Sincerity and Other Works: Collected Papers of Donald Meltzer

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Among the subjects this volume touches on are adult psychopathology, psychoanalytic technique, developmental theory, the training of psychoanalysts, child and adolescent psychopathology, and the appraisal and application of the work of W. Bion and of R. Money-Kyrle. This is a good introduction to Dr Meltzer's work but it is those readers with clinical psychoanalytic experience and a working acquaintance with his neo-Kleinian contributions who will enjoy this book the most.

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1. Towards a structural concept of anxiety (1955)

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The author formulates here the existence of an anxiety apparatus whose functioning is a part of the ego and the personality structure and illustrates how in attacking this apparatus the ego is attacking itself. An example is given of the workings of the death instinct and a differentiation is made between the ego’s defence mechanisms and other pathological character devices.

The concept of anxiety has long held a central position in the psychoanalytic theory of personality functioning and disorders. And yet, much as it is talked of and written about, there is no consensus about it. and it is variously considered an affect, an ego state, transformed id energy, or a dynamism. This vagueness and fluidity of concept seems to have an adverse effect on communication among workers in the field. This paper represents an experiment in thinking about anxiety as a structural entity and attempts to follow up the implications of such a point of view. First I shall try to outline a broad concept of a way of life to which anxiety is essential, viewing it as an apparatus available to the ego. A structural concept of anxiety will be offered, and the functioning of this so-called anxiety apparatus, with its two-fold implication for the ego, will be examined. Next, two sources will be defined, followed by a discussion of their relative importance for psychic health and disease. This finally will lead to a discussion of the mechanisms of defence and an attempt to distinguish them from various character processes.

 

2. Note on a transient inhibition of chewing (1959)

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This analysis of a borderline case in the threshold of the depressive position was written one year after the publication ofMelanie Klein’s “Envy and Gratitude” (1957) and is an application of the theory of envy and a study of splitting processes through projective identification With clinical material from one week of a young man’s analysis, the author shows how the reconstruction of good internal objects and a surge towards the integration of the ego is intimately linked to the danger of fragmentation of the ego and objects.

This brief clinical paper sets out to demonstrate a critical week in the third year of the analysis of a borderline schizoid case. The material represents the culmination of certain lines of work during the previous year aimed at demonstrating psychic reality to the patient but also stands as the beginning of a period of six months characterized by marked clinical improvement outside the analysis and the most dogged resistance to any further advance within the consulting-room.

 

3. Lectures and seminars in Kleinian child psychiatry [in collaboration with Esther Bick) (1960)

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in collaboration with Esther Bick

These previously unpublished transcripts of impromptu lectures, given at the Tavistock Clinic to Tavistock-trained child psychotherapists—John Bremner, Edna O’Shaughnessy, Dina Rosenbluth, Isca Salzberger, and Frances Tusttn—follow the original format. Each theoretical introduction is followed by the discussion of clinical material of early analytic sessions. The colloquial style with some repetitions was left unchanged and gives a flavour of those early teaching seminars. They also illustrate a novel way of presenting clinical material with careful monitoring of psychic changes in the patient and in the transference, recorded in parallel to the clinical descriptions. The heading of the lectures on elementary Kleinian nosology of childhood disturbances are:(1) the technical basis of psychoanalytic observation and the theoretical basis of classification of psychological disorders; (2) psychosis: domination by psychotic anxieties: split-off psychotic parts; (3) mutilations of the ego; (4) the unifying concept of hypochondria; (5) infantile autism, and (6) adolescence. One can see many ideas put forward in these lectures that appear later inThe Psycho-analytical Process (1967a) and other worksin particular, the notions of the aesthetic appreciation of the object the intrusive attack through projective identification into the internal object autism, and differential diagnosis.

 

4. A contribution to the metapsychology of cyclothymic states (1963)

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Detailed clinical examples from a 5½-year analysis illustrate the nature of internal objects that underlies the tendency to regress from obsessional organizations to hypomarxia. The basis of mania in unconscious phantasy expresses itself by a tendency to turn against good internal objects with oral greeddue to unintegrated primal envywith the aim of violently removing a structure integral to the breast felt to be penis-like, co-extensive with the nipple, and a source of strength, creativity, and Judgement in the mother. The breast-penis, because it is not retained after being stolen without becoming highly persecuting, is projected into father’s penis, which becomes idealized and an object of greed at all levels and zones. The breast, now reduced to being a passive container, is open to further attacks, since love and admiration for it have greatly diminished.

