A Clinical Application of Bion's Concepts: Dreaming, Transformation, Containment and Change

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This work depicts clinical applications stemming from Dr Wilfred Ruprecht Bion's contributions to psychoanalysis. It may be used as a practical companion to The Language of Bion: A Dictionary of Concepts also by P.C. Sandler. Both constitute a natural arrangement of Bion's concepts; "natural" being the help the selected concepts may provide to any analyst who understands and uses the observations underlying the concepts effectively in his or her everyday clinical work. It also contains expansions of Bion's concepts arising out of clinical observations, made possible by those very contributions - a common-sense invariant in science. Universes of hitherto unknown - but existing - facts are observed, and through observation and application expanding universes are unlocked to consciousness (and therefore awareness). Some chapters will help the reader understand Bion's original concepts and apply them in clinical practice. Other chapters are more explicit and go beyond what was adumbrated or indicated by Bion, in the light of phenomena observed against the background of Bion's contributions. These chapters also indicate the intertwined nature of his contributions.

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CHAPTER ONE: A space-time context for Freud's “Interpretation of Dreams”

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As with psychoanalysis in general, the scientific movement's reaction to the Freud's seminal work which gave rise to psychoanalysis, “The Interpretation of Dreams” (which recently completed its centennial), covered a paradoxical range: astonishment, welcome surprise and idolisation on the one hand, and abhorrence, dismissal and doubt on the other. On both sides there were some misunderstandings, which were the hallmark of the psychoanalytical endeavour from its inception. This echoes the general public reaction to medicine itself and its multifarious attempts, as well to things regarded as “new” by the many institutional establishments. As an unavoidable consequence, “The Interpretation of Dreams” was subjected to a mixture of expansions and oblivion—also in the psychoanalytical establishment (or “movement” in Freud's parlance; Freud, 1914) which was also formed over one hundred years.

My investigations, published in book form elsewhere as well as in short papers, (Sandler, 1997–2003; 2001) allow me to state that Sig-mund Freud furnished practical use for some of the realistic achievements usually attributed to the Enlightenment and Romantic movements. By realistic I mean artistic and scientific modes of apprehension of the two forms of the same ineffable existence we usually call reality, psychic (immaterial) and concrete (material). One may focus the issue more precisely: Freud furnished one of at least four practical uses of the profound, sublime and tender achievements of the German and British developments of the French Enlightenment and Romantic movements. Lest one be surprised to regard scientific achievements as sublime, it will suffice to recommend to them the practice of science. No real scientist has failed to undergo this emotional experience—which can be subsumed by “intuition”, an instant grasp of reality with no interference of logical thought, according Kant—when immersed in a scientific finding. This is true of the great discoverers and of the artisans who apply those discoveries in their daily practice (including technological applications), even though repetition may be conducive to debasement and blunting of the emotional experience itself. The latter is the experience of truth. It must be no coincidence that many people take pride in their work and in a job well done. Whether machining a piece of steel or playing the piano, one is able to experience this. “To make a dream true” is a familiar experience; conversely, “to dream is to make truth true” also is, but it took many centuries to realise this and to put it into useful practice.

 

CHAPTER TWO: “The Interpretation of Dreams”: a scientific tradition and resistance to it

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The initial chapters, whose form is repeated throughout the work, relate respectively to the earlier literature dealing with the issue of dreams and the relationship of dreams with life when one is wide awake.

I find it noteworthy that researchers into the system of the mind and psychic reality are always harassed as if they were second-rate researchers, and are accused of being non-scientific because of the realm they choose or were chosen to investigate. As pointed out earlier (and by many other authors), the same problems assail and more often than not embarrass any scientific investigators in any scientific area, and are not the exclusive domain of the analyst. But some prejudices or obvious parti-pris that are taken for granted with any other researcher are unfairly put into doubt when the issue is psychoanalysis; alas, not just by non-analysts. For example, that life, and real life, does not proceed differently in every hour of every day. One may notice and respect alterations in hormone secretion and different activity cycles of the hypothalamus, pineal gland and adrenal gland by day and at night; but these are undiminished in total when night and day are considered together, as they obviously mustbe. Why does one also respect the night-time lessening of neuronal afferent stimuli reaching the central nervous system and the corresponding increase in daytime, when the total sum is equal if nighttime and daytime life are considered as a whole? And why are there still so many difficulties with dreams (which continue, despite consciously avowed allegiance to their significance, rather like a religious vow made by non-religious practitioners), despite the fact that “The Interpretation of Dreams” was published over a century ago? Which continue undiminished, even though their perception also suffers an inverse cyclical variation from night (when they are better apprehended) to day (when apprehension lessens) but keeps the same pattern when the whole entity of night and day is considered? Life does not pause at night.1

 

CHAPTER THREE: Old wine in new bottles: authors reviving Freud's psychoanalytic ethos

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Contact with reality is not dependent on dream work; accessibility to the personality of the material derived from this contact is dependent on dream work.

