The Emergence of Analytic Oneness

Into the Heart of Psychoanalysis

Ofra Eshel

• Publisher: Routledge
• Year: 2019
• eBook ISBN: 9781351815963
• Topic: Psychology
• Subtopic: Mental Health in Psychology
• Index: Psychology

The Emergence of Analytic Oneness is a profound and penetrating exploration of a fundamental dimension of analytic presence and patient–analyst interconnectedness that offers new possibilities for extending the reach of psychoanalytic treatment and working with some of the most difficult treatment situations.

Eshel listens with a 'hearing heart' and gives herself over to being within the patient's experiential world and the grip of the unfolding analytic process. She has gone with her patients into black holes, dissociation, deadness, sleepiness, petrifaction, silence, longings, the depths of perversion, and the enigmas of telepathic dreams, while experiencing the emergence of patient–analyst two-in-oneness, with its challenges and mysteries. Drawing on Winnicott's posthumous writings and Bion's late work and going beyond recent analytic notions of intersubjectivity and witnessing to interconnectedness and 'withnessing,' Eshel offers her own understanding of at-one-ment or "being-in-oneness" with the patient's emotional reality as the only state of analytic being that can meet and transform core unthinkable breakdown and mental catastrophe. The critical question here is to what extent the analyst is willing and able to open the boundaries of his or her psyche to the patient, especially in difficult, unbearable and devastated-devastating states.

Eshel's clinical narratives are detailed, intense, theoretically grounded, and very moving. The Emergence of Analytic Oneness will be an invaluable guide for psychoanalysts, psychotherapists, and students in these fields who want to extend their reach into deeper levels of disturbance in the difficult clinical work they do.

Part I

Within the depths of being

Experiences in a new dimension

No matter how deep our analytical experience, this is just the tip of the iceberg of that mystery. It is a mystery, and we are just starting to learn the mystery behind it.

(Bion in Buenos Aires, 2018/1968)

There is something about going into the depths, and even further, beyond what we think the depths can be.

(Merle Molofsky, 2012)

Chapter 1

The heart

Or, what’s heart got to do with it?

What does it mean to approach the heart of psychoanalytic work? In this chapter, I will delve, clinically and theoretically, into the essential meanings and experiences that this question carries for me.

A “hearing heart”

The peculiar biblical combination of a “hearing heart”—”לב שומע“—has captured my imagination and thinking and carved out a space in my clinical understanding over many years. As a child in primary school, I studied the biblical story of King Solomon asking God to give him a “hearing heart” to be able to judge the people (I Kings 3:9), and I was perplexed by this peculiar combination—how can a heart hear? The marvel of a “hearing heart” followed me into my first analytic paper on storytelling and listening in the analytic situation (1996). Later on, in my paper on containing (2002a [Hebrew], 2004a [English]), I emphasize the importance, even the necessity, of the analyst’s “hearing heart”—hearing, listening, and understanding with one’s heart—in the process of containing. And, more recently (2012a, 2015a, 2016a—chapter 9 in this book), once more, it forms a fundamental aspect of my thinking when facing the “voice” of trauma or breakdown.

When translating my 2002 paper on containing from Hebrew to English, I was surprised to discover that the standard translations of the Bible into English diminish the peculiarity of this combination by changing the “hearing heart” to “an understanding heart,”¹ “a discerning heart,”² “an understanding mind,”³ and “a thoughtful mind.”⁴ Only the Oxford Study Bible comes closer to the original Hebrew—“a heart with skill to listen.” These translations miss a subtle yet crucial further occurrence in the Hebrew biblical narrative. Although King Solomon asks God for a “hearing heart” (”לב שומע“), he is given “a wise and an understanding heart” (“לב חכם ונבון”), and also “both riches and honour”:

Behold, I have done according to thy words: lo, I have given thee a wise and an understanding heart, so that there was none like thee before thee, neither after thee shall any arise like unto thee. And I have also given thee that which thou hast not asked, both riches and honour.

(I Kings 3:12–13)

Thus, “the wisdom of God was in him” (3:28), yet not a “hearing heart.”

