“Meeting of Traditions: Field, Link and Matrix in Psychoanalytic Theory and Practice”

7 to 10 November, 2013

 Plenary Session

 

 

Drives and Fields: Are Drive Theory and Intersubjectivity Really Incompatible?

Speakers: Steven Knoblauch (USA) – Donnel Stern (USA) – Carlos Nemirovsky (Argentina) Interlocutor: Alejandro Ávila Espada (España) 

Dr. Carlos Nemirovsky (Argentina) [1]

Preliminary observations

On receiving the proposal from the Organizing Committee of the Congress to discuss the compatibility of drive theory and intersubjectivity, I was tempted to develop the topic metapsychologically. However, I was wary of straying from clinical experience when discussing core issues, given that the theoretical concepts are constructed on a basis of dialectics with our practice. Therefore, I will attempt to show with the same clinical material the way in which I am working today, a way which is quite different from the way I used to work some time ago and, perhaps, from how I will proceed in the future. I would first like to look at some aspects that the title of this meeting refers to. These will include:

1) The Question of Reality

The question set out is whether both theories are truly compatible. I remember my great grandfather (a rabbi, according to family lore) who, on hearing an answer which he considered to be too categorical, used to ask “Is that really so?” and in so doing created more doubts that certainties.

What are we referring to with the word ‘reality’? L.B. Alberti (Berger, R., 1976), a painter and Renaissance critic, awe-struck by the new, three-dimensional perspective, based on mathematics and geometry, which developed following on Giotto, said “at last we are able to see the world as God created it”. That was his definition of reality, at that time. A number of centuries later we could refer in another way to our perception, with the paradigm which was perhaps Dalí, when he said “When I see, I invent” (Ades, D., 1982, p.64).

These days, it is not difficult for us to accept that we each invent our own realities, that we create our own objects from that which exists in the material world and try to explain it with the theories that we have at hand. If we are in good health, we move within a transitional space (Winnicott, D.W., 1971).

Theories, like perspectives, are always provisional; they follow one on the other according to the times and they tend to have an expiry date, even if this is somewhat uncertain. Perception is always preconception, construction and interpretation and when we say it we are in fact emphasizing our power to make seen what we wish others to see. 

2) The Question of Theory

I would also like to look at the use of the singular: theory. Today, we have many theories at hand, theories which are both drive-related and intersubjective (that is, if we are to consider the intersubjective focus to be a theory and not a perspective, or a metatheory, as I believe it to be). My inference here is that the desire to generate fruitful polemic brought those who organized the topic of discussion at this table to invite us to contrast Freudian theory with other perspectives. According to Freud, the motor of things psychological is the drive or instinct[2]. He asserted that it is only desire, and nothing else, that can set the apparatus in motion. However, we must remember that Freudian theory isn’t itself a homogenous construct. The concept of drive changed in nature inside of Freud’s own work and even if desire (sexual, infantile, immortal, driven by instinct) as a motor is present throughout his works, with the introduction of narcissism the instinct / reality equation changes – this also happens after the assertion of the death instinct.

In parallel to the vicissitudes of the concept of instinct, the structuring of the ‘psychological apparatus’ as a processor of drives – as a transforming agent of instincts with the aim of making them compatible with life in society through defense mechanisms – acquires new forms all along the evolution of Freudian theory.

We cannot, considering this, speak of a sole drive theory. Other authors also locate instinct inside of his conceptual frame, from M. Klein and the post-Kleinian group (Meltzer, Bion, Rosenfeld) to thinkers such as Fairbairn, Winnicott, Kohut, Loewald, Mitchell and Ogden.

That which is instinctive always in my view comes with the cultural in a stimulatory or inhibitory context. Culture alters biology and merges with it in such a way as the elements from which it is constructed become inseparable.

Elsa’s case

“Insanity is not being able to find anyone to stand you.”
Winnicott (1984) quoting his friend J. Rickman

Elsa, 47, was brought for consultation by a friend who had seen her falling down drunk a number of times. She, the friend, told me that Elsa “had been acting suicidally”, knocking her head against the wall and biting her hands until they bled.

The first interview lasted for over two hours and during that I decided, not without some hesitation, that I would take her into treatment. Anxious and reticent, Elsa told me that she had been abandoned by her husband who, without prior notice, had left the house that they shared and gone away with a younger woman. Elsa repeated a number of times: “I don’t want to go into treatment and even less so with a man. They are all bastards.”

