Imprisoned Pain and Its Transformation

Views: 1090
Ratings: (0)

This book is a festschrift for Sydney Klein, an eminent British Psychoanalyst whose work on such topics as children, groups, psychosomatic illness, delinquent perversions, manic states, and autistic phenomena is known worldwide. His thinking reflects the work of Melanie Klein and Wilfred Bion, as well as that of other eminent writers, such as Frances Tustin.In this volume, clinicians from a wide range of backgrounds reflect on the debt they owe to his work, and in particular on the idea of analysis as a means for understanding and transforming psychic pain. The papers cover a wide range of topics, from theoretical papers to detailed clinical discussions. Edna O'Shaughnessy discusses the anal organization of the instincts, Michael Feldman writes on projective identification, Leslie Sohn on the envious superego, Anne Alvarez on work with borderline children, and Mauro Maura on autism. In these and the other contributions, readers will find a depth of experience and clarity of thought reflecting amply Sydney Klein's contribution to psychoanalysis. This book is invaluable for anyone concerned with the state of psychoanalysis today.

List price: $37.99

Your Price: $30.39

You Save: 20%

 

14 Slices

Format Buy Remix

1. Moral imperatives in work with borderline children: the grammar of wishes and the grammar of needs

ePub

Anne Alvarez

In this chapter Anne Alvarez describes how supervision with Sydney Klein played a decisive part in transforming her understanding of the importance of the grammar of interpretation— that not all interpretations have to unmask hidden desires on the negative side but, rather, can help the evolving process of growth and understanding. This is particularly important in borderline patients in whom such unmasking interpretations may be ego-depleting in that they do not take into account the immediate meaning of the child’s communication.

I first came in contact with Sydney Klein’s supervision in a clinical seminar organized for qualified child psychotherapists sometime in 1969 or 1970. At one point I presented some case material from a usually depressed, rather cut-off boy named “Stephen”, who had returned from the summer break somewhat excited: walking on the moors during his holiday, he had found the skull of a sheep. I reported that I had explored with Stephen what I saw as the rather disturbing idea of his fascination with the skull. I had linked this with possible destructive phantasies connected with anger about the break from treatment—that is, why and how, in the transference, might I have “been turned into” a skull instead of a live object? Dr Klein listened, I think with some impatience, and then offered several other possibilities: perhaps Stephen was not indulging his aggressive phantasies; perhaps he was, on the contrary, disturbed by them, and indeed even afraid that they had been realized—that his object had been stripped down or denuded in some way. Or, he added, perhaps Stephen was fascinated because he was relieved and moved at the evidence of the skull’s—and his object’s—survival over time. What Klein said made me appalled by the narrowness and meanness of my own thinking, and eventually I managed to have individual supervision with him.

 

2. Unconscious phantasy and knowledge: a case study

ePub

Gabriel I a Crauso

Cabriella Crauso describes the gradual untangling of the painful psychic constellation locked inside the symptom of body dysmorphic disorder in an adolescent girl—namely, a hatred of the appearance of her eyes and nose. The analyst describes the gradual transformation of this obsession with release of pain in emotionally meaningful experience expressed in the transference through both drawings and language. This involved much work on the patient’s hatred of parental sexuality and the relation of that to the wish to cut off various bodily structures.

The case of Little Hans (Freud, 1909b) certainly changed Freud’s thinking, so much so that he included a whole new section, “The Sexual Researches of Children”, in his 1915 version of “Three Essays on Sexuality” (1905d), in which he states that the instinct for knowledge in children is closely linked to sexual problems.

Later Melanie Klein also linked curiosity with sexuality when she spoke of the epistemophilic instinct focused first on the mother’s body and its phantasied content. For her, the child’s capacity to symbolize and therefore to know is proportional to his capacity to work through his most primitive and persecutory anxieties within his relationship to his maternal object.

 

3. Catastrophe, containment, and manic defences

ePub

Silvia Oclander-Coldie

Silvia Oclander-Coldie writes about a boy who had experienced a severe trauma as a young child brought up in a country at war. This experience remained in him, imprisoned and unprocessed, resulting in omnipotent manic defences expressed in apparently unprovoked violent attacks on other children. During the therapy he made a particular comment, which alerted Silvia Oclander-Coldie to the fact that real trauma may have occurred. Following further exploration with the parents, she decided to bring the facts of this experience into the playroom.

