Absolute Truth and Unbearable Psychic Pain

Psychoanalytic Perspectives on Concrete Experience

Allan Frosch

• Publisher: Routledge
• Year: 2018
• eBook ISBN: 9780429910548
• Topic: Psychology
• Subtopic: History & Theory in Psychology
• Index: Psychology

This book offers a wealth of original contributions, all promising steps towards a fuller understanding of the phenomenon of "concreteness" and towards more effective approaches to the clinical challenges concreteness poses.

Chapter One
Concretisation, reflective thought, and the emissary function of the dream

Maxine Anderson

Introduction

It seems that we live in at least two mental worlds: one defined by intense sensory experience, and another more gently crafted by attunement and thought. While we may wish to think of ourselves as residing primarily and maturely amid thought and reflection, a clear-eyed view will reveal that we spend much if not most of our time in the concrete, sensory-dominated world of “how it is”. Indeed this sensory level of experience shades and shapes much of the texture of our emotional lives, but perhaps due to its bedrock nature and profound impact, it may also exert a gravitational pull, easily dismantling the products of thought and our capacities to think back into the basic sensory elements from which they evolve. In this chapter I will attempt to explore some aspects of this to and fro between these two realms of the psyche and the de-animating power of the entropic pull. In addition I will illustrate some countermeasures we may employ to restore and protect the realm of thought. And I will also suggest that the well-attended dream has a role to play both as guide to and emissary between these different realms of the psyche.

One added introductory note: while heavily influenced by Bion, and several of his students, whom I will note, I will try to remain descriptive of clinical and personal experience in this discussion, hoping to invite new ideas to emerge and to avoid the possible narrowing of thought which heavy reliance upon theory can impose.

The concrete state of mind

Simply put, the concrete state of mind relates to reality in terms of sensory perception and sensory experience, defining reality in terms of what the peripheral senses convey. More specifically it is a state of mind in which metaphor and symbolic thought are not available. For instance, before the laws of gravity came into general awareness, people explained apples dropping from a tree as “just falling down”. Without access to symbolic thought or reasoning we rely on sensory experience and sensory-based explanations of reality.

From this perspective there is no reference to interiority or to inner space where one may feel held in mind or where thought might reside. Years ago a five-year-old patient responded to my giving a thoughtful context for his rampages with a startled statement of “Oh, at my house we don’t do that … things just happen and then Mom yells at me.” This young patient was expressing the experiential world of “how it is” (“things just happen”), but once he felt held in mind by my efforts to understand he could begin to contrast this with his experience of his mother’s non-receiving (“yelling”) state of mind. At the time I was impressed by this very young child’s observation, but also I could more deeply appreciate how a child’s development including his capacities for thought may be impacted by his parent’s (in)capacities to receive and to really think about his experiences and expressions.

The development of the capacity for thought

My current notions about the development of the capacity for reflective thought involve the notion of “reverie”, Bion’s notion of the quality of the care-taking mind’s openness to respond to tension or distress, and by way of thinking about that distress to transform it into meaning (Bion, 1962). The distress-based self then gradually learns that a mind “out there” is transforming his/her unthinkable experience into meaningful communication. The growing self thus learns through the process of being thought about how to think about itself and the world. This capacity, born by feeling held in mind, offers a leap beyond the two-dimensional, concrete “how it is” world. A three-dimensional mind with space for thought and reflection comes into view via the experience of having been thought about, and having felt known. And it is this same function that serves our therapeutic efforts to nourish our distressed patients, as well as our own distressed selves. Nevertheless, when concretisation is predominant, we need to be aware that these thinking and knowing capacities will often collapse back to the two-dimensional (“how it is”) mental world defined by sensory experience, often with such intensity as to be considered a so-called “truth”.

