Supervisions with Donald Meltzer

Citation preview

DONALD MELTZER

WITH ROSA CASTE LLLA,

CARLOS TABBIA AND LLUIS FARRE

KARNAC

SUPERVISIONS WITH

D O N A L D MELTZER

"Simsbury House", by Rosa Castella

SUPERVISIONS WITH

DONALD MELTZER

The Simsbury Seminars

Donald

Meltzer with

Rosa Castella, Carlos Jabb'ia, andUufs Farre

KARNAC LONDON

NEW YORK

First published in 2003 by H. Karnac (Books) Ltd, 118 Finchley Road, London NW3 5HT Copyright © 2003 Donald Meltzer, Rosa Castella, Carlos Tabbia, and Lluis Farre The rights of Donald Meltzer, Rosa Castella, Carlos Tabbia, and Lluis Farre to be identified as the authors of this work have been asserted in accordance with §§ 77 and 78 of the Copyright Design and Patents Act 1988. Translation by Crispina Sanders. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the publisher. British Library Cataloguing in Publication Data A C.I.P. for this book is available from the British Library ISBN: 9 7 8 - 1 - 8 5 5 7 5 - 9 5 3 - 4 10

9 8 7 6 5 4 3 2 1

Edited, designed, and produced by Communication Crafts www.kamacbooks.com

CONTENTS

CONTRIBUTORS PROLOGUE INTRODUCTION

PART I

1993-1996 1

Lucia (May 1993)

The Kafkaesque confinement of anorexia:

rebellion and sacrifice, violence and survival,

in the claustrum

Lluis

Farre

2 Dolores (May 1993) A doll's story: bidimensionality, adhesiveness, and submission in flight from the aesthetic conflict Rosa Castella

Vi

CONTENTS

3 Andres (February 1994) The rhetorico-critical vs. the admiring-lyrical perspective: egocentricity and negativism in hysteria Lluis Farre

4 Margarita (February 1994)

Egocentricity and attachment to infantile gratification:

irritability, competitiveness, and servility

Rosa Castella

5 Eduardo (February 1994)

On passivity generated by voyeurism

Carlos Tabbia

6 Eduardo (July 1994)

Living in anal grandiosity

Carlos Tabbia

7 Montse (July 1994) Incontinence and omnipotence in the world of the infant: coming out of the claustrum Rosa Castella

8 Francis 0uly 1994)

Arrogance and grandiosity in oedipal triumph

Lluis Farre

9 Eduardo (February 1995)

The construction of delusion

Carlos Tabbia

10 Carmela (February 1995) Social anxieties as an obstacle to intimate relationships: a Cinderella's story Rosa Castella

11 Eduardo Qune 1995) Grandiosity on the wane Carlos Tabbia

CONTENTS

12 Eva (June 1995) Bisexuality and oedipal triumph: obstacles to intimacy in the ceremonial family Rasa Castella 13 Roberto Qtme 1995) Chaos, guarantor of the clandestine: paranoia i n the world of the borderline psychotic Lluis

Farre

14 Agnes (April 1996) Latency lies, and lack of emotional contact: acting out against the establishing of the analytic situation Rosa Castella

15 Pilar (April 1996) Masturbatory addiction i n the manic-depressive organization: secrecy, manipulation, creation of confusion, and delinquency Lluis

Farre

16 Eduardo (April 1996) Reduction of perversion i n an "Oblomov" type Carlos Tabbia

PART I I

1997-1998 17 Claudia (February 1997) Latency, obsessive watchfulness, control, and emotional evacuation Rosa Castella

18 Abelardo (February 1997) Passivity, exhibitionism, and voyeurism: absence of interests and of object relations—impasse Lluis

Farre

Viii

CONTENTS

19 Eduardo (February 1997) Not so much a pervert, more a voyeur and a fantasist Carlos Tabbia

252

20 Lucas (May 1998) Seduction, grandiosity, and confabulation i n a malcontent: the story of an insatiable mouth Rosa Castella

264

21 Antonia (May 1998) Scientism vs. imagination, the mechanistic vs. emotionality: incapacity for symbol formation Lluis Farre

