The Soul, the Mind, and the Psychoanalyst

David Rosenfeld

• Publisher: Routledge
• Year: 2019
• Topic: Psychology
• eBook ISBN:
  9780429922275
• Subtopic: History & Theory in Psychology
• Index: Psychology

This book is based on various cases whose common factor is how the psychoanalytic setting is created: the internalization and realization inside the patient`s mind: with the feeling of fixed hours and the transferential relation with the psychoanalyst. Referring to the great masters of psychoanalysis, the author guides us step by step through the mysterious terrain of the mind, especially in its most regressive, primitive and psychotic aspects. Thomas Ogden, commenting on the papers collected here, wrote that 'they represent two of the most important contributions of the past decade to the understanding of the psychoanalytic treatment of psychotic patients'. This book is intended to be felt and thought about. The reader is asked to read between the lines, to imagine and feel beyond the words on the page. It will appeal to psychoanalysts, psychotherapists and students.

Chapter One
September 11th: military dictatorship and psychotic episode—year 1973

Even in a state so far removed from reality as hallucinatory confusion . . . that at one time in some corner of their mind there was a normal person hidden.

Freud, 1940a

In this clinical history I describe the story of a young patient who could be considered a paradigmatic case illustrating the effects produced by military dictatorships that were similar in several South American countries.

In the methodological perspective, the therapist is faced with the not always easy task of continuing to think as a psychoanalyst in spite of the real traumatic events suffered by the patient, in terms of the patient’s unconscious dynamics in the transference, while also considering his infantile world—and, especially, to be able to bring to a verbal level the terrible traumatic experience of a child under 2 years of age, who was handed over to a neighbour while his parents were being kidnapped by military personnel and then taken to secret centres of detention and torture.

The traumatic stress for a child, unprepared to anticipate danger, faced with the terrible, abrupt disappearance of his mother’s and father’s familiar voices and faces, is very difficult to work through. This traumatic stress remains forever engraved on the child’s receptive mind, which is prone to great sensitivity and suffering in relation to separations and abandonment. For this reason I tried to pay special attention to our leave-taking at the end of each session (see the session in which the patient turns into a butterfly).

The grandmother had taken charge of the child and filled a fundamental role: reconstructing lost internal and external relationships.

The childhood and family history came up in the sessions in a confused, disordered way and was sometimes enacted during the session without words. It was reassembled, reconstructed, taken apart and reorganized again in the patient’s mind and in mine as well.

At other times, this history was enacted within the session—he ripped pillows apart, wore dirty clothes, and looked like an 18-month-old baby.

Throughout the interviews I slowly found out how the parents had been persecuted and terribly tortured by the military and secret services of the Pinochet dictatorship.

In time they were able to escape from their country, Chile, and hide in an abbey in Brazil. But there they were harried by the secret services, since the dictatorship in Brazil—like those in Argentina, Uruguay, and Chile—had organized the Condor Plan, with which they persecuted, tortured, and murdered all those who opposed their dictatorships.

Later, the family were able to move secretly to a suburb of Buenos Aires, where they continued to live.

This clinical history begins with the patient’s treatment in the city of Buenos Aires, which began after he was released from a psychiatric hospital following a psychotic episode.

The title refers to a historical fact that occurred on 11 September 1973: the day the coup d’état began in Chile, when Pinochet ordered the attack and aerial bombardment of the presidential palace, assassinating President Salvador Allende—elected in free elections—and the members of his Cabinet.

This is the other story.

"Abelard"

Methodological problems

My approach to the treatment of this patient included taking into account the real—that is, the reality of his parents’ disappearance when Abelard was 18 months old and the consequent real destruction of family relationships. At the other pole, I tried to continue to think as a psychoanalyst, in order to understand his internal world, as well as the transference and the repetition of infantile traumata and psychosis in the transference.

One wonders whether it is possible to keep oneself, as a psychoanalyst, within the strict boundaries of cold scientificism and avoid being moved and abandoning one’s role when confronted with the terrible and serious facts of bloody dictatorships that destroy lives and minds. This describes the complexity of this treatment.

