Theaters Of The Mind

Illusion And Truth On The Psychoanalytic Stage

Joyce McDougall

• Publisher: Routledge
• Year: 2013
• ISBN:
  9781135888350
• Edition: 1
• Topic: Psychology
• Subtopic: History & Theory in Psychology
• Index: Psychology

Using the theatre as a central metaphor, this text provides a flexible framework to explore the psychic realities of the characters within us. Case studies underscore how different kinds of patients construct particular fantasies as a response to the pain of earlier life scenarios.

1

Static and Ec-static States: Reflections on the Psychoanalytic Process

Stepping onto the Psychoanalytic Stage

The scenarios are written in an unknown language; the dialogue is inaudible, sometimes reduced to mime; the characters are as yet unnamed. The psychic dramas of the theaters of the mind thus await production on the analytic stage. In the hope of finding meaning and easing pain, two people step out on that stage to bring the drama to life as psychic reality. The analysand has only vague memories for a script, a sense of having been there before but no precise idea of the settings, characters, or actions to be encountered. The analyst already knows, from long years of personal analysis, what the analysand will discover: that we stumble upon these scenes and people, sometimes with utter astonishment, sometimes with a feeling that we have found the missing part of a puzzle, and sometimes with the strength to hear the end of a story or to look at scenes that once seemed fearful to bear.

Analysands taking their first uncertain steps onto this inner stage do so with extreme caution. They are wary of that unknown guide, the analyst. At one moment they believe that the analyst already knows all the scenarios awaiting production; at other times they worry that the analyst will not provide support if the dramas become too strange or too frightening. And indeed this internal world is peopled in a weird and contradictory way. The psychic scenes and the characters in them give themselves away through sudden strange associations, fantasies, slips of the tongue, or dreams, thus sliding through the conscious use of language.

Yet it is these unconscious revelations that often give the analyst a glimpse of what the analysand is seeking, stumblingly, to put on stage.

Listen to this patient speaking of a close friend who has just lost her only son. In the midst of her tears she suddenly thinks of her own younger brother, whom she loves dearly. She begins to worry about his health and the fact that she has been negligent in asking for news of him. “All those digestive problems he's been having … my God, I hope he doesn't die of intestinal cancer like Daddy!” She cries once more, this time over her brother's anticipated death, telling me how much she loves him and remembering the good times they had shared in childhood.

At this moment there are two people inside my patient seeking to come on stage. One is the very small girl of the past who, in a state of inexpressible distress, wished death upon this intruder into her family. The joy with which the long-awaited son was greeted had seriously attacked her feeling of identity, raising doubts about her femininity and about whether she was still loved. The other is the adult woman who sincerely loves and admires her brother. The only person speaking at this moment is the adult, but the little girl within her is begging to be allowed to speak her lines and express her feelings. Her conscious adult self cannot admit that she ever harbored feelings of hate for her brother, because she does not yet realize that, even in childhood, her love always triumphed over her hate. The only hint of the scene to come is that my patient feels unaccountably anxious and begins to wonder why she has not written her beloved brother for so long. The time when the timid but affectionate adult within her will accept a dialogue with the small assassin who also inhabits her internal world has not yet come. Only the analyst knows that the woman hates the little girl within her, that the drama will involve understanding her and eventually loving her and forgiving her.

The theater as a metaphor for psychic reality owes its beginnings to Breuer's celebrated patient, Anna O, whose treatment gave Freud many of his first brilliant insights into the workings of the unconscious mind. Fortunately for science, Anna O did not react well to hypnosis, with which Breuer initially attempted to treat her. In a sense it was she who taught her psychiatrist how to conduct her treatment. In recounting to Breuer her perpetual daydreams and other free associations, she referred to her communications as “my private theater.” With the discovery that many of her severe hysterical symptoms—deafness, visual disturbances, and muscular paralyses—disappeared after having been “talked away,” as Breuer put it, Anna O christened this hitherto unheard-of method of treatment her “talking cure.” At other times, since the talking cure appeared to get rid of many thoughts and feelings that encumbered her mind, she referred to it as “chimney sweeping” (Breuer and Freud 1895).