279

22 Eduardo (May 1998) A pleasant but disappointing liar Carlos Tabbm

294

Epilogue Good luck Donald Meltzer

ANALYTIC

INDEXES

315

325

CONTRIBUTORS

is a psychologist, a founder member of the Psychoanalytic Group of Barcelona, and a member of the Catalan Association of Psychoanalytical Psychotherapy, of the AEPP, and of the EFPP. She has worked in the Spanish National Health Service and is founder of the Clinical Psychology Service of the Fundacio Puigvert of Barcelona. She works in private practice. She counts among her publications Rosa Castella

being a co-author of Psychoanalytic Work with Children and Adults.

Llui s Farre is a doctor of psychology, a founder member of the Psycho-

analytic Group of Barcelona, and a member of the Catalan Association of Psychoanalytical Psychotherapy. He is a training analyst at the AEPP and at the EFPP. He is director of die Clinical Psychology Department at the Fundacio Puigvert of Barcelona—linked to the Spanish National Health Service. He also works in private practice. He is co-

author of Psicoterapia psicoanalztica focal y breve, Psicoterapia degrupo con ninos, and Psychoanalytic Work with Children and Adults.

Donald Meltzer was educated at Yale University and New York University College of Medicine. He trained in adult and child psychiatry at Washington University in St Louis and came to England in 1954 to ix

X

CONTRIBUTORS

complete his psychoanalytic training with Melanie Klein. He has worked i n close collaboration w i t h Wilfred Bion, Roger Money-Kyrle, and Esther Bick, and he taught at the Tavistock Clinic and at the British Psycho-Analytical Society where he was a Training Analyst. He also lectures extensively i n , among other countries, Italy, Spain, France, Norway, and Argentina, and he has his private practice i n Oxford. His books—The Psychoanalytical Extended Kleinian

Metapsychology, Development,

Process, Explorations

The Apprehension

Sexual

States

in Autism,

of Mind,

Studies

Dream

of Beauty, The Claustrum,

Life,

in The

and his

collected papers, Sincerity and Other Works—have been widely trans­ lated. Carlos Tabbia has a degree i n philosophy and psychology from A r ­ gentina and a doctorate i n psychology from the University of Barce­ lona. A founder member of the Psychoanalytic Group of Barcelona and a training psychotherapist for the AEPP and EFPP, he works i n private practice and i n the public health service (community assistance to psychotic patients). He is a contributor to Psychoanalytic Work with Children and Adults and co-editor of Adolescentes.

Translator

Crispina Sanders is a translator and interpreter, specializing i n psy­ choanalysis. She graduated i n English and French Language and Lit­ erature i n Salamanca where she also followed a Diploma course i n psychology. She has taught i n English and Spanish universities and has worked i n publishing. She had analysis w i t h Donald Meltzer and studied the Infant Observation Course at the Tavistock Clinic. She works regularly with the Psychoanalytic Group of Barcelona and is a visiting lecturer i n the Interpreting Course at die University of West­ minster. She is joint translator of the Spanish edition of The Claustrum.

PROLOGUE

T

his book, the fruit of 15 years of working together i n Barcelona and at Simsbury i n Oxford, is once again a tribute to the unusual friendship and cooperation between the group of psychoanalytic psychotherapists and Donald Meltzer and Catharine Mack Smith, a cooperation that has been so mutually productive i n an amazing way. The Introduction, which catches the mood of the meet­ ings, is self-explanatory: the key is affection, mutual and evocative. The translator of the English version, Crispina Sanders, was present at the Oxford meetings, and the Barcelona translator—equally excel­ lent—was Franchise Soetens. A t the end of the book are three separate indexes: central ideas, main subjects, and diagnoses. These indicate the scope of the discus­ sions, which cover the whole of the ideas of post-Kleinian psychoa­ nalysis starting w i t h Bion's ideas on groups, Freud's elaboration of his metapsychology, and the theory of confusions (geographic and zonal), through ideas about thinking, and finally the theory of projective iden­ tification (including the claustrum and the theory of aesthetics and aesthetic anxiety). These subjects arise in the course of the clinical work and form the matrix of clinical thought and technique. They show what a spell­ xi

