Seeds of Illness, Seeds of Recovery

The Genesis of Suffering and the Role of Psychoanalysis

Antonino Ferro

• Publisher: Routledge
• Year: 2004
• eBook ISBN: 9781135447175
• Topic: Psychology
• Subtopic: Mental Health in Psychology
• Index: Psychology

Illustrated with richly detailed clinical vignettes, Seeds of Illness, Seeds of Recovery offers a fascinating investigation into the origins, modes and treatment of psychical suffering.

Antonino Ferro provides a clear account of his conception of the way the mind works, his interpretation of the analytic understanding of psychopathology, his reconceptualization of the therapeutic process, and implications for analytic technique derived from his view of the therapeutic action of psychoanalysis.

Drawing on and developing the ideas of Wilfred Bion, Ferro gives a unique perspective on subjects including:

• Container Inadequacy and Violent Emotions
• The waking dream and narrations
• 'Evidence': starting again from Bion
• Self-analysis and gradients of functioning in the analyst.

This highly original approach to the problem of therapeutic factors in psychoanalysis will be of interest to all practising and training psychoanalysts and psychotherapists.

1

SEEDS OF ILLNESS AND THE ROLE OF DEFENCES

As an approach to the problem of the therapeutic factors in psychoanalysis, it seems to me helpful to consider first the seeds of illness and the defences deployed by patients.

We may accept the view of Bion (e.g. 1962, 1963, 1965) that every mind, at birth, needs another mind in order to develop. This development takes place through an interplay of projections and introjections. Primitive anxieties and sense impressions are evacuated into the mother’s mind (by projective identification) and, after ‘processing and decontamination’ by the maternal α function, returned to the child in the form of representable elements (α elements) together with the method for processing them (the α function).

The child’s primitive projection of evacuated anxieties and sense impressions calls for a process of reception, transformation and return that includes the ‘instructions’ for developing the ‘unknown factor’ capable of changing β into α elements. In the normal course of this process, which is repeated over and over again, the α function gradually becomes operational in the child’s mind.

From then on, and to an increasing extent in ‘non-emergency’ situations, the system operates as follows: proto-emotions and proto-sense impressions – i.e. β elements – are transformed by the child’s α function into α elements through the correct functioning of this introjected unknown (the α function).

The α element is the proto-visual (or proto-auditory, etc.) component of thought; its existence shows that what was exerting pressure in β form has been transformed into a visual pictogram (Rocha Barros 2000). For instance, the first pictographic reflection of a primal experience of rage and revenge might be ‘a blood-filled swimming pool’.

Alpha elements are formed constantly and constitute the building blocks of waking dream thought – that is, of the proto-visual matrix that constantly ‘films’ sensations and sense impressions, turning them into images that cannot be directly known.

The proto-visual film (a sequence of α elements) produced in this way by the α function must undergo further operations in order to attain the status of thought and narrative image, and hence of internal or shareable discourse.

The ‘narrative derivatives’ (Ferro 1998a, 1998b, 1998c, 1999e, 1999f, 2001b) of this waking dream thought act as ‘carriers’ towards the knowable by means of operations whereby a narrative fabric is woven. These operations are bound up with the development of

and of

, and the possibilities extend from narrative unravelling (Ps) to clear-cut woven structures (D) and the interplay of ‘negative capability’ and the ‘selected fact’.

This second level entails the sufficient development (which is always consequent upon a good enough relationship) of more elaborate mental qualities, such as that of

through repeated experiences of micro-being in unison, or of

which discovers possible ways of existing if it encounters an elastic and available

. It also entails the development of ‘negative capability’ and the ability to withstand Ps (mediated by the experience of the emotions present in the other’s mind), and of the ‘selected fact’ and of D – i.e. the capacity to mourn – which always takes place by way of the encounter with the capacity to mourn (the presence of the third party) in the other’s mind.

Two loci of pathology can readily be distinguished on the basis of this simplified schema: (a) severe pathology in which the α function is lacking, and (b) pathology due to maldevelopment of

, Ps↔D and/or NC↔SF (i.e. container/contained; paranoid-schizoid position/depressive position; negative capability/selected fact).

All type (a) pathologies involve a primal deficiency in the formation of the visual pictogram, in which the ‘mind’ itself may even have failed to form. This situation may be likened to a cine camera with no film stock: the basic frames out of which the eventual movie should be composed are lacking. In type (b) pathologies, on the other hand, ‘α elements’ are formed, but the apparatus for processing them is deficient. The film is exposed, but then either it is not developed (there are no ‘narrative derivatives’) or the directorial function required to edit the vast number of frames shot – the Ps↔D work – is lacking, or else there is no place to keep the developed film (absence of

), and so on.

