Feeling, Being, and the Sense of Self

A New Perspective on Identity, Affect and Narcissistic Disorders

Marcus West

• Publisher: Routledge
• Year: 2018
• Print ISBN:
  9780367105617
• eBook ISBN:
  9780429913655
• Topic: Psychology
• Subtopic: Abnormal Psychology
• Index: Psychology

This book explores the underlying mechanisms of the psyche. It traces the development of the individual and, in particular, the development of the sense of self, which is understood to be intimately related to the individual's object relations and to play a crucial role in core clinical phenomena. The book outlines a new perspective on identity and affect which sheds light into the heartland of analytic theory, providing fresh insights into narcissism, and narcissistic, borderline, hysteric, and schizoid psychopathologies.

Part I
An "Identity-Affect" Model

Chapter One
The clinical picture

Introduction

An outline of the theoretical picture having been given in the Introduction, this chapter first describes the analysis of a patient, whom I will call Rachel, with whom the themes in this book began to take more substantial shape for me. The chapter then introduces theory relevant to the clinical picture, and outlines the identity–affect model, before returning to complete the clinical narrative, drawing together the theoretical and clinical threads.

Rachel’s analysis was far from a model one. It represents, in part, the story of my analytic development from inexperience, struggling with boundary issues, and trying to come to grips with this kind of clinical situation, to a more developed analytic attitude. The “errors” were crucial to the generation of the model developed herein and tell us, I believe, much that is important about the nature and functioning of the psyche.

Clinical outline

I had been seeing Rachel four times a week for about six years and, despite my best efforts, things were not going well. Rachel had originally sought analysis to help her deal with her many fears and anxieties: she felt she had no substance or resources in herself, she was powerfully reliant on others, and feared she would not survive in the world. She was frightened that she would black out in public and had done so on at least one occasion.

There was an initial period, characterized by a predominantly positive transference, where Rachel was very appreciative of the analysis and fully committed to the work on her difficulties, fears, dreams, and desires. After six years, however, rather than feeling more stable and secure, she was now deeply regressed and acutely sensitive to everything that was going on around her. In particular, she was sensitive to my attitude and position with respect to her— whether she felt I was being, for example, warm and concerned or distant and irritated.

I realized that there were many occasions when Rachel could quite accurately gauge what I was feeling; however, her perceptions and reactions to me seemed, at first, mystifying. These reactions were also becoming increasingly extreme. If she did not experience me as warm, sympathetic, understanding or concerned, she would experience terror, panic, acute pain, and rage, feeling that she was dying or being killed off by me. She would sometimes tell me that she would not survive to the next session, that she would die or would kill herself, or would not be able to stop from harming herself; she would, then, hide all the knives and scissors in her house.

Rachel would also tell me that if I would not hug her or answer her questions she could not continue with the analysis. There were occasions when she would ring me at home, demanding answers to questions that had come up in the day’s session. Sometimes these were hypothetical questions about whether I would ever hug her, or what contact there might be between us after the analysis had finished.

If at all possible I would not answer her questions directly, but would rather try to explore these issues with her. Frequently this was not satisfactory for her and a crisis would ensue where Rachel would rage at me, telling me how bad I was. She would make clear what the consequences of my not answering her questions were— her hurting herself, not surviving, or leaving the analysis. On two occasions she threatened to report me to my registering body. As we lived through these crises, Rachel would usually emerge from them apparently feeling stronger and that she had really “got to the point”. She would often tell me she was grateful to me for maintaining my line.

There were rare occasions when I did answer directly, as the discussions had become interminable, hypothetical, and seemed, to me, meaningless. I felt I wanted to bring them back down to earth and/or I did not know what else to do or say. Perhaps, sometimes, unconsciously, I wanted to avoid the inevitable further confrontations. Answering such questions often led to a greater sense of confusion and expectation—if I would answer this question why would I not answer all her questions?

Following the crises things might be all right for a little while, but something else would soon trigger another crisis that would this time come on more suddenly and acutely. Rachel would then experience things more deeply, she would fragment more quickly and express herself more powerfully. She was clearly becoming increasingly deeply regressed.

Over time I was able to see that the trigger for these crises depended on whether I was identifying with Rachel’s position— seeing things her way and acting in a way that coincided with what she wanted—or whether, instead, I was maintaining my own, separate position and perspective, which did not coincide with hers.

