Michael Balint

Object Relations, Pure and Applied

Andrew Elder, Robert Gosling, Harold Stewart

• Publisher: Routledge
• Year: 2003
• Topic: Psychology
• eBook ISBN:
  9781134760725
• Subtopic: History & Theory in Psychology
• Index: Psychology

Whilst Michael Balint's applied work is widely known, many of his theoretical contributions have been incorporated into everyday analysis without due recognition of their source. In this account of his thinking, Harold Stewart evaluates the extent of Balint's contribution to psychoanalysis and firmly re-establishes his place within the development of Object Relations theory.

The first section examines Balint's theories of human psychological development, defining such concepts as primary love, ocnophilia and philobatia, the basic fault and the three areas of the mind. The author places Balint's understanding of the analyst's influence and technique in the context of his relationship with Sandor Ferenczi, his analyst and mentor.

The second section of this work looks at how the "Balint Group" has contributed to the assessment and understanding of emotional problems in various areas, including general practice, marital work and psychosexual medicine. A charismatic teacher, Balint's method of work with General Practitioners has become an established worldwide institution.
Features of this work, including the use of countertransference and the affective response of the doctor are vividly described here by two General Practitioners, Andrew Elder and Robert Gosling.

Michael Balint: Object Relations, Pure and Applied brings alive Balint's teaching and practice and demonstrates the relevance of his theories to many of the problematic issues in current analytic practice.

Part One

Psychoanalysis

1

Primary Love and Psychoanalytic Technique (1952)

This book contains the papers that represent Balint’s contributions to the theory and practice of psychoanalysis from the years 1930 to 1952 and I shall consider those that seem most relevant to the general thrust of his thinking. In the Preface, he gives a brief overall view of his work:

After having ambivalently criticized The Interpretation of Dreams and The Psychopathology of Everyday Life, I was at the age of 21 decisively and definitely conquered for psychoanalysis by the Three Contributions and Totem and Taboo. In some form or other, these two directions of research—the development of the individual sexual function and the development of human relationships—have remained in the focus of my interest ever since. Coming from medicine, and strongly biased by my predilection for the exact sciences, my approach to these two problems was mainly, though not exclusively, through clinical observation; this meant studying the processes as they develop and change under the impact of the analytical situation in the patient, that is, studying the psychoanalyst’s technique and the patient’s responses to it. This volume collects my papers written during the years 1930–1952 on these three intimately interlinked topics—human sexuality, object-relations, and psychoanalytic technique.

(1952a:5)

It would be true to say that all of his subsequent publications continued the task of researching and exploring these three topics.

His very first psychoanalytic paper, ‘Perversion or a Hysterical Symptom?’, was written in 1925 and is not included in this book but is published in his second volume, Problems of Human Pleasure and Behaviour (1956). It concerns the topic of homosexuality, and it gives a brief clinical account of whether a patient’s symptoms should be considered a perversion or hysterical in nature. It already reveals his enquiring and questioning mind, particularly in the highlighting of the deficiencies and limitations of the current knowledge of psychoanalysis at the time of writing. Like Freud, he was always aware of the present limits of psychoanalytic understanding and of the need for continual probing and research to extend the limits.

‘Psychosexual Parallels to the Fundamental Law of Biogenetics’, published in 1930, was his next paper and is the first in the book. He discusses the development of psychosexuality in terms of the biological development of the species. The relationship between psychosexual development and the biological development of different forms of animal life from the most simple and primitive had particularly interested Ferenczi, who developed these ideas in his book Thalassa: A Theory of Genitality (1938), an original and unique contribution to psychoanalytic thinking and speculation. Balint, who often proclaims his positive transference feelings to his analyst and mentor, is clearly impressed by Ferenczi’s thinking in the writing of his own paper. The fundamental law of biogenetics as formulated by Ernst Haeckel postulates that the development of the individual from the initial fertilization of the egg repeats the evolutionary development of the race, phylogenesis, or to use Balint’s adaptation of this: ‘The fertilized human egg knows all about phylogenesis; it recapitulates it in its own development’ (1952a:11). This refers only to the body, but Balint develops the theme to include the development of the mind, which is also recapitulating the development of the species, and he uses the development of psychosexual phases, as described by Freud and Abraham, to further his ideas. They are developed in some biological detail, as befits a psychoanalyst whose first professional training was as a biologist.