The tension between two mental realms

Such a collapse into the concrete may occur more often than we might imagine, as evidenced by our powerful uncontained emotions. For example, when we are encumbered by fear, anxiety, or rage we feel pressured and defensive but also probably unable to conceptualise that we are being tormented by fear, pressured by anxiety, or swept away by rage. Our clamorous emotions so easily overtaking the quiet space of repose and thought reduce any sense of inner space to a two-dimensional, reactive experience etched by that affect. And when we cannot think about this process we are condemned to be defined by that sensory experience, so that we are unable to think about being tormented or pressured; instead, we feel concretely “trapped forever” within that fear, rage, or anxiety. A similar state is characteristic of our intensely held “certainties”: in the absence of thought we are condemned to the pressured insistence of being either absolutely right, or catastrophically wrong.

The similarity continues, when as the clinician I feel I have become the target of an intense barrage, such as a penetrating accusation, or overwhelming rage, I may feel my boundaries thinned or breached, and feel myself inclined to slip into a concrete, reactive place as well. The barrage may be something my patient cannot bear to feel, such as a sense of futility, incompetence, or stupidity, which then is unconsciously but violently projected my way. In my clinical openness I may then feel that unbearable emotion, and because of the intensity of the projection I feel overtaken or defined by its “truth”, and then in turn “become” the hopeless, incompetent, or stupid one. Of course, when so defined I do not have access to my thinking self, and am thus unable to think about the situation as a matter of my receiving and not being able to metabolise a mind-numbing projection. In order to reverse this process of concretisation, that is to rescue my thinking capacity, I need to be able to develop a sturdy boundary, in the moment, if possible, or continuously, as I can, in order to protect my thought and my capacity for awareness about the nature of this type of functioning. And, as most of us know, acquiring this facility often takes years of clinical experience.

Another circumstance related to my slipping into the concrete, reactive mode is my own inner debilitation, be it from fatigue, pre-occupation, chagrin, or any other of those elements that can trigger doubt about my own capacities. My own doubt can penetrate and wither my thinking capacities as thoroughly as can my patient’s accusations, and can lead to my connection with my thinking self giving way to a heavy, dull sense of “being incompetent or stupid or wrong”. It is as if doubt mimics the erosive effects of concretisation, acting to neutralise the products of thought, and altering meaning from an animate (thinkable) state toward a deanimated (drained of meaning or unthinkable) one. It follows here that when I am without thought I am condemned to concrete experience and reactivity.

Concretisation as the mechanism for the deanimation of thought

I would now like to turn to some of the mechanisms involved in this concretising process. In a previous paper (Anderson, 1999) I include a quote from P. C. Sandler (1997): “There appears to be a universal tendency to replace psychic reality with material reality, which coexists with and opposes the development of thinking … [that is] the existence of an active concretization … [which] ‘turns’ in phantasy, in the mind of the person, either patient or analyst, what is animate (linked with meaning) into what is inanimate (a more meaningless sensory state)” (p. 47).

In his argument for the concept of a normative concretising function which he terms “anti-alpha function”, Sandler further states:

The human mind has difficulty containing immaterial abstractions within psychic boundaries … The material products resulting from the action of anti-alpha function carry with them from the beginning the marks of such defensive processes as denial, reaction formation, displacement and condensation. The concretization of psychic reality precludes the occurrence of free association … [and fosters] acting out. When anti-alpha function is in operation, one is bound to “transform”, as it were, energy into matter … it seems that the mind promotes an active transformation of what is alive into what is dead, and people deal with living creatures and their productions … as if they were inanimate … the container or receptacle is also regarded as an inanimate thing. (1997, pp. 47–49)

As part of his discussion, Sandler also reviews the way concretisation fuels the virulence of some forms of projective identification:

Projective identification is the concretization of an emotion and of feelings; through this very concretization one is enabled to build up a phantasy of “projecting” something into someone else, for the “something” projected is not a thing, it is not material, but the person who projects deals with it sensuously, as if it were a concrete thing amenable to be projected … (1997, p. 48).