Xii

PROLOGUE

binding method the study of the transference-countertransference is, w i t h careful attention to the ramifications of the oedipal complex at its various levels, particularly at the obscure part-object levels. The consequence is an experience of excitement and exhaustion. Donald Meltzer

INTRODUCTION

T

his book acknowledges a debt of gratitude. A t the end of a long dinner held in the autumn of 2001 by the Psychoanalytic Group of Barcelona to celebrate fifteen years of uninterrupted work w i t h Donald Meltzer and Catharine Mack Smith, each member of the group paid their personal tribute. For three of us that tribute took the form of a bound volume of our supervisions at Simsbury between 1993 and 1998. I t was a very emotive occasion, as Donald Meltzer told us that he intended to travel less and was therefore effectively saying goodbye to the group. He offered us—as always—his hospitality i n Oxford to continue working i n small groups. As he held our book in his hands, he said softly: "This has got to be published. . . A n d here we are, i n print. It was a moment of tessera hospitalis, the atmosphere of quintessen­ tial Latin hospitality, that has enveloped our clinical trail since the day, long ago, that it converged on Meltzer's. It is in that spirit that we offer this work i n progress, which readers may find familiar alongside their own. We see ourselves as elders, not only i n age but i n the tradition of a nostalgia for the fora where professionals, craftsmen, workers of all kinds meet to share tools, knowledge, skills, and—ultimately—igno­ rance, the wellspring of thought. Though susceptible by nature to those displacements where theoretical business is transacted, we still xiii

XJV

INTRODUCTION

pine for an inexpert youth when—perhaps less prone to misgivings— we sought to reduce our shortcomings, always opting for loyal friend­ ship offered w i t h a generosity no less rigorous than the affection that banishes feelings of humiliation and unworthiness and reinforces con­ fidence and trust. This book is meant to be as much a sharing w i t h others the generos­ ity of a learning experience as an invitation to that nostalgic place where the vicissitudes of our daily work can be talked about. We are, or we try to be, clinicians looking to find other clinicians w i t h whom to carry on the hospitality of dialogue. A n d because of that we present our experience "without frills", with only the grammatical corrections necessary in the transcription. Our aim in doing this is to be able to communicate what we well know to be difficult to communicate: the atmosphere that presided—and still does—over our clinical encoun­ ters, our supervisions, to use the old name. We trust that something of that atmosphere is conveyed i n the text. There has been quite a lot of talk in recent times about the atmos­ phere that should accompany or support the supervision process. This is not the right time to go into such a complex and thorny subject, but we can at least say a few words about our own experience, in retreat at Simsbury. To begin with, the approach to the house through the beautiful dense woods of Headington sets the mood. Near the entrance a bird­ table on a pole stands sentry, and then one finds the house, comfortable and welcoming, severely simple, and containing all that is necessary. Then just before you step in, between handshakes, hugs and kisses, and the sniffings of the dog, a different mood sets i n and the unique­ ness of the meeting begins to unfold imperceptibly as the work begins: the concentration of attention—around the fire in winter—and exqui­ site listening at all times of the year, sincerity beyond fear of embar­ rassment or threats of criticism, reflection, silence while new ideas start to emerge. The conversation flows between mugs of milky coffee and the smoke of tobacco still allowed, w i t h breaks to go to the kitchen and share what the host has prepared and the visitors brought along: Rioja goes well w i t h puddings, and so does potato omelette and ham and tomato bread. We carry on until—like in children's stories—time runs out. The anticipation of nostalgia makes us open our diaries and set dates for new journeys through the woods: the one outside is cold in winter, magnificent in the spring and the autumn; the one inside always amazing, disquieting, awesome. Then it is time to say goodbye

INTRODUCTION

XV

w i t h hands, arms, and lips; we walk down the path, and we leave behind the two nests—the one for the turtledoves that Donald put up one lazy day, and the one i n the house, that other nest that only he knows how he has managed to build, but build it he has, masterfully, so that all those of us who have been made welcome i n it feel capable today of moving i n other spaces w i t h more courage and a stronger sense of freedom, well stocked w i t h the fruits of an unusual generos­ ity, feeling grateful and respectful. We still go to Oxford and shall do as long as life permits, but the nest has moved to Alexandra Road. Simsbury w i l l remain in our memory. Rosa Castella Carlos Tabbia Lluts Farre

