Bi‐ocularity,the functioning mind of the psychoanalyst

With the use of clinical material the author discusses the importance of a ‘bi‐ocular’ mode of attentiveness, one pole of which rests on the psychic process of reverie and the other on ‘analysing’. This is necessary to foster the development of a psychic space in which experiences which were ‘in the shadow’ or unrepresented, can come to the fore and be given shape first pictorially and later ideationally. This requires staying with and fostering the ambiguity of the different times and spaces without collapsing them into the clear, logical and explanatory. It requires the psychoanalyst to make space for that which is ‘other’, other than just apparently here and now, and other than just ‘you and me’, while maintaining the analytic ‘fire’ in a situation in which there is ‘no model in real life’, a place maximally geared to that which is not apparent.     

Embodying analysis: the body and the therapeutic process

This paper considers the transfer of somatic effects from patient to analyst, which gives rise to embodied countertransference, functioning as an organ of primitive communication. By means of processes of projective identification, the analyst experiences somatic disturbances within himself or herself that are connected to the split‐off complexes of the analysand. The analysty’s own attempt at mind‐body integration ushers the patient towards a progressive understanding and acceptance of his or her inner suffering. Such experiences of psychic contagion between patient and analyst are related to Jung’s ‘psychology of the transference’ and the idea of the ‘subtle body’ as an unconscious shared area. The re‐attribution of meaning to pre‐verbal psychic experiences within the ‘embodied reverie’ of the analyst enables the analytic dyad to reach the archetypal energies and structuring power of the collective unconscious. A detailed case example is presented of how the emergence of the vitalizing connection between the psyche and the soma, severed through traumatic early relations with parents or carers, allows the instinctual impulse of the Self to manifest, thereby reactivating the process of individuation.     

Disintegration of the self and the regeneration of ‘psychic skin’ in the treatment of traumatized refugees

This paper presents a tentative understanding of the characteristics of the extreme traumas, elsewhere called ‘complex PTSD’, that some refugees and asylum‐seekers bring into therapy. It suggests that these kinds of traumas suffered during adulthood may involve a disintegration of the self and a loss of ‘psychic skin’. This conceptualization is derived from the treatment of a refugee who survived multiple extreme traumas and with whom efforts were made in therapy to identify a complex methodology making use of supplementary therapeutic tools in addition to individual psychotherapy. The case demonstrates how the disintegration of self implies not only a deep somato‐psychic dissociation, but also a loss of intrapsychic and interpersonal space. In the treatment this was worked through via repetition of the victim‐aggressor dynamics at multiple levels. In the end, the therapeutic context was structured like a set of concentric layers, creating a ‘bandage’ over the patient's wounds whilst his ‘psychic skin’ was able to regenerate. The conditions triggered by extreme traumas in refugees challenge some of the cornerstones of individual psychoanalytic technique, as well as the idea that individual therapy may be thought of as existing in an environmental vacuum.     

The couch and the chador

The authors present a clinical discussion of the psychic functions of the chador, a veil‐like outer garment worn in public by some Iranian women. Drawing on Anzieu’s theoretical concept of the skin ego, the authors suggest that the chador does not just cover the body; it may also envelop the psyche and function as a second skin for the ego. The maternal function of a holding environment is symbolically displaced on any clothing that ‘hides,’‘covers,’‘veils,’ or ‘dresses’ the body. The skin’s containing functions are extended through sensory and metonymic mediations to clothes, thus providing an imaginary maternal sack for the person. The clinical vignettes presented here suggest that for some Iranian women the chador may work, on one hand, as a second skin ego and a shield against a perceived intrusive world. On the other hand, it may work as a punitive maternal superego, a ‘holding cell’ in a jail that paralyses the separation/individuation process. Operating in the service of the patient’s resistance and defense, the chador may also function as a psychic refuge and a place to hide on the couch.     

