More on living authentically with death

Speaking of  existential anxiety [see post 7-12-14] and, with the knowledge of death,  living authentically, Philip Larkin renders it poignantly:

Aubade

BY PHILIP LARKIN

I work all day, and get half-drunk at night.   

Waking at four to soundless dark, I stare.   

In time the curtain-edges will grow light.   

Till then I see what’s really always there:   

Unresting death, a whole day nearer now,   

Making all thought impossible but how   

And where and when I shall myself die.   

Arid interrogation: yet the dread

Of dying, and being dead,

Flashes afresh to hold and horrify.

The mind blanks at the glare. Not in remorse   

—The good not done, the love not given, time   

Torn off unused—nor wretchedly because   

An only life can take so long to climb

Clear of its wrong beginnings, and may never;   

But at the total emptiness for ever,

The sure extinction that we travel to

And shall be lost in always. Not to be here,   

Not to be anywhere,

And soon; nothing more terrible, nothing more true.

This is a special way of being afraid

No trick dispels. Religion used to try,

That vast moth-eaten musical brocade

Created to pretend we never die,

And specious stuff that says No rational being

Can fear a thing it will not feel, not seeing

That this is what we fear—no sight, no sound,   

No touch or taste or smell, nothing to think with,   

Nothing to love or link with,

The anaesthetic from which none come round.

And so it stays just on the edge of vision,   

A small unfocused blur, a standing chill   

That slows each impulse down to indecision.   

Most things may never happen: this one will,   

And realisation of it rages out

In furnace-fear when we are caught without   

People or drink. Courage is no good:

It means not scaring others. Being brave   

Lets no one off the grave.

Death is no different whined at than withstood.

Slowly light strengthens, and the room takes shape.   

It stands plain as a wardrobe, what we know,   

Have always known, know that we can’t escape,   

Yet can’t accept. One side will have to go.

Meanwhile telephones crouch, getting ready to ring   

In locked-up offices, and all the uncaring

Intricate rented world begins to rouse.

The sky is white as clay, with no sun.

Work has to be done.

Postmen like doctors go from house to house.

Guilty Man again?

Kohut wrote that modern man had moved from the Freudian 19^th Century  ‘guilty man’ [conflicted about libidinal and aggressive strivings, failing to live up to ideals] to ‘tragic man’ [blocked not only in strivings toward libidinal and aggressive pleasures, but blocked in creativity, expression, and in developing a selfhood, a defective and failed self, despairing and empty]. Stolorow invokes Heidegger’s authenticity and existential guilt as coexisting with one another, where existential guilt is to be accountable for and to own what is ‘mineness’.  If anxiety discloses authentic living, then Stolorow notes, shame belies it, for in shame we do not belong to the self but to the gazing other.

Heidegger expected authentic living to evoke anxiety because authentic living would own our mortality, finitude, our “being-toward-death.” Being absorbed in everyday life keeps inevitable, impending death from awareness. Stolorow posits that death and traumatic loss have similar effects. He notes how catastrophic loss shatters the “absolutisms of everyday life” and rips the veil to reveal our finitude, and the finitude of all whom we love, plunging us into anxiety. He writes, “authentic being-toward-death is always also a being-toward-loss.”

Bob Dylan may have written that ‘he who is not busy being born is busy dying’ but Heidegger and Stolorow might contend that in life it is both, simultaneously. I hold my lover in my arms, bittersweet knowing my arms will soon be empty. Do I savor the sweetness more deeply because it will soon be gone? or do I become embittered at the meaninglessness because soon we will both be gone from existence? or both?

Stolorow writes that a relational home helps us bear and integrate the eternal grieving.

Stolorow, R.D. (2011). Toward Greater Authenticity: From Shame to Existential Guilt, Anxiety, and Grief. Int. J. Psychoanal. Self Psychol., 6:285-287.

Because of the color of the wheat

"Come and play with me," proposed the little prince."I am so unhappy."

"I cannot play with you," the fox said. "I am not tamed."

“…What does that mean-- 'tame'?"

"It is an act too often neglected," said the fox. It means to establish ties."…"To me, you are still nothing more than a little boy who is just like a hundred thousand other little boys. And I have no need of you. And you, on your part, have no need of me. To you, I am nothing more than a fox like a hundred thousand other foxes. But if you tame me, then we shall need each other. To me, you will be unique in all the world. To you, I shall be unique in all the world...

