Studio Michała Łapińskiego

Being a Psychoanalyst: A Personal Journey with Bion 

tylko po angielsku 

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Introduction

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The personal nature of the paper is due to the fact that it was originally written for and presented at the EPF conference hosted by the Polish Psychoanalytical Society in Warsaw in March 2018. Warsaw is the city of my birth, and there I also began my life as an analyst. My life and analytical journey have taken me across the globe and brought me to the other side of the world, to Australia. I used this paper as an opportunity to offer reflections on my analytical path, with hope that they refer also to more general analytical issues, worth discussing and not limited to any particular continent, nor personal context. With the same intention I also shared this paper at the conference in Mumbai in September 2018. 

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A virtual companion in my discussion is Bion. You may ask why? Many people and ideas have assisted me on my analytical journey, however, Bion has been most influential in guiding me through the significant part of my later development, and has helped me to be where I am now. Therefore, I will be using some of his thoughts, and my own ideas inspired by his work, as a part of what I am going to reflect on. 

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Unfortunately, for the reason of confidentiality, the clinical material which constituted an important part of my discussion had to be excluded from this publication. 

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The beginnings 

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Bion leads us to consider that a thought that may become a word has to be acquired, born out of experience — and as he puts it using his favourite Milton's expression — "won from the void and formless infinite".

He lets us contemplate that crucial moment when a choice is made, at the crossroads of the psyche, where one path leads to a birth of thought, and the other — away from it. He considers it "the critical decision", and the choice as "one that lies between procedures designed to evade frustration and those designed to modify it." (Bion, 1962). The first direction is inimical to thinking; the latter path leads to the development of the processing and thinking mind.The choice is made poignant by the fact that the mind from the onset has to deal with loss and psychic pain — and this process continues through life.

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When Bion talks about the choice he does not tell us who is making that choice, and on what basis it is made. This may suggest the objectless world, a "formless infinite". But it would be only an illusion of an unpeopled universe in which the "I" bears the name of existence.

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In fact, a thought does not come about by itself. In order to come to being it needs Another — the breast - the mind - the person — who, as it is discovered later, is coupled with another Other.

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A lot needs to happen in that relationship and in others for the life experiences to be tolerated, contained and processed for the thought to be given a home, "a habitation and a name" (William Blake), and for the mind to grow. But how does it all begin? … Maybe the very origins of mental life will remain obscure as ever.

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These considerations bring me to a related question, how is an analyst born? How does one become an analyst? Bion says, "You can't make doctors or analysts they have to be born." (Bion, 1994) but we may say that even though the germ of personality is formed in the earliest childhood, and even in the womb of the mother, the birth of an analyst, similarly as the psychological birth of a human being, is extended over time. 

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So if there is such a thing as a psychoanalytic personality, then maybe it is worth asking how such a person has come to being; how someone, at a certain stage of his life, arrives at the decision to explore conscious and unconscious mind. He embarks on an analytical journey, first, of course, starting with himself, and then helping others in their explorations. If we relate such a journey to someone's life history, we perhaps could consider events, influences and developments that were instrumental and formative for someone becoming and being an analyst for a large part of one's life.

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I could identify certain areas which, looking from the current perspective, could be considered important in leading me towards the path of psychoanalysis. I will highlight only some of them, those which I hope may be of general interest and worth discussing.

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Loss and trauma, as well as survival and recovery, have been as much a part of my life and the life of my family across the three generations, as they have constituted a part of the history of Poland, the country of my birth. 

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My maternal grandparents, together with their 3-year-old daughter — my mother — escaped from Russia, where they lived at the time, after the Bolshevik revolution. When I was 3, we lost our home, and the foundations of our existence were destroyed when after the fall of the 1944 Warsaw Uprising we ended up being deported out of the burning city.

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But our family, luckier than many others, largely survived. My father went unscathed when fighting the Germans in 1939. He could also thank his luck for being just wounded on the first day of the Warsaw Uprising, thus escaping the fate of thousands of his combatant colleagues who perished. The only close death was of my maternal uncle killed by the Soviets when they invaded Eastern Poland in 1939.  I was given his name as my middle name. 

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Much later, my own adult family also was to undergo the trauma and loss associated with our migration to Australia. It was our attempt to survive and recover from the loss of any hope for a free democratic Poland which had been irrevocably, as we believed at the time, destroyed under the sway of the martial law imposed in 1981, crushing not only the Solidarity movement but also the spirit of the people.

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Traumatic loss can be kept at bay, but its effects, even if not seen, may not be erased. The process of recovery from the disintegration invoked by the trauma may lead to an integration that can be more or less constructive. 

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I was growing up after the 2nd World War when the country was rebuilt, as was the existence of my original family, in the more peaceful but still not easy times. Warsaw, as we see it today, like Phoenix raised from the ashes, but its rebirth was directed and controlled by the new communist regime, which had been brought in on the bayonets of the Soviets — liberators/occupants — and sanctioned by the post-war partition of Europe, divided by the Iron Curtain. 

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That development was a form of reintegration for the city and country which suffered traumatic disintegration through the period of war and upheaval. At the same time, it was like a pathological organisation that secured a form of survival and fostered some growth, but at the cost of suppression of freedoms and of lasting impoverishment — not only of the material existence but of the spirit. 

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Growing up in that system, even though might not necessarily expose you to the extremes of oppression, certainly meant living in a depriving and severely constrained environment. You were also confronted with the need to find your way through a web of distortions, obfuscations and lies, which, despite your efforts, you might find yourself to be caught in, particularly if you listened only to the propaganda, and did not have access to alternative views.

