Living Psychoanalysis

From theory to experience

Michael Parsons

• Publisher: Routledge
• Year: 2014
• Print ISBN: 9780415626477
• eBook ISBN: 9781317695707
• Topic: Psychology
• Subtopic: Mental Health in Psychology
• Index: Psychology

Living Psychoanalysis: From Theory to Experience represents a decade of work from one of today's leading psychoanalysts. Michael Parsons brings to life clinical psychoanalysis and its theoretical foundations, offering new developments in analytic theory and vivid examples of work in the consulting room. The book also explores connections between psychoanalysis, art and literature, showing how psychoanalytic insights can enrich our lives far beyond the clinical situation.

Living Psychoanalysis comprises four main sections:

Life and Death – asks what it means to be fully and creatively alive, and introduces the concept of avant-coup

Sexuality, Narcissism and the Oedipus complex – develops fresh ways of understanding these key concepts

How analysts listen – explores links between psychoanalytic listening and the way artists look at the world, and introduces the concept of the internal analytic setting

The Independent tradition in British psychoanalysis – considers the theoretical foundations of Independent clinical technique, and discusses from various perspectives the role of training in developing the identity of analysts and analytic therapists

With fresh theoretical concepts and a focus on specific aspects of clinical practice, Living Psychoanalysis: From Theory to Experience will be a valuable resource for analysts, therapists and professionals who wish to extend their vision of psychoanalysis. It will also be of great interest to general readers concerned to deepen their understanding of the links between culture and the mind.

Part I

BETWEEN DEATH AND THE PRIMAL SCENE

‘It’s a poor sort of memory that only works backwards,’ the Queen remarked.

Lewis Carroll, Through the Looking-Glass, and What Alice Found There (1871: Chapter 5)

1

KEEPING DEATH ALIVE

What does it mean to be fully and creatively alive? The question is at the heart of this book. It is the focus of this chapter and the next, and it resonates through all the rest.

Have psychoanalysts anything to say about this? Are there specifically psycho analytic ideas about what constitutes being alive in the full sense of the word? The answer given by this book is strongly in the affirmative. Psychoanalysis has a lot to offer on the subject, and two analysts who make a good starting point are Donald Winnicott and Thomas Ogden.

Winnicott’s work has been called ‘a kind of biography of the sense of aliveness as it unfolds in infancy and throughout a lifetime’ (Eigen, 1996: xxi). As regards infancy, Winnicott said that work with borderline patients took him ‘to the early human condition, and here I mean to the early life of the individual rather than to the mental mechanisms of earliest infancy’ (Winnicott, 1965: 235). At the other end of life, Winnicott’s prayer, ‘May I be alive when I die!’—reported by his wife Clare (Winnicott, C., 1989: 4)—confirms the continual importance to him of true aliveness.

In his book Playing and Reality, Winnicott makes a fundamental distinction between two ways of living. The first is based on a relationship to reality that he calls ‘creative apperception’ (Winnicott, 1971a: 65). ‘Apperception’ is an unfamiliar word but an important concept. It means perceiving something and setting it in relation to past experience. This is how we create our personal repertoires of meaning. Unconscious linking allows new perceptions to take on idiosyncratic significance, structuring an alive and dynamic internal world. Psychological health or illness depends on the extent to which this happens: on how far we are able, or find ourselves unable, to live creatively in this manner. And it does go this way round. It is not that our quality of living depends on the level of psycho logical health we have achieved. It is rather that our psychological health, or lack of it, is a manifestation of the quality of aliveness we have achieved.

Claiming that a central aspect of psychoanalysis is to develop the capacity for being alive is more radical than it might seem. Psychoanalysis began as a treatment for neurotic symptoms, then came to encompass character disturbance, perverse and borderline conditions and psychotic states. All these affect the quality of people’s lives. The assumption might be that analysis improves the quality of patients’ living by the way it deals with such disorders. Change in how patients experience their lives would then be seen as a consequence—a desirable one, but still essentially a by-product—of the primary psychoanalytic work of addressing the mental mechanisms of pathology. The shift implied by Winnicott, which I am developing and extending, is to take how people experience their living as a central focus of psychoanalysis, and to give primary status to the question of how a person’s aliveness is impaired. Neurotic and character disturbances can be viewed, not as pathological entities requiring specific treatment, but as markers of the way that people are not managing to be as fully alive as they could be.

Ogden also regards a capacity for aliveness as fundamental to a person’s well-being.

I believe that every form of psychopathology represents a specific type of limitation of the individual’s capacity to be fully alive as a human being. The goal of analysis from this point of view is larger than that of the resolution of unconscious intrapsychic conflict, the diminution of symptomatology, the enhancement of reflective subjectivity and self-understanding, and the increase of sense of personal agency. Although one’s sense of being alive is intimately intertwined with each of the above-mentioned capacities, I believe that the experience of aliveness is a quality that is super ordinate to these capacities and must be considered as an aspect of the analytic experience in its own terms.