As far as I could infer, she had always been unstable, erratic and anxious, and had had frequent fits of anger which were as intense as they were fleeting. Both her and her husband had had affairs and they had separated for short periods during the 30 years that they had been married. Their only child, a daughter, lived abroad studying for a Master’s.

During the first year of treatment, we saw each other between four and five times a week; afterwards, we continued three times a week without interruption. Elsa used the couch from the very start and I asked a colleague who was a psychiatrist to medicate her. They were able to set up monthly meetings and, when necessary, telephone contact.

In the course of the first months, Elsa accused me of being unfit for the job, greedy and of speculating with the pain of others. She mocked my interventions, at times laughing out loud, and threatened to report me for malpractice. She said: “Do you really think that you know something about life? Because, to me, it seems to me that you’ve never been out of the consulting room or the library. It seems that you are a boring idiot”. She became ironic when I pointed out some of her emotions, saying: “Not only do you not know anything about life, but you know nothing about women either”. On a few occasions, she got up from the couch, interrupted the session and left, slamming the door behind her. Her attitudes swung from defiance to paranoia and entering into a deep and prolonged weeping.

At each session, Elsa was in a different mood and even within the sessions her identifications changed with ease. The influence that other people had over her was easy to see: she copied gestures and words, she imitated, transforming herself without being aware of it.

It seemed at that time impossible to find a resource to allow for the setting up of an environment of reflection. She ended many sessions saying: “I’m not coming any more”, or “This is the last time I’m going to talk because you are a fool”. She oscillated between attack and emptiness, saying “Nobody loves me. I’m going to kill myself”, “The only thing that you’re interested in is the money and, if I don’t have it, you’ll kick me out” and “I’m alone and devastated”. She experienced feelings of extreme depression, futility and unreality, transforming her experiences of emptiness and desperation into attack.

At the start of the second year of treatment, before I convinced myself that her opinion of me (stupid, foolish, boring, only interested in money, ignorant) was correct, the relationship changed. The atmosphere became more one of confidence and Elsa started to tell me some episodes of her personal history. On a few occasions, the session ran over time because I felt that it wasn’t possible to finish without putting her supervision at risk. A number of times she phoned me and told me that she wasn’t able to continue in that way, that I was useless and she said her final goodbyes. Once, in the early hours, she phoned me to tell me that she was going to finish her treatment and that she was going to end her life. I suggested that she decide nothing at that moment, that she take a tea and phone me in 15 minutes. I was trying to win time to think who I could count on to help me restrain her and, in the end, where she could be hospitalized. On calling me again, she apologized for disturbing me and, to my surprise, I was able to ascertain that she was calm. The following day, in the session, she said sarcastically: “So you cure people with tea? Aren’t you ashamed? What did you study psychoanalysis for then?” This session marked a watershed: I intervened very little and her paranoiac defenses gradually crumbled away to be replaced by the appearance of a memory which she recovered for the first time, that of her grandfather drinking tea while she played on his lap. She was sad as she left the session, but there was a smile on her face.

During the first holidays which occurred in the course of treatment, we had a weekly telephone session. I also talked to her once during that week to see how she was. I was, for her, a hated object, an object of attachment, and at times her ideal[3] but, and not without ambivalence, I became over time her safest and most trustworthy contact.

All along Elsa’s treatment, I tried to empathize with her, even if this was often not possible – I waited, therefore, for my patience to complete the task in the session.

I tried to tolerate the buffeting of curiosity, jealousy and envy (hers and mine) in the sessions and thought of how much I could contribute and how I could encourage those states. I attempted to endure the intense negative transferences involved and accept being placed in the role of a plant support used to guide the growth of a plant in a certain direction.

When some situation threatened the continuation of the treatment (short breaks away due to public holidays or instability in state institutions), Elsa went back to insulting, but with less vehemence than previously.

At that stage of her analysis, my tools were similar to those interventions which Killigmo (1989) terms ‘affirmative’. I favored differentiating her person from others, establishing a sequence of events, discerning dreams from hallucination in the transition to wakefulness and reflecting with her on her fantasies relating to the consensual world. I used words with an eye to establishing a point of contact, so that she could differentiate and bear her emotions and would realize that it was she who was experiencing them. Regressive moments were very frequent and I tried to adapt to them as they came up: she curled up in the fetal position on the couch, she asked me for water, she stopped speaking and she didn’t want me to interrupt her (she told me that she was daydreaming).