An interesting feature of this paper is that it introduces two concepts, both in biological terms, that he develops later in terms of psychology. These are regression and new beginning. He points out that in the process of reproduction, the cells after union become more primitive in nature, and suggests ‘that the organism regresses to an earlier stage of evolution, returning to long-abandoned life-forms, in order to begin its existence anew from there’ (1952a:37). He then suggests that ‘This new beginning plays a very important part in the living world. The development of each fertilized egg represents a new beginning’ (1952a:37). This concept of regression to something earlier and more primitive, together with the stage of being followed by a new beginning of further development, is to become of major importance in his contributions to theory and technique. In fact, his next paper, in 1932, is entitled ‘Character Analysis and New Beginning’ and deals precisely with these issues.

He opens with the observation that patients are no longer satisfied with the removal of symptoms and wish to continue their treatment after this has occurred. He believes that they ‘wish, often unconsciously, to be able to love free from anxiety and lose their fear of complete surrender’ (1952a: 159). Furthermore, some patients represent a new type of patient whose suffering is often not of symptoms but of getting little pleasure from anything in life. Such patients are afraid of excitation, even of the gratifying pleasure itself. Analytic work always leads back to childhood situations, either with adults evoking sexual excitation in the child that it was unable to bear, or of adults treating children with such coldness and spartan severity that it resulted in normal needs for warmth and tenderness exceeding the given possibilities of libidinal discharge and so evoking anxiety. He adds a third situation, which was described by Ferenczi in his seminal paper, ‘Confusion of Tongues between the Adults and the Child’ (1933), where the child, having been sexually excited by the adult and having openly shown it, is both rejected and subjected to severe moral reproof by the adult.

From this, Balint concludes that the therapeutic aim with these mistrustful patients is that they ‘must learn in the course of treatment to be able again to give themselves up to love, to pleasure, to enjoyment, as fiercely and innocently as they were able to do in their earliest childhood’ (1952a:162). He discusses the technical processes required and introduces a new technical concept. Freud had written in ‘Remembering, Repeating and Working-through’ (1914) that the aim of the analytic work was to enable the patient to remember, and that this required some repetition or acting-out. Freud had suggested that the patient reproduced everything from the reservoirs of repressed material that had already permeated his general character—his inhibitions and disadvantageous attitudes of mind, which constituted his pathological traits of character. Balint adds that it is not only the pathological traits but all his traits of character that are displayed, as the patient could only behave as he really is. As these traits are analysed in their varied manifestations, it becomes clear that they are directed against the anxiety ‘of full surrender, against the unbearable excitation: as this becomes conscious the situation in childhood usually also comes to light where the child’s trust was betrayed’ (1952a:163).

Unfortunately, this coming to light in itself rarely results in change and Balint believes that in spite of the fact that the patient is helped to realize that he is no longer a child and that the analyst does not behave like the original adults, the change does not occur as the amount of excitation, the degree of the tension, is actually determined by the patient himself. Balint was then thinking in economic terms of amounts of excitation and tension bearable by the patient, and the task of the analyst was to help the patient achieve an optimal degree of tension as a result of which outbursts of affect occurred together with the appearance of fragments of memory not previously accessible to consciousness. He does not describe what his revision of technique consisted of; he himself states that ‘without clinical examples, any discussion of technique is useless’ (1952a:164). It is unfortunate that often in his writings Balint does not give clinical examples to illustrate his concepts, and this does tend to lessen the possibilities for the reader to understand his position fully.

Balint then describes that, together with an outburst of affect and the recovery of forgotten memories, a new beginning results. By this term he means ‘a change in the behaviour, more exactly in the libido structure, of the patient…he still has to learn anew to be able to love innocently, unconditionally, as only children can love. This dropping of condition I call the new beginning’ (1952a:165). He gives the examples of one patient holding the analyst’s finger in her hand; of another patient bringing a series of dreams day by day in which she was a child becoming older in successive dreams and doing nothing but love, with her different ways of loving repeating her whole development.

