Wednesday, July 19, 2017

Lullaby

    Clinicians just starting out often worry about saying the ‘right’ thing to a patient. I often tell supervisees that people come to us not for answers, and not necessarily for words, but for “something more,” such as a longing to be recognized, to have someone take an interest in their inner lives. As humans, we usually have an interest in others, and as therapists, a deep interest in others and in their inner lives. We have a desire to know more, and we make an effort not to impinge with our curiosity, to have a benevolent curiosity if you will. So far so good.
     People also come to us needing to be held in mind. Just as caregivers grow the brains of their infants by gazing at them, by enjoying them, by remembering and imagining what it was like to be such a baby with an inner life and with experiences, so the holding a patient in mind (even outside of the session) comes to us as we reflect on and imagine the past, present, and future experiences of our patients. The caregivers’ interest grows the baby’s inner life: the baby experiences itself as ‘I am interesting. I am important. I have a right to be here. I exist.’ 
Sometimes our patients need such things from us: to be held in mind, to be enjoyed, to hold our interest, to have their feelings “marked” (in the same direction of the affect, without being identical). These experiences are part of “implicit relational knowing” and do not require words to effect reconfigurations in brain anatomy and brain chemistry. 
Sometimes our most sorrowful of patients have missed out on some necessary pre-verbal experiences: of being gazed at, nursed, rocked, sung to, of being held in the caregiver’s arms, and being held in mind. Ogden called this very important fundamental stage of sensory experience the autistic-contiguous position. It is the foundation or sensory ‘floor’ upon which subsequent experience is integrated and organized.  
    I recall a 15 year old boy with a horrible history of abandonment, neglect and physical and sexual abuse, often in foster care, who was court ordered to see me after punching his father. (His father had called the police.)  The boy arrived for the first appointment very angry. He crossed his arms, declared emphatically that he was not going to talk to me, and promptly fell asleep on the couch for the entire session. 
Perhaps I had the autistic-contiguous position in mind. Perhaps I was thinking about this boy’s childhood (some of it previously revealed to me by his father when the father had made the appointment) and thus was imagining that this boy had probably never been held in the mind of a caregiver, never been held in a caregiver’s arms and been rocked and sung to, never had consistent opportunities for mutual regulation of distressing affects. But, whatever the 'reason,' I began to sing him a lullaby as he slept there immobile. When the session was over, he lept off the couch. He returned the following week and each week thereafter, and talked and told me his sorrows. (He even hoped to continue long past the six months ordered by the court.)

Ogden, TH. (1989) The Primitive Edge of Experience. Northvale, NJ: Jason Aronson.

Thursday, July 13, 2017

Intersubjectivity and China

In psychoanalysis we talk a lot about intersubjectivity, seeing the other, the different other, as “an equivalent center of being” (Benjamin), the recognizing of difference. In the USA, with travel bans and threats to build walls between countries, we lament the negation of the other, the falling to one side of a polarity, failing to sustain the tension between differing subjectivities.

In 2010 I congratulated the talented Chinese therapist I supervised, for the Nobel Peace Prize had been bestowed on her fellow countryman Liu Xiaobo. She had not heard. 

Censorship was only one area against which human rights activist Liu struggled. He authored books on democracy and human rights.  Liu, imprisoned after co-authoring in 2008 ‘Charter 08’ -- a petition-manifesto signed by hundreds which criticized Chinese government and called for political reform -- was not allowed to receive the Prize in person. He died today, disallowed from receiving treatment outside of China for liver cancer. He is the first Nobel laureate to die in detention in almost eighty years. Liu had been previously imprisoned for over a decade after taking part in the 1989 Tiananmen Square protest, where students faced down tanks. He had been an activist for human rights in China since then.

Sunday, July 9, 2017

Black Girl Interrupted, Black Girls’ Internalization

Internalization alludes to aspects of the other, including those projected, which can become part of the self, encoded experientially and procedurally in the brain, as do interactions or way of interacting with the other. What the other feels about the self, what is implicitly communicated, also becomes part of the sense of self, whether positive or negative feelings. It is the feeling (affect) more than the action that is encoded. Whether the self can come to expect soothing or neglect is also internalized. This procedural knowledge is carried forth into later life.

Black girls age 5-9 years are seen as older than their years, called ‘adultification,’ according to a recently published study by Jamilia J Blake, PhD, Associate Professor of Educational Psychology at Texas A&M University and Rebecca Epstein, Executive Director of Georgetown Law’s Center on Poverty and Inequality. Blake and Epstein found that black girls are seen by the school and juvenile justice systems as more adult and less innocent than their white peers. They are perceived as needing less protection and less comfort and nurturing, and were found to be punished more harshly than white peers, e.g. five times more likely than white girls and twice as likely as white boys to be suspended from school. Teachers were more likely to call the police on black girls and prosecutors less likely to drop cases against them than white girls. While a previous study by a separate research team [Perry] had shown a similar ‘adultification’ of black boys from about age ten years, black girls showed a higher disportionate rate of disciplinary action than even black boys, thought due to ‘gender transgressions’ (violating norms of femininity).