A

considerable body of knowledge has been built up on the metapsychology of cyclothymic states, in both the symptomatic (manic-depressive psychosis) and characterologic (cyclothymic character) forms, through the contributions of Freud, Abraham, Klein, Lewin, Helene Deutsch, Fenichel, and Schilder. to mention only a few of the major investigators who have taken a special interest in this area.

 

5. The differentiation of somatic delusions from hypochondria (1963)

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In this illustration of a metapsychological differentiation between hypochondriacal symptoms and somatic delusions, two cases are described in which the analysis of a somatic delusion consists of a process of reintegration of severely and widely split-off parts of the self happening late in the analytic process.

INTRODUCTION

When Freud (1914c), in his paper “On Narcissism”, suggested that hypochondriacal anxiety stood in relation to ego-libido as does neurotic anxiety to object libido, he had in mind the psychiatric syndrome of hypochondriasis and the hypochondria of schizophrenics. Since then, however, such anxiety has been referred to more contexts, broadly for two reasons: First, hypochondriacal elements have been recognized as playing a part in the clinical picture of the neuroses. Secondly, the deepening of psychoanalytic work has brought forth hypochondriacal phenomena as a ubiquitous and inevitable event in the transference.

The consequence of this development has been a broadening of the scope of the term and a corresponding loss of definition. “Hypochondriacal” has come to include clinical phenomena earlier described by such terms as “organ language”, “somatization”, “somatic delusion”, and “psychosomatic”;. In a sense, this coalescence has been correct, for these various terms were used descriptively, not metapsychologically, and often inconsistently. Furthermore, the earlier sharp distinction between psychic and physical has been found to be unsatisfactory. Freud (1914c) suggested on the one hand that organ changes akin to those in the genital during excitement might occur in hypochondria to increase the erogenicity of the organ. He also suggested a continuity between hypochondriasis, neurasthenia, and anxiety neurosis that has been richly confirmed through the work of Melanie Klein on internal objects. She herself (Klein, 1935) first differentiated depressive and persecutory types of hypochondria, and later (1961), further broadened the term by including the hypochondriacal reaction to and elaboration of primarily organic diseases.

 

6. The dual unconscious basis of materialism (1965)

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The Imago Group, to whom this paper was presented, consisted of people interested in applying psychoanalytic findings to other disciplines. They met regularly in the early 1960s, and among those attending were: Katherine Jones (Ernest Jones’s wife), R. Money-Kyrle (psychoanalyst), Adrian Stokes (art critic), R. Wollheim (philosopher), the Holmes’ (an USE sociologist and his wife), and Ernst Gombrich (art critic and historian),

The author talks here about the concern with measurable possessions and how the extension of self-esteem through an identification with possession takes place through envy, delusional Jealousy, projective identification and the defences used against them. He illustrates this by examining the social attitudes towards land tenure and the introduction of machinery to thirteenth-century rural England. Towards the end of the paper he refers to the “apocalyptic dread” feared in earlier centuries, as an inevitable consequence of the loss of a human relationship with the mother’s body, which leads to the haunting dread of catastrophe: the death of the mother. When this paper was written in 1965, there were intimations of a “bomb” capable of apocalyptic destructiveness. This paper anticipates the writings stimulated by the danger of nuclear arms proliferation of the 1980s,

 

7. Return to the imperative: an ethical implication of psychoanalytic findings (1965)

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The author describes how “laws’ of psychic reality with an ethical significance have to be differentiated from the “moral” implication of discoveries about the structure and function of the superego.

But If the word “this” Is to apply, as it should, to something that we directly experience, it cannot apply to the cat as an object In the outer world, but only to our own percept of a cat. Thus we must not say “this is a cat”, but “this is a percept such as we associate with cat”, or “this is a cat percept”. This phase, in turn, can be replaced by “I am cat-perceptive.

Bertrand Russell, “An Inquiry into Meaning and Truth”, 1940

I start this paper with Lord Russell’s statement for two reasons. First of all. It succinctly states that “egocentric particulars”, as he calls such words as I, this, now, etc., are utilized to introduce statements about what Freud called. The perception of psychic qualities’, in his definition of the function of consciousness. The second reason is because of the interesting shifts from the subjunctive to the imperative mode of speech that take place as soon as he utilizes an egocentric particular himself. While it is “If the word this is … tt cannot …” to begin with, suddenly we hear that “we must not” …”. Also note that it is “we” who “must” use egocentric particulars correctly, meaning that if I use them as statements of self-observation and you use them “intend(ing) to make a statement about something which is not merely a part of (your) own biography …”, we will not understand one another.

