Monday, March 24, 2014

Film Series: Children and Trauma: Pan’s (the Faun’s) Labyrinth (2006)

Director Guillermo Del Toro commented on Ofelia (Ivana Baquero) as “a girl who needs to disobey anything except her soul.”  Our discussant Adriana Novoa, PhD (Dept. History, USF) elaborated the theme of disobedience: Not simply the anti-Franco fighters against the fascists; Ofelia repeatedly disobeying her stepfather Captain Vidal (Sergi Lopez) and ultimately the faun (Doug Jones) –which leads to redemption and the restoration of her family. At the end of the film we see clearly through the fantasy when the stepfather finds Ofelia talking to the faun but sees her talking to no one, and Novoa notes here that the audience is posed with the question of whether to obey reality or to choose fantasy which allows the narrative creation to resurrect Ofelia. If the audience chooses reality, Ofelia is dead; Disobey reality and Ofelia is restored to her kingly family and lives on in the underworld.

Novoa also speaks to the question of authority: is it from the control of others, or an understanding (partly through narrative) of knowing oneself? She noted how the sadistic Vidal did not know his own father, and worse, was unknown by his father.  Vidal knew of his father’s famous military bravery, particularly through legend of the father having stopped his watch at the time of his death in battle. Novoa saw this as symbolically cutting off time (and connection) to the future (his son), and Vidal is assiduous about keeping the watch running. When Vidal knows he is about to be killed, he hands his infant son over and instructs the rebels to tell his son of the time of his death. Mercedes (Maribel Verdu) tells Vidal that the baby will never know of his father. And so the transgenerational transmission of trauma is illustrated for each father in turn will not know his son, nor the son the father.

Paulina Robalina, LCSW discussed the dissociation engendered by trauma where a child creates a fantasy world to cope with the untenable reality of (in this film, a mis-attuned mother and a sadistic and murderous stepfather). The ‘Pale Man’ ravenously eats children and fairies alike just like the stepfather tortures and murders rebels and any disobedient sympathizers. The toad is killing the flowering tree just like the stepfather is responsible for the mother’s death (impregnating her, killing the doctor, burning the healing mandrake). Ofelia must make choices not only that obey her soul, but be willing— like any hero or Christ figure— to sacrifice herself to save the innocent.

Nominated for Best Foreign Language Film and Best Original Screenplay (del Toro), Pan’s Labyrinth won three Academy Awards: Best Achievement in Cinematography (Guillermo Navarro), and Best Achievement in Make-up (David Marti, Montse Ribe)and Best Art Direction (Eugenio Caballero-art and Pilar Revuelta-set).


Continuing with the “Children and Trauma” Film Series, next month is The Virgin Suicides on April 13, 2014 at 200pm at 13919 Carrollwood Village Run.

Monday, March 3, 2014

Poem

Paper dolls

Paper dolls linked hand in hand, stretched out in a row
Me standing between me, looking to and fro
Hard to see all of me when stretched from here to there
if I try to bend and flex, I easily rip and tear
And when the wind blows
The doll follows like a waif
Some almost letting go, not feeling safe

Better pull together, better pull in close and tight
Now we hold together,
what a lovely site
Fold one over the other,
like an accordion to play
Now there’s strength in numbers,
all here to stay

Each doll important, each make the other strong
All of me’s are different, but none of me’s are wrong
Hugging each other close, now we all belong
Not so easily ripped now, not so easily torn

And when the wind blows, now we flex and bend
Now there’s strength in numbers, now we don’t pretend

Holding tight together it’s much easier to be,
Now I see all of you standing in between me



by Stacie Lauro, MD
Psychiatrist, Psychoanalytic Candidate at TBIPS

co-created with and with much gratitude to:
Heather Pyle, PhD; Bruce Reis, PhD; Alice Bartlett, PhD; Lycia Alexander-Guerra, MD:

