Idiomatic Expressions and Somatic Experience in Psychoanalysis
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Idiomatic Expressions and Somatic Experience in Psychoanalysis

Relational and Inter-Subjective Perspectives

Ravit Raufman

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eBook - ePub

Idiomatic Expressions and Somatic Experience in Psychoanalysis

Relational and Inter-Subjective Perspectives

Ravit Raufman

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About This Book

Idiomatic Expressions and Somatic Experience in Psychoanalysis examines how verbal and non-verbal language is used in the consulting room, and how those different modes of communication interact to provide a more comprehensive picture of the patient's relational world. It is the product of a comprehensive research project exploring the affinity between idiomatic expressions and somatic behaviors and symptoms. Idiomatic expressions are viewed as bridging the gap between somatic sensations and mental experiences.

Ravit Raufman deals with one of the fundamental aspects in human life- the way our behavior is governed by unconscious primary experiences, suggesting methods by which to decipher patient behaviors that are apparently detached and unreasonable. The first part presents case studies of people who enact and revive verbal idiomatic expressions through their behavior. The second describes how therapists use non-verbal mechanisms, operating in their own minds, to understand their patients' inner lives. Based on relational and inter-subjective approaches in psychoanalysis, the case studies illustrate the various ways in which the therapist's subjective experience is "objectively" used to learn about patients' subjective relational experience, so as to verbally formulate experiences that are pre-verbal. Raufman combines Freudian ideas regarding the affinity between somatic symptoms and verbal expressions, with a contemporary relational perspective. The book combines scientific findings with a narrative style, including life-stories of various individuals, as well as a description of the therapist's own subjective experience.

This book will appeal to clinical psychologists and psychoanalytic psychotherapists as well as anyone interested in understanding human psyche and behavior.

