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Part I
SOMATIC SHELTERS
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SUBJECTS IN SIGHT, SOUND, AND TOUCH
Sensation and movement are basic bodily phenomena, involved in living and functioning. I chose to start examining our body–mind interweaving by illuminating various aspects of their involvement in our lives. In the consulting room, patient and analyst share an inter-subjective analytic space as envelopes or shelters that have strong physical presence: they see each other and are seen by each other, they most often don’t touch each other but the wish and the need is there, they hear and are heard, they smell and generate the sense of taste, their physical presence is within a posture that, even when minimal, is in motion. These experiences of sensation and movement are common human expressions and shelters, whose subjective utilization is being unfolded in the analytic process: when they are used unconsciously for self-defense, attraction, self-delineation, expelling of aggressiveness, or a sense of aliveness.
In the consulting room a variety of sense data is, in fact, manifested and exchanged between the patient and the analyst (sights, sounds, smells, tastes, along with modalities of minor motor activity, rigidity vs movement). In the verbatim—the verbal accounts as the familiar form of reporting from analyses by the analysts—their words are recorded, and feelings are added. Bodily communication is occasionally specified under a given topic. But, in my experience, often the sensory and motor experiences stand out like “an elephant in the room,” having a marked existence to which neither party knows how to relate, and which therapists tend to regard as either too private or invasive, too awkward to be put into words. When those sensations are put into words, they may be experienced as confronting, as attacks, or acquire physical metaphors that are not always based on actual physical experiencing (see Chapter 13).
The purpose of the treatment for the patient is to bring meaningless but dominating and disturbing sensations into subjective meaning, to make sense of one’s diverse expressions of malaise. The analytic goal is to transform those experiences which are often felt/raw sense data with no personal associations and meaning attached to become experiences that are thought out and can be communicated.
In following Bion’s (1962) view, the felt/raw sense data—stored as beta elements—will transform within the alpha function into alpha elements, where thinking, memory, and learning can be achieved. According to Anzieu’s (1985, 1990) view, the goal of both adequate development and treatment is transforming the language of the skin-ego or the psychic envelopes, where the early experienced data are recorded and organized in various body functions—especially the skin—into a psychological ego. It is for the analyst to enable this transformation, to function in representing the alpha elements, thinking and associating while being able to share the patient’s beta elements, with the sensual experiences that serve as psychoanalytic material. It is for the analytic space to serve as “skin-ego”—to provide the patient with the safety and opportunity to re-experience, process, and own primary emotional, unprocessed data. I have loosely adapted as shelters Anzieu’s concept of “envelopes.”
I open by observing experiences related to the senses of sight, sound, and touch whose primacy in organizing our psychic life is debated in psychoanalytic thinking. It is to examine how each one of these senses, by their various modalities, becomes involved in our daily life and in treatment—for attraction, self-defense, communication, and, sometimes, as substitutes for the others. In essence, Freud (1912, 1913) adamantly advocated the avoidance of having the analyst be seen: he emphasized the gaze as a seductive agent, interfering in one’s ability to concentrate. One can say that this focus coincided with the etiquette of the period—not to stare, while its interpretation as eroticizing sight has been maintained in psychoanalysis. However, for him sound was considered as a basic organizer, in having human speaking voices penetrating our mind, creating an intermediate zone between external and internal, communicating social norms, and constituting the ego and the super ego.
For Winnicott (1971) (after Lacan), however, sight was the basic psychic organizer—it was the mother’s approving gaze in mirroring her child that ensures our internalized sense of self. Anzieu (1985), on his part, advocated the sense of touch and the “skin-ego” as even more fundamental in organizing our psychic life than the gaze; due to the characteristics of the skin, the touch supplies a sense of volume (through its double-layered structure). It supplies the feeling of social relatedness in being the only reciprocal sense—the touching party is the touched one. Above all, it is the first container of our physical and psychological entirety, preceding the brain in combining and processing the overall bodily information. However, touch maintains a concrete level of processing and a perverse human contact; therefore, the sound should replace it in the consulting room to provide accurate “touching,” to create a facilitating “sonorous bath.”
Today the mutual presence and visibility—as signified by the body—is a given that relational psychoanalysis introduced into analytic thinking and practice. It meets the contemporary culture of accessibility and democracy. In this light we shall examine the respective presence of these three modalities of sensation in the analytic process.
I see you/you see me
Looking and being looked at involves the need to be confirmed by the other and the approval for one’s attractiveness, but it also signifies shame for what may be seen and fear of its recriminations. In the consulting room sight has become an involved matter, which we shall now examine: how seeing and being seen is experienced by the analyst and how seeing and being seen works for the patient.