Towards the end of the third year of analysis, I started to focus more on transferential interpretations. I interpreted ‘classic’ transference, that which I understand as a repetition of the past preventing the apparition of a new link which we had been editing (Nemirovsky, C., 2007, 2011). I also tried to construct an account of the history of the treatment, right from the start of the relationship. Elsa, for her part, clung to her “analytic space” and, on the other hand, she resisted entering it; she threw me out of her life in fear of being abandoned once again. Certain memories started to emerge which became integrated to her history, repairing in that way their fragmentation. As the sessions passed, I got to know about the violent arguments between her parents during her infancy and adolescence. She was a child of her father’s second marriage and was much younger than her siblings with whom she had little contact. Elsa tried to lock herself into her room which, although it was indeed hers, was right beside her parents’ with a door connecting them directly. When the isolation in which she tried to survive proved not to be enough, she designed ear plugs and in that way she attempted to avoid the parental invasion in her life which paralyzed her. In her telling of her story, she expressed the desire to form a family which would create a relationship different from that which she had experienced.

This experience showed me that the very construction of the story of these patients is in itself an achievement and is something that creates confidence that the therapeutic relationship is proceeding in the right direction. I began to understand that the affective spontaneity of the analyst – that which comes after years of losing fear and feeling more secure as a professional – is an essential ingredient to make it possible for the patient to listen to us and therefore allow us too exercise our power as analysts. Without affective spontaneity, the possibility of the patient progressing will not be found.

Between the fourth and the fifth year of analysis, the way in which we related to each other changed a lot. Both of us were, probably, less defensive and more open in the sessions. We were able to be calmer most of the time. Elsa got a job in an institution and was able to maintain it and she started an emotional relationship with a man who, soon afterwards, fell ill and died. Contrary to my fears, she reacted more in mourning than in a collapse. She did not cave in. She was upset, she cried and she remained down without losing what she had gained workwise.

Between the fifth and sixth year of analysis, Elsa’s started to take more care of her appearance, probably as she had perceived that I found her attractive. She started to try to seduce me in a way which was not particularly subtle. She told me that at the start of the treatment I seemed to her to be stupid, but that later I became more interesting for her. I was able to tell her, with the possibility of being heard, that she wanted to build with me a romantic relationship just as she had lost, one in which each person cares for the other. I told her that I understood that she needed to feel loved and that it must have been very difficult for her to know that I was trying to help her in my role as a professional without establishing a loving relationship. I interpreted that she was attempting to set up / to construct an Oedipal relationship for the first time and that the seduction was not only a defense against the emptiness, as had happened a few years previously, but was also an attempt to now change herself into a woman who would be chosen by a man who would take care of her, giving her security and affection.

In the final years of her treatment, it was no longer necessary to contain Elsa. Little by little, areas of calm appeared in her which facilitated reflection. I felt able to achieve a ‘floating attention’ without having to be especially worried about maintaining the setting; furthermore, her emergencies were less frequent. I found my self gradually working with a neurotic patient, one that was very different from the patient I had started working with and one who I was able to help to integrate. She tried to control her instincts, with defenses which were very different and more elaborated, and this allowed me the possibility to a symbolic verbal access starting from the transferential link.

Short observations on the case

“You show me the honor of calling upon me to submit a report to the Academy concerning my previous life as an ape [….] your experience as apes, gentlemen—to the extent that you have something of that sort behind you—cannot be more distant from you than mine is from me. But it tickles at the heels of everyone who walks here on earth, the small chimpanzee as well as the great Achilles.” (Kafka, F., 1917) (Author´s translation).

That which characterizes human beings depends on the relation between three factors which come together in the manner of an alloy: the biological matter from which we animals are made; intellectual capacities particular to our mental development; others (the environment in which we live and our cultural context). Our instincts will appear and will acquire human form if, and only if, they are stimulated by others of the same species.

In the history of our discipline, the objective of clinical investigation was transferred from the study of drives and the psychic apparatus to the object. The paradigmatic change in theory was formulated, I believe, by Fairbairn following the clinical path taken by Ferenczi decades previously.

