Antònia Grimalt
Pathological defensive organization in a patient in his late
adolescence
Who shows a child as he really is? Who sees him among the stars?
And puts the measure of distance in his hands ...
... To contain death, the whole of death Even before life has begun
To contain it so gently and not to be angry –
This is indescribable
(Rilke, 1912b, p. 48)
Introduction
I would like to give a theoretical introduction (which I won’t read) about the piece of
work which is predominantly clinical.
We can consider ourselves as living in, at least, two mental worlds: one defined by the
intense sensory experience and another more gently crafted by attunement and
thought. While we may wish to think of ourselves as residing primarily and maturely
amid thought and reflection, a clear–eyed view will reveal that we spend much if not
most of our time in the concrete sensory dominated world of “how things are”. We
may ‘suppose a universal tendency to substitute the psychic reality (animate) by
material reality (inanimate), which coexists and opposes the evolution of thinking ... I
mean an active concretization which transforms the animate (with emotional
meaning) into inanimate (a sensorial state without meaning). Indeed this sensory
level of experience shades and shapes much of the texture of our emotional lives, and
perhaps due to its bedrock nature and profound impact, it may also exert a
gravitational pull, easily dismantling the products of thought and our capacities to
think back into the basic sensory elements from which they evolve (Anderson 2012,
Grimalt 2013a). It can appear with an unusual intensity in the adolescent where the
sensual body takes over the possibility of thought. I will attempt to explore some
aspects of the to and fro between these two realms of the psyche (and the deanimating power of the entropic pull) in the evolution of Pablo’s analysis.
In line with this I would like to focus on the recurrence of the infantile protomental in
the adolescent that determine or renders difficult the process of a normal adolescent
crisis (Grimalt 2013b). We can say that adolescent crisis proper is, first of all, a crisis
of the early development. The sensual and affective burden in the adolescent awakens
early anxieties in the claustro-agoraphobic register. How to contain these strong
sensations and emotions without enough psychic structure to contain them? A
defensive encapsulation can take place because of the traumatic impact of primary
experiences of differentiation and separation.
The ego, as Freud says, is “first and foremost a bodily ego” ultimately derived from
bodily sensations. But the body itself is in turn something that is “produced” from
birth on (Civitarese 2013). Sensations and perceptions are not pure or natural, but
somehow also learned, that is to say shaped by the mother’s discourse. The first
homeland of the ego is a pre-symbolic language made up of rhythms, tones of voice,
sounds, words, silences, gestures, expressions, smells and colours. The construction of
identity starts in the play of assonance and dissonance, absence and non-absence. A
fluid bundle of sensory experiences marked from the very beginning by caesuras, gaps
and spacing provides the principal media for the birth of psychological meaning and
the rudiments for the processing of the emotional experience in a primary self yet
unreflective. The first experiences of contact, or in the literal sense, the first
impressions, which correspond fully to the autistic forms described by Tustin (1986),
later become associated with ideas of security, protection, relaxation, and from then
on the eclipse of the body towards the dawn of thought.
The process whereby a person becomes a subject and comes to structure a feeling of
self-cohesion implies the incorporation of codes, rules and regulations. The identity
defined by the sexed body has a performative dimension. It is the result of attributions
of meaning that give shape to reality in the very act of giving it a name. Thus the body
is a significant body, a text being written and rewritten within an intersubjective
matrix made of primitive sensorial interchanges. The feeling of continuity of being and
the ability to think are two different processes that run parallel to one another, like
DNA helixes containing chromosomes, and are fundamental to human beings.
However, this intersubjective matrix has its own vicissitudes, as Bion raises in the
dynamic bidirectional relationship container/contained. Due either to a strong
intolerance by the child, or a deficit of primary containing, or both, a pattern of
disturbing interaction can take place. The contribution from neuroscience, infant
observation, infant research and attachment theory confirm the extent to which micro
traumas in early object relations acutely aggravate and distort infant self-sensual
physiological activity. One of the outcomes can be the substitution of normal relating
for hypertrophic forms of withdrawal. The precocious nature of injury on the infant
mental emotional development creates traumatic areas that leave holes in integration
processes which can compromise the developmental potential, where concrete
sensory experience ends up prevailing over symbolic, emotional, mental, relational
experience. These anti-relational defences that counter psychic agony acquire over
time a dangerous idiosyncratic automatic quality, that ends up nourishing itself on the
fascinating pleasure of omnipotence that withdrawal into these areas of "nonexperience" involves.
Tustin (1986) and Alvarez (1992) stress this point which, if it is not registered, can
lead to antitransformational therapeutic errors. We risk giving interpretations of
content when the patient’s aim is to use an unemotional communication to avoid the
relationship. Any hint at a transference relationship is absent. In the adolescent, it is
extremely important to monitor these states carefully in order to distinguish a normal
need of benign self-protective forms that consolidate a self who is struggling to
process the invasion of sensoriality, from malignant forms turning into a pleasure
giving dimension.
Bion says (1991) that if a mother cannot handle a baby’s projective identifications, or
if she takes them in and then joins the baby in its panic, the baby will end up not only
with a fear of dying but also with a nameless terror. The baby, instead of introjecting a
container object, ends up with an internal object that despoils meaning and destroys
his thought. The alpha-elements become despoiled of emotions because of a lack of an
emotional link. Then images can be used as a way of evacuating emotions, in the line
of transformation in hallucinosis (Bion 1963). I hope to show how Pablo in his retreat
was talking about images void of any emotion, using them in a sensorial way to avoid
contact with me and his emotions.
During adolescence, there is a need for symbolic reordering. Due to the dismantling of
the representational system constructed through childhood, primitive anxieties come
back into play. The more solid the internalization of the containing objects, the easier
the reworking through of these anxieties.
However, catastrophic anxiety is set off when separation from the object is
experienced as a loss of the self. In such cases the mental representation remains
"excessively" dependent on sensory elements that don't quite constitute an element
referring to symbol formation. This situation of little differentiation does not favour
mental representation. Unconscious phantasy is, therefore, dramatized or acted out
with the external object (Folch, P., 1995) instead of being represented. Consequently,
the displacement towards substitutive objects and its symbolising impulse remain
inhibited. This affects ego organisation and functions. Catastrophic anxieties stimulate
omnipotent mechanisms that predominate within the encapsulated space.
