OGDEN
90
ON HOLDING AND CONTAINING, BEING AND DREAMING 91
91
92 THOMAS OGDEN
92
ON HOLDING AND CONTAINING, BEING AND DREAMING 93
93
94 THOMAS OGDEN
Concluding comments
At its core, Winnicott’s holding is a conception of the mother’s/
analyst’s role in safeguarding the continuity of the infant’s or child’s
experience of being and becoming over time. Psychological develop-
ment is a process in which the infant or child increasingly takes
on the mother’s function of maintaining the continuity of his
experience of being alive. Maturation, from this perspective, entails
the development of the infant’s or child’s capacity to generate and
maintain for himself a sense of the continuity of his being over time—
time that increasingly reflects a rhythm that is experienced by the
infant or child as outside his control. Common to all forms of holding
of the continuity of one’s own being in time is the sensation-based
emotional state of being gently, sturdily wrapped in the arms of the
mother. In health, that physical/psychological core of holding
remains a constant throughout one’s life.
In contrast, Bion’s container-contained at every turn involves
a dynamic emotional interaction between dream-thoughts (the
94
ON HOLDING AND CONTAINING, BEING AND DREAMING 95
122 contained) and the capacity for dreaming (the container). Container
2 and contained are fiercely, muscularly in tension with one another,
3 coexisting in an uneasy state of mutual dependence.
4 Winnicott’s holding and Bion’s container-contained represent
5 different analytic vertices from which to view the same analytic
6 experience. Holding is concerned primarily with being and its
7222 relationship to time; the container-contained is centrally concerned
8 with the processing (dreaming) of thoughts derived from lived
9 emotional experience. Together they afford “stereoscopic” depth to
10 the understanding of the emotional experiences that occur in the
1 analytic setting.
2
3
4 Notes
5222 1. I am reminded here of a comment made by Borges regarding
6 proprietorship and chronology of ideas. In a preface to a volume of his
7 poems, Borges wrote: “If in the following pages there is some successful
8 verse or other, may the reader forgive me the audacity of having written
9 it before him. We are all one; our inconsequential minds are much alike,
20 and circumstances so influence us that it is something of an accident that
1 you are the reader and I the writer—the unsure, ardent writer—of my
2 verses” (1964, p. 269).
3 2. I am indebted to Dr Margaret Fulton for drawing my attention to Poe’s
4 poem.
5
6
7 References
8 Bion, W. R. (1959b). Experiences in Groups. London: Tavistock, 1961.
9 Bion, W. R. (1959c). Attacks on linking. In: Second Thoughts. London:
30 Heinemann, 1967.
1 Bion, W. R. (1962a). Learning from Experience. London: Karnac, 1984.
2 Bion, W. R. (1962b). A theory of thinking. In: Second Thoughts. London:
3 Heinemann, 1967.
4 Bion, W. R. (1970). Attention and Interpretation. London: Tavistock.
5 Borges, J.L. (1964). Obra poetica.
6 Freud, S. (1900). The Interpretation of Dreams. SE 4–5.
7 Heaney, S. (1984). Clearances: In Memoriam M.K.H., 1911–1984.
8 Ogden, T. (1980). On the nature of schizophrenic conflict. Int. J. Psycho-Anal.
922 61: 513–533.
95
96 THOMAS OGDEN
96
122 CHAPTER SEVEN
2
3
4
5
6
7222 The virtues of Anna Freud
8
9
10
Some considerations on the technique of child
1
analysis and the importance of the developmental
2
dimension, based on two of her posthumous
3
papers and a letter: an appreciation of her
4
contribution as “quasi-Winnicottian”
5222
6 Vincenzo Bonaminio
7
8
I
9 n this piece I look at two posthumous and little-known papers
20 by Anna Freud, in order to offer some wider observations of my
1 own on her virtues as a clinician and researcher in the field of
2 child psychoanalysis. Both papers were published in a commemora-
3 tive issue of The Bulletin of the Hampstead Clinic (1983, vol. 6,
4 Part 1) a few months after her death in 1982. Neither has a place in
5 the body of her work that is best known and referred to, but it is my
6 view that they contain, in distilled form, many of the salient features
7 that have marked her contribution to child psychoanalysis and
8 psychoanalysis in general, and that they merit further close attention.
9 The first paper takes the unusual form of an excerpt. In it we find
30 the transcription of some comments she made during a series of
1 seminars on the technique of child analysis, given, together with Ruth
2 Thomas, for her colleagues and students at the Hampstead Child
3 Therapy Clinic in 1965.
4 The reader will notice from the discontinuous flow and truncated
5 formulation of the themes, and the abrupt succession of paragraphs
6 into which they are edited, that these are impromptu remarks on
7 clinical material presented in the seminars, along with observations
8 and requests for clarification made by the participants, most likely
922 by the students. For these reasons it is by no means a text that reads
97
98 VINCENZO BONAMINIO
98
THE VIRTUES OF ANNA FREUD 99
122 the child take home the toys from therapy?” “Are we allowed to
2 answer the child’s questions?” These seem to be the questions which
3 stand behind some of the headings in this paper, questions arising
4 from the audience in the seminars, or stemming from day-by-day
5 interaction with trainees in child analysis. There is no doubt that this
6 constant barrage can be embarrassing, but provided one has been
7222 able to create a facilitating environment for the students, such questions
8 have the right to exist.
9 Anna Freud is there with her answers. It is not their content that
10 matters so much as the fact that they indicate the existence of a space
1 in which those questions could be asked. It is certainly possible to
2 disagree with some of her opinions, and from time to time there are
3 hints of an idea of child analysis that harks back to its pedagogical
4 origins, but I don’t think there is one single other piece of writing
5222 from the literature on the techniques of child analysis in which
6
questions of this kind are tackled with so much head-on immediacy
7
and such salutary resourcefulness. At the same time, while “direct”
8
answers to such questions are given, she warns that
9
20
the great danger is . . . to make too many rules . . . [which] block
1
the way . . . You have to use your own judgement . . . and do
2
what you think will bring you nearer to the meaning . . . This
3
means that you are much safer if you have no general answer of
4
5 this kind. And if the answer were printed in a book—that if a
6 patient asks you for play material, always supply it—this wouldn’t
7 be a help, it would be a hindrance to your finding out why it is
8 asked. Whereas if you know that what you want is to know why
9 the patient asks, you will try this and that and the other until you
30 have got the meaning. [1983a, p. 116]
1
2 In my view this is an exceptional piece of psychoanalytic technique
3 in vivo: on one level, we see that Anna Freud says that as a child
4 analyst one has to stick to the concreteness of what the child is asking
5 for, it cannot be bypassed if one wants to “get the meaning”, the two
6 things go hand in hand. On another level, she is herself in the very
7 same position as she is describing to her students. She carefully
8 listens to their questions, picks them up as concretely as they have
922 been asked, allows space for such questions, and at the same time
99
100 VINCENZO BONAMINIO
100
THE VIRTUES OF ANNA FREUD 101
101
102 VINCENZO BONAMINIO
102
THE VIRTUES OF ANNA FREUD 103
122 . . . it is only in recent years that I have become able to wait and
2 wait for the natural evolution of the transference arising out from
3 the patient’s growing trust in the psychoanalytic technique and
4 setting and to avoid breaking up this natural process by making
5 interpretations. It will be noticed that I am talking about the
6 making of interpretations and not about interpretations as such
7222 . . . It appals me to think how much deep change I have prevented
8 or delayed in patients in a certain classification category by my
9 personal need to interpret. If only we can wait, the patient arrives
10 at understanding creatively and with immense joy, and I now
1 enjoy this joy more than I used to enjoy the sense of having been
2 clever. I think I interpret mainly to let the patient know the limit
3 of my understanding. [1969]
4
5222 This radical shift of accent toward the analyst’s side of the
6 interpretive function is purely Winnicottian: it is Winnicott’s original
7 contribution to the subject, one that has its own internal development
8 starting from his early writings. I have tried to show this elsewhere
9 in discussing his conception of interpretation in psychoanalysis
20 (2001), so I do not mean here that we should make this comparison
1 of Anna Freud’s and Winnicott’s positions too close; differences
2 are to be recognized, and Anna Freud’s classical conception of
3 interpretation is miles away from Winnicott’s. Notwithstanding
4 this, I think we can appreciate a further similarity between them if
5 that genuine clinical attitude towards the patient that I was referring
6 to above, and not a prejudicial schematization, is seen in her
7 contribution to technique.