Pentheus rather than Oedipus: On perversion,survival and analytic ‘presencing’1

Following an introductory review of the main developments in the psychoanalytic thinking on perversion, the author focuses on her own understanding of perversion and its treatment, based on the psychoanalytic treatment of patients with severe sexual perversions. This paper uses the term ‘autotomy’ (borrowed from the fi eld of biology) to describe perversion formation as an ‘autotomous’ defence solution involving massive dissociative splitting in the service of psychic survival within a violent, traumatic early childhood situation; thus, a compulsively enacted ‘desire for ritualised trauma’ ensues. The specifi c nature of the perverse scenario embodies the specifi c experiential core quality of the traumatic situation. It is an actual repetition in the present of the imprint of a past destructive experience which is pre‐arranged and stage‐managed; it thus encounters haunting scenes of dread or psychic annihilation while, at the same time, controlling, sanitising and disavowing them. Hence, the world of severe perversion is no longer oedipal, but rather the world of Pentheus, Euripides's most tragic hero‐a world dominated by a mixture of a mother's madness, devourment, destruction and rituals of desire. According to this view, the (diffi cult) psychoanalytic treatment of perversion focuses on patient‐analyst interconnectedness‐brought about by the analyst's ‘givenness to being present’ or ‘presencing’‐at a deep, primary level of contact and impact (the emphasis being on the ontological dimension of experience). This evolving therapeutic entity creates and actualises a new, alternative experiential‐emotional reality within the pervert's alienated world, eventually generating a change in the perverse essence. The author illustrate this approach with three clinical vignettes.     

Law and psychology in conflict

It is argued that a link prevails between the phenomenology of externality present in classical liberal theory and the state of mind known as schizophrenia. To escape the social reality of possessive individualism, especially the conception of consequences, ends, habits, routine, the schizophrenic individual ‘withdraws’ or regresses into a psychic universe that contains a dimension unrelated to the consciousness and values of externality: the pursuit of wealth and things, the calculated regard of the other as an instrument for enriching the self. The schizophrenic is incapable of adapting his ‘ego’ to the necessities of the social environment; he cannot defend himself in ‘conventional’ or ‘normal’ ways from the demands of living in a social milieu where the expectations and judgments of others impose intolerable pressures on consciousness. Instead the individual undergoing the painful process of withdrawal constructs a set of psychic defenses that from the standpoint of the external world appear to be ‘strange’, ‘odd’, ‘bizarre’, or ‘demented’. The ‘mode of Being’ of the schizophrenic has nothing in common with the life‐style of the acquisitive, status‐conscious society. Some consideration is given to the political implications and meaning of the schizophrenic's withdrawal.     

Inhibiting the mentalizing capacities

This paper describes a phobic patient who inhibited her capacity to mentalize defensively in situations when emotionally overwhelmed. When provoked by anxiety, she used the ‘silencing-method’, not reflecting on her internal world or her relationships. In order to avoid painful thinking, she stopped mentalizing and used practical or physical activities as a psychic retreat from an unpleasant reality. In psychoanalysis, she developed a growing tolerance to conceiving her own mental states However, even after several years of analysis, inhibiting her mentalizing capacities remained her defensive strategy. This paper suggests that phobia could be understood as an intolerance of conceiving mental states, preventing integration of psychic trauma. Improvement of the mentalizing capacities through psychoanalysis makes phobic symptoms fade.     

Psychotic withdrawal and the overthrow of psychic reality1

The author attempts to distinguish between the world of fantasy and the imagination (which fuels our capacity to ‘dream’) from a withdrawal into fantasy. In this withdrawal, the foundations of which are laid in childhood, a dissociation from psychic reality starts and from it the delusional world arises and constitutes the adult illness. During therapies of adult patients who have experienced a psychotic state, it is often possible to reconstruct the state of infantile withdrawal and understand how their dissociation from reality was ignored or unknowingly encouraged by their parents. Children destined to develop psychosis enter into the dissociated world not just as a defence against anguish or loneliness, but also for the pleasure of experiencing a delusional self‐suffi ciency and a gratifying omnipotence in which anything is possible. Mental workings that take place in the withdrawal do not follow the rules governing normal psychic functioning. Those fantasies cannot be either repressed or ‘dreamed’ in order to be transformed into thoughts. These psychopathological structures, which develop early and autonomously, have to be understood during analytical therapy in their origins and ‘deconstructed’ in order to help the patient to escape from their dominion. By means of clinical examples, the author tries to shed light on the possible ways of reaching patients in their psychotic shelters, thereby helping them to re‐emerge into a psychic reality.     