What does this mean? Hazan (2008), who, too, relates the “hearing heart” to analytic listening, offers an intriguing explanation:

It seems to me that buried in this ancient text is a unique insight into the essence of analytic listening, and, even if it is not found there, a contemporary listening to the text allows us to derive this insight from it. What I am saying is that it is referring to a wish that will always remain only partially fulfilled, and, at best, we must be satisfied with a wise and understanding heart, which is no small feat. But even if we do not receive a hearing heart, it exists there as a poetic ideal which constitutes part of who we are, and serves as a landmark which determines the azimuth according to which we listen.

(p. 7, italics in original)

I understand this differently. I think that in the biblical text a “hearing heart” thus becomes a great human longing that cannot be obtained from without, not even through Divine giving; nor does it pertain to the realm of wisdom, even Divine wisdom. All of these may confer “a wise and an understanding heart.”⁵ The “hearing heart,” however, can be attained only through a willingness to dare to open one’s heart and soul to another human being. It is thus at the core of the analyst’s difficult, sometimes exceedingly difficult, struggle to give himself/herself over—with all one’s heart, soul, might (Eigen, 1981, based on Deuteronomy 6:5)—to being there within the troubled emotional experience of the patient’s world—staying open and attuned, sensing, hearing, and feeling the “voice” of the patient’s trauma or breakdown that cries out (Caruth, 1996; Eshel, 2015a, 2016a—chapter 9).

Tustin’s “heart-break”—or, “Who needs a heart when a heart can be broken?”⁶

Then, into my “heart” thinking entered Frances Tustin’s “heart-break.” In the early 1990s, I became acquainted with Tustin’s writings, and although I did not work with autistic children, they influenced the way I thought of and practiced psychoanalytic treatment, especially with severely disturbed patients. I was affected not only by her ideas, but also by the distinctive way in which she expressed them—in imagery that she carried over throughout all of her books: “the black hole of traumatic bodily separateness”⁷ (1972, 1981/1992, 1986, 1990), “the protective shell against an original agony” (1990), “at root, there is such a terror of worse than death” (1972). And, in particular, I was enthralled by her words regarding “the heart-break which is at the centre of human existence” (1972). She wrote about it powerfully in her first book, ending on a somewhat enigmatic note:

Distribution of largesse may seem like sympathy and kindness. Manipulation of materials, often of an extremely capable and skilful kind, may seem like creative activity. But these are not the works of creative imagination or caring. For this to occur, the heart-break which is at the centre of human existence has to be experienced again and again in ever-widening contexts of developing maturity. The care of psychotic children demands people who have experienced this.

(Tustin, 1972, p. 83, my italics)

“Who needs a heart when a heart can be broken?” The words of Tina Turner’s song resounded while I was reading Tustin’s words. And, in Tustin’s last book (1990), a very experienced medical director of a psychiatric clinic admonished a young psychiatrist regarding his patient, “You should never have taken such a patient. These patients break therapists’ hearts.” But Tustin, who over the years (1991, 1994) undauntedly discarded some of her early key ideas, retained the idea of “broken-heartedness”—from her first book in1972 to her last, 18 years later, in 1990. She recounts in the latter, that the young psychiatrist mentioned above, who was admonished by his director, had come to consult her about his patient, and as the result of what she had learned from autistic children, she

. . . was able to help this psychiatrist to see that these patients threaten to break therapists’ hearts because they themselves are ‘heartbroken.’ The ‘heartbreak’ goes beyond what we usually mean by the term. The feeling of brokenness goes into the very fabric of their being . . .. Their sense of ‘being’ was felt to be threatened. Annihilation stared them in the face, and very desperate steps had to be taken to combat it. To combat it and to cover their brokenness, they developed the plaster cast of autism. This concretized experience of encapsulation spells death to the psyche . . .. Understanding their sense of agony helps us.

(1990, pp. 155–157)⁸

Tustin’s years-long profound understanding of the “broken-heart” converges with my years-long journey regarding the significance of the “hearing heart” in psychoanalysis, becoming now a meeting of hearts.