(Bion, 1958–1979, p. 45)

Bion was the first scientist to use the term reverie. It is probably untranslatable as it is more often than not transferred into other languages, even though its gist can be fully grasped. Due to the universal nature of the unconscious and of genetically determined human instincts, it had to become the chosen title of musical pieces, all of them endowed with extreme delicacy and sensibility. If their penetration among the hearing public as soon as they are heard ever since then, irrespective of place, is of any importance, it will be acknowledged that those manifestations coined (or better, concocted) by two Romantic composers, Franz Schubert and Robert Schumann, conveyed the French verbal formulation better. After all, both Enlightenment and Romantic messages were first brought by French people and later developed by English and Germanauthors—to new heights unheard since then. Reverie and its German analogue, Träumerei, are terms which still do not exist in English and Portuguese, among other languages.1 The quasi-oneiroid vector and meaning of reverie displays its links with the Bildungskraft of the German Romantic Movement as well as with Traumdeutung, Freud's “Interpretation of Dreams”.

 

CHAPTER FOUR: Bion's exploration of the “royal road”

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Forty years ago, it was common sense to state that Freud opened many broad roads and avenues which were left unexplored or unexpanded. Thirty years ago this common sense was debased into a commonplace. As such, it lost its value and was forgotten. Many “new theories” were proposed instead of new directions and ways to progress. Like comets, they had a sparkling life and disappeared after a considerable hullabaloo and fashion-dictated bandwagons advertising them as “the last word in psychoanalysis”. “Freud-bashing” became more common in psychoanalytical publications. As time went by, it became more frequent than expansions of Freud's work. Finally! After so many partially failed attempts, like those initiated by Jung, Stekel and Adler, revealing hate for the truths entailed and uncovered by psychoanalysis and hardships linked to the need for the analyst to be analysed him- or herself, the “Freud-bashing” done outside the psychoanalytical movement became internal. At the same time, the prestige of psychoanalysis as a useful social practice began to drift, with no end in sight. It may be debated whether and to what extent the so-called state of “one psychoanalysis or many” which led to the so-called “crisis of psychoanalysis” islinked to an abandonment of the very ethos of psychoanalysis, here understood as the individual clinical word dedicated to free associations as emanations of the unconscious, of the unconscious itself, the unknown; of Oedipus, sexuality, thinking processes, and narcissistic features of the paranoid-schizoid position. Attempts to prove that Freud “was right” also emerged, but with proofs drawn in a non-psychoanalytic framework, that is, downgrading the empirical, clinical evidence obtained through psychoanalysis proper. In our view, either to prove that he was wrong or to prove that he was right are just two different sides of the same unacknowledged coin—distrust of psychoanalysis. Therefore, not only were many of Freud's roads forgotten, but some of them were left unexplored.

 

CHAPTER FIVE: Functions of dreams

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Iwill now focus on some functions of dreams that were elicited after, and made possible by, those described by Freud (1900, p. 572; 1916–17a, p. 131).

We are dealing in fact with totalities which are “put asunder” through our lack of adequate words to express them as they are in reality. In other words, we lack an adequate apparatus to apprehend reality as it really is (“O” in Bion's proposed notation; “psychic reality”, or “unconscious” in Freud's notation), as much as we lack an adequate language to express it. The dream would be an attempt to express both, but fails in both. Like any human endeavour, failure is a built-in feature of the self-entitled homo sapiens. For if we describe the unconscious as the depository of the supreme principle of human biological reality as well as the attempts to deny it, any emotional experience to express the unconscious will be a servant to two utterly different masters, and will be attributed with incompatible functions. Unconscious phantasies embody both contradictoryand mutually destructive functions, as expressed by dreams, as we shall see. Perhaps it is a matter of human development—we are one of the youngest species on Earth. The dream is

 

CHAPTER SIX: Clinical illustrations

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The following brief clinical reports try to illustrate some intra- and extra-session hypotheses on “interpretation”—or, perhaps more accurately “construction”—of dreams. They are based on at least two factors:

•  immanence, or experience lived with the analysand, provided by personal contact four times a week for months and years. This furnishes indications which come to our minds in a spontaneous way as the analyst's free associations. Its initial manifestation coincides with Freud's manifest content.