What adults project onto children affects the way children see themselves. So, what happens when children are seen as less innocent and more adult like (whether ‘adultified’ or parentified)? are punished more harshly? and given less nurturing? Do they grow up perceiving themselves to be ‘bad’ and unworthy of their longings for [inter]dependency, comfort, and help? Do they feel undeserving of tender caring and instead are the caregivers, or, worse, so bereft of receiving care that their subsequent and understandable resentment and anger lead to lashing out, even becoming the delinquents others expected all along?

Saturday, July 1, 2017

Recognition

Recognition is the ability to take in the other person’s perspective, finding sameness and difference in the other’s mind and accepting it; to see the other as a separate self and the needs and desires of the other as equally valid (intersubjectivity). Recognition may be the deepest longing in a human being; and it is incumbent upon the analyst to provide it.


USA Washington Journalisten im Wei├čen Haus (Getty Images/M. Wilson)

Last month I was felt both ‘recognized’ and embarrassed when on June 19 Germany’s international news organization DW (Deutsche Welle)’s Freedom of Speech Award went to a U.S. recipient: the White House Correspondents’ Association. 

[This award honors a journalist who toils under great oppression yet continues to stand for freedom of expression and human rights despite consequences, sometimes fatal ones. In 2015,  the Saudi blogger Badawi (imprisoned) was so honored; and, in 2016, it went to the Turkish editor Ergin who dared oppose Pres. Erdogan.] 

Journalists continue to hold governments accountable even when told, as currently in the U.S., that they are liars who disseminate  “fake news.” I felt ‘seen’ that, even across the ocean, a prestigious news organization recognizes our plight and sympathizes and encourages us. I felt embarrassed because I had complacently thought that the USA would/could never allow such an attack on a fundamental freedom. Freedom of the press is the mainstay of democracy, a necessary watchdog on government and private industry alike. Hopefully, we recognize this.

Saturday, June 24, 2017

Bullies and Bystanders

Tomorrow June 25, St.Petersburg, FL celebrates diversity with its Gay Pride Parade. I am reminded of two old movies, Tea and Sympathy and Rebel Without A Cause, from a time in which diversity was not so celebrated.

Tea and Sympathy (1956)(directed by Vincente Minnelli, based on Robert Anderson’s 1953 play of the same name) is oppressive to watch when viewed from the 21st Century.  Difference is taunted and ostracized. A prep school senior, Tom Lee (John Kerr) is called “sister boy” [for what could be worse from the hypermasculine POV than being compared to a woman/girl] because he prefers music, theater and poetry to baseball and mountain climbing. He is bullied to suicidal thoughts. The coach and house headmaster’s wife Mrs. Reynolds (Deborah Kerr) takes Tom’s part. Defending Tom to her husband (Leif Erickson) and chastising him for being a bystander, she says “‘He’s not like me, therefore he’s capable of all possible crimes.’ ... [T]he tribe has to find a scapegoat to reaffirm your shaky position... If he could be manly, then you had to question your own definition of manliness.” Eschewing the false dichotomy, she rails against her husband’s black and white thinking. [Twemlow and Sacco write about bullying in their ebook Preventing Bullying and School Violence].  But should one mistake Tom for a homosexual, as his classmates do, one only need note the foreshadowing in Tom’s reading of Candida to confirm his love for Mrs. Reynolds. [Wikipedia’s author writes it is Voltaire’s Candide, but I think this is a mistake, for it is in GB Shaw’s play that a young man falls for, and seemingly desperately needs, the older, married woman. Candida chooses the man who needs her more, her husband, who must so desperately dissociate his need for her. Mrs. Reynolds, however, a modern woman, I suppose-- or perhaps riddled with the shame and guilt her constraining contemporary society demands -- chooses neither man.]

Also painful to watch is how women are treated in this film. Mrs. Reynolds, her opinions interrupted and disregarded and spoken to by her husband as if she were a child, is relegated to the keeper of men’s emotions and the one who attempts to smooth over painful feelings in her husband and Tom. The local soda shop’s server Ellie Martin, a former ‘a-dime-a-dance gal, is unrelentingly sexually harassed by the “regular guys” from the local prep school.


Rebel Without A Cause (1955) (directed by Nicholas Ray) also portrays the bullying of boys who are Other or different. In the 1950’s, a gay theme could appear only as subtext, but the bullying of Plato (Sal Mineo) was undoubtedly, in part, about his homosexuality (noted by the photo of Alan Ladd in his locker, and by his crush on Jim Stark (James Dean)). His torment ends with possible suicide by cop. Mineo, hailed today by the LGBT community as one of their own, was nominated for Best Supporting Actor for this role and, at that time, was the youngest actor (16 years old) ever to be nominated for an Oscar. James Dean, himself posthumously nominated for this role (and for Giant), was purported to have ‘experimented’ with homosexual liaisons, as well as to have been sexually abused when younger by a pastor. Dean, also an auto racer, died prematurely in a car accident at age twenty-four.

