41 Chapters
Medium 9781855759107

1. The setting

Cohen, Margaret Karnac Books ePub

… sent before my time
Into this breathing world, scarce half made up

Shakespeare, Richard III, Act I, Scene 1

One enters the neonatal intensive care unit (NICU) through a locked door. From the very beginning one has strong thoughts: this is a world apart—some privileged people have cards that open the door, others have to wait until they have identified themselves. It is a world to which one has to gain entry. There is a sense that what is inside is fragile and that what is outside may be dangerous. Sometimes doctors who occasionally have to run quickly with babies from the labour ward to the NICU are worried about gaining entry fast enough. In the time that I have been working on the NICU, entry to the unit has become more difficult—and I think this is to do with a stronger perception that we live in a dangerous world. I have often thought that there is something womb-like about the unit: it is apart from the rest of the hospital, hard to gain entry to, and very enclosed.

Figure 1. Incubator.

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Medium 9781782204343

7 - Supervision as a Space for the Co-Creation of Imaginative Conjectures

Karnac Books ePub

Clara Nemas

“So these are my ideas on supervision. You can see [it] is not like a master class in music. It is more of a participation—more like playing in the orchestra; just contributing…”

Donald Meltzer, “On the Nature of Supervision”
(in Oelsner & Oelsner, 2005)

Contact with the work and the person of Donald Meltzer has produced in all who met him not only a strong conviction in the value of the psychoanalytic method and a most vivid approach to our clinical work with children, adolescents, and adults, but also changes to our view of the world, of life, and of the human being. All this made of each contact with Meltzer an emotional learning experience: a K-link, to use Bion's term. But it was in his supervisions—“eye openers”, as Francis Tustin once called them—that one could feel the passion, the capacity for observation, and the “real proof of his experience” and creativity full at work. I must say that none of this would have been possible without the generosity of Benito López, our teacher for so many years, who first introduced us, in Buenos Aires, to the work of Meltzer and, later, to his dear friend, the man himself in person.

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Medium 9781855752405

12. Living in intrusive identification

Meltzer, Donald Karnac Books ePub

Carlos Tabbia Leoni

It is difficult for me to unite the term “living” with that of “intrusive identification” as I consider that the relation between both is practically exclusive. The “living” of projective identification is a mere reflection or a parody of the “living” in relation with the objects. “Living” being able to tolerate the conjunction of the “links of relationship” with the “anti-links”— anti-emotion, anti-knowledge, and anti-life (cf. Meltzer et aL, 1986)—favours not only the development of the mind, but also the capacity to experience love, joy, hope, pain, aesthetic pleasure, conflicts, and so on, all of which is impossible while one is “living in intrusive identification”. One only lives outside the object. Inside the object one only survives, only lives badly.

“Living inside an object” is an omnipotent fantasy correlative to “intrusive identification” in an internal object,1 transformed into a “claustrum”; this fantasy differs from the communicative function of projective identification. Some of the queries that emerge from this nuclear theme are the following. Is claustrophilia2 an omnipresent fantasy? Does the object of the claustrophilia always become a claustrum? Into which internal objects is the intrusion carried out? What is the motive that drives one to lose one’s life in order to attain a pseudo-existence? What are the consequences of intrusion for that part of the self that penetrates intrusively into the object? My contribution will be centred on this latter query. I would like to present, using different material, what happens to the intrusive part that seeks, to a varying degree, to live inside the other. In this chapter, I show the relationship of the self with its objects, or the paralysation of the self as a result of masturbatory-intrusive attacks on the internal objects; subsequently, I discuss the mental state of the inhabitants of the claustrum; and, finally, I illustrate all of this with the clinical material of a borderline patient. One could reformulate the claustrophilic motivation giving as an example a “joke” attributed to Cantinflas (a Mexican comedian): “What do we come into the world for?—to suffer? If that’s the case, we’re going back!” The subjacent fantasy of return-intrusion-confusion3 with the object seeks to eliminate pain, implicit in the differentiation subject-object. But, the price paid for avoiding mental pain is high. Once the patient has worked his or her way inside the internal object, he or she remains trapped there. Meltzer pointed out in a seminar4 that once Jane, the patient he was discussing, had penetrated the object, she remained separate from other people by a glass division, referring to the glass divisions of the compartments where she worked, inside which she adopted the necessary social behaviour but was incapable of maintaining intimate social relations. Inside the object one is protected from the world, but one also loses it—like the Wolf Man, who felt fortunate to have come into the world protected by a foetal lining, a veil that hid him from the world and hid the world from him (Freud, 1918b [1914]). The flight from the world in intrusive identification is so great that there is neither any contact with reality nor any idea of psychic reality (internal-external); there is a lack of the idea of nature, and reality is anthropomorphized; one does not live sufficiently in the external world, therefore access to meanings and value is banned; time, if it exists, is circular. Meltzer (1992a) enumerates other consequences of intrusion: “… the intruding part of the personality suffers from anxieties that are contingent on the fact of being uninvited. He is a trespasser, an impostor, a poseur, a. fraud, potentially a traitor. But he is also an exile from the world of intimacy, from the beauty of the world, which at best he can see, hear, smell, taste only second-hand through the medium of the object” (p. 72, emphasis added). The intruder feels as much a prisoner as Segismundo in La vida es sueno, by Pedro Calderon de la Barca [1600-1681], in his tower:

