Flexibility of the Psychoanalytic Approach in the Treatment of a Suicidal Patient: Stubborn Silences as “Playing Dead”

The author presents the clinical case of a patient in his third analysis who seemed emotionless, did not feel alive, and complained of an uncontrollable urge to gamble, with disastrous financial results. His previous four-session-a-week “orthodox” analysis had left him prey to a sense of emptiness and to intense suicidal urges. He wanted only two weekly sessions, which became three after some analytic work. The author stresses the danger of rigidly following inflexible standards and the consequent activation of a pseudo-compliance in the analysand. A more slowly paced psychoanalysis should not be considered lower in the pecking order than “high-frequency” treatment, the author maintains: It requires great creative subjective involvement on the part of the analyst and close interaction in the context of the analytic couple. The author shows how this analysis involved a series of interactions in which the analyst was called upon to exercise a complex responsiveness, attuned in each instance to the patient's current needs. Finally he focuses on some clinical passages to show how the patient's internal theories represent a glaring assault on common sense and how death was not recognized perceptionally on a realistic level, but was instead replaced with acting out death against himself by keeping himself mentally dead and by suicidal urges.     

Developing a Capacity for Bodily Concern: Antonio Damasio and the Psychoanalysis of Body–Mind Relationship

ABSTRACT

The author starts from the assumption that the body is the mind’s primary object. He explores the link between his clinical research about the Body–Mind relationship and neuroscience, by focusing particularly on the contribution by Antonio Damasio who has emphasized the importance of the bodily roots of mental functioning. In many patients nowadays, developing a capacity for “concern for one’s own body” is a stepping stone toward a genuine non-imitative mental functioning. This perspective contrasts with psychoanalytic orientations that give priority to recognition of the other and intersubjective dynamics.