8 Let us continue to read a few lines more from this paper. As
9 Winnicott considers the risk that the analyst’s “need to interpret”
30 may be “preventing deep change” in the patient, so does Anna Freud
1 when she affirms that
2
3 it is a great danger to get a child accustomed to a constant
4 flow of interpretation, which to him becomes a sort of nagging
5 so that he listens to it as little as to the nagging of a nagging
6 mother. It becomes a sort of translation game . . . Interpretations
7 thrown at the child indiscriminately are a great mistake . . . The
8 interpretation of symbolic material as such is a very doubtful
922 matter anyway, because it is usually meaningless to the child.
103
104 VINCENZO BONAMINIO
104
THE VIRTUES OF ANNA FREUD 105
105
106 VINCENZO BONAMINIO
106
THE VIRTUES OF ANNA FREUD 107
122 ought to be able, every now and then, to take off his or her own
2 psychoanalytic spectacles and take a long-sighted, somewhat
3 distanced view of the clinical material that the child brings to the
4 psychoanalytic relationship, so as to be able to grasp its overall
5 pattern and give it a new, more complex meaning.
6 By analogy, I think that the distance separating us from those
7222 heroic days of the controversial debates and current developments
8 in psychoanalysis offers us an overall view of Anna Freud’s
9 contribution to the psychoanalytic study of children and adolescents.
10 Thus we will inevitably grasp its richness, its articulacy, complexity
1 and rigour, and we will simultaneously see in it the roots of many
2 contemporary trends in psychoanalytic research on the development
3 of the individual. Take, for example, her seminal essay of 1945,
4 “Indications for Child Analysis”. Starting with the title, this paper
5222 should, in my view, be regarded a posteriori as a kind of program-
6
matic declaration of what were to be the subsequent directions of
7
her clinical research. She concludes: “In the foregoing pages an
8
attempt has been made to find indications for the therapeutic use of
9
child analysis not so much in the neurotic manifestations themselves
20
as in the bearing of these manifestations on the maturation processes
1
within the individual child. Emphasis is shifted thereby from the
2
purely clinical aspects of a case to the developmental aspect” (1945,
3
p. 37). Assessing Anna Freud’s psychoanalytic legacy, a paper by
4
Anne-Marie Sandler (1996) focuses in particular on the concept of
5
6 developmental disturbance. This is a clinical topic of considerable
7 relevance and timeliness, one that has its roots in the emphasis Anna
8 Freud always placed on the importance of psychoanalytic diagnostic
9 evaluation.
30 Before dealing briefly with this statement in more general terms,
1 I would like to suggest also reading it in terms more strictly inherent
2 in the therapeutic process with a single child in analysis. The shift
3 in emphasis from the purely clinical aspects to the developmental
4 ones also brings with it the vast subject of adapting analytic technique
5 not only to the various phases of the child’s and adolescent’s
6 development (a classically Anna Freudian topic) but also to the
7 various states of integration of the self and of mental functioning (as
8 we would put it nowadays) with which one might say the child
922 enters into analysis and with which we as analysts are faced.
107
108 VINCENZO BONAMINIO
108
THE VIRTUES OF ANNA FREUD 109
109
110 VINCENZO BONAMINIO
of the humanising process] . . . are taken all too much for granted as
mere consequences of growth and maturation.”
From this point on, in that dry, immediate style of hers, with that
exemplary clarity of exposition that distinguishes all her work, and
with the essential rigour of her theoretical and clinical thinking, Anna
Freud asks herself, her audience and her readers questions that even
today beneficially disrupt our certainties and what we take for
granted about psychoanalytic knowledge about children: “Is there a
consensus about the age when the developmental steps toward
recognition of danger are finally taken? Or, more meaningfully, how
long does a child advanced in motor skills outstrip his appreciation
of potential damage? What is the relation of this to a boy’s natural
wish for adventure heroism and athletical prowess?” (1983b, p. 111).
It is all the harder to gainsay the relevance of these questions if
we consider them, as I believe we must, not just as pertinent features
of the theory of the development of narcissism and the self as well
as the object relationship, but most of all as live questions which
confront the child or adolescent analyst and therapist in the various
forms whereby transference unfolds and evolves with their patients,
who are first and foremost individuals in the process of development
and change.
References
Bion, W.R. (1961). Experiences in groups and other papers. London: Tavistock.
Bonaminio, V. (1993). Il concetto di alleanza terapeutica nella psicoanalisi
infantile. Richard e Piggle, 1: 75–78.
Bonaminio, V. (2001). Through Winnicott to Winnicott. Notes on manic
defences, withdrawal and regression, and interpretation in Psychoanalytic
explorations. In: M. Bertolini, A. Giannakoulas, M. Hernandez (Eds.),
Squiggles and Spaces: Revisiting the work of D. W. Winnicott, Volume 1.
Philadelphia and London: Whurr.
Freud, A. (1930). Four Lectures on Psychoanalysis for Teachers and parents.
In: The Writings of Anna Freud, I (1922–1935). London: Hogarth, 1974.
Freud, A. (1945). Indications for child analysis. In: The writings of Anna Freud,
IV (1945–1956). London: Hogarth, 1969.
Freud, A. (1965). Normality and pathology in childhood. In: The writings of
Anna Freud, VI (1965). London: Hogarth.
Freud, A. (1983a). Excerpts from Seminars and Meetings: The Technique of
Child Analysis. The Bulletin of the Hampstead Clinic, 6: 115–128.
110
THE VIRTUES OF ANNA FREUD 111
122 Freud, A. (1983b). The Past Revisited. The Bulletin of the Hampstead Clinic, 6:
2 107–113.
3 Gampel, Y. (1994). Occhi che sentono e orecchie che vedono. Qualche
4 riflessione sulla formazione nell’analisi infantile. Richard e Piggle, 2: 26–36.
5 Sandler, A.-M. (1996). The psychoanalytic legacy of Anna Freud. The
6 Psychoanalytic Study of the Child, 51: 270–284.
7222 Wallerstein, R.S. (1984). Anna Freud: Radical Innovator and Staunch
8 Conservative. Psychoanalytic Study of the Child, 39: 65–80.
9 Winnicott, D.W. (1958). Child analysis in the latency period. In: The
10 Maturational Process and the Facilitating Environment. London: Hogarth,
1 1965. [Karnac, 1990]
2 Winnicott, D.W. (1969). The use of an object and relating through identi-
fications. In: Playing and reality. London: Tavistock, 1971. [Routledge, 1982]
3
4
5222
6
7
8
9
20
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2
3
4
5
6
7
8
9
30
1
2
3
4
5
6
7
8
922
111
CHAPTER EIGHT
A
t a heart clinic, in the early days of his career, Winnicott
began to note the response of children to situations of
anxiety: “an anxious child, during a physical examination
in a heart clinic, may have a heart that is thumping, or at times almost
standing still, or the heart may be racing away” (1941, p. 62).
The state thus described suggests that the child fears for its life.
In later works he was to describe what amounts to a fear of
annihilation and its attendant “unthinkable anxiety” (1962, p. 56).
And yet Winnicott’s philosophy of development is known mostly
for its hopeful aspects. For example, it was he who first highlighted
the infant’s resourceful use of the maternal object in the process of
creating and enriching a self. A sense of infantile potency permeates
Winnicott’s writings, intimating human abilities and possibilities in
the course of a troubled existence.
