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.”

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.

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.

Revisiting the Classics of Countertransference and Free Association

As far as I know Heimann was the first to expand countertransference from “transference on the part of the analyst” to include “all the feelings which the analyst experiences towards his patient.” She noted that feelings for another can be both transference feelings and “refer to another person in his own right and not as a parent substitute,” that is, “not everything a patient feels about his analyst is due to transference.” Moreover, Heimann noted, this countertransference was not to be eschewed, but to be used as an important tool to understanding the patient’s unconscious, stating that the analyst’s feelings in response to the patient are “the most dynamic way in which the patient’s voice reaches” the analyst. She evoked Freud and contemporary analyst when she wrote “the analyst’s unconscious understands that of his patient.” Heimann also stressed that the analytic situation is “a relationship between two persons.” [her italics]

Even if contemporary analysts then part ways with Heimann— who interpreted the psychological world through drive and defense and the structural theory, did not see enactments as inevitable, and may have over interpreted the transference and underemphasized attachment needs— we laud her relational use of countertransference and her intimation of its co-creation –here I give the benefit of the doubt that she could not help but see what came from the patient and was received by the analyst was a co-creation though she does not insert the ‘co’: “the analyst's counter-transference is not only part and parcel of the analytic relationship, but it is the patient's creation.”

Forty years later, Aron notes how psychoanalysis, as contemporarily practiced, often neglects the free association method. The classical technique of free association, unlinked from drive and defense and  updated  by a two-person psychology, remains useful, he writes, to avoid the pitfalls of the analyst’s being overly self referential as to transference and projective identification. While Heimann noted that the patient contributes to the analyst’s countertransference, likewise, in its converse, Aron notes, the analyst contributes to the free association of the patient. Aron does not, however, advocate an a priori bias toward interpreting implicit transference resistance nor toward interpreting the interactional impact of the analyst, but says that the analyst must follow the patient’s lead (associations) in deciding when and how to intervene. He concludes with : “The[free association] method presupposes that all that the patient says can be meaningfully tied together and shown to belong to a continuum of psychic life…”

Aron, .L. (1990). Free Association and Changing Models of Mind. J. Amer. Acad. Psychoanal., 18:439-459.

Heimann, P. (1950). On Counter-Transference. Int. J. Psycho-Anal., 31:81-84

Benjamin on Recognition and Regulation

In bringing front and center to psychoanalytic discourse the subjectivity of the mother (not just the mother as object to the infant), Jessica Benjamin, adding to Daniel Stern’s paradigm of play, elaborates the importance, the imperativeness, of mutual recognition in the clinical encounter. What an honor (made possible by a contribution from the Florida Organization for Relational Studies) to have such a gifted and renowned thinker at the December 7, 2013 local Tampa Bay Psychoanalytic Society program meeting.

Attachment and infant-caregiver research have shown that sharing of affective states, where one experiences and understands that another ‘feels the same as I do,’ co-creates a rhythm of interaction—what Benjamin calls the rhythmic third (formerly called the one in the third)—which diminishes existential fear and isolation. The rhythmic third, the up and down orientation of affect in the same direction— which is soothing in its recognition, lets the analyst, as well, know that s/he is not alone in the universe.

It is through recognition, of shared affective states, that affect regulation occurs. Intersubjectivity is the sharing of affective states. It transforms complementarity such that one can feel empowered  with a sense of agency because, not only is one recognized but, one can recognize the other’s feeling in a way that can be shared and creates joy. Mutual recognition can be effected and empowers the self by seeing the self as recognizer, more powerful than simply being mirrored (recognized). Benjamin says recognition and regulation are “twins,” that is, are interdependent. As such, mutuality needs to be in the foreground. Affect regulation is necessary but not sufficient, for we do not want only to keep affects within a tolerable, manageable range. We want additionally to create meaning, acquired within the communion of mutual recognition.

A cornerstone of mutuality is the recognition of impact.  It is the realization by the mother that the child actually needs to discover something about her responses, what it is like for her to be a real human being in a real world. Recognition adds to regulation when the analyst can manifest the impact of the analysand such that the analysand experiences both the analyst and her/himself as a subject with feelings and agency. Sometimes recognition of affects at all from the analyst is a new experience for the patient.