Here's hoping for better days, days when bystanders stand up to bullies and difference is celebrated.

Thursday, June 15, 2017

Fargo

    My favorite TV show (on Fx), inspired by the Coen brothers’ film of the same name, set in Minnesota, always features a laudable female, police chief. Gloria Burgle (Carrie Coon) is that policewoman, only In this its third season, she is demoted from chief, has been left by her husband for a man, has a teenager who prefers the mall to her, and feels she does not exist. Confirmation of her non-existence comes from the sensors on automatic door openers,  soap dispensers, and faucets, none of which ever sense her presence, so do not open, dispense soap, nor turn the water on.
    It is only in the penultimate episode of the season, when Gloria has a listening ear in Winnie Lopez (Olivia Sandoval), a neighboring town’s police officer, that things change for her. Like Horatio to Hamlet, WInnie hears, really hears, and what she hears is Gloria’s fears about not existing. Subsequently, Gloria is able to engage with soap dispenser and faucet sensors. This reminds me, of course, of how infants (and adults) need to be seen and held in the mind of the other to feel one’s existence in the world, to feel part of something bigger than oneself. Good-enough caregivers provide this, as do good-enough therapists, by seeing and holding the experience of the other in mind.
    I was also reminded of Hegel’s understanding that a subject cannot be fully a subject until recognized by another equal subject [within independence is this dependence, that is, there is interdependence]; and of the title of a Dean Martin song, ‘You’re nobody ‘til somebody loves you;’ Here love is embodied in the seeing, accepting,and welcoming in of the other, all the parts of the whole other, without having to give up the self (that is, done whether we agree with the other or not). Yesterday, was a sad day in northern Virginia, when baseball practice became tragedy. Perhaps the good coming from it will be a bit more understanding of the other [side of the Congressional aisle].

Monday, June 12, 2017

New Cycle of Courses begins Sept 20, 2017

The Tampa Bay Institute for Psychoanalytic Studies (TBIPS) is pleased to announce a new cycle of its four year curriculum starting Sept 20, 2017. You can start at the beginning with 'Introduction to Psychoanalytic Concepts.' As you know,  theories and methodology in psychoanalysis have changed tremendously over the decades, thanks to contributions from caregiver-infant and attachment research, and from neuroscience.  While relationship and the 'unconscious' (or 'non-counscious') remain paramount, gone are the days of authoritarian and distant analysts who knew the secrets of the individual's mind. Instead, analysis is a collaborative effort of building safe and supportive relationships where  new ways of being in the world and healing  can take place. At TBIPS we emphasize an open and welcoming attitude, both for students and patients, and focus on development, attachment, and making whole the fragmentation caused by trauma.

Please know that TBIPS is happy to accept long distance candidates (courses, personal therapy, supervision0 for training and students for course work. We would be delighted to have you join us in the Fall. Further information can be found at tampapsychoanalytic.com.

Monday, June 5, 2017

Response to Co-creation of Dreams, posted May 22

One can imagine that the fences in the patient’s dream are less about “unspoken boundaries” between the patient and his father and more about those that stand between the patient and the therapist. One can imagine the patient feeling the intimate confines of the consulting office and a desire for therapeutic boundaries to vanish leaving him and the therapist free to explore the vast horizons beyond.

In my mind, the two benevolent white-haired men could symbolize wisdom and morality. They have perhaps ascended from above to give the patient an understanding of both the permeability of the boundaries that he and the therapist have co-created and his understanding their moral necessity. 

The therapist, too, in her dream, is reaching out past the boundaries and, like her patient, understands the need to maintain them and consequently turns away.

Interestingly, by disclosing her dream to the patient, she is in fact reaching past the boundaries and thereby simultaneously expanding them and reaffirming that they are there. Her disclosure reveals her trust that he understands the limits of the therapeutic relationship and the necessity of those limits. Her sadness demonstrates that, despite the application of clinical terminology like “transference,” “counter transference,” and “therapeutic alliance,” underneath are real people with real emotions, which are sometimes intense and sometimes bump up against the therapeutic boundaries. This is, as the patient says, romantic, at least in the sense that true love involves walking the boundary between the selfish desire to possess and the selfless sacrifice of putting the other’s happiness above that selfish desire.

Therapeutic relationships sometimes walk this line, but a patient whose relationship with his father was distant probably benefits more from experiencing the reality beneath the “therapeutic alliance” than he does from any clinical assessment of his psychological history. I suspect that while he most likely grieves the lack of a relationship with his father, what he desires now is real connectedness. The lack of a relationship with his father may explain his desires for connectedness, but it doesn't satisfy it. The emotional reality behind the therapeutic alliance demonstrates that such connectedness is possible, that he is a person who is worth investing in emotionally, and that limits around the connectedness do not diminish its worth. 

