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.     

Transformations in hallucinosis and the receptivity of the analyst

Bion describes transformation in hallucinosis (TH) as a psychic defence present in elusive psychotic scenarios in which there is a total adherence to concrete reality: as the hallucinatory activity which physiologically infiltrates perception and allows us to know reality, setting it off against a background of familiarity; and then, surprisingly, as the ideal state of mind towards which the analyst has to move in order to intuit the facts of the analysis. When hallucinosis is followed by ‘awakening’, the analyst gains understanding from the experience and goes through a transformation that will inevitably be transmitted to the analytic field and to the patient. In this paper I illustrate Bion's concept and underline its eminently intersubjective nature. Then I differentiate it from two other technical devices: reverie, which unlike hallucinosis does not imply the persistence of a feeling of the real, and Ferro's transformation in dreaming, i.e. purposeful listening to everything that is said in the analysis as if it were the telling of a dream. Finally, I try to demonstrate the practical utility of the concept of transformation in hallucinosis in order to read the complex dynamics of a clinical vignette. Though not well known (only two references in English in the PEP archive), TH proves to be remarkably versatile and productive for thinking about psychoanalytic theory, technique and clinical work.     

Negative hallucinations,dreams and hallucinations: The framing structure and its representation in the analytic setting

This paper explores the meaning of a patient's hallucinatory experiences in the course of a five times a week analysis. I will locate my understanding within the context of André Green's ideas on the role of the framing structure and the negative hallucination in the structuring of the mind. The understanding of the transference and countertransference was crucial in the creation of meaning and enabling the transformations that took place in the analytic process. Through a detailed analysis of a clinical example the author examines Bion's distinction between hysterical hallucinations and psychotic hallucinations and formulates her own hypothesis about the distinctions between the two. The paper suggests that whilst psychotic hallucinations express a conflict between life and death, in the hysterical hallucination it is between love and hate. The paper also contains some reflections on the dramatic nature of the analytic encounter.     

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.     

The work of the psychoanalyst in the field of psychosis1

Psychosis questions the foundations of psychoanalytic theory and challenges our ultimate convictions about psychic functioning. Using her clinical practice, the author explores the foundations of representation and underscores the central position of sensoriality in constituting a representation. Psychoanalytical work with a psychotic subject requires a certain sharing of the psychotic experience which puts the analyst in touch with raw material grasped as a fragment of sensoriality that must consequently be shaped and figured so that the subject's representational activity can resume. The author thus uses the Freudian notion of figuration to specify this ‘raw material’ and its sensory texture. She then refers to Aulagnier's pictograms as a way of thinking about sensoriality under the sign of displeasure and pain rather than pleasure. In the light of this theoretical development, the author re‐examines the opening excerpts from her clinical cases to come up with a practice of interpretation as figuration that allows jointly for the shaping of the raw material and the identifying import of this shaping.     

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.     

On the nature of intuitive and delusional thought: Its implications in clinical work with psychotic patients

The author tries to differentiate intuitive imagination from delusional imagination and hypothesises that psychosis alters the system of intuitive thinking, which consequently cannot develop in a dynamic and selective way. Scholars of different disciplines, far removed from psychoanalysis, such as Einstein, Hadamard or Poincar, believe that intuitive thinking works in the unconscious by means of hidden processes, which permit a creative meeting of ideas. Thanks to Bion's work, psychoanalysts have begun to understand that waking thinking is unconsciously intertwined with dream‐work. The delusional construction is similar to a dreamlike sensorial production but, unlike a real dream, it remains in the waking memory and creates characters which live independently of the ‘dreamer's’ awareness. It is a dream that never ends. On the contrary, the real dream disappears when it has brought its communicative task to an end. In the analysis of psychotic patients it is very important to analyse the delusional imagination which dominates the personality and continuously transforms the mental state, twisting emotional truth. The delusional imagination is so deeply rooted in the patient's mental functioning that, even after systematic analysis, the delusional world, which had seemed to disappear, re‐emerges under new configurations. The psychotic core remains encapsulated; it produces unsteadiness and may induce further psychotic states in the patient. The author reports some analytic material of a patient, who, after a delusional episode treated with drugs, shows a vivid psychotic functioning. Some considerations are added on the nature of the psychotic state and on the therapeutic approach used to transform the delusional structure. This paper particularly deals with the difficulty in working through the psychotic episode and in ‘deconstructing’the delusional experience because of the terror connected with it. In the reported case, the analytic work changed the delusional construction into a more benign one characterised by phobic qualities. The analysis of the psychotic transference allowed the focus to be on the hidden work which had been continuously influencing the transferential picture of the analyst and the patient's psychic reality.     