The latency complex: the dead hand of anti‐development

It is common knowledge that the same phenomena can be viewed in a variety of ways. This paper considers the implications of a constellation observed in some adult patients who have increasingly reminded the author of some of the children of latency age with whom he has also worked. In the literature these patients may also have been thought about in terms of ‘defences of the self’ (Fordham), patients who are ‘difficult to reach’ (Joseph), ‘psychic retreats’ (Steiner), and those who make ‘attacks on linking’ (Bion). They may equally be considered in terms of schizoid, narcissistic or borderline personalities, or as showing features on the autistic spectrum, such as mindlessness and extreme obsessionality. Writers such as Helene Deutsch with her concept of an ‘as‐if personality’, Winnicott with his ‘false self’, and Rosenfeld, discussing the split‐off parts of the personality in narcissistic patients, have also offered much to think about in their consideration of some of these phenomena. This paper proposes yet another vertex – the author's own imaginative conjecture – that is by no means mutually exclusive of any of these others.     

Transcending the caesura: Reverie,dreaming and counter‐dreaming

The author reflects about our capacity to get in touch with primitive, irrepresentable, seemingly unreachable parts of the Self and with the unrepressed unconscious. It is suggested that when the patient's dreaming comes to a halt, or encounters a caesura, the analyst dreams that which the patient cannot. Getting in touch with such primitive mental states and with the origin of the Self is aspired to, not so much for discovering historical truth or recovering unconscious content, as for generating motion between different parts of the psyche. The movement itself is what expands the mind and facilitates psychic growth. Bion's brave and daring notion of ‘caesura’, suggesting a link between mature emotions and thinking and intra‐uterine life, serves as a model for bridging seemingly unbridgeable states of mind. Bion inspires us to ‘dream’ creatively, to let our minds roam freely, stressing the analyst's speculative imagination and intuition often bordering on hallucination. However, being on the seam between conscious and unconscious, dreaming subverts the psychic equilibrium and poses a threat of catastrophe as a result of the confusion it affords between the psychotic and the non‐psychotic parts of the personality. Hence there is a tendency to try and evade it through a more saturated mode of thinking, often relying on external reality. The analyst's dreaming and intuition, perhaps a remnant of intra‐uterine life, is elaborated as means of penetrating and transcending the caesura, thus facilitating patient and analyst to bear unbearable states of mind and the painful awareness of the unknowability of the emotional experience. This is illustrated clinically.     

An application of bi‐logical theory to the study of psychic change and mourning4

The authors propose that the process of psychic change involves the ‘working through’ of mourning for the loss of ‘theories of life’ that are based on narcissistic omnipotent beliefs. These theories need to be changed by other more realistic ones regarding how to resolve the inherent and natural problems of existence. Questioning the ‘truth’ of these theories of life, as well as the acquisition of the perception of the existence of time, makes up part of the process referred to, and this applies to the analyst in a certain way as much as to the patient. Such problems are lived, re‐edited and revised in the transference/countertransference relationship. The authors present a clinical illustration. They explore the concepts of symmetry, asymmetry, homogenization and differentiation in MatteBlanco's bi‐logical theory and propose that these are important to the comprehension of the dynamic of the psychic changes which occur in a non‐static analytic process.     

Psychological implications of a vision disorder

The paper discusses how the condition of crossed‐eyes affects a baby's eye contact with mother and potentially results in the loss of a vital emotional connection with her during the earliest days of life. This loss may contribute to a rupture that arrests emotional development at a deep psychic level. It is suggested that, in the same way as premature separation, the rupture can precipitate a ‘fusional complex’, a defence that develops to protect the infant against psychotic anxieties. The paper proposes that psychological development atrophies in this place and creates a blind spot. These ideas are explored through analytic theory and developmental literature. The dreams of a patient and his art are used to illustrate a 10‐year ‘alchemical’ process of bringing repressed material into consciousness and transformation. Healing the psychological wounds of deficits in early eye contact may be found to bring sight to a blind spot that was created by the nature of the condition itself.     