Freud writes that the analyst “must turn his own unconscious like a receptive organ toward the transmitting unconscious of the patient. He must adjust himself to the patient as a telephone receiver is adjusted to the transmitting microphone” (1912, pp. 115–116). And Bion says, “If the analyst is prepared to listen, have his eye open, his ears open, his senses open, his intuition open, it has an effect upon the patient who seems to grow” (cited by F. Bion, 1995, p. 106). I see the “hearing heart” as an essential part of the analyst’s increased receptive capacity, and emphasize the crucial necessity of the analyst’s openness of heart. And adding Tustin’s idea of “broken-heartedness,” it is the analyst/therapist’s heart that hears and “experiences again and again the heart-break which is at the centre of human existence,” especially when the patient’s transmission is unthinkably broken. In the Hebrew verse “With all one’s heart, with all one’s soul, and with all one’s might” (Deuteronomy, 6:5), the word “heart” is spelled with a double letter beit לבב—ב levav—rather than the usual לב lev (that again, does not find expression in the English translation). It is this double “heartedness” that I put forward here. This very vital quality of the analyst’s hearing and experiencing “broken-heartedness” engenders a different possibility for reaching and meeting the painful immensity of the brokenness of a human[e] psyche.

“I have called upon poets and writers to help me in this task . . . we need to be encircled by their integrating aesthetic embrace,” writes Tustin (1986, p 12). I would now like to address the clinical meaning of hearing, experiencing, and staying with the heart-break through the tragic, horrifying story of Count Ugolino, told to Dante and Virgil in the depths of the Inferno (The Divine Comedy, 1320), and through my own case illustration. Let me begin with Dante.

Dante and Ugolino in the Inferno—the unmet weeping of the broken-heart

Dante’s Divine Comedy, written 700 years ago and still widely considered one of the greatest classics of Western literature,⁹ describes in the first-person Dante’s journey through the three realms of the dead: Inferno (Hell), Purgatorio (Purgatory), and Paradiso (Paradise or Heaven). Dante is guided through Hell and Purgatory by Virgil, the great Roman poet he reveres, who protects him mentally and physically from the horrors of the journey, while his guide through Paradise is Beatrice, his ideal woman and the love of his youth.¹⁰ But Dante does not want to write allegoric poetry; rather, he writes “a detailed and exact diary of a journey . . . [in which] the most prominent theme is the naturalist precision of the description” (Stav, 2007, p. 59), with tangible physical descriptions and a richness of visual imagery.

Dante and Virgil’s journey through Inferno is narrated in onerous and excruciating detail, in over 34 cantos. They descend, circle by circle, through the nine circles of Hell, which are teeming with wickedness, horrifying tortures, and unending lamentation, and each of the nine circles represents increasing levels of evil, horrors, and agony. The last, bottommost circle of Hell, “the lowest point of all evil,” is the circle of treachery—betrayal is the ultimate sin in the eyes of Dante—divided into four sections according to the type of betrayal: of blood relatives, of homeland or party, of one’s guests, and of masters and benefactors. Depending on the form of their treachery, traitors are forever entrapped in varying degrees in the vast ever-frozen Lake Cocytus (from the Greek Κωκυτός, “lamentation”), filled with heartbroken voices. Here, in Canto 33—the penultimate canto of the journey through Hell—Count Ugolino tells Dante his gruesome story, the longest and most tragic story told by any of the characters in Inferno.

It is an appalling story that begins with a horrifying scene, in which Dante and Virgil (at the end of Canto 32) see in the frozen lake a man who is gnawing another man’s head and neck from behind “as in hunger people will gnaw bread.” Dante inquires what has warranted such cruelty, “O you who show by such a bestial mark/The hate you have for him whom you are eating,/Tell me why” (Canto 32, p. 185). The man raises his mouth from the bleeding skull and wipes his lips on his victim’s hair. Identifying himself as Count Ugolino from Pisa and the other man as the Archbishop Ruggieri, who informed on him, he begins to tell of his “desperate grief, which presses on my heart.” But although Ugolino is condemned to eternal damnation at the lowest circle of Hell for political treachery, he makes no attempt to exonerate himself of the crime; his story, instead, is about the terrible days during which he and his innocent children were cruelly killed, starving to death.