So, if the process of emotional development is partially halted, the adolescent feels
pushed to use his/her own sensations to lessen unconsciously felt anxieties, which
echo non mentalized facts of the early childhood. The psychoanalytic relationship can
be crucial to redress the mental and emotional growing. The silent aspects of the
setting, with its characteristics of rhythm, consistency and regularity (which evoke the
early basic rhythm), can establish an essential basis for the transformation and
emotional processing in a new relational experience.
Pablo
Pablo’s birth had not been planned. The mother got pregnant when her daughter was
12 and the son around 15 years old.
At 17, he had no friends and seldom went out. Intelligent, he could solve sophisticated
problems, but failed in simple operations, and wasn’t able to organize himself. This
was related to me by the father in the first interview; the father commented
(dismissively) that when Pablo was with people always had a “stupid” gawking
expression on his face.
He had no contact with his elder brother due to the great age difference between
them. Because of his “shyness” and his schoolmates’ “bullying behavior”, he’d always
been uncomfortable at school. He also had difficulties in language which, in my
opinion, stemmed from old autistic enclaves (Coromines 1991, 1994). As a child he
had received treatment for these difficulties, being subsequently treated by
psychotherapy for many years.
The course of Pablo's analysis may, in a schematic way, be divided into three stages:
a)
Encapsulation. The retreat
b)
Communication of contents of his encapsulated world
c)
Coming out of the retreat. Challenges and dangers. Between defiance and
trickery
The Retreat
Pablo started analysis 5 times a week. His communication was flat and unemotional.
In the first session, referring to the strange sensation he had, caused by not seeing my
face, he commented without pause: "I suppose this must be normal, but I still haven't
got the trick of it". In his account, his parents and siblings were hardly treated as
entities. There was some reference to the father's control of his studies and religious
or philosophical chats with his mother. The atmosphere in the sessions was one of
emotional void, with Pablo sometimes being silent, retreated into his world, at other
times there was a flood of words, where the content was less important than the fact
of not stopping speaking, in order to escape from himself and his emotions; all in all,
made it very difficult to reach him. In the middle of everything, however, some hint of
his despair appeared: he projected himself into the future at 50, living alone in a
messy house; he would never be able to find a girl who could love him. I considered
this image as an actual version of a devitalized self whose hopes in his objects (so, in
the transference) were very poor, one can understand from this his retreat into his
world. He was always alone at home, cutting the leaves off his mother’s plants, or
masturbating compulsively. When he had an exam, he played by throwing papers into
the wastepaper basket, with the magical thought that if he hit the target enough times,
he would pass the exam.
The differentiation difficulties, the problems of representing mentally the distance
and separation of the object, appeared as well as a disorganization in time: he
systematically arrived late because he left his house when the session should have
been starting. As if the fantasy of being in the session, meant being there without
having to make any effort to move, ignoring the notion of distance, so of separation.
At the beginning, I hardly existed for him; my impression was that, for him, I was a
virtual character. His position on the couch was peculiar: stretched out, in silence,
while bringing the tips of his fingers together in a repetitive way, or twiddling his
thumbs without them ever touching. The words that would follow, ''I' m
overwhelmed", seemed to be without emotional content and of a sensorial quality.
Then, he would tell something in a descriptive way that induced a representation of
successive, static images in me: "he had to begin studying and so sat down in his
father's armchair, to read the newspaper and smoke a cigarette. If his father was at
home, he pretended to be studying behind his book, submerged in imaginary games”. I
could hardly resonate, the communication was dismantled. The image of a small baby
came to my mind, one who plays with sounds and speaks for the pleasure of listening
to himself.
My countertransference struggles were to avoid adhering to the concrete content of
his communication and becoming “superegoic”, enacting the role of a father, forcing
my presence; most of the time, my task was to endure anxieties of non-existence. I
tried to think if the difficulties I experienced in rescuing something lively from his
communication, had something to do with his being "overwhelmed": was it the
leftovers of an emotional experience concretized, kidnapped into images that fought
to occupy a concrete space, which dispersed attention? I could intuit that my real
existence could be disturbing to him; Pablo probably felt uneasiness, and the word
"overwhelmed", so near to the sensation, neutralized something that at another level
could have been experienced with persecutory anxiety. My interventions were
ignored, and he continued by saying something ambiguous in order to remain in his
world without becoming disturbed. He didn't dream, although sometimes he woke up
with nightmares that he was never able to remember. It was difficult for him to fall
asleep in bed; he could stay awake for hours, imagining things.
During his second year of analysis this fusional, repetitive atmosphere in which a kind
of automatism predominated, gave way one day, to his surprise when he realized that
my front door hadn't been opened immediately to him when he pressed the bell (1).
This brought back the memory of how, when he was small and thirsty, he would
imagine himself to be getting out of bed and drinking, and he felt as though he really
had just done that. He specified that this would happen when he was awake, not
asleep. This memory made it possible for him to intuit his omnipotent way of
functioning. “The automatically-opened door” sustained his limitless daydreaming
and he avoided any catastrophic discontinuity. He started to register the existence of a
separate and real object in the analysis.
Discussion of this initial period
When facing the novelty of the analytic situation, Pablo didn’t oppose the proposal to
lie on the couch; he adapted to the situation, resorting to some kind of "trick". This
trick seems to have consisted of "informing" about his feeling overwhelmed, and then
getting himself tangled up in his fantasy in a monotonous, repetitive and emotionless
way. In this way, all awareness of separation and differentiation in time and space was
avoided. If we make an analogy of “pretending to be studying” in his father's presence,
in the transference he dramatizes his feigning, "pretending to be analysed", in order to
push away his unease. At this time in the analysis the experience tended to remain on
an avoiding concrete (inanimate) level.
Communication Of Contents Of His Encapsulated World
Pablo only seemed to become aware that he was of legal age when he received a
voting card for an upcoming election. He tried to invert the situation with a daydream:
"As a child I’d dreamt so much about being grown up, that now that I am grown up I
imagine that I’m still small and I am living in a dream". He then associated a phantasy
at the beginning of the analysis: he would be successful in tricking me with a false
image of himself and I would allow him to go. Immediately afterwards he sank into an
invented game: "There's a dead man on the ground carrying on his back a kind of
backpack. The cause of death must be determined… One would wonder if the dead man
is a farmworker ... One could be misled … It turns out that the backpack was a parachute
that hadn't opened up".