However, besides type (a) and type (b) pathologies, there is another possibility. Here the quantity of sensory stimulation, whether exteroceptive or proprioceptive, outstrips the capacity of the α function to form α elements. We then have a ‘traumatic’ situation, in which the quantitative level of stimulation (β elements) exceeds what can be transformed into α and rendered thinkable. This may be referred to as type (c) pathology, due to accumulation and trauma, in which trauma is occasioned by any situation that gives rise to more β than can be transformed into α and then processed and woven into emotions and thoughts.

There are of course an infinite number of possible combinations of (a), (b) and (c).

In an excess situation of type (c), in which there are more β elements than can be metabolized, various defence mechanisms may be deployed to cope with them. (It is obviously not easy to distinguish between an excess of β and a deficiency of the α function or of Ps↔D,

or NC↔SF.)

The first defence mechanism is the formation of undigested facts (partially processed β elements stored in ‘lumps’) waiting to be transformed by an α function: I have termed these ‘balpha’ elements (Ferro 1996a, 1999a), and they are bound up with the transference.

We are familiar with other defence mechanisms – for example, splitting (in which the amount of β that cannot be processed is split off and projected); disavowal; negation; psychosomatic disorders; hallucinations; characteropathic acting out; perversions; psychic dismantling; or narcissism.

I am discussing defence mechanisms and the resulting symptoms together for the sake of simplicity; they could also be classified by severity, time of onset and ease of transformation.

Take, for example, ‘narcissism’. This is a successful defence mechanism that operates when there is no ‘place’ to weave and elaborate proto-emotional states, which are then split off, projected and caused to be experienced by others, who are treated in spite of themselves as subsidiary α functions. The hard core of ‘narcissism’ coincides with an agglomerate of compacted balpha elements.

As stated, the common element in all defences is that they allow an excess of β elements to be managed in normal or catastrophic situations. (Let me say in passing that, as a species, we constantly face an excess of β elements and that, on the social level too, we devise strategies to evacuate, split off, hyper-control or phobicize the quantities of proto-emotions and proto-sense impressions that we are unable to transform into ‘poetry of the mind’ – i.e. into thoughts, emotions and affects. Wars, oppression and racism are some of these mechanisms, the investigation of which does not, in my view, fall within the competence of a psychoanalyst – for in order for there to be a specific ‘analyst’, there must also be a specific ‘patient’ and a specific ‘setting’, and if one of these elements is lacking, the other two cannot exist either.)

Of course, we all constantly deploy every single defence mechanism, but these defences become pathological only when they become ‘established’ in the place of flexible mental functioning. Whereas on the one hand they are a source of (sometimes very severe) pathology, on the other they are nevertheless a successful means of warding off even worse mental catastrophes, such as swamping of the mind, total mental dysfunction or even the complete failure of mental development.

The relevant therapeutic factors here would be ‘reparative positive’ elements to counterbalance the negative ones discussed above, which we can now reconsider in terms of type (a), (b) and (c) pathologies, bearing in mind that most patients are in effect chimeras of types (a), (b) and (c).

In accordance with the same scheme, there are type (c) analytic treatments, in which the patient’s α function and apparatus for thinking thoughts are intact, but burdened with an excess of ‘undigested facts’ that give rise to transferences and projective identifications, which can be resolved only if the analyst can help in the process of assigning meaning or new meaning. These are the relatively few patients deemed analysable by classical criteria, who can tolerate classical interpretations because they have ‘a place’ to put them and ‘means’ of working them through, with the result of enrichment.

There are also type (b) analytic treatments, in which the undigested contents can be tackled only after work has been done on the mental functions that are lacking – e.g. a deficiency on the level of

or of Ps↔D oscillations. These concern borderline and narcissistic pathologies in which the α function is operational but its products are unmanageable; in this case, a classical interpretation often generates more persecution than growth, because there is nowhere to accommodate it and no ‘way’ of using it.

Then there are type (a) analytic treatments – research analyses – in which the α function is significantly deficient, so that the β→α work must be ‘redone’ (or, in this case, done for the first time) by the transformation of ‘discrete quanta’ of β into individual α elements, so that individual α elements can be formed and the method of forming them can be introjected.

In these cases classical, or elaborate, interpretations merely constitute further sensory stimuli that give rise to evacuation, as Bion himself points out when he states that even ‘thoughts’ can be evacuated like β elements if the capacity to receive them is lacking (Bion 1962).