The emotions “stirred up” (dare I say ignited) in the therapeutic relationship are indeed the mutual property of the therapist and the patient, but I wonder if Dr. Alexander-Guerra understands her role in the co-creation process (for it is an evolving process). Does she understand that by making the therapist’s session with the patient blog-worthy, she has added a layer of legitimacy to the emotions? I wonder if as a result, the therapist feels more secure in her relationship with the patient and if the patient reciprocally feels more secure. I wonder if Dr. Alexander-Guerra understands if she is now part of the co-creation between the therapist and the patient. I wonder if the patient has read this and feels a mutuality with Dr. Alexander-Guerra. I would if I were the patient.

         submitted anonymously

Friday, June 2, 2017

Graduation

 On the TV show Major Crimes (Season 1: Episode 4,  aired 9/3/2012), a foster child, dealing with always having to leave and start over someplace new, that is, with always being a stranger, and, also, dealing with always expecting to be repeatedly sent away to a new place, requests, from his latest foster mother, thirty days notice before he is sent away again. She reassures him: “Whatever happens here, you will one day go off and be the new kid again. But no matter where you go, no matter when, you’ll never be a stranger to me. I will always know you.”  



That brief interchange resonated with me as a psychotherapist because for a short while we ‘foster’ the growth and development of our patients, temporarily providing safety and succor, while growing ourselves. The world is a better place for both of us. But despite this fostering of a most emotionally intimate of relationships, our patients, like our children grown, must leave us; and we are left to mourn. We take solace in the recognition that they will never be strangers, joy in that we have known and, in some ways, will always know them. We send them off and into the world with great pride, matched with loss.

Monday, May 29, 2017

The 100th Birthday of John F. Kennedy falls today on Memorial Day

This year’s Memorial Day also happens to be the 100th Birthday of John F. Kennedy. Born May 29, 1917, he was the 35th president of the United States, and himself a WWII veteran of the Navy. A quick study, having learning from the Bay of Pigs debacle and negotiations with the then Soviet Union to get missiles out of Cuba, under pressure from Freedom Riders, Martin Luther King, Jr, and many others, Kennedy turned his attention to Civil Rights. It was only after his assassination in November 1963 that his successor Lyndon B. Johnson was able to get passed through Congress the Civil Rights Act of 1964 which outlawed discrimination based on race, color, religion, sex, or national origin. [We might remember today just what types of discrimination were outlawed.]

Memorial Day is a time to pause and remember those who died as soldiers, Marines, Airmen and women, sailors, Coast and National Guard persons. We thank them. Today might also, perhaps, be a time to recommit ourselves to giving back for their service by offering an hour a week pro bono psychotherapy to the family members, or veterans who remain, through, for example, Tampa Bay Institute for Psychoanalytic Studies’ Veterans Family Initiative.  Many clinicians in the Tampa Bay area have generously given of their time and expertise to help families and wounded warriors afford much needed mental health services. We thank them as well.

Friday, May 26, 2017

From Fantasy to Imagination

Bromberg tells us that “the negotiation of selfhood and otherness...has a lot to do with imagination and creativity.” and that “The relative presence of “imagination” in human discourse overlaps to no small degree with the relative capacity for intersubjectivity that exists in any relationship.” [Being able to let in another’s experience allows for a “shared intersubjective space.”] Bromberg expands the shared space to include shared imagination, “loosen[ing] the rigidity” of one’s singular believes about the self [and other] to allow for a “relational unconscious.” I take this to mean if one is stuck in solipsistic fantasy, there is little to no room for interrelating with others much less comprehending that there exists another’s mind, one with separate contents from one’s own. He writes:
The cocreation of a lived, relational unconscious more and more nourishes the willingness of each person to participate in a growing sense of “We” that includes “Me” and “You” as part of their individually expanded self-experiences. By living together in the enacted shadow of what is visible but not perceived, an opportunity is afforded to encounter what has been hidden in plain sight. … This allows their relationship greater interpersonal spontaneity and creative self-expression that is carried by an expanded sense of selfhood into the world “out there.”

Relying on Winnicott’s 1971 paper on “Dreaming, Fantasying, and Living,” Bromberg elaborates that fantasy is a dissociated (‘Not me’) state while imagination embraces the ‘Me’. A colleague of mine noted that fantasy is somehow without hope [a remedy to hopelessness], while imagination includes hope about the future.  Winnicott put it, in his enigmatically paradoxical way, like this: ”In fantasying, what happens, happens immediately, except that it does not happen at all.”

Bromberg explains:
For a person who is “imagining,” the state of affairs is different; the person is experiencing the self as it now exists, projected into the future. Because the self  being imagined is the same self that is doing the imagining, the person as he is now has the capacity to act into a future that is real to him because the future that is imagined in the here-and-now is itself real. When the capacity to transform fantasy into imagination starts to increase, self-state transitions do not disrupt self-continuity, which in turn allows the present and the future to be bridged and thus to coexist. The person does not have to remain stuck in fantasy. What is imagined is not impossible for the self in the present; it just hasn't happened yet. [Einsteinian]

When the therapist can imagine, much like the mother for the infant, the patient’s expanding future on the horizon, then the patient, too, can consider such a future. The mother develops the mind of the infant by holding the infant in mind. The therapist develops the imagination of the patient by imagining.