The image suggests how Pablo might have experienced the separation from his
primary object: a catastrophic experience of being thrown out into the void of
nothingness with no arms to hold him. In the transference he expressed his need to
take refuge in an imaginary world in order to escape these catastrophic anxieties. He
also expressed the fragility of this world: how hanging on through his senses to his
daydreams, substituting and eliminating a relationship with a real object, led to his
own annihilation and made the passing on to the formation of symbols difficult.
Now, in the transference, he was letting me know his fragility and desperate need to
retreat into an fantasy world, to get away from massive catastrophic anxieties; how
the despair for his helplessness, drove him to revert the situation and to transform it
into a game where it was my turn to put up with the disorientation, not knowing how
to get hold of feelings, while he had the omnipotent solution to the riddle. The game,
however, in which I was the depositary of his confusion and he was the holder of the
solution to the riddle, was now a game where we both were involved.
My efforts to make sense of the immediacy of his experience allowed me to discover,
step by step, that his isolation was not impermeable, and although his words didn't
appear to give credit to his relationship with me, the communication through his
dreaming opened up. He then experienced the conflict between remaining withdrawn
and risking himself to a shared experience.
Pablo's imaginary games dramatized the mortal risk of being left without protection
and, from that, his need for retreat. He created a world without parents, siblings or
emotions. I was for him someone to be kept informed or deceived, in order to avoid
the catastrophe of his falling into the empty space. But Pablo was able to communicate
his daydreaming. When he spoke about those "games", he shared with me the
contents of his withdrawn world. On the one hand I was just one more element of his
refuge. I was also, however, a disquieting object, alien to his world. I needed to
tolerate his veiled threats of death without obliging him to jump over the edge. My
aim was just to show him what happened in the session.
When he was capable of passing an exam at the University for the first time, he felt
desolated, and became depressed. His omnipotence had been challenged suddenly by
his real success and then he realized how much was left to be done for real progress.
Then he started to dream, describing dreams as something alien to him, in line with
his omnipotent phantasies, so as to get rid of strange experiences, letting them go
through the narration of dream images, giving no associations. "I was in a bus with a
friend and we met a girl … I had got on without a ticket and, while we were talking to
her, a ticket collector came up and asked to see my ticket … I said he didn't know who he
was talking to, and that my mother was the biggest shareholder of the bus company… I
pushed him and he fell onto a seat … Suddenly I realised what I’d done, held out my hand
to him and helped him get up".
Pablo was now representing some aspects of an internal drama and the analytic
relationship: his desire to remain in a fusional, protected world without involving
himself in the analytic work as the author of his dreams and the subject of his life.
However, when he realized that the analysis was more than just riding inside an
object, his curiosity was aroused, as can be seen from a dream a few sessions later:
He started the session saying that he dreamt a lot of nonsense and, on waking up, he
asked himself: “How is it possible for me to dream this lot of nonsense” ... "It was a
strange dream, like an adventure story in which Sherlock Holmes was searching for
Watson, who had been kidnapped and taken to a very odd place, like an unknown
dimension… there was a hole through which a very narrow stairway descended. To go
through, a man would have to bend down … it took one to a place where there was a
wall which crushed people and turned them into drawings ... or like those figures made
out of thin wood which have to be shaped ... it was a bidimensional world in which
people were also bidimensional, … no, they were three dimensional … but Sherlock
Holmes went in and out of this world. He went up the stairs and came upon some
servants wearing black skirts and white aprons, very well dressed, and he fled from
them. He continued upwards when suddenly he realised that the long stairway was made
out of cardboard and he could touch it with his hand ... I didn't suffer in this dream; I was
watching it like I would a film ... there was only a moment when I was suffering, and that
was when Sherlock Holmes touched the staircase, because I thought it could be me".
I spoke about his fear of suffering; he felt that emotions made things more
complicated, and he tried to look at them as in a film: disconnecting from sullenness,
rage, and sadness, withdrawing himself into a flat world were things did happen
according to his wishes. However all of that could end in disaster with him sinking
into madness. At the same time, he seemed to communicate his worry that I could get
kidnapped in this unreal world, which would result in leaving aside essential and
important things in his life without being able to understand his suffering. He
answered in a distant and polite way: It is true that I don’t show my feelings. But, after
a silence he added: “I’ve just remembered when Sherlock Holmes descended, he came
upon a room where there was a group of men who said, 'Look at this one'. A voice that
didn't seem to be present said: 'Leave him alone. I'm following his investigation'. I don't
know if the men were policemen or criminals. I don't know if I saw it really in a film, but
there was a film in which there's an enemy of Sherlock Holmes whose name is Moriarty!
(2) And both followed the investigation that the other guy was doing".
Comments on this period
So, in a spiral of transformations, Pablo is capable of representing the oscillation
between the concrete bidimensional thinking<—>abstract tridimensional symbolic
capacities.
In the session, the dream is brought alive with its dramatization. The fact of telling me
the dream speaks about the wish to investigate in his mind and, in the session, the
relationship with an analyst whom he maintains hijacked in his fantasies. But this
investigation makes him hit against, see, touch concretely a very anxious state of
relationships and of his own personality: anxieties of having a false and unreal
equilibrium without any basis to lean on, so making it possible to fall through a hole
into the void. He tries to minimize his perception, and the resulting anxiety, by
distancing himself from the emotional meaning, as we can see from his comment
about “dreaming nonsense”.
The content of the dream speaks about the drama. Sherlock Holmes, a cooperative
part of Pablo, tries to enquire: where is the analyst? How is Watson, the humble
assistant with practical common sense? Pablo feels he has to renounce his
omnipotence - the man had to bend down- so as to inquire into the crimes against
reality and to investigate the unknown dimension: the reality. The result of this
investigation is that the A is in his mind a drawing, a bidimensional figure, without any
other dimension than the one created by himself in his daydreaming. He goes away
from this perception in a manic form (going upstairs in a fast ascent of endless
daydreaming) to avoid the depression of perceiving the result of his investigation.
However, this staircase is artificial, and he can touch it with his hands (when touching
it, he realises the bidimensional flatness). There is a moment of anxiety which is
quickly avoided by taking emotional distance.
The hint of anxiety that emerges in the dream could make one think that’s a beginning
of his worry about living in a fictitious world. But all in all I think the worry was, then,
rather mine.