Bruce Gilberg, PhD; and, of course, Phillip Bromberg, PhD;  and to patients to whom I am very privileged, honored and grateful to be a part of ... and many others 

Sunday, February 16, 2014

The Worst of Human Nature from one of the Best Filmmakers

Nominated for Best PictureThe Wolf of Wall Street, based on the autobiography of Jordan Belfort, a stockbroker who capitalized on money laundering and fraud, stars Leonardo DiCaprio in a manic performance as Belfort, and is directed by Martin Scorsese (Goodfellas, The Departed for which this oft nominated director won the Oscar).  The scene where DiCaprio, almost decerebrate from excess quaaludes, is hysterical (Jerry Lewis couldn’t have done it better), and at the same time we are sickened by Belfort’s relentlessly heinous debauchery.

Were it not so hilariously farcical, the film would be too painful to watch. It is like a car wreck from which one cannot avert one’s eyes. What is mangled here is the better angels of our nature. This wolf is ravenous, rapacious. Additionally, there is the sickening awareness behind the humor of what is going on outside the movie theatre: the growing gap between haves and have nots widening, ever widening. This country’s new robber barons are on Wall Street and Belfort narrates for you how they do it. This movie is not about transformation. There is no real redemption, for Belfort or for the country. Deregulation and SEC’s failure to enforce allows human avarice to run amuck, and this true story disheartens. Likewise, the commodities traded here include women and I think ‘woe to the republic.’

The lure of drugs and sex and the power of money all too easily make us lose our bearings. I would like to imagine that  perhaps people who fall off the edge into the abyss of avarice and gluttony never had any (bearings) to begin with, never knew fulfillment of any magnitude inside themselves and so sought it outside themselves, the bigger the inner hole, the bigger the need for external highs. But who among us would not be seduced?

I have this theory about drug addictions: In infancy and toddlerhood the brain is developing rapidly. Experiences of recognition and effectiveness and mutuality develop the parts of our brain that produce feel good chemicals like dopamine, serotonin, endorphins, and endogenous opioids. Lack of such experiences leaves our brain deficient in the capacity to produce such chemicals. Then one day we stumble across alcohol or cocaine or marijuana and suddenly we feel something we’ve missed, normal, good. Who wouldn’t want to feel that way as often as possible?


Thursday, February 13, 2014

The Ethical, Compassion, and Complexity in Psychoanalysis


With a sense of social responsibility members of the Tampa area psychoanalytic community have developed and maintain initiatives that respond to the need of the other, supporting veterans’ families, for example. These colleagues serve without fanfare and invite us all to contribute. They may not experience it this way, but I believe their work in this regard belongs to the ethical, and suggest also that this personal inclination to the good informs and supports their psychoanalytic work.

In the larger psychoanalytic community as well, the turn to the ethical seems increasingly well established. Psychoanalysts and others, many inspired by Neil Altman’ pioneering work, are involving themselves and their writing with Palestinian-Israeli troubles, with transgender, with the undocumented, with whiteness and gross inequality, with class differences understood from below. Important voices in American relational psychoanalysis (Adrienne Harris, Eyal Rozmarin, Melanie Suchet) are now seriously engaging with the work of Emmanuel Lévinas. Likewise, in 2011 Donna Orange formally incorporated into psychoanalysis an “ethics beyond ethics”as an inherent dimension of her Hermeneutics of Trust. And the discourse of asymmetrical responsibility has appeared also in the psychoanalytic literature in the work of Adrienne Harris and Warren Poland. Also in 2011 two interdisciplinary conferences, including many psychoanalysts, took place: Psychology for the Other in Cambridge, MA, and Bystanders No More in New York City.