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Looking back, I can see that I was fortunate to be made aware of different perspectives and thus to have an opportunity to develop some critical thinking. I was challenged in that direction by conflicting views that were expressed, sometimes fiercely, within my family in political discussions between my father and my maternal grandfather. I was also exposed to the clash between the official propaganda in media pronouncements and in what was taught at school, and from what I learned listening to jammed broadcasts of Radio Free Europe and The Voice of America.

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I learnt, painstakingly at times, about the importance and fragility of truth. I could experience first-hand the destructive impact of propaganda, and the threat arising from any kind of dogmatism.

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At the same time, it led me to gradually develop the conviction that the best way towards understanding is through the dialectics of the opposites, through a scenario of discussion and debate, which involves continuous questioning of the givens and beliefs, and should also include verification of data from various sources. 

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Thus, long before I discovered psychoanalysis, I had been interested in the relationship with truth and with reality, and also aware of threats and obstacles to them. 

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Becoming an analyst

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On that topic, Bion says the following,

"… you can go on too long with training and seminars. It is only after you have qualified [as an analyst] that you have a chance of becoming an analyst. The analyst you become is you and you alone; you have to respect the uniqueness of your own personality—that is what you use, not all these interpretations ..." (Bion, 1994, p. 15) "… that somebody else would give, (and you may end up using) instead of giving the interpretation you want to give. " (p. 16)

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This refers to a general theme of growth of the psyche which Bion discusses in many ways. He highlights also obstacles to that growth arising from lack of freedom, from the deficiency of a breathing, nourishing space in which thought can germinate and propagate. 

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This applies also to the growth of a psychoanalyst. Having experienced psychoanalytic societies and institutions, I can see his point. The structure of teaching programs can prevail over content; the essence of what psychoanalysis is about can be lost in a labyrinth of soulless procedures or bureaucratic requirements; the toxic politics can thwart collegial collaboration and debate. But the idea that you become an analyst only after you have freed yourself from the yoke of the training does not convince me. 

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However, what can I say? The history of my psychoanalytical education illustrates different kinds of problems, arising from the training conducted outside established psychoanalytic organisations. Now that kind of psychoanalytical education has become a common occurrence and has been to a large extent institutionalised in various parts of the world, where support and some structure is offered to those who seek training without having a local body to offer it. 

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When I decided to become an analyst while living in one of the euphemistically called "people's democracies" of Eastern Europe, there was no available support or facilitation for someone who wanted to train as an analyst. It was an individual endeavour, severely hampered by lack of access to training analysts as well as by the existence of impenetrable borders and by financial restrictions. Therefore, it required considerable motivation, persistence and often sacrifices. 

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In those difficult circumstances, I benefitted from the opportunity to become a member of a group of enthusiastic and committed psychotherapists who managed to conduct psychoanalytically oriented work, creating, in the unfavourable environment, a unique niche in which we could develop and grow. The work at the beginning principally involved group psychotherapy and was psychodynamic in its approach. Gradually, it underwent some differentiation, and some of us chose the strictly psychoanalytic path. I was one of them. 

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I was certainly driven, as many analytical candidates are, by the need to deal with my personal issues such as the conflictual relationship with my authoritarian father; the profound impact of the death of my mother when I was still a medical student; the subsequent dispersion of my original family; and later, my wish to succeed in my own adult family life. 

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My motivation also flowed on from the belief that in order to deeply understand other people you have to do it first with yourself. I wanted to grow within a psychoanalytically oriented framework, and I was aiming to achieve what I believed was the best realisation of that endeavour — by becoming an analyst. 

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Bion pays a lot of attention to the discerning of what is genuine and essential in the analytical function. He is at pains to demonstrate the difference between what this entity called psychoanalysis really is, and what it only purports to be when it relies not on its "essence" but on tokens, shibboleths and other derivatives of the craft, that can replace or obscure "the real thing". 

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One of the major obstacles to becoming an analyst, is, paradoxically, according to Bion, a strong urge to prove that one is, or is called, an analyst. This can restrict the capacity to function really analytically.

 

I believe that even when one is endorsed as an analyst, this is only the beginning. The analytical life is a continuous process of being, learning and becoming. And this is not equivalent to acquiring a title or a status, however prestigious it might be, and neither should it lead to "resting on your laurels". 

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Initially, that certainly was not a problem for me. Becoming an analyst in Poland would not lead to an elevation in professional status, increased prestige nor to financial gains. I could very well continue to practice as a psychotherapist. But I chose the analytical path. 

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The fact that my training took place outside established training structures influenced me in several ways. Firstly, it highlighted for me the importance of personal analysis. Mine was conducted in Prague, in Czechoslovakia, by one of the few direct members of the IPA who somehow managed to continue practising psychoanalysis, one could say, underground. I stayed in Prague for prolonged periods, then travelled there, on what would be now called a "shuttle basis". 

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I considered personal analysis the central part of my analytical development. It was not just a treatment tool nor a training requirement, but a meaningful endeavour, combining the need for personal and professional growth. I felt that one flowed from the other, in mutual interrelatedness.

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As the result of my experience of "the real thing", I had to revise many idealisations of psychoanalysis but I indeed found a confirmation of my initial supposition that there was something special and worthwhile about it. 

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I highly valued any opportunity for analytical supervision, the more so that my access to it was limited and difficult. I tried to use thoroughly and extract as much as I could from every supervision hour and continued that work on my own.