I wish to discuss the difficult task, in these extreme situations, of a psychoanalyst who is treating a patient as well as the child within this patient.

Although I cannot omit my intense emotional response to the patient’s descriptions, I tried to work with the instruments of psychoanalytic science (Klimovsky, 1971, 1980a).

The clinical and theoretical conclusions and the models used in this clinical work can be applied to other, similar cases.

As for the analytic technique, I tried to be very cautious and not too intrusive, in order to avoid hasty interpretations, given the patient’s fragility, and because I assumed that words could be felt as if they were torturers in his ears (see the session when he says: “Don’t torture me, Doctor”).

I also carefully awaited the appropriate material before interpreting his sexual problem, which was quite mixed up in his internal world with the tortures and sexual abuses suffered by his mother at the hands of the military.

In the final conclusions I include a section on the childhood origins of mental confusion, particularly because of the family’s confusing double-binds.

The father’s role is also described in the final conclusions, including the oedipal conflict.

The confusions of self-identity with his mother’s female body are described, as well as his own fantasies of his internal world. (Example: at one point, the patient says: “The truth is, sometimes when I wake up and look at myself in the mirror . . . I think I’m seeing my Mum’s face. . . . ”)

I have selected the material in order to show what happens in the transference between the patient and the analyst, including acting out or enactment in the session, ranging from sobbing to violence, and the therapist’s intense countertransferential emotional experiences.

I used some models that were useful to understand the mental dynamics and moments of psychotic confusion.

The patient re-creates in the transference moments of the first months of life and of his psychotic episode.

One of the methods of investigation used is “autistic encapsulation”: the encapsulation of aspects of good relationships and good infantile relations in the patient’s mind (Rosenfeld, 1992b).

The other basic model is that, in the face of severe real traumata, all introjections or introjective identifications can disappear.

For this reason, I move between two poles of the problem: one, the possibility that everything introjected can disappear; the other, healthier aspects lie “autistically encapsulated” in a different mental space. When the introjects disappear, they can sometimes be recovered. In my experience treating survivors fleeing from the Nazis in Europe, they sometimes remember their own names or their childhood language—German, Italian, and so on—only decades later, while others remember the songs and music of those early years.

This patient ultimately believed that he had also lost his internal and emotional relationships.

Aside from the patient’s psychotic moments and mental confusion, we also gradually investigated and discovered the family’s systems of communication: double-binds and contradictory messages, as well as a distorted perception of reality, especially by his mother. It was important to detect the confusing double-binds his mother tended to give Abelard, as well as the way she distorted his perception of reality, sometimes with simple anecdotes that, nonetheless, produced intense effects in the young patient’s mind. For example, she told him that she had gone to speak to the psychoanalyst because he had asked her to do so, which was not true. This is the family foundation or basis of his psychopathology and mental fragility, in addition to the patient’s own dynamics and psychopathology. It is also related to the role of the father, as we shall see in the theoretical conclusions.

We are psychoanalysts and also teachers in a way, since we teach the patient other aspects of the world and reality and, of course, of internal reality as well.

Psychoanalysis, besides interpreting, tries to teach patients to be epistemologists of themselves.

The treatment

The first interview

I had to have the first interview in the house where Abelard lived—the home of his grandmother, with whom he was living.

The patient, a young man of 23, hardly left his bed and was very isolated from his friends.

I went to see him at about 11 am.

He walked into the room as if still asleep and looked untidy and unclean. I thought that he was also over-medicated.

Both the patient and his grandmother—a very kind and affectionate person—said that he couldn’t manage to wake up yet, so he went back to bed. He only returned at 2 pm.

Then, when he got up, we talked about a future treatment with me, and he asked me if we could have an “espresso” at the corner café, since he also didn’t want his grandmother to listen in. I accepted.

The patient went out with me, untidy and uncombed. He started talking about his psychiatric hospitalization and, later, about his medication. He said that it made him feel “groggy, dizzy, sleepy”.

He went on talking about his state of abulia and isolation. He explained that he preferred to live with his grandmother, who was very affectionate towards him, rather than with his mother or father, who were divorced.

He told me he didn’t like to go to dances or parties, adding that he had only a few friends—though good ones, with whom he went out to eat.