My use of the theater metaphor refers not only to inner psychic reality but also to the psychoanalytic process itself. Here I am indebted to the clinical genius of Melanie Klein. I well remember the horizon that opened before me when I first read her fundamental work, The Psychoanalysis of Children (1932). She was the first psychoanalyst to recognize the profound symbolic significance of children's play (which indeed to a child's mind is not playing but working, or “working through” the problems of living) and from there to conceive the idea that analysis of children could be conducted with the use of toys representing many different people and animals. The games, she saw, provide insight into the structure of the child's unconscious mind. Klein claimed that “free” play (which in fact is no more “free” than the associations so labeled in adult analysis) would fulfill the same function as that of verbal communication in psychoanalytic work with adults. The play-scene created by Klein's small patient Peter comes vividly to mind. This three-and-a-half-year-old announced that he had a new brother called Fritz. While recounting this he banged two horses together in various ways. The analyst remarked that this made her think of two people bumping together, to which Peter replied, “No, that's not nice” but added that they are like people who are bumping each other and that “the horses have bumped together too and now they're going to sleep.” As might be suspected, this peaceful solution to the primal scene that can produce a little Fritz was not entirely to Peter's liking. Thus we are not surprised to learn that as his game continued he completely covered the horses with miniature bricks and announced proudly, “Now they're quite dead; I've buried them” (p. 41). This game was an acceptable solution to what were undoubtedly overwhelming but inadmissible feelings of pain and narcissistic mortification.

The psychoanalysis of the grown-up children that we are when we call ourselves adults also reveals a playful aspect, a dimension of “as if,” “let's suppose that…,” or “I'm just playing at….” This psychoanalytic work then moves onto a stage on which all the internal characters and psychic scenarios that have been removed from conscious recall may once again come to life. In this first chapter I hope to give some insight into what occurs within the mind of the analyst while listening to the patient's associations, metaphors, sudden silences, and slips of the tongue, as well as identifying with the moods and feelings that emerge with each new theme. The process of working out and working through that each patient elaborates in “free-floating” associations induces a parallel process of “free-floating” theorizations (Castoriadis-Aulagnier 1975) in the mind of the analyst, who attempts to process and organize the analytic material that forms the body of each session. In my own analytical work, I am aware that my free-floating hypotheses, born of my own as well as my patient's psychic realities, slowly lead me to understand the unique relationship that each analysand establishes with me, and I with each analysand. I try to anticipate the different aspects of each particular relationship, knowing that changing affective experiences will bring about many transformations and many reversals. I come to discover who I am at different times for the patient; there are several mothers, several fathers, and many other “split” people of the past in each person's internal universe. As time goes on, I also become the representative of every padent's personal ideals as well as the incarnation of all that has prevented their realization and that has been a stumbling-block to finding life an exciting, albeit complex and often frustrating, adventure.

The “Work” of Psychoanalysis

The slow process of reconstructing the psychic scenarios hidden in the archives of the mind and recognizing the characters who play the leading roles has a name in psychoanalytic theory. It is called psychical work or the work of elaboration. Freud talked frequently of the work (Arbeit) accomplished by the mind: dream-work (Traumarbeit), the work of mourning (Trauerarbeit), working out (psychische Verarbeitung), and working through (Durcharbeitung). It is the two latter terms with which we are concerned here. Laplanche and Pontalis in their authoritative book, The Language of Psychoanalysis (1973), have carefully delineated Freud's distinction between the two forms of elaboration, psychical working out and working through. Working out pertains to the mental apparatus and the concept of its functioning and intrapsychic workings. Working through refers more specifically to the psyche's work in the psychotherapeutic process and to the painstaking constructions involved in the course of psychoanalytic treatment. Laplanche and Pontalis emphasize the evident analogy in the application of the “work” metaphor to the two concepts. To this I would add one further comment, namely, that the psychical working out and working through on the part of analysands has its counterpart in the activity of analysts, since analysts too work upon, elaborate in their own minds, all that is happening between them and their patients.