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Information

Publisher
Routledge
Year
2018
ISBN
9781351117203
Edition
1

Section 1
From language to experience

Language Hidden Behind Experiences

Idiomatic expressions that bridge the gap between somatic and mental experiences

A while ago, a patient related the following dream to me:
I am rehearsing with an orchestra I usually play with. I’m trying to play my flute, but it is very difficult and challenging. All of a sudden, my mother comes to help me, because she realizes I’m making considerable efforts and she wants to support me. She stands next to me, on my right side.
The dreamer then explained that unlike other musical instruments, you must be careful how you hold the flute when you play with other musicians so that it won’t stick in your neighbor’s face.
The idiomatic expression – “to stand by me,” attains a realization in the dream, by portraying a palpable picture, in which the mother stands by the dreamer’s side. More specifically, she stands to her right. However, this meant the dreamer couldn’t go on playing because she had no “room” to hold her flute, as her right side was now “blocked” or “taken up” by her mother. This dream narrative demonstrates in its pictorial, dreamlike language several complex, profound issues regarding how the patient’s mother, although trying to help, could not give her the space she truly needed. The concrete way in which this subconscious issue came to the patient’s consciousness convinced her of its relevancy, and she could finally start addressing it consciously, to understand how it influenced her inner life.
Another example is that of a young woman, who had recently become a mother. She related the following dream:
She goes to the sea shore. Suddenly she realizes that instead of wearing her sun hat, which protects her skin from the sun, she has on a shower cap.
This concrete picture enabled her to discuss the different “hats” she wears in her daily life while fulfilling different roles – mother, a working woman, etc. The dream, using its unique language, conveys its messages in a very sophisticated manner. The dreamer could see – or sometimes feel – the dream messages and then work through them. In the distinctive, visual way of dreams, it managed to bypass the dreamer’s defense mechanisms, allowing contact with the primary levels of the mental organization. When the patient and I discussed this dream, it was possible to talk more comprehensively about the various meanings of the dilemmas involved in becoming a mother, and of the resulting high price. Of course, she could have talked about these issues without the dream. However, the dream not only reminded her that she was preoccupied with this problem; it also demonstrated, most vividly and concretely, the deep meaning of this situation on the somatic-sensorial level, not only as an abstract idea. The dream provides a glimpse into the language of the psyche and tells us something about the psyche’s way of communicating with itself.
A further example includes the very familiar and frequent idiom: “What’s the point?” A young depressive patient related the following dream to me:
I’m standing in front of a table full of refreshments, but feel no desire for anything on the table. I think to myself: “What’s the point?”
(In Hebrew, instead of the word “point,” we use the word “taste” which makes the pictorial language of the dream even more precise, as the dreamer is a Hebrew speaker). This sensorial experience is a direct translation of his mental state and also of the metaphorical meaning of the well-known idiomatic expression. It expresses the dreamer’s lack of sensorial contact with his surroundings, a common characteristic of depression. The somatic senses govern the first, primary contact of a baby with his or her environment. This is how babies start becoming involved with the surrounding environment – through their first contact with the mother or other care-givers. We know that many eating disorders are also associated with the early impairment of attachment issues. The direct analogy between taste – a fundamental sense through which basic needs are satisfied – and the questions of whether life has any meaning, becomes reasonably clear in the above dream. The dream image helps us trace back and identify the origin of the depression. In a way, this example is similar to the idiom: “It doesn’t smell good,” which I will discuss in another chapter of this book.
As stated at the outset, the human psyche has its own unique language. The first section in the book presents therapeutic vignettes, through the adoption of theoretical frameworks with which I have been involved in recent years. It is the study of the unique status of idiomatic expressions, our ability to use words to reach non-verbal modes of experience. Identifying idiomatic expressions hidden behind a distinct symptom may function as part of the therapeutic process. This process helps to extricate the symptoms from their detached, isolated, enigmatic status, making them more accessible to consciousness. It applies in particular to what we call “somatic idioms” – idiomatic expressions that include body parts, or body gestures. These expressions have a unique status in human experience. On the somatic-sensorial/abstract continuum, they play a significant role in the way the body represents itself through language. Each of the chapters in the next section exemplifies this idea. This theoretical framework, based on early Freudian ideas, is weaved together with my relational attitude adopted in my clinical practice. I hope the book overcomes the inconsistencies in language and theory. However, I find these apparently different schools of thought to be highly associated with each other. Language is always relational. Linguistic phenomena cloaked behind various symptoms, and vice versa (sensorial and somatic reactions evoked by language), always take shape in the presence of the other, whether “internal” objects or “external” ones. Listening to the ways primary processes can be allowed to unfold in language, and using the intersubjective matrix and our own relational world to validate, or provide various symptoms with meanings, may be the venue in which these different theoretical orientations meet. Drawing on Bion’s assertion that interpretations are only useful if they share the qualities of passion, sense and myth, Cartwright takes this to mean that “containing interpretations work on linking sensory information outside the dreaming process (the ‘proper object’), with myth (coherent products of the ‘dream object’: the dreamed up idea of a precious symbiosis) in the context of shared emotions” (Cartwright, 2013, p. 98). This way, he emphasizes the intersubjective component in the theory of thinking, in which the containing quality of the mother, as well as the therapist, plays central role. Other analysts also addressed the relational variations of Bion’s theory of thinking (see Billow, 2003). In this book I alternate between concepts and ideas coined and developed by different schools of thought in psychoanalysis, in the hope that this will not confuse the readers, but rather expand the ways we understand each of them.

References

Billow, R. (2003). Relational Variations of the “Container-Contained,” Contemporary Psychoanalysis, 39(1): 27–50.
Cartwright, D. (2013). Clinical Features of the Container Function, Psychoanalytic Psychotherapy in South Africa, 21(2): 73–104.

