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CHAPTER NINE: Countertransference with mentally handicapped patients

Neville Symington Karnac Books ePub

“If only Walter had been born a dog and not a human child, how easy it would be to end her sense of responsibility. A vet with a pill or an injection, administered while she protested love and kindness, could free her”

(Cook, 1978, p. 46)

At the time when I was conducting a workshop on the psychotherapy of mentally handicapped people at the A Tavistock we were all confronted one day with a very shocking piece of knowledge. It was a piece of knowledge that each of us possessed but it had not come to light until one particular session of the workshop. It was that we all treated mentally handicapped people with contempt and that we did not have this contempt towards “normal” people. I will explain the matter in more detail.

In the workshop we had decided in one term to try to differentiate our psychodynamic technique with the mentally handicapped from that used with “normal” people. Thus, we investigated our manner of interpretation, the nature of the transference in this category of client, and the anxiety attending on change. The question of countertransference also came under review. It was then that the discovery I have alluded to was made. On the level of consciousness we had sympathy towards mentally handicapped people, which had in part instigated the formation of the workshop. We had also come to realize the painful isolation that many mentally handicapped people live in. Therefore, on the level of consciousness, we were passionately devoted to our work with these people, had a self-righteous self-regard, and felt critical towards those colleagues of ours who would only consider people suitable for psychotherapy if they had a university level IQ. Our contempt then had been below the threshold of awareness. This is how the shocking story of our inner attitudes came about.

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22. Reverse perspective

Neville Symington Karnac Books ePub

The greatest wisdoms are not those which are written down but those which are passed between human beings who understand each other.

Salley Vickers, Miss Garnet’s Angel (2000, pp. 232-233)

I said at the beginning that it was necessary to read this book twice, but I am going to try to gather some of the key elements together into one.

The first thing that needs to be said is that the model I am proposing in this book is a myth. It is not a concrete thing. It is one way of organizing the internal determinants that go to make up the state that we call madness. It is a particular observational angle upon it, and in that statement is already the suggestion that other angles are left out. The question I want to address here is “How does the perspective that gives rise to madness become reversed so that we no longer have madness but sanity?” If we can answer this question, we shall have made a momentous contribution. The problem is that the answer is something that each individual clinician has to make, and what is more we are not talking of an intellectual answer alone but one that is intellectual and emotional. Therefore it requires not just an intellectual effort but an emotional transformation. What we are looking for, then, is a reversal of the perspective that generates madness.

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9. Meissner's Critique of Freud

Neville Symington Karnac Books ePub

Quite by the way, why did none of the devout create psychoanalysis? Why did one have to wait for a completely godless Jew?

(Freud, 1963)

The most comprehensive assessment of Freud's attitude to religion is to be found in W. W. Meissner's book Psychoanalysis and Religious Experience. Meissner examines Freud's arguments in his main texts on religion, and then in particular discusses the great debate on religion that took place between Freud and Oskar Pfister, a friend and colleague. In this chapter I shall look at this debate, and Meissner's perceptive commentary on it.


Freud published The Future of an Illusion in Imago in 1927, and Pfister published a reply the following year entitled The Illusion of a Future. Pfister, a Lutheran pastor working in a parish in Zurich, discovered Freud's writings in 1908 and from that moment became an enthusiastic disciple. Despite being a firm believer in the Christian faith, he and Freud remained firm friends. It was probably Pfister's unbounded respect for Freud's genius that enabled Freud to tolerate his friend's disagreement with his own religious position. Freud was thus pleased that it was Pfister who replied to his article against religion (the subtitle of Pfister's article is ‘A friendly dispute with Prof. Dr. Sigm. Freud’). He knew his article would call forth replies from defenders of religious faith, and this being the case, a reply from Pfister was more welcome than from some other quarter, which would probably be more hostile.

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Chapter Four: Nightmare in Lisbon

Neville Symington Karnac Books ePub

Iarrived in Lisbon early in 1957 on the Andes which docked at the Alcantara Quay and I was met by my mother and Clay Wilson. After the violent rupture of my mother's friendship with Clare she became friendly with Clay and decided to set up a teashop with her in Cascais. Clay was the most unlikely person to be running a teashop. She was a fulsome figure of a woman who drank heavily, was somewhat insensitive, and very different from Clare. My mother and Clay were sharing a flat in Monte Estoril and had arranged for me to stay there too. I initially set up office with Count Gerald O'Kelly de Gallagh. He had been the Irish ambassador or minister in Lisbon and when he retired he started a small business selling French wine and brandy to a few gourmet customers. I worked for him and also started my own business. O'Kelly had a difficult task selling expensive French wines to the Portuguese who were well supplied with their own wine; his wines cost twenty times more than local varieties. His logo was: The cheapest is never the best; the best is ever the cheapest. The day after I arrived I went to visit him at the office which I was to share with him. He was a short, vigorous man with white hair and a goatee beard. He had hooded eyes that stimulated a distrust and reserve in me. At that first meeting he said he would like to ask me to dinner but his wife was a little ill that day, but as soon as she recovered he would invite me. The next day his wife died. I went to the funeral a day later. The coffin was brought to the graveside and he was standing there watching when, to my alarm, the coffin was opened with the body exposed and two men poured quicklime over the corpse. He stood there watching as all the diplomatic corps of Lisbon stood in a large circle gazing at this macabre scene. He seemed to me like a caged animal in a zoo being watched by voyeuristic tourists. I felt so sorry for him. A few days later he invited my mother and me to lunch. A little papillon dog came into the room and whined. He said, “He used to climb onto my wife's lap; he is whining because now there is no lap.” When lunch was ended he asked if we would stay while he read aloud to us a story. I was too moved by his recent loss to hear the story but I remember he read with effective power. I came to know him quite well over the next few months but I was always somewhat timid in his presence.

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8. The jelly

Neville Symington Karnac Books ePub


A wave comes from the left
And thaf s the way I move,
My tail is a rudder
But currents are a pilot
That decide every heading.
The currents are a pressure
That I’m unable to resist
My tail can only move me
Quicker down their channels
I am their helpless victim.
A tone of voice; a raised eyebrow;
A haughty manner or nose in the air,
A suspicious look or a rude gaze,
These are the currents that drive me
Along life’s waterways.
I’m in a shoal with others,
I feel their bodies swish
And I swirl with them all;
They are the currents of my life
With no soul to resist.

Neville Symington

I have said that the presence of narcissism prevents the individual from initiating emotional action of a positive kind (Symington, 2000, p. 52). This makes sense when we realize that the centre of the personality is an amorphous jelly. Sometimes people will describe it by saying things like:

“When my girlfriend became angry, with me I was a jelly inside.”


“Although I am speaking to you coherently, I am just a heap of fragments inside.”

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