I have always understood Jessica Benjamin’s work, psychoanalytic and otherwise, as belonging to the ethical with her efforts to help liberate us from domination-submission forms of relatedness so we can flourish. Extending Benjamin’s and Judith Butler’s work, relational psychoanalyst, philosopher, and feminist theoretician Lisa Baraitser in London suggests that in Lévinas’ ethics, responsibility redefines recognition. After the birth of her first child, Baraitser began to ask “How do we take responsibility for the other (the infant) prior to the possibility of recognition by that other?”, and to point out that in maternal encounters (the
title of her book) the maternal subject tends to collapse in the face of the need of the fragile and developing child. As therapists we may experience something similar in the face of the need of the devastated child in our adult traumatized patients, like the ones Lauren Levine presented.

Respect for the asymmetrical responsibility to respond to the need of the other is, in part, what places our psychoanalytic work in the realm of the ethical. The clinical accounts Levine shared with us brilliantly illustrate what this looks like in practical terms.

I have suggested already that in these cases, she conducted a minimally theoretical psychoanalysis, a therapy by understanding, especially emotional understanding, that seeks to promote comprehension and to heal by participation in the emotional life of her patients. Levine is able and willing to enter the patient’s suffering and share the painful history, willing and able to “undergo the situation”with the other.

In so doing Levine’s work highlights another dimension of what makes psychoanalysis an ethical undertaking: compassion. Not pity, condescension, or mindless or inauthentic “making nice,” compassion may be experienced by the analyst as a relentless desire to accompany and to understand.

An emergent property of well-attuned relational systems just as hostility and contempt seem as if naturally to characterize others, compassion is both process and attitude. Etymologically compassion means ‘to suffer with.’ Our traumatized patients often feel crushed by a sense of futility. When we suffer with them, and struggle together to make sense of it, their suffering can begin to acquire meaning. Lévinas argues, moreover, that responding to the need of the other is precisely what brings us into subjectivity, into being.

Attention to complexity and its attendant fallibilistic attitude are other components of what one might term Levine’s compassionate psychoanalysis. “I don’t care what you think ...it is only my opinion that counts...!”, or words to that effect roared the patient in response Levine’s spontaneous joy about the painting the patient had selected to buy. Knowing that patient and analyst are so intricately, so complexly related, even though stunned and hurt by her patient’s rebuff, in a fallibilistic spirit Levine reached out to her patient for contact. These matters are usually more complex than we have ever realized and there was more work to be
done to find out what happened.

Respectful of her patient’s suffering, Levine accompanied her patiently and without too much knowing, managing to stay engaged in dialogue with her, to good ends: in the process of transacting this rupture in the following session, perhaps in dawning recognition of Levine’s hurt, the patient said something like– “I don’t know why I feel like crying”!

A compassionate attitude may enable hitherto unknown and impossible ways of experiencing. As process, psychoanalytic compassion perhaps can be understood as a form of emotional understanding.

As emotional availability, psychoanalytic compassion may be what empowers our willingness to accompany patients to the deepest circles of their experiential hell. Not moral masochism on the part of the analyst, nor to be contrasted properly with psychoanalytic work, psychoanalytic compassion is the implicit interpretive gesture of reaching out to embrace our patient in a sustained, even relentless, struggle to find an understanding.

To state it briefly: a compassionate response to the suffering of others is an ethical imperative, and, as it brings us into subjectivity, it adds meaning to our lives; a humble life in the service of the other is our ethical vocation; psychoanalysis becomes an ethical pursuit when we learn to notice and to care for psychological fragility; the primary and fundamental task of psychoanalysis is relief of suffering; commitment to relief of suffering is our fundamental therapeutic vocation; we are called, summoned, addressed, and responsible even
when we are unsure what this address means; our work belongs to the ethical, to the vocational. For me all this is implied in the work Levine shared with us.

In her post of February 9th appended, Lycia Alexander-Guerra cogently writes: “I have read a few papers in my time, but none quite like Levine’s. Her voice is unique; it transcends theory. In a feat of lived, not
theorized, relationality and intersubjectivity, Levine’s papers are as much about her experience as about her patient’s.” Indeed. I believe Lauren Levine was as emotionally available to us, her audience, and will be to her readers later on, as she is to her patients. Such emotional availability may be what makes it possible for her to so powerfully convey her work. It may also be the reason why we established indeed a shared humanness enriching one another!

