Film today: The Sixth Sense

The 2014-2015 Film Series of The Tampa Bay Institute for Psychoanalytic Studies, Inc (T-BIPS) and The Tampa Bay Psychoanalytic Society presents today the M. Night Shyamalan film, The Sixth Sense, starring Bruce Willis as a child psychologist Dr. Crow and Haley Joel Osment as his disturbed patient, Cole. And what ails Cole the most? Like so many gifted children in a disturbed world of family ghosts, he sees what no one else can bear to see.

That parents in many families unwittingly reveal their torments –having dissociated or repressed their own past traumas of chronic misrecognition; attacks on their reality; or physical, emotional, and sexual abuse— inadvertently leads to terrifying consequences for their children and themselves. It is not only the ghosts of Shyamalan’s film who are lost souls, but all of us who cannot face our own trauma, including our inevitable finitude. Our wish not to see what Cole sees, along with our collective denial of death, allows the audience to believe that Dr. Crow must be alive after having been shot a year earlier. This despite that crows, of course, were well known to have been long associated with death, or its harbinger. The crow has also been attributed powers as a spirit guide, with the powers of sight and transformation.

It is Dr. Crow who must lead lost souls, both living and dead, to some form of grace. The ghosts are tormented by their self deception— they do not know they are dead. Cole, like the gifted child in a family haunted by the ghosts of past trauma, struggles valiantly to face that which he also wishes to avoid (seeing the torment of others). Ironically, perhaps inevitably, it is the healer himself who cannot face his own truth—for we are all wounded healers—and Cole can only be helped to face, to listen to, the ghosts as he helps Dr. Cole face his own plight.  The wisdom in Cole is his gentleness in revealing what he intuitively understands is too painful for Dr. Cole to see.

[Is it an ethical dilemma for the therapist to be blind about one’s self (and only on the road to healing) while simultaneously attempting to heal patients? Is it incumbent upon the therapist to be set free by one’s own truth before ever attempting to help others? Perhaps Cole and Crow were both lucky to have encountered one another, despite the pain engendered on their way to a second chance.] 

Depression is Us

Bromberg, who has written cogently on the patient’s need to stay the same (not give up a part of himself or lose a sense of who he is) while changing, cautions the analyst against attempts to alleviate a patient’s depression without first respecting that depression is not merely an affective state but is also who the patient is: “For many people [depression] is a self-state with its own narrative, its own memory configuration, its own perceptual reality, and its own style of relatedness to others.” Because the patient has a need to preserve the self and self meaning, he cannot easily allow the analyst to destroy a part of his personal reality as if it is meaningless.

By giving in to a patient’s demands in an effort to relieve him of his depression the analyst attacks the patient’s self and speaks to the analyst’s incapacity to bear with him his suffering. Gratification of patient’s needs (in attempts, for example, to relieve depression) can become “a form of misrecognition, …evidence to the patient that the analyst is unable or unwilling to authentically ‘live with’ the patient’s state of mind.” While “patients in general need soul-searching emotional openness from their analysts” the analyst’s inauthenticity makes it difficult for her to give the patient what is actually needed—genuine mutuality— and so the patient understandably responds by pushing the analyst “to the edge” in the hope of helping her change into someone more capable of genuine mutuality.

Bromberg, P.M. (1994). “Speak! That I May See You”: Some Reflections on Dissociation, Reality, and Psychoanalytic Listening. Psychoanal. Dial., 4:517-547.

Body sensations as the precursor to thought

Patients with psychosomatic disorders have been variously conceived as lacking in symbolization, being alexithymic (without words for emotions), and having deficits in mentalization. Lombardi’s paper is reminiscent of our discussions in the Repetitive Painful States course about symbolic origins, or lack thereof, and the development of (bodily) experience into “the differentiating force of thought.” According to Lombardi, the body is the starting point for mental activity, and upon it psychic reality is based. “[T]he body furnishes the constitutive elements from which are derived both the precursors of the emotions and the perceptual structure out of which the ego develops.” Without an internal construct, internalization is meaningless.

Furthermore, “[T]he sensory level imposes itself as the sole condition for gaining access to existence.” Through bodily sensations (such as the smell of an unwashed body) Ogden’s autistic-contiguous position posits experience of the feeling that one exists, for “the body [is] the first and founding entity upon which the subject’s identity is based.” The body is used in an attempt to repair and heal the internal void. In attempts to feel real or alive one may attack the body (e.g. self mutilation). Conversely, bodily sensations may be marginalized or corporeity rejected altogether (such as in Lombardi's clinical case of the man with anorexia nervosa; or in the extreme case of psychotic depersonalization). Therapists, then, may find verbal communication obfuscated by the predominance or exclusion, respectively, of the sensory-emotional dimension.