Monday, May 22, 2017

Co-creation of Dreams

A therapist discloses to a patient the dream she had about him the night of their previous session:
I was sitting next to you on the couch in my office. You were sitting in the middle of the couch and I was to your left. We were facing each other. I reached over and touched your face. Your skin was soft. You then reached over to me and I felt guilt and sadness. So I turned away crying, feeling that loss. I wondered if you felt I was rejecting of you. I turned back to you and you said, “I love your father.”
The therapist recognized the resurgence of familiar feelings: her love for her patient, the patient’s love for her, and how it could not be; also familiar feelings with the therapist’s father. The therapist knew she also loved her father, and he, her, and it could not be. So, said the therapist, I am in touch with my sadness.
  
The patient shares his dream:
I was in the backyard. There was a helicopter overhead. It started coming down, through the trees. I could see the pilot, we made eye contact, and waved, two men with white hair. Then the fence disappeared. Then it changed to the backyard of my childhood home and there were fields with no end.
The patient quipped [associated], Why can’t I dream about sex instead of about benevolent old men with white hair?


The therapist mused aloud, Maybe this is about your father, the unspoken lifelong wish that there were no longer barriers between the two of you, instead of your usual, professed indifference toward a preoccupied, distant and disdainful father.


The patient and therapist had long since past been in the throes of an erotic transference- countertransference. The patient, old enough to be the father of the female therapist, had, before therapy, used extra marital affairs to help him feel desired and competent. The female therapist had lost her own father when she but was a toddler. Now there was more honest, intimate relating between therapist and patient, able now to uphold boundaries without the presence of fences between them, and without the fear that boundary violations would occur. The patient, now able to talk about sexual desires without the urge to have to act on them. He no longer could accept hurting his wife with his infidelities.


Bromberg writes that the feelings stirred up in the therapist about the patient are not the personal property of the therapist, but belong to both.


The therapist, having understood about co-creation, no longer felt ashamed about her dream. She was able to feel the mutuality of her own father’s love. The patient said, “There is something  so romantic about recognizing feelings that one can’t act on.” The therapist felt  sadness, not romance.

Wednesday, May 3, 2017

Envy and Failed Mutual Regulation

The final semester at TBIPS for fourth year candidates and students includes an Electives course in which each candidate has the opportunity to teach the rest of the class about an area of interest chosen by the candidate. We are presently learning about the relationship between mothers and daughters and how not ‘good enough’ mothers can affect their daughters, daughters who later come to us for treatment. Those in the class with a Kleinian bent emphasize envy. We were discussing today Charles’ (2001) paper “Stealing Beauty” about how narcissistic mothers envy their children and cannot help them succeed, nor bear to see their children as separate subjects. Sometimes their envy is transformed into self sacrifice (a reaction formation).

I have my personal doubts about whether envy is innate and, instead, see it as a problem arising from failed early relationships. An interesting, more specific thought came up in class today when Bharat Bharat, an aspiring psychology student auditing the class, asked about whether envy is genetic and whether it is somehow linked to children in those delayed gratification studies (don’t eat the marshmallow now and get an extra one later) who may later grow up to want (enviously) what they do not have (and cannot manage to get due to problems with delayed gratification).  Because I see children with poor impulse control as having a problem with self regulation, and problems with self regulation as a product of failed mutual regulation in early attachment relationships, I then wondered whether envy, if a problem with self regulation, stems from failure of early mutual regulation. Is failed mutual regulation (and, thus, insecure attachment) a mechanism for the development of envy?

If the caregiver, -- due to a history of trauma which now leads the caregiver to be preoccupied, dissociated, and unable to be with the child and with the child’s mind-- is unable to help the child feel attuned to and seen (unable to feel important enough), a child might feel deficient and defective, setting up a vulnerability for envy. This mechanism does not require envy of a good breast (but may include it), and, moreover, does not require gymnastic feats of imagination to explain envy, at least, to my mind.

Thursday, March 30, 2017

Dissociation as the hallmark of trauma

Because Adrienne Harris so eloquently discussed intergenerational transmission of trauma on March 18, 2017 at the Tampa Bay Psychoanalytic Society [see 3-21-2017 post], I thought I might share a bit of what Bruce Bradfield’s wrote on the subject:

“[P]sychic trauma...attempts to make meaning out of a phenomenon that resists knowing. … [D]issociation [i]s a primarily relational process, which keeps traumatic experience
unformulated and ambiguously signified in both the mother and her child. … [It is] a defense against intolerably painful affective states,which manifests in the mother’s intrapsychic experience, and in the relationship between mother and child…[T]rauma [is]...an experience that overwhelms the individual with inassimilable affects.