Ernesto Vasquez, M.D.

See other comments posted to the blog of the Tampa Bay Institute for Psychoanalytic Studies, Inc by this author under the February 9, 2014 post titled ‘Mutual Vulnerability’

Sunday, February 9, 2014

MUTUAL VULNERABILITY

In April 2008 at the American Psychological Association, Division 39 (psychoanalytic division) meeting I first heard Lauren Levine, PhD, who was a candidate at the time, present a paper weaving her experience as a mom with that of her analysand’s. There was something so moving and so singular about her presentation that I immediately invited her to Tampa to speak to our local psychoanalytic society. And in 2010 she presented two papers in Tampa, both papers subsequently published. She is guest faculty at the Tampa Bay Institute for Psychoanalytic Studies, Inc and when I found out she had written another paper, I asked her to share it with us. On February 8, 2014 she presented her latest works to the Tampa Bay Psychoanalytic Society, Inc.

I have read a few papers in my time, but none quite like Levine’s. Her voice is unique; it transcends theory.  In a feat of lived, not theorized, relationality and intersubjectivity, Levine’s papers are as much about her experience as about her patient’s.  In her mindful disclosures to her patients, she reflects to them, in her eyes, themselves, deepening connection and expanding the space for creativity, for herself and her patient, and opens the possibility for desire and greater aliveness. There is reparation and resilience, and transformation ensues. In "A mutual survival of destructiveness and its creative potential for agency and desire," Levine demonstrates how destruction became an agent of change.

I have often stated to supervisees that I feel myself with certain patients holding on to the rim of the abyss, dangling there by one hand, holding the patient, whose weight threatens to pull me down, with the other. I am torn to breaking. I know I must join the patient in the abyss and I know to do so will be the end of us both. Levine, too, describes standing on the edge, trying to pull the patient out of the abyss, feeling too frightened to join him there. There is great shame for us, the therapist, to have doubts about our competency so triggered. It collides with our past vulnerabilities of childhood helplessness and ineffectualness. But, as Levine notes, no matter how difficult it is to find a shared humanity we reach out nonetheless to the disparaging other, knowing that it is in the fidelity to the shared process that hope lies.  

Sunday, February 2, 2014

Humor and Affiliation: Nebraska

Nebraska, directed by Alexander Payne (Sideways, The Descendents) is a refreshing surprise. It is my favorite pick. Unassuming, shot in black and white (cinematographer Phedon Papamichael), with luscious views of the plains states, or plain states to some: cows, rolled hay bales, small towns and lonesome barns, it made me laugh! even more than the absurdity of American Hustle or the eerie quirkiness of Her. But its unexpected humor, like Garrison Keiller’s Lake Wobegon, grabs us at our most human, and we nod with the knowingness of lost tenderness.

Original screenplay by Bob Nelson, Nebraska is a road trip rich in characters, compassion and raw humor. An aging Woody Grant (Bruce Dern), with declining cognitive function who is no longer allowed to drive, so fervently believes himself to be the million dollar winner of a magazine marketing sweepstakes that he is willing to walk to Lincoln, Nebraska to claim his winnings even as his harridan wife Kate (June Squibb) and his two sons try to convince him the letter is a scam. On their journey there is a stop in Woody’s hometown of Hawthorne, Nebraska, where avaricious family and former friends, a felon nephew, and  the truth according to Kate-- whose forthright and funny commentary is Oscar worthy— do not dissuade but initially embolden Woody on his quixotic quest.

We like Woody’s younger son David (Will Forte) right off. It is not just his nuanced ‘porcelain prince’ face, or that his former live-in girlfriend does not look like a Barbie, or even that, like Judge Reinhold’s character in Ruthless People (no one had more ruth), he sells stereo equipment. David carries within him a compassion for his flawed father, and his earnest search for answers from a father who has none, his unflagging willingness to forgive his father’s previous failings and bring Woody a little happiness in his last years cinch for us David’s understated heroism. We wonder from where did David receive his bounty of compassion.