(Ogden, 1995: 696)

Ogden lays stress on aliveness as something to be actively experienced. Bion’s concepts of beta-elements, alpha-elements and alpha-function have become a familiar part of the psychoanalytic vocabulary. But they were developed for a specific reason. Bion needed them in order to conceptualise the difference between experiencing something and, on the other hand, having it merely happen to one. In the latter case, one may feel pain ‘but will not suffer it and so cannot be said to discover it … The patient who will not suffer pain fails to “suffer” pleasure’ (Bion, 1970: 9). Bion and Ogden are addressing, in highly condensed fashion, two different things at the same time: the experience of living one’s life with conscious awareness of its significance; and the need for an unconscious internal organisation that allows that to happen. The quality of our living is determined by how far the latter allows us to discover the former.

The second way of living described by Winnicott results from the lack of such an internal organisation. He calls this ‘living by compliance’, and it comprises a very different relationship to reality from creative apperception. Compliance is essentially a failure of independence. ‘The world and its details [are] recognised, but only as something to be fitted in with or demanding adaptation’ (Winnicott, 1971a: 65). The contrast Winnicott draws between these ways of being is stark. He calls them ‘alternatives of living creatively or uncreatively’. Creative apperception, he says, ‘makes the individual feel that life is worth living’. Compliance ‘carries with it a sense of futility’ and is ‘a sick basis for life’ (Winnicott, 1971a: 65). Sometimes, of course, adapting to the world around us is necessary and valuable as a matter of choice. But the capacity to exercise this inward freedom of choice cannot be taken for granted. It needs the right sort of experience to have been available for a child; one which the child has been able to make use of for the development of its independent psychic structure.

In his paper ‘The theory of the parent-infant relationship’ Winnicott (1965 [1960]: 37–55) sets out to clarify how this sort of early experience evolves. He sees it as a series of stages to which, taken together, he gave the name of ‘holding’. The infant progresses from ‘absolute dependence’ through ‘relative dependence’ to a last stage, which one might expect to be the attainment of independence and its consolidation. Instead, however, Winnicott calls it ‘towards independence’. The unfinished quality of the movement which this indicates reveals that dependence is not denied. To depend, for the evolution of internal psychic structure, on a reliable developmental framework is not what Winnicott means by compliance. On the contrary, being able to depend on such a framework is the precursor of an identity that will be capable of independence. If such a framework is absent, however, or cannot be internalised by the child, there is an unconscious, anxiety-driven deadening of psychic evolution, giving rise to a compliant dependence on the opinions and attitudes of others as the basis for life.

The three stages which comprise ‘holding’ are followed in Winnicott’s scheme by ‘mother and infant living together’ and finally ‘father, mother and infant, all three living together’ (Winnicott, 1965 [1960]: 43). ‘Living’ is a charged word. Ogden has made a particular study of the evocative, multilayered ways in which Winnicott uses language. ‘The life of the writing’, he says of Winnicott’s work, ‘is critical to, and inseparable from, the life of the ideas’ (Ogden, 2001: 206). There is a chapter in Playing and Reality (Winnicott, 1971a: 104–110) called ‘The place where we live’. This might be taken to mean the mental space which we inhabit, like the house, or the street, where we live. But true aliveness was a lifelong concern of Winnicott’s, and his linguistic subtlety allows us to read this also as ‘The place where we LIVE’; meaning the place in which, when we manage to be in it, we become fully alive.

If a family (whatever its make-up) has been ‘living together’ in the sense of being fully alive together, the child’s internal movement towards independence will be that much easier. The eventual shift from ‘father, mother and infant living together’, to the child being able to live separately, is a developmental transformation. The late adolescent or young adult moving away from under the parents’ roof has to make an internal move as well, and the most important function of the change of address may be to get this inward leaving home under way.

A further sort of ‘inwardly leaving home’ faces everyone throughout life. We all have ways of being that we take for granted, which operate as a kind of psychic home base. Creative living means not complying automatically with these. The German title of Freud’s (1919b) paper known in English as ‘The Uncanny’ is ‘Das Unheimliche’, a word that evokes a sense of alien strangeness with a distinctly frightening quality. Deriving from the root ‘heim-’, meaning ‘home’, it connotes all that with which we are not ‘at home’. Creative living implies being open to our own particular ‘Unheimliche’.

This has a special importance in psychoanalytic therapy. There is a risk that the demands of the clinical situation may evoke in analysts and therapists a kind of internal compliance. Analysts have different styles and personalities. They have an analytic superego internalised from their trainers; invisible assumptions about the analytic relation ship which go back to their own analyses; and preconceptions about what kind of work they do best. If these are never challenged an analyst may continue silently complying with them, hardly even conscious that they are there. The result will be analysis which is unobjectionable in a routine sort of way, but uncreative. For analysts to avoid this entails a degree of suspicion towards ways of analysing with which they are too much at ease. They need to not be compliant with what they are at home with in themselves.