This, though, is then followed by an

almost insatiable longing to repeat again and again such newly begun infantile manifestations of love. After this dies down, which only rarely takes any considerable time, the anxiety disappears and the patient is able to recognize and accept her newly begun wishes and either realize them in reality or renounce them.

(1952a:166)

This new beginning is repeated in various ways, and Balint equates this with the process of ‘working-through’ as described by Freud.

This account of these various processes will be seen as the forerunner of his future writing on the topic of therapeutic regression, which culminates in The Basic Fault. In this description is the origin of the process that thirty-six years later he calls benign regression, and in the brief reference to ‘almost insatiable longings’ he hints at the other type of regression, malignant regression.

Balint briefly considers the notion of character, and suggests that it ‘controls the relation of man to the objects of his love and hate possibilities …it always means a more or less extensive limitation of love and hate possibilities…it means a limitation of the capacity for love and enjoyment’ (1952a:169). At the time of the writing of this paper in 1932, it was a controversial issue whether the analyst should attempt to alter the patient’s character or not, and Balint with this discussion of technique and character is expressing the view that character analysis is both necessary and essential. This is the view that has later become universally accepted in treatment and training.

His paper in 1934 on ‘The Final Goal of Psychoanalytic Treatment’ is based partly on the arguments and views described in the previous paper on new beginning, and partly on the arguments which are to be set out more extensively and cogently in his next paper on the pre-genital organizations of the libido. This is one of Balint’s seminal papers, written in 1935, and is entitled ‘Critical Notes on the Theory of the Pregenital Organizations of the Libido’. It deals with the problem of ‘the development of object-relations i.e. the development of love’ (1935b:51). The fact that he describes the development of object relations in terms of love, or libido, and not in terms of hate or destructiveness being an equal to love, is a theme that runs through all his thinking. He steadfastly maintains that the development of hate is always secondary to that of love and is not a primary drive in its right. It arises from experiences of frustration and separation. Of the British object relations school, only Fairbairn takes a similar position but in his own different theoretical framework.

The paper is devoted to the development of sexual object relations, and he intentionally does not discuss the changing instinctual sexual aims of oral, anal, urethral, genital, and other forms of gratification. He notes:

However deeply we are able to penetrate with our analytic technique and observations into the history of a man’s life, we have always, without exception, found object-relations. Auto-erotic forms of gratification were either harmless play, or they already represented compromise formations. They were revealed in analysis as mechanisms of consolation for, or of defence against, objects which had been lost or had led the child into severe conflicts. The same is true of the phenomena of so-called pregenital love, such as ‘anal-sadistic’ or ‘phallic’ love, and also of the ‘negative Oedipus complex’. They are unimportant and harmless or, if of importance, then to be analysed and resolved…. I do not enquire why oral, and, urethral genital etc. forms of gratification appear in the development and what they signify, but confine my problem to the question why the attitude of the individual to his environment and especially to his love-objects changes, and what are the causes of the various forms of object-relations which we describe as oral, anal, phallic, genital, narcissistic, etc., love.

(1935b:59)

Balint held, following Ferenczi in Thalassa, that object relations pre-dominate even in the deepest layers of the mind, and that in the end phase of deep analytic work, at the phase of the ‘new beginning’, the nature of this first object relation is expressed quite clearly:

The person in question does not love, but wishes to be loved. This passive wish is certainly sexual, libidinous. The demand that these wishes shall be gratified by the environment is absolutely unproblematical and is often expressed quite vehemently with great displays of energy, almost as if it were a matter of life and death. The aim of all these wishes does not, however, correspond to what one generally means by sensual or erotic, but rather what Freud has called tender, aim-inhibited. Non-gratification calls forth passionate reactions; gratification, on the other hand, only a quiet, tranquil sense of well-being.

(1935b:61)

This primary tendency is called ‘passive object-love’, a term introduced by Ferenczi, and is described as ‘I shall be loved always, everywhere, in every way, my whole body, my whole being—without any criticism, without the slightest effort on my part—[this] is the final aim of all erotic striving’ (1935b:63). This primary tendency is retained throughout life and the attaining of it is achieved in roundabout ways; one way is via narcissism on the basis that ‘if the world does not love me enough, I have to love and gratify myself (1935b:63). The other way is via ‘active object-love’, on the basis that ‘we love and gratify our partner in order to be loved and gratified by him in return’ (1935b:66).