Incumbent on the analyst is survival (Winnicott) so that the analysand does not have confirmation of the fear that her/his feelings can destroy the other. Yet, as Benjamin notes, it is not always easy for the clinician to tolerate and bear the affective state of another, particularly the pull to despair. To help mark (Gergely ) –similar enough to help the patient know you are on the same page, but dissimilar enough so patient does not fear you yourself will be dysregulated and overwhelmed; the mother marks her response to the infant’s distress by showing that she is not distressed in the same way but also that she knows the infant is distressed— affect, Benjamin looks to the third.  By acknowledging what is happening [e.g. ‘Your expectation that I not disappoint you is not unreasonable, you deserve understanding; and yet I am not perfect and so cannot always live up to your expectation.’] creates  a sense of the moral third, a sense of a lawful world where meaning exists and, though expectations can be violated, attachment can be recreated.

Breakdowns in mutuality occur when complementarity prevails. It is as if only one can survive. It is the belief that only one subjectivity is in the room, as if the other is not allowed to have thoughts, or as if one is making the other feel something. This is a breakdown of the moral third where it seems the other can only submit or resist. Benjamin advocates the need for parents to implicitly communicate to their children (or analysts to their analysands) that there is a lawful world in which other subjectivities can exist, a world of mutual understanding where everyone has a right to live, called a moral third. Sharing of affect allows us a way out of an impasse.

[The third, an unfelicitous term which has not ‘jumped’ to common psychoanalytic  parlance, seeks, noted Benjamin, another word to capture that area where negotiation can occur, where two are united to transcend destruction, where the analyst is not under the sway of projective identification and can retain the capacity to think, and where the analyst can tolerate greater degrees of vulnerability. At dinner last night, Paulina Robalina suggested “intermedium.”]

Nelson Mandela has died

              Nelson Mandela     July 18, 1918-December 5, 2013

Peace and reconciliation, not revenge.

He defeated the enemy with forgiveness, 

A Differing Perspective on the Irma Dream

The hall—numerous guests, whom we were receiving

He becomes aware of himself as a multiple self .Different parts of himself are gathering together unconsciously to negotiate their existence .He is dissociated though therefore he cannot experience this multiple existence of his parts as owned by himself therefore he alleviates himself from accompanied anxiety by projecting the ownership to familiar persons with whom there are ‘unfinished businesses’.

I reproached Irma for not having accepted my solution; I said: ‘If you still get pains, it's your own fault,

He approaches first the internal saboteur self-state. The pains are substitutes of cocaine. He is aware of taking cocaine as a self -attacking procedure and is afraid of recognizing the devastating power of such a self state .He comes aware of the Winnicotian anxiety of self-fragmentation and tries to renegotiate this relationship in himself.

Irma's complaint: pains in her throat and abdomen and stomach; it was choking her

The survivor self state is taking the lead now. It complaints to himself that he was not listening to it so far. This part of himself was warning him by physical symptoms (the pain in his nose) that something was going on, it was calling for his attention and action.Throat ,abdomen and stomach are somatic areas that are used for digestion. His survivor self state warns him of not being able to digest his theory thoroughly; his theory is incomplete, in pain. He starts to feel guilty of having constituted a theory that is inadequate (this is a disguised occurrence of a narcissistic injury).

She looked pale and puffy

By visual representations he becomes aware of his vulnerable (narcissistically wounded) self. He still cannot own this part as his and he needs to project it on a wounded woman (Irma) as way to feel superior to his injury.

I was alarmed at the idea that I had missed an organic illness

He is becoming alerted on his inability to reflect properly on himself. He is becoming gradually aware that his grandiosity made him blind to experience his vulnerability. He is unconsciously aware that his internal saboteur would be able to create a physical illness that he could not cope with or/and eliminate its origins.He starts to understand that his physical problem with his nose and his solution to it(taking cocaine)could bring him into psychological death ,implying he was aware of his ‘deadly’ addiction to cocaine.