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Probably in the result of those experiences, in my approach to supervision I rely on the premise that the supervisee should not be offered a super-vision of someone who "knows best" but be encouraged to appreciate understanding that she derives from experiencing her own work and learning from it — thus becoming her own supervisor. 

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I consider it very important in the development of an analyst not only to continue with self-analysis but, regardless of the level of his experience, to have an opportunity to compare and contrast one's own work with that of others. During my training, I was missing contact with other candidates. I compensated for that deficiency by using every opportunity to take part in analytical meetings and conferences. Later, throughout my whole analytical life, I participated in peer groups as well as in clinical meetings, like those organised by the EPF, in which analytical work was explored in detail and in-depth.

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I have been reading psychoanalytical literature long before embarking on the defined analytical path. Obtaining it required, of course, a considerable effort. Later, the psychoanalytic interest group which I founded in Warsaw had access to the literature thanks to donations received via the IPA. It helped me in conducting regular psychoanalytical seminars. 

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I have continued reading throughout my analytical life out of my own interest, for the reasons of self-learning and teaching. My diverse reading has led me to see psychoanalysis as a "broad church", encompassing various theoretical orientations and different approaches to practice. At the same time, I have not been committed to any particular "denomination", even though I might identify myself periodically with one or another. 

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My misgivings about accepting any dogmatism or doctrine have led me naturally to a more eclectic perspective from which I feel free to use various theoretic approaches. From this perspective, they can be considered to represent different ways of describing the same thing— an analytical object. For example, a "Kleinian" baby, a "Winnicottian" one, and the one described let's say, by Lacan, are still referring to the same infant whose condition and "nature" we try to elucidate. 

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At the same time eclecticism can suffer from a certain lack of consistency, and liberalism, when taken too far, may become an acceptance that "anything goes". I have seen examples of questionable or even dangerous developments when the pursuit of such "freedoms" was disguising entitled omnipotence; when scrutiny was avoided and self-reflection became absent. 

Perhaps we may consider narcissism as an occupational hazard for the analyst, not so much in its more benign self-comforting and self-affirming aspect but one associated with grandiosity and righteousness. This form of narcissism may arise from various sources but can be fuelled by insecurity and anxiety which are intrinsic to our difficult profession. 

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If it is associated with omnipotent and entitled overreach, it can lead to boundary encroachments, sometimes with disastrous consequences. But the fear of transgressions can also breed a self-centred attitude in which the analyst may see himself as righteous and superior—paternalistically, as a source of all wisdom, or, maternally, as a source of all goodness. Primary maternal preoccupation or primary paternal contribution can be replaced primarily by narcissistic inclination. When such an attitude becomes uncritically entrenched there is not much room for acknowledgement that the patient not only takes but contributes, and that the analytical candidate can have useful insights. A dualistic perspective can be distorted and the dialectical approach becomes one-directional.

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Bion helps us to understand that there is always a need for a container—but it should not be like a straitjacket; the boundaries are necessary—but they need to be adaptable. There is always a dialectic tension between a creative "wild" idea and the need for its "taming". He elucidates it clearly when he talks about the relationship between the mystic and the establishment, which is relevant not only for the group but also for intrapsychic processes. (Bion, 1970)

Claiming allegiance to a doctrine or to "the best way to practice the proper analysis" can be reassuring but at the same time, it can pave the way to an ivory tower where psychoanalysis may only vegetate and stagnate rather than vigorously grow.

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Notwithstanding the importance of a debate between various viewpoints, such a debate can become problematic when it ceases to be a potentially productive contest of ideas and become an expression of sectarian allegiances, which Bion dismisses with the following,

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" ...it does seem to be rather ridiculous that one finds oneself in a position of being supposed to be in that line of succession, instead of just one of the units in it. It is still more ridiculous that one is expected to participate in a sort of competition for precedence as to who is top. Top of what? ... I am always hearing ... that I am a Kleinian, that I am crazy; or that I am not a Kleinian, or not a psychoanalyst. Is it possible to be interested in that sort of dispute?"

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Difficulties of being an analyst

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I turned to Bion when in my psychoanalytical work I was encountering patients who challenged my analytical skills, tested my endurance and patience, and even threatened my emotional balance. My reading and then teaching of his work have led me to appreciate more and more his contribution to psychoanalysis in general, and to my development in particular.

Especially significant were the experiences associated with my, what could be described, as my "returning to Poland bringing Bion" —-in the form of lectures and seminars. Those, along with my assisting with the translation of Bion's major works into Polish, allowed me, by operating across two different languages to distance myself from some constraint of words. I could better discern and appreciate the underlying propositions — the "essential Bion" — in its richness and truth, as well as in its elusiveness and opaqueness.

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It is consistent with Bion's reference to words that can be as much conveyors of truth as they can become its great deterrents. His thinking initially appeared to me exactly like that — dry, abstract and obscure, disconnected from emotional meaning. His work acquired significance for me only when I was able to connect it with my actual analytical work and with myself as an instrument of that work. It facilitated for me experiences that I had not had access to and awareness of before. I felt freer to think my own thoughts and found myself gradually changing my way of working. It has not been a linear or painless process but I think that it has made me stronger as an analyst. At the same time, using Bion's phrase, it has "made me aware of the depth of my own ignorance".

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This process has been confirmed in supervision and teaching in which I could see how the others were discovering a "true Bion" not in words of his texts but through their own experiences.