The analytic process can be viewed from different kinds of vantage points (Parsons, 2000: 192ff; see also Chapter 11, p.200). Analysts may see it as something on which to capitalise, so as to extract understanding from it and convey that to the patient. This vantage point produces interpretations aiming to convey relatively specific insights, in the hope that the patient will comprehend them and benefit from them in the manner intended by the analyst. The analytic process may also be seen as unfolding by its own momentum and finding its own direction. The analyst’s main concern in this case is not to get in the way of what is happening. When interpretations emanate from this different vantage point, the analyst’s hope is for them to take on a life of their own in the patient’s mind, undergoing all sorts of surprising transformations. Analysts should, in principle, be able to shift freely back and forth along a dimension between these vantage points, sensitive both to where the patient is at the moment, and to the long-term needs of the analysis. Analysts vary, however, in whereabouts they work most comfortably on this dimension. Different analysts will feel more at home at different points on it. The difficult necessity is to pay deliberate attention to the parts of it where they do not feel at home: to where it may feel unheimlich.

Here is an example of the need to be on guard against a kind of clinical automatism. A patient in analysis reported two dreams from the previous night. In the first she is in a city. It is all dark and seems dangerous. There are explosions going off. Or they might be fireworks. In the second dream, there is a car, which seems to be in a tent. In the car are a mother and daughter who are friends of the patient’s. Some gas is getting into the tent. Suddenly there is a big explosion, the car is blown up, the mother and daughter are killed. Then the patient is in a train, and the daughter who was in the car is also there, apparently alive. The patient thinks the daughter must be a hallucination, but then thinks ‘Even if she is, it’s still nice to see her again’. The dream ended there, and the patient said she was frustrated at her dreams still being dominated by her destructiveness, just as they were at the beginning of her analysis.

Turning explosions into fireworks and bringing the daughter killed in the explosion back to life could be seen as showing a wish by the patient to deny her destructiveness. On the other hand, the fireworks and the daughter’s restoration might be clues to a creative, life-enhancing aspect of the patient which she is ‘in-tent’ on denying, by going on seeing herself as destructive.

Whether the analyst takes up the patient’s destructiveness or her attempts to be more alive will depend on other indications, and the overall state of the analysis. It will also be more generally influenced by the analyst’s clinical style, theoretical preconceptions and individual personality. All analysts have their predispositions which incline them to particular modes of understanding and interpretation. The clinical need, however, is to offer whatever intervention may be most helpful to a patient: silence, specific interpretations, open-ended interpretations; of the transference, in the transference, extra-transference, and so on. It may be assumed that analysts arrive at their theoretical and clinical orientations by an evaluation, influenced of course by their own analysis and by important teachers, of the relative scientific merits of the viewpoints they encounter. What is not much discussed is how analysts adopt the positions that they do because certain analytic standpoints suit their character structure better than others. For analysts to remain inwardly available across a range of possibilities involves keeping themselves open specifically in directions contrary to their theoretical preconceptions and personal inclinations. To analyse well on one’s psychic home ground is not such a problem. For consistent good results one has to play well away from home too.

There are different kinds of strange ness. Some things are outside our familiar range of experience but, when they happen, are still encompassable by our usual ways of thinking. Unexpected as they are, we can still be at home with them. What is unheimlich, however, destabilises our habitual ways of making sense of the world, producing a particular quality of anxiety as it does so. It calls into question the framework of understanding within which we feel safe. This is the Unheimliche to which we must be open if we are to be fully alive, both personally and as therapists.

The difference is illustrated by the following clinical examples.

A man who had gained considerably from analytic therapy in the past sought further analysis because he still did not really feel his life had meaning. After coming five times a week for about a year, he said the gains from his previous treatment had been genuine, but they were also like the cloud of ink that a squid releases to obscure itself from an attacker. He thought he used his improvements to conceal a deeper refusal to allow some central part of himself to be touched. This seems a useful insight, and his being able to say it appears to indicate a developing trust in the analytic relationship. On the other hand, how much was the apparent progress that this implies yet another cloud of ink hiding his determination not to let his analyst get close to him? Behind this straightforward caution about a concealed negative transference, I had a different and more unnerving sensation. The image implied that we were both underwater. For this man to imagine himself, and invite me to imagine him, as a squid, had something obscurely repellent about it, and the darkness of the ink diffusing in the water as it came towards me felt malign and dangerous. Far from being just a helpful metaphor, the patient’s words in fact conveyed to me something uncannily horrible.

It was important for me not to take refuge in the correct and useful understanding he had voiced about utilising his improvement defensively. I needed to accept, and not distance myself from, the experience of being overtaken, deep underwater, by a black miasma. This patient was not English and sometimes, when looking for the expression that he wanted, he would first use a word in his own language. He did so on this occasion, before working his way round to the English word ‘squid’. Attempting to hold on to the uncanny horror I had felt, I was interested to try and find, in a dictionary of his language, the word he had first used. It turned out to mean not simply ‘squid’, but a giant, monster squid; and the word had a secondary meaning of a person with insatiable demands who never lets go of their prey. It seemed that my uncanny sense of foreboding was well-founded.

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Table of contents

• Cover Page
• Half Title page
• Series page
• Title Page
• Copyright Page
• Dedication
• Contents
• List of figures
• Acknowledgements
• Introduction
• Part I Between Death and the Primal Scene
• Part II Concepts on the Move
• Part III The Activity of Listening
• Part IV Clinical Practice Taking Shape
• Bibliography
• Name Index
• Subject Index