When I try to connect the dream emotional experience, his answer is a bit withdrawn.
He then recovers another piece where a voice outside him appears, saying that he is
following his investigation: we could say that the session now became a space for
dreaming. But he shows the horror that going deepen into this investigation means: to
see himself and to be seen is to be surrounded by persecution and confusion.
Synthesizing: the dream is the manifestation of his knowing how the daydreaming
creates artificial people and that reality is an unknown dimension. He avoids the
horror and anxiety of his discovery by distancing himself emotionally: he is not
involved, all of these things are nonsense.
The bidimensional world suggests a space in the session where we had little real
existence. Watson, the humble bearer of practical common sense is kidnapped, and
the patient can feel inclined to inquire into what kind of analyst he has, what reality
and the external object are like, thus abandoning omnipotence. In this inquiry there
are fleeting moments of emotional contact which allow for the discovery of part
objects in black and white. Anxiety about falling into an empty space pushes him into
fleeing once more into his world of daydreaming.
Pablo’s organisation aims to avoid emotional experiences, putting aside his own vital
aspects; his realization of the three-dimensional world is an unhappy solution to the
bidimensional world. The transition between these two different ways of experiencing
is not a peaceful one, because it implies accepting the distance and absence which, at
this level of anxiety, mean the catastrophic annihilation of the ego (Bodner, Grimalt
1996).
We can understand now the function of the organisation, and the challenges against
which it protected Pablo. To keep the organization functioning, he actively used his
illusions to avoid contact with reality, leaning on the persistence of very poorly
differentiated nuclei. The partial denial of reality led to an emotional isolation which
affects thinking, because thinking "requires links, including links between parents,
which is what patients with disturbances in the early oedipal situation cannot
tolerate” (Segal, 1989).
The recognition of the object not only widened his awareness, but also expressed the
conflict: to experience a relationship meant death to his omnipotent retreat. At the
same time, the idea of his analyst as a differentiated object who brought meaning to
him, stimulated his desire to re-establish the lost fusion.
This movement appeared in his dreams as curiosity, intrusion and conflict between
knowing and not knowing. Installed in the maternal bus, he attacks with violence
anyone who asks him to be responsible. The incipient awareness, however, of
"travelling inside the analysis" allowed him to recuperate his curiosity about the
analyst which had, up until now, been inhibited. In the second dream he puts on the
stage the distribution of his objects as well as their functions. In this way, the
investigator bends down to observe the unknown, the wall crushes the objects, taking
away their third dimension, the stairway "flattens out" when the investigator touches
it with his hand.
With his dream vocabulary, Pablo represents his perception of himself and of the
analytic situation. My analytical mind becomes a place where labouring feminine
objects are separated from masculine objects, policemen or criminal. It is a symbolic
language that depicts, at the same time, his tendency to crush the symbolic dimension
itself. This dream vocabulary represents the dynamics of the bidimensionality by the
action of the wall. It depicts the sensory, tactile, and flattened-out object in his mental
representation, the dramatic tension between the concrete and the metaphorical,
which are coolly observed. Pablo looks at his dream as he would a film, while I was
wondering if the formation of symbols would serve his process of thinking or the
denial of meaning.
When I pick up his fear of emotions, Moriarty appears, the evil brain who opposes
Sherlock Holmes’s investigations every step of the way. He expresses, in this way, the
radical opposition between knowing and not knowing, but he also recuperates his
ability to symbolise, which seemed to have been kidnapped, like Watson. In the
dream, the voice of someone who can't be seen is heard, and with that voice, vision,
touch and sound come on the scene as roots of "common sense", the consensuallity
that gives body to the flat object, but of a paranoid quality.
Segal (1956) shows that the child's ability to symbolise "can be used to treat early,
unresolved conflicts by symbolising them". It is the paradoxical way the mind has of
symbolising even a failure in symbolising. The dream represents as much the material
with which the retreat and the flat objects are made, as the fight between enemy parts
to direct the investigation, between inquiring and simulating, and whether or not
its products favour real insight or falsifications.
When Moriarty Takes Over
Pablo arrived at the following session saying that he was afraid of wetting the couch
because his hair was wet. He later described how he had become tangled up in a game
while studying: “I imagined that I was being followed in a tube station and I wasn't
afraid. I jumped on the train tracks just like in the films".
The infiltrating quality of what he said, pronounced with no emotion or violence
drove me to comment that he seemed to enjoy this game, seeking to escape in this way
from his tension.
He responded by saying that he couldn't do anything. There was a disconnection in
the way he spoke about how absurd it was to want to know about everything and not
knowing about anything. His anxiety slipped away as he spoke about it. He continued
by telling that he spent hours imagining that he was holding up a bank. The police were
after him, but he was in a very small car that he cut down in size even more in order to
be able to get into narrow places where the police could not follow him. He made a big
deal about his ability to hide, but faced with my silence, he said that he felt mad
because "one isn't responsible for what one dreams but one is for what one thinks". He
had gone back to dreaming about stupid things: "Ramon and I were on a mountain ...
There was a ramshackle car, good only for its parts. A boy my age was driving it ... it had
no wheels. I left Ramon on to one side and made the boy chase me in the car. And I
played around, darting all over, seeing if the boy could catch me; the boy finally fell over
the edge of a precipice where other cars had been junked ... there was an explosion and
the driver died ... at the funeral the mother of the boy went up to Ramon and said "
You're a murderer". I didn't say anything and was certain that he wouldn't deny it but
would rather defend himself". Others, Pablo added, had often taken the blame for things
he'd done.
The depiction of a desolate internal world with inert leftovers of experiences, allowed
for a better understanding of the emotional emptiness of the beginning of Pablo's
analysis. His helpless part was obscure, unknown and with the object, met with
disaster. The emotional experience expressed the catastrophe of a playing to the
death that placed in the foreground the destiny of an aggression which did not
manifest directly in the transference, but rather was acted out with subtlety, and
induced ambiguities, persecution and confusion, without any signs of manifest
violence.
Comments
The analytic inquiry allows the observance of the disaster, the precipice of broken
down cars, the evasion of guilt. If Moriarty "takes charge of the investigation", then
Pablo doesn't go out in search of his analyst but rather it is the "police version" of the
investigation that chases him in an exciting game with death. His tactics were
confusing and made me lose my way. In the confusion it was unclear if Pablo cut up
his objects or mutilated his self to the point where it disappeared, or both. In this way,
we could both fall over the precipice in his internal world, an internal world destroyed
by the projection of his aggression and his panic at the assimilation of this aggression.