Analysands are indeed engaged in a demanding task. They are invited to “say everything” that comes to their minds and at the same time to “do nothing.” That is, they may not act out upon the associations and awakened emotions that come to mind but instead must elaborate them, work them over as ideas to be explored. The labor required by this unusual request may be thought of as demands that the unconscious, instinctual self makes upon the mental apparatus. These drives and their inevitable conflicts are obliged to find verbal expression. The I must speak its lines. Once communicated, the lines can be worked through and given new meaning. Analysts, while trying to identify as profoundly as possible with their analysands' inner conflicts, must also be on the alert for their own instinctual promptings and conflicts, since their psychic theaters are just as complex, just as dynamic, as those of their patients. Analysts are continually engaged in the psychological process of working out personal wishes and tensions in the course of the treatment, and therefore they must constantly use their capacities for self-analysis to continue the work of elaboration. In order to grasp what is happening in the minds of their analysands, they must also reflect upon—work through—the thoughts, feelings, and fantasies stirred up in them by their patients' analytical communications. The case history of Karen, discussed later in this chapter, provides a glimpse into this process.

The analyst's work does not end when the session with the analysand is over. In my own practice, the possible significance of a patient's dream, strange illness, or unaccountable accident often hits me suddenly, when I least expect it, when I am no longer “at work.” This discovery frequently reveals my own incongruities, unexpected feelings, and odd associations to my patient's words. Thinking about these revelations usually raises more questions than it provides answers, and differs from what analysts engage in when they let their thoughts and feelings float along with those of their patients. Their reflections away from the consulting room seek to put order into the chaos of the human psyche, to find in the inchoate movements perceptible in every analysis further insight into the mysterious nature of the creative process that produces psychic change. This kind of elaboration, while it may sometimes give rise to interpretations in the course of a given analysis, more often leads to questioning the classical psychoanalytic concepts themselves, perhaps to broadening or narrowing their application or to a search for new hypotheses and the beginnings of what may become new concepts. These must then be integrated into the existing body of doctrine or, if they replace earlier metapsychological concepts, must be shown to have greater explanatory power.

Analysts thus have two distinct modes of thinking about their work, one clinical and the other theoretical. What do these modes have in common, and what differentiates them?

From one perspective these two activities—clinical elaboration and theoretical elaboration—may be considered incompatible. Clinical elaboration involves a specific way of listening and trying to get into the patient's experience. The analyst is at liberty to think and to fantasize about the analysand's analytic communications. A preoccupation with theory could only obscure what the analyst is trying to discern of the latent communication behind each patient's analytic discourse. Although what we hear is immeasurably enlarged by all we have learned, and may still learn, from different theoreticians, such learning enriches our clinical work only to the extent that the theories have become an intimate part of our own analytic experience—not only the experience of personal analysis and the confirmation that clinical practice brings, but also the continuing self-analysis in which all analysts must engage. Without the enrichment of self-knowledge, theory is an impediment rather than an aid to what we hear. It may block the emergence of new hypotheses about the psychic reality of, and our specific reactions to, each of our patients. Should that occur, the two psychic theaters, that of the analyst and that of the analysand, may collide instead of completing each other.

Many fine clinicians who think deeply about their patients have no particular desire to “write psychoanalysis” (Smirnoff 1977). For those of us who do write, the activity of setting down what we think and feel about our work can be a flight from the shared solitude of the analytic couple enclosed within the walls of the consulting room. Furthermore, this particular kind of writing helps us to deal with the specific tensions of analytic work. These tensions arise from all that is unknown, perhaps unknowable, about the human psyche, as well as from the inevitable limitation of psychoanalysis to do more than alleviate certain forms of human suffering and the frequent failures to do even that. To highlight the important difference as well as the links between clinical and theoretical forms of psychic elaboration, I will briefly review Freud's initial concept of psychic work and then give an example, drawn from my own clinical practice, to illustrate the way in which clinical elaboration may be transformed into theoretical elaboration by means of a piece of analytical writing.