Chapter 1
Below the surface

It was so beautiful and so fine, the likes of which could never have been woven in the world above.
(From the fairy tale The Three Feathers)
Dreams open a concealed door into a place where new, fascinating modes of conversation are permitted between my patients and me. From this space, we set out on a shared journey, a quest for meanings and function. The first chapter of this book, therefore, discusses this intriguing subject and presents one of the several possible techniques of working with dreams – communicating the realization of the idiomatic expression, which so often characterizes the unique language of dreams and fairy tales. These are the two main topics of my academic and clinical occupations.
Many developments have occurred in psychoanalytic thought since the age of Freud. However, despite the many resulting changes in the status of dreams and how we use them in the therapeutic endeavor, they continue to engage the various psychoanalytic approaches. The dream’s unique language, which often invites primary, sensual, and visual scenes, improves the contact with multifaceted layers of the human psyche. Deciphering an idiomatic expression hidden behind a concrete event in the dream helps to touch upon the dream’s location on the border between the somatic and metaphorical aspects of the human psyche.
In the case I am describing in this chapter, Rebecca, a woman in her fifties, was dreaming that she was resting with her husband on their double bed.
Strangely, the bed’s location was not apparent; it was not in the usual place in the bedroom. Under the bed something was stirring, perhaps the sea or some troubled waters. Suddenly, a childhood friend appeared, and the scene shifted to another time and location. Rebecca woke up, feeling baffled and uncomfortable. She said she was familiar with this vague malaise since it had accompanied her for years, but seemed detached from her current waking life. Insisting that this sensation was unrelated to her pleasant and comfortable waking life, Rebecca nevertheless felt it was important enough to begin therapy.
What I was called to address was the gap between the image of the couple resting comfortably on their bed, above the surface, and Rebecca’s discomfort, caused by the strange stirring under the bed, below the surface. We are often disturbed by unknown causes, having lost contact with our own inner life. Many people describe their situation as apparently “having it all,” but they do not feel free and happy. Sometimes they even suffer from severe stress that seems unrelated to their situation. This gap reminds us that the human psyche has its own, often vague and enigmatic language. An important role of the psychotherapeutic endeavor is to build bridges that enable us to “speak” our mind and decipher this language. Such understanding allows us to examine our therapeutic methods and to reach the deeper layers of human experience. It helps us to find the words needed to access the non-verbal areas of our primary experiences. The psyche’s non-verbal language termed by Freud the “Primary Process,” often uses symbols and images.
Since typically a bed is located in the bedroom, the ambivalence of Rebecca’s dream bed’s location is disconnected and detached from its usual context in reality and moved to a different sphere, while under the bed lurks the turbulent sea, or just “something” in the dream’s language. This scene depicts the dreamer’s situation in life. If we look at it as if it were a picture, we can see how it visually represents the image of a mental state. The dream image reveals that “something is troubling the dreamer,” and shows exactly where this “something” is located – under the bed, below the surface of Rebecca’s apparently relaxed relations with her husband. When we examine the possible meaning of the dream, it is necessary to discuss its idioms as part of the unique language of the psyche, translating images into words.
Freud studied the relationships between verbal expressions and somatic symptoms during the early stages of the development of his psychoanalytic theory. In Studies on Hysteria, Breuer and Freud described the creation of somatic symptoms as a symbolization of verbal expressions (Breuer and Freud, 1895). Yigael attempts to follow the development of Freud’s idea, referring to the case of Cecily Koertner (2001, pp. 179–180). In this case, Freud described how in one of Cecily’s acute attacks of facial neuralgia, she remembered a time of being furious with her husband. These bitter feelings followed a conversation during which he had insulted her. Suddenly she put her hand on her cheek and cried out loudly, apparently in great pain, saying: “It was like a slap in the face.” The somatic pain was indicative of a particular kind of psychic suffering.
We can explain the creation of symbolic conversion by the simultaneous presence of thoughts accompanied by both physical and somatic pain. The latter represents the former through what Freud calls the “Associative reverberation of the psychic life” (Bruer and Freud, 1895, p. 252).