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I have come to believe that the spirit of Bion is best reflected not in his concepts, however illuminating they may appear, but in how we go about performing our analytical tasks, inspired by his ideas but not beholden to them.

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In the analysis we inevitably have to use words, but, as Bion says, 

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"The words can be institutionalised – containing the new ideas – to promote them and shared for the purpose of enlightenment, or, alternatively, turning them into a dogmatic text, thus stifling further development and growth." (Bion, 1970)

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If we accept, following Bion that "In the consulting room, analyst and patient are two frightened and dangerous animals" we also rely on the fact that "Hopefully, one of them is less so than the other". (Bion, 1980)

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But then comes the crunch: encountering the psychoanalytical experience which — when true and real — is, using again the Bion's expression, not like just looking serenely and from the distance at the stripes on the tiger but it can be an overwhelming, terrifying and maddening experience of facing the frightening tiger itself — O. By this sign Bion referred to an unknown, and undefined quality, the ultimate essence of the experience, neither good nor bad. But coming closer to O can be like approaching a god-like ideal entity or an absolute evil core; it can be enlightening and enlivening, or maddening. It can become a journey of Daedalus who freed himself, and well equipped with his experience and wisdom, could navigate close to the sun but was also able to come down to earth; or it can be the fate of Icarus who was struck down from his arrogant and foolhardy attempt to reach IT, the essence, the sun.

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So perhaps it is possible to only make more or less successful attempts at becoming O, finding possibly authentic forms of representing it, and then, hopefully, going on being (using a Winnicott expression) and growing. To try to capture O and possess the essence of it, "to get it", as it were, can lead to a dead-end or is an invitation to madness.

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It also has to be accepted that there are instances when a retreat is a prudent option, for the patient and/or for the analyst. 

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On other occasions, you can also find the heart in discovering that the tiger may change its appearance and nature when looked closely at — it may turn out to be a terrified or confused kitten.

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Capacity and preparedness for meeting the truth of emotional experience are paralleled and combined with the ongoing work which I called "cultivation of alpha function" (Lapinski, 2012). Both aspects require also the appropriate and consistent analytical attitude which Bion called "without memory and desire". These concepts form the core of his thinking about the functioning and the role of the analyst. 

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In a similar spirit, Antonino Ferro reformulates the analytical task,

 

"The analyst thus presents him- or herself as a person capable of listening, understanding, grasping and describing the emotions of the field and as a catalyst of further transformations - on the basis that there is not an unconscious to be revealed, but a capacity for thinking to be developed, and that the development of the capacity for thinking allows closer and closer contact with previously non-negotiable areas …" (Ferro, 2005)

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Cultivation of the cognitive functioning allows the experiences to be contained and transformed into usable forms, in the process akin to dreaming, which leads to the growth and strengthening of the thinking mind, which eventually can become more able to conceptualise.

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This requires fine-tuning of the analytical approach, such as, for example, suggested by Anne Alvarez,

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"Thought may have to be thinkable long before the therapist should concern himself with luxurious questions about who is having it. This idea may imply, in order of priority, first naming it and containing it, and sometimes sharing it ... only afterwards locating it in the self or object, and only after that considering the even more luxurious question of why the patient is having it." (Alvarez, 1993)

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If we indeed accept that psychoanalysis is about the relationship with the truth, we can also assume that there will be many ways of making contact with it. They can be interpretative or not, and for interpretations we can use different kinds of language — scientific or poetic, rational or emotive, or a language of myths and dreams. It can be a subject of discussion, whether the contact with emotional experience, which is in itself indispensable for interpretations, can dispense with interpretations. Bion was saying, "A real poet is able to use language that is penetrating and durable. I would like to be able to use language that did the same".

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Bion's work helps us also appreciate the significance of the phenomena arising from a misdirection of the development of thought and misuse of conceptualisations. They can take the form of rigid beliefs, delusions and "foregone conclusions" or concretised thinking mishaps. They can become "gods of the gaps" (Lapinski, 2012) - they are constructs that fill the gaps in understanding by attempting to seal them with concrete reified ideas. The work that needs to be done involves deconstruction, de-concretisation of those cognitive blocks and distortions, as well as de-mystification of delusional beliefs. 

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Consequently, the central to this work is real freedom of thought facilitated in the patient, starting with the analyst, who needs to free himself as much as possible from the bondage of memory, desire … and "understanding" — but the understanding of the kind that can insidiously turn into immutable, reified convictions which thwart his freedom of thought and stifle liveliness of the analytical endeavour.

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Thus, central to Bion's thinking is understanding of the cognitive functioning and its distortions that underpin many difficulties in the analytical process affecting the patient, the analyst, and the analytic field.

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One of the manifestations of cognitive dysfunction is psychotic functioning, which is not restricted to clinical psychosis. 

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Bion's thinking helps to understand its facets and dynamics: excessive use of projective identification and prevalence of non-symbolic, concrete thinking; the proliferation of primitive anxieties with an ever-present threat of mental disintegration; the use of defensive organisations which, acting as pathological containers to maintain psychic balance, offers a semblance of integration. 

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These processes dominate the weak ego which cannot grow through learning from experience. The psyche takes an anti-truth and anti-growth direction. The analysis may be ineffective or can become a threat to thus maintained mental balance.

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I find it useful to consider, following Bion and others (for example, de Masi, and earlier Rosenfeld) the coexistence of the psychotic part of personality with another part (or parts) that can be neurotic or healthy; it allows me to think about the unity and disparity of these parts, and also about the complex relationship between them. As the analysis progresses and the sway of the psychotic part lessens, dealing with this relationship can become a focus of the necessary and productive work. 

