Psychoanalytic Approaches to Loss

Mourning, Melancholia and Couples

Timothy Keogh, Cynthia Gregory-Roberts, Timothy Keogh, Cynthia Gregory-Roberts

• Editorial: Routledge
• Año: 2018
• ISBN:
  9780429857119
• Edición: 1
• Categoría: Psychology
• Categoría: Psychotherapy Counselling

Psychoanalytic Approaches to Loss: Mourning, Melancholia and Couples applies psychoanalytic ideas to the clinically complex issue of loss in couples and families and outlines a new model for the treatment of associated unresolved grief. In line with contemporary approaches to couple and family psychoanalysis, this integrated object relations and link theory model provides a clear framework and approach for assessing and treating this clinical presentation.

The book brings together contributions from internationally known and respected clinicians and authors who focus on loss, including repeated pregnancy loss, the loss of a child or parent and the loss of a relationship itself. These psychoanalytic couple therapists take the reader inside their consulting rooms, enabling observation of their approaches to the treatment of couples experiencing loss and associated unresolved grief.

Psychoanalytic Approaches to Loss: Mourning, Melancholia and Couples will make an important contribution to the literature on grief and mourning and the application of psychoanalytic thinking to couples presenting with difficulties linked to unresolved grief, following loss. It represents an essential resource to psychotherapists, counsellors, family therapists, mental health professionals and many others supporting those experiencing loss.

Part I

Theoretical understandings and clinical approaches to loss

Chapter 1

Psychoanalytic understandings of loss and their relevance to couples and families

Timothy Keogh

Introduction

The development of psychoanalytic understandings of loss are to be found in the writings of Freud, Abrahams and the object relations theorists who followed, notably Klein and Fairbairn. Their theoretical ideas and concepts concerning loss have had an enduring value and have been elaborated further by contemporary theorists. The value of integrating link theory with these understandings of loss is discussed separately in Chapter 2.

In order to contemplate the value of these ideas to contemporary clinical presentations, firstly consider the case of Melissa and Peter, who attended therapy at the suggestion of their general practitioner after a series of increasingly hostile arguments. Although they were previously a happy and seemingly well-functioning couple, during a recent argument Melissa said that she felt she could no longer stay in the marriage. About ten months previously, they had lost their only baby daughter, Felicity, as a result of a cot death. The couple were initially extremely distressed, yet appeared to manage to get on with their daily lives. Their family were supportive, but no one seemed to want to talk about their loss once the funeral was over.

Some months after the funeral, Melissa cut herself by accident as she was making breakfast and at first could not stop the bleeding. She was distressed about the thought of the unstoppable bleeding. Alone at the time, she had accused herself of stupidity in doing such a thing. She had also started to feel she could not do anything right, doubted her competency at work and questioned her capacity to drive safely. When considering a further pregnancy, she thought that perhaps God did not want her to be a mother. Initially, Peter appeared to grieve the loss of their baby and resume his normal level of functioning. Despite this he had begun complaining to his brother about Melissa becoming more critical of him. About 9 months after the death of Felicity, Peter’s boss had told him that he was concerned about Peter’s lack of productivity. Peter increasingly felt that he was not what the company needed – that he was not an asset for his employer.

The couple only mentioned Felicity occasionally. At these times Melissa’s eyes would fill with tears. Peter felt that he was upsetting her by talking about Felicity and so stopped referring to her. Friends also avoided talking about the death with the couple. Melissa subsequently became more critical of Peter, even somewhat unreasonably suggesting that his absence from home, associated with the demands of his job, was related to the loss of Felicity. This hurt and shocked him. He ultimately felt he could do nothing right in her eyes. He found it hard to understand why she had become so unreasonable. The combination of the problems at home and the felt pressure at work saw Peter lose his job. This led to further criticisms from Melissa, who held him responsible for everything that was going wrong. Neither of them had classic signs of clinical depression, but their general practitioner, noting the history of loss and the self/other recriminatory features in their way of relating, referred them for couple therapy.

One can see in this couple the manifestations of a melancholic-type reaction to the loss of their daughter, where the self-recrimination attendant on the loss, was experienced in the form of the couple’s increasing arguments, where blaming the other was pre-dominant. The impoverished ego functioning was a salient feature of both parties, as was the splitting and projection. With this case vignette in mind, let us now review the development of psychoanalytic concepts concerning mourning and melancholia.

The development of psychoanalytic theories of mourning and melancholia

Psychoanalytical understandings concerning the dynamics of melancholic reactions, of the type described above, draw on a rich history of documented accounts of distressing reactions to loss, which have attracted a varied terminology over time (Jackson, 1986). What all of these accounts have in common is the description of states of dejection and self-blame, where the sufferer sees himself as central in the personal narrative of loss.

