On boredom: A close encounter with encapsulated parts of the psyche

The psychoanalytical literature has numerous scattered references to the analyst's experience of boredom, especially amongst writers working with primitive mental states. In the present paper, the author tries to gather some of these references in an attempt to integrate the various facets of this widespread phenomenon, and reflect on some clinical issues and dilemmas it raises. It is suggested that the experience of boredom in analysis may be a reaction to an encounter with a hidden, encapsulated part of the psyche, a bidimensional area of experience in which mental activity has been suspended, and experience remains meaningless. This is a barren area of lack, an encounter with the autistic core of the psyche. However, boredom may also be an experiential expression of despair, a re-living of primitive object relations with an emotionally non-existent primary object. Through bringing the emptiness and desolation into analysis, the individual makes room for the empty, blunt, dead inner object which resides within him, and that needs to be integrated into the psyche. This inner object is a vital part of the patient's inner world, part of his history, and can neither be erased nor filled in order to eradicate the emptiness. This is illustrated by clinical material from patients along the spectrum of autism, autistic reaction following trauma and autistic barriers in neurotic patients.     

The impossible reparation

This article discusses the phantasy of returning to the past and symbiotically merging with the mother, which, in an autistic patient, constituted an attempt of impossible reparation. This mode of reparation resulted in a cycle in which any attempt to repair the inner experience by contact with an external object was destined to be disappointing because of the desire for an infantile connection without separateness. The author reviews the literature on reparation and emphasises recent developments resulting from work with Autism Spectrum Disorder children who are far from the depressive position and who have difficulty bearing separateness. The author recognises an essential positive aspect of reparation independent of the ability to perceive the object as separate and suggests that when working with very primitive emotional states, it seems suitable to use a wider definition for what can be considered essentially a primitive reparative act or a precursor for reparation. Next, the author discusses the significance of a phantasy of impossible reparation in an autistic girl with emphasis on the importance of considering the reparative aspects of this defensive phantasy to enable development. Finally, the author relates to the despair that occurs in both analyst and patient when the phantasy is not transformed.     

Emptiness as defense in severe regressive states

This paper examines the empty states experienced by severely ill borderline patients. At times of stressful regression, these patients use complaints of emptiness to describe profound disturbances of affect, cognition, object relations, and bodily experience. Empty states may be seen as complex defensive configurations which protect a borderline level of psychic structure from the impact of aggressively charged object relations, and ward off further regression to states of fragmentation or fusion. Severely ill borderline patients consolidate an empty screen by means of a characteristic repertoire of primitive defenses consisting of various forms of projective identification, including bitriangulation and projective identification of psychic agencies, somatization, acting out, and specific alterations in cognition. The author describes the highly deviant organizations of the object world seen in empty states, and the complex and disturbing countertransferences which these states evoke.     

The Theory of Transformations and Autistic States Autistic Transformations: A Proposal1

This work integrates two areas of thinking: one in which the author develops considerationsregardingobservationmethodsofmentalphenomenainpsychoanalysis according to Bion's theory of transformations; the other in which she is concerned with the investigation of primitive mental states‐protomental states‐more specifi cally, the autistic states of neurotic patients, described by Tustin. Some ideas on the ‘philosophical’ position underlying transformations theory are elaborated, particularly emphasizing the idea that the same phenomenon in psychoanalysis may be considered from different perspectives, as long as it is situated within the theoretical reference frame to which it belongs. The author considers the idea that this method of phenomenon observation is part of a wider context of general human knowledge, in which uncertainty and relativity of concepts are the main components. By adopting transformations theory as a perspective of phenomena observation that pervades the analytical meeting, the author questions whether it is possible to include other groups of transformation of emotional experiences in this theory, which shows particular phenomena with specifi c qualities, distinct from those emphasized by Bion. She hypothesizes that autistic phenomena present in neurotic patients, characterizing autistic states, may be considered and detached, making up a particular group of transformation of emotional experience, which analysts often face in their daily practice. She names this group ‘autistic transformations’.     

ANALYTIC MIND USE AND INTERPSYCHIC COMMUNICATION: DRIVING FORCE IN ANALYTIC TECHNIQUE,PATHWAY TO UNCONSCIOUS MENTAL LIFE

Developed from established psychoanalytic knowledge among different psychoanalytic cultures concerning unconscious interpsychic communication, analysts' use of their receptive mental experience—their analytic mind use, including the somatic, unconscious, and less accessible derivatives—represents a significant investigative road to patients' unconscious mental life, particularly with poorly symbolized mental states. The author expands upon this tradition, exploring what happens when patients unconsciously experience and identify with the analyst's psychic functioning. The technical implications of the analyst's “instrument” are described, including the analyst's ego regression, creation of inner space, taking mind as object, bearing uncertainty and intense affect, and self‐analysis. Brief case vignettes illustrate the structure and obstacles to this work.     