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The analysis of such patients presents a challenge to its both participants. It puts particular demands on the patient, and also on the analyst.

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Part of this challenge is to transcend those 'tales of ordinary madness' so they could be transformed into a communic-ative and communic-able disease, and the personality can become better integrated, so it is more amenable to meaning and ... healing.

Bion, while acknowledging the limitations of the analytical approach, supports the notion of its usefulness. He says,

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"... psychoanalysis has at lasts come to the stage when it is able to scratch the surface of things … from the point of view of what we want to do, especially if we are going to have to deal with patients which are not really like the sort of patient which is spoken of in classical psychoanalysis, then not only are we to treat these patients, but we have to invent the methods by which we are going to treat them." (Bion, 2013)

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Some of these patients may be considered unanalysable and impossible to treat, and some in fact are. However, the late Danielle Quinodoz in her paper, The Psychoanalyst of the Future: Wise Enough to Dare to Be Mad At Times, argued in favour of taking on such "impossible patients" who, in her opinion, could benefit from analysis. She described how her work with such patients challenged her way of thinking, her emotional endurance and her sanity. And to those who suggested that she "must be mad to take on such patients" she replied, 'Today, you have to be mad to be a psychoanalyst!' (Quinodoz, (2001)

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This leads to thinking that psychoanalysis with a particular patient is not something that can be "applied". It is something that has to be born, learnt and developed, found, along with the patient finding herself, in the process of emerging from the unformed and confused, and away from the misconstrued.

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According to Bion, an important assumption that guides the patient and the analyst in this pursuit,

 

..." is that the personality of analyst and analysand can survive the loss of protective coat of lies, subterfuge, evasion and hallucination and may even be fortified and enriched by the loss. It is an assumption strongly disputed by the psychotic and by the group, which relies on psychotic mechanisms for its coherence and sense of well-being." (Bion, 1965)

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Bion also warns,

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"The practising analyst must get hardened to mental breakdowns and become reconciled to the feeling of continuously breaking down; that is the price which we have to pay for growth. … We have to be reconciled to the feeling that we are on the verge of a breakdown, or some kind of mental disaster; we have to have a certain toughness to stand this continuing experience of mental growth. … So you can take your choice: mental stagnation and decay on the one hand, or perpetual upheaval on the other — like living in the middle of a mental breakdown, without being clear whether one is breaking up or breaking down." (Bion, 1990)

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We can surmise that Bion was able to come closer to madness, including his own than most can. He came close enough to have a good look and to recount what he saw. He was able to give some directions and describe his ways of dealing with that predicament. He also gave words of warning against carelessness, omnipotence and hubris, and strongly suggested for every analyst to follow his/her own authentic path — and in a realistic way.

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The concept of mind development and emotional growth is central to Bion's conceptualisations of mental processes and of the psychoanalytic endeavour. This applies both to the patient and the analyst, as both share the experiences that hopefully can lead to growth, and both face difficulties and fears thwarting such development. 

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As the patient becomes stronger, she does not have to resort to psychotic mechanisms and has a lesser need for a straightjacket — also can feel freer in her explorations and in her experiences to be alive, to be herself. Then she is looking at developing a new life form for herself, and in an environment in which it could safely grow.

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This is not magically "being born again" but rather, as Winnicott put it, "coming to being" — that is, becoming herself — in a painstaking, arduous but genuine way.

I think that the same may apply to the analyst who develops his/her own way of being an analyst — in general, and specifically with each of his patients. 

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Bion says,

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" You have to be a practising analyst before you discover that it is worth your while talking to patients the way that you talk to them — never mind whether it is sanctified by appearing in one of the Collected Works. That experience convinces you that it is worthwhile having some respect for your Self, for what you think and imagine and speculate …"

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An analyst is born? Out of what? Maybe as Bion suggests,

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"… a 'marriage' (which is) taking place between you and you; a marriage between your thoughts and feelings. The intuition which is blind and the concept when is empty can get together in a way which makes a complete mature thought." (Bion, 1980)

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The analyst in the world of our times

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In recent decades, psychoanalysis has made significant progress in understanding the primitive and undifferentiated layers of the psyche and the associated serious psychiatric, cognitive and somato-psychic disorders. New clinical approaches have been developed that deal with emotional and cognitive dysfunction and aim at a renewal of the patient's psychic functions. It is also a psychoanalysis based on the direct experience, a "real-time psychoanalysis". (see Najeeb, 2008) The interactive and dyadic aspect of the analytical relationship acquires a special meaning in it, requiring significant involvement on the part of the analyst. This direction of psychoanalysis has been propagated, among others, by Bion, and developed in various ways by analysts such as Tustin, Grotstein, Ferro, Vermote, Ogden, Lombardi, Bergstein, and de Masi. I am mentioning here those from whose work I have benefitted most. Those original approaches often require a re-evaluation of the established psychoanalytic paradigms and revision of our ways of working.

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We may ask ourselves to what extent those new psychoanalytical approaches can also help in better understanding the primitive, psychotic layer of socio-political and cultural processes we experience in our times. And, more importantly, how much such understanding can be applied and can lead to significant, real changes. Opinions in this respect are divided.