The analyst sees
We shall start with the analyst’s experience of seeing. In one of my clinical seminars in which the following experiences came up, the modality of seeing was not included in the planning, but it was added on the spot as I realized that the participants in the seminar had been storing in their therapeutic work too many difficult sights. As in post-trauma and according to Bion’s beta elements—they needed to be exposed and worked through via alpha function into alpha elements. One participant told of a patient of hers, a young man, who when first arriving for treatment, looked like a cave-man—with a wild growth of hair and beard and dirty fingernails. Her sense of horror was based on the thought that she had: how the normal family that he came from could let him get to this state of neglect. Only then could she attach his frightening look to what frightened her—that this young man, who was at the age of her own daughter, signified neglect that could happen to her and hers too, that no one is immune against deviation from “normality.”
I referred to this counter-transference matter through Racker’s position (1953) that we cannot remain on the normal-healthy side, while the patient signifies “sickness.” The horrifying sight that a patient evokes may touch not directly upon our personal childhood memories, but upon their evolvement into the parental role. It may shake a magical belief that we surpassed our parents’ and childhood difficulties, while having to confront them through patients. Another participant reminded the seminar of the particular role of that man’s shocking appearance—to get him noticed as a cry for help.
Other participants contributed more descriptions of difficult sights they were coping with: physical distortions and changes due to a disease, in which the person had a particular appearance beforehand but had no time to adjust to the new appearance that befell him or her. One participant told how she copes with a physical deformity of an old person, as she finds herself listening more than looking. Another participant who works with children told how it was difficult for her when parents of deformed or autistic children pushed her to invest in the child’s appearance and compliance: how difficult it is to attend to those parents in a culture that stresses beauty.
The embarrassment in facing the sight of a big and exposed bosom was brought up: the difficulty in finding words for “private parts” and “intimate body functions,” especially in the shadow of sexual seduction and experimentation, which may be unconsciously affecting the patient’s gestures and visibility. The therapist’s embarrassment called for exploration of his or her own personal inhibitions and fears with regard to sexuality and seduction in the consulting room and in general, in order to start naming—giving words to what we see—the sight of an exposed bosom in one party that may be enticing an envious or aroused response in the other party, the sight of a very thin or fat body of a person/woman declaring that “there is no problem,” and other sights.
The sights seen by the analyst—the patient as a cave-man, a patient who has become fatter or skinnier, a bewildered look, an infantile style of dressing, a seductive person—apparently have to be recognized and processed. However, seeing is a mutual experience; even when the patient lies on the couch he can see the analyst’s legs that she tries to hide by a skirt, grief in the analyst’s eyes not otherwise acknowledged, or an appealing appearance. Those are sights to be recognized and utilized, although more often are taken as embarrassing to the analyst.
My patient Sylvie (see Chapter 10), since progress in the analysis, is more capable of referring to her bodily presence in the consulting room. It is summer, and she lies on the couch. I notice that she is gradually pulling up her long dress, her legs becoming more and more exposed up to her panties. I cannot stop myself from saying: “What is it that you are doing?” Sylvie smiles and says: “It’s hot,” but she is willing to explore this matter: how she wishes her body to attract sexually now, how she is showing me how sexy she is, and that showing is more natural for her than verbal admission.
Sue (see Chapter 4), a young woman, is at a stage of her treatment in which a magical belief of hers that if she loses weight she would find a steady boyfriend—fails to materialize and she regains weight. I see her in her usual posture of lying along the armchair, but now she seems to me like a whale in a net. I realize that my gaze is now needed to grasp both her big body and the pain in the corner of her eyes, both expressing the feelings of anger and hurt that had so far been concealed behind her witty words. My gaze is needed to record her now-exposed feelings, along with making sure that she can use her size to protest but not to overdo it and impair the physical and psychological gains she has mastered in treatment so far. Lily (see Chapter 8) shows her therapist her sore eye; she needs her to see and inspect it. For her, a borderline adolescent, this is a first move in agreeing to be taken care of, at first in a concrete–physical manner.
These are some modes in which the sight envelope or shelter is being manifested and mastered in the analytic space, when the analyst sees.