If, at the beginning, anxiety and frustration were not evident, in the course of the
analysis Pablo comes to split off and project his aggression into a part of me which he
then defends himself from, either by ignoring me or through trickery and
manipulation. However, there was a certain unconscious awareness that Moriarty's
attitude of not-knowing ended in catastrophe.
This function does not represent the not-knowing, but rather a kind of tricked
knowing, deception, symbolic falsification. That's why he allowed people to take the
blame, distancing himself from recognition of his own destructive and destroyed
aspects, allowing Ramon to be accused ("he is the murderer!"). The "Moriarty function"
doesn't destroy the formation of concepts, but it does distort them by creating
misunderstandings (Bion, 1962; Money-Kyrle, 1968).
I looked for a way to intervene, avoiding the provocative game, but Pablo’s defences
made the encounter between us difficult. Pablo became anguished, though, not only
when he imagined "stupid things" over which he maintained a conscious control, but
now his dreams depicted the precipice of destruction. He acted out the content of the
dream in the transference when he made me go after him, "darting from one place to
another", despite the catastrophic consequences. He not only felt contemptuous about
the game but also seemed to enjoy it. At the same time that his anxiety was soothed,
the enjoyment kept up the defensive organisation, thus kidnapping aspects of his ego
functioning.
In this way his phantasies, were not used for working through difficulties and gaining
insight, but rather for the degradation of the symbolic function and a showing off of
his trickery when his ability to understand had to submit to the threats of the
idealised destructiveness.
Leaving the Retreat and the Risks Involved
Between Defiance and Trickery
Towards the third year of analysis, Pablo's father’s difficulties in his job appear in
Pablo’s account. He spoke of his father (for the first time) with admiration, as a man
who started with nothing and worked his way up, going far. If things went badly for
him, it wasn't because he hadn't done everything in his power to make them go well.
He, Pablo, however, spent his time looking for excuses, feeling sorry for himself: "I
thought my problem was my shyness and for that reason I started psychoanalysis, but I
can now see that my problem is deceit". He acknowledged that his parents had done a
lot for him but he had made little use of their help. These expressions of sincere
contact didn't seem able, however, to promote any real insight.
Pablo's life was, nevertheless, gradually changing. He got his driving licence, he
started going out with friends, meeting girls, and occasionally realised with pain that
he'd lost years of his adolescence. He went from being off in his daydreams to looking
for relationships, feeling emotions, conflicts and disappointments. At Christmas in his
fifth year of analysis he met a girl two years his senior, who became the centre of his
phantasies. Manifest rage was now aroused at feeling so dependent on the
relationship, as he feared he wouldn't be reciprocated in his feelings with the same
intensity. He was able to realise that the problem was not whether to go out with Sara
or not but rather it was his feeling of being stuck to her, and unable to stop thinking
about her.
This time of new relationships and break-ups, in which he experienced his feelings in
a tormenting way, coincided with the diagnosis of a serious disease in his father. A
short while before the Christmas break, and in his sixth year of analysis, his way of
speaking became dramatic: "Today I really feel like a madman. I went with Raquel to
our country home. We made love on my parents' bed. We didn't get in, - we put a blanket
over the bed, but I spilled wine on it. I left it in the washing machine. If my mother finds
it, she'll begin to wonder".
He continued: he'd returned home late, finding the door locked from the inside. His
mother was angry; he thought she had probably discovered his deceit; he told her yet
another lie so that she wouldn't suspect anything. Pablo’s speech was again dramatic.
"I have to do this now that my father is feeling so bad! ... I feel as if I were outside of
myself, as if I were floating above a door. I feel really bad, the day is dragging as it never
has before in my whole life".
I also had to question myself. What transference object was I now being called on to
represent? Someone who prohibits sexual intercourse? Someone who has to see and
persecute? Was he depositing in me a part of himself that was able to observe? I
decided to tell him that he seemed to relate the fact of having sexual intercourse with
his father's illness. He responded by saying it wasn't "the fact" but rather "the place":
“I think that I really blew it because afterwards we went to this girl's flat where we could
have made love" ... "I don't know what to do, if I should tell my parents, but it would be
awful".
The daydreaming which Pablo wanted to resort to in the face of his anxiety had to do
with going back in time to when he was a small boy in his parents' bed. He felt that
now that meant to be mad. Facing his dilemma caused him panic, and he would flee
from it again. That is why he presented himself as a child who wishes to cover up
signs of his growing up and his increasing autonomy.
In the last session before Christmas he showed a more defiant attitude towards me,
and he was able to see how he used his ability to progress: "Before it was as if I were
very far from drunken-driving accidents. I had no friends with whom to get drunk. It's as
if before I had no arms and everyone felt sorry for me. Now it's as though I had them but
used them to strike out". During the break, he took out his father's car and hit the wall
as he left the garage. He was drunk and talking with his friends who were sitting in the
back seat.
A few months later, and near to the Easter break his habitual doubts (as before every
vacation) regarding psychoanalysis, and if it helped him or not, turned into a taught
conviction that analysis had done a lot for him. As a result he planned on ending the
analysis at Easter and his university studies in June.
His difficulty in keeping in contact with his aggression, and the resulting guilt, are
reflected in a dream: “There was a guy I met in Y (the country village) who told me that
he sniffed glue in a plastic bag and took cocaine. He was very bold ... a typical delinquent.
In the dream we were in a park and there was a very pretty girl, a brunette with long
hair. It looked as though the guy and the girl knew each other, because he told her that
she was very pretty, and she answered: "I like it when you tell me that". I was carrying a
knife ... He grabbed it from me and ordered her to strip. She told him to stop being stupid.
When I grabbed the knife from him, he began to drag himself along the ground with his
arms, as if he were paralyzed. He asked me for the knife… and suddenly turned into a
cigarette butt that was burning down. He turned into ashes and was blown away by the
wind … I tried to keep him from disappearing by stepping on the ashes".
He was able to connect with his strategies when he said it was the dream of a
madman, but that he had wanted to be like that guy who takes advantage of others to
feel superior. The dream expresses his despair, despair because contact with the
destructive aspect of himself, that denigrates and attacks the object of his desire,
disappears and becomes volatile.