Elsewhere in my paper I also mention Meltzer’s notion that the vulnerable receiver of those projections also deals with them sensuously. When we do not have access to our protected thinking selves (our “good internal objects” to use Meltzer’s terms) we are subject to being overwhelmed by the bombardment of untransformable sensory elements (withering projections or accusations) and thus to being defined by them (“becoming dull and incompetent”) which—again in Meltzer’s terms—is finding oneself encumbered by “dead objects”. Meltzer holds that this is a universal human occurrence when live-minded thought is not available. Concretisation, then, may usefully be thought of as the mechanism active in the deanimation of thought or as providing the gateway where dead objects may enter or prevail (Anderson, 1999, p. 513).

The lack of inner agency and the pull to the familiar

The self in a sensory-dominated world, then, not in touch with the interiority of mindfulness, has no notion of mental space or of inner agency. Instead the self is experienced as a two-dimensional target or surface for sensory impact, and can only relate reactively to agency and responsibility as if to causes and powers residing outside the self (“It’s all your fault” … “My boss is so mean and I am so small” or … “There is no help available”). And in this state without the protection of compassionate thought the cruel, self-battering so-called superego, as the embodiment of psychic trauma, is experienced concretely as a brutal, condemning “truth” about one’s inadequacy or badness.

One patient, Ms A, lost her mother when she was very small, and due to an overwhelmed family atmosphere she seemed to have had little or no experience in feeling held in mind or known about. While she has attained moderate success professionally, she seems to have spent much of her life feeling lost or “in hiding”, moderately and at times seriously depressed, paralysed by passivity, and unable to feel much sense of attachment or commitment to person or place. Loyalty to and identification with her dead mother appears to underlie a “bleak forever” state of mind, which early in our work seemed impervious to my attempts to bring understanding. While more recently she has come to feel more accompanied and understood—and thus more alive—this reprieve is short-lived as she seems to gravitate back to the identification with the inanimate bleakness as “who I am … what I have always known”. It appears that loyalties to the familiar past, as deadened and painful as they may be, can powerfully outweigh the as yet unknown possibilities for new life and hope which my patient discovers when she can internalise our work and begin to connect with live-minded thought, attendant self-reflection, and budding self-respect.

Yet at times our patients do have rather clear insights into these burdensome dilemmas that can so entrap them: Mr B, subject to violent outbursts but also capable at times of reflecting upon his own concreteness, observed, I thought astutely, that his immaturities and agitations seem to propel him back into the state where his familiar violent primitive emotions take charge, convincing him that to invoke restraint and concern is “too hard … not fair … too much of a burden”. Mr B seemed to eloquently express how the violent protest from his own concrete states could attack or expel potential thought and inner agency. He further seemed to be describing an outrage that creates a war zone, violently shredding his inner authority (“It’s not fair … I shouldn’t have to”) such that at those times he feels caught in the debris field of jagged self-loathing (“I’m so worthless … just a piece of shit”). He continues to describe these attacks upon his own capacities as preserving a “perverse bubble” (his words) as a residence for the infantile, impulsive, impoverished self, which so hates (and so refuses) to grow up. These reflections, he muses, are an elaborate description of a complicated, self-perpetuating temper tantrum.

While Mr B cannot yet fully appreciate the development of his self-observing capacities, I can appreciate them and can also witness their continued growth even alongside the violent outbursts, which, while diminishing, can still wreak internal havoc. Meanwhile, these states of self-condemnation are heart-wrenching to witness because when the patient is in their grip he is entirely out of touch with any sense of history, hope, or the possibility for growth.

We can see then that what we consider as emotional growth is a complex business. The rather quiet forces for mental growth are countered by familiar and thus persuasive sensory intensities, which concretely press towards the status quo as “the truth” or “what I have always known”. These resistances to change, because of their power and tenacity, seem to resemble a force of nature.

