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Bion and Intuition in the Clinical Setting
Antònia Grimalt, Antònia Grimalt
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eBook - ePub
Bion and Intuition in the Clinical Setting
Antònia Grimalt, Antònia Grimalt
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About This Book
Bion and Intuition in the Clinical Setting focuses on Bion's investigation of the intuitive approach to clinical data and lays out how Bion's method encouraged constant effort by the analysts to relinquish its reliance on sensory and conceptual-verbal faculties to make room for intuition.
Based on the work of the biannual Bion conference, this book includes contributions from the most eminent voices on Bion's work. Spanning topics such as the primordial mind, intuitive comprehension and desire, the contributors in this volume illustrate how they incorporate the concept of intuition in their own clinical developments. Each chapter examines different elements of how Bion's research approaches the difficulties faced by analysts in the approach and discrimination of primitive emotional levels in the patient-analyst communication.
This book will be of key interest to analysts and analytic therapists of all schools and is an essential resource for those that follow the work of Bion.
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Chapter 1 Negation as a method for intuiting psychoanalytic discoveries Bion’s turning point in “notes on memory and desire”
DOI: 10.4324/9781003293385-2
Bion’s (1967a) paper, “Notes on Memory and Desire”, is considered by many to be a turning point in his theoretical and clinical thought, separating the “early” and “late” Bion. Through this paper and several other related notions, Bion has explicitly developed a method of negation designed to free psychoanalytic observation from its reliance on sensory and conceptual-verbal faculties, as almost exclusive means for grasping mental reality. Bion’s method involves constant efforts by the analyst’s consciousness to negate its reliance on these faculties, to “make room” for intuition.
In a way, Bion’s method is an expansion of one of the meanings of Freud’s (1925) notion of negation, referring to the function of judgment. In Freud’s model, negating the sensory perception of the external object is required for the establishment of internal representations. This notion of negation echoes Freud’s letter to Lou Andreas – Salome in which he described his experience when writing:
I know that in writing I have to blind myself artificially in order to focus all the light on one dark spot, renouncing cohesion, harmony, rhetoric and everything which you call symbolic, frightened as I am by the experience that any such claim or expectation involves the danger of distorting the matter under investigation, even though it may embellish it. Then you come along and add what is missing, build upon it, putting what has been isolated back into its proper context.(Freud, 1916, p. 312)
Bion quoted this paragraph on various occasions, perhaps because Freud is emphasizing here – more than in any other reference – the negation not only of the sensory perception system but also of all secondary process functions in the conscious mind. This experiential description nevertheless contradicts Freud’s (1911) metapsychology, which gives almost exclusive primacy to the conscious mind, with its sensory and verbal capacities to grasp reality.
In formulating the method of negation, Bion also drew on Bergson’s (1896) distinction between utilitarian intellect and intuition. Bergson points out the effort needed to negate the utilitarian intellect that controls consciousness, to purge perception of the automatic tendencies of inference and to enable the function of intuition, which is the only faculty that can perceive the essence of things (Torres, 2013).
Another source of inspiration for Bion’s method is Negative Theology (apophasis). Mawson (2014) quotes from the Ascent of Mount Carmel written by 16th-century monk, St. John of the Cross, the demand for abandoning “memory in all its forms”, including the five senses, in order to attain unity with God. This influence is reflected in the paper’s religious structure and style. It begins with some postulates about memory and desire, follows with positive and negative commandments and concludes with consolation for those who adhere to these commandments. It reminds Momigliano (1981) of the Jewish Shemah prayer.
Important as these theoretical and philosophical sources may be, Bion’s method of negation is above all based on his clinical experience. One should especially note the clinical examples he gave at various seminars (Bion, 1967b) throughout the year he spent writing this paper, to understand the experiences that gave rise to his theoretical thinking. Bion mentions these experiences as essentially “indescribable” (85) and “going off the end of the spectrum” (60). These patients bear a psychic pain so intense that it cannot be put into words; it remains buried deep within the mind as an indecipherable, unexperienced and unrepresented essence, which they are thus unable to express.
A few years before the “Notes”, Bion (1962) saw the conscious and the unconscious as working in harmonious collaboration. First there is the conscious perception of information coming from the patient via the senses and language; then, this data is transformed into unconscious material in order to create what Bion termed “binocular vision”. The turning point in his thinking occurred when he discovered that the transformations occurring in the session are much faster than the cognitive ability designed to perceive them. They occur, at the “speed of thought” (Bion, 1967c, p. 166) – the psychological equivalent of the speed of the light. Hence his conclusion that in these cases, conscious perception, which is designed to serve our daily needs, interferes with intuition – our more precise unconscious perception, capable of perceiving mental changes. Therefore, the negation of consciousness should be radical and occur right from the start, in the very formation of clinical facts.
Clinical implications
I suggest four clinical aspects of this negation method, which posits intuition at the center of the clinical encounter:
Tuning the mind
Bion (1965) referred to this ‘tuned’ consciousness as “a sort of positive lack of anything in one’s mind” (13), a kind of empty consciousness. The thought exercise he proposed involved thinking about “the patient you are going to see tomorrow” (7). This sort of negative thought exercise resembles a Zen Kōan, as the patient who will arrive tomorrow is a non-existent entity. Any attempt to grasp it traps us in rigid memories, as the patient (and the analyst as well) has already changed since the previous session.