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4. The beauty and the violence of love

Meltzer, Donald Karnac Books ePub

Didier Houzel

Melanie Klein was fundamentally original in the way, for example, she so quickly adopted the second theory of the instincts as proposed by Freud in 1920 in Beyond the Pleasure Principle, in spite of the fact that, at the same time, it was rejected by most psychoanalysts. Klein’s support for the theory of the death instinct constituted one of the sources of her remarkable gift for exploring the world of psychosis and the more primitive levels of psychic development. That said, she never really succeeded in integrating the concept of the death instinct with her own metapsychological model; she endeavoured to assign to all mental suffering and to every defence mechanism some degree of fantasy content based on a libidinal or aggressive cathexis either of the individual’s own body or of the object. She did this, for instance, in her earlier writings where, following Karl Abraham, she described the aggressive impulses of infancy in terms of oral, anal, urethral, and muscular attacks, this sadistic phase reaching a climax at the end of the first year of life. Once she had adopted the theory of life and death instincts, she was able not only to investigate the deepest layers of the unconscious even more thoroughly, but also to draw up such an outstandingly coherent map of the mind and its development that, even today, its riches are far from exhausted. Nonetheless, Klein did to some extent fail in her attempt to formulate a concrete description of mental and psycho-pathological processes, in so far as her sole reference was to zones and functions of the body; it was only at a much later date, when she introduced the concept of envy (1957), that she went some way to remedying this situation. But even then her description remained incomplete, given that she still felt obliged, in her account of its pathogenic and non-pathogenic effects, to claim that envy was constitutional in origin; in so doing, she moved away from the field of investigation specific to psychoanalysis, something that never fails to generate serious epistemological, theoretical, and even technical difficulties.

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Medium 9781782204343

10 - The Second Life of Dreaming

Karnac Books ePub

Jeffrey L. Eaton

“[W]hat of the fruitful harvest of those dreams which succeed in grasping the nettle of mental pain, resolving a conflict, relinquishing an untenable position? We will surely wish our hypothesis about dream-life to shed some light on this question of growth.”

Donald Meltzer, Dream-Life (1983)

For Donald Meltzer, dreaming is at the centre of the psychoanalytic experience. He links the exploration of dreams with the efficacy of the psychoanalytic process. Exploring dream-life helps to glimpse the way dreaming contributes to what Meltzer calls “the question of growth”. Here, I offer some personal reflections, inspired by Meltzer, on the fruitful harvest of dreams and dreaming.

The second life of dreaming

What is the fate of the dream, the thing-in-itself, upon waking? The situation is simple: the dream has vanished. In fact, we never remember our dreams. Upon waking, we can collect only bits of evidence that the dream was recently alive and wandering inside us. The fragments and details, the emotions, and the unpredictable residue that lingers from the inventiveness of our dream-life are like the skeletal traces of a fabulous lost beast. The dream itself can never be recovered, relived, or represented in any complete way.

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