"… if you tame me, it will be as if the sun came to shine on my life. I shall know the sound of a step that will be different from all the others. Other steps send me hurrying back underneath the ground. Yours will call me, like music, out of my burrow. And then look: you see the grain-fields down yonder? I do not eat bread. Wheat is of no use to me. The wheat fields have nothing to say to me. And that is sad. But you have hair that is the colour of gold. Think how wonderful that will be when you have tamed me! The grain, which is also golden, will bring me back the thought of you. And I shall love to listen to the wind in the wheat.."

"What must I do, to tame you?" asked the little prince.

"You must be very patient," replied the fox. "First you will sit down at a little distance from me-- like that-- in the grass. I shall look at you out of the corner of my eye, and you will say nothing. Words are the source of misunderstandings. But you will sit a little closer to me, every day..."

The next day the little prince came back.

"It would have been better to come back at the same hour," said the fox. "If, for example, you come at four o'clock in the afternoon, then at three o'clock I shall begin to be happy. I shall feel happier and happier as the hour advances. At four o'clock, I shall already be worrying and jumping about. I shall show you how happy I am! But if you come at just any time, I shall never know at what hour my heart is to be ready to greet you... One must observe the proper rites..."

So the little prince tamed the fox.

And when the hour of departure drew near--

 "Ah," said the fox, "I shall cry."

"It is your own fault," said the little prince. "I never wished you any sort of harm; but you wanted me to tame you..."

"Yes, that is so," said the fox.

"But now you are going to cry!" said the little prince.

"Yes, that is so," said the fox.

"Then it has done you no good at all!"

"It has done me good," said the fox, "because of the color of the wheat fields."

From The Little Prince (1943) by Antoine de Saint-Exupery

Bromberg’s Multiplicity of Selves: Dissociation and Eating Disorders

When we think of multiplicity and dissociation we think of Phillip Bromberg who wrote the beautifully rendered Standing in the Spaces (1998), Awakening the Dreamer (2006) and The Shadow of the Tsunami (2011).  I deem felicitous everything he puts to pen for Bromberg weaves stories, memoir, and theory into useful relation with clinical practice. Not only does he long emphasize how trauma leads to dysregulation of affect and to dissociation (as well as an inability to contain desire), but he highlights the inevitable dissociation by all of us, including the analyst, as we continually shift our myriad self states from background to foreground. [Bromberg sees the unitary self as illusion, albeit a “developmentally necessary illusion”.] These shifts or dissociations are in response to interpersonal interactions in an almost infinite number of transitory permutations which are co-created between one self state of the patient in conjunction with one of the analyst. Treatment, then,

draws the work into a dialectic between the here and now and the there and then, allowing the mutual construction of a transitional reality in which both the patient's and the analyst's dissociated experience have an opportunity to coexist as a perceived event different enough from the patient's narrative “truth” about relationships to permit internal repair to take place and the patient's reliance on dissociation to be gradually surrendered. To be fully in the moment is to be fully allowing new (as yet unprocessed) experience to interface perceptually with episodic memory, thus optimizing its potential for integration into narrative memory and, ultimately, enriching self-narrative—the goal of any form of treatment.

Dissociation, writes Bromberg, forecloses “the possibility of holding in a single state of consciousness two incompatible modes of relating.” It is the traumatized patients who most require our affective honesty in combination with safety. How are we to be genuine regarding the effect patients have on us while simultaneously avoiding shaming them or, worse, misconstruing their intentions in order to meet our own needs?  It is through a secure attachment, with its consistently repeated safe interpersonal interactions, which allows for affect regulation. Disruptions in mutual regulation create a break in intersubjectivity in which  the patient or the analyst may— until righting oneself once again in the ability to see the other as an equal subject— disparage, blame, or judge harshly the other.

We cannot undo the trauma that has been inflicted on patients, but Bromberg notes that, instead, we can try “to cure them of what they still do to themselves (and to others) in order to cope with what was done to them in the past.” Bromberg sees most of the symptoms of eating disorders as an outcome of dissociation. It is also thought (Boris, 1986) that dysregulation of desire in infancy is linked to the dysregulation of appetite [and choice] where “[g]reed is a state that attempts to eliminate the potential for traumatic rupture in human relatedness by replacing relationship with food —a solution that is largely self-contained and thus not subject to betrayal by the ‘other’.” Anorexia is the renunciation [through dissociation] of desire, but at its core, Bromberg writes, “is a loss of faith in the reliability of human relatedness” for “Trauma creates the experience of nonreparability…” Dissociation is, then, “not just insularity but regulation.”  And the “insularity reflects the necessity to remain ready for danger at all times so it can never—as with the original traumatic experiences—arrive unanticipated.” Binging and purging, also accomplished via dissociation, are an attempt to bound the self, delineate an unfragmented edge.