 

8. An Interruption technique for the analytic impasse (1968)

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This study of impasse and its differentiation from other resistances, based on the structure of the transference, suggests a technical device for dealing with impasse and appeals to the analysts personal responsibility in relation to his internal objects. It underlines how tlxis method demands courage and personal emotional involvement This seems to be the first of a series of papers on the committed use of countertrcmsferencef born out of the description of the author’s clinical work.

In my book. Vie Psychoanalytical Process (Meltzer. 1967a). 1 have described in some detail the structure of the “threshold of the depressive position” and the economic balance in relation to mental pain that forms the background for this most characteristic impasse of the psychoanalytic procedure. I have witnessed it during the past years of clinical work and supervision, and during the last six years I have experimented with several methods of dealing with the impasse. Finally. I have adopted one that seems humane, rational, and reasonably safe, and one that has proved on the whole surprisingly successful.

 

9. A note on analytic receptivity (1968)

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The role of visual perception of the patients material at the expense of the verbal is delineated, and the importance is stressed of developing a sensitivity specific to the verbal expressions of the unconscious.

Awide experience of supervising other analysts and students has helped me to recognize in myself. In my own work, certain strengths and weaknesses in analytic receptivity, one of which, now that it has begun to improve a bit, I would like to describe.

Although certainly collateral senses such as smell or postural sense play some part in analytic communication, by far the most important are auditory and visual. I have an impression that analysts generally fall into two categories— verbal and visual—in regard to the material with which they work most easily. The writings of the two greatest analysts, Freud and Melanie Klein, suggest a strong divergence in their sensitivity in these areas, Freud being astonishingly sensitive to verbal nuance, while Melanie Klein seems to have had a primarily visual imagination, particularly well suited to work with children. This can most clearly be seen in the dream material from their writings, say in “Dora” (Freud, 1905 [1901]), as compared with Envy and Gratitude (Klein, 1957).

 

10. The relation of aims to methodology in the treatment of children (1968)

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The author postulates here that the aims in the treatment of children are identical to the analysts interests and desires, while methodology is linked to the quality of internal objects. He remarks on the importance of aimsnot goalsin the psychoanalytic process, and that the psychoanalytic method and technique are guided by internal objects and not by what is “right” and “wrong”.

Iwant to attempt a purely psychoanalytic approach to a question that is not necessarily a psychoanalytic one by any means. Therefore I am going to start with two dreams from a patient, one dating from the beginning of the last year of his analysis, the other from the end of that year.

In the first dream the patient, a young doctor who was considering applying for analytic training,

.found himself wading Into the sea following a tall man dressed in a sou’wester. In the distance there seemed to be a milk bottle, either floating or partly submerged. As the water became deeper and deeper, the patient felt panic that at any moment he might become unable to touch bottom and would be swept away by the current

 

11. Positive and negative forms (1970)

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In this study of spaces in the geography of the mind, the author questions whether they have formal qualities that are aesthetically meaningful apart from the meaning of the objects by which they are bounded. (Spaces are concretely conceptualized in unconscious phantasy in relation to time.) We must be reminded that this “arcfxitectural” paper originates around the time that Explorations in Autism (1975) was written, where the pathological link between space and time comes under clinical and theoretical scrutiny. In this paper the author also proposes the creation of a Clinical Data Service to be made available to various professionals (aesthetes, philosophers, architects, etc.) willing to explore the Kleinian psychoanalytic view of their particular area of interest. This was to be a bulletin with papers written by psychoanalysts with special interests. This project did not become a viable proposition.

This is primarily a methodological paper insofar as its aim is to set out a problem in aesthetics, mainly related to sculpture and architecture, in a form that may lend itself to psychoanalytic solution, at a certain level, and then by some illustrations to draw forth a methodology to which analysts could, individually and collectively, contribute towards its investigation.

 

12. Sincerity: a study In the atmosphere of human relations (1971)

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This “chapter”which was, in fact written as a book in 1971has remained unpublished until now. It presents a phenomenological conception of “sincerity” and links it with emotionality and states of mind Using the text of three plays by Harold Pinter—”The Dwarfs”, “The Birthday Party”, and “The Homecoming”as “clinical material”, the author makes a systematic and detailed analysis and puts forward new, thought-provoking, ideas—as, for instance, the differentiation between insincerity and unsincerity in human relations. The notion of the claiistrum is mentioned here in connection with “The Birthday Party”. more than twenty years before the book on the subject (The Claustrum, 1992) appeared as a comprehensive investigation into claustrophobic phenomena and borderline patients.