In his formulation of these two ways of re-achieving a passive object-love, Balint puts forward two important new psychoanalytical concepts. The first concerns the theory of narcissism. Balint demonstrates that there are several inconsistencies in the theory of primary narcissism, which leads him to suggest that the theory should be discarded in favour of primary object relationships and that narcissism is always a secondary phenomenon. This antedates the similar change in Melanie Klein’s views on primary narcissism, since in 1936, Joan Riviere in her paper on the Kleinian position ‘On the Genesis of Psychical Conflict in Earliest Infancy’ given to the Vienna Psychoanalytical Society was using the concept of primary narcissism prior to object-relatedness:‘These two counterparts represent the aims and significance of the projection and introjection focuses, which develop out of primary narcissism as external objects begin to be perceived’ (1952:52).

The second new concept concerns the nature of the active object-love. He writes:

Others, however—and they form the vast majority—can reach the aim of the ‘passive object-love’ only by roundabout ways. Education enforces, even devises, these by-paths. If the child is offered too little, it invests its autoerotism, hitherto practised in a playful way, with its whole libido, becomes narcissistic or aggressive or both. If it gets something it becomes, as it were, moulded by the gratification received. The successive stages of development so frequently and regularly found—anal-sadistic, phallic and finally genital object-relations—have not a biological but a cultural basis. As you see I have left out the oral relation. Purposely, for I cannot make culture, i.e. education, solely responsible for this.

(Balint 1935b:63)

Looked at in this way, the pregenital object-relations, the pregenital forms of love, appear in another light. They can no longer be explained biologically, but must be considered, to use perhaps a rather strong expression, as artifacts, i.e. we must make society in general, or the individual educator in question, responsible for them. Moreover, our clinical therapy has always acted as if this were an acknowledged fact.

(1935b:66)

He then goes on to add:

Thus, and I mean it quite seriously, if children could be properly brought up, they would not have to struggle through the complicated forms of pregenital object-relations which are only forced upon them…. But today I cannot visualise clearly this development from passive object-love with its tender sexual aim, to active object-love with its genital sensual aims. All the less because the origin of passionateness, of sensual orgastic lust, is not clear to me.

(1935b:67)

Balint is differentiating the pre-genital aims of sexuality from the varieties of pre-genital object-relational organizations and is claiming that the latter are not directly related to the former in a biologically determined manner. The pre-genital aims themselves are biologically determined, but the way that these are incorporated into the object-relational organizations is determined by the environment—that is, culture and education. This interesting line of investigation into the relationship between these two lines is not, however, continued in his further papers, where he concentrates on object relationships and not on pre-genital phases. However, with this differentiation of the development of human relations from the development of sexual aims towards objects, Balint is describing a situation which was later to be developed in his own way by Winnicott (1963). Winnicott differentiates between the ‘object-mother’ and the ‘environmentmother’, describing ‘the environment-mother who receives all that can be called affection and sensuous co-existence; it is the object-mother who becomes the target for excited experience backed by crude instinct-tension’ (p. 76). This resembles Balint’s dual development lines, but Winnicott relates the development of the capacity for concern to the coming together in the infant’s mind of the object-mother and environment-mother, rather than considering the effects of culture and education on these two lines as Balint has done.

In his next paper, ‘Eros and Aphrodite’ (1936b), he turns to the other topic that he specifically excluded from ‘Pregenital Organizations of the Libido’, the development of sexual aims, of the acquisition of pleasure, of erotism, of sensual orgastic lust. It is principally an examination of the difference between fore-pleasure and end-pleasure in libidinal experiences. He suggests that they are two sep...

Table of contents

• Cover
• Dedication
• Half Title
• Title Page
• Copyright
• Contents
• Preface
• Biographical sketch
• Introduction
• Part One: Psychoanalysis
• Part Two: Applied psychoanalysis
• Michael Balint: a select bibliography
• References
• Name index
• Subject index