Logics of the Mind

A Clinical View

Jorge L. Ahumada

• Publisher: Routledge
• Year: 2018
• Print ISBN: 9780367325411
• eBook ISBN: 9780429915802
• Topic: Psychology
• Subtopic: Mental Health in Psychology
• Index: Psychology

This collection of papers, spanning the last fifteen years, presents a spirited defence of Freud's clinical method, considering the 'crisis of psychoanalysis' in the wider context of a crisis of reflective thought in society as a whole. Expressing the wish to 'clarify and polish the glass through which we see the psychoanalytic experience', Jorge Ahumada seeks to redefine the functions of psychoanalysis for the era of mass media, in which the classic Freudian neuroses have mostly been replaced by what he terms 'pathologies of peremptory gratification'.

Chapter One
What is a clinical fact? Clinical psychoanalysis as inductive method

This chapter is an inquiry into the nature of clinical facts in psychoanalysis. The attainment of the representability of psychic reality being a requisite for insight, the author examines inductive processes on the part of both analyst and analysand, which are to be considered proper aspects of the study of clinical facts. It is argued that the analyst chooses his interpretations guided in good measure by non-verbal material that is based on how he intuits that he is "used" by the analysand and the ways the analysand feels "used" by him; such non-verbal clues to the nature of the unconscious relational "frames" operating in sessions guide him to select relevant associations from the universe of the analysand's verbal utterances. He thus comes to voice his interpretations, purveying a "mapping" of psychic reality that typically makes use of a new viewpoint for description. Insight is achieved when the analysand attains ostensive refutation or redefinition of his unconscious "theories" about the relationship, and this happens only in concrete individual situations, when the effects of his relational unconscious "theories" come to be contrasted observationally in diverse "screens", perceptual and mnemic, against the background of the analyst's neutrality: in such a way unconscious "theories" attain the Pcs.-Cs. domain of the "no".

Science, as you know, is not a revelation; long after its beginnings it still lacks the attributes of definiteness, immutability and infallibility for which human thought so deeply longs

Sigmund Freud (1926e, p. 191)

Clinical facts are part of a process, and that which can be taken as our main question today—"what does the analyst attend to in the clinical situation?"—is of a piece with a less often considered but equally cardinal question: "what does the analysand attend to, consciously and unconsciously?", or, in wider terms, "how does the analysand operate inductively?"

As we are aware, not all analysts allow even a modest degree of independence to clinical facts: it is a premise of the "creative-hermeneutic" stance that there are no facts, and then no clinical ones; hence it holds that what matters is that the analyst constructs a coherent whole, which does not reproduce a phantasy pre-existent in the subject's unconscious but causes it to exist by voicing it (Viderman, 1970). In such an outlook facts become radically theory-dependent—in the case of Viderman's outspoken creationism, facts are deemed to be "language-dependent" inasmuch as the analyst's words are deemed to cause psychic facts. A quite different matter is to allow that our approach to facts is not assumption free, as did that eminent empiricist, Sigmund Freud:

Even at the stage of description it is not possible to avoid applying certain abstract ideas to the material at hand, ideas derived from somewhere or other but certainly not from the new observations alone. [1915c, p. 117]

Here we may follow Whewell, who states:

The distinction of Fact and Theory is only relative. Events and phenomena, considered as Particulars which may be colligated by Induction, are Facts; considered as Generalities already obtained by colligation of other Facts, they are Theories. [1858, p. 161]

Assumptions and theories, following Freud, have no claim to primacy, being "scaffoldings ready to be discarded" (1914c, p. 77) as soon as new clinical findings require. While I can agree with Spence (1994) that much of what we listen to is not ostensive by any stretch of the imagination, I hold that it is our task to arrive, and help the analysand arrive, at an ostensiveness of "facts", which, as our colleague Jean-Michel Quinodoz (1994) emphasizes in his companion paper, are both relational and subjective.