The catastrophic destruction of a mother-child relationship occurred during a war situation. It devastated the psychological development of a baby, later producing uncontrollable violence and reliance on massive projective identification and manic defences.

I observed in great detail the operation of these processes in “Simon”, a child whose intolerable and uncontainable manic and aggressive behaviour made it necessary for his parents to bring him for psychoanalytic treatment. They became aware of his problem when he was 3 years old. He was totally isolated in his nursery school, where he attacked other children. They sought help when he could not settle in primary school, refusing to attend or demanding that his mother stayed with him; he could not make friends. His outbursts of intense aggression were apparently unmotivated, and it was impossible for anyone to reach him and calm him down. Very persecuted, he complained that he was hated by everybody.

 

4. The significance of perversion: to prevent intimacy

ePub

Gabriele Pasquali

In his chapter Gabriele Pasquali shows that a perversion protects against the emotional pain of intimacy. A dream, which was in three parts, each of which described a sexual activity, was crucial to understanding how his patient, a young woman, had not been able to be emotionally intimate because of perverse sexual excitement in three modes. These were represented in the dream and enacted in the analysis. Her fear of intimacy derived from childhood experience but was only combated when the secret sexual fantasies came into the open in the analysis. In this case, her emotional pain was imprisoned by her masochistic excitement with physical pain.

A deep-rooted passion for clinical work leaves Sydney Klein little time for expounding theories: he is first and foremost a clinician. He has conveyed this same passion to me and has contributed to its growth: my chapter describes, through clinical material spanning over a number of years, the emergence of a perversion and its transformation in the course of the analysis. The clinical change has shown up in the transference and resulted in a greater capacity of the patient to use insight.

 

5. Shadow lives: a discussion of Reading in the Dark, a novel by Seamus Deane

ePub

Kate Barrows

Traumata that cannot be spoken about can remain as areas of unresolved mourning. Caregivers in this position are likely to pass on these unworked-through “ghosts” to their own children, who are thus prevented from working through their developmental hurdles and from living their own lives. Kate Barrows illustrates this, using material from the book Reading in the Dark by Seamus Deane (1997) and also material from a patient. She suggests that lack of containment of the child’s aggressive and lively feelings may lead to encapsulated areas of autism, as described by H. Sydney Klein (1980), the lack of containment being linked to ghost-producing traumata in the parents’ lives.

On the stairs, there was a clear, plain silence. It was a short staircase, fourteen steps in all, covered in lino from which the original pattern had been polished away to the point where it had the look of a faint memory. Eleven steps took you to the turn of the stairs where the cathedral and the sky always hung in the window frame. Three more steps took you on to the landing, about six feet long.

 

6. On using an alphabet: recombining separable components

ePub

Maria Rhode

The adequate function of the psychic skin depends on a part-object union between the parents which precedes normal splitting, as described by Melanie Klein. Autistic children have very early anxieties about the integrity of the skin and other body parts and the boundary between themselves and ot/iers. Maria Rhode describes her psychoanalytic work with an autistic boy who confused mental demarcations with bodily damage, resulting in defects in this boundary that made him unable, among other problems, to use letters of the alphabet as abstractions. He felt, rather, that words were bodies that became mutilated if the letters were moved into different words. She suggests that the basis of the capacity to tolerate new experience (Bion’s PS*-*D) is the ability to split in a way that does not damage the primitive parental link. She explores the qualities of this skin—its permeability and its resilience.

In “Autistic Phenomena in Neurotic Patients”, H. Sydney Klein (1980) describes a patient whose 4-week-old baby began to cry when he stopped talking to his wife during breast-feeding. “As soon as he started to talk again, the baby settled down.” A few weeks later, the opposite took place: the father’s voice, which earlier had been felt as a necessary support, had become an intrusion. “In the context of the session, it appeared that there is a change from an early experience of a good third object which supports the nipple to one in which it becomes hostile and intrusive.” This change implies that the capacity for appropriate splitting, which Melanie Klein (1946) considered essential for overcoming chaos and confusion and preparing for later integration, is preceded developmentally by an experience of feeling sustained by the union of the parents on the level of part-objects or of sensory modalities (touch and hearing in this particular baby).