By comparison, Klein’s outlook on the human infant is thought
to be so dark as to lack basic optimism. Conflicted by nature, and
enviously attacking the very nurturing that sustains him, the human
infant is, at times, his own worst enemy. She shows his inner world
as regularly devastated by destructive rages; and ironically, at such
times, when he needs his objects most, he cannot—as Winnicott
seems to suggest—simply make use of them to recover. Projections
may have turned the very objects needed by the infant into perse-
cutors, thus exacerbating his sense of an isolated struggle.
Klein did suggest a more evolved psychic state in the depressive
position, and in her thinking it does bring the life-affirming discovery
112
COMPATIBLE OUTLOOKS? 113
113
114 MEIRA LIKIERMAN
concepts from each and use them within a single framework. Indeed,
the idea of two theories that retain a kinship and are close at source
in spite of their differences can make the prospect of such an
integration encouraging.
But what would such an integration mean? It would clearly
require more than selecting individual concepts from different
frameworks and placing them side by side. A concept wrenched
out of its theoretical context necessarily pulls with it a chain of
other assumptions and premises, and indeed would not make sense
without them. Concepts from different theories are properly
differentiated precisely by their contextual sense. This begins to
complicate the task of eclecticism. In addition, Winnicott did not
merely choose to disagree lightly with one or two Kleinian concepts
without shifting much in the way. In fact, some of his ideas were
intended to offer major challenges that would have required her to
re-adjust her thinking. Therefore, while a simple polarization of two
theories is reductive, so is the notion that an assortment of aspects
from each can be randomly united. While neither a polarization nor
a simple pick-and-mix is a satisfactory alternative, it is possible to
argue for a third option, that of complementarity. Indeed, there are
areas of theory in both Winnicott and Klein that could be drawn on
to create an intermediate, but theoretically and clinically useful area.
An area of this kind does not exclude the presence of both similar
and different aspects of theory; indeed, complementarity also clarifies
areas of thinking that could make mutually compatible additions
to a particular understanding.
This chapter will highlight the compatible area of thinking in Klein
and Winnicott around the concept of reparation. Klein’s definition
gains indispensable dimensions from Winnicott’s theory, both when
he is deliberately using her concept and when he is not. In the
notion of reparation, the theories of Klein and Winnicott reveal a
significant complementarity that has broader implications. This is
because reparation touches on the larger issue of destruction—both
internal and external—in human life, and offers ideas on our means
of responding to it. To highlight this area, there will first be an
overview of both theories with an emphasis on their affinities and
divergences. With such a comparison in mind, it is then possible to
approach the issue of how human beings manage to “repair”, and
to examine the contributions from both theories.
114
COMPATIBLE OUTLOOKS? 115
115
116 MEIRA LIKIERMAN
116
COMPATIBLE OUTLOOKS? 117
117
118 MEIRA LIKIERMAN
118
COMPATIBLE OUTLOOKS? 119
119
120 MEIRA LIKIERMAN
120
COMPATIBLE OUTLOOKS? 121
121
122 MEIRA LIKIERMAN
122
COMPATIBLE OUTLOOKS? 123
123
124 MEIRA LIKIERMAN
124
COMPATIBLE OUTLOOKS? 125
125
126 MEIRA LIKIERMAN
References
Klein, M. (1935). A contribution to the psychogenesis of manic-depressive
states. In: The Writings of Melanie Klein, I: Love, Guilt and Reparation and
other works 1921–45. London: Hogarth, 1975.
Klein, M. (1946). Notes on some schizoid mechanisms. In: The Writings of
Melanie Klein, 3: Envy and Gratitude and other works 1946–63. London:
Hogarth, 1975.
Klein, M. (1957). Envy and gratitude. In: The Writings of Melanie Klein, 3: Envy
and Gratitude and other works 1946–63. London: Hogarth, 1975.
Likierman, M. (2001). Melanie Klein: Her Work in Context. London: Continuum.
126
COMPATIBLE OUTLOOKS? 127
122 Winnicott, D.W. (1941). The observation of infants in a set situation. In:
2 Through Paediatrics to Psycho-Analysis. London: Hogarth, 1958.
3 Winnicott, D.W. (1945). Primitive emotional development. In: Through
4 Paediatrics to Psycho-Analysis. London: Hogarth, 1958.
5 Winnicott, D.W. (1947). Hate in the countertransference. In: Through
6 Paediatrics to Psycho-Analysis. London: Hogarth, 1958.
7222 Winnicott, D.W. (1949). Birth memories, Birth Trauma, and Anxiety. In:
8 Through Paediatrics to Psycho-Analysis. London: Hogarth, 1958.
9 Winnicott, D.W. (1950) Aggression in relation to emotional development.
10 In: Through Paediatrics to Psycho-Analysis. London: Hogarth, 1958.
1 Winnicott, D.W. (1960). The theory of the parent-infant relationship. In: The
2 Maturational Process and the Facilitating Environment. London: Hogarth,
1965. [Karnac, 1990]
3
Winnicott, D. W. (1962). Ego integration in child development. In: The
4
Maturational Process and the Facilitating Environment. London: Hogarth,
5222
1965. [Karnac, 1990]
6
7
8
9
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2
3
4
5
6
7
8
9
30
1
2
3
4
5
6
7
8
922
127
CHAPTER NINE
W
hen Michael Balint and Donald Winnicott treated severely
disturbed patients, they both felt that it was necessary to
use particular parameters at certain stages during the
course of psychoanalytic therapy. They held similar assumptions
about the technical changes that became advisable when treating
these patients, and reasoned their case on the basis of their concep-
tualization of infant development. They were in agreement that at
the early stages the facilitating environment makes an essential
contribution to healthy development, and contributes to severe
pathology if it fails. Neither accepted the concept of the death
instinct, but they accepted Freud’s theory of libidinal development
and infantile sexuality with the oedipal phase when the child has
become able to engage in three-cornered interpersonal relations as
a whole person. Conflicts at this stage can lead to psycho-neurotic
disorders in later life that are treated with the classical approach of
interpretation and reconstruction as Freud had devised. However,
they felt that this technique was not sufficient to reach out to those
patients whose illness was due to failures of environmental
adaptation during infant development.
Balint and Winnicott became acquainted with psychoanalytic
thought when they read some of Freud’s publications. Balint wrote:
“After having highly ambivalently criticized The Interpretations of
128
MICHAEL BALINT AND DONALD WINNICOTT 129
122 Dreams and The Psychopathology of Everyday Life, I was, at the age
2 of 21, decisively and definitely conquered for psycho-analysis by the
3 Three Essays on Sexuality and Totem and Taboo. In some form or other
4 these two directions of research—the development of the individual
5 sexual function and the development of human relationships—have
6 remained in the focus of my interest ever since” (Balint, 1952, p. vii).
7222 When Winnicott was a medical student he had to spend three
8 months as an inpatient because of a lung abscess, and a friend lent
9 him a book by Freud.1 He had had in mind to become a GP
10 somewhere in the countryside, but now decided to have an analysis
1 and stay in London. He specialized in paediatrics and started a long
2 analysis with James Strachey (C. Winnicott, 1989).
3 Both Balint and Winnicott argued their conceptualizations of
4 infant development in terms of classical drive theory and the devel-
5222 opment of object relations. Balint makes a strong case for secondary
6 narcissism from the word go. As Harold Stewart has pointed out in
7 his evaluation of Balint’s contributions to psychoanalysis (Stewart,
8 1996), his early publications have a strong biological bias. Balint
9 emphasized that the infant starts off in the womb already intensely
20 related to the non-human environment with soft boundaries with
1 which the embryo lives in a harmonious mix-up. Post-partum, this
2 state is still largely realized for a while as the mother provides
3 conditions for the infant that allow him to exist in a state of primary
4 love, by which Balint means being loved without conditions attached.