The emergence of "facts" in a given clinical situation depends less on the analyst's theories than on his ability to build an intuitional and observational field for the patient and for himself, on his keeping to his neutrality, on his intuitive and observational capacities, and on whatever countertransference insights he is capable of. A happy guess, an act of invention of a conception not previously apparent, the finding, that is, of "one supposition that succeeds in binding together the Facts" (Whewell, 1858, p. 136), allowing description from a new and more adequate standpoint, is necessary for successful induction. While a framework of conceptions or theories is the background to the emergence of such happy conjectures, these do not derive from theory in any direct way. Against the primacy of theory, Bion (1977, p. 18) quotes Darwin: "it is fatal to reason whilst observing, though so necessary beforehand and so useful afterwards". Deeming the psychoanalytic domain intuitable, Bion holds that memory, desire, and understanding hinder intuition (1992, p. 315).

Psychoanalytic facts must, in my view, evolve, for both analyst and analysand, from the intuitable to the observable: in Peirce's terms (1901-1903), from abduction to induction: from the emergence of a hypothesis to its experiential, observational testing. Intuition is not enough. From Aristotle on, induction has depended on observation, and our field is no exception: effective insights are, as we have learnt from Richfield (1954), ostensive ones, built on the direct observational grasp of psychic facts. We can usually expect these to be consciously available first to the analyst on the basis of whatever intuitional and observational grasp of the analysand's (and of his own!) psychic reality he can muster, and then, with the help of his descriptive verbal mappings—the interpretations— eventually to the patient.

My purpose here is to inquire how in the analytic situation the analysand operates within the frame of a system of inductive testing of his unconscious "theories"·, here ostensive "facts" will come up mainly against the analysand's unconscious "theories" and assumptions, and often against ours too—that is, as I will explain later on, counterinductively. To this end, I offer two clinical vignettes: the first describes the protracted struggles of a post-autistic adolescent for and against awareness of "clinical facts"—that is, of his psychic reality—in the frame of an unremitting negative transference; the second approaches in logical terms an aspect of the process of distinguishing between psychic and factual reality.

Ostensive, says logician Susanne Langer (1953), is that which may be pointed to by saying "this", such also being her definition of individual—be it a person, event, or thing. Against the current "flight into hermeneutics" in the appraisal of the interpretive method, Cheshire and Thomä (1991, p. 429) hold that from the "Project" (1950 [1895]) onwards, Freud, the former neuropathologist, struggled for a way of "staining" (i.e. turning into something observable) the unconscious states and processes inaccessible even to introspection—a way he found, they state, in free association and dream interpretation, to which the setting, transference, and analytic neutrality must also be added. Laplanche (1992) notes that Freud's Deutung is much less hermeneutic than is our term "interpretation": deuten auf is to point with the finger or to indicate with the eyes, so in Freud's usage it is an ostensive term. Not that I think that a hard-and-fast line divides intuition from observation; much if not all of our intuition is, I surmise, dimly observational in ways of which we are not conscious: a favourite term of Bion's was adumbrate. William Blake puts it more poetically: wise men see outlines. Let us turn now to our first clinical example.

First clinical example: "john"

"John", a 13-year-old boy, was brought to consultation because he was withdrawn and indeed lethargic at school; on vacations he was livelier, but aloof and cold to adults. His parents were divorced when he was 4, at which time his mother had gone through a depressive episode. His father, an emotionally isolated man who worked abroad, saw or telephoned him quite randomly. The mother, an overly dedicated teacher prone to feelings of failure, volunteered that she felt the strain of being both mother and father to John. A brother one year younger was subject to sporadic immoderate bouts of rage. John was usually compliant and non-committal, but he gave way to grotesque grimaces in public or in front of mirrors, which infuriated his mother. At school and with homework his attention span was nil; he attended a special school.