 

7. Some reflections on comparing obsessional neurosis and autism

ePub

Mauro Morra

Mauro Morra compares obsessional neurosis with autism, which always has obsessional features. He finds that omnipotent control is the underlying structural element shared by both, and he comments that Meltzer sees them as the same—both involving an attack on certain mental capacities. An autistic nucleus is illustrated in four clinical cases ranging from childhood to adulthood. The chapter includes comments by Frances Tustin, who suggests that the over-closeness between mother and infant is sensual, not emotional.

I have always been struck by the fact that there are certain similarities in the symptoms of adult obsessional neurosis and child autism, which undoubtedly are two separate disorders. The main common features that we can find both in the literature and in our practice are the withdrawal of affects and the presence of obsessional tendencies.

On the question of whether the presence of common symptoms in the two illnesses is fortuitous or whether there is, on the contrary, some underlying similarity in personality structure, I do not have a definitive answer, but I am inclined to think that there are some important common features in both those organizations of the mind.

 

8. The anal organization of the instincts: a note on theories past and present

ePub

Edna O’Shaughnessy

This chapter explores the changes in Freud’s theory of successive libidinal stages during the subsequent evolution of psychoanalytic thinking, looking especially at the anal stage. Melanie Klein saw all zones as operating simultaneously. Edna O’Shaughnessy describes various body splits, front and back or upper and lower parts, and illustrates this in a patient with obsessional neurosis who withdrew from relating to a dead breast and slipped down into an idealized anal psychic retreat. His despair about reparation, his imprisoned pain, was defended against by a controlling, perverse, and sadistic transference. She believes that if anal sadism dominates the child’s object relations, it is an abnormal development.

In the field of psychoanalysis, when a new theory wins acceptance, the old often lingers and co-exists with the new, without the two being placed in formal juxtaposition. I should like to return to Freud’s concept of an anal organization of the instincts and discuss it in the light of later psychoanalytic findings. I suggest that, like a trunk in the attic stuffed with all kinds of things from the past, we keep it because we know there are things of much value there, even though we never sort them out. On reading again Freud’s Three Essays on Sexuality (1905d), one is struck with awe. Freud was the pioneer in a vast terrain of sexuality, development, and pathology. I discuss the evolution, as psychoanalysis has progressed, of one strand of his thinking about sexuality—namely, his theory of successive libidinal phases—oral, anal, phallic, genital. The psychic importance of all the erotogenic zones is accepted by analysts, but for a long time there have been new hypotheses about their interaction—that is, that they interact not consecutively in a linear course of development, but simultaneously. Yet, as Kernberg (1969) has remarked, the idea of a consecutive sequence of libidinal phases still exerts a powerful hold on the psychoanalytic imagination.

 

9. When the bough breaks: working with parents and infants

ePub

Ruth Safier

This chapter returns again to the theme elaborated in chapter 5: the intrusion into the child of the caregiver’s own traumatic experience. Ruth Safier discusses parent-infant therapy with a particular focus on those mothers who are at the extreme end of the containment spectrum—that is, those who project their own anxieties into their babies. She illustrates how these infants are swamped with the mother’s problems while their own primary anxieties are not touched. She also relates some of the very painful insights arising from this work to psychoanalytic technique.

Working directly with parents and infants offers the psychoanalyst another vantage point from which to observe primitive mental mechanisms, and a ringside seat to the tragedy of psychopathology in the making. The challenge for the analyst lies in intervening before the patterns of failure become entrenched. There may also be implications for work with the adult patient in analysis.

This is painful and disturbing work, and the impact on the therapist is very direct. Dilys Daws (1993) says that the acute emotionality that is a feature of the work with parents and infants is both the reason for them presenting and also the vehicle for change.

 

10. Observing babies and supporting the staff

ePub

Margaret Cohen

Further on the theme discussed in chapter 5, in this chapter about infant observation in a neonatal intensive care unit where the babies are very premature or ill—for example, on drug withdrawal, as some of the mothers are heroin addicts—the focus is on one baby in particular, who is on methadone and possibly has AIDS. Powerful feelings are aroused in the nurses and in the observer. Margaret Cohen describes the gradual development in this baby of a sense of containment, the beginnings of exploration of her world and the rudimentary symbolic expression of a psychic conflict related to the experience of methadone.