Fairbairn (1941) suggests the libido as a seeker of objects and not of pleasure, the erogenous zones to be intermediary channels, and libidinal phases to be “techniques of the ego” whose aim it is to regulate object relations. In that way, the foundations were laid for a concept that we could name ‘primary impulse’ (the search for objects as the central engine of the psyche), differing from those ‘secondary impulses’ held up by Freud: sexuality riding on the back of instincts (anaclisis). Elsewhere, M. Klein constructs a scene where the drama of relational objects driven by unconscious fantasy (correlational to instinct) is displayed.

Subsequently, Winnicott, D.W. (1957) differentiated ‘profound’ from ‘primitive’: “Deep is not synonymous with early because an infant needs a degree of maturity, before becoming to be able to be deep” (p. 109-110). The earlier tend not to be part of the self, but yes of the history of the subject: they refer to what the environment gives in the very first moments of life outside of the womb and responding to needs, in terms of support, manipulation and object presentation. The deeper experience starts to enter later (on top of that ‘net’ which has already been constructed) as content of the self, originating from experience and configurating itself as an internal world at the same time as the construction of the agencies. That which turns out to be ‘deeper’ will appear if we make possible with treatment the development of that which failed early on.

If in the immediate environment of the birth there were failings which generated traumatic situations, later, in the context of an analysis, transferences will appear which represent needs and not desires and these will sometimes be resolved by the psychoanalytic frame and the parainterpretative aspects of the analyst’s work (presence, tone and pitch of voice, actions) (Nemirovsky, C., 2007, 2013).

The patient, according to Winnicott (Winnicott, D.W., 1974), needs to ‘remember’ the early infantile collapse of which they have not heard anything because it has yet to happen. The memory will only start to be edited when it can be lived in the transference, usually as an enactment in which the patient and the analyst participate. The patient can gain access to the memory if the analyst makes this possible.

At the start of Elsa’s treatment, I could not have expected of her a remembering based on repression. The base from which we set out was the construction of a ‘frame’ without forcing the ‘adaptation’ and avoiding submission. This setting allowed me to think without so much anxiety and for her to accept it as her own, as an inhabitable space (as Elsa said to me referring to the first stages of her analysis: “We were building a house for me”). A space for hope was gradually generated, preserving at the same time the potential space between the two. She was able to see that her hostility did not destroy the link and that the relation was able to contain her drive overflow.

This case illustrates a way of working which integrates both approaches: drive and intersubjectivity. We always work in an intersubjective context, but it is not always possible for the patient to access the possible benefits with experiences that Winnicott termed ‘deeper’. The early experience, with its deficiencies, is resolved when a regular setting is established and with the attitudes of the analyst (with what we are and how we express ourselves, not with what we say and what we appear to be). The patient needs to settle into a setting that can be relied upon, one which will not judge and which will contain their chaotic behavior. This was of primary importance and indeed it was from this that Elsa was able to recognize her emotions, register her body in feeling herself to be alive, understand the chronological sequence and reflect. Starting with the mechanisms of dissociation and expulsion that fragmented her at the start of the treatment, she went on to use repression. From the initial survival, she started to develop acceptable work and social lives. My tools were combined: from the affirmative interventions used in an attempt to reply to her needs, I moved on to the interpretation of her desire. (Nemirovsky, C., 2013)

The decisive factor for change was, in my view, the link experience within the transference. Relation and interpretation are the therapeutic tools that we have at our disposal. Working with Elsa showed to me that the evolution of the psyche does not end with childhood. There is not, in that sense, an end point. The psyche is always open to that which it takes from the other because of its attitude. Such significance is registered in the quality of the relation and not only in the semantics of the language.

The criteria of the possibility of analysis derive from the possibility to create a suitable space, one which creates space for the continuation of elements whose development has been detained. If the attitude of the analyst facilitates this, adapting to the needs of the patient, there appear the skills necessary to receive and make use of interpretations of unconscious content for the extension of their consciousness.

Some clarifications concerning my own evolution

“Nothing is built on stone; all is built on sand, but we must build as if the sand were stone.”