Commentary on ‘The arms of the chimeras’ by Béatrice Ithier

In this Commentary I will first of all summarise my understanding of the proposal set out by Béatrice Ithier concerning her concept of the ‘chimera’. The main part of my essay will focus on Ithier's claim that her concept of the chimera could be described as a ‘mental squiggle’ because it corresponds to Winnicott's work illustrated in his book ‘Therapeutic Consultations’ (1971). At the core of Ithier's chimera is the notion of a traumatic link between analyst and patient, which is the reason she enlists the work of Winnicott. I will argue, however, that Ithier's claim is based on a misperception of the theory that underpins Winnicott's therapeutic consultations because, different from Ithier's clinical examples of work with traumatised patients, Winnicott is careful to select cases who are from an ‘average expectable environment’ i.e. a good enough family. Moreover, Winnicott does not refer to any traumatic affinity with his patients, or to experiencing a quasi‐hallucinatory state of mind during the course of the consultations. These aspects are not incorporated into his theory. In contrast (to the concept Ithier attempts to advance), Winnicott's squiggle game constitutes an application of psychoanalysis intended as a diagnostic consultation. In that sense Winnicott's therapeutic consultations are comparable with the ordinary everyday work between analyst and analysand in a psychoanalytic treatment. My Commentary concludes with a question concerning the distinction between the ordinary countertransference in working with patients who are thinking symbolically in contrast to an extraordinary countertransference that I suggest is more likely to arise with patients who are traumatised and thus functioning at a borderline or psychotic level.     

A serious misunderstanding: synchronicity and the generation of meaning

Abstract: This paper points to the problem caused by the fact that numerous academic ‘Jung studies’ are conducted on the basis of the English translation of Jung's works without any knowledge of his original texts and illustrates it with the misconstrual that Jung's concept of synchronicity suffered in the studies of many recent authors, as exemplified by two articles in the September 2011 issue of the JAP. The translation of ‘sinngemäße Koinzidenz’ as ‘meaningful coincidence’ seduced those writers to take synchronistic ‘meaning’ as meaning the meaningfulness of life or even as ‘transcendent meaning’, which is incompatible with Jung's synchronicity concept, and to replace Jung's strictly intellectual project of establishing an explanatory principle for synchronistic events (in addition to the principle of causality for all other events) by the fundamentally different project of focusing on the impact that such events may have for the experiencing subjective mind, on ‘human meaning‐making’, and, with a decidedly anti‐intellectual bias, of hoping for ‘shifts into non‐rational states of mind’.     

Psychosis,symbol, affectivity 2: another perspective on the treatment of psychotic disorder

This is the second of two papers concerning our study into an integrated approach to psychotic disorders conducted at the University Psychiatry Unit of Palermo’s Polyclinic over approximately 15 years; this paper concentrates on the clinical phenomena. The study aimed to find the best possible treatment and to improve the prognosis of this patient group. We have explored the efficacy of a range of psycho-therapeutic (cognitive-behavioural, systemic-relational, psychodynamic, group and others), psycho-pharmaceutical, psychiatric rehabilitative and psycho-educational treatments, with a hermeneutic approach instead of a systematic one. The study’s conclusions, described in the paper, are that all psychotic functions start with a nuclear psychic issue connected to emotional development. We describe how the most significant symptoms of acute psychotic manifestations (delusions and misperceptions) make use of an encrypted psychological meaning that can be decoded through the patient’s symbolic language. This language is a key element in diagnosis and in the choice of treatment. The paper describes how we revised our understanding of psychosis from being a brain disease to being a process aimed at the rearrangement of psychic functioning. Our significant results are described.     