Much of the pressure she put upon me was to encourage, cajole, or force me to see things the way she did. This was both to experience the security, satisfaction, and gratification of feeling alongside or at one with me (this included wanting me to feel sexually towards her) and to avoid the terrible feelings of annihilation, terror, pain, and rage that would occur if I was not identified but separate. This situation was underlined by the fact that she felt she had no substance herself, and so relied on me to guarantee that she felt good about herself, to give her some stability, and to provide her with her very sense of existence.

One of the fruits of the first few years’ work with Rachel was being able to identify the terrible mix of feelings she experienced: to recognize them as terror, panic, rage, and so on. Previously, Rachel had been unable to recognize these as her own feelings, but had felt that she was being assailed from outside and taken over by a force, like some kind of daemon, that she did not understand and could not bear; she had a series of dreams about just such a daemon.

Rachel was thus in a terrible state, reeling from crisis to crisis— crises that might last a few moments, a session, a day, a week, or even longer. I felt that she genuinely believed, at these times, that she would die. As time passed, however, and she did survive, she and I, in our different ways, seemed almost to get used to living in this terrible way.

She felt that despite, or even because of, the terrible crises we were getting down to the real issues that had never been reached before. She would tell me that she felt very real and alive. I was left hoping, albeit with increasingly less conviction, that something would come of all this, that the regression was necessary, and that it would lead somewhere. Clearly I was under tremendous pressure too, and, as the years passed, and as Rachel’s mental state deterio-rated, so the analysis also took its toll on me.

Before looking at the way in which the analysis proceeded, the evolution of the transference and the countertransference, and describing something of Rachel’s early life, the question of how what was going on might be understood theoretically is addressed.

Analyses of the clinical situation

There are several main conceptualizations that best capture the picture with Rachel.

Freud would describe the clinical situation described above as a negative therapeutic reaction—a type of resistance born from the fact that certain patients appear to prefer suffering to being cured. Freud linked this to a number of factors: unconscious guilt, and the subject’s wish to prove his superiority over the analyst (1923b), masochism (1924c), super-ego resistance (1926d) and, ultimately, the “irreducible nature of the death instinct” (1937c). Although the term “negative therapeutic reaction” is over-determined, in so far as having a number of different explanations associated with it, it is useful descriptively, and shows the ways that Freud was struggling with similar clinical issues.

Michael Balint would describe the situation with Rachel as a malignant regression, where the patient seeks “gratification of (his) instinctual cravings . .. an external event, an action by his object” (Balint, 1968, p. 141). The clinical picture he describes was very similar to my experience with Rachel. He writes:

. .. it seemed that [the patient] could never have enough; as soon as one of their primitive wishes or needs was satisfied, it was replaced by a new wish or craving, equally demanding and urgent. This, in some cases, led to the development of addiction-like states which were very difficult to handle, and in some cases proved—as Freud predicted—intractable. [ibid., p. 138]

He continues:

As long as the patient’s expectations and demands are met, the therapist is allowed to observe most interesting, revealing events and pari passu his patient will feel better, appreciative and grateful. This is one side of the coin, but there is an obverse side too. If the expectations are not or cannot be met, what follows is unending suffering or unending vituperation, or both together. [ibid., p. 140]

Klein (1946) talks in terms of projective identification, and addresses both the pressure put on the other and the patient’s lack of sense of self. She sees the depletion of the sense of self as a result of the projection of disavowed parts of the self on to the other. The attempt to harm, possess, or control the other is due to the fact that the individual does not distinguish self from other, and attempts to control those parts of themselves that they have projected into the other by controlling the other. Chapter Four takes up the question of projective identification in detail.

Bion (1959) developed the notion of projective identification, contrasting normal with excessive projective identification, and proposed the theory of container–contained (1962a) where the patient’s unmanageable affects (the “contained”—beta elements) are transformed in the container (the (m)other/analyst) into manageable, thinkable, alpha elements. Bion (1959) also described the patient’s attacks on any links to objects experienced as separate from the self. He addressed the attacks on the patient’s and analyst’s thinking capacities, writing that: “[the] lack of progress in any direction must be attributed in part to the destruction of a capacity for curiosity and the consequent ability to learn” (Bion, 1959, p. 101).

Meltzer (1992) developed Bion’s theory of the container– contained into the concept of the claustrum, where the individual aims to intrusively take up residence in the other’s insides for defensive purposes, just as I felt Rachel wanted to reside inside me.

Betty Joseph (1982) described one group of patients whom she felt were “addicted to near-death”, and who were extremely passive and masochistically excited by the patterns of self-annihilating despair and self-destruction in which they wish to get caught up with the analyst. Rachel could also be seen in this way.