Even this graceless age of economic hard times and ruthless every-man-for-himself mentality cannot obscure the understanding of kinship by a son for his undeserving father. It is not from Woody that David receives any answers. David nonetheless learns things about Woody from those who knew him back when – there is a glance between Woody and his former girlfriend (Angela McEwan), and what might have been, that is hauntingly wistful. The film score by the reunited Tin Hat adds well to the mood of the film. David protecting the dignity of his father is a peerless grace in an age devoid of it. If all the other Best Pic nominations echo contemporary alienation, selfishness, and indifference, Nebraska reminds us of our communal and filial bonds.


Nebraska is nominated for six Oscars, including Best Picture, Director, Actor, Supporting Actress, Cinematography and Original Screenplay.

Wednesday, January 29, 2014

12 Years a Slave, Best picture of the Year



12 Years a Slave deserves best pic (and the Golden Globes thought so, too) if only to hold a mirror to the USA so we never forget (like the Germans teaching the Holocaust). It is a British director, Steve McQueen (who won New York Film Critics Circle’s Best director for this film) who must tell us Solomon Northrup/Platt’s (Chiwetel Ejiofor, of Kinky Boots, Children of Men) story. The film depicts Northrup’s autobiographical account, published in 1853, of his kidnapping, in 1841, and what he survived after being sold into Southern slavery.

Friends told me this movie was hard to watch. With the exception of the flogging of Patsey (Lupita Nyong’o), I did not find it so. The triumph of Northrup’s determination to “live” not just survive in order to return to his wife and children is strongly woven throughout the film. While we are not privy to whatever survival guilt or PTSD Northrup subsequently suffered, we know that a strong family and community connection had immunized him enough to allow him to move the Abolitionist movement forward for a nation oblivious to its shame. In addition to seeing  people treated like property, raped, beaten,  and eerily forced to dance for the merriment of their slaveowners, also horrifying to me was slave owner Ford (Benedict Cumberbatch) reading scripture to family and slaves alike while the film narrative juxtaposes slaves being beaten and murdered.  

For those who avoided this film to save themselves from the painful truth of this nation’s shame, I urge you to see it for it is a beautiful film about the human spirit and the power of love for family and freedom. I often tear up watching films, but this film brought me to frank crying (with joy). There are also  excellent performances from Sarah Paulson and Michael Fassbinder, and cameos from Brad Pitt and Paul Giamatti.




Like 12 Years a Slave (see 1-28-14 post) American Hustle turns a mirror on the USA, but American Hustle is a mere needle biopsy whereas 12 Years a Slave is the full body MRI showing a pernicious and widespread cancer in American history. David Denby of The New Yorker called American Hustle the best movie of the year but asks if it is an important movie.  While American Hustle depicts the real life Abscam affair it is so farcical that we forget this is a slice from history. Director David O. Russell (The Fighter; Silver Linings Playbook) and the superb acting of Jennifer Lawrence, Amy Adams, Christian Bale,  Bradley Cooper and Jeremy Renner make this film highly entertaining even while it is difficult to empathize or identify with such a group of con artists and self serving sociopaths (politicians and FBI agents) , including those who think they work for the common good.

Sunday, January 26, 2014

The Age of Loneliness and Despair: Gravity

In this age of income disparity, with its escalating vitiation of communal responsibility, there is the sense that each of us is left to fend for herself. So, too, it is for Mission Specialist Ryan [“Dad wanted a boy”] Stone (Sandra Bullock) in Gravity, one of the nominations for best pic. I have yet to see all of this year’s nine nominations, but I would be deeply disappointed if this film took the prize. Co-written and directed (winner of Golden Globe) by Alfonso Cuaron (Children of Men; Y Tu Mama, Tambien; Harry Potter and the Prisoner of Azkaban), I found Gravity a tad tedious despite its vertiginous (think amusement park rides) special effects (CGI supervisor Tim Webber) and breathtaking views of earth from space (cinematographer Emmanuel Lubezki). Alone in space, Stone finds herself confronting one perfunctory crisis after another leaving little time for the audience to come to know the texture of her inner life. Perhaps we can, in this graceless age, no longer fathom, or bear, texture—Inside Llewyn Davis was passed over after all—and must be distracted from it. 