I took her to the window to look down her throat. She showed some recalcitrance, like women with false teeth. I thought to myself that really there was no need for her to do that

His addicted part of himself receives finally more attention and consequently there is a more careful glance to it. The internal saboteur initially resists such a closer relationship. The false teeth are representing the oral aggression of the internal saboteur ,the false self that is disguised under the narcissistic cocoon. He understands the vanity of his narcissistic defences though he is not ready to explore them deeper.

What I saw in her throat: a white patch and turbinal bones with scabs on them

He moves more deeply to understand his wounded self. He can now contain some pain of his traumatized self and the wounded self’s image becomes clearer.

I at once called in Dr. M., and he repeated the examination

He doubts his self image is accurate and calls for an external representation of himself . Dr.M is his disguised Mother .His mother is being put in authoritarian position, although he is in need of his mother’s representation he becomes aware of his rage against her of putting him in an inferior position. On another level Dr M is really his superior colleague and he painfully questions him of the way he represents Froyd as a medical professional.Froyd becomes aware of his dependent positioning around authoritative figures. The cocaine dependency is a self-attacking manifestation of his grandiose self-rage attacking the self of himself that is need of external mirroring.

Dr. M. was pale, had a clean-shaven chin and walked with a limp

He is fighting against the external object .His maternal representation of him cannot be internalized without pain. He is becoming furious of such a procedure and he unconsciously realizes the nature of his narcissistic injury. On another level he is aware that the closer his relationships get the more his narcissistic vulnerability (his fear of how other people perceive him) is expressed.

My friend Otto was now standing beside the patient and my friend Leopold was examining her and indicated that there was a dull area low down on the left

.

He is still questioning his representation in other significant authoritarian people of his circle. Leopold is one of his self-states that can see clearly his narcissistic wound. The underlying friendship with Otto and leopeold (his self-states) indicates his self becomes more cohesive.

A portion of the skin on the left shoulder was infiltrated

He understands his death anxiety issue as another narcissistic wound. He understands he is not immortal and he is connected more with the physical pain that is his disguised  pain of realizing he is getting older .

In spite of her dress

The dress is the narcissistic defenses that although there are still there they cannot longer hide the narcissistic wound. However he is afraid of a possible collapse without his defences therefore the dress cannot be taken away.

Dr. M. said: ‘It's an infection, but no matter. Dysentery will supervene and the toxin will be eliminated

Dr.M becomes familiar with his injury but cannot offer more empathy. Froyd becomes aware that his theory although significant in understanding the symptom lacks proper interpersonalization and here there is another narcissistic injury  .On another route his mother was able to understand his vulnerabilities though her understanding was not expressed properly for him.

We were directly aware of the origin of the infection.

The self states party reveal a coherent self. He understands now the psychodynamics of his injury and has a clearer opinion of what went wrong.

When she was feeling unwell, my friend Otto had given her an injection

He understands he needs his friends to overcome his injury; he can now let them become closer to him.  On another level he understands there are parts of himself that are healthy and can really help him if he sustain  a better internal relationship with them.

A preparation of propyl… propyls … propionic acid

He needs to smell the perfume of closer relationships but still he gets in the paranoid position .The perfume is perceived as contaminating acid, that is closeness is still threatening. He is shimmering between close and distant. 

Injections of that sort ought not to be made so thoughtlessly

He understands the paradox of taking care of himself with cocaine a way that is revealing his self-attacking mechanisms. On another level the injection could be an interpersonal injection that is necessary to be done thought anxiety provoking if not regulated in proper dose of proximity.

And probably the syringe had not been clean

Here there is indication of phantasies of being contaminated by close relationships (indication that his mother was scary for him).

by Stavros Charalambides

We Hardly Knew Ye

fifty years ago today

Frequency and the Frame

Stern considers the argument over frequency when analysts try to define what psychoanalysis is. He advocates that intrinsic criteria (not extrinsic criteria such as frequency) ought to define what analysis is, and does not think interpretation of transference is such an intrinsic, defining criterion. What is intrinsic to the process emerges from the dyad within the ‘analytic third’ and requires “freedom to find their way into” the process. Frequency does not distinguish psychoanalytic psychotherapy from psychoanalysis, but rather it is the training of the clinician, and her willingness to engage in such a process with each particular patient, which delineates therapy from analysis. This willingness includes an openness to negotiation.