5 At the beginning everything is provided for by well adjusted nursing
6 care. But soon the infant has to recognize objects and spaces between
7 objects. If a lack of fit between the infant and the nursing mother
8 because of biological or psychological conditions becomes prominent,
9 a basic fault develops in the mind, and this can give rise to com-
30 pulsive pathological characteristics. Balint has described two of them
1 in detail: there is an ocnophilic characteristic of clinging to objects
2 or seeking free spaces; and one of developing ego skills which he
3 called philobatic. Balint explained his use of the term “basic fault”
4 from its meaning in crystallography, where it denotes a sudden
5 irregularity in the overall structure: “an irregularity which in normal
6 circumstances might lie hidden, but if strains and stresses occur, may
7 lead to a break, profoundly disrupting the overall structure” (Balint,
8 1968). He conceived of the mind in terms of three areas: the basic
922 fault area which is characterized by primitive, exclusively two-object
129
130 MARGRET TONNESMANN
130
MICHAEL BALINT AND DONALD WINNICOTT 131
131
132 MARGRET TONNESMANN
132
MICHAEL BALINT AND DONALD WINNICOTT 133
122 Verbalization and interpretation of such acting out would fail the
2 patient’s pre-verbal state of communication and lead to a repetition
3 of the original trauma that led to the basic fault. It is characteristic
4 of the early primary love relationship that the object cannot be given
5 any consideration. Hence in particular any form of transference
6 interpretation has to be avoided. If the patient can benefit from the
7222 token satisfaction of his urgent needs, he is enabled to find himself,
8 as he often says. He can give up his compulsive, pathological relating
9 to objects, can free himself and find new and better ways of relating.
10 Balint had conceptualized “regression” and “new beginning” in one
1 of his early papers. He used here Haeckel’s biogenetic laws and
2 maintained that new developments in the mind require regression
3 to early primitive modes from which a new beginning, a better way
4 of adaptation can develop. However, some patients cannot make use
5222 of benign regression. It frequently breaks down, and the patient shows
6 signs of desperate clinging to a separate whole object. The regression
7 has now become malignant and is aimed at gratification, with
8 addiction-like states of craving for satisfaction of instinctual demands
9 from the analyst. There are signs of severe hysteria, with genital-
20 orgasmic elements in both the normal and the regressed forms of
1 transference.2 In a short vignette, Balint (1968) showed how after the
2 last analytic session of the week he handled his patient’s demand
3 for an extra session over the weekend. Occasionally the patient had
4 been given an extra session at weekends in the past. It had given
5 him great satisfaction, but it was only rarely that during such an extra
6 session any real analytic work was done. On this occasion the Friday
7 session had passed without any true contact between the patient
8 and his analyst as he had to make the analyst useless. When he was
9 leaving the room, he said that he felt awful and could he have a
30 session sometime over the weekend. Balint judged this request as
1 one aiming at gratification, and considered how he could best
2 respond to the patient’s request. If he made an interpretation pointing
3 out the craving for gratification, the patient would feel even more
4 wretched for having made this demand—if he agreed with his
5 analyst. If he disagreed with him, he would experience the analyst
6 as unkind and cruel, and his tensions in the therapy would increase.
7 An interpretation as the patient’s resistance or as a transference of
8 aggressiveness and hatred from his childhood would have a similar
922 result. If, however, the analyst satisfied the patient’s demand for an
133
134 MARGRET TONNESMANN
134
MICHAEL BALINT AND DONALD WINNICOTT 135
122 Balint then poses the question of how the analyst can foster the
2 regression. His discussion centres mainly on what the analyst should
3 avoid: he should avoid becoming a mighty and knowledgeable
4 object for the patient. He warns against making too many transfer-
5 ence interpretations, as this will force the patient into an ocnophilic
6 world, and the patient is then not given enough opportunities to
7222 make his own discoveries. The analyst has to be flexible to adjust
8 to the patient’s needs and alternate between the primary love, the
9 ocnophilic and the philobatic worlds. He has to allow the patient to
10 use him as a kind of primary substance, by which he means to be
1 experienced as indestructible like earth, water, air or fire. He must
2 avoid becoming omnipotent in the patient’s eyes, as this will increase
3 the danger of malignant regression.
4 The analyst has to be unobtrusive and keep in mind that words
5222 have become unreliable. He has to bear with the patient’s regression
6 and not interpret it. He therefore has to accept the acting out during
7 the sessions, and he has to be felt by the patient as just being there.
8 He should not give primary love but just be there and offer the
9 patient the possibility of cathecting him as primary love object.
20 The patient should be given plenty of time to work through the
1 basic fault. This can mean refraining from interpretative work for a
2 longish time. When the basic fault has healed off, the analysis can
3 resume its ordinary course of free association, interpretation and
4 reconstruction. It is then that the therapeutic regression, like all
5 parameters that may occur in an analysis, will have to be worked
6 through. However, Balint makes it clear that for him every analysis
7 should have moments when the patient can regress to primary love
8 and basic fault levels of functioning.
9 Donald Winnicott maintained that patients who have suffered
30 traumatic impingement during infancy and have developed a false
1 self need a therapeutic regression during analytic therapy. At the
2 beginning, these patients will respond with false self adaptation to
3 the therapy, or they will use the care-taking function of the false self
4 and talk about their core emotional self. Winnicott discussed how the
5 false self can be a highly organized and sophisticated ego device that
6 allows for false but effective living. He described patients who had
7 had a satisfactory analysis because their false self adaptation made
8 their analysis a rewarding experience for them and their analysts. But
922 when the analysis was terminated, they found that they were still
135
136 MARGRET TONNESMANN
136
MICHAEL BALINT AND DONALD WINNICOTT 137
122 If the analyst can meet the regressed patient’s needs, there will
2 still come a time when the analyst makes a mistake. It may only be
3 a small mistake, but at this moment the patient reacts fiercely. He
4 experiences it as a total let-down and becomes very angry indeed.
5 These are the moments when the impingements of the original
6 environmental failure situations are repeated during the analysis.
7222 Winnicott speaks metaphorically of the unfreezing of the early
8 frozen failure situations that are not available to memory but are
9 stored and can therefore be repeated in the acting out. It is important
10 that these mistakes indicating the early failure are discussed and
1 understood by both the patient and the analyst. As the patient is now
2 an adult, he can experience the anger in the here-and-now, but the
3 anger belongs to the original failure situation. Winnicott has
4 described how he once forgot to have certain papers that the patient
5222 had given him put in the right place. The patient was allowed to go
6 straight into the consulting room and saw the mistake. By the time
7 Winnicott joined her she was consumed with rage and wanted to
8 know why it had happened. Had Winnicott forgotten to put the
9 papers in the right place in response to her or had it been something
20 within him that made him react in this way? Winnicott stressed that
1 it is essential to explain the reasons fully to the patient without giving
2 too much personal information away. In this case he actually said
3 to the patient that he was not the tidiest of people. It had happened
4 and presumably would happen again. If she wanted to stay with him
5 in treatment she would have to put up with it.
6 Such failure situations may be repeated via the analyst’s mistakes.
7 Each time they will explain a specific environmental failure that the
8 infant had suffered. In time, the patient will be able to make a move
9 forward towards independence with a true self that can feel real and
30 experience living.
1 Whether the regressed patient can recover at the end of the session
2 and leave depends partly on the degree and organisation of an
3 observer ego. Winnicott maintained that patients who are similar in
4 their immediate clinical aspects may be very different in this respect.
5 Some patients have a strong observing ego but others are unable
6 to recover from the regression during the analytic hour and need
7 nursing care. Winnicott conceived of radical withdrawal during a
8 session as a defence against regression. He described a case when,
922 shortly before his summer holidays, the patient became very cutting
137
138 MARGRET TONNESMANN
towards him and finally left the session. He was even doubtful
whether the patient would return, but she came back the next day
and apologized. However, he maintained that when the analyst is
quick enough and can understand the regressive move that is being
defended against by the withdrawal, some analytic work can be
done. Otherwise the withdrawal will function as a defence and the
session is lost for analytic work.
Winnicott always stressed that regressive moves of the patient aim
at progression, and renewed stages of dependence aim at independ-
ence. When they occur during analytic therapy, they can be seen as
signs of the patients’ hope that they will find an environment which
will finally facilitate emotional living for them and free them from
their often crippling sense of futility. The analytic management, how-
ever, has to stay within the analytic setting. At a later stage of the
analysis, when the setting can again support ordinary interpretation
and transference, the parameters of the analytic management have
to be worked through, as Eissler (1953) advised for all parameters that
maintain and do not disrupt the overall process of analytic therapy.