“[E]lements of parental traumatic experience are passed on to their children …and… subsequent generations. …[D]issociation is a consequence of a disruption of the parent’s caregiving capacity. [The parent’s] disrupted capacity to be emotionally attuned to the child ...[and] may impact on the child’s expectations[.]... [W]hat may be dissociated are not only the emotions associated with the parent’s trauma, but also the child’s need for relationship with the parent. …[T]rauma [is] communicated through patterns of relationship. … [C]hildhood interpersonal trauma has implications for the development of a particular disruption in lived experience [going on being], affecting attachment relationships directly. [There is] a relation between attachment style and posttraumatic responses.

“[A]ttunement within the relationship between mother and child facilitates the development of a capacity to integrate and contain painful emotions. … [D]issociation [is] an experience of disruption of the... capacity to integrate painful affective experiences. [D]issociation [is] manifest in future interpersonal relationships. …[and] reflects the incommunicability of traumatic histories, with trauma being held in familial and individual narratives as something unformulated and nameless.”


Thursday, March 23, 2017

Survival, Destruction, Attachment and Going on Being, and Sexuality

Winnicott wrote of the importance of the mother’s survival (neither retaliating nor withdrawing) [see post of 2-28-12] of the the infant’s aggression, but, lest we forget that the mother does not survive unscathed, Harris [see post of 3-21-17] referred us to Ogden’s Destruction Reconceived (1) in which Ogden states that the destruction must succeed in part, that is, the infant must know he has an impact. Referring to Winnicott’s ‘The Use of an Object and Relating through Identifications’ Ogden writes:


.... In my reading/writing of the paper, the mother becomes real for the infant in the process of his actually destroying her as an external object (destroying her sense of herself as an adequate mother), and his perceiving that destruction. She also becomes a real external object for the infant in the process of his experiencing the psychological work involved in surviving destruction, a form of work that does not occur in the world of fantasied objects. The analyst or mother may not be able to survive destruction. It is essential that the analyst be able to acknowledge to himself his inability to survive and, if necessary, to end the analysis because of the very damaging effects for both patient and analyst of prolonged experience of this sort.


In discussing Winnicott on bisexuality (2), Harris considered - for Winnicott’s patient-  the conditions for going on being, to feel continuous in time. She considered that Winnicott’s patient’s mother’s “madness,” intergenerationally transmitted to the patient, might include a break in her going on being-ness. Then I had what I thought to be an exciting thought about attachment. Schore writes that attachment is affect regulation (or, conversely, that affect regulation engenders attachment) but what if attachment is also the capacity to be sufficiently present (hold in mind the infant) such that the infant experience a continuous going on being? Failure of the mother to go on being vitiates, maybe momentarily annihilates, her ability to facilitate her infant’s going on being, leading to disorganized attachment.


Another exciting thought of the day came from Peter Rudnytsky. Harris was discussing the “excess” of sexuality which Ruth Stein wrote was “essentially traumatic” for the infant and Peter mused: shouldn’t a ‘good enough’ mother be able to help the infant regulate this ‘excess’? [just as she does for other excesses, such as hunger. That is, what makes sexuality so unique that it cannot be contained and managed within a good enough relationship? Have we really returned to essentialism to give sex such a boogeyman status?]


2. Winnicott, D.W. (1971). Playing and Reality. London: Tavistock Publications. The Split-Off Male and Female Elements to be Found in Men and Women p.72

Tuesday, March 21, 2017

The Analyst's Self-care; Ghosts, and Witnessing

The local (Tampa Bay) psychoanalytic society had the pleasure of hosting, on March 18, 2017,  Adrienne Harris, renowned psychoanalyst and author, known for her work on gender and, more recently, on the analyst’s ‘ghosts,’ that is, what ‘haunts’ the analyst and makes her or him less able to see the patient’s ghosts. Ghosts are a sign of blocked mourning of what has been lost or never was, but also, pointedly, about the confrontation with the limits of our immortality/omnipotence by the knowledge of the finality of death.  


This countertransferential problem of ghosts may be aggravated by the analyst’s overlooking the importance of self-care. Therapists get so interested in taking care of others that they often ignore their own self-care. Citing Lyons-Ruth, Harris reminded us that children with disorganized attachment can cope by becoming disorganized, and, later, our patients, or they organize the best they can and become caretakers of their parents (what Lyons-Ruth called “tend/befriend”) in a “precocious maturity” and, later become therapists and other caregiving professionals.


Rey noted that many of his psychotic patients sought not to change themselves but, instead,  to repair damaged internal objects from their childhoods. Apprey called this the “pluperfect errand,” an impossible task to go back and fix the other of the past. Harris said, therapists, too, may have an unconscious hope in our mission as analysts, which is “organized around our omnipotence,” to help others. “Some therapists have masochistic levels of commitment” to their patients, where they will try to do anything to intervene or help their patients. This penchant also may come with an increased capacity to be attuned to others. Harris mused about one version of the Greek myth of Philoctetes: that he could only be a perfect archer if his wound remained unhealed.