Barcelona

PART I

1993-1996

1

[MAY

1993]

Lucia The Kafkaesque confinement of anorexia: rebellion and sacrifice, violence and survival, in the claustrum Llufs Farre

T

\hi$ is a girl who worries me a lot Her name is Lucia, and she is 20 years old. It was her parents who brought her to analysis after a spell in hospital with a serious anorexic condition. The psychiatrist who saw her there recommended that she should have psychoanalytic psychotherapy as well as the hospital's programme of group therapy for anorexics. Lucia is of medium height; she has very long brown hair. She could be pretty if it were not for her rigid gait and her cross facial expression. When her parents suggest that I can see her alone, she insists that she has been brought to me against her will, that she does not want to eat and she will not eat, and that she does not want to get better because she will be forced to go back to the university course she was doing last year where she worked so intensely that it exhausted her. She just wants to sleep, stay in bed without moving or eating, and be left alone. She throws back at her parents their complaint that they suffer a lot on her account, while they do not seem to realize that she suffers when she eats. She accuses her father of not having paid attention to her until she became ill, and her sister of torturing her by saying that she is to blame for everything bad that happens at home. She adds that her sister has always criticized what she does, what she reads, what she studies, and that she belittles her. Lucia is scared of her. Before she buys or reads anything, she thinks txvice: "My sister said I would not be capable of doing Physics and that any other course was not worth doing. I did thefirst year, and in June I passed

3

4

SUPERVISIONS W I T H

DONALD

MELTZER

four of thefive subjects, which neither she nor my brother ever managed." Not eating has become an obsession. She confesses she has obsessions. When s feels passionate about something, she repeats it many times. She likes film she saw Dracula recently. She has seen it six times. She has bought seven o eight books on Dracula, as well as thefilm, the soundtrack, etc. "I do not wan to get better. If I do, I'll have to go back to studying? Her hard and determined tone when she speaks about not eating, abou her anger against her family and her suffering, makes me say to her that I a not interested in making her eat but that I can offer her my-interest in helpin her to understand what is happening, in the hope that it will decrease her suffering. She immediately agrees to continue exploratory[ consultations an possibly therapy. DONALD MELTZER: YOU have acted correctly. It is very good, because the only thing you have to do is stay away from laying down rules. You must not appear in her eyes as one of die people who force her to eat and study. In this way you will not be a friend to her, but at least you will be acceptable. That is always the essential analytic attitude; where your interest and intentions are exclusively focused on understanding, that is all. You draw away from any kind of action and take up an observing and thinking stance. It is important with these anorexic children to make it clear from the beginning that you are not concerned with whether they eat or not, or even whether they will live or die, because there is nothing you can do. You must show them clearly that you are impotent, that the matter is not in your hands. Carry on, please. Additional

information

Lucia has a sister who is 27 years old and a brother who is 25. She was born at full term, weighing in at 3.100 kg. Because of problems with her back, her mother was advised not to breast-feed. Due to a diabeti imbalance and in order that "the baby would not be fat like her eldest sister mother followed a very strict diet during the pregnancy. The baby milk tha Lucia was given was not what the paediatrician indicated, and it caused problems. Added to this were Lucia's own feeding problems: she would take three orfour short sips and then spit. Her bottles had to be warmed up agai five or six times for each feed. These problems persisted when she was put on solids. To her parents' surprise, she started walking suddenly at the age of 9 months. She quite simply stood up and walked. She was toilet trained very soon, but after the family moved from Granada to Valencia she started wet

MAY

1993

LUCIA

5

ting her bed. This continued until she was 18 years old, and from the age of 14 she was prescribed Tofranil When she was taken to the park, she would run away the moment the adults took their eyes off her; on two occasions she was almost run over. At home she would climb onto the table and, if somebody was watching her, would throw herself off it whether they could catch her or not She never allowed anyone to take her by the hand, and she was not fond of being kissed or stroked.

