Bion and Primitive Mental States

Trauma and the Symbiotic Link

Judy K. Eekhoff

• Publisher: Routledge
• Year: 2021
• eBook ISBN: 9781000515213
• Edition: 1
• Topic: Psychology
• Subtopic: Mental Health in Psychology
• Index: Psychology

This clinically focused book explores W. R. Bion's thinking on primitive and unrepresented mental states and shows how therapists can work effectively with traumatized patients who are difficult to reach.

The author illuminates how trauma survivors suffer from direct access to primal undifferentiated positions of the psyche that lie outside the symbolic order of the mind and are resistant to treatment. This access, unmediated by symbolic representation but represented in the body, disrupts the normal trajectory of development and of relationship. Integrating theory and clinical application, the book addresses processes of symbolization, somatic receptivity, and the use of countertransference when working therapeutically with undeveloped areas of the mind. It also demonstrates how primitive body relations and object relations include the body of the analyst as part of the analytic frame and are essential in establishing a therapeutic alliance.

Illustrated with detailed clinical vignettes, Bion and Primitive Mental States is important reading for psychoanalysts, psychologists, social workers, and educators who wish to understand primitive states of mind and body in patients who have previously been considered untreatable.

Chapter 1

Trauma and primal mental states

DOI: 10.4324/9781003241683-1

The individual always displays some aspect of his personality that is stable and constant even though it may be very difficult to detect in the welter of evidence for instability.

(Bion, 1966, p. 42)

Trauma, according to Freud (1920), is defined by the failure of the internal contact barrier to protect the psyche from bombardment. Feeling bombarded is an internal response to either an internal or an external event that arises when our necessary defensive organizations fail us. The internal response, one of being overwhelmed, shuts down the capacity to think, leaving an unmentalized state that is present but not memorable. A flooding of the senses also interferes with the ability to make meaning out of the experience and to remember it. Freud (ibid.) further emphasized:

The excitations coming from within are, however, in their intensity and in other, qualitative, respects – in their amplitude, perhaps – more commensurate with the system’s method of working than the stimuli which stream in from the external world. This state of things produces two definite results. First, the feelings of pleasure and unpleasure (which are an index to what is happening in the interior of the apparatus) predominate over all external stimuli. And secondly, a particular way is adopted of dealing with any internal excitations which produce too great an increase of unpleasure: there is a tendency to treat them as though they were acting, not from the inside, but from the outside, so that it may be possible to bring the shield against stimuli into operation as a means of defence against them. This is the origin of projection, which is destined to play such a large part in the causation of pathological processes.

(p. 29)

In his paper, Freud is not denying the external trauma. Rather, he is describing the response from the individual who shuts down and projects the response outside. Still, in spite of the shutdown, the traumatic internal experience remains in the psyche soma of the person and returns again and again, needing to be discharged. It is not only discharge that is necessary: the experience must be remembered and worked through and ultimately grieved. I say grieved, because the traumatic response changes a person. This change involves loss, even when the trauma occurs in infancy and early childhood. In fact, all loss ultimately recalls early loss of the breast. When grief is not possible, a fixation occurs. The trauma may not be fully remembered in the mind but remains present and represented but unsymbolized in the body. The body remembers and brings the experience back in what the French term a re-presentation (Scarfone, 2015). When the loss evoked by trauma cannot be mourned, symbolization cannot progress normally. Sublimation and internalization are compromised.

An unmentalized state that comes in response to a trauma marks an unthinkable thought. The unthinkable thought may be unthinkable because of a defense or a deficit. It may be unthinkable because of a developmental difficulty. Bion (1957/1984, 1962a, 1962b, 1965, 1970) has given us a model for working with the unthinkable and the unknowable (Bergstein, 2013). He also gives us a model for working with “O” or with the Real. Patients who have been traumatized frequently have difficulty being able to approach thinking the unthinkable. They have difficulty tolerating the frustrations inevitable in not knowing what is coming and in not having control. Facing the unknown seems extraordinarily dangerous to them. Facing the known may be even worse. Included in this is a difficulty that has arisen in the development of the apparatus that develops and uses thoughts.