Unfortunately, self-care may be circumvented by the shame felt over needing, neediness, the shame of disappointed or unfulfilled need, as if all are not entitled to self-care.

Harris also talked about “Ghosts and Demons in the 21st Century.” She asked, “How do cultures come to terms with impossible betrayals?” and noted that “ghosts proliferate when there is no witness” to trauma. Ferenczi had also pointed out in Confusion of Tongues that the lack of a witness is as catastrophic as the traumatic event itself. Harris cited Ireland’s great famine. When catastrophe goes unwitnessed, it reveals itself in symptoms (e.g. alcoholism), sometimes generations later. “Melancholia is a hallmark of ghosts.” These “ghosts are lived through enactments, carrying and reproducing historical trauma.”

Another unwitnessed or insufficiently witnessed historical catastrophe is US slavery, its unfaceable and unspeakable horrors more recently coming to light. Stalinism, too, went long unwitnessed, with its subsequent flourishing of “the grotesque,” the admixture of horror and comedy, in art and literature.

Tuesday, March 14, 2017

Where is the pre-oedipal father in psychoanalyic theory?

Freeman advocates for increased conceptualizing of the pre-Oedipal father in psychoanalytic theory. Freudian psychoanalysis placed the Oedipus complex at the foundation of neurosis: “from its inception, psychoanalytic theory has been thoroughly imbued with allusions to the symbolic power of father…[m]ost poignantly...in the formation of the individual psyche [the Oedipus complex] and of civilization itself” [the superego], yet requires the relative absence of the  pre-Oedipal father for its theory, an assumption now questioned, as well as found to be constraining on men, and unnecessarily gendered. Freeman finds a “curious tension between the symbolic presence and substantive absence of fathers… embedded at the heart of psychoanalytic theory.” (Yet psychoanalytic theory represented this pre-Oedipally absent paternal authority in the so-called phallic mother.) 

The paradox: father, the “absent authority”, is relatively absent in psychoanalytic discourse, yet the “symbolic weight” of the father in psychoanalytic theory overlooks the “exclusive presence of the mother...as the lynchpin of early childhood development.” (Klein first turned our attention to the mother-infant dyad, but its importance was previously overshadowed by the Freudian idea of the Oedipus complex where the child must repress earlier fantasies, developed in the relative absence of the pre-Oedipal father, and “yield...to the moral order represented by the father” which will then give rise to the child’s separate identity and morality. The disembodied father was also emphasized by Lacan: the “real father” distinguished from the “symbolic father” or “the-name-of-the-father.”)


In the Oedipus complex, “the child’s initial confrontation with the father is marked by aggressive resentment and fear”. This pejorative take means the boy reveres and resents the father. Freud ignored or denied the early paternal-infant interaction. For the boy, father arrives on the scene and severs the mother-infant engulfment (and risk of incest). The boy "turns... toward culture” as if the father  psychologically birthed the child [just as Zeus, from his head, birthed Athena]. (Western religion, too, emphasizes the symbolic role of the Father (God) as procreator.) The girl, however, disavows her mother for bringing her into the world without a penis. In actuality, father’s role is not merely as authority, but also includes “containers, protectors, facilitators, models, challengers, initiators, sanctioners, and mentors.” including “a prenatal role (father as “mother-facilitator”), and pre-oedipal roles (e.g., “identification” and “gender identity”).”


It is the quality of parenting and not the gender or sexuality of the parent which is important. Freeman questions psychoanalytic theory’s gendered Oedipal theory which serves to suppress female sexuality and to deny male “access to the psychological vocabulary of love and emotional connectedness that define the maternal sphere.” She notes the male dilemma: “the expression of involved forms of fatherhood ... would at once provide emotional relief from the inevitable “discontents” of civilization while presenting a painful threat to masculine identity within a patriarchal culture. … Rather, parenting is identified as a form of compensatory pleasure for mothers alone”.  Freeman makes a point for the benefits of both parents participating in child-rearing.



Thursday, March 9, 2017

Envy Revisited: From intrapsychic to relationally co-created intersubjective envy

Envy was originally conceived as a derivative of the death instinct (Ego psychology, drives). Eventually environmental failures were posited as causes of envy (Object relations, Self psychology), and envy is now seen as coming out of the intersubjective matrix (Relational). Segal posited that need (in neediness envy) might be met in relationships, or it might be denied, with deadening effect. The authors conversely note that denial of need might not be deadening, but an attempt at self preservation in the face of environmental (relational) failure, as noted by WInnicott. [Chronic denial of need (and desire) can lead to an existential emptiness, deadness.]