In step with the diagnostic impression of secondary encapsulated autism (Tustin, 1986), in his four-times-weekly sessions John took to a "deadly serious" silence save for bouts of grimacing, at once mocking and self-demeaning; his few isolated comments he did not pursue. He answered questions telegraphically, if at all: if, for example, at the start of session I asked him, "How are you, John?", he would just say, "Very well". It was pointed out to him in many ways that he did not think that talking about himself to me—or to anyone else, for that matter—could be of help; in fact, he had little use for words. However, he would listen to my attempts at guessing what was going on, and often he would nod when he felt I was right; then he would curl up on his sofa and fall sound asleep. He would not draw and, more generally, he refused to play what he felt to be the analyst's game—that is, to be a collaborator. But as the months went by, on growing more confident, he played repetitive games with objects he brought along, such as coins or a steel ball-bearing that he would balance on his drawing board, or else he would grab one of my pipes and gently play with it while looking sideways at my reaction. As long as he kept moving at his games and I kept quiet, he would be lively; if I imposed my "game" by interpreting, he would listen eagerly, but he would soon become lethargic and fall asleep. Of John's scant utterances, which came out of the blue, I will single out one on poor little toads run over by trucks on country roads. This seems to be a clinical "fact" that is of a different type from those coming from observations such as John's silences or lethargy or his deadly serious demeanour. I take it to be an unconscious abduction, a conjecture that in this case is not known to its beholder and refers to the here-and-now. There can be few doubts that to John the conscious referent of this statement is unrelated to the clinical situation but can be taken as a verbal model of a central dimension of his enacted unconscious relationship to me as an external phantasy object—that is, as a verbal "diagnosis" of the way in which I, as an external object, have come to "incarnate" his unconscious internal one. However, it is useful to introduce at this point a logical distinction between the two levels of the analyst's role: as a transference "object", having some degree of conscious ostensiveness, and as a transference-relational "frame", which is not consciously observable to the patient and must be intuited or inferred by the analyst. Such a distinction is implicit in Betty Joseph's (1985) consideration of transference as a "total situation". Quoting Klein (1952, p. 55) to the effect that "it is essential to think in terms of total situations transferred from the past to the present", Joseph adds:

She [Klein] went on to describe how for many years transference had been understood in terms of direct references to the analyst. ... It seems to me that the notion of total situations is fundamental. ... What he [the analysand] brings in can best be gauged by focusing our attention on what goes on in the relationship, how he uses the analyst, alongside and beyond what he is saying. [1985, p. 447, italics added]

So, transference can be understood restrictively as direct cognitive references to the analyst, or in a wider, more unconscious sense as a pragmatic level of "use": John's comment points to this wider, "frame" level of the relationship. The remark about poor little toads run over by trucks alludes to the projected covert murderous rivalry and its denial, which very much lead the process; it puts into words his attitude in the session and in his games. What it alludes to can be described as the pragmatic enactment of a relational proposition: I, his analyst (but more generally, adults), am to poor little John as trucks are to little toads (analyst = overbearing truck; John = run-over toad). This free association is, then, John's unknown interpretive mapping of an aspect of his ongoing unconscious link to me; having no immediate effect on his overriding denial of his psychic reality, it does not bring him nearer to an insight. It must be noted that it was essential that neither of us overtly act out this rivalry; once, he started making small paper bullets, which, in a lively and increasingly manic mood, he would shoot in seemingly random fashion, in a kind of Russian roulette aimed at hitting/not hitting me; when a "bullet" did hit my pillow close to my face and he thought he had scored a hit, he froze into the state of unmitigated terror, which Tustin (1991) puts at the core of autism. He interrupted his shooting game forever, interpretation proving ineffectual.