Both Balint and Winnicott argued that patients who have suffered
traumas at the beginning of infancy need to regress during analytic
therapy to pre-verbal functioning in order to communicate the
environmental failure that constituted the defensive ego device of a
basic fault (Balint) or a false self (Winnicott). As they conceptualize
early development differently, Balint in terms of secondary
narcissism and Winnicott in terms of primary narcissism, they
understand the dynamics of the therapeutic regression in terms
of their theoretical assumptions. However, they both emphasize
that the patient has regressed to a primitive two-person relationship
of a pre-verbal nature and communicates by acting out during the
session. To reach the patient, the analyst has to halt all interpretations
and instead has to act in with the patient so that the original traumas
can be activated and repeated. When the analyst no longer functions
within the as-if situation of the transference, this means that the
analyst has to engage with the patient as the person he is. To do so
within the boundaries of the analytic setting is a delicate operation,
and both Balint and Winnicott warn against an analyst undertaking
such therapy without having had enough experience in ordinary
transference analysis with its stable analytic setting. When Balint talks
of being with the patient or just being there and so offering the patient
138
MICHAEL BALINT AND DONALD WINNICOTT 139
139
140 MARGRET TONNESMANN
in Balint’s publications. This may lead to the question whether Balint had
Ferenczi’s cases (of which he had detailed knowledge) in mind in his
general description of the clinical picture of malignant regression.
References
Balint, M. (1952). Preface to the First Edition. In: Primary Love and Psycho-
Analytic Technique (2nd. rev. and enlarged ed.). London: Tavistock.
Balint, M. (1968). The Basic Fault: Therapeutic Aspects of Regression. London:
Tavistock.
Bollas, C. (1987). Shadow of the Object: Analysis of the Unthought Known.
London: Free Association Books.
Eissler, K.R. (1953). The Effect of the Structure of the Ego on Psycho-Analytic
Technique. Journal of the American Psychoanalytic Association, 48: 875–882.
Ferenczi, S. (1988). The Clinical Diary of Sándor Ferenczi. J. Dupont (Ed.).
Cambridge, MA: Harvard University Press.
Stewart, H. (1989). Technique at the basic fault and regression. In: Psychic
Experience and Problems of Technique. London: Routledge, 1992.
Stewart, H. (1992). Psychic Experience and Problems of Technique. London:
Routledge.
Stewart, H. (1996). Michael Balint. Object Relations Pure and Applied. London:
Routledge.
Winnicott, C. (1989). D.W.W.: A Reflection. In: C. Winnicott, R. Shepherd,
& M. Davis (Eds.), Psycho-Analytic Explorations. London: Karnac.
140
122 CHAPTER TEN
2
3
4
5
6
7222 Therapeutic relations:
8
9
Sándor Ferenczi and the
10 British Independents
1
2
3
Julia Borossa
4
I
5222 n an obituary for Sándor Ferenczi, Michael Balint paid homage
6 to his mentor in the following terms: “If I had to sum up in a
7 single word what our dear departed master had really been,
8 I would simply say: a doctor, a doctor in the most noble, richest
9 meaning of the term” (Balint, 1934). It is a striking, seemingly
20 contradictory homage to pay a man who had chosen to make
1 psychoanalysis rather than medicine his life’s work. Indeed, the
2 tensions, both practical and theoretical, between the medical and the
3 psychoanalytic disciplines are well known and well documented
4 (Casement, 2004). In the 1920s, when the fledgling American
5 Psychoanalytical Society wished to restrict practice to members
6 possessing a medical qualification, Ferenczi fully sided with Freud
7 in opposition to the move (Freud/Ferenczi, 2000). Balint, however,
8 was not referring to such controversies, far ranging though they may
9 be in their consequences for psychoanalysis as a profession. Rather,
30 he was paying homage to Ferenczi’s profound commitment to the
1 act of healing, understood quite simply as the alleviation of suffering
2 first and foremost, which for him extended beyond disciplinary,
3 political, institutional and even theoretical concerns. It is this
4 commitment that lay at the core of Ferenczi’s focus in his writings
5 on the therapeutic relationship, a focus that led him to a number of
6 radical revisions of his own practice and to a sustained critique of
7 what he saw as the power relationship at its core. Accordingly, this
8 paper will concentrate on Ferenczi’s views on technique and the
922 therapeutic interaction, drawing out the conceptual links between
141
142 JULIA BOROSSA
The lines of advance are clearly drawn for the future institution-
alization of psychoanalysis, and they were understood, at least in
part, on a basic notion of “authority”: of Freud over his disciples, of
analyst over patient. What is also sketched out in the above quotation
is a programme of who may write what for whom and why.
As is well known, Freud viewed countertransference, his term for
the analyst’s transference, much as he did transference itself: as a
resistance which had to be overcome in the course of practising
psychoanalysis, as well as a puzzle that needed to be solved if the
treatment was to proceed in a satisfactory fashion. The following
passage is taken from one of the few pieces in which he treats
the concept in his published writings: “We have become aware of
142
THERAPEUTIC RELATIONS 143
143
144 JULIA BOROSSA
144
THERAPEUTIC RELATIONS 145
122 colleagues whose work appeared to be, in the context of the highly
2 charged theoretical stakes of the recent debates, eclectic and concil-
3 iatory. But this was a misleading impression: the group emerged in
4 the late 1940s as a powerful political force in British psychoanalysis,
5 whilst paradoxically deriving their cohesiveness and their strength
6 as a group from elusive clinical concerns. Their very existence as a
7222 group depended on the assumption that it was indeed possible to
8 separate out theoretical and clinical truths, and moreover that
9 psychoanalytic truth was to be found in the latter: this is indeed the
10 way that the story of their formation as a group is usually told.
1 Let us take, for example, the following quotations from two key
2 volumes about the group. The first is from an intellectual history of
3 the Independents and the second from an introduction to an
4 anthology of their writings.
5222
6 Independents come together because they are all committed
7 psychoanalysts in the first place, and then not because they
8 espouse any particular theory within it, but simply because they
9 have an attitude in common. This is to evaluate and respect ideas
20 for their truth value no matter whence they come. [Rayner, 1991,
1 p. 9, emphasis mine]
2 They start from a point of theoretical uncertainty with their
3 patients. But what other people see as their handicap is in fact
4 the Independents’ strength. What they have to offer is primarily
5 but not exclusively a professional stance, a professional attitude.
6 [Kohon, 1986, p. 72, emphasis mine]
7
8 However, the question of the true nature and location of
9 psychoanalytic knowledge constitutes a sticking point. Intent on their
30 task of trying to forge a definite group identity for the Independents,
1 the two authors quoted invoke the elusive “truth” of psychoanalytic
2 conviction. In both cases that conviction is twinned with an ethic of
3 professionalism and a privileging of the clinical interaction. However,
4 the complexity of the issue becomes apparent when it is recalled that
5 it is precisely with a conviction imparted by practice that the
6 identities of patient and analyst become almost indistinguishable. It
7 is precisely this coming together of the identities of the two parties
8 of the clinical encounter, in all the complexity involved, which
922 constituted one of Ferenczi’s key areas of interest.
145
146 JULIA BOROSSA
146
THERAPEUTIC RELATIONS 147
147
148 JULIA BOROSSA
148
THERAPEUTIC RELATIONS 149
149
150 JULIA BOROSSA
150
THERAPEUTIC RELATIONS 151
151
152 JULIA BOROSSA
152
THERAPEUTIC RELATIONS 153
122 feel like “two equally terrified children” (1988, p. 56). The fascination
2 of this document lies in the unwavering trust in psychoanalysis it
3 reveals, as well as in the clear answer it gives to the question of the
4 identity of the analyst: this identity lies strikingly close to the identity
5 of the patient. Indeed, for Ferenczi, “the best analyst is a patient who
6 has been cured” (1988, p. 115). Alongside more general remarks on
7222 the nature of analytic practice, Ferenczi wove together the narrative
8 of his analytic relationship with four patients—four women, three
9 of whom have been identified: Izette de Forest, Clara Thompson
10 and Elisabeth Severn. The first two, particularly Clara Thompson,
1 subsequently gained prominence as analysts in America (Shapiro,
2 1993, pp. 159–174).