Changes had occurred in the quality of his anxiety. In a Friday session, after
expressing his discouragement because Raquel didn't pay any attention to him, he
began to complain about a pain in his feet which was the consequence of some
medical treatment he was undergoing. When I spoke to him about how this new pain
was caused by his comings and goings, the farewells and new reencounters, he didn't
pay me any attention. His expression changed though, and the session became a space
charged with emotions, with lively and comprehensible projective identifications. He
continued talking about what he planned on doing at the weekend, but he suddenly
stopped and became thoughtful: "It's as though I couldn't stand to have holes in time,
as if I needed to fill them up".
I told him that he conveyed how he felt when he was ignored, when it seemed that it
didn't matter if he was there or not. He was able to realise that he attempted to flee
from the pain of feeling interested in and dependent on his analysis, and from his fear
of not being reciprocated in this interest to the same degree.
"Yes, I think that's right, that something like that happens to me here. The problem is
that I don't know what has happened to me. I feel like I lost my happiness and I'm afraid
to lose what I have. It's as though I had filled up my body with a black and very thick
paint that won't let me expand, and I can't get rid of it. Not even with turpentine, not
even with psychoanalysis. It has already dried up a lot but it is as if I had lost my hope in
being able to get rid of more".
Discussion
As the analysis progressed, Pablo's isolation appeared as an alternative to the libidinal
and aggressive conflicts of the oedipal situation. If the function of his phantasies was
to create a protected world, then their content produced versions of the transference
situation in the light of his anxiety and defences.
At the same time, however, the phantasies constituted a subtle type of acting out
because they were directed towards me in order to convert me into what McDougall
(1972) describes as an "anonymous spectator", which would mean a perverse aspect
of this acting out. This author believes that the dramatization of the primary scene
requires a spectator in order to recuperate the destroyed internal object and, in this
manner, protect the patient from psychosis or disorganisation. Pablo seeks to
reconstruct, through my gaze, the object that substitutes the precipice of the
destroyed cars. To keep up this fiction, perverse functioning "takes up a lost battle
with reality" (McDougall, J., ibid), in which the analyst-mother must be counted on, in
the denigration of the paternal, differentiating function.
If Pablo abandons his trickery, and acknowledges his relationship, “he can't stop
thinking about it". If he doesn't distort the situation, in his persecution, then he can
allow himself to be aware of his dependence. The dilemma and the pressure, that I
perceived, expressed aspects of him not "represented by words but rather by feelings
and impulses to act that would tend to provoke avoidance or collusion" (Feldman,
1989).
Emerging from his refuge, Pablo can express some of the challenges he feels in the
analysis: depending on the functions of the analyst, assuming or not his own
autonomy, continuing to be inhibited or taking on risks and anxiety. Differentiation, or
"having sexual intercourse in his parent’s bed", omnipotently occupying my mind and
taking over its products, all disturb him. For that reason he feels guilt about the wine
stain on the blanket that bears witness to the intrusion perpetrated on the parental
couple. It shows his illusion of living in my mind as well as his desire to rub me out
with the manic resorting to "putting everything in the washing machine".
To consolidate his identity, Pablo needs to recuperate the parts of himself that have
been put into his objects, which would modify his relationships with them. The dream
represents Pablo's aggressive, sadistic, and threatening part, but it is converted,
however, into ashes "like a cigarette butt which gradually burns down", despite his
efforts to keep it there. It makes the conflict between blowing that part up into
fragments of aggression and recuperating it to put it to the service of a very evident
progress. This blowing up of aspects of the self would correspond to the defensive
fragmentation that follows the reintrojection of objects that could arouse guilt or
depression (Bion, W., 1958).
He is aware of the "coat of black paint" that covers him and prevents his development:
the characterological structuring of his defences. He is also aware of the fact that the
analysis has to some degree "dissolved" this coat of paint. This increases his fear,
which is disguised as despair, of being left without protection.
The Outcome
After Easter, Pablo decided to continue his analysis until the summer. The idea of
ending presided over the sessions. A month before the summer break, he began a
session speaking in an empty tone of voice about the terror he felt about leaving the
analysis. After a long silence he said unconcernedly, "Oh, yesterday I went to the
university to see my grades and I passed. Now I only need three more courses to finish
the degree. I didn't study at all yesterday. I took my brother's calculator and did
something that's not in the books ... It's a way of erasing the memory but it can be
recuperated by pressing a key. I could use this system to introduce data into it, to copy in
the exam". He remained silent for a long while, and then continued: "Although I don't
know who would value this ... we are allowed to take a calculator to the exam. They
pretend that they don't see anything because they don't care if you cheat or not. What
they care about is how you solve the problems". The silence that followed was even
longer.
I told him that now he was leaving the analysis to me. Would I pretend that I didn't see
anything or would I get frightened? He wanted to get rid of his emotions so as to avoid
a real fear. He said no in an uneasy way, and that he was thinking about what isn't in
the books and in a way to falsify credit cards. "There are people who do that but I
wouldn't do it to steal. I don't think I would be interested in that". He had read an article
about what motivates delinquents - that they do it for money. He would steal for
pleasure. "I think that if these things interest me, I could look for constructive
possibilities".
I told him that we could now observe the system that a part of himself valued: the
trick that made the terror disappear by getting rid of a helpless aspect of himself that
needed help. And we could observe the little credit that this functioning had, although
he would want to hang on to it in order to avoid a commitment to his real abilities.
Frightened, he responded by saying that he didn't know what he had - whether it was
anxiety or depression, and he wanted me to explain it all to him! He removed his
abilities again, making himself small in order to get inside, attempting to turn the
analysis into a collusively tranquilizing experience.
A week later he spoke of his plans to go out with friends. He recalled the accident he'd
had with his father's car when he was drunk, and started a dissertation on the
"drunken environments". The lack of emotion and the length of the narration induced
me to ask him why he was telling me all of this. Was it-that he wanted me to be
worried that he wouldn't return on Monday? Perhaps he wasn't too sure about not
repeating the experience, but he wanted to leave his concern in me as if I really could
be in charge of protecting him.
He remained in thoughtful silence, and began to speak about his way of driving:
"Looking behind me. When I speak, I turn around … Many people have told me that …
maybe I should start to believe it ... many people feel insecure driving ... I feel just the
opposite though. I'm too sure of myself'.