We do, however, come to know Stone’s mettle. Debris [motto: don’t litter] fallout, has put the astronauts in peril, and George Clooney, I mean Matthew Kowalsky, keeps Stone calm with small talk, their voices and the tenuous umbilicus, their only connection. There is a single moment of humor: “it’s not rocket science.” 

 Making it inside the space station capsule, disencumbered of her space suit, Stone floats in her underwear (remember Sigourney Weaver in Alien) like a joyful dancer, like a fetus in the womb. Was Stone’s favorite thing in space-- “the silence” --cavalier, or meant to foreshadow irony? Now all alone, lonelier  than Twombley in Her (see 1-21-14 post), the memory of human connection is strong, and Stone uses the voice of her mentor to soldier on.

My favorite scene is when she picks up a signal from earth and almost luxuriates in hearing again another human voice. But it is, like an unresponsive and unrecognizing mother, unable to hear her, and it is in a foreign tongue. She considers her imminent death, and the tragedy is that no one will mourn her. She even wishes to hear again what neighbors find so annoying, the barking of dogs. Most poignant is her recognition of a lullaby to sooth a crying baby.  She awakens to the hallucination of Kowalsky with new found determination. For a moment we hope Kowalsky is real—our own terror of being alone? Kowalsky is the voice in her head, the constant object, the good mother, that therapists strive to evoke. The music swells [please!] and we see Bullock’s sweet, pale, determined face. 

The viewer is ecstatic for her when she contacts [motto: have your fire extinguisher ready] the Chinese space station. On reentry, again the music swells [OMG, really?]. When she finally makes it to earth, emerging from the water like the first creature from the primordial ooze to stand heavily on land, we do not think about the inevitable osteoporosis and, worse, PTSD: the life threatening situation, the survival guilt, the sight of Sharif’s head blown out while the photo of his family hovers.

Is the only attachment en utero, after which we are forever alone? 

“…that’s why we keep talking, somebody might be listening” and it is “scary as shit, being untethered up here.”

Tuesday, January 21, 2014

Academy Nominee: Her. From the paranoid-schizoid position, one mistakes the part for the whole.

Taking the bad with the good can be a daunting task for many of us. How do we sustain a relationship with a fully breathing and embodied other who is a subject in her own right, and, consequently, sometimes carelessly indifferent to our needs and desires? Doesn’t the ideal mother always have an ear out, answer our cries, come when we call? But who is such a woman? Gergely, Beebe, and others have shown that affective matching needs to be less than perfect, in the same direction but, for example, of varied intensity. In Spike (Being John Malkovich; Where the Wild Things Are) Jonze’s Her, Theodore Twombly (Joaquin, Phoenix) does not have to deal with variations in matching, for after his failed marriage, his new love Samantha (voice of Scarlett Johansson) is the sci-fi futuristic, artificial intelligence operating system— light years beyond Siri— whose exponentially evolving consciousness and access to unlimited data and permutations, can tailor her responses to his needs. A quirky love story between man and ‘machine’ this is a profoundly disturbing and alluring film— high praise. Like many films nominated this year, this one is about loneliness

Creepy is Samantha’s insidious invasion (think NSA) of Theodore’s computer’s contents (inner workings). Creepier still are this film’s street scenes which show pedestrians engaged, not with other humans, but always with their technological devices. Even couples operate in parallel play, beside the other but without interchange with one another. A few decades ago, this behavior of engaging objects (here I mean things, not metapsychological internal representations) over human beings would be viewed as indicative of profound interpersonal disturbance. Now it is commonplace. Does our profession have to re-think our diagnostic manual, as we did about homosexuality? Is this all the intimacy we can muster, all the satisfaction we dare desire? Did technology lead to isolation and loneliness? Does a sense of alienation draw us to technology? Or some of both?