As Bleger (1967/2013, p. 120, footnote) says, “For a phenomenon to be psychological, it is not necessary that it first be mental”. The psychological exists in the body before the mind makes meaning of it. When thoughts appear in the body (Eekhoff, 2018, 2019, 2021), the mind develops to cope with them. The body holds experience as sense impressions and dream images. When trauma happens, the implicit memory of the body contains it even when the mind is overwhelmed. The external experience that purportedly was the cause of the traumatic overwhelm varies. It may or may not generally be agreed upon by others to be sufficiently extreme as to cause such an internal reaction, but what others perceive is not important. What is important is each person’s unique and individual response.

As analysts, we are interested in our patient’s point of view. For example, my patient Elizabeth (Chapters 2 and 7, this volume) purportedly lived a satisfying and successful life until she was rear-ended in a minor traffic accident. The bump evoked a psychic catastrophe (Bion, 1966, 1970). The emotional turbulence evoked a cataclysmic psychic breakdown, one that upended her life and interfered with her capacity to work, to parent, and to support herself. It also left her in a constant state of suicidal despair. She responded to the bump as if her world were coming to an end.

In a certain sense, it did. Her ability to tolerate difficult circumstances, such as the bump, was greatly diminished. Her primitive psychic defenses were breached and collapsed, not to be easily repaired. Her body’s vulnerability recalled the bodily vulnerability experienced in her traumatizing childhood when she purportedly was physically and emotionally abused. The minor car accident changed her life forever in that it opened a flood of affective excitations and emotional memories of her childhood that had never before risen to emotional consciousness. It was not that she did not know what had happened in her childhood. She had not repressed those experiences. She had successfully sublimated her trauma and creatively used her energy to help others. She had also split off the memories in feelings (Klein, 1961, p. 136, 1975) and the memories in sensorium (Eekhoff, 2019, pp. 99–100). It was as if those emotional and perceptual experiences had happened to somebody else.

When the internal response, as with Elizabeth, is one of being overwhelmed in the face of perceived danger, an unmentalized but forever present psychological event persists. The ‘unpleasure’ of the traumatic overwhelm is held in the body and does not reach the mind where it could be processed and repressed. Loss of the illusion of safety cannot be mourned.

A seemingly minor traumatic event can tap into previously unprocessed traumas held in the body, bringing the unmentalized again into awareness where it may possibly be processed and worked through. The awareness comes without the symbolizing containment of language.

This is more complicated than remembering, repeating, and working through (Freud, 1914) because, when these original traumatic events occur in the first years of life, the capacity for repression may be compromised even before it is established, even as the capacity for symbolic language is not yet fully developed. More primitive defenses of a primal nature are called upon in order to cope with the trauma. These primal protections may involve an autistic retreat into the body during which relationship with another body is symbiotic, although unrecognized (Bleger, 1967/2013).

My patient gained access to her earlier trauma via a minor car accident. The emotional catastrophe of earlier unprocessed traumatic experiences of childhood abuse came to consciousness. Her background experience was a background of danger not a background of safety (Sandler, 1960). Her immediate breakdown included a memory of a breakdown that had already occurred (Ferenczi, 1924; Winnicott, 1974), gave her emotional access to previously unmentalized traumas, and evoked catastrophic responses. Her childhood trauma was an accumulated series of events, not just one event to be experienced and forgotten. Cumulative trauma impacts the body and the mind in numerous self-perpetuating ways. It remains as a constant presence, whether or not recalled.

Elizabeth had not forgotten these events had occurred. Rather, she had successfully split off and sequestered their emotional significance. She was able to sublimate and redirect her energies and attention. Her minor traffic accident, which was not her fault, brought feelings of helplessness and vulnerability back to her. Once returned, her feelings of helplessness overwhelmed her symbolic processing. Instead of being a person who had been traumatized, she became her trauma. In becoming her trauma, actual reality blurred with psychic reality, interfering with her mental processing. Reality and imagination became one.