D.M.: She would throw herself off the table whether they were watch­ ing her or not? Lmis : If she was on top of the table and nobody was looking at her she wouldn't do anything, but when they looked at her she would throw herself off whether they were near enough to catch her or not. D.M.: One assumes they managed to catch her. . . . This is a hard tale of provocation addressed to the others to save her life. A n d i t goes far back i n time. Mrs Klein used to say that many childhood accidents are no more than suicide attempts carried out with inappropriate means. One gets the impression of a girl who arrived i n the world protest­ ing; her tendency to escape and having to catch her seem to be the dominant themes i n her life from the very beginning. One could ask oneself, where is she running to? Or what is she escaping from? Maybe both of these questions are pertinent. She is running towards an excit­ ing place or object relation, and she is fleeing her persecutors, her jailers, e t c . . . . I n general, to my mind, this looks like a claustrophobic phenomenon; she experiences herself as a prisoner, as somebody who is tormented, who w i l l eventually be the victim in a sacrifice, w i l l be killed, etc. A n d i n keeping w i t h this, her sister is the high priestess i n the high temple of this satanic religion. Why she wanted to study Physics is something we do not know, but it seems to be a part of the tools of that system of torture she has been subjected to: she has to study something. LI: I want to point out that she is studying Physics because her father is a physicist and both her elder sister and her brother have studied or are studying it. Also, her sister often says to her: 'The only degree worth studying is Physics—everything else is rubbish/' D.M.: She is the high priestess i n the temple of Physics. I imagine the father is a successful physicist, isn't he? LI: I am not sure. D.M.: Is i t a wealthy family? LI: I would say they are upper-middle-class. [The general comment in

6

SUPERVISIONS W I T H

DONALD

MELTZER

the group is that they must be well off to be able to afford that kind of education for all three children.] At the age of 1 year she used to sleep in her grandmother's room but would cry out in terror, until they realized that she was staring at the holy cross. When they removed it from above the bed, she was able to sleep. D.M.: One can see evidence of this satanic religion at the age of 1, and of what for her was the symbol of that satanic religion. Ps: We were talking about this case at the airport when we were coming here. We thought you should have a holy cross ready to bring out i n front of this patient [laughter]. 1

DM.:

To protect himself?

Ps: To exorcize her. L I : Maybe both. D.M.: I do not think this is going to be an easy case. Carry on, please. Her parents describe Lucia as being extremely intelligent hard working, and sensitive. "But she prefers to do people favours and look after them to being looked after herself." She idealizes relationships, and if people disappoint her she will detest them forever. She was never a great eater, but when she started her university course the anorexia set in. She already had "quirky ideas" such as, when she was given a pair of binoculars as a present, thinking that maybe just as she saw people with them they could see her. She started having windows and blinds closed because she said people might be able to see her from a helicopter. Her mother says that Lucia hates having her periods and that she is happy to be anorexic because that way she avoids them. "She never liked children; from a very young age she used to say that she was enough." She often has nightmares. Nobody has ever heard—not even in horror films—screams as scary as Lucia makes in her dreams. "They could give you a heart attack", her mother says. D.M.: She is the youngest of the siblings. Her brother is the middle one, and her sister, the high priestess, is the eldest. How many years older than her? LI: Seven. D.M.: There are some aspects that do not fit in w i t h the general picture of this girl; they are the ones that refer to her preferring to do favours and look after people rather than be looked after. I think that by that " P s " refers to any of the psychotherapists from Barcelona taking part in the group supervisions. 1