Because some things the analyst imposes “unilaterally,”Goldberg also does not think that everything in the clinical situation is co-created or negotiable. [Here I think he may have a too narrow definition of negotiation. Negotiation requires that we put our desires on the table, but does not guarantee that we get to have what we want. Negotiation means it can be talked about in a welcoming way, and is not the same as compromise or submission.]  Goldberg agrees that analysis cannot be defined simply by external criteria such as frequency, but notes that certain external criteria – a place of meeting, an agreed upon meeting time, for example—and an understanding not to physically harm each other, are required for the process and for a sense of safety. He asks us to consider the purpose of the frame and what is its mechanism of action. It is not enough that frequency be negotiable, rather we must investigate what effect increased or decreased frequency has on psychic reality and self regulation.  But what is intrinsic to analysis? Goldberg cautions against but notes that what we believe intrinsic often cannot be separated from our theoretical point of view.

Goldberg, P. (2009). With Respect to the Analytic Frame: Commentary on Paper by Steven Stern. Psa. Dial., 19:669-674.

Stern, S. (2009). Session Frequency and the Definition of Psychoanalysis. Psychoanal. Dial., 19:639-655

Responding to Patients

There is no formula for what to say or when to say it. Rather, in a moment to moment appreciation of the effect our words have had on a patient, we will perpetually fumble and tweak our utterances. Attention to detail in communication will guide us as we attempt to proceed in a meaningful way. After we speak, patients may say nothing; they may quietly consider our words; they may sigh in relief or exasperation; they may weep silently; they may appear as if slapped in the face. We strive to be attuned to minute changes— in face, posture, breath, tone, prosody, and so on, as well as in narrative—for the effect we may have had. We do well to be able to admit when we have made a mistake. Often, a response from the patient with confirmatory material, or new material, means we have said something of meaning to the patient.

We ask ourselves: When do I feel compelled to speak up? Am I aware of at least some of my motivations to speak? Do they include the wish to know more, or only to correct or inform the patient? Can I apply an experience-near, emotional, and cognitive context to my remarks? Am I more or less attuned or empathically immersed in this moment? Am I involved or distracted? Is something in my own physical state or personal life having an effect on my level of attunement? Is something in my visceral or fantasy experience in the moment intimating unspoken information about the patient’s experience? What might it being trying to tell us?Does something about the patient’s demeanor, affect, voice, or the content of the material lead me to dissociate from it? What do I find so disturbing, and why? Do I want to invite the patient to help me in exploring answers to these questions?

Buirski and Haglund, from a Self psychology perspective, move us into the area of how we respond to or what we say to patients. They note interpretations that provide new cognitive knowledge when made with empathic attunement –resonating both cognitively and affectively—serve the selfobject function of promoting self cohesion through self understanding.  They go so far as to say that “for  verbal interpretations to generate meaningful cognitive and emotional understanding, they must be given within the context of a primary selfobject relationship” [italics mine]. An interpretation, constructed from the experience of both patient and analyst, is meant to help organize the patient’s experience. While their paper is about how verbal interpretation can serve as a selfobject function, they nevertheless recognize the function of procedural and perceptual communication in making meaning. Haim, while from a more traditional perspective, nonetheless asks, “When the analyst talks, is he working to regulate the patient’s tension level, or her or his own?” Haim is forthright about her uncertainties of when to respond and what to say.  She decides that “the best time to make an intervention is when the patients asks for one” [Spotnitz’s ‘contact functioning’]. Both authors seem aware of the relational and intersubjective component of experience between patient and analyst.

Buirski, P., Haglund, P. (1999). Chapter 3 The Selfobject Function of Interpretation. Progress in Self Psychology, 15:31-49.

Haim, R.J. (1990). The Timing of Interventions: A Countertransference Dilemma, when to Talk and When Not to Talk. Mod. Psychoanal., 15:79-87.