Trauma includes numerous factors that are about both the stimulus and the response. The experience of being traumatized includes:

• the person’s unique capacity to cope with stimuli;
• the person’s ability to recover from the overwhelming experience;
• the person’s age at the time of the traumatic experiences;
• the kind and degree of the stimuli, whether internal or external;
• the duration of the traumatic stimuli; and
• the source of the traumatic stimuli.

Since trauma evokes extreme protections, a patient’s continual use of these defenses in the face of seemingly lesser external traumatic experiences can be baffling for those around them. Primal and primitive defenses mark a continuing catastrophe that characterizes an ongoing resonance of suffering (Green, 2007). When these extraordinary defenses fail, panic attacks can occur. The breakdown involves a shutdown of the symbolic order and a return to sign and signal. Ongoing experiences of primal and primitive mental states become the norm. Psychic filters that protect against the trauma have been breached. Psychic defenses that promote functioning fail. Primitive and primal dissociation via use of the senses foregrounds.

A psychic shutdown creates an ongoing secondary trauma: the patient is unable to trust her own sensations, perceptions, emotions, and cognitions. The shutdown interferes with the person’s ability to know what is real and what is not (Ferenczi, 1913, 1928). Not knowing what is real is terrifying. Fear and paranoia are natural consequences of not being able to trust one’s self. The shutdown also interferes with object relationships. The internalized bad objects, some of which come from identifying with the aggressor (Ferenczi, 1933), as well as the ‘unpleasure’ they evoke are split off and projected outward into others. At times, the trauma even makes splitting difficult (Ferenczi, 1930; Bion, 1957/1984). No relationship is safe. Disrupted relationships are a consequence of such projection, just as a paucity of projective identification also disrupts them. Fear and paranoia destroy basic trust. I will say more about why and how this occurs shortly.

Primal mental states

Trauma survivors develop extreme protections in order to cope with these experiences of blurred boundaries and extreme dependence. Their psychic survival depends upon them. These defensive protections are more primitive than repression. They are even more primitive than splitting and projective identification. These involve primary identifications that interfere with the development of a cohesive core identity. Without a cohesive identity or a subjective sense of self, relationships are superficial and based on bodily proximity (Eekhoff, 2017). The use of these early mental states for protection is strictly speaking not a regression. These states have remained present and useful no matter that time has passed since the trauma. They are not states of sensory integration but states of sensory and psychic diffusion.

Today, we might label these diffusions as autistic or schizoid defenses. They are evoked from the fight, flight, freeze, or fawn defensive instincts inborn in all of us. These extreme protections have extreme consequences, including a distortion in the sense of time and space. Without a sense of time and space, thinking becomes limited to concrete and operational processes. Introjection (Ferenczi, 1909) and internalization are diminished owing to a lack of awareness of inner space. Splitting processes are disrupted (Ferenczi, 1930). Surfaces are important, since spaces cannot be closed (Meltzer, 1974). Mimicry becomes a means of holding the self together (Bick, 1968, 1986; Ferenczi, 1932b, 1988; Eekhoff, 2019). Secondarily, mimicry may become a means of hiding. Mimicry used in this way interferes with the capacity for discrimination, differentiation, and splitting. In these circumstances, mimicry is not used as a stepping path for learning.

There are those who might say that primal states are not mental. I would agree that they are primarily body states – states of s...

Table of contents

• Cover
• Endorsements
• Half Title
• Series Page
• Title Page
• Copyright Page
• Table of Contents
• Acknowledgements
• Preface
• 1. Trauma and primal mental states
• 2. No words to say it: trauma and its aftermath
• 3. The Black Hole: alarm signal of catastrophe
• 4. Primitive identification and confusional mental states
• 5. Terrified by suffering, tormented by pain
• 6. Introjective identification: the analytic work of evocation
• 7. Breaking down, breaking up, or breaking through?
• 8. The spark of life
• 9. Intuition and transformations in O
• Index