This chapter was originally written for the doctors and nurses of the New Natal Intensive Care Unit (NNICU) where I work as a child psychotherapist. This Unit works mainly with very premature babies but also with very sick babies and those withdrawn from the drug their mothers were taking when they were in utero. The process of such a withdrawal is often very painful for the baby and taxing on the Staff’s imagination and patience. The chapter is concerned with the connection between these two. The Unit is divided into a high-dependency nursery and a special-care nursery, which is less technological. Parents are encouraged to spend time beside their babies and to take on some of their care little by little. Attempts are made to keep the lighting low and the noise controlled, but this is an environment of intense medical involvement. I would like to thank the Staff for their generosity in allowing me to work in their midst.

 

11. Projective identification: the analyst’s involvement

ePub

Michael Feldman

Michael Feldman describes in detail a particular form of interaction between patient and analyst where the latter is enacting— without initially being aware of it because it is congruent with some view he has of himself—the role that the patient wishes him to play. What the patient has projected into the analyst is not so much a part of the self but an archaic object relationship, and it is in this that the patient hopes to coerce the analyst to play a part as opposed to thinking about it. In this way the frightening discrepancy between the patient’s phantasy and the actual analytic situation can be reduced to comfortable proportions. But if this occurs, the pain remains imprisoned.

In Klein’s original formulation of the mechanism of projective identification, she referred to an unconscious phantasy in which the patient expelled (usually) disturbing contents into another object. This object is partially transformed in the patient’s mind as a consequence of the projection, being now possessed of qualities the patient has expelled. In addition to its use as a method of evacuation, Klein suggested that projective identification may fulfil a variety of other unconscious functions for the patient, such as leading him to believe that he possesses the object or controls it from within. These projective processes usually alternate with introjective ones. Thus the phantasy of forceful entry into the object by parts of the self in order to possess or control the object creates problems with normal introjection, which the patient may find difficult to distinguish from forceful entry from the outside, in retribution for his own violent projections (M. Klein, 1946, p. 11). The exploration of these unconscious phantasies has increased our understanding of the functions and defensive needs these primitive mental mechanisms serve for the patient. While the elucidation of these processes has, in the past, often seemed to emphasize the analyst’s role as a dispassionate observer, the impingement of the patient’s phantasies and actions on the analyst has in fact been recognized from the earliest days of psychoanalysis. Following the early work of Heimann (1950) and Racker (1958), there has been increasing interest in the systematic investigation of the way the patient’s phantasies, expressed in gross or subtle, verbal or non-verbal means, may come to influence the analyst’s state of mind and behaviour. Fairbairn (1958) wrote, “In a sense psychoanalytic treatment resolves itself into a struggle on the part of the patient to press gang his relationship with the analyst into the closed system of the inner world through the agency of transference.” We now recognize that while this conscious or unconscious pressure on the analyst may interfere with his functioning, it can also serve as an invaluable source of information concerning the patient’s unconscious mental life—his internal object relations in particular. More recently, a number of authors have been concerned to elaborate the concept of countertransference into what is described as an “interactive” model of psychoanalysis, where the emphasis is on the significance of the analyst’s own subjective experiences in his understanding of the patient and his method of responding to him or her. Tuckett (1995) has provided an excellent commentary on some of the interesting work in this area. Building upon the notions of Racker (1958), Sandler (1976), and Joseph (1989a), he elaborates a model of the analytic situation in which both the patient and the analyst engage in unconscious enactment, placing more or less subtle pressure on the other to relate to them in terms of a present unconscious phantasy. He makes the point that “… Enactment makes it possible to know in represent-able and communicable ways about deep unconscious identifications and primitive levels of functioning which could otherwise only be guessed at or discussed at the intellectual level”.