At the heart of the concept of psychic elaboration, whether expressed in working out or in working through, is the notion of labor: the ineluctable obligation to work that instinctual human nature imposes and the equally implicit demand, in the analytic situation, to work through the thoughts and fantasies prompted by instinctual drives. Each analytic discovery is inevitably met with resistance that requires further psychic work when it implies new insights into aspects of one's life. In this chapter I shall use the more general term elaboration to include both the spontaneous functioning of the mind and the repetition and working through of analytic findings. My main concern is to explore the necessity for psychic work that is imposed upon us by drives and conflicts and by the internal dramas to which they give rise.

Static and Ec-static Psychic States

In Freud's conception, the mind's work was always linked to the notions of unpleasure, mental pain, and what he termed libidinal stasis, a static or dammed-up state of being that he believed was responsible for the formation of neurotic or psychotic symptoms. He did not hold that this stasis was the sole cause of psychic suffering, nor did he believe that mental stasis had no effects other than pathogenic ones. In fact, in Freudian theory libidinal tension could also find expression in sublimations and in the discovery of objects and activities that bring satisfaction to the person whose psychic structure allows such developments. In other words, since there are an infinite number of ways in which people may resolve, avoid, transform, or otherwise deal with tensions and mental pain, the release of the static libidinal state and the disappearance of the unpleasurable state depend on the direction taken by the psyche in its laboring efforts.

In order to retain the flavor of Freud's original metaphor of stasis, I have chosen the terms static and ec-static to describe the states of mind in which the work of symptom-formation and its psychic elaboration occurs. The ec-static state is that which puts an end to the earlier stasis or blocked state of mental pain. The nature of the “ecstasy” may range from the physical sphere to the mental and from the pathological to the sublime. The overall aim of the mind's work is of course the maintenance of libidinal homeostasis, in both its object-oriented and self-oriented (narcissistic) dimensions.

It was Charcot (1888) who first used the term elaboration psychique, from which Freud and Breuer drew their early theoretical inspiration in their research into mental functioning. But in contrast to Charcot, who held that mental work was the cause of psychological symptoms, Freud and Breuer proposed that the persistence of symptoms was due to a lack of psychic labor. These two positions do not appear to me to be mutually exclusive. The psychic work, in Charcot's conception, that might (in today's terminology) give rise to neurotic or psychotic symptoms or to a perversion or character disorder is the primitive creation or work of a child's psyche in its attempt to escape mental pain and/or make sense of incoherent parental communications. Such early infantile inventions tend to close the door, once and for all, to any further elaboration of these attempts at self-cure and therefore in adulthood become full-blown neuroses or psychoses. This premature closure in childhood also prevents the individual from finding more adequate means of dealing with the complexities of adult life. Thus the Freud-Breuer conception expresses the hope that psychotherapeutic work will set in motion new psychic elaboration and lead to the relief of symptoms and the discovery of more satisfactory libidinal and sublimatory activities.

I suggest that the static states of mind that give rise to neuroses and psychoses can have an alternative outcome. Such a blockage may well be present yet leave no mental trace of its existence if, because of a radical split between psyche and soma, the psyche does not register the mental pain or conflict. When this occurs, the individual has no psychic representation of painful affect and the I creates no protective solutions. In other words there is no sign of psychic work, and the soma is left to cope alone with the somatic pole of affect. Certain people, in total ignorance of their internal or external stress and its accompanying tensions, are not alerted to the necessity for psychic elaboration of their problems. A patient of mine, for example, who was unaware of her deep emotional dependence on her daughter, had a first attack of ulcerative colitis when her daughter left home to study and a second attack, which nearly cost her life, when her daughter left the country to get married. Such a split between psyche and soma always inc...