He expressed interest in knowing what the individual treatment with me would be like, and we talked about it. We agreed to have another interview at 5 pm.

In this interval, I spoke to the psychiatrist medicating him, who was pleasant and correct. I told him that the patient seemed over-medicated to me. The “family therapist” also came in to talk to me, insinuating that she didn’t believe young Abelard needed individual therapy, and that “she was already treating the family”.

At 5 PM, I met with the patient again. He looked tidier, and said he had taken a shower.

I told him what I had talked about with the psychiatrist and the family therapist who was treating him and his family. Abelard looked at me with surprise and said, “But . . . but I don’t go to those family meetings. She only treats my mother and sister, and sometimes calls my father. . . . ” I didn’t conceal my expression of surprise and annoyance, and told him what the “family therapist” had told me.

Later, he told me he would be going out to dinner with a friend that evening. He added that he actually went out with friends very seldom.

We then talked about the treatment he would start with me, which a member of the family had agreed to pay for.

He and his grandmother decided he would move to the house of an aunt who lived near my office, since the house he was living in was quite far away—in another city south of Buenos Aires.

I offered him a session every day, and, as in other cases like his, I asked him to come twice a day for the first two or three months. Abelard accepted my offer of treatment.

I then explained what the treatment with me would be like. I told him that I always start the treatment very intensively in these cases.

The book came unbound (First session)

Abelard came to my office. He is now staying with his aunt, who lives near my office, so that he can have sessions every day.

The patient’s physical appearance is in total disorder: he wears tennis shoes much too large for him, thick socks that fall down around his ankles, a pair of shorts, socks of different colours, both legs hairy, his T-shirt dirty, and a cowboy hat, with hair falling down all over.

He immediately tells me that he has just come from his aunt’s house; I ask him, “How are you? How’s it going?” The patient’s answer surprises me. He says, “Well, I’m doing well with the alcohol.” Then he adds, “I don’t know what to do, I wake up at 5 am, I don’t know what to do, I don’t know what to do. . . . I wander around and I read. I wake up, I wander around, I go out for a walk. At 5 am there is nobody on the streets of the city.”

I ask whether he had a nightmare or “saw something” that might have woken him up suddenly. The patient answers tangentially: “I was walking alone.” I ask, “Did you think of coming here or calling me at night?” The patient only answers, “I don’t know, I don’t know, I walked and walked.” Then he tells me that he walked all the way to a downtown area where there are several bookstores, and he read a few pages of poetry, adding, “How nice! In Buenos Aires there are bookstores open at night.” (I thought about the transference relation: that in this new treatment he had discovered a place where he could go and be received).

Then the patient says that he walked down a very well-known avenue downtown, and although he preferred to talk about the book of poetry he had bought to calm himself down, the therapist thought that this was the narration of a person who was having a nightmare he couldn’t shake off. This was only a countertransference feeling. At the end of the session, I tell him that it is a good sign that he has thought about coming in and getting treatment with me, and that if he woke up some time from a nightmare, it would be good for him to come in or phone me. The patient answers, “Yes, I could do that, it’s going to help me.”

The patient gives some details of aspects of the book he bought, which I consider narrations in the form of poetry, written by people who have suffered. I don’t interpret this, as I am tryi...

Table of contents

• Cover
• Half Title
• Title
• Copyright
• Dedication
• Contents
• ACKNOWLEDGEMENTS
• FOREWORD
• PREFACE
• ABOUT THE AUTHOR
• CHAPTER ONE September 11th: military dictatorship and psychotic episode—year 1973
• CHAPTER TWO Eating disorders: psychoanalytic technique
• CHAPTER THREE Drug abuse, regression, and primitive object relations
• CHAPTER FOUR Psychotic addiction to video games
• CHAPTER FIVE Listening to and interpreting a psychotic patient
• CHAPTER SIX Autistic encapsulation
• CHAPTER SEVEN Psychotic body image
• CHAPTER EIGHT Dialogue with Shakespeare and Jean-Paul Sartre about psychoanalysis and scientific methodology
• REFERENCES AND BIBLIOGRAPHY
• INDEX