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For example, Andrew Samuels, a British Jungian analyst who involves himself with those questions, also practically in the form of consultations, believes that even though psychoanalysts and psychotherapists have a lot to offer, they overestimate the importance of their insights for processes that take place outside the analytic situation. In fact, and here he quotes the title of the book published in England, "We've Had a Hundred Years of Psychotherapy—and the World's Getting Worse." Freud, Jung and their luminous followers invited the world into therapy, but the world didn't show up for its first therapy session. (Samuels, 2004)

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In this situation, it is difficult not to sink into resignation and ... fall silent.

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On the other hand, Hanna Segal in her article from 1987 spoke about situations in which silence is a crime, and the analyst's making his voice heard — his duty. At that time it concerned the existing nuclear threat which could obliterate life on earth. That situation was due to the madness to which humankind has succumbed, resorting to omnipotence and denial of reality. A paranoid vision of the world was realised, splitting it into mutually combating camps that kept one another in check through the threat of mutual total destruction (MAD). It created a dubious balance based on mutual projections and was underpinned by persecutory fears. (Segal, 1987)

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Segal argued that taking the public stance by the analysts was just as necessary as when they were dealing with the psychotic process in the patient. Not only they should not give in to it, but they should face it and make every effort to restore sanity and common sense.

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Hanna Segal took up this topic again in a short article published 20 years later. She noticed the repetition of the same phenomena and processes, the symptoms of insanity still proliferating the world, in successive geopolitical constellations. She highlighted the extent of human destruction, but at the same time expressed hope that it could be counteracted by undertaking "the unending task of exposing lies and striving for the preservation of sane human values". (Segal, 2006)

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These propositions are repeatedly tested, Now, after several years, we see further examples of the repetition of destructive, global processes of psychotic nature. And the threat is even more general. The painful knowledge of how people can destroy each other has been supplemented by the awareness of the ongoing, man-generated ruin of our planet. What can be even more disturbing, is the realisation that we are not able to use this awareness and implement changes that are necessary to prevent the unfolding catastrophe. It is particularly disturbing for a psychoanalyst to observe the process of distortion of the truth and to witness attacks on the very concepts of truth, honesty, and tolerance. Destruction of the truth is as dangerous and devastating as the destruction of the globe.

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These are not new phenomena, but they take on modern forms. "Our times" brought with it incredible fragmentation and dispersion, universality and proliferation of the same processes thanks to new technical devices and social media. It is difficult to escape from them and defend oneself against them. It is not easy to stand on the ground of reality when almost unlimited access to information produces a flood of its unconnected bits. The propaganda praying on primitive emotions like fear and hatred can be frighteningly effective with the help of contemporary means, as was documented in the recent film about Brexit (2019). The rise and persistence of the "post-truth" "trumpism" have provided us with ample evidence demonstrating how easily and widely primitive fears, paranoia, lies and delusions can dominate public discourse and politics, swaying public attitudes in the direction of psychotic functioning. "Twitterisation" of the public opinion seems to reflect and reinforce the process akin to psychotic fragmentation which draws people in, and which is not accompanied by critical reflection. It is more difficult to stand on the ground of truth when its very existence and value are undermined. In this context, the "task of exposing lies and striving for the preservation of sane human values" postulated by Hanna Segal may seem doomed to fail.

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One can also wonder whether the problem does not lie in the weakness of our voice. Freud already admitted that "the voice of the intellect is soft."

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Where does this statement come from? Why would the reason be lacking in strength, while delusion and stupidity would have power? I think that view of Freud, who we, as psychoanalysts probably share, may be biased. It is based on our faith in solving human problems, as in psychoanalysis, through dialogue, cooperation and by reaching consensus through compromises. It is the trust in the "democratic ego". This insufficiently takes into account the problem of power, which perhaps psychoanalysts sometimes prefer not to deal with. The point, however, is that the results of the dialogue depend not only on the value of the arguments but on the power behind them. "The voice of reason is weak", especially in a system that is based on the pursuit of power through total control applied also to the truth and to words.

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Systems, both psychological and social, are organisations that determine the form and direction of activities conducted in them. In addition, a system protects against disasters, disintegration and chaos. But the nature of the system will be determined by whoever has power over it. The psychotic system, with its particular paranoid manifestation, is dominated by a special mentality accompanied by attitudes and actions subordinated to it.

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An unparalleled analysis of such a system was provided by Orwell in his novel 1984. His vision can be considered not only a dystopian pastiche of the Stalinist reality. It has a more universal meaning, applicable to socio-political, interpersonal and intrapsychic processes. Orwell provided insight into the operation of paranoid processes — black and white splitting, projection and erosion of rational thinking —- in the service of a totalitarian system. He showed the impact of this system on individual and collective minds. He described how highly valued "unshaken beliefs" can act in the service of brainwashing, guaranteeing the dominance of this totalitarian state of mind. They can take the form of lofty concepts based on heroism, patriotism or religion, of which delusional and destructive nature is masked and "whitewashed". Hatred and violence are sanctioned and uncritically accepted under the black and white system of divisions. The effect of such a system is the enslavement and disappearance of independent thinking. The ultimate defeat is the act of internal surrender. This is a psychological disaster, a "soul murder", as Shengold (2011) calls it.

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It should be acknowledged that there are psychoanalysts who are concerned with the analysis of socio-political processes. Among them are those who undertake consultative and advisory roles by initiating in conducting psycho-political dialogues (see Volkan, 1999).