His plans to interrupt his analysis could have had aspects of adolescent defiance: he
had to be able to get on by himself. At the same time, however, he played the game of
not really committing himself to his abilities. In one session he told a "joke” he'd
invented and played on a (girl) friend with Ramon: they made this (girl) friend (who
worked in an optician's) believe that the patient had been mute since childhood and
needed glasses. Ramon interpreted the patient’s sign language; Pablo told her that
even with all of these difficulties he'd taken a university degree. The girl, in
admiration, said that there was much to be proud about in that, while she showed him
pair after pair of glasses. He didn't like any of them, and none of them seemed to fit
him either. Later, in the session, he said that he had to function on his own without
seeking interpreters in his life.
He was now, nevertheless, too aware of his strategies. He could grasp the madness
implied in trying to maintain that what had been real was just a game: the idea of
feeling helpless, with language difficulties when he was small, and had problems in
expressing and acknowledging his emotions; also the need of the analysis to be able to
look at his internal and external reality, which he didn't like at all.
His difficulties, however, in tolerating and facing up to depressive pain led him to seek
provocation once again, trying to space out time, and make things happen in my mind;
as if with the trickery of the game, the past could become the present and the future
not being unknown.
In the very last sessions he was able to convey a genuine recognition as well as a
conscious desire to commit himself to what he'd been able to understand about
himself. He assured me that he was not running away from anything, that fleeing
would imply thinking that the analysis hadn’t done anything, when in fact he thought
that the analysis had done a lot. I wondered about how much authentic defiance there
was dictating his decisions, and how much of it was deception that he had just got
tangled up in.
I think that, for the analyst, letting adolescent patients leave is hard because he or she
can never be certain whether they will be able to live out their talents and realize their
potential.
Discussion
When Pablo dramatizes his phantasies of drunken driving, he projects into me his
concern about the danger he's in. Many people feel insecure driving, but Pablo is sure
of himself even when he looks backwards instead of looking ahead. I could feel how
difficult it was to think in this situation and the patient knew that he could confuse me.
When he brags about his recklessness, he attracted all of my attention on to himself,
and I felt under pressure to become a real protective maternal object, thus
jeopardizing the analytic function. In fact, Pablo drove drunk with his own
omnipotence, looking backwards, trying to become a small child again. He tried to
make me desperate to protect him from death, substituting the analytic workingthrough with a collusive acting-out.
The degradation of the authentic feeling of challenge, conducive to establishing his
identity, can be seen acting out the primitive oedipal conflict of intruding on the
combined couple, in order to recuperate the lost fusion in the transference. It is a
desperate attempt at control that cannot be abandoned.
There are games that allow for acquiring and using symbols; the degradation of the
game becomes a habit that impedes maturation. Authentic separation anxiety is
replaced by phantasies and death games, with the subsequent damage done to the
symbolic function.
Pablo, who was now able to take on, to a certain degree, his own decisions and goals
oscillated between his fear of being left without protection, his recognition of his
obvious progress, and his manic denial expressed in the "joke" at the end, in which he
made fun of his own difficulties as well as his achievements. At the same time, he
dramatized his tendency to "dismantle" his objects, thus remaining mute, and with no
vision, at the mercy of an "interpreter".
Some Closing Ideas
In the first stage of the analysis, marked by an emotional flatness, one may question
whether or not this flatness can be due to the adolescent's difficulty in settling down
in the transference, to technical problems in the interaction with me, or to the
expression of the patient's mental state (Bodner, Grimalt 1996). The "tricks" used to
avoid the experience point towards difficulties in treating primitive anxiety, which
makes its development remain partially encapsulated. The transference situation
offers the adolescent a "second opportunity" to fill in infantile voids (Lebovici, S.,
1979), confronted with long avoided conflicts or deficits.
Various authors have emphasized the need to carefully analyse not only the
adolescent's development crisis and present depression, but also his more archaic
conflicts (Laufer, M., Bios, P., Brenman-Pick; 1. Quoted by Lebovici, ibid). As I was
commenting at the beginning, the stability that the baby achieves through normal
processes of projection and introjection may become disturbed by the mother's
inability to tolerate the projected anxiety or the excessive destructive omnipotence of
the child's phantasy (Segal, H., 1975). In these circumstances, clinical manifestations
of schizoid mechanisms may be more obvious than paranoid anxieties, thus
contributing to encapsulation.
In the encapsulated states, catastrophic anxiety is left intact and is not assimilated into
the developmental process in the same manner as the internal and "excessively
sensorial" object is also not assimilated. The result is a peculiar kind of object and
internal space (Rosenfeld, 1971; Sohn, L., 1985), little suited to the interchanges that
favour growth and mental development.
I tried to accompany the process with impressions based on my observation of the
patient and countertransference data, trying to wait patiently for meaning as the
analysis progressed. The contents of the dreams and games are expressed in the
dynamics of the transference.
If was difficult, at the beginning of the analysis, to locate the patient because he was
hiding in his retreat. As the analysis progressed, I still couldn’t find Pablo because he
showed new strategies dominated by manic defences and the exciting game of death
and confusion. There was, nevertheless, progress in his ability to have contact with his
libidinal and aggressive impulses and the goals of the Oedipal situation. He began to
play with the idea of abandoning the analysis, of assuming his sexuality, his feelings.
When Pablo's imaginary world and dreaming unfolded in front of me, I was able to
observe elements of his functioning as well as the underlying dynamics. The
backpack-parachute represented his little differentiated object, whose loss supposed
the collapse and death of the self as well as the catastrophic anxiety that underlied the
danger of losing his defences.
The encapsulated world and contents appeared; and the predominance of possession
of the object rather than love for it. He could recognise the object but on the condition
of crushing the third dimension with a defensive wall. At this level his ability to love
was possibly experienced in a concrete way, as a scooping out, like his sexuality
which, like the stain, must be effaced. Early pathology in self-object differentiation
inhibits an unfolding of the Oedipal conflict and inclines towards perverse solutions.
The omnipotent intrusion in the maternal bus is as much a fusional defence in the face
of separation anxiety as aggression due to the presence of another object which comes
in between. When the analysis appears as mental representation, a world of objects
and conflicts arises. The appearance of the third element destroys the phantasy of
fusion, stimulating curiosity in the measure that omnipotence declines. If curiosity is
represented by Sherlock Holmes, then omniscience takes refuge in Moriarty (-k), who
opposes, step by step, the aim of the investigation and gives it all a perverse nuance.