Psychoanalysis of maturescence (definition,metapsychology, and clinical practice)

This article offers an entirely new way of addressing middle age or mid‐life. It uses the neologism maturescence to denote this process's metapsychological feature, and it proposes a meta‐psychology of maturescence in order to allow a ‘direct understanding of maturescence’ instead of the ‘indirect understanding of maturescence’, which psychoanalytic literature generally alludes to. The paper examines somatic processes specific to male and female climacterics and is focused on to the tension between the soma and the body. It examines the drive increase that Freud posed in climacterics and the somatic climacteric imbalance that begets specific drive activity demanding psychic work, with very different pathways depending on the individual's specific working‐through activity. It discusses what happens to the individual when he/she is no longer able to procreate and begins to age; why this process is equivalent for individuals who had children and for others who could not or did not. This somatic event provides a universal constant from which it is possible to understand any individual variable.     

Unconscious phantasy: Some historical and conceptual dimensions

This paper seeks firstly to grasp both conceptually and historically the different phenomenologies that are captured by the term ‘Unconscious Phantasy’. The term is shown to refer to a number of distinct though overlapping conceptual domains. These include: phantasy as scene, phantasy as representation of drive, phantasy as representation of wish as its fulfilment, phantasy as split off activity of the mind functioning under the aegis of the pleasure principle; phantasy as representation of the minds own activities (which Wollheim calls’ the way “the mind represents its own activities to itself’’). Lastly unconscious phantasy is understood as being the basic foundation of all mental life, including drives, impulses, all anxiety situations and defences. Having mapped out this territory through following the development of the concept in the work of Freud and Klein, the author draws on the work of the philosopher Richard Wollheim who, the author contends, has made a fundamental contribution to our conceptual understanding of unconscious phantasy. In the last section of the paper, the author draws a distinction between what he terms ‘objects’ (namely psychic objects) and what he terms ‘facts’. It is suggested that this distinction, though implicit in much of our work, benefits from being made explicit and that in so doing an important dimension of analytic work is illuminated. We aim to help the patient to discover what he is like, to understand the ways in which he conceives and misconceives himself, to unravel the fact‐ness of himself and his world from its ‘object qualities’, to differentiate between unconscious phantasy and reality.     

Working psychodynamically and psychosocially with women who have been raped

In this paper, I analyse aspects of the experience of some female University students who have been raped drawing on a Kleinian psychoanalytic perspective and Layton’s concept of ‘normative unconscious processes’. I suggest that Klein’s writing provides a theoretical basis for thinking about the projective and introjective processes that may be at play between perpetrator and ‘victim’. Here, I focus upon Kleinian conceptualisations of castration anxiety, fragmentation, envy, greed and guilt. In terms of ‘normative unconscious processes’, I explore how castration anxiety (in a more symbolic sense of powerlessness), fragmentation, envy, greed and guilt may also operate within social discourses around sexual violence. Specifically, I draw upon Freyd’s concept of DARVO and Payne’s Rape Myth Acceptance Scale which both explain ‘victim blaming’ in terms of the social reversal of the positions of perpetrator and ‘victim’. I illustrate this social process with reference to representations of rape within the mainstream media. My hypothesis is that, although the ‘psychic’ and the ‘social’ are two contrasting positions theoretically, it is possible to draw on both of them to make sense of the experience of working with rape clinically.

The clinical context of this paper is my work as a psychodynamic counsellor at a modern London-based University. I draw on composite case studies of women who have been raped, drawing on both ‘psychic’ and ‘social’ perspectives. I seek to explore how the ‘psychic’ and the ‘social’ can be integrated in different ways depending upon the clinical situation. I suggest that they can be mutually enriching ways of working. Through approaching how the ‘psychic’ and the ‘social’ might interrelate from a clinical viewpoint, I conclude that the idea of ‘working psychosocially’ is of most use when approached as a flexible concept that different clinicians may draw on in different ways with different patients.     