•  transcendence, when reality (facts, events, and people) is not what its appearance would suggest it is. We can never know ultimately what it is, but we are able to know, transitorily, what it is not. I have observed that, from “is not” to “is not”, in steps whose stuff is mistakes and/or frustrations, we might get closer to what is, without ever arriving there, but being, during this “journey”. I start from Bion's observation that the experience of no-breast (the “is not”) may be a (or the) condition for the inception of thought processes. Or, if we become able to abandon these beliefsone by one, and come to base ourselves on facts, we may obtain firm (though always transitory and partial) pieces and aspects, glimpses of the reality, and can configure an approximate outline of its wholeness, however slowly. One day, one may see “that is that; it is not anything else”; or “I am what I am and I am no one other than myself”. Its manifestations encircle the latent content and are construed from the reality of the session, experienced by the analytic couple but focusing bits of intrapsychic structures and functions emanating from the patient.

 

CHAPTER SEVEN: Observation and communication

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Bion's main theories—alpha function, links, elements of psychoanalysis, transformations and the language of achievement— form an interdependent, evolving whole which actualises itself in the decisive moments that compose a session. Here I will attempt to display a mode of their clinical use through focusing on their most developed form: Bion's application of the mathematical concept of transformations and invariants. With the exception of this concept I have not encumbered the text with quotations and bibliographic references to definitions (for example, container and contained, elements of psychoanalysis); all the terms used can be seen in the annotated historical and epistemological presentations of the theory available elsewhere (Sandler, 2005, 2006).

Considering any psychoanalytical session as an emotional experience, what elements in it must be selected to make it clear that the experience had been a psychoanalysis and could have been nothing else? [Bion, 1963, p. 14]

Under the heading of theories of technique, Freud distinguished between theories of psychoanalytic observation and theories of psychoanalysis. This distinction was expanded by Menninger (1958).

 

CHAPTER EIGHT: Clinical illustrations

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Mary obtained her PhD ten years ago and went on to postdoctoral studies abroad. She had approximately five years of analysis with a fairly well-known professional. After two years seeing him she decided to become a psychoanalyst. After an unsuccessful first attempt she was accepted by an IPA-recognised psychoanalytical institute. She ostensibly sought me out on the double grounds that her analyst had no training functions and that she had seen a conference presentation of mine.

An intelligent, highly cultured, self-indulgent woman, Mary is the only child of an elderly and well-to-do middle-class couple, who have carried on working and helping her financially. She is a chemist; she thinks she is a failure in her profession: “See, I have a postgraduate degree and what happened? I am stuck in a dead-end job, going nowhere”. She reports with a barely concealed pride having had “homosexual” experiences with two university colleagues, sharing her home with them. They had constant quarrels until the association was dissolved. She got married after two years of a first “analysis” (as she had seen it) and became pregnant. When she looked forme she had just had her second child. During this experience she decided to be an analyst “because I am fed up with this silly, technical profession which doesn't require any brains”.

 

CHAPTER NINE: Bion's theory of container and contained

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All Bion's concepts derive from practice. His texts contain real technical hints, albeit formulated in colloquial, rather than technical terms (which are often just jargon). Let us first look at the concept and then proceed to the clinical illustrations.

As I tried to adumbrate in The Language of Bion: a Dictionary of Concepts (2005), the double term “container-contained” embodies a paradox: something that contains and something that is contained perform a double function, namely the function of containing and of being contained vis-à-vis each other. It seems to me that in order to be able to use the concept of Container-Contained, it is seminal to keep firmly in mind the paradoxical double feature of every fact happening in nature (and in human nature) which was described in the Introduction of this book—namely, that psychic reality and material reality are two forms of an ultimate same existence.

Container-contained is a form of relationship from the inception of life that allows emotional growth and the growth of thinking processes. It is the process through which accrual of meaning is obtained; therefore container-contained is equated to thinking itself. It represents the most developed form of Bion's theory of thinking,which took him approximately nine years to complete. It can also be seen as a formulation of Freud's observation on human sexuality under the vertex of the thought processes.