 by ‘noticing,’ through the impact of forced involvement with what the patient needs to call attention to without communicative speech, the dissociated self can start to exist, and a transition begins to take place... But the success of the transition depends on the ability of the patient to destroy successfully the analyst's unilateral experience of ‘what this is “really” all about’... The problem for the analyst, of course, is that his own self-image, which is a part of all this, is also dismantled, and it is this destruction he must ‘survive,’ … [Winnicott (1969)

Bromberg, P.M. (2001). Treating Patients with Symptoms—and Symptoms with Patience: Reflections on Shame, Dissociation, and Eating Disorders. Psychoanal. Dial., 11:891-912.

Civil Rights Act of 1964

On this day fifty years ago, the Civil Rights Act of 1964, which outlawed discrimination based on race, sex, color, creed, and national origin, was signed into law by President Lyndon B. Johnson— less than eighteen months after John F. Kennedy called for such a law in his Civil Rights speech on June 11, 1963, a speech given on the heels of the biting police dogs and fire hoses in Birmingham that Spring. This landmark civil rights legislation outlawed racial segregation in schools and at lunch counters where I grew up. It added a richness and breadth to my school day experiences.  

It is the American dream to have the freedom for self determination, not subjugated by predetermination. Neil Altman writes: “Problems arise…when one loses the dialectical relationship between being free and being determined, when one fails to take account both of our human capacity for freedom and the ways in which that freedom is limited.” Foucault reminded us how society, its institutions and history, organizes our thinking around constructed power structures.  Damaging others through subjugation of their capacity for self determination, whether talking sex or race, ought to generate guilt. But operating in the paranoid-schizoid position we split ourselves (good me - bad me) and split others. 

Separating ourselves is antithetical to healing, whether done from within— through dissociation, disavowal, projection, and denial— or from without— through racism, misogyny, contempt for others. To address our dis-integration by these mechanisms we must first acknowledge our participation in them. Once acknowledged, a public (that is, explicit) dialogue can happen. Traumatic experience otherwise remains split off, unspoken. The Fourteenth and Nineteenth Amendments, and subsequent Civil Rights legislation, came about through dialogue, sometimes waging.

We organize ourselves not merely around drives, but more over around attachment and belonging.  When excluded and left out we feel ashamed. 

There is security in finding others like ourselves, but there is joy in finding like-mindedness amongst difference.

Happy Independence Day, USA.

100 years ago today -a little historical perspective

What is and what is true depends on one’s perspective. One hundred years ago today, the assassinations in Sarajevo of Archduke Franz Ferdinand, the heir to the throne of the Austro-Hungarian Empire, and his pregnant wife Sophie by the young Serbian nationalist Gavrilo Princip propelled humanity into the bloodiest century ever, almost 17 million deaths in WWI, and, after German humiliation contributing to the later rise of fascism, over 80 million in WWII. 

Differing perspectives? In Sarajevo today, Princip is seen by Serbians, not as an assassin but as a liberation hero for his stand against the occupation and aggression of the Austro-Hungarian Empire, while non-Serb Bosnians see Princip as the forerunner of the Serbians who bombed Sarajevo in the 1990’s and, in ethnic cleansing, killed so many of its citizens. After WWI, Christian Yogoslavians  claimed this atheist revolutionary  as a martyr, and, after WWII, Communist Yugoslavia praised him as pan-Yugoslav patriot. 

So we hold our theories and truths very lightly as we re-write, rather, re-configure with patients' their histories. New neuronal connections allow for an increasingly expanded repertoire from which to construct 'truth' about what has been, but the negotiation of relationship on an ever shifting foundation can give motion sickness to its participants. Today the contemporary analyst has given up her perch as the arbitrator of truth and struggles to welcome in a kaleidoscope of emerging and ever changing points of view found within both her patient and herself. This poses its difficulties for patients who need a definitive answer on what is and what was. Likewise, it poses difficulty for the analyst who finds uncertainty anxiety provoking.  

   

                       

Countertransference and Disclosure

Another interesting paper on countertransference is by Zachrisson who sees countertransference as “the analyst’s participation in the relationship.” He writes, “Countertransference refers to something happening in the analyst. …Something takes place in the analyst threatening to bring him or her out of analytic position.” In other words, it may threaten the analytic frame by vitiating the therapist’s analytic attitude. It may seem that Zachrisson has the old fashioned view of seeing countertransference as something to be avoided, but instead he writes “An essential aspect of analytic attitude is precisely this: to allow the expression of what is in the patient's psyche, irrespective of which feelings or thoughts are there, and regardless of what feelings these may evoke in the analyst.” These feelings are to be borne and reflected upon by the analyst, and I would add, reflected upon by both participants. If, as Lachmann intimates, co-construction includes countertransference, then would it not follow that exploration which situates both participants in its construction ought to be part of a necessary negotiation?