Manic denial of feeling in the face of the destroyed aspects, as well as the idealisation
of the ability to destroy, conceal and deceive, take command of the feared depressive
collapse.
When awareness of separation and tolerance of the exclusion fail, then a profound
unbalance between love and hate disturbs object relating, and mental representation
becomes markedly concrete. Following Hinshelwood (1989), we may consider as
perverse the development of object relations beyond the paranoid-schizoid position,
when the personality is dominated by an excess of destruction.
The time and space which had been denied at the height of Pablo’s omnipotence
now appear as separation, as a place for his sexuality. The awareness of separation is
expressed in the anxiety over where to have intercourse: in his phantasies, in the
space given over to his infantile daydreaming, or in a space of his own with desire,
emotion and frustration? The tendency to act out and mania are manifest in the
transference.
Along with an encapsulated world of omnipotence, Pablo develops, in parallel, his
ability to symbolise. He cannot use it, though, to favour greater insight because of the
depressive anxiety felt for his destroyed objects. This gives rise to the falsification, the
obstructive game, and a resorting to magic omnipotence.
We may think that Pablo was not able, in the transference and in his internal world, to
tolerate being the excluded object, the receiver of the contribution of the creative
parental couple. Along with the differences between sexes, the acceptance of
differences between generations was one of the challenges presented by the oedipal
situation that Pablo tried to elude or "turn a blind eye" to.
Even though the defensive structure persists, there are important changes in the
analysis and in Pablo’s life. I think that this type of evolution can be characterised as a
modification in the ambit in which object relations unfold and within the
psychopathological organisation. Numerous authors point out the difficulties in
achieving substantial changes in the pathological defensive organisation because of a
narcissistic base and perverse traits that sustain it. In the case of Pablo, even though
confirming this idea in its essential aspects, there are changes in his life situation and
expressions in the transference which should not be underestimated; moreover, he
started analysis being an adolescent. Defensive encapsulation and inhibition also
diminish, although with a risk of manic behaviour. The highly organised defences
against emotions, and a tendency toward seduction by false solutions, persist. The
danger is that defences, organized around an ideative content, take over, giving way to
a conviction of self-sufficiency.
I think that this conviction, functionally embedded, would be a new expression of the
encapsulated organisation of defences, but this does not diminish the therapeutic
value of the analytic process. Along with the encapsulated world and a defensive
withdrawal, other areas of emotional experiences, object relating, and symbolising
processes have developed, all of which substantially modify important aspects of
Pablo's life.
Summary
I have been trying to show the evolution of the analysis of a patient in his late
adolescence with a defensive organization which manifests itself as an affective
isolation and inhibition faced with oedipal conflict. His difficulties are related to early
perturbation of differentiation processes with anxieties of catastrophic quality.
------------------------------
1.
I have a button in my consulting room which, when a patient presses my
doorbell, allows me to automatically open the door.
2.
Moriarty (as you know) is a character from Conan Doyle's books: a brain that is
devoted to evil and is Sherlock Holmes’s opponent.
References
Anderson, M. (2012). “Concretisation, reflective thought, and the emissary function
of the dream”. In Absolute truth and unbearable psychic pain, Psychoanalytic
Perspectives on Concrete Experience. Frosch, A. Editor. Karnac. London
Bion, W.R, (1958). On hallucination, Int. J. Psychoanal; 39:266-275
Bion,W.R.(1962). Aprendiendo de la experiencia. Ed. Paidos, Barcelona Bion, W.R.
(1965). Transformations. William Heinemann, Medical Books Ltd.
Bodner G, Grimalt A (1996) La situación edípica y sus desafíos. Anuario Ibérico de
Psicoanàlisis; num 4. Madrid
Coromines,J. (1991). Psicopatologia i desenvolupament arcaics. E. Espaxs. Barcelona
Coromines, J.(1994). Intent d ’ establir un pont entre el problema de
desenvolupament i organitzacions patològiques en el nen i en l’adult. Institut de
Psicoanàlisi de Barcelona. Octubre 1994.
Eskelinen T, Grimalt A (1993). Somni , somieig i joc: Creixe (r)-ment. Revista Catalana
de Psicoanàlisi. Vol. X/Núm. 1-2
Feldman, M.(1989) “The Oedipus Complex: manifestation in the inner world and the
therapeutic situation”. In The Oedipus Complex Today, Karnac Books. London
Folch, P (1995). Realitat psíquica: simbolització i espai mental. Barcelona
Psychoanalytic Institute.
Grimalt,A (2013b). Discussion of “The hour of the stranger”. In Masculinity and
Femininity Today. Palerm and Thomson-Salo, Eds. London . Karnac
Grimalt,A (2013a) ¿Mentalización o transformación?:
Experiencia sensorial<=>Experiencia emocional. Revista Temas de psicoanálisis
(http://www.temasdepsicoanalisis.org/hemeroteca/numero-5-enero-2013/)
Himselwood,R.D. (1989). A dictionary of Kleinian Though. Free Assoc. books, London.
Lebovici, S (1979). L ’exp er ience d u p sycha na lyste chez l ’enfa nt et ch ez l ’a d ulte .
XXXIXème Congrès des Psychanalystes de langue française, Puf, Paris
McDougall, J (1972). Primal scene and sexual perversion, Int. J. Psychoanal,53: 371384
Money-Kyrle, R. (1968) Cognitive Development. Int. J. Psychoanal; 49,691
Rilke, R.M.(1912b). Duino elegies, S. Mitchel (trans.) New York: W.W. Norton 1978.
Rosenfeld, H. (1971). Contribution to the psychopathology of psychotic states: the
importance of projective identification in the ego structure and the object relations of
the psychotic patient. In Bott Spillius, E, Melanie Klein Today. Vol. 1, Routledge, London
1988.
Segal, H. (1956). Depression in the Schizofrenic. Int. J. Psychoanal- 37 339-43
Segal, H. (1989). Introducction to The Oedipal Complex today. London. Karnac books.
Sohn, L (1985). Narcissistic organization, projective identification, and the formation
of the identificate, en Bott Spillius, E. Melanie Klein Today. Vol. 1, Routledge, London
1988.