When imprisoned for treachery in a tall tower together with his four sons, he dreamed one night that a man, a lord and master, with hunting dogs, was chasing after a wolf and his cubs, the dogs catching them and tearing them to pieces. He woke up from this nightmare, feeling an imminent catastrophe, and hearing his famished sons crying out in their sleep. But when the morning came, they heard that instead of bringing them food, the gate to the tower prison had been locked and they were left to starve to death. Ugolino looked silently at his sons, his heart turning to stone as his sons cried, until his youngest son, Anselmo asked in fear: “Why do you stare so, father, what is the matter?” But Ugolino neither cried nor could reply that entire day and night. The next day, when he saw “on their faces the look that was in my own,” he bit his hands in deep grief, and they thought that it was from hunger. They thus offered him to eat their bodies, the bodies he had given to them. Ugolino was silent in view of such suffering, and all of them remained silent for the next two days. On the fourth day of their torment, his son Gaddo threw himself at his father’s feet, cried out for help, “My father, why do you not help us?” and died; the remaining three brothers died one after the other over the following two days. Ugolino who had turned “blind and crazy,” groped over his dead children and for two days later called out their names; “And then, hunger had more force than grief.” (Canto 33, pp. 186–188)

Ugolino’s last statement that hunger proved stronger than grief has been interpreted in two ways: either that Ugolino devoured his children’s corpses after being driven mad with hunger, or that starvation killed him after he had failed to die of grief. Whatever the case, Ugolino ends his story and resumes gnawing on Ruggieri’s skull. “[W]ith his eyes bulging,/He again seized the skull with his teeth,/Which, on the bone, were as strong as the dog’s” (Canto 33, p. 188).

At this point, the text presents harsh but impersonal lines, cursing Pisa, wishing for its downfall, “For if Count Ugolino is supposed/to have betrayed you so that you lost your castles,/You had no right to put his sons to torture./Their tender age made them innocent,/You modern Thebes!” (Canto 33, p. 188). And Dante and Virgil move on, passing to the third ring of traitors.

What has happened here? Why, after telling his dreadful story, does Ugolino immediately revert to the same cannibalistic behavior as before? In recent years, the notion of “witness” has increasingly gained currency in clinical psychoanalytic thinking, particularly in cases of trauma (Caruth, 1995; Grand, 2000; Reis, 2009a; Stern, 2012; Amir, 2012). The witness is an attentive presence that enables the traumatized person to face the traumatic. For the trauma leaves the survivor cut off, disconnected, lonely, and lost, with nobody to turn to—“The trauma survivor remains solitary in the moment of her [or his] own extinction . . . possessed in its impenetrable solitude” (Grand, 2000, p. 4). Reis (2009a) compellingly broadens the notion of witnessing and suggest that “it is the analytic encounter that allows traumatic repetition to take on the quality of a communication, an address to another, rather than remain meaningless reproduction” (p. 1359).

In Dante’s classical text, the most essential features of witnessing are present: Dante’s question to Ugolino is asked from a real wish to know—there is a concentrated listening. And at the end there is an angry outcry regarding the injustice of the dreadful punishment of Ugolino’s innocent children. So, what is missing here? Why after all this does Ugolino immediately return to the relentless cannibalism of before?

Perhaps the answer lies in Ugolino’s two moments of emotional relating...

Table of contents

• Cover Page
• Praise
• Half Title
• Series Page
• Title Page
• Copyright Page
• Dedication
• Table of Contents
• Acknowledgments
• About the Author
• Introduction: On the Emergence of Analytic Oneness— Challenges and Mysteries
• Part I Within the Depths of Being: Experiences in a New Dimension
• Part II The “Voice” of Breakdown
• References
• Index