Odgen makes use of countertransference and “the subjective contribution of the analyst,” Zachrisson writes, and advocates “analysis of this intersubjective construction” to aid the analyst in accessing “the patient’s inner states.” Because “[s]ubjectivity is present ubiquitously” Zachrisson uses Ogden’s concept of the analytic third to help ‘contain’ both “the subjectivity of the analyst” and “the ubiquity of counter transference.” Furthermore, Zachrisson takes Aron’s ideas about the analytic endeavor being both mutual and asymmetric, the latter making expressions by the analyst “both important and complicated” and reminds the analyst that “such openness must be conscious, clear, and contemplated.”  Here I would interject that this would be the ideal, and as such, unattainable, for enactments, sometimes through spontaneous disclosures, are inevitable. Where the analyst can be more easily mindful is in the attitude to allow everything in from the patient, including the painful explication of the effect on the patient of the analyst’s missteps.  As Zachrisson puts it, “In the intersubjective perspective, the analyst’s relationship to the patient is marked by a high degree of mutual subjectivity.”

Zachrisson cautions, “It is decisive to differentiate the case where the analyst enacts his own needs from the case where the primary aim is to communicate an understanding of the patient’s inner world or of the actual relationship. … If he manages to keep his reflecting stance, the countertransference can be useful. If he loses it, the countertransference becomes disturbing.”

Zachrisson, A. (2009). Countertransference and Changes in the Conception of the Psychoanalytic Relationship. Int. Forum Psychoanal., 18:177-188.  

Countertransference?

Can candidates in training, or even seasoned analysts, ever tire of discussing our ‘countertransference’ and the importance of our self reflection? At TBIPS we include the analyst’s contribution— inadvertent or deliberate, explicit or implicit— in our discussions throughout the training, and in every course. Heimann extended the Freudian concept of countertransference (the analyst’s neurotic transference to the patient) to include all feelings and reactions to the patient, acknowledging that countertransference provided useful information about the patient, even positing that the patient created the countertransference. Thus, countertransference was not to be eschewed but, instead, utilized. Lachmann poses the question of whether we are ready to dispense with the term ‘countertransference’ altogether.

Lachmann, from his Self Psychology approach, advocates that the analyst provide (ideally, always) a self object experience for the patient. He gives a clinical example of how he welcomed in Cecilia’s inexhaustible talk about her favorite soap opera. One TBIPS candidate, Stavros Charalambides, noted that Lachmann missed an opportunity for negotiation when he did not pose to Cecilia whether she wanted the analyst to continue listening to the lives of her soap opera characters or whether she wanted to consider if something else might also be worthy of their attention. My Relational bias wonders, too, whether it does a disservice to a patient when we deprive them of knowing their impact on us. I greatly admire Lachmann’s work and often assign his papers, but I, too, was left wanting more from the clinical vignette in his paper. Perhaps Cecelia, over time, goes further than the connection to her mother merely through a soap opera. Maybe Cecilia’s mother can offer nothing more, but how sad if this remains their only connection. Maybe Cecilia’s father can never connect to her except when she does for him, like compiling a book about him. Maybe Cecilia’s acceptance of what little her parents are capable of offering was great progress. But what if an inadvertent outcome for Cecilia was that she had become a self object experience for her parents just as Lachman was for Cecilia, and that she never learns to negotiate to include her own needs?

Lachmann is a great fan of co-construction, now termed co-creation, and wrote with Beebe a wonderful paper on mutual regulation between infant and mother, but I had some questions about why Lachmann does not extend co-construction to include countertransference when he writes “…even if I had felt angry, that would not indicate to me that Cecilia's motivation was to make me angry.” Lachmann, I suppose, is considering other motivations of Celia’s, such as the attempt to make a connection, or an attempt to know her analyst’s mind, for example, which only as a by-product might make her analyst angry. Because Lachmann sees co-construction as “understood,” he does not tell us where the analyst’s contribution is to the Self psychologist’s two dimensions of transference:  the self object dimension and the representational dimension.  Sometimes, I need it made explicit, as may the patient.

Heimann, P. (1950). On counter transference. Int. J. Psycho-Anal., 31, 81. 