Evolution precedes interpretation
Bion shifts the key role of interpretation in classical psychoanalysis towards intuiting evolution. Interpretation is the verbal expression of what is revealed through extensive intuitive listening to evolution. The place from which one offers the interpretation is a depressive position. Still, this revelation is short-lived and made possible only by negation, by immersing oneself once again in the confusion and senselessness of the paranoid-schizoid position. According to Bion: “if one can be patient enough, one will see a pattern in this stuff which is turning up” (Bion, 1967b, p. 14). The notion of “being patient” captures in a unified manner the patience, the suffering, and the patient. Intuiting evolution is thus an often-unsettling emotional journey towards interpretation, which entails unconscious psychic work and requires the analytic pair to oscillate between positions.
Clinical vignette: Lily
Early on in Lily’s therapy, I began confusing her name with similar-sounding names, occasionally using these out loud, without even noticing that I was doing so. Sadly, for both of us, this would sometimes happen during the more intimate moments of therapy. When I thought about what was happening, I felt that I disliked her name for some reason and that I was using an alternative that I found more personal. This was so even though her name was rather common and had evoked no resistance in me beforehand. Every time I called her by the wrong name, it would hurt her, causing a crisis in therapy to the extent that she nearly decided to terminate. She was certain that I was doing this on purpose. Besides sharing her pain, all I could say during those weeks was that I still did not understand what was happening to me, but that I believed that I would eventually. One day, after another session ended in this painful manner, I had the clear feeling of having ‘grasped’ what it was about, though I was still unable to formulate for myself what exactly was taking place. Without knowing much about her past, I felt that she was an un-held child, as if no one had even named her. In our next session, I asked her if she knew how or why she was given that particular name. In tears, she said that she never liked her name and that, as a girl, she had even thought about changing it, as she found it vulgar. Then, she told me that her mother had oddly chosen to name her after one of her favorite cosmetic products. We were both silent and sad about this empty and impersonal choice her mother made in naming her. There was no need to say anything more. I felt that now I could love her with the name she had been given and no longer altered it unawares.
In this case, negation involved the rejection of the quick explanations that came to mind as well as waiting and letting things grow inside me while having faith that they are on their way. For example, right from the start, Lily developed intense love-transference and, though I considered many times the possibility that I was reacting with negative counter-transference, it was not enough to convince me. Later on, in this period, the image of another patient with the same name that I had treated years before came to mind – it was difficult for me to like her as she had an air of neglect and carelessness and often engaged in indiscriminate sex. I had to let this foreign image develop inside me to perceive that a certain aspect of neglect that I found difficult to bear; was also present in my current patient. This eventually led me to the intuitive grasping of the deep connection between her name and maternal neglect.
I believe that Lily felt the relative calm I had maintained, and this made it possible to hold the situation. My question about how she was named was, in fact, an interpretation that stemmed from an evolution that happened inside me and only had to be pointed out, although I did not know what the answer would be.
Bion’s clinical vignette
At one of his 1967 Los Angeles seminars, Bion (1967b) talks about a schizophrenic patient whose speech was so incoherent throughout analysis that Bion was constantly on the verge of falling asleep. Bion’s attention suddenly woke up in one session, when the patient began telling him a dream: in his dream, the patient and his children were walking along a riverbank. All of a sudden, his children fell into the river and the strong current washed them away. The patient jumped in to save his children and was carried away with them to where the water vanished underground. “I can tell you”, he says to Bion, “I never woke up so quickly in my life” (56).
After recounting the dream, the patient completely passed out, lying speechless and inert. Bion, to my mind, finding it hard to bear this sudden change, responds by saying, in a somewhat rude and detached manner, that it seems he did not wake up fast enough. The patient simply reverted to his regular incoherence and Bion concludes this vignette with words that express profound frustration: “that was that”.
It was clear to Bion that the telling of the dream was one of the most significant and precious moments in the entire analysis, but there was nothing he could do to make this more present. The rare moment became a missed opportunity. Bion shares this with his audience without offering – or requesting – any explanation for what had happened.
Reading this description, I was astounded to recall the words Bion (1992) wrote in his diary, Cogitations, some eleven years later. Now at the end of his life, the words that the patient had said at the end of the dream came back to him and Bion asks himself if it was not him, the analyst, who was “too ‘wide’ awake, too conscious, too rational” (366). And he continues:
what sights did the patient see that made him ‘wake up’ so fast that he could not be swept down the stream? Was it the danger of becoming, like me, too wide awake? Or, like me, too fast asleep – in fact, the sleep of death?(p. 366)
Bion writes this shortly before the anniversary of the battle of Amiens, which he took part in during World War I, sixty years earlier- the very day that he later said he had died on (Bion, 1982, p. 265). In his memoirs (Bion, 1982, pp. 121–141; Bion, 1997, pp. 22–38), Bion tells about watching soldiers drown in the Steenbeck river where he fought, and how, for many years after the war, as a student, he would wake up drenched in sweat from a terrible nightmare in which he saw himself sliding down a slippery slope into the gushing and muddy river (Bion, 1985, p. 16).
This painful example shows how the evolution of the patient depends on the evolution of the analyst. It was only negation that made it possible to carry this crucial and misunderstood analytic moment for years on end. When negation is possible, evolution can last a lifetime, even long after the end of analysis.
Moving towards at-one-ment with the patient’s emotional reality
In the “Notes”, Bion states: “Awareness of the sensuous accompaniments of emotional experience are a hindrance to the psychoanalyst’s intuition of the reality with which he must be at one” (Bion, 1967a, p. 136). In this statement Bion presents a radical view that contradicts mainstream approaches, which emphasize the communicational and bodily aspects of emotion. Instead, the essential element of emotions is their existence as an individual’s ‘experience’ – which is inherently silent and lies within the confines of the individual. The emotions of the other subject are transcendent essences; they do not really “come through” or are transmitted to us the way sense impressions do, nor are we at all capable of transmitting them to another person without undergoing a transformation which changes their original state. Bion goes a step further beyond language – not only language is barely able to get across emotional essences, t...