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However, it may be suggested that politics is not compatible with the ideas and practice of psychoanalysis. Political functioning is governed by the pursuit of power, control and profit. Understanding and truth are subordinated to those aims. Of course, this does not mean that there cannot exist different systems of power which are more effective and more successful in the implementation of the principles of democracy and liberalism. In an analytical situation, however, even if problems of power and control may be present, respect for truth, tolerance and humanism are essential. Psychoanalysis seeks to understand and enrich the human soul, not to win the "government of souls".

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Freud, despite his doubts, similarly to Segal, maintained hope that the voice of reason could prevail. Some hope can be drawn from the fact that there is no shortage of wisdom in the social and even in the political sphere. It is not difficult to find insightful discussions and analyses. There are more or less ambitious and convincing proposals as to how to solve the existing world problems. There is also no shortage of advocates of the progressive and rational views who are ready to serve the public and who have the heart in the right place. The problem lies not in the lack of reason and insight, but in that they do not carry enough effective power. In addition, the so-called progressives are not always able to resist black and white polarisation. Self-aggrandisement, along with condemnation and contempt for the opponent, can interfere with the initiation of a dialogue with him, without which there is no chance of compromise and consensus.

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It is such extreme polarisation that reinforces the domination of the paranoid system, and its strength and persistence may undermine faith in the possibility of changes and reforms. Even in the work with one patient dominated by such a system it may turn out that not only a renewal is impossible, but an attempt to introduce change may result in a conflict or even a catastrophe. Notwithstanding that, the experience shows that some of those patients can be helped analytically in getting out of such domination and with initiating healthy development. But it is necessary to appeal to those forces in the patient that want to change and to establish a dialogue and constructive cooperation with them.

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The paranoid system is opposed to the system based on the thinking apparatus and the "democratic ego". The paranoid system is derived from chaos and the trauma of a primitive catastrophe, and it is an attempt to contain it. Despite the appearance of cohesiveness and order, such a system is unstable. It is continuously threatened by a catastrophe: a collapse, crash or dissolution. It can be said that the very existence of this system constitutes itself a catastrophe. It is based on the colonisation of the development space, limiting the psychic life and thwarting the growth of the thinking mind. Problems are solved not through dialogue and compromise but through polarisation and fighting. 

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A renewal requires the restoration of conditions under which a rational, thinking, "democratic ego" can contain and effectively manage the range of human emotions, particularly threatening and traumatic ones, as well will be able to deal with the problems of reality. Such a change involves a shift in the balance of power through which the paranoid systemic loses its dominant position.

 

Psychic catastrophe and its consequences

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Freud saw the role of psychic catastrophe in the genesis of a paranoid system. He considered Schreber's delusion of the end of the world as the "projection of his internal catastrophe" and his delusional system as an attempt of the rebuilding "this shattered subjective world". He said, 'The paranoiac builds the world again, not more splendid, it is true, but at least so that he can once more live in it'." Later, he considered a delusion to be " like a patch over the place where originally a rent had appeared in the ego's relation to the external world". (In Steiner, 1991)

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Hanna Segal considered a delusional system both as a result of and as a defence against a catastrophe resulting from traumatic losses and leading to "the infantile situation in which the ego is flooded by destructive and self-destructive impulses threatening annihilation." She emphasised the mainly destructive nature of such a system which is based on omnipotence, rejection of dependency and turning away from reality. (Segal, 1972)

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Frances Tustin while considering autistic states described basic problems with existence. She showed how primitive terrors such as: of falling forever, precipice or a bottomless pit, and also of spilling or dissolving, are attempted to be managed by reactive rigid formations such as encapsulation. She considered those, "the expression of a hypertrophied, crude body 'ego' which had been startled into precocious development along an aberrant path by the impingement of unbuffered awareness of bodily separateness from the mother. This puffed-up ego is not a 'true' ego formed by bearable contact with the outside world. It is both a deceit and a conceit." It is an 'empty fake', a 'hollow sham' that does not even have a 'self' to be 'false'. (Tustin, 1986)

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Volkan speaks of the necessity of creating any, even delusional identity when the existence is threatened by psychotic disintegration. (Volkan, 1999)

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Those formulations concern primitive body-mind states when corporeality and psyche are not yet differentiated. Their disorders which are characterised by a discontinuity of existence, a disruption of the sense of identity and a significant loss of mental functions were the subject of interest of many analysts dealing with this kind of patients, such as Esther Bick, Mitrani, Ogden. Recently, Lombardi has linked those phenomena with the emergence of psychotic states (Lombardi, 2008).

A psychological disaster is often described using geophysical terms, such as implosion, landslide, earthquake or tsunami. The latter, like the volcanic eruption, is a consequence of the movement of tectonic plates. This is an apt metaphor because it suggests the existence of a weakness in the seemingly stable system in the form of a fault line, as well as the action of opposing forces. The combination of those factors leads to a disaster. The term "fault line" would refer to the basis of somato-psychic existence, whose weakness we can postulate, especially if there is a psychotic breakdown. In English, the term fault line is particularly meaningful because fault also means defect as well as guilt.

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That's why Michael Balint used the term "basic fault" to describe a deep problem embedded in the psyche, the problem which he, like Winnicott, attributed to an early environmental failure. A patient who is experiencing such a problem "feels there is a fault within him, a fault that must be put right (which) is felt to be a fault, not a complex, not a conflict… (and) that the cause of this fault is that someone has either failed the patient or defaulted on him". Balint, similarly to Winnicott, recognised the patient's fears of a repetition of that primary catastrophe in the analysis. They believed that the analyst's task is to remedy that situation, supplementing the traditional analytical approach with offering "environmental provision", sometimes even in the form of a physical contact with the patient. (Balint,1979; Winnicott, 1965)

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It can be added that such a sense of a "fault" leads often to attribution. When something terrible happens it is easier to conclude that it must be someone's fault — that it was done to me or that was I who have done it.