While looking at a Cape Horn clipper's lamp that lights my office, its vent-holes abruptly reminded John of the Bermuda Triangle. Work on this led to some inroads into his denial of psychic reality: he grasped my saying that both the session and his inner world are to him a sort of Bermuda Triangle where emotional contents are felt to vanish without trace (it helped that we had already explored how, for example, on vacations his playmates would fade away in town). Shortly thereafter he recounted a nightmare in which he was falling in front of a tall building, and then the scene changed and he was looking with no feelings or anxieties at his badly torn, dead body after hitting the pavement. As he brought no associations to the dream, I asked him to draw it, which to my surprise he did, in several scenes (see Fig. 1). These depict what I take to be his main transference defence: his devitalization in the face of the oversized and overbearing phallic analyst (note that he draws himself as a minimal stick puppet), as well as the main transference conflict, an overarching unconscious phallic rivalry. Let me underline that there was no overt anxiety or hostility addressed at me: unconscious hostility leads to autotomy (Ferenczi, 1924), to a dematerialization illustrated by the lizard's sacrifice of its tail to the predator. The dream, and then its drawing, are steps in the "staining" process that to Cheshire and Thomä (1991) is at the core of Freud's method; his devitalization in the frame of unconscious rivalry attains representability in the passage from an enacted and until then unrepresentable and unthinkable "concrete representation by identification", in Money-Kyrle's terms, to a visual "ideographic representation". [To Money-Kyrle the unconscious operates in terms of class notions, imageless preconceptions of the objects, or situations of major biological import. These "class" notions we cannot consciously imagine, although we can recognize their members: what may later become a representation of an absent or separate object is, he says (1965, p. 400), first experienced concretely as an identification, introjective or projective, with the object, in a kind of "concrete representation by identification"—a subject studied in much of Melanie Klein's work belongs. The second stage, of "ideographic representation", occurs mainly through "visual metaphors"; to this level pertains Freud's dream-thinking. The third stage, of verbal thought, rules consciousness.]

FIGURE 1 Pesadilla [Nightmare]

In-session sleeping went on for months. Interpretations, even those agreed to subtly by John and leading to such changes in his liveliness and his relationships to his peers and family (but not at this time in his studies) that friends and relatives would say "this is a different child", did not make a dent on his lethargy in the session—so much so that I had to shake him to wake him up when time ran out.

After watching a film on television about the discovery of the sunken remains of the Titanic, he dreamt that it hit a big iceberg and slowly sank into the deep in utter silence. This came to be interpreted both ways: as his hitting what he unconsciously felt to be my "wall" of icy coldness towards his enthusiasms and, increasingly, as his having made my therapeutic enthusiasm hit the wall of his cold aloofness. Disappointments were, I surmise, a component of the "wall", and hence he would evade enthusiasms or needs. In a third dream he had come in a run-down bus to a service station; on his asking for some water, the attendant became angry and chased him as he fled up a thorny hill.

While, as far as I can gather, John feels no discernible anger or depression on listening to me, and he admits that he may be quite interested in what I was saying, it is a clinical fact that my voice was by itself enough to turn the overriding, annihilating phallic-rivalry "frame" on and hence to turn him off, the devitalization and collapse into sleep (into the pavement in the first dream, into the deep in the second) being the unconsciously chosen alternative to annihilating collision. Covert explosive rivalry and intolerance to need and disillusion are interrelated unconscious relational "frames", which, while not ostensively seen by John as my individual attributes, act as a pragmatic "frame"—that is, as a meta-level to most of his verbalizations and to the co...

Table of contents

• Cover
• Half Title
• Title
• Copyright
• Contents
• ACKNOWLEDGEMENTS
• FOREWORD
• PREFACE
• Introduction The crisis of culture and the crisis of psychoanalysis
• 1 What is a clinical fact? Clinical psychoanalysis as inductive method
• 2 The analyst as "base"
• 3 On the transposition of self and object
• 4 The unconscious delusion of "goodness"
• 5 Perverse and symbiotic organizations in narcissistic object relationships
• 6 On narcissistic identification and the shadow of the object
• 7 Trauma, identification, evolution
• 8 On the limitations and the infiniteness of analysis
• Epilogue The role of writing and psychoanalytic writings
• REFERENCES
• INDEX