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.     

High emotional arousal and failures in reality monitoring: Pathways to auditory hallucinations in non‐psychotic children?

Recent research has confirmed the presence of auditory hallucinations in non‐psychotic children, with this research also suggesting that such hallucinations may be more common than previously thought. While auditory hallucinations in children have frequently been associated with high levels of emotional stress, there is still a poor understanding of how this stress may precipitate hallucinations, and why some children experience hallucinations while others seem not to. The current study assessed the association between high levels of trauma symptomatology, anxiety and depression, and the presence of hallucinations against matched controls. Results indicated that hallucinating children had significantly higher mean anxiety, depression and, in particular, re‐experiencing scores than did the children in the control group. These results were examined within the framework of reality monitoring, that is, the ability to distinguish between externally or internally generated sources of information. The notion of high levels of emotional distress decreasing the efficiency of reality monitoring and leading to the possibility of confusion between internally and externally generated stimuli was discussed, with the conclusion advanced that the misattribution of an externally generated source – either held as a memory or as a traumatic re‐experiencing – as an internally generated one, underlies hallucinatory experiences.     

Temporality in Psychosis: Loss of Lived Time in an Alien World

This article presents a model of the temporal structure of psychic life. Time is a rule-guided process. A person's psychic life, too, yields to an examination of necessary and regulated operations. To outline both the regular and the modified perception of time within psychic life, Sigmund Freud's model of the drive interaction is brought to bear on Jacques Marie Émile Lacan's understanding of psychosis. Both Freud's and Lacan's findings are explained with an eye on the temporal dimension of the psyche, temporal modifications manifested in states of psychotic delusion, and the role of time for one's meaningful engagement with the world. Psychic time is nonlinear. The future, the past, and the present must be engaged simultaneously, albeit not in the same way, to yield the sense of temporal fullness. For Freud, the cooperative functioning of the drives accounts for the sustainment of the lucid psychic life, whereas modifications in the drives’ interactions signal psychic disturbances. Lacan (1955/1993) stresses the atemporal character of the nonexistent, negated, or lost reality that pressures an individual to enter a psychotic delusion. This article makes the assumption that the psychological states in which the reckoning with time is lost are the consequences of an unsuccessful incorporation of traumatic stimuli that are caused both by outside phenomena and by the actions of an individual's inner drives. The findings of this article support the view that psychic traumas necessitate modifications to the sense of time. The findings also offer an understanding of the kinds of temporal modifications that occur in an individual's psychic life and the way in which these temporal changes lead to the experience of radical otherness that is present in some cases of psychological disturbances.     

A psychoanalytical phenomenology of perversion1

After stating that the current tasks of psychoanalytic research should fundamentally include the exploration of the analyst's mental processes in sessions with the patient, the author describes the analytical relation as one having an intersubjective nature. Seen from the outside, the analytical relation evidences two poles: a symmetric structural pole where both analyst and patient share a single world and a single approach to reality, and a functional asymmetric pole that defines the assignment of the respective roles. In the analysis of a perverse patient, the symmetry‐asymmetry polarities acquire some very particular characteristics. Seen from the perspective of the analyst's subjectivity, perversion appears in the analyst's mind as a surreptitious and unexpected transgression of the basic agreement that facilitates and structures intersubjective encounters. It may go as far as altering the Aristotelian rules of logic. When coming into contact with the psychic reality of a perverse patient, what happens in the analyst's mind is that a world takes shape. This world is misleadingly coloured by an erotisation that sooner or later will acquire some characteristics of violence. The perverse nucleus, as a false reality, remains dangling in mid‐air as an experience that is inaccessible to the analyst's empathy. The only way the analyst can reach it is from the ‘periphery’ of the patient's psychic reality, by trying in an indirect way to lead him back to his intersubjective roots. At this point, the author's intention is to explain this intersubjective phenomenon in terms of metapsychological and empirical research‐based theories. Finally, some ideas on the psychogenesis of perversion are set forth.     