 

CHAPTER TEN: Empirical sources: container and contained in the clinic

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Andrew was a gifted young professional in his twenties. He has already contributed to this book (in Chapter Six). He did not know exactly why he had sought me out—he said that his father's best friend, a successful professional, had undergone an analysis for many years and had greatly valued the work done. His father insisted that he should come, stating that this friend was successful because of his analysis.

Andrew kept coming for the next fourteen years, four times a week. His history, if taken superficially, gives no hints of overt psychosis. But here and there some facts emerge that indicate otherwise. To give just one example, he had undergone a kind of accident in the sea, with a surfboard. Since he was an expert swimmer and used to practising this sport, this was a hint that allowed me to hypothesise the presence of a covert suicidal tendency. He narrowly escaped drowning thanks to the swift action of another surfer who happened to notice that something had gone badly wrong (it seems that the lace became loose and the surfboard ended up hitting his head; he cannot say exactly what happened). Soon some lifeguards came to helpboth. When confronted with this view in the very first interview with me, he became very sad and burst into tears. He now mentioned his father, whom he saw as a successful man in terms of earning money. But … only after a financial disaster when Andrew was six: his father worked in a rather large engineering firm which went bankrupt and he suddenly found himself unemployed. Later, his father set up a consultancy firm to organise lobbies for contractors who could have plenty of government-ordered work without the risk of crashing. It seems that he developed a greed-control system that avoided predatory competition between contractors of the kind that destroyed the firm he had worked with. The work demanded heavy involvement with politicians and had some shadowy, seemingly illegal intermediate steps linked to bribery, but it worked so well that all parties were always satisfied. The father enjoyed an enduring, stable position and respect for more than two decades. Andrew nevertheless feared that he could be unmasked and humiliated or prosecuted. He also stated that he very much liked cultural activities such as philosophy, theatre and literature, but decided to work in an exacting profession which he felt was far removed from this.

 

CHAPTER ELEVEN: Catastrophic change or fear of change felt as catastrophe?

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Catastrophe (katastrophe) in Greek theatre means turbulence from which ruin and disaster ensue. It differs from catastrophic change (catastro?pha), which is a change in fate, good or bad. Initially Bion used the first term to depict a sudden perturbation or change in a given real or hallucinated status quo. This perturbation leads to the destruction of this very same status quo. He adopted the term “catastrophic change” to depict a mental configuration. Catastrophic change may be felt as a catastrophe when resistance to growth prevails, especially with regard to experiencing the depressive position. An insight may be conducive to an inner catastrophic change. To regard the latter as a catastrophe discloses hate of truth and hate of psychoanalysis (Sandler, 2005). Bion's experience with certified psychotics allowed him to formulate the concept. Like all psychoanalytical discoveries, it is not confined to psychiatric nosological entities, being observable in real life, in an analytic session and in dreams.

 

CHAPTER TWELVE: When addiction means diminution: clinical illustrations

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In the previous chapter we hinted that fear or abhorrence of catastrophic change could be likened to addiction. Addiction to what? At the risk of stating the obvious, one could say: addiction to pleasure and desire. This may focus our attention not on addiction to drugs, religion, work or whatever—these are manifestations. If a psychoanalytic nosology seeks an expression closer to “O”, the numinous realm, this could be a more general description which will account for the multifarious individualities and particular cases. Alongside the apprehension of the psychotic and non-psychotic personalities (Bion, 1957a; reviewed in Sandler, 2005), one may say that when the psychotic personality prevails, fear of catastrophic change prevails. It would, in the hallucinated, pleasure-ridden mind of the person, threaten his (hallucinated) status quo, prompting an uncontrolled psychotic bout. The psychodynamics of this functioning can be recognised by the use the psychotic personality makes of the neurotic personality. So the observer will have contact with outward, external appearances typical of the neurotic part, such as adaptation to social and cultural codes and the appearance of hysterical, obsessive and phobic symptoms. Conversely, when the neuroticpart prevails, abhorrence of catastrophic change prevails. Analytically trained observers will detect the outward, external appearance of psychotic traits such as rationalisation (as in the case of Schreber), persecution, and self-importance and self-reference. If this psychoanalytic nosology tries to make use of the theory of instincts, then in the case of fear of catastrophic change, life instincts prevail; while in the case of abhorrence, hateful and destructive instincts (directed at the reality of life as it is) prevail.

 



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