3 But it is the latter, Elisabeth Severn, in the grip of a severe
4 regression for large portions of her treatment with Ferenczi, who
5222 came to occupy more and more of his time and played the central
6
role in the Clinical Diary. She is credited with initiating Ferenczi’s
7
experimentation with “mutual analysis” (Fortune, 1993, pp. 101–120),
8
which he describes in the volume. Ferenczi wrote: “It should be noted
9
in my favour that I accompany my patients to these depths and with
20
the aid of my own complexes can, so to speak, cry with them” (1988,
1
p. 61). As Severn’s analysis became more and more demanding,
2
Ferenczi spent several hours per day with her, relinquishing other
3
patients. But more astonishingly, Ferenczi recorded in the diary how
4
5 he and the patient R.N. (as Severn was known) would take turns on
6 the couch, after she had repeatedly solicited the right to analyse him.
7 She struggled with memories of childhood sexual abuse, whilst he
8 grappled with his feelings of misogyny. The attempt certainly held
9 elements of a utopian move towards realigning analytic power
30 relations, forcing Ferenczi to confront his fears, his awareness of the
1 fragility of his sanity and his sense of control. His fears, in short, of
2 placing himself in the patient’s power. “Why then,” he asks, “should
3 he, the patient place himself blindly in the power of the doctor?”
4 (1988, p. 92) Self-disclosure on one side was met by self-disclosure
5 on the other until Ferenczi, physically and mentally exhausted, but
6 despite his utopian quest still ultimately the one in charge, first
7 reverted to conventional treatment and finally terminated the
8 analysis. Ferenczi died a few months later of pernicious anaemia,
922 whilst Elisabeth Severn recovered sufficiently to write articles and
153
154 JULIA BOROSSA
154
THERAPEUTIC RELATIONS 155
155
156 JULIA BOROSSA
156
THERAPEUTIC RELATIONS 157
122 which the analyst holds up to the patient, but the patient holds one
2 up to the analyst too” (ibid., p. 37).
3 This represents a change in theoretical perspective vis-à-vis
4 countertransference. But what were the stakes involved for the
5 profession, the reasons for the phobic resistance of Little’s colleagues,
6 and under what conditions, if any, might the full autobiographical
7222 implications of the concept be expressed? To address that question,
8 we need to examine Little’s paper from a slightly different angle. It
9 is introduced by a clinical vignette. “I will begin with a story,” she
10 writes. The story she tells is about a patient who is encouraged by
1 his (male) analyst to make a radio broadcast, in a field which holds
2 some interest for the analyst, on the wake of his mother’s death. Later,
3 during the session following the broadcast, the analyst interprets the
4 patient’s subsequent depression and anxiety as fear of the analyst’s
5222 jealousy. The patient accepts this interpretation, but realizes years
6 later that he had not been allowed to mourn, and the interpretation
7 had been “the correct one at the time for the analyst, who had actually
8 been jealous of him, and that it was the analyst’s unconscious
9 guilt that had led to the giving of an inappropriate interpretation”
20 (ibid., p. 32).
1 There is an interesting discrepancy between this narrative and the
2 one reprinted in Little’s collected papers (1981, amended 1986). The
3 second version’s opening line reads: “I will begin with a true story,
4 from my own experience” (1986, p. 33). Little then proceeds to reveal
5 the autobiographical basis to the story: in fact, she was the patient.
6 The death of her father occurred shortly after she was due to present
7 her membership paper to the British Psychoanalytical Society.
8 Her analyst, Ella Sharpe, encouraged her to go ahead with her
9 presentation anyway, with the aforementioned results. One of the
30 striking aspects of this second version is the possibility of mutual
1 analysis that it hints at, albeit one that became possible only in
2 retrospect. At the time of the interpretation, still in analysis and only
3 just fully qualified, Little complied. It was only much later, a couple
4 of years into her life as a fully fledged analyst, indeed after Ella
5 Sharpe’s death, that she offered her own interpretation of the events,
6 involving her understanding of her analyst’s transference.
7 Little’s use of countertransference in her later paper “R—the
8 analyst’s total response to his patient’s needs” (1957) is more
922 straightforward, and is illustrative of what is to this day a classic
157
158 JULIA BOROSSA
At last I told her how painful her distress was, not only to herself
and to her family, but to me. I said that no one could be near
her in that state without being deeply affected. I felt sorrow with
her, and for her, in her loss. The effect was instantaneous and
very great. Within the hour she became calmer, lay down on the
couch, and cried ordinarily sadly. [1957]
158
THERAPEUTIC RELATIONS 159
122 Little-the-patient was writing for, in the place of her analyst. This
2 unusual case history shows Little playing fast and loose with the roles
3 and voices assigned to patient and analyst by the narrative conven-
4 tions which regulate how the analytic relationship may be portrayed
5 and safeguard the authority and authoritativeness of the analyst
6 as a trained professional working within certain institutional
7222 parameters.
8 In his Clinical Diary, Ferenczi had expressed his theoretical belief
9 in the mutuality of the roles of patient and analyst, and illustrated
10 this belief by writing himself into the position of patient. Ferenczi’s
1 “private” text was made public fifty years after it was written. His
2 work generally has been praised by some as facilitating change in
3 the psychoanalytic institution, but this change was based on a kind
4 of self-recognition, a mark of the institution already having evolved.
5222 “The pieces of a puzzle click together, and a new historical narrative
6 begins to emerge” (Aron & Harris, 1993, p.2). But the diary itself is
7 another matter, and generally considered a research tool, an evocative
8 archival document rather than a viable model for clinical practice or
9 therapeutic attitude. By publishing such an autobiographical piece,
20 Margaret Little was doing something clearly subversive. The
1 narrative of the analytic interaction that she was offering would not
2 appear as an acceptable one, and Little’s autobiographical writings
3 caused a particular consternation in the psychoanalytic community
4 at the very time when Ferenczi’s Clinical Diary was starting to
5 circulate in the English-speaking analytic community. Little’s account
6 of her analysis with Winnicott was turned down by the editors of
7 the International Journal of Psychoanalysis and appeared in Free
8 Associations (Young, 1990). Others thought that it constituted a
9 breach of decorum at best, exhibitionism at worst. One Independent
30 analyst recounts an interesting slip of the typewriter that one of his
1 colleagues made whilst drafting a review of Little’s papers. He had
2 meant to write “Why did she have to go so public?” Instead, it came
3 out as “Why did she have to go so pubic?” (Casement, 1992) There
4 clearly is a complex set of rules in play which make certain texts,
5 certain authorial positions, indeed certain technical positions
6 acceptable and others not. Consider the following condemnation
7 from one of her colleagues: “Margaret Little has always written in a
8 self-revealing way, and I think the paper about her analysis with
922 Winnicott quite frankly was embarrassing. I think it just reeks of what
159
160 JULIA BOROSSA
Conclusion
Countertransference theory, although tentatively developed at first,
began changing the practice of psychoanalysis. The authority of the
analyst was challenged by the gradual acceptance of his or her own
less-than-reliable and imperfectly known and controlled unconscious
as a key factor in the therapy. Analysts were calling for a different
type of relationship with the patient, a seemingly less authoritarian
as well as a less mystifying one. In the theoretical writings which set
the groundwork, from Ferenczi to Little’s early texts and beyond,
the following thematic concerns were also highlighted. External
reality (things, circumstances) could not be bracketed off and had to
be taken into account. The patient’s free associations, her words and
her symptoms, previously thought to be just as coherent as words,
were not the only material at the analyst’s disposal. This meant that
interpretation as understood until then was no longer sufficient. Any
account of the therapeutic encounter could not merely concentrate
160
THERAPEUTIC RELATIONS 161
161
162 JULIA BOROSSA
162
THERAPEUTIC RELATIONS 163
163
164 JULIA BOROSSA
Rodman, F.R. (2003). Winnicott: Life and Work. Cambridge, MA: Perseus
Publishing.