Precipitation anxiety

Therapy with autistic and psychotic children led the author to introduce the concept of precipitation anxiety. Freud's first theory of the instincts was expressed in the dynamics of conflict, but his subsequent development of life and death instincts is better understood in terms of a gradient of energy between two extremities of the same axis. Object relations result from a caesura (Bion) which creates a gradient of psychic energy experienced initially as a precipice which, if left unregulated, generates intolerable anxiety. Satisfactory emotional encounters with the mind of the object bring about the necessary adjustments to the slope of the gradient. Autistic mechanisms may block off precipitation anxiety, but they also prevent mental growth. Both the dynamics of conflict and the dynamics of the gradient are vital for psychic development, but the very existence of the former is contingent on successful negotiation of the energy gradient (working through). After illustrating his thesis with clinical material drawn from a group therapeutic setting, the author discusses points of convergence and divergence with two other fundamental notions: the aesthetic conflict (Meltzer) and premature psychic birth (Tustin). The proposed model furthers our understanding of the therapeutic process and stresses the importance of the containing object in the transference situation.     

The many faces of lying

In this paper the author explores the psychic functions of lying and draws on Glasser's (1979) notions of self-preservative and sadistic violence to identify three selfobject configurations. Each of these is associated with specific anxieties to which the lie offers an apparent solution. The first configuration is sadistic lying. Here the intent is to attack and triumph over the duped other. The lie allows the object to be controlled and humiliated. This gratifies the self by reversing an earlier humiliation. The second and third configurations are both forms of self-preservative lying, where the lie may be best conceived as a symptom of hope (Winnicott, 1985). In the second configuration, the object is felt to be unavailable or inscrutable. The lie may be used to create an attractive self that will elicit the object's love, admiration and concern. In this way, the lie serves to eliminate doubt about the object's intentions towards the self. In the third configuration, the object is felt to be intrusive, and the dyadic relationship is overpowering. Here the lie can represent an attempt to insert a third into the relationship.     

Transformations of Emotional Experience

In this paper the author approaches mental pain and the problems in a psychoanalytic treatment of patients with difficulties in the psychic transformation of their emotional experiences. The author is interested in the symbolic failure related to the obstruction of development of phantasies, dreams, dream‐thoughts, etc. She differentiates symbolization disturbances related to hypertrophic projective identification from a detention of these primitive communications and emotional isolation. She puts forward the conjecture that one factor in the arrest of this development is the detention of projective identifications and that, when this primitive means of communication is re‐established in a container–contained relationship of mutual benefit, this initiates the development of a symbolization process that can replace the pathological ‘protection’. Another hypothesis she develops is that of inaccessible caesuras that, associated with the detention of projective identification, obstruct any integrative or interactive movement. This caesura and the detention of projective identifications affect mental functions needed for dealing with mental pain. The personality is left with precarious mental equipment for transforming emotional experiences. How can a psychoanalytical process stimulate the development of creative symbolization, transforming the emotional experiences and leading towards mental growth? The author approaches the clinical problem with the metaphor of the psychic birth of emotional experience. The modulation of mental pain in a container–contained relationship is a central problem for the development of the human mind. For discovering and giving a meaning to emotional experience, the infant depends on reverie, a function necessary in order to develop an evolved consciousness capable of being aware, which is different from the rudimentary consciousness that perceives but does not understand. The development of mature mental equipment is associated with the personality's attitude towards mental pain. The differentiation between psychotic, neurotic or autistic functioning depends on what defences are erected to avoid mental pain. The primary link between infant and mother is where the building of mental equipment takes place, through communicational forms that, to begin with, are not verbal. The author suggests the need for the development of an ideo‐grammar (in gestures, paralinguistic forms, etc.) in primary relations, as the precursor forms that will become the matrix for the mental tools for dealing with emotional experiences in a mature way. The paper stresses the significance of the parental containing function for the development of symbolization of prenatal emotional experiences. This containment develops ideograms, transformations of sense impressions into proto‐symbols, instruments that attenuate the traumatic experiences of helplessness. The author takes Bion's ideas about extending the notion of dream‐work to an alpha function that goes on continually, day and night, transforming raw emotional experiences in a ‘dream’. In order to acquire a meaning, facts need to be ‘dreamed’ in this extended sense. Meaning and truth are the nurture of the mind. Mental growth, the development of adequate tools – including reverie – for dealing with mental pain, seen from a psychoanalytic perspective including reverie, implies that the object becomes a provider of meanings. Analysis begins to aim primarily at the generation or expansion of the mental container, instead of predominantly working on unconscious contents as such.     