In the clinical situation, an area for envy is when the patient envies traits, imagined or real, of the therapist (patience, or equanimity, or friends, or a family life) which the patient does not possess, or vice versa. Sometimes envy, whose neediness is shaming by revealing the imperfect or incomplete self, makes it hard for one to accept something from the other, except perhaps to grab and steal it. The acceptance and containment by the self of envy allows one to feel sadness and loss for what one does not have. Some people feel chronically deprived.They may wonder why others have love or friends or accolades, and ‘Why not me?” They may hold no hope for their future, for getting what they want, except sometimes when they are demanding. When envy is present in patients, they may criticize others and the therapist; they may accuse the therapist of withholding help and care. [Because of the unpleasantness of their chronic criticism, patients may be accurate about the therapist’s withholding.] A patient’s deprivation and envy may leave the therapist feeling guilty,frustrated, incompetent and helpless. Fees are also fraught with envy dynamics, for either party. The patient can have much more income than the therapist, or much less.

“Envy attacks the links of relationships” rejecting what is given to avoid admitting need, eschewing mutuality and reciprocity because separateness seems unbearable. Narcissistic envy destroys meaning and creativity, because, say the authors, progress means moving toward death. [Perhaps, it destroys creativity because it is an injury not to be born, like Venus on the halfshell, fully formed.] They conclude, “The capacity to contains the pains of envy serves to reconstruct or create a link in which the pathological envy that destroys the linkis transformed into an awareness and a recognition that subjects are immersed in the endless dialectic of sameness and difference. They therefore constantly compete, desire, and attack each other in the intersubjective encounter. This awareness becomes synthesized into a synthetic whole  of love and hate, enriching and destroying, recognizing and separating and knowing.”



Shoshani, M., Shoshani, B., Kella, R., Becker, M. (2012). Green Eyes, Crows, and Scorpions: Envy in the Contexts of Neediness, Separateness, and Narcissism. Psychoanal. Psychol., 29:440-458.

Three Forms of Envy

Shoshani, et al delineate three forms of envy: neediness, separation, and narcissistic. They illustrate their ideas with clinical cases illustrating how dissociated parts are regained and how the therapeutic dyad can help contain envy. The authors conceive of envy both as a drive and an intersubjective co-creation, “as both an object and a relation,...coexisting without being mutually exclusive.” They see these two as a dialectic, that is, “each creates, destroys, and re-creates the other...”

In citing Klein and Segal, the authors note that both Klein and Segal saw envy as partly constitutional deriving from aggression and the death instinct and is the wish to take away and/or destroy something desired that another person possesses. Envy, said Segal, is derived from both need and admiration of that which is desired. They see Spillius as adding a more relational aspect, noting that no one is comfortable with envy.

The authors find it “clinically useful to conceive of malignant envy as one of the leading anxieties,”  a “disintegrating feeling” that  humans are “desperate” to avoid and thus “evoke hatred, cruelty, blindness, narrow-mindedness, self destruction, and destruction of the other
both as expressions of envy and as a means of counteracting its devastating influence.”

Neediness envy, “results from the realization that the other has something we need but do not have” and the wish to be connected to the other includes the wish to secretly posses the coveted possession. In Othello, envy, “the green-eyed monster,” is directed at the nurturing other and includes the wish to devalue/destroy the other. “[T]he most  consuming aspect of envy is the one directed against the person who gives us what we so desperately need but feel helpless to provide ourselves with.” (The authors consider jealousy triadic, and envy dyadic, thus interpreting Shakespeare’s ‘jealousy’ to really be envy.) Neediness envy arises from recognition by child that I am small and needy.

Separateness envy results from the “dependency on the other who is separate from me, has a mind of his or her own, and who is not in my possession” [under my control]. Here the wish to be connected includes eliminating separateness through merger. The author’s use Tolstoy’s The Kreutzer Sonata and its protagonist’s envy and hatred toward his wife as an example of “imprisoning and objectifying the other.” He finds his wife’s subjectivity (separateness) so unbearable that he murders her.

According to the authors, separateness is the precondition for envy, as when when the child discovers it cannot control its mother, and gives rise to all three forms of envy, including invidious comparison of self to the separate other. They agree with Symington that “shame, [then] is the progenitor  of envy.” For the infant who maintains the grandiose self (fails to move, in Winnicott’s terms, from object relating to object usage), there still exists the awareness of the self as deficient, separate,  and needy.

Narcissistic envy “arises from the painful realization of one’s own limitations...vis-a-vis fantas[ies] of all-inclusive omnipotence and immortality” and entails, not the relationship between self and other (object), but between self and unconscious fantasy. Agnon’s short story, The Doctor’s Divorce, shows a man unable to accept that he did not exist for his wife before they met, that is, “he did not always exist” for her and so is not eternal, death being the deepest narcissistic injury. Narcissistic envy can also arise when a parent who is competent explicitly or implicitly belittles the less competent child by, for example, failing to allow twinship or idealizing transferences.


Shoshani, M., Shoshani, B., Kella, R., Becker, M. (2012). Green Eyes, Crows, and Scorpions: Envy in the Contexts of Neediness, Separateness, and Narcissism. Psychoanal. Psychol., 29:440-458.