Shapiro, S. (1993). Clara Thompson: Ferenczi’s Messenger with Half a
Message. In: L. Aron & A. Harris, The Legacy of Sándor Ferenczi, Hillsdale,
NJ: The Analytic Press, 1993.
Stanton, M. (1991). Sándor Ferenczi: Reconsidering Active Intervention.
Northvale, NJ: Aronson.
Winnicott, D.W. (1945). Primitive emotional development. In: Through
Paediatrics to Psycho-Analysis. London: Hogarth, 1958.
Winnicott, D.W. (1947). Hate in the countertransference. In: Through
Paediatrics to Psycho-Analysis. London: Hogarth, 1958.
Winnicott, D.W. (1949). Birth memories, Birth Trauma, and Anxiety. In:
Through Paediatrics to Psycho-Analysis. London: Hogarth, 1958.
Winnicott, D.W. (1963). On Communicating and Not Communicating
Leading to a Study of Certain Opposites. In: The Maturational Process and
the Facilitating Environment London: Hogarth, 1965. [Karnac, 1990]
Young, R. M. (1990.) The Analytic Space: Countertransference and Evocative
Knowledge. www.findingstone.com/professionals/monographs/the
analyticspace.htm.
164
122 CHAPTER ELEVEN
2
3
4
5
6
7222 The suppressed madness of
8
9
sane analysts
10
1 Ken Wright
2
3
4
I
5222 n 1961, the British psychoanalyst Martin James wrote to Winnicott
6 of “the mixture of fright and misunderstanding [surrounding]
7 your work in some circles. Those with literal or obsessional
8 minded approaches cannot comprehend your allusive and illustra-
9 tive skills, which I find so attractive. I do think that your approach
20 is typically British and totally beyond the comprehension of the
1 Teutonic Hartmann style of theorist” (Rodman, 2003, p. 285).
2 His comments remind us that Winnicott’s ideas were often
3 difficult for his colleagues to understand. Not only were they
4 novel and against the trend, but they were expressed in poetic and
5 unfamiliar language. Winnicott preferred, as he put it, the “flash of
6 insight” to the “painful task of spelling things out” (Rodman, 2003),
7 and if his fellow analysts struggled with these idiosyncratic ways, it
8 seems hardly surprising. However, James’s use of the word “fright”
9 is remarkably strong and raises the possibility that more was at stake
30 than frustration and misunderstanding. It suggests that Winnicott
1 was not just strange and difficult to grasp but also disturbing to his
2 analytic audiences. Reflecting on this, I began to wonder if his
3 disregard of their ways of thinking might have disturbed their sense
4 of security and touched on a latent fear of madness. This idea
5 reopened some earlier thoughts about the relation of an analyst to
6 his theories, and how those theories might help to maintain the
7 analyst’s feeling of sanity.
8 Theories can be used in different ways: while on the one hand
922 they organize ideas about reality, they can also function as a refuge
165
166 KEN WRIGHT
from reality. The first use is explicit and object-related; the second is
covert and could be called narcissistic (Wright, 1991). By “object-
related” I refer to the use of theory to know and understand the
object; by “narcissistic” I refer to an unconscious holding function
of theory that may at times underpin the integrity of the self. These
different functions do not necessarily preclude each other, for just
as Bion (1961) envisaged the operation of hidden assumptions within
the work group, so there could be covert narcissistic uses of theory
within a more object-related deployment.
In thinking of how theories function, it has to be remembered they
are symbolic structures, and the way symbols are used will reflect
the psychological needs of the user (Segal, 1986; Wright, 1991).
Normally we think of symbols in their mature, object-related form,
in other words as separated from their objects and thus usable as
tools for exploring reality. Functioning in an object-related way,
theory is a structure of this kind. By contrast, a narcissistically
functioning theory is more primitive—it holds or contains experience
rather than signifying it, and is more concerned with the economy of
the self than with exploration of the object. An early example of such
a primitive structure is Winnicott’s transitional object which supports
the infant’s sense of going on being during the mother’s absence by
containing, or holding on to, a needed experience of the mother
(Winnicott, 1951).
When I refer to a narcissistic use of theory, it is this holding,
containing function that I have in mind. Theory in this mode holds
and contains the analyst’s self, just as the transitional object holds and
contains the infant experience. In this situation, a threat to the
analyst’s theory is a threat to the analyst’s self. When the analyst
defends his theory, he is at this moment protecting the integrity of
his self rather than the scientific content of his theory. In such a case,
we could say that the theory is functioning as a transitional structure—
as a complex symbol that supports the “going on being” (Winnicott,
1962) of the analyst.
This idea has far-reaching implications. Insofar as the analyst’s
theory functions as a holding structure, its use as a tool for exploring
reality is compromised. New observations or new ideas will now
open the door to “unthinkable anxiety”, and “reality” becomes a
threat. It loses its quality of being that separate and interesting object
which the theory was designed to explore, and becomes instead an
166
THE SUPPRESSED MADNESS OF SANE ANALYSTS 167
167
168 KEN WRIGHT
material and on the other hand to his own inner structure of theories.
Into this context we can now put Bion’s advice to the analyst at work
that he put aside memory and desire (1970). The juxtaposition is
interesting, for it now seems clear that Bion is asking the analyst to
tolerate the un-integrated state. He is asking him to relinquish his
hold on theory and remain in a place where meaning is fragmentary
and incomplete. “Don’t close the gap,” he says; don’t make a forced
integration—a panicky organization of the material in terms of
theory or of yesterday’s hypothesis—because that is the window
through which the new can be glimpsed, the “new” being part of
that separate reality that the analyst wants to understand. Bion does
not say, however, what Winnicott possibly implies, that this window
onto reality is also the entry point for unthinkable anxiety: the place,
if you like, through which the “suppressed madness of sane analysts”
may appear.
How the analyst works in this un-integrated area between theory
and reality—whether he remains open or jumps for the closure of
theory—depends on the strength of his own holding structures. If
he is able to take maternal holding for granted, he can step out from
the shelter of his theories. If, on the other hand, his theories have
become a substitute for maternal holding—a kind of false container—
they will be his only refuge from terror and the unstructured void.
Clinically, the consequences are important: the analyst who can take
holding for granted and wait for meaning to emerge will work very
differently from the one who must pull the meanings together in
order to remain intact.
In summary, then, insofar as an analyst’s theory becomes a
substitute for maternal holding, the space of uncertainty between
theory and clinical reality becomes a danger zone. Not knowing
becomes hard to tolerate, and the analyst then falls into premature
knowing in order to escape not knowing. To be adrift in uncertainty
is to feel un-held, so the analyst now hugs his theory close and draws
the whole of reality into its web.
For this analyst, or an analyst in this state, the bulwark against
such feelings is the coherence of his theories and the comprehensive-
ness of his interpretations. If in doubt, he interprets, for this will
contain the patient’s anxiety—or so he thinks, not considering that
his own anxiety may be the problem. From a different perspective,
though, such comprehensive interpretation is not in the patient’s
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THE SUPPRESSED MADNESS OF SANE ANALYSTS 169
122 interest and takes from him the opportunity to form his own ideas.
2 Pushed into shape by the analyst’s interpretative zeal, he is denied
3 the chance of making integrations of his own, and thus re-experiences
4 an earlier trauma of deficient holding and forced, or premature
5 integration (a kind of false self situation).
6 This overall scenario reminds me of one of my training patients,
7222 and I’m going to give you a very short clinical vignette. The patient
8 was a young man who had suffered significant breaks in the fabric
9 of early holding. He was exceptionally bright and verbal, highly
10 successful in his working life, and I now realize he had dealt with
1 breaks in holding by precisely the kind of premature integration we
2 are discussing. He was a keen amateur musician, and I remember
3 him telling me he was a lover of the legato line. When I asked him
4 what this was, he described how it was a line of music played in a
5222 seamless manner, without any breaks at all. There must not even be
6 a break for breathing, he said; you had to control your breathing in
7 such a way that the music continued to flow.