Working clinically with concrete mental states

I would now like to illustrate some aspects of the dilemma that emerges at the interface between concreteness and reflective thought, by way of a few clinical vignettes from my work with a patient I have seen for several years, a woman, whom I will call Ms C. This woman, the youngest of several children, felt exposed not only to the absence of an emotionally available mother but also to the presence of paternal cruelty, as well as to the consequence of family chaos, abuse, and neglect cascading from preceding generations. Such trauma and the absence of protective reverie have for much of her life left my patient feeling persecuted and identified with the chaos, ready to defend it as “freedom” in the face of any attempts to bring order or containment. Even so, she has struggled ceaselessly to get the therapeutic help she so desperately needs in order to grow. I think our mutual regard for the therapy and for each other bring resilience on both our parts to this often tempestuous work.

Technically, I find my attempts to speak therapeutically to her require ongoing care. For instance, when she is feeling tormented and chaotic any comment of mine is felt to be an attempt to restrain her, to limit her “freedom” and thus to force something upon her. I often have to speak to that very issue to demarcate the way she experiences my attempts to label and contain her chaos as “squelching her freedom”. Also, since in this state of mind she perceives her literal experience to be the only possible view, any difference on my part is felt as my being at best “not understanding” but more likely as my causing her distress by my nonalignment. Here then, “understanding” is equated with “agreement” and any separate-mindedness is considered to be a cause for suspicion and blame. I therefore have to remain aware of this tension regarding non-alignment and at times speak to “how misunderstanding and perhaps even how mean you feel me to be when I do not agree with your point of view” or something similar.

In addition, as suggested, when Ms C is caught in a pit of hate and despair she feels defined by that brutal chaos of her childhood, and all my best efforts are likely to be seen through the lens of negativity. Recently I realised several hours before an appointment with her that I might be late in returning from an emergent appointment of my own away from the office. I felt that she would likely become very agitated if I was not there at the accustomed time, so I thought it wise for me to call and leave word that I might be a few minutes late. The only opportunity I had to make this call, given the timing of the day, was just a couple of minutes before another patient came. I did manage to reach and inform Ms C, who seemed appreciative, but I then had to ring off as my next scheduled patient was ringing in. At the time I felt relieved to have reached her.

As it turned out I was not late, but when she came in several hours later she was in a rage, saying “Never call me again, never … never ….” It took her several minutes to calm down and I could see that the call had deeply distressed her, which was at first puzzling to me. Over the hour I could piece together that she felt my possibly being late meant that I was preferring to be with someone other than her, and to make matters worse that I had rung off abruptly, probably to see that someone else, an action which just rubbed her nose in the “fact” of my not preferring her. Ms C’s outrage filled the room and nearly the whole of my mind as well, and it was difficult for me to think or say anything helpful; further, any potential understandings were only mocked and belittled. Feeling quite attacked I had to fight to keep a clear head; and any attempt to frame her rage in terms of her feeling so hurt was met with such disdain that at the time I only felt small and helpless. In addition I could feel myself nudging towards descent into a concrete retaliatory rage, a wish to throw up my hands and more or less yell back at her. But in my efforts to stay thoughtful about my patient, I reca...

Table of contents

• Cover
• Half Title
• Title
• Copyright
• Dedication
• Contents
• ACKNOWLEDGEMENTS
• ABOUT THE EDITOR AND CONTRIBUTORS
• SERIES EDITOR'S PREFACE
• INTRODUCTION
• CHAPTER ONE Concretisation, reflective thought, and the emissary function of the dream
• CHAPTER TWO Content and process in the treatment of concrete patients
• CHAPTER THREE Transitional organising experience in analytic process: movements towards symbolising space via the dyad
• CHAPTER FOUR Enactment: opportunity for symbolising trauma
• CHAPTER FIVE The bureaucratisation of thought and language in groups and organisations
• CHAPTER SIX Painting poppies: on the relationship between concrete and metaphorical thinking
• CHAPTER SEVEN When words fail
• CHAPTER EIGHT Some observations about working with body narcissism with concrete patients
• INDEX