For an autistic child, a point-by-point, frame-by-frame elaboration would make more sense than a complicated and elaborate exhaustive interpretation, which would merely be an evacuation of the analyst’s truth in the absence of a receiver.

I shall attempt in the following chapters to illustrate clearly the appropriate techniques for working on levels (c), (b) and (a).

In passing, I should like to make a brief comment about the ‘death instinct’. It is in my view a real entity, but only in the sense of a transgenerational legacy of accumulated β elements which it has not been possible to transform and elaborate. In other words, I do not believe in a death instinct as such, but consider that there are transgenerational amounts of β elements that outstrip the present capacity of our species to elaborate them. When things go well, we call this accumulation the psychotic part of the personality which each of us shares with all mankind. In other cases, we refer to it as destruction, or the death instinct; but surely this is merely the residue over and above what it has been possible to elaborate in thought. The issue here is purely quantitative, as our capacity for mentalization still falls short of our requirements, so that the ‘discarded material’ remains active, exerting pressure, and often causes us to act out, commit acts of violence, or fall victim to psychosomatic or mental illness.

Another concept to be reflected upon anew, if we are to be ‘in unison’ with the patient, is ‘omnipotence’, whereby the patient, for example, exercises, or attempts to exercise, absolute control over the object. In my opinion, this style of relationship is a ‘necessity’ for the patient, for two main reasons.

In the first case, total control over the world and within relationships serves to minimize sensory and proto-emotional afferences where the α function is deficient (as in autistic ‘control’). Here, the control avoids the genesis of potentially unmanageable proto-emotional states (precursors of emotions); the patient is like a tightrope walker inching her way along the thinnest of cords knowing that the slightest breath of wind could be fatal.

Second, jealousy and the need for possession may be concealing a ‘shipwreck syndrome’, in which, owing to early relational shortcomings, the subject needs the object just as a shipwrecked non-swimmer needs the plank he is clinging to.

In the first situation, the patient cannot tolerate the slightest change; she keeps everything around her, including inanimate objects, ‘under control’ and tyrannizes everyone so as to prevent changes that might give rise to protostimuli, which would be unmanageable.

In the second situation, the patient exercises possessive and jealous control out of the fear of ‘sinking’ or drowning if he does not ‘cling’ to the object. ‘I’m like a flight controller,’ one of these patients said, ‘and if anyone wants to leave me I’ll cut their legs off.’

The concept of ‘frustration’ also calls for clarification. Let us consider the example of a negative response to a demand. The problem is not so much the mourning thereby involved, but that ‘frustration’ entails a change in the subject’s state of mind, with the generation of sense impressions versus proto-emotions. If the α function is insufficient, the turbulence arising cannot be managed, so that, because it cannot be ‘pictographed in the form of α elements’, it becomes a source of ill-being that can be relieved either by evacuation or, in favourable circumstances, through successive cycles of ‘mental rumination’.

In the case of violence against the self, I also regard defences as the lesser evil. They are like a lizard that ‘sheds’ its tail: although mutilated, the creature saves most of itself. Splitting, for instance, is an instance of violence against the self, but the splitting off of unmanageable parts is often the only way to survive. If this is true of mutilation involving parts of the self, I believe it applies in the same way – where an appropriate capacity for mentalization is lacking – to many forms of self-mutilation and self-harm. In anorexia, for example, emotions of uncontainable violence are split off and ‘starved’ because this is the only possible way of managing them so as to save what can be saved.

The aim of this eulogy of defence is, of course, to understand the profound reasons for its existence. Obviously, it can only be a starting point for finding other strategies to save the mind that involve less sacrifice of the self, of the internal world or of the body.

Psychic suffering often has its origins in the trauma of availability/nonavailability, or, better, the gradient of availability, in the other’s mind, together with the type and quality of emotions present, with which, as Bion would say, the mind of the other is suffused. If the analyst’s mind is cluttered with emotions different from those expected b...

Table of contents

• Cover
• Halftitle
• Title
• Copyright
• Contents
• Foreword
• 1 Seeds of illness and the role of defences
• 2 The culture of reverie and the culture of evacuation
• 3 Container inadequacy and violent emotions
• 4 Nachträglichkeit and the stork: the analytic field and dream thought
• 5 The waking dream and narrations
• 6 ‘Evidence’: starting again from Bion
• 7 From the tyranny of the superego to the democracy of affects: the transformational passage through the analyst’s mind
• 8 Self-analysis and gradients of functioning in the analyst
• 9 Pivotal-age crises and pivotal-event crises
• 10 Psychoanalysis and narration
• Bibliography
• Index