The Possibility of Psychic Conflict in Seneca's De Ira

This paper explores the potential for psychic conflict within Seneca's moral psychology. Some scholars have taken Seneca's explicit claim in De Ira that the soul is unitary to preclude any kind of simultaneous psychic conflict, while other interpreters have suggested that Seneca views all cases of anger as instances of akrasia. I argue that Seneca's account of anger provides the resources for accommodating some types of simultaneous psychic conflict; however, he denies the possibility of psychic conflict between two action-generating impulses, thus rejecting the phenomena of genuine akrasia and enkrateia. Although superficially counterintuitive, Seneca's cognitivist account of anger, according to which anger is complex and requires assent to the propositions that ‘I have been wronged’ and ‘I ought to seek revenge’, renders his denial of akrasia and enkrateia more plausible.     

Words that touch2

In this paper the author examines her own use of language as a psychoanalyst and asks: what is the best way to help analysands to find the words to express not only what they are thinking but also what they are feeling and experiencing? In common with other psychoanalysts, the author has observed that each of us simultaneously utilises both advanced psychic mechanisms that are accessible to symbolism and more archaic ones, which are less so. However, she draws a distinction between people who are able to tolerate the perception of their own heterogeneity, even if it is sometimes a source of suffering, and those whom she terms ‘heterogeneous patients’. Patients in the latter category, whose lack of internal cohesion causes them anxiety, are afraid of losing their sense of identity. The author asks how we can understand their language and how we should speak to them. She uses several clinical examples to demonstrate that ‘heterogeneous patients’ need to be touched with a language that does not confine itself to imparting thoughts verbally but also conveys feelings and the sensations that accompany those feelings. It is also an ‘incarnated’ language because the words pronounced by the analyst can awaken, or reawaken, bodily fantasies in the patient. These words may enable him to find an emotional meaning in forgotten sensory or bodily experiences, which may then become a starting point for his work of thinking and of symbolisation.     

The reality of the other: Dreaming of the analyst1

The author discusses the obstacles to symbolization encountered when the analyst appears in the first dream of an analysis: the reality of the other is represented through the seeming recognition of the person of the analyst, who is portrayed in undisguised form. The interpretation of this first dream gives rise to reflections on the meaning of the other’s reality in analysis: precisely this realistic representation indicates that the function of the other in the construction of the psychic world has been abolished. An analogous phenomenon is observed in the countertransference, as the analyst’s mental processes are occluded by an exclusively self‐generated interpretation of the patient’s psychic world. For the analyst too, the reality of the other proves not to play a significant part in the construction of her interpretation. A ‘turning‐point’ dream after five years bears witness to the power of the transforming function performed by the other throughout the analysis, by way of the representation of characters who stand for the necessary presence of a third party in the construction of a personal psychic reality. The author examines the mutual denial of the other’s otherness, as expressed by the vicissitudes of the transference and countertransference between analyst and patient, otherness being experienced as a disturbance of self‐sufficient narcissistic functioning. The paper ends with an analysis of the transformations that took place in the analytic relationship.     

Trauma,resilience and healthy and unhealthy forms of dissociation

This paper outlines the difference between healthy and unhealthy forms of dissociation following, and in response to, traumatic experience, in particular the experience of refugees, calling on 30 years’ experience in working with refugees in voluntary and public sectors, including 20 years at the Refugee Therapy Centre, London. It differentiates dissociation from repression, and looks at some of the specific traumatic experiences associated with refugees’ displacement and situation, particularly relating to loss. Four key characteristics of resilience are described: ‘psychic space’, ‘sense of self’, and the use of a ‘listening other’ and ‘healthy dissociation/resiliency’. Two vignettes are given to illustrate the difference between healthy and unhealthy dissociation.