Borges, J.L., Fragments of an Apocryphal Gospel : “Fragmentos de un Evangelio apócrifo”, 41.”Elogio de     la sombra”, OC, Emecé: Bs.As. 1974, 1011-1012. (Author´s translation)

I was trained in an institution (APdeBA, the Buenos Aires Psychoanalytic Association) right from its foundation in 1977. There, we as candidates studied almost exclusively the works of Freud and M. Klein. Occasionally, we read articles by other authors. Almost all the teachers and supervisors were Freudian or Kleinian. Gradually over the years, the first Lacanian analysts appeared at the same time as many of us started to become interested in the works of Ferenczi, Fairbairn, Kohut and Winnicott. A few, very few, of us then started to look into the North Americans in an attempt to overcome a prejudice which was well-rooted in Argentina with respect to North American psychoanalysis. Four schools, without watertight divisions, were formed in the institution – Freudian, Kleinian / Post-Kleinian, Lacanian and Kohut / Winnicottian – as well as some members who tended towards the psychoanalysis of the River Plate region based on the work of Pichon Riviere, Bleger, Baranger and Liberman.

As we shared seminars and clinical work, we all modified our positions over time: Freudian and Kleinian analysts started to include the context and the vicissitudes of the object in their interventions. The bibliography used in the works produce expanded, especially with the appearance of numerous quotations of Winnicott and other authors of the Middle Group. We discovered a Ferenczi without omissions; projective identification was less used to explain human relations. More and more credit was given to the field theory of the Baranger. In short, the range of thought was widening while at the same time being always linked to questions of institutional power. The defenders of the Freudian and Kleinian ‘colors’ were left behind and within the current framework of our institution the debates have changed: without stridency, the theories went into crisis and perhaps that extreme disillusionment with theory brought us to include much more clinical material in our discussions and prove that it was not possible to tackle clinical material with the metapsychologies that we used in the past.

Furthermore, the patients that consult with us today are quite different from those of years ago and what we can consider to be new tools have also come to hand: it is not many years ago that we started, slowly and with great resistance, to introduce in our literature the concept of enactment and question notions that were previously so highly-valued such as neutrality and abstinence and, moreover, to redefine the importance of the frame (which has in recent times been modified greatly: we now usually see patients just one or two times a week). We are in a process where we generate new languages, running the risk of making our jargon an even greater mess, but it is a process which is undoubtedly worthwhile.

Bibliography

Ades, D. (1982) Dali and Surrealism. Publisher, Harper and Row, NY.

Avenburg, R. (1995)  El término “instinkt” en la obra de Freud. Inédito.

Berger, R. (1976) El conocimiento de la pintura.  Noguer, Barcelona.

Fairbairn, W.R.(1941) A revised psychopathology of the psychosis and psychoneurosis. International Journal of Psycho-Anal. Vol.4, pags. 751-81.

Kafka, F. (1917) A Report to an Academy. Madrid: Akal.

Killingmo, B. (1989) Conflict and deficit: Implications for Technics. International Journal of  Psycho-Anal, 70. Libro anual de Psicoanálisis. Lima: Imago. P.111-126

Leivi, M. (2013) Comunicación al Grupo de Integración Psicoanalítico, Buenos Aires.

Nemirovsky, C. (2007) Winnicott y Kohut. Nuevas perspectivas en psicoanálisis, psicoterapia y psiquiatría.  Buenos Aires: Grama, 3ª. Ed. (2013).

 

——– (2011) Cuestiones de la práctica actual del Psicoanalisis. Revista Peruana de Psicoanálisis, n. 11. 63-74.

 

——– (2013)  The Girl who Commited Hara-Kiri and other clinical and Historical Essays, London: Karnak   75-88.

 

Winnicott, D, W. (1957) On the Contribution of Direct Child Observation to Psycho- Analysis. 109-114. The Maturational Processes and the Facilitationg Environment: Studies in the Theory of Emotional Development. London: Hogarth Press & The Institute of Psycho-Analysis, 1965.

——– (1961) Varieties of Psychoterapy . Home is Where We Start From. London:Penguin, 1986. 101-111.

——– (1971) Playing and Reality. London: Tavistock.

——– (1974) Fear of Breackdown. Int. Rev. of Psych-Anal. N.1 y Psicoanálisis, Vol IV, N.  2, 1982. Temor al derrumbe (1982, 2, p. 269-280).

——– (1984) Deprivation an Delinquency. Ed. C. Winnicott, R. Shepherd, & M. Davis) London: Penguin, 1986. P. 239.

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