LUCIA

MAY 1993

7

she is referring to her attitude towards her fellow sufferers in the world she lives in, towards anybody who can be felt by her to be one of the prison inmates. She can be very gracious and kind towards them, but first they have to prove that they really are fellow sufferers. From that position one can reach the extreme one of killing people so as to alleviate their suffering. I don't know if you might have heard about the case of the nurse who worked in a children's hospital here in England and killed some of them. The matter of the binoculars and of being seen seems to be a part of the claustrophobic anxiety, of being spied on Is this the first session? Have you only just started to see her? LI: No, this is the third session, and I have brought the fourth one too. I have been seeing her since April. I want to point out that she has lost weight—though not a lot—since I started seeing her and there have been self-inflicted injuries. Yesterday, in the after­ noon—the last time I saw her (I see her twice a week, which is what we agreed on at the beginning, with the possibility of making it more often if we thought it necessary)—her arms and hands were covered in cuts she had given herself with her father's razor. She had scratched herself all over. They were superfi­ cial wounds, as the blade was the modern sort, not a knife. She looked like Christ on the cross. With that blade she would not have been able to cut her veins, but she was able to seriously damage her skin. f

D.M.: When did you start working with her? LI: On the 8th of April.

D.M.: At what time of the day do you see her?

LI: On Mondays at 9.00 o'clock in the morning and on Thursdays at

3.30.

D.M.: So this is the third session. Does she sit up or lie on the couch?

LI: She lies on the couch.

D.M.: She accepted that easily

LI: Yes. Her mother said: "She won't talk because she does not talk to

the psychiatrist." But with me she has no problems; she talks non-stop.

Session of Monday,

19 April 1993

PATIENT: I went to Valencia at the weekend. Myfriends called me but I don't want to go out with anybody in Valencia.

DM.: She has friends! That's a surprise! LI: She had... .

8

SUPERVISIONS WITH D O N A L D MELTZER

Before I was ill they never took any notice of me, now they do. 1 don't want to see them.

D.M.: This is what she says about her parents, that they did not take notice of her until she became ill. Ps: Why are you surprised that she has got friends? D.M.: She does not seem very sociable. . . . Perhaps they are not friends, but school acquaintances, colleagues,,.. LI: Yes, that is what it is.

My mother says that I have to go out, to see them. I say that I don't want to; I don't have good memories from Valencia. All my friends from there left me in the lurch. I don't want to go back. I didn't like the school either; I was dying to come to Barcelona to study. When I got here it was even worse, but I prefer to stay here without studying rather than going back there. I have no wish to remember anything about school.

D.M.: Does the family still live in Valencia? LI: Some of the time; and some of the time they live in Barcelona. They have a house in Valencia. D.M.: How far is it from Barcelona? LI: About 300 km. They spend weekends there.

There, there were people who laughed at me. Here, they leave me alone; I know fewer people, and those I know do not insist if I say I don't feel like going out. I have a good friend here in Barcelona. My other friend is from Valencia, and she goes there at weekends; I get on well with her.

D.M.: Who goes to Valencia, she or her friend? LI: She does.

I get nervous when my friends from Valencia call One of them told me once that she was afraid of me. I couldn't understand it. I had not done anything to her. And another thing: they gossip about one another. I am sure they gossip about me too. ... I don't like their company. If I go to Valencia I feel that I have to go out, so I make excuses, invent false commitments, etc. .., just so as not to go out with them. And also, we haven't got anything in common any more—more than two years have gone by, we have different relationships, Ifeel out of place, I do no want to go there. I spent the entire weekend trying to sleep and to read; finally I managed to get a book and sit down to read. I have had a bad time of it because I am more and more caught up in the subject of food. They watch me; they are

MAY 1993

LUCIA

9

always on top of me. My father says that if I start group therapy they won't keep tabs on me about food any more: But he is lying; he will continue to watch me. If I start going and see that I am putting on weight, 1 shall stop. I am not interested in going there and talking about whether I am a little bit thinner or fatter. It is stupid. And I dislike the doctors there because they put a tube in my stomach when I arrived there, at the beginning.. .. M y parents are going to go on and on at me about food. I tell them thai I am not going to eat; that when they stop watching me I shall stop eating: a year can go by, more perhaps, but I shall not eat, however much group therapy or other nonsense I do.