8 This man’s reaction to analysis—and to my attempts at being an
9 analyst—was stormy in the extreme. I was too anxious to be able to
20 provide him with the holding legato line he so desperately sought.
1 So what did I do? I gave him interpretations, interpretations and
2 more interpretations.
3 I would certainly now do differently. But if I had to defend my
4 actions from those far-off days, I would say that he was a difficult
5 case by any standards and I was a frightened and inexperienced
6 trainee. I felt thrown by the patient’s hostility, and any intuitive
7 capacity for holding that I had would quickly dissipate under
8 fire. Moreover, I was brought up in an analytic atmosphere which
9 overvalued interpretation, so this paper is also about unlearning
30 those early lessons and learning to refrain from interpretation.
1 To give you the flavour of that time, the early 1970s: at the
2 Tavistock Clinic where I did my psychotherapy training, a relatively
3 unknown analyst, Henry Ezriel, told his students that all of their
4 communications to the patient should take the form of an interpre-
5 tation. And they should say nothing at all to the patient until they
6 were clear about each of the three parts that constituted an inter-
7 pretation: the required, the avoided and the catastrophic elements of the
8 patient’s experience. These had to be unravelled from the material
922 in every instance and only then could an interpretation be made.
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170 KEN WRIGHT
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THE SUPPRESSED MADNESS OF SANE ANALYSTS 171
122 believe that interpretation itself is the best way of holding and
2 containing, and others who believe it is traumatic and distancing.
3 But Winnicott’s ideas also stay with us—in this context, the idea that
4 the analyst often interprets to satisfy his own need rather than the
5 patient’s (you could call this a narcissistic rather than an object-
6 related use of interpretation). This was certainly what happened with
7222 my training patient: I interpreted in order to hold myself together
8 in the face of overwhelming anxiety. I clung to theory and
9 interpretation, and hugged them close. I had to protect myself from
10 the dangerous reality of my patient and keep him at a distance. And
1 I had to stop myself falling apart. Not surprisingly, I was little use
2 to my patient at these times.
3 Thirty years on I ask myself what I would do now. Would I give
4 my patient a less bumpy ride? And what might I do differently?
5222 From a theoretical perspective, I am sure that I would now try to
6 hold and contain rather than interpret. But what does this actually
7 mean? When I referred earlier to these terms as our new clichés, I
8 was suggesting that we all assume we know what these terms mean
9 but actually fail to examine their practical implications in a nitty-
20 gritty sort of way. In other words, we fall short of spelling out what
1 holding and containing actually mean in a practical, operational
2 sense. This, I believe, is partly to do with the nature of the process.
3 While interpretation is essentially a product of standing back and
4 reflecting, and thus to some extent we can observe what we do and
5 recall what we thought and said, holding and containing involve
6 more intuitive, immediate responses, and so it is harder to revisit
7 them. To do so is like trying to remember the steps you made in an
8 impromptu dance; they were right at the time, but did not conform
9 to known patterns. How do you catch and hold on to such responses
30 that you make on the wing?
1 But we have to start somewhere, and I would describe what I now
2 try and do as increasingly conversational. I am less the analyst who
3 knows and understands it all (the Sherlock Holmes perhaps) and more
4 the helpful and always curious assistant (maybe a kind of Dr
5 Watson). I listen to, and try to engage with, the images and rhythms
6 of the session, and I make fewer interpretations from that “other
7 place”—by which I mean that very separate place where the analyst
8 sits on his own. In my experience, an interpretation often cuts across
922 the emotional flow of the session and brings things to a halt. So I
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172 KEN WRIGHT
now try not to “make interpretations” in this sense but to ride with
the flow, dropping in my observations as and when it feels possible.
Holding and containing involve being with the patient in a way that
interpretation does not. How we speak with the patient, how we
interact, the timbre and rhythm of our exchanges, the way we try
and find “words that touch”, to use a beautiful phrase of Danielle
Quinodoz—all these things are part of the process.
In trying to clarify my thoughts, I have turned to the literature on
infant research, for, unlike psychoanalytic writing, it talks of the
patterns of mother-infant conversation (I am thinking of Trevarthen’s
proto-conversation) and the importance of synchrony and resonance
to infant well-being. Daniel Stern’s work on attunement has also
seemed relevant: attunement is image-based and pre-verbal, and uses
an iconic symbolism of shape, form, tempo and rhythm to mirror
experience and communicate that sharing has been achieved
(Quinodoz, 2003; Stern, 1985; Winnicott, 1967b). These writings have
helped me to realize that holding and containing lie in the prosody
of the session as much as in the content.
Not so interpretation; like the “subtle knife” in Philip Pullman’s
His Dark Materials trilogy, it cuts through from one world to another.
It cuts through and separates the thought, the idea, from lived
experience; but in so doing it risks destroying the life it dissects. By
contrast, holding and containing have more to do with fostering life;
their whole purpose lies in creating the conditions within which
experience can begin to live. I can now better understand Winnicott’s
position: interpretation assumes robustness, a place for experience,
and experience itself, already firmly established. In the absence of
these things, interpretation is impingement, or dogmatic tyranny;
there is not yet anything to interpret, because living experience has
yet to come into being.
I started this paper by considering how theory could be used to
defend the analyst against fear of madness and how its derivative,
interpretation, could be inflated in importance to bolster these
ends. I showed how theory could become a transitional object for
the analyst, thus foreclosing its use as an instrument of clinical
exploration. I suggested that when it is overvalued and used in this
way the patient may suffer abuse from its over-deployment. In the
last part of my paper, I illustrated these ideas through a clinical
vignette and indicated some of the ways they had altered my own
172
THE SUPPRESSED MADNESS OF SANE ANALYSTS 173
173
INDEX
174
INDEX 175
175
176 INDEX
Jones, Ernest 37, 38, 147 mothers 24, 50, 58–60, 72, 77, 130
baby’s unit status 83
Klein, Melanie 19, 24–6, 28, 30, 34, maternal care 10, 13, 14, 15
37, 38, 42–4, 72, 101–2, 105, as object 82
112–26, 144, 147, 156 and psychosis 62–74
anxiety 118, 124 mysticism 41
death instinct 116–18, 122, 123,
124 needs 11
envy 117, 122, 124
falling to pieces 122–3 O, concept of 41
projective identification 87 object relations 17, 39, 44, 109, 129,
reparation 114, 123, 125 166
Kris, Ernst 63, 144 in-formative 15–16
object representation 15
Lacan, Jacques 20, 38, 39, 71–2 object-seeking 18
language 11 objects
Lapanche, J. 11, 58, 59 analysts as 106
latent thoughts 16 babies as 71
Lévi-Strauss 52–3 externality of 2
libido 37, 40, 51, 52, 115, 128 finding 33
literary criticism 24 internal damaged 25, 26
Little, Margaret 156–60 making 33
mothers as 82
Mannoni, Maud, 38, 62 relating to 57, 139
memories 22 as signifier 39
conceptual 14 transitional 37, 166
existence 21 use 21
Milner, Marion 9, 28–31, 33–48 Oedipus complex 43, 49, 51
absent-mindedness 39, 46–7 myth 52–3
centrality of feeling 35 pre-oedipal triangle 72
ecstasy 40, 41, 45
emergence of self 35, 39–45 painting 28–30, 44
framed gap 35–6, 39, 42, 45 paranoia 69
illusion 35, 36, 37, 47 parental intuition 11
symbol formation 35, 36–9, parents 13, 15, 17, 19 see also
47 maternal care
Mitchell, J. 49 patient-analyst relationship 8, 17
mortality 27 patient’s use of analyst 17, 18, 19
mother-infant relationship 25, 35, personality idiom 9–15, 19, 20, 22
36, 37, 44, 59, 62–74, 87 moves 16, 19
176
INDEX 177
177
178 INDEX
178