The patient sees
Max is a young man who, in the analytic process (see Chapter 12) admits: “Sometimes I feel empty from within, and have only my outer part as a shell,” in a period that he gave up on a sado-masochistic liaison. He scrutinizes his analyst’s face, hair, hands, and clothing; she reports in supervision a growing sense of self-consciousness. However, she pays attention to the function of his gaze on her in organizing his mental chaos when he is on his own, trying to hold on to her and compose a gestalt from her various body parts: “Sometimes I have eyes, sometimes I have hair, but I don’t manage to remember a face.” However, it is her voice that he hears when he feels he is drowning in his void. This is how he started internalizing the object to form a subjective core, beneath his external (empty) shell.
Upon such intimacy and fusion, Max and his analyst needed later on to unknot an intense erotic transference. Max gradually learned to go beyond the sense of masculine (oedipal) humiliation when his mastery of the object failed to respond to a primary omnipotent control, and the analyst overcame her fear of being seen not only as an (maternal) object but also as a woman, to enable negotiation on a more developed level as well.
Max sees and examines his analyst; patients see the analysts’ appearance—grief, sickness, and aging. However, analysts and therapists often report feeling invaded by patients’ gazes. They also report a personal difficulty arising in their own treatment: when they notice in their analyst an illness or other physical change, which the analyst denies with determination, while they lose faith in the person and the process.
As pointed out, the sight of the analyst’s physical presence has a history of being banned. In the beginning of psychoanalysis Freud defined the principles of anonymity, neutrality, and abstinence to make sure that the analyst would be equipped to meet the unconscious scripts and the instinctual wishes of the patient, while being protected against them. The body of the analyst was removed from the sight of the lying patient; the avoidance of the patient’s gaze was a way for the analyst to survive the fantasizing of the hysterical female patient. Freud (1913) established the analyst’s avoidance of the patient’s gaze first by a personal motive:
I cannot put up with being stared at by other people for eight hours a day (or more). Since, while I am listening to the patient, I, too, give myself over to the current of my unconscious thoughts, I do not wish my expressions of face to give the patient material for interpretations or to influence him in what he tells me.
(p. 134)
He concludes his recommendations to physicians practicing psychoanalysis (1912) by an instruction of that nature: “The doctor should be opaque to his patients and, like a mirror, should show them nothing but what is shown to him” (p. 118).
Although later on the sight envelope was acknowledged by Winnicott (1971) in the form of the mirroring function, in which the gaze of the care-giver is what provides the nascent self its terms for self-recognition, and in Kohut’s (1971) mirroring transference, in which the analyst is to provide the patient a gleam in the eye, which was missing in his or her development, and has to be repaired—in actuality, the fact of being mutually seen is still felt as confusing and invasive.
Apparently, the basic structuring of the analytic physical space to avoid eye-contact has maintained its overpowering effect, and analysts and therapists still seem to need a hand in accepting and processing the reality of being seen; still, mutual visual presence is often taken as embarrassing. Today, the physical presence of the analyst as a subject, signifying otherness and separateness, is a given that the relational psychoanalysis introduced into analytic thinking and practice to meet the contemporary culture. Therefore, I suggest amending this lack in accepting and making use of the analyst’s visibility (and will later elaborate on this issue when dealing with transference; see Chapter 12).
Contemporary therapists, due to their training and present-day reality, are capable of concentrating on the inner and outer processes. No posture can ensure the analyst’s invisibility, and the contemporary patient is freer in determining when to avoid eye contact in order to concentrate on one’s psychic journey, and when to seek it. Thus, in this freer environment, the visual experiences are an integral part of the analytic process.
The sounds in the consulting room
Developmentally, it is through the permeability of the universe of sound (and also of taste and smell), that a self as pre-individual psychical introjections enables a rudimentary unity and identity. Gradually, it is through sound that the boundaries and limits of the self are established into a three-dimensional domain, while interfacing with and depending upon tactile sensations and the changing volume by breathing. This is how the auditory sensations participate to create a complex sensory experience, which is not only physical, but social and symbolic.
In the consulting room two people talk, exchange sounds in search of meaning. Their voices often communicate a hidden message beyond mere words. Sometimes one’s scream calls for the other’s resonance for the pain involved or the need to make sure of being heard; sometimes the analyst’s soft voice can be experienced as too monotonous for a musical patient to endure and trust. Fluctuations in one’s voice may portray different transference figures or different voices internalized in the patient: of a criticizing, seducing, authoritarian parent, of a criticized child, of a criticizing super ego, or of a defended drive. Auditory attunement is required not only for this mélange of voices in the patient’s delivery, but also for the possible effect of the analyst’s actual voice as evading, salvaging, or seducing.
Yelling and other voices
Freud (1895) views the baby’...