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In the contemporary psychoanalytical approaches, particular significance is given to catastrophic and undifferentiated experiences in the formation of the psyche and its disturbances, and to the methods of dealing with them analytically.

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The authors such as, for example, Bergstein and Vermote, in their work influenced by Bion describe their way of dealing with the primitive psychic processes derived from the unrepressed unconscious (Bergstein) or from the undifferentiated level (Vermote). However, they don't suggest any "environmental provision" but an involved, receptive presence of the analyst due to which the patient's experiences, filled with terrors or not yet felt, can acquire contained and manageable forms through what Bion described as the transformation in O, that is by identifications with the patient through participation in his deep experiences (Bion, 1965, 1970).

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These ideas are connected with Bion's concept of the catastrophic change that can be associated with a disaster but also can lead to growth. Bion emphasises that "The practising analyst must get hardened to mental breakdowns and become reconciled to the feeling of continuously breaking down; that is the price which we have to pay for growth." (Bion, 1990) With this approach, facing the catastrophe is inevitable and may be even considered necessary.

For example, Bergstein suggests that "primarily through the analyst's capacity and willingness to experience the agonies of breakdown in his flesh … to experience a catastrophic change, to lose his identity, even if momentarily." — in the process of sharing it with the patient, the experience of catastrophic change can undergo a transformation. (Bergstein, 2014) A similar approach is presented in the work of others, e.g. Lombardi and Vermote. However, Vermote advocates caution, believing that it is "too risky to rely on the transformation in O in psychotics and severe borderline patients and I have felt that in treating them, it is better to rely on … the transformation in K, and to focus on containment and enhancing the alpha function in these patients." (Vermote, 2011)

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In my opinion, those two aspects of the work are not mutually exclusive and can be applied in various degrees, alongside careful monitoring of the state of mind of the patient and of the analyst.

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Difficulties of being human?

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We can accept after Bion that the primary and principal cause of suffering and mental disorders are not suppressed drives or excessive destructiveness, but humanisation — the fact that there is a mind which elevates us above animals, which are ruled by the instincts. At the same time, it is a mind that is unable to meet the demands of the outside world we inhabit, and cannot effectively control our internal world, which is inhabited by descendants of our animal ancestors. If we accept Bion's suggestions, we must accept, with a blow to our narcissism, that our thinking mind is inadequate as a tool of self-knowledge, nor does it guarantee control over the world of things, let alone over the domain of emotions.

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Bion questions the ability of the human being, along with his rational mind, of which he is so proud, to deal with his own existence. Similarly to Freud, for whom scientific thinking could resemble thinking of a schizophrenic, for Bion the weakness of the human mind "may be closer to the weakness of psychotic thinking than superficial scrutiny would admit." (Bion, 1962, p. 14) Philosophy and exact sciences will also fail us. Although he believes in the value of psychoanalysis, he doubts the possibility of a fully 'satisfactory' understanding of oneself and the world in which we live even with its help. We are left with our trouble with existence.

From that perspective, the fundamental problem that psychoanalysis should deal with is the inadequacy of the thinking mind in relation to experiences that cannot eventuate, or which become excessive and violent. The result is pain, trauma or mental catastrophe. A mind that is weekend or underdeveloped is less likely to deal with them without resorting to destructive activities. Their effect may be limitation or paralysis of the mental functions or even extinction of the life itself.

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The paranoid system can be considered a specific case of the essential problems of existence. The possibilities of change would lie in its special dynamics, but also in the potential of the human mind to deal with the essence of this existence. Can we have reason to be optimistic about it?

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Bion does not offer a reassuring or easy answer. He says, among other things, that,"… the human animal has not ceased to be persecuted by his mind and the thoughts usually associated with it – whatever their origin may be... Refuge is sure to be sought in mindlessness, sexualization, acting-out, and degrees of stupor. "(Bion, 1970, p. 126)

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And also,

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"Confronted by the unknown, human being would destroy it. Put into a verbal formulation of visual image, it is as if the reaction were, 'Here is something I don't understand – I'll kill it'. But a few might say, 'Here is something I don't understand – I must find out'. (Bion, 1990, p. 28)

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Embarking on the analytical path means that we believe in finding those other "few". So did Bion. He showed through his entire analytical work, just like Freud and Segal, that he is not pessimistic, but realistic in his expectations as to the possibility of change. He certainly would not believe that using the words of a Polish poet, Słowacki, some "fateful force" can "transform ordinary bread eaters into angels".

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If we consider a possibility of a change in the person who has been affected by psychological catastrophes and whose fate has been determined by the dynamics of the paranoid system, we cannot expect her to become completely someone else, but we can hope that thanks to the analysis she will be able to face and challenge both her demons and angels and may get a chance for a better human existence.

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The analyst would be satisfied if he could hear from such a patient a statement similar to that written by Frances Tustin about her analysis with Bion,

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"It seems to me that over the years I have been enabled to bring together the "awful" satanic and the god-like aspects which I experienced (at the beginning of my analysis with) Dr Bion. … I know now that I am neither a saint nor a sinner, but an ordinary human being beset by all the pitfalls the human flesh is heir to, but which to the psychotic feel like insufferable catastrophes. " (Tustin, 1981, p.178)

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