Introduction to object relations group psychotherapy.

The author shows how object relations group therapy focuses on primitive defense mechanisms that shape the group-entity image or "basic assumptions group." Such primitive defense mechanisms as splitting, projective identification, omnipotent denial, projection, and introjection are the mental resources to protect the endangered self and the threatened objects from the fantasized imminent destruction. Object relations group psychotherapy addresses those defenses and the underlying psychotic anxieties, offering members opportunities to search for other ways to respond to their primitive fears. The author introduces two extensive clinical vignettes to illustrate how object relations group methods are different from other group-centered psychoanalytic techniques. He concludes by commenting on future theoretical refinements and on the problems in the professional practice of this modality.     

Fonagy and Freud. Psychological versus psychic reality

Peter Fonagy and Mary Target present their Playing with reality theory as a developmental theory centred on the concept of psychic reality. This paper compares Fonagy and Target's use of the concept of psychic reality with Freud's original concept. It is argued that the concept of psychic reality has been redefined from delineating a psychic reality stemming from the unconscious to denoting a kind of conscious or preconscious psychological reality characterized by an experience of equality between the internal and the external worlds. The theoretical discussion is illustrated by being applied to eating disorder pathology, which by Fonagy and colleagues is described as associated with thought processes characterized by psychic reality.     

The violent adolescent: the urge to destroy versus the urge to feel alive

The dynamics of adolescent violence are explored from theoretical and developmental perspectives applied to the review of psychoanalytic studies of violence and three cases: the case of Willie Bosket, presented in Fox Butterfield's All God's Children, an adolescent treated by one of the authors, and observation of staff dynamics in a juvenile detention facility. Studies indicate that violence is used to preserve a sense of existence and psychic equilibrium as well as to express rage and destroy unwanted projected parts of the self and dangerous intrusions into a fragile self-coherence. In the case studies, violent activity serves a number of psychic functions: it leads to high arousal states and the feeling of being alive thereby disavowing underlying feelings of deadness and depression, it serves to contain and discharge overwhelming chaotic and rageful feelings, and it enacts object ties and the unconscious fantasies of the parent. Staff dynamics in a treatment setting for juvenile offenders reflect the intrapsychic dynamics of the juvenile offender prone to acting out, projection, hypervigilance to signs of disrespect, and disavowal of unwanted affects including helplessness and vulnerability.     

The Patient-Staff Community Meeting: A Tea Party with the Mad Hatter

The author shows how object relations group therapy focuses on primitive defense mechanisms that shape the group-entity image or “basic assumptions group.” Such primitive defense mechanisms as splitting, projective identification, omnipotent denial, projection, and introjection are the mental resources to protect the endangered self and the threatened objects from the fantasized imminent destruction. Object relations group psychotherapy addresses those defenses and the underlying psychotic anxieties, offering members opportunities to search for other ways to respond to their primitive fears. The author introduces two extensive clinical vignettes to illustrate how object relations group methods are different from other group-centered psychoanalytic techniques. He concludes by commenting on future theoretical refinements and on the problems in the professional practice of this modality.     

Life within death: Towards a metapsychology of catastrophic psychic trauma

In this paper the author offers a phenomenology and a metapsychology for the effects on the mind of catastrophic psychic trauma, defined as the reaction of the psyche to an utterly external event, which the person is helpless to resist, and against which there is no possible defense. The author affirms that the experience of 'infinite affliction' produces a radical break in being which disarticulates the psyche and causes a headlong descent to the most primitive levels of psychic functioning. When there is a complete surrender to the process of disarticulation, it continues until it extinguishes even the most basic level of mental activity, contact with sensation, producing psychic and then psychogenic death. The author then offers a phenomenological and metapsychological analysis of how the process of disarticulation is stopped so that the state of survival is assured, affirming that, faced with this situation of utter emergency, the survival urge instantly mobilizes the organism in furious activity to preserve life and regenerates psychic activity by sensing the ongoing existence of the psychesoma. Then anguish precipitates on to the body and is sensed as psychophysical pain, which diverts conscious attention from the infinite destruction of utter affliction which is thus encapsulated so that, as an experience, it is no longer present to the mind. This assures survival, but it leaves the psyche in a state of non-integration and begins the unending battle for mastery over the deadly inner object which ceaselessly threatens to become present. This constitutes the precariousness of the state of survival.     