The melancholic-type reaction to loss, where the self is narcissistically identified with the lost object with which one is attached, is also common in those who suffer an experience of loss, other than an actual death (see Chapter 9). Whilst Freud’s (1917) writings focused on the significant loss of a loved one through death, he also noted that mourning would result after “the loss of some abstraction which has taken the place of one, such as fatherland, liberty, an ideal or so on” (p. 243). This might include the loss of a relationship or a loss associated with different life stages, such as old age (McGinley & Varchevker, 2010). A common instance of loss not involving death is where a young person experiences the end of a first romantic relationship. Those with a melancholic tendency are hit hard and struggle to recover and lose their capacity to function. Consider the plight of Werther in Goethe’s classic, The Sorrows of Young Werther (Goethe, 1774). Werther is plunged into a serious melancholic state as a result of the loss of his love, Lotte, who he discovers is betrothed to another. He asks:

Must it ever be thus – that the source of our happiness must also be the fountain of our misery? The full and ardent sentiment which animated my heart with the love of nature, overwhelming me with a torrent of delight, and which brought all paradise before me, has now become an insupportable torment, a demon which perpetually pursues and harasses me. (Goethe, 1774)

Importantly, the personality of Werther, as Auden (1971) has suggested, was burdened with an excess of narcissism and arguably (attachment) insecurity, which rendered him vulnerable to feeling responsible for so much of his own unhappiness.

Freud’s contribution

Accounts of melancholia and melancholic-type reactions can be found throughout recorded history. It was, however, Freud (1917), in his seminal paper Mourning and Melancholia, who researched accounts of melancholia and compared and contrasted them to normal mourning, in order to understand the underlying psychodynamics in the former. He saw that melancholia, in contrast to normal mourning, could result in unremitting emotional suffering and misery and in extreme cases could (where there were substantial unconscious sadistic impulses towards the lost loved object) encompass the risk of suicide. Relatedly, it is not uncommon in couples who exhibit manifestations of complicated grief, for one partner to feel so (unreasonably) responsible for the death of a child that the verdict of that partner’s internal judge (harsh superego) is that he does not deserve to live.

Freud wrote about melancholia at a time when he was developing his overall Magnum Opus, his theory of psychoanalysis. The development of his theory was characterised by a progression of thought which led initially to his topographic model wherein he accounted for unconscious, pre-conscious, and conscious states, to a structural (and more widely known) model by which he explained psychological conflicts and psychopathology. On the basis of his structural model he described the id as an instinctual reservoir of strivings and impulses; the ego, that which negotiated these with the demands of reality; and the superego, which he saw as the basis of conscience (Schimmel, 2014). In melancholia, he saw this last sub-structure as taking on an exaggerated role (like the internal judge referred to in the vignette above), which shaped it (the superego) into an agency, which instead of being supportive and helpful becomes something by which an individual can feel driven, compelled, and persecuted. Freud saw it forming an accusatory relationship with an ego, such that the latter feels impaired and inferior, as in the case of the experience of both Peter and Melissa.

Freud’s Mourning and Melancholia was written as the fifth in a series of papers, which helped to redefine Freud’s theory of psychoanalysis. It followed his paper, On Narcissism (Freud, 1916), where he had outlined the importance of identificatory psychic mechanisms and, in particular, narcissistic identifications in the determination of certain forms of psychopathology. It was a time of prolific output for Freud who, at 61 years of age, was dealing with his own losses. His half-brother Emanuel, with whom he had a close relationship, had died in 1914; at the same age Freud’s father had died. Freud was also left in a state of loneliness and uncertainty as his three sons had gone off to fight in the war (Gay, 1995).

Importantly, Freud, in his 1917 paper, noted that for the mourner it is the loss of the object that is at the centre of the experience, whereas in melancholia it is the loss of a part of oneself, due to a narcissistic identification. Couples who lose children in whom they have been narcissistically invested, often feel that it is impossible to continue as a couple, as their lost child has previously defined them and they experience a loss of that sense of definition with the loss of their child. Frequently, such couples often make an unwise decision to rush into becoming pregnant again as a solution to their psychic pain.

Freud had originally talked about mourning from a cultural perspective in Totem and Taboo (Freud, 1913). Here he noted that there could be ambivalent feelings towards the dead that made their spirits feel potentially demonic and frightening. In Mourning and Melancholia, he showed how such processes could operate intrapsychically. He not only emphasised the role of narcissism in this, but also the roles of ambivalence (towards the lost object) and sadism, which he saw as factors in taking loss reactions into the direction of melancholia.