Lachmann, F.M. (2001). A Farewell to Countertransference. Int. Forum Psychoanal., 10:242-246.

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Hate, Envy, and Destructiveness in the Clinical Situation (16 weeks) Wednesdays 12:30 pm -1:45pm Working with the affectively dysregulated patient presents increased challenges for the clinician, including the need to survive (i.e., neither withdraw from nor retaliate against the patient). Negotiating intersubjective space will be discussed, as will contributions from object relations and how understanding trauma informs our interpersonal interactions. Fee: $250 for a single course; $200 if enrolled in full semester.   Instructor:  Lorrie Gold      

                                         

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The Third: Moving from Complementarity to Triangular Space

Aron enumerates various ways we conceive of "something beyond the dyad” called the [analytic] third:  “a context within which we emerge, … an emergent property of dyadic interaction and … a dyadic achievement that creates the psychic space necessary for reflexive self-awareness and mentalization" (the understanding that the other has contents of mind, as well, and different from one’s own—an important and necessary component for mutual recognition of relational intersubjectivity). What a recognition of paradox regarding the third: that we emerge from it, as well as it from us, and it is something we create and utilize.

What makes the analytic third so useful? Aron, and Benjamin, state that “thirdness…allows the analyst to restore a process of identification with the patient’s position without losing her own perspective.” This is a refreshing experience of learning negotiation procedurally for a patient raised in an environment of negation (“where the acceptance of one person’s subjectivity meant an obliteration of the other’s”).  Learned complementarity— your way or my way, no in between— can ensue, and play out in the transference-countertransference dialectic, and  an analytic impasse may result. Aron tells us that this impasse can sometimes be averted by opening the intersubjective space to create an analytic third where the analyst is open to the patient’s multiple and contradictory identifications.

Benjamin delineates two types of the third: The ‘one-in-the-third’ (the rhythmic third) — where oneness is experienced in a rhythmic pattern between two such as reciprocal speech or eye gaze, is dyadic and exists early (pre-oedipal) in relationship— and the ‘third-in-the-one’ – where the conflict within the mind of one can act as a third position.  For some, like Britton, where the ‘triangular’ space is created in the analyst’s mind, the mother's mind creates the third position. For Benjamin, the rhythmic third emerges, not from one mind, but from within the dyad. Her third-in-the-one (the intentional third), on the other hand, says Aron, "creates a space for differentiation" [from oneness], much like 'marking' (described by Gergely when the mother gives her version of the infant's response, differentiating her response as a reflective mirroring rather than one generated from within her. The infant has the capacity to see the mother's response as separate from its own.) Marking, then, is not a perfect match, but a reflection, as well, of otherness, a kind of mirroring that "is a dyadic phenomenon, functioning as a differentiating third point emerging between" two people and, as such, does not require a third person to separate the infant from the mother. Marking creates the third-in-the-one [in the one dyad]. We can have both the connection, in the one-in-the-third, and difference, in the third-in-the-one.

Aron notes that the Lousanne group’s investigation of triangularity in infancy shows the capacity at an early age to have triadic interactions between two people (e.g., from the mother’s mind emerges a third position) indicating that triangularity can no longer be conceived as the hallmark of the oedipal phase. The child no longer needs the primal scene (relationship of parents which excludes the child) to have experience with the third. Rather, the child is privy to the emerging third position within the mother’s mind. A third point of reference can emerge from the dyad within the mind of one and, when shared, can facilitate self-reflection and mentalization.  

Aron points out how certain self disclosures by the analyst can create thirdness in the analytic dyad. When the analyst lets her  mind be known (when , e.g., she disagrees with herself or is of two minds [e.g. I want to respond to your request for advice, but concerned that, if I do, I would be too much like your controlling, know-it-all father”]— that is, where analysts disclose "aspects of their inner processes"—a thirdness is introduced in the dyad, where the disclosure itself can serve as the strange attractor (from chaos theory, which allows the possibility to shake up linear thinking and have a reconfiguration of elements). Aron writes, “[T]he analyst’s reflexive self-awareness, a dialogue with one’s self, creates a third point.” When made explicit, the patient becomes privy to the analyst’s mind, both its contents and its way of  working. It is this third point of view which allows for the third space, and in this space, both analyst and patient can think together about connection and difference.

See also on this same paper the post of Jan 27, 2013. Compare and contrast it to ideas in Aron’s 1995 paper (in the post of Jun 8, 2014.)

Aron, L. (2006). Analytic Impasse and the Third: Clinical implications of intersubjectivity theory. Int. J. PsychoAnal., 87:349-368