Incorporation of an invasive object

The author discusses the experience of 'being invaded' that is sometimes communicated by certain severely disturbed patients. The complaint can sometimes be couched in terms of bodily suffering and such patients may state that they have the experience of a 'foreign body' inside. It is suggested that these patients have suffered severe early failure of containment of their projections, while at the same time they have incorporated primitive characteristics of the object that have been powerfully projected into them. An object that invades in this way, it is suggested, experiences a compulsive need to expel unbearable states of mind using others as a repository. The infant incorporates these violent projections as part of his own mental representational system, and normal identifi cation processes are disrupted. There follows impairment of the development of the sense of self. Clinical examples of how the invasive experience manifests itself in the analytic setting and in the transference and countertransference are presented. It is argued that this highly complex form of early subject-object interaction (prior to the differentiation of psyche-soma) is more likely to be found in severely narcissistically disturbed individuals. Some refl ections on the origins of invasive phenomena are given.     

All holes are the same: Emerging from the confusion

The author describes a type of mental development in which the primitive libidinal value of faeces and urine is kept unaltered all through adulthood. In this instance, individuals harbour fantasies of projective identifi cation with the internal parents, denying their real dependence, which leads to a pseudomaturity. These fantasies are usually accompanied by anal and genital masturbation and have intense aggressive content. Furthermore, there is a signifi cant confusion among all body orifi ces, leading to an inability to distinguish the self from the object, the inner world from outside reality. Individuals with this type of development can only maintain limited object relations and have highly erotized excretory activities. Manipulation of faeces may occur. This structure works as a defence against breakdown, but may also provide pleasure as it gives the illusion of omnipotent control of the object, as typical in pathological organizations. The author presents clinical material and discusses the diffi culties of the analysis, in which the patient tries to seduce the analyst into colluding with his mental functioning, primarily as a means of communication as well as a projection of his despair and his disbelief in the analyst's ability to help him.     

On receiving what has gone astray, on finding what has got lost

Disturbing emotions that act as bodily cryptograms waiting to be deciphered are currently understood as intra-psychic trauma. The author briefly discusses Fordham's concepts of deintegration and primitive identity, as well as early patterns of mother-infant attunement to describe how the empathic capacity of the analyst is dramatically challenged in helping patients to give birth to unbearable emotions that remain an undifferentiated entity. Referring to Ogden's understanding of the mechanism of projective identification, the author will explore how unconscious mental processes in the analyst and the patient can work at re-activating failures in the deintegrative process. Clinical material is presented to show how unconscious psychic events that affect the patient but cannot be known consciously can be born into mind by the analytic couple.     

Murder: A psychotherapeutic investigation

This paper suggests that it is theoretically necessary and clinically useful to make a distinction between two types of psychic encapsulation within the broader literature. The proposed distinction, as it relates to these psychic structural manifestations, is illustrated here as applied to anorexia. The author suggests that psychic encapsulation is commonly encountered in work with anorexics, and that each type seems to imply a somewhat different therapeutic course. The distinction is made between anorexic patients who appear to display evidence of autistic/autistoid encapsulation as opposed to those who seem to manifest non-autistoid/later traumatic encapsulation – termed secondary adjunctive encapsulation in this paper. Defensive encapsulations are associated with pathological organisations of the personality – both within and beyond these structures, they exert an organising power over central mental processes. Psychic encapsulation and pathological organisations are defensive structural developments – the result of psychic trauma. Clinical material from three cases is presented to illustrate the arguments.     

Beyond the representation field

Abstract

This article outlines the importance of representation and several Freudian concepts such as Vorstellung, Trieb, and word and object representations. The author refers to the division of the analytical process into two main fields: the field of representation, and the field of the Real, which is characterized by impossibility. He then states that this field is the proper field of psychoanalysis. The author presents two clinical vignettes in an attempt to demonstrate the significance of the analytical act as a tool to deal with such extreme psychic situations.     

The relevance of the Oedipus myth to fostered and adopted children

The paper makes a conceptual distinction between aggressive phantasies and acts against the object and a destructive form of potentially objectless violence resulting from attacks on the mental capacity for linking terms of –K. In thinking about the issue of the internal states leading to mindless destructiveness, the author suggests that such behaviour may result from active envious attacks on the capacity for linking, but that, in some cases, early trauma may result in a more passive breakdown of the human disposition for creating emotional mental links. The discussion of the clinical history of a destructive latency child who was born at six months of gestational age connects the traumatic beginning of his life with his violent behaviour.