The Jungian analyst, Michael Fordham (1974), describes a syndrome that he calls a “defence of the self” where the patient attacks anything that is seen as other than self, describing this as a primitive biological aversion to alien matter. (Britton [1998, p. 58] echoes this same biological aversion to otherness.) Fordham describes how, in the analysis, “not-self” parts of the analyst, “seen by the patient as technique, method etc.” are attacked by the patient. He describes these attacks as “violent attempts to attack and do away with the bad object-[which] can reach a level at which one must speak in terms of annihilation” (Fordham, 1974, p. 140). Describing the clinical situation that, on occasion, echoed my experience with Rachel, he writes:

In its most dramatic form the syndrome may develop so that the interview becomes filled with negative affects and confusion, until the whole of the dialectic seems to break down. The time may be filled with denigrating the analyst’s interventions, ending up in loud groans, screams or tears whenever the analyst speaks: the patient uses every means at his disposal to prevent the analyst’s interventions from becoming meaningful. [Fordham, 1974, p. 140]

Donald Kalsched (1996), another Jungian analyst, describes a form of defence similar to an identification with the aggressor, which he calls an “archetypal defence of the personal spirit”. Here the individual forms a punishing inner object that keeps the core of the individual isolated in order to prevent exposure to further hurt. The daemon that Rachel dreamt of repeatedly would correspond to just such a malevolent object.

Peter Fonagy (1991), investigating borderline phenomena, talks of the vital importance of reflective function—the capacity to conceive of conscious and unconscious mental states in oneself and others—and understands the patient’s disavowal of otherness as an “inhibition and defence against conceiving of his own or his objects’ mental functioning”.

Finally, in terms of categorization and personality type, Britton usefully develops Rosenfeld’s views on thin-skinned and thick-skinned narcissism (Britton, 1998, pp. 46ff.), where Rachel could be seen as a thin-skinned narcissist, which Britton calls borderline, reacting hypersensitively to her objects.

Predominantly, however, Rachel could be understood to be hysteric, although she showed marked borderline features. As Khan writes: “the hysteric seeks, omnipotently, to solve new life tasks with sexual reverie and complicity with the adult humans, and beseeches them to take over the necessary and required ego-functions” (Khan, 1975, p. 53).

While Rachel’s predominant personality type might have been hysteric, there is much overlap between hysteric, borderline, narcissistic, and even schizoid functioning (see Part II), and further analysis and investigation revealed much about the nature of the psyche itself and the reason for that overlap.

In summary then, Rachel could be seen to be in a malignant regression, employing excessive projective identification, aiming to reside in me in the manner of a claustrum, defended against anything she experienced as not-self, attacking links to anything experienced as separate, and attacking her own and my capacities for thinking and reflective function; in terms of personality type she was predominantly hysteric. I found these views the most clinically accessible, descriptive, and useful.

While these theories were helpful and sometimes illuminating, showing me, reassuringly, that at least people had trodden similar ground before, I felt that none fully reflected the situation before me. The traditional Kleinian picture, in particular, concerning the loss of sense of self being seen as due to parts of the self having been projected on to the other, just did not feel quite right; for example, the depletion of Rachel’s sense of self did not seem to be because of parts of herself were being projected into me (although I could see that what I did had a very big effect in determining what she felt)—this explanation did not do justice to the nature of the interaction that was taking place. As the situation stood, I was not sure what to do (or not to do) in order to move on from the impasse in the analysis with Rachel.

The identity—affect model

One of the main elements of the analysis which required particular attention, and which threw particular light on the question of identity, was Rachel’s feeling that she was essentially nothing and that she had no substance. This preoccupied her enormously and seemed pivotal in her demand that I stand in for or, at least, stand by her in order to provide her with some stability and solidity. I saw that the more deeply Rachel experienced things, the more real and true they felt to her, and the more certain she was about them. This experience was also mirrored with other patients. It was not simply true of clinical situations, however, but applied across the whole range of “everyday” beliefs and experiences. The times that Rachel felt that she was more truly “herself” were those which, at the same time, paradoxically, she had little or no sense of “I”.

I came to see that there was a part of her that operated predominantly in an affective manner, by which she was dominated. I understood this to be her “emotional core” (West, 2004)—a term which I hope gets close to the subjective feel of this part of the self.

These affective experiences can be understood to be structured, coloured, and to some extent generated by an af...

Table of contents

• Cover
• Half Title
• Title
• Copyright
• Contents
• Dedication
• ACKNOWLEDGEMENTS
• PREFACE
• INTRODUCTION
• PART I: AN "IDENTITY-AFFECT" MODEL
• PART II: PERSONALITY TYPES
• REFERENCES
• INDEX