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.     

The explosion of the present and the encapsulation of time: Transference phenomena in the analysis of a psychotic patient

The paper deals with some basic problems concerning the experience of time and space in the psychoanalytic treatment of psychotic patients. Whereas borderline patients tend to distort the experience of time and space under emotional pressure, the concepts of time and space seem to dissolve in acute psychotic states of mind. Sometimes this manifests itself in an explosion of the present, where the past is ubiquitous and the future is perceived as the end of all times. The case of a 48 year‐old patient with the external diagnosis of ‘paranoid–hallucinatory schizophrenia’ is presented to illustrate that the main task is to recreate a structure to contain the experience of space and time. Such a development may occur if primitive psychotic anxieties can be taken up and metabolized. A near‐psychotic decompensation before the first break and the development of a transference psychosis in the second year of the analysis are depicted in detail. Subsequently some developments became visible which helped the patient to better tolerate catastrophic fears of loss. This included the formation of a structure which the patient called ‘hibernation’ enabling her to psychically survive without falling apart. By retreating into her ‘time capsule’ she managed to overcome breaks and to delay her fears of fragmentation until they could be taken up and worked through in the transference. The creation of a structure like the patient's ‘time capsule’ is considered to be an attempt to construct the experience of time and space. It prevented a collapse of her internal space thereby enabling further steps towards thinking and symbolization. In conclusion, some theoretical and clinical aspects are discussed including the role of the countertransference.     

Critical refl ections on intersubjectivity in psychoanalysis1

The authors review the philosophical trend known as postmodernism and the way it has infl uenced a part of psychoanalytic thought, concluding with some comments on the qualities and shortcomings of the new developments. The authors consider the origins and the cultural and aesthetic‐philosophical meaning of postmodernism, identifying some key concepts such as deconstructionism, the disappearance of the ‘individual subject’ and individual identity, and the rejection of ‘in‐depth’ models of psychoanalysis. Then they examine various, wide‐ranging developments in psychoanalytic thought and treatment. They review the intersubjective fi eld in psychoanalysis, especially in the USA, and then explore whether the underlying lack of truth to be discovered, stressed by these ‘new view’ statements, or the fact that the ‘truth’ only exists in linguistic‐narrative constructions is consistent with basic analytic concepts such as the unconscious, phantasy, transference and countertransference, which recall the tri‐dimensional nature of inner psychic reality. The psychoanalytic process is a condition activated through a bond that is able to hold and contain the relationship of the analytic couple and the patient's unconscious world and not through hermeneutic or narrative constructions.     

Fire at the theatre: (Un)reality of/in the transference and interpretation1

Only in Bion's extended idea of ‘waking dream thought’ is the oneiric paradigm of the cure (already an obvious Freudian principle) completely applicable. The author's basic hypothesis is that, by adopting this paradigm thoroughly, one can combine the radical antirealism which is expressed in the postulate by which all the patient's communications are transference‐connected (here meaning ‘false connection’‐i.e. as projection/displacement of elements of the patient's inner psychic world) with the ‘reality’ of the transference, that is to say with the conviction that the facts of the analysis are co‐determined by the patient‐analyst dyad and actually rooted in how they interact. The Freudian metaphor of the fi re at the theatre is reintroduced here to suggest the crisis of the therapist's internal setting and capacity for reverie, which occurs when the irreducible ambiguity of the transference is resolved defensively, either in the patient's external reality or in his unconscious fantasy constellation. The author gives three clinical examples. The fi rst shows some of the not necessarily negative effects of this temporary crisis. The other two vignettes show a way of listening to the traumatic events of the patient's life from a perspective (that of the ‘analytic fi eld’) which is thought to be potentially the most transformative and vital to the analytical relationship.