INTRODUCTION

Let us suppose that the human brain Is the most complicated thing in the universe and that its existence has for some few millennia past made possible the emergence and evolution of the most complicated phenomenon in the universe, the human mind. Can we doubt that the essence of this phenomenon is emotion and that the great solipsistic loneliness of which all humans suffer rests in the impossibility of knowing—really feeling—some other human’s emotions. For the bodily sensations we may achieve a sense of conviction by repeating, experimentally, the situation in which the other felt pain, saw redness, heard A-sharp. True, conviction is not knowing, but it will serve our needs. But how are we to repeat experimentally the situation in which A felt love, remorse, fear, humiliation so that B might experience conviction regarding the identity of his emotions? If lovers in the climax of their passion may later doubt each other, what hope is there of trust in less mutual areas of feeling?

 

13. Towards an atelier system (1971)

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This article, written for circulation amongst the members of the British Psycho-Analytical Society, offers a critical view of the selection, training, and qualification of candidates at the Institute of Psycho Analysis, It did not enhance the author’s popularity with tlie psychoanalytic “establishment” that he suggested an organization to teach and learn psychoanalysis in a less authoritarian setting to function concurrently with the “official” training. These were felt in 1971 to be subversive ideas, and they aroused fears that the interest of psychoanalysts would be deflected away from the Society and from the established theories and doctrines,

Some years of effort by the Curriculum Committee having now resulted In a new course of study for students and a new organization of teaching staff, the task has arisen for It of evaluation, feedback, development. Some of the difficulties in this area that have come under discussion throw into sharp relief the essential nature of the educational system we have, as a matter of course, perpetuated. It gives rise to some uneasiness and a need to reconsider the system itself. Insofar as these concerns with the microcosm of psychoanalysis, and thus with thought and opinion growing out of immediate experience and conflict, bear upon our understanding of the larger world, they can be considered of general interest. It Is for this reason, I presume, that Dr Klauber invited me to write up some ideas I had expressed for distribution in the Scientific Bulletin.

 

14. Routine and inspired Interpretations: their relation to the weaning process in analysis (1973)

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This clinical paper on the theory of technique explores the use of inspiration in the psychoanalytic method and was written as a further development of the book on The Psycho-analytical Process (1967a). Uke many of the author’s papers on technique, this is a frank exposition of clinical work by the author, which provocatively deeds with issues of countertransference, thinking, acting out, the function of the interpretative activity in analysis, and wild analysis.

This paper is one of a series of essentially personal studies that have grown out of and are therefore an extension of the investigation of the nature of the psychoanalytic process that I reported in my book (1967a). In that work 1 left rather empty the description of the interpretive function of the analyst as one of his modes of participation in the therapeutic relationship, as it was not central to the main theme. This centred on the process and its evolution seen as arising essentially in the unconscious of the patient. But it is probably true that any analysis that really taps the passions of the patient does the same for the analyst and promotes a development that can further his own self-analysis. Insofar as this is true, the main industrial hazard of this work lies in the danger of the transference-countertransference process taking a turn in the direction of perversion and thus becoming anti-therapeutic for both members of the undertaking.

 

15. Repression* forgetting, and unfaithfulness (1974)

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This clinical study of repression follows the vicissitudes of forgetfulness and unfaithfulness to love objects in the transference situation, when splitting and the use of projective identification have lessened in the threshold of Hie depressive position.

INTRODUCTION

The concept of repression winds its way throughout the entire length of Freud’s work, beginning with the Studies in Hysteria (1895d) and ending with “Analysis Terminable and Interminable” (1937c). At first he considered it to be equivalent to the concept of defence, but later he differentiated between repression as a specific mechanism and defence as the wider category of defensive operations. In this process of subsuming repression under the wider category, the concept tended to get lost. Writing about it in the 1937 paper “Analysis Terminable and Interminable”, Freud attempted to rescue it from being overwhelmed by the other mechanisms that were being described by various authors at the time. I do not wish here to trace in any detail the ways in which Freud struggled to give this important concept definitive form, the ways in which it was linked to the libido theory, later in a sense “sexualized” and linked to the conflicts between male and female and between active and passive, and, finally, linked to anxiety when Freud saw that anxiety was a motive force of repression and not a consequence of its activity. Instead, I want to turn attention to two more poetic statements of Freud’s—one a very early statement in which he tried to find a model for the concept of the transference, and one thirty years later, when he tried to use the same model to describe the action of repression. I turn to these more poetic statements because I think that in them we find something of the clinician’s vision, which is in the case of Freud something very different from the theoretician’s conceptions.