 

12. Psychic turbulence

ePub

Patricia Daniel

Patricia Daniel describes the complicated changes in the transference of a lonely, cut-off young man whose desperate need to be understood was repeatedly negated by various manoeuvres, such as ambiguity and falseness, by which he quickly moved away from genuine contact. He feared being shattered by contact with his own shattered internal objects. Images of glass are drawn on to convey qualities, especially of ambiguity—reflection with transparency, fragility, and shattering. With the gradual analytic dismantling of this combination of manic and obsessional defences, the psychic equilibrium that kept his pain imprisoned, was upset resulting in a turbulent, confused state. At the same time his dreams reflected greater stability.

This chapter is about defensive structures and the anxiety and psychic pain in changing them. I shall start by describing defences that were mobilized during the first part of an analysis and how these protected an ego felt to be extremely fragile, and which also sought to evade contact with an object felt to be shattered. These psychic structures were formed from a complex interlocking between schizoid and manic mechanisms. As the analysis proceeded, there was a change to a different structure in which a tie to an object was established and the patient began to experience conflict and anxiety, but the loosening of defences brought other problems associated with the movement towards more fluid but also more turbulent states.

 

13. The concept of the envious/jealous superego

ePub

Leslie Sohn

Leslie Sohn explores the concept of the envious or mad superego, its hypnotic quality, and its inevitable jealous component, illustrating this in the analyses of both non-psychotic and extremely disturbed psychotic patients, including murderers, all of whom had experienced considerable deprivation in childhood. Once the rest of the ego is in thrall to this envious/jealous superego, emotional pain will remain imprisoned—one might say embedded—in hallucinatory voices and delusions.

In the conclusion to her monograph, “Envy and Gratitude”, Melanie Klein (1957) says:

I have described in other connections the impact of the earliest internalized persecutory object—the retaliating, devouring and poisonous breast, I would now assume that the projection of the infant’s envy lends a particular complexion to his anxiety about the primal and later internal persecution. The “envious superego” is felt to disturb or annihilate all attempts at reparation and creativeness. It is also felt to make constant and exorbitant demands on the individual’s gratitude. For to persecution are added the guilt feelings that the persecutory internal objects are the result of the individual’s own envious and destructive impulses which have primarily spoilt the good object. The need for punishment, which finds satisfaction by the increased devaluation of the self, leads to a vicious circle. [p. 231]

 

14. Frozen pain

ePub

Joan Symington

This chapter outlines Bion’s relinquishment of the term superego and his expansion of the concept to include a ubiquitous “god” hostile to growth of the mind. This god arises from a primitive search both for the “cause” of the obstruction and for those morally responsible. This search interferes with the development of thought (selected fact and Ps D move), as illustrated in the analysis of a deprived woman whose pain was imprisoned in a frozen depression. Fear of this “god” resulted in persistent evacuation of the contents of her mind until the god could be confronted through an inner strengthening of the parental couple.

Sydney Klein has always been interested in Bion’s work and thinks that much of it has not been understood. One aspect of this is Bion’s idea of the superego. Bion viewed the transformation of emotional experience towards O or the ultimately unknowable reality as the pivot of analytic work, elaborating the L, H, or K link necessary for this transformation and the minus links against it. Related to the latter is his expanded view of the superego. This is revealed in his writings as he moves from the idea, expressed in his early paper, “Attacks on Linking” (Bion, 1959), of an ego destructive superego, associated with perceived imperviousness of the object to a god hostile to the acquisition of knowledge of emotional experience— that is, hostile to transformations in O. This “god” is a ubiquitous anti-growth component of social life, seen in myths and embodied in groups and institutions (Bion, 1970, p. 112). Melanie Klein did not agree with Bion’s use of the term “superego”, which she thought should be reserved for internal objects (H. S. Klein, personal communication, 1996). In fact, Bion practically abandoned the term, saying in 1978 that in his experience he had found little evidence for the ego, superego, and id; rather, the self that has the capability of being a good father or mother is kept under (Bion, 1978).

 

Details

Print Book
E-Books
Slices

Format name
ePub (DRM)
Encrypted
true
Sku
9781780497662
Isbn
9781780497662
File size
0 Bytes
Printing
Disabled
Copying
Disabled
Read aloud
No
Format name
ePub
Encrypted
No
Printing
Allowed
Copying
Allowed
Read aloud
Allowed
Sku
In metadata
Isbn
In metadata
File size
In metadata