Freud was essentially arguing that the self-recriminations and reproaches that the patient with melancholic reaction experiences, are in fact accusations against the lost love-object that have been transferred onto herself, or her ego. Freud (1917), in explaining these phenomena for the first time, also indicated that the ego could split and aspects of the self could be projected onto an “other” with whom she is unconsciously identified. As Scharff and Scharff (1991) have noted, the couple dyad provides an ideal vehicle for the maintenance of such splitting and projection. Link theorists, notably Pichon Rivière (2017), also described how “the link”, which is co-constructed by the couple, is the means through which such a pathological exchange of projective and introjective processes occurs and can either maintain or interfere with these processes.

In terms of splitting of the ego Freud noted how a bad self (part of the ego) could also become victim to a primitive and more brutal version of the superego, when he noted: “The shadow of the object fell upon the ego, so that the latter could henceforth be criticised by a special mental faculty like an object, like the forsaken object” (p. 249).

Ogden (2009) notes,

The shadow metaphor suggests the melancholic’s experience of identifying with the abandoned object has a thin, two-dimensional quality as opposed to a lively robust feeling tone. The painful experience of loss is short-circuited by the melancholic’s identification with the object, thus denying the separateness of the object: the object is I and I am the object. There is no loss; an external object (the abandoned object) is omnipotently replaced by an internal one (the ego-identified-with-the-object). (p. 131, italics added)

In such a narcissistic internal world, the lost object therefore becomes transformed into a lost (split-off) part of the self/ego. It then becomes subject to the grievances about the lost object. This is linked to Freud’s characterisation of all negative feelings that the patient experiences about himself as being those which he felt towards the lost object. As highlighted in relation to the story of young Werther, Freud also noted the role of sadism in melancholia. In this regard he pointed to the “indubitably pleasurable self-torment of melancholia” (Freud, 1917, p. 211). Perhaps it is only when this element of sadism is fully appreciated that we can realise how such sadism (and relatedly masochism), as part of the displacement of negativity away from the lost love-object, can also push an individual in the direction of suicide (see also the Introduction).

Freud’s views on many subjects, including mourning and melancholia, were of course strongly challenged. In this regard, in the only audio recording Freud ever made, he noted:

I started my professional activity as a neurologist trying to bring relief to my neurotic patients. Under the influence of an older friend and by my own efforts, I discovered some important new facts about the unconscious in psychic life, the role of instinctual urges, and so on. Out of these findings grew a new science, psychoanalysis, a part of psychology, and a new method of treatment of the neuroses. I had to pay heavily for this bit of good luck. People did not believe in my facts and thought my theories unsavory. Resistance was strong and unrelenting … the struggle is not yet over. (Freud, 1938)

Freud’s understanding about melancholia has, however, stood the test of time and matched up well to subsequent research concerning loss and bereavement, his ideas on the subject thus providing a valuable legacy.

Abraham’s views on melancholia

We are also indebted to other psychoanalytic theorists who developed Freud’s ideas. Abraham (1915) is one such theorist who was also thinking about the subjects of mourning and melancholia at the same time as Freud. Indeed, Mourning and Melancholia was a paper that was much influenced by Freud’s communications with Abraham, who was researching depressive psychosis as Freud was writing his paper. Abraham thought of depressive psychosis as a condition of unresolved mourning. Abraham and Freud, in studying the normal and pathological variants of mourning, agreed that normal mourning was a natural and required psychological reaction to loss and, even though it involved a departure from a normal attitude towards life, it should not be treated as an illness.

As an example of the influence they had on each other’s ideas, consider the following part of a letter Abraham (1915) sent to Freud well before the publication of Mourning and Melancholia:

Even though I do not yet see that the melancholic displaces onto himself all the reproaches that are aimed at his love-object and that serve to denigrate it, all that you say about identification with the love-object is perfectly clear to me. Perhaps I could not fully grasp this because of the compression of your arguments. With my patients it appeared to me as if the melancholic, incapable of loving as he is, desperately tries to get possession of a love-object. In my experience, he does in fact identify with his love-object, cannot tolerate its loss, and is hyper-sensitive to the slightest unfriendliness, etc. from that side. He often allows himself to be tormented by the loved person in masochistic self-punishment. He reproaches himself for this instead of reproaching the loved person, because unconsciously he has done far greater harm to that person (omnipotence of thought). That is how I deduced it in my analyses. (p. 303)

Abraham (1924a) therefore, also concurred with Freud about the relevance of sadism in making sense of the self-reproach of the melancholic. He felt that the dejected state emanated from repressed hostile feelings towards the love-object. His thoughts about melancholia were also based on the presence of several etiological factors, which he saw as fundamental in i...