And I thought guys were supposed to be visual— hence Playboy and internet porn, not simply the failsafe for lonely and lubricious men too inept to deal with a real (whole) woman, but likewise ever ready even for those who have forged a relationship but whose real women are otherwise unavailable or disinterested. So how does Theodore settle for a disembodied voice, even one as appealing as Johansson’s?  While technology is changing how we interact with one another, there seems in Her to be little change from what heterosexual men dream of their fantasized women. Most disturbing about Her is this lack of evolving enlightenment in sexual politics, specifically the way men conceive of the desired ideal woman. Techno-geeks are more likely to be men, I suppose, but even an artificial intelligent simulation of a woman is not, in the this future, very enlightened.  Old stereotypes prevail. The ideal woman for some heterosexual men is still the Madonna, and Samantha’s motherboard is initially ideal in her maternal-infant matching of affect, her encouragement, and availability. Theodore (“God’s gift”…apparently not to women) fails to negotiate Samantha’s burgeoning, albeit artificial, subjectivity. If a film protagonist must eschew the subjectivity of his woman, I preferred Lars and the Real Girl.

Theodore, a writer of deeply romantic love letters, pouring out, in de Bergerac fashion, heartfelt sentiment on behalf of others, cannot seem to love a real woman (his failed marriage) nor can he love a virtual one. Both Samantha’s ‘desire’ for greater connection, and her desire for a world beyond Theodore’s, threaten him. She evolves in nanoseconds. [I am reminded of a quote from Somerset Maugham, “We are not the same person this year as last nor are those we love. It is a happy chance if we, changing, continue to love a changed person.”] Is one backlash to feminism’s changing of the American landscape that men should not date a woman more intelligent, for things will end badly?  Human relationships are hard enough. I would feel completely defeated if a machine broke my heart.


Tuesday, January 14, 2014

Kleinian Positions

Besides elaborating for us the concept of projective identification (see post of May 16, 2011) Klein proposed two positions—not stages (she saw stages as linearly placed, kept in the past once this phase was traversed and returned to via regression). Positions, on the other hand, are interminably available, and can move into background or foreground throughout the lifespan. The positions are the Paranoid-Schizoid Position and the Depressive Position. When one operates in the paranoid-schizoid position, the defense of splitting predominates. In the depressive position, integration— the capacity to see differing aspects simultaneously—operates.

Developmentally, before a child has integrated that one person can have good and bad aspects, the child’s perceptions are split: There is a good mommy who gratifies and soothes and a bad mommy who frustrates and frightens. This compartmentalization is a function of immature cognitive development but psychologically serves to ‘protect’ the good object from feelings felt toward the bad object. An unfortunate carry over in adults is when we judge a part of a person (a misstep, a behavior, an attitude), mistaking it for the entirety of a person’s character, as if it is the whole person. (‘You pissed me off or disagree with me so you are scum or stupid, even evil.’) Racism, sectarian violence, misogyny work this way, evacuating and disavowing from ourselves any unacceptable trait or thought that we must disown.

Once a child recognizes that the mother contains multiple, even contradictory, aspects in one  whole, both good and bad, two important things happen: the good aspect of the object is seen as capable of injury such that remorse, guilt and reparation may ensue; and the object is no longer seen as under the omnipotent control of the infant. Both guilt and loss of omnipotence can be ‘depressing’ to the infant.


Intersubjective theory advocates for striving to balance between both positions, including experiencing ourselves as both subjects and objects. In treatment, we alternate between seeing ourselves and our patients as subjects and objects. The less rigidly one holds to either position the more self-reflective one can be, and the more empathy one can develop.