 

16. Narcissistic foundation of the erotic transference (1974)

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This examination of the eroticized transference as an expression of a hidden focus of the narcissistic organization— which accounts for its intractable resistanceand which is usually accompanied by a compromised countertransference, includes an enlightening discussion on the technique for dealing with the erotic transference. Chapter seventeen, also written in 1974. discusses further the role ofpregenital confusions in erotomania.

The concept of Oedipal conflict, even when taken at both part- and whole-object levels, coupled with powerful concepts such as zonal and geographical confusions, or recognized in terms of the powerful anxieties that drive the utilization of erotism as a defensive manoeuvre—this whole orchestration of the concept—does not seem adequate, in the sense of being able to cover the phenomenology at hand. My thesis is that the dynamic approach to the problem of eroti-zatlon of the transference, and therefore the problem of a powerful type of resistance that lends itself too well to acting-out both in and out of the transference, does not adequately reveal the complexity of mental functioning, nor is interpretation along these lines successful in promoting working through.

 

17. The role of pregenital confusions in erotomania (1974)

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A clinical example using mainly dream material illustrates how the narcissistic organization interferes with a proper differentiation between adult and infantile levels of functioning and with the ability to protect tnternal objects (mother’s body and identity) from intrusive attacks through projective identification. Chapter sixteen provides further elucidation of the narcissistic organization and technique.

When Mrs Rfirst came to analysis, she was disquieted mainly by evidences of an inexplicable coldness and brutality, which burst out at her children, a boy and girl, whose development seemed in many ways unsatisfactory. But in the course of a difficult analysis, and against great resistance, the idealization of her husband and their marriage broke down and revealed a floridly perverse relationship in which she played the willing slave to his genius, obsessionaltty, and selfishness. As she gradually disengaged herself from this, the relationship became insupportable, and they agreed to stay together for the children’s sake alone. Through this four-year period the analytic situation forged slowly ahead in the face of a strongly erotic transference and intense voyeurism, which gradually revealed an infantile situation of fusion with a parental couple related to sharing the parental bedroom during her breast-feeding period. This generated a strongly blissful state of mind, which resisted interpretation, but when it yielded on occasions, evidences appeared of a brutal wilfulness and independence of Judgement covered by surface compliance. This attitude had indeed characterized her childhood following a period of stress during which a change of house, removal from the parental bedroom, weaning, toilet training, and the birth of a baby sister had followed hard upon the heels of one another.

 

18. Adhesive identification (1974)

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In this lecture, the author traces Esther Bick’s investigations and his own clinical findings with autistic patients, to describe a type of narcissistic identification that is different from projective identification and about which he had ior(tten at length in Explorations in Autism (1975), which appeared soon afterwards. (See particularly chapter 9on Dimensionalityof that book.)

Psychoanalysis is such an essentially historical subject and method that it really does not make sense to talk about it in any way but historically, and, of course, we have to start with Freud. However, history is like the law: the law is what the courts do, and history is what historians say; and my history is different from your history and you must not expect It necessarily to correspond. It is Just my way of understanding psychoanalytic history. It Is a very peculiar science that we have. I do not begin yet to understand how it works or develops, and why sometimes it does not develop and sometimes it seems to shoot ahead. You can see in Freud’s way of working that while he thought himself an inductive scientist, he certainly did not work purely Inductively at all—he worked deductively at times. The process of his development is interestingly documented. We have in the marvellous and somewhat horrific “Project for a Scientific Psychology” (Freud. 1950a [1887-19021), a document that states with such clarity a mass of preconceptions that he had to gradually whittle away and get rid of in order to change from a neurophysiologist to the great phenomenological psychologist that he eventually became. I suppose all of us have to do that. We have from our education and development a massive preconception of models and theories and ideas that we gradually have to get rid of in order to free ourselves to receive new impressions and to think new thoughts and entertain new models. It seems to me an extraordinarily difficult process; it tends inevitably to grind to a halt. How is it that we get kicked forward? It seems to start mainly in our consulting-rooms; when we are in trouble and nothing good seems to be happening, we begin to think again, and what I am going to present here is an outgrowth of being in trouble, and trying to find new ways of thinking.

 

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