Relying on the work of Ferrari, Lombardi writes that “the continuous flow of sensations from the body” and “the intersection of sensations and thoughts” allow the “potential for expressing current emotions” such as ‘I am afraid’; I don’t feel well; I feel lost; you are beautiful; I love you; I hate you.’ “[T]hinking is deemed to be at all times connected with feeling.”

Delusions, obsessions, phobias, may be primitive sensory expressions, a necessary resort until more favorable conditions for mentalization present themselves “such as an encounter with an analytic reverie, which afford[s] an opportunity for…language proper and hence thought…[and for] the construction of a language to enable corporeity to speak.” Just as the mother’s reverie quells tensions allowing for mental space to process (‘receive and recognize’) the infant’s bodily sensations, providing an “area of transition from the concreteness of sensation to the first forms of abstraction and representability,” psychotherapy gingerly develops language to allow for symbolic expression and for the re-integration of the false duality between mind and body. Aptly put, Lombardi notes, “The function of analysis is to lead the analysand back to a real lived dimension so as to generate fragments of authentic experience.”

Lombardi, R. (2002). Primitive Mental States and the B... Ferrari's Concrete Original Object. Int. J. Psycho-Anal., 83:363-381.

Attachment and Separateness

Both separateness and attachment develop our self identity. Mahlerian separation theories did not distinguish the development of the individual from development and maintenance of relationships, where, through internalization [a specious distinction between inside and outside], object constancy is eventually established allowing for more comfortable separateness. In contrast, attachment theories see the development of the individual as inherently interactive, with the self made up of past and present internal relationships. Relatedness, instead of the individual, is emphasized. Blass and Blatt speak of  the dialectic between separation (development of ‘self’) and attachment (the development of ‘self with other’), reminding us that it is not a linear process, but two distinct lines of development, whose progress in one line is essential to the other, each being continually renegotiated and reintegrated throughout the life cycle. The two primary developmental tasks, then, are the establishment of a consolidated, positive sense of self and the capacity to maintain mutually satisfying relationships. Within these interpersonal relationships, one learns to accept the limitations of the other, accept separateness and ambivalence.

Osofsky, likewise, sees the self as developing, and existing, within relationships. She notes that internalization of relationship experiences (of self as good and competent, or, conversely, self as bad and incompetent) become the internal representations, Bowlby’s internal working models—based on real life events – [and, perhaps, Stern’s RIGS, representations of interactions that have been generalized]. Early affect sharing and communication in the developing relationship between mother and infant contribute to the infant’s differentiation of self from other, that is, the self develops within the caregiver system [Winnicott’s no such thing as a baby]. The quality of this affect sharing and mutual regulation, affecting the quality of attachment, influence the child’s developing sense of self and of others. An infant can only “be competent to the extent that there is a caregiving environment that is alert and responsive to the infant’s ‘signals’.”  Meaning develops according to what the child means to the parent, and implicit rules of relating become the basis of the sense of self and the self with others. Later, “the analysand forms a relationship with the analyst that recreates and [hopefully] reworks old ‘working models’ of attachment figures.”

The self comes into being through interaction with important caregivers and through experiences of the self as separate. Blass and Blatt take Kohut’s ideas about the self as primarily a separate, self-contained  entity, and grapple with the paradox of self as continually embedded in relationship with others, that is, as also attached in loving relationship to others. They note that Kohut failed to emphasize that object ties (attachment) “can be based on other motives in addition to narcissistic ones.” They also point out how empathy as an expression of attachment can conflict with the self’s need to experience oneself as differentiated within a relationship, the “wish to be incomprehensible, obscure, [Winnicott’s private self] and thus separate.” Kohut struggled with whether to consider the selfobject experience as intrapsychic or interpersonal. Loewald put it in neither realm, but ‘in an intermediate region.’ Kohut spoke to relationships in regard to their contribution to self cohesion (that is, the other as selfobject), and distinguished object love and narcissism on degree of: differentiation between self and other; drive satisfaction; and contribution to self cohesion. Paradoxically, object love is attachment with increased differentiation, whereas the narcissistic aim is separateness (and intimates self interest) despite decreased differentiation (experiencing other as part of self, perhaps through projective identification).  In fact, write Blass and Blatt, “ongoing existence of others is experienced as an inherent and integral component of the individual’s cohesive sense of self separate and autonomous.” This paradox speaks to the speciousness of dichotomizing differentiation (separateness) and attachment for, as Blass and Blatt note, they are dialectically intertwined. Likewise, there is conflict and tension between the aims of attachment and autonomy. Thus, negotiation between autonomy (separateness) and relatedness (attachment), between self-sufficiency and dependency, is a universal human dilemma.

Blass, R.B., Blatt, S.J. (1992). Attachment and Separateness—A Theoretical Context for Integration of Object Relations Theory with Self Psychology.  Psychoanal. St. Child, 47:189-203.

Osofsky, J.D. (1995). Perspectives on Attachment and Psychoanalysis. Psychoanal. Psychol., 12:347-362.