In another example, Cecily told Freud that when she was fifteen years old, she was lying in bed under the strict supervision of her grandmother. She felt a sharp pain between her eyes. Freud’s analysis explained that the pain was associated with her grandmother’s “penetrating” stare and the belief that her grandmother suspected her of something. The unpleasant feeling of being “under the scrutinizing eye” of someone, with suspicion directed against her, was converted into somatic pain.
Yigael mentions that Freud’s use of the “symbolic” concept is different, almost antithetical to its conventional use, even his own later use (2001, p. 179). For example, when we relate to a flag as a symbol, the effect is a high concentration of values, standpoints and emotions in one object (the extent of which cannot be accurately assessed). In Freud’s later works, the somatic symptom becomes a representative symbol that implies or stands for an abstract idea or repressed conflict. Conversely, while working on Studies on Hysteria, and within the context of the affiliation between verbal expression and somatic expression, Freud argued that the symptom is a precise translation of an idiom into a distinct sensation. Freud even adds that this is not a matter of an overdeveloped imagination; the hysteric simply relates literally to the linguistic expression. After many insulting remarks, the feeling of “a stab in the heart” or “a slap in the face” revives a sensation to which the linguistic expression owes its origin (Bruer and Freud, 1895, p. 254). It appears that Freud is saying that we are speaking of the simplest and most primitive verbal expressions, connected to sensation in an automatic manner, similar to the connection between sensations and the body’s various parts. The hysteric is “right” in preserving the original meaning of words, and indicates the outstanding strength of their innervation.
While developing psychoanalysis, Freud attributed great importance to various aspects of relating to language. However, the attempt to view the symptom as an exact equivalent of a verbal expression was almost entirely neglected, at the price of seeing the symptom as a symbolic expression of an unconscious conflict. During the period of Studies on Hysteria, Freud didn’t connect the symptoms to early childhood experiences – a connection which we now view as essential to understanding the shared origin of early sensor-somatic experiences and idiomatic expressions involving body parts. Many other analytic researchers have tried to follow Freud’s ideas regarding the affinity between symptoms and language, including Klein, Winnicott, Bion, Ogden, Bick, McDougall, Meltzer, Tustin, Lacan and others. However, none of these analysts specifically discussed the unique status of somatic idioms, its distinction from other verbal expressions and how they are transformed into somatic symptoms.
Even McDougall, who relates to verbal expressions that have a direct connection to physiological phenomena, and argues (similarly to Ogden, Bick and others) that the symptoms originate in pre-verbal experiences (McDougall, 1989), offers a theoretical mechanism which is somewhat different from the clinical one. Furthermore, she fails to explain the connection between verbal expression and myocardial infarction satis factorily. And yet, her ideas are in line with many other analytical attempts to place the earliest impressions of life outside the symbolic/linguistic zone. These conceptualizations show a clear awareness of possible connections between somatic experiences and verbal expressions but still view the earliest somatic area as being pre-verbal.
Clinical psychology regards words and verbal expressions as having the power to reach the deepest levels of the body/mind, which is one of the leading principles that psychoanalytic therapy strives to achieve. At the same time, the psychoanalytic theory assumes that there are layers within the mental systems that are pre-verbal. Therefore, the theory ought to explain precisely how the verbal can and should approach and reach this pre-verbal layer, which is said by the same theory to exist beyond its grasp. In this book, I demonstrate how exposing the relations between the somatic level of mental organization and verbal aspects in human experience might, in some situations, be of therapeutic value, since it creates a type of bridge. This bridge serves to connect primary and secondary thought processes, as well as somatic symptoms and verbal idiomatic expressions. Therefore, idioms and their realizations in the forms of behavioral symptoms might serve as a fundamental key to investigating these different layers. As exemplified in the cases described in this book, idiomatic expressions exist on the border between sensations emerging from somatic experiences and the verbal realm.
Let’s return to Rebecca’s dream. It provided her with a visual way of observing her life and seeing “with her own eyes” that something was stirri...

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