D.M.: This is very interesting; she talks as if she were not aware of the need to eat. It is characteristic of these anorexic girls that they are unaware of having a physiology and a body that needs food. Every­ thing revolves around the battle of wills between her and the people who want to force her to eat; this battle becomes a show-down of personalities, and it could go on indefinitely. It wouldn't be until they felt physically incapable of moving, too weak, that they would begin to realize that they have a body that needs to be fed. It is extraordinary. Ps: Do they ever realize it? Because I have a patient who is very weak but is still sticking to her guns. D.M.: I think i t is part of the claustrophobic situation that some con­ cepts have a measure of validity i n i t that is quite different from the same thing i n the external world. For example, death is something that happens when you get killed—i.e. it is not a physiological event. In the claustrophobic world, death is only the result of someone else's ac­ tions. Either you kill or you get killed; but the concept of dying does not exist. It's the same with food. Food is not something you need; it is a pleasure—i.e. something you like or don't like. Anorexics don't like it because It produces fat and fat is disgusting. They see food as being always related to fat and faeces. Faeces and fat are disgusting, and food has no other function. Another characteristic of this claustrophobic situation is that as a victim who does not want to belong to the group that is carrying out the cruel acts, the only possibilities open to you are submission or rebellion, or being seen to be submitting, which in fact is rebellion. The option of freedom does not exist; you have to be a victim because otherwise you would be an executioner. There is no other choice. Every decision has the meaning of either submitting, or rebelling, or

10

SUPERVISIONS WITH DONALD

MELTZER

showing that you are submitting. If you do not join the establishment to become one of the torturers, then you stay in the place of the victim, and then the only thing worthwhile is survival. Survival has nothing to do w i t h living; it is to do w i t h winning, beating, managing to avoid being crushed. Most of the anorexics that one sees in analysis are not borderline psycho tics. They are youngsters with a part of their personality inside the claustrum and a sane part outside, trying to manage somehow i n spite of the habits, attitudes, and conduct of the part that lives in the claustrophobic world. This part of the sane personality that lives out­ side tries to make a pact with the anorexic phenomenon so that i t won't destroy relationships, activities, interests. A n d so the way it deals w i t h the phenomenon is by pretending that not eating, being extremely thin, does not have a basis in illness, but that it is something one does for cosmetic reasons, that it is a matter of aesthetics, of beauty, that one does it to look more beautiful. It is true that the part that is living in the claustrum is very perse­ cuted, but this is not a paranoid dimension, since it is being persecuted in a real social sense. And this is because she experiences herself as living in a totalitarian and persecutory incarceration, like in a concen­ tration camp. In the case of this girl, where there seems to be a part of her that is capable of living outside the claustrophobic world, available for life i n the external world, that part comes across as i n a paranoid relationship w i t h her sister. The part that lives in the claustrophobic world sees the part that lives outside, which is psychotic, as the cause of the triumph of her sister over her. It is because of that psychotic part that her sister has triumphed over her. This is how the part that lives i n the claustro­ phobic world sees things. And that claustrophobic part that feels beaten is too proud to admit that it is totally conquered by the illness, a prisoner of it. It adopts a rebellious attitude and acts as if i t did not matter to her, as if in fact she did not want to have friends or be w i t h them, did not want to go out, preferred to be lying i n bed, doing nothing. But all of this is nothing more than not wanting to admit that she is i n the grip of her illness. What we have been listening to in the session contains those two aspects: the rebellious attitude that says, " i t is not true that I mind not having all this", and the psychotic confession that she is defeated. Is she on medication at the moment?

LI: Yes.

MAY

1993



LUCIA

11

D.M.: Why does she take it? LI: Because her parents force her to. Ps: It is Tofranil, an antidepressant. D.M.: Okay.

Something has just happened: my father has seen that one can study cinema here. But now I am not interested any more, I am already 20,I have lost two years, wasted my time. I can't do anything now, Ifeel too old to do anything. D.M.: Her anorexia began two years ago, did it not? LI: Yes. D.M,: Those are the two years she has "lost". That attitude towards time is very characteristic of claustrophobia: time is considered as a slice of life that has been taken away from them, that they have lost, they have not got it. . . . A n d as a result they feel they are "out of the race", at a disadvantage vis-a-vis their colleagues, and everybody who is 20 is two years ahead of them and it is impossible to catch up w i t h them. A n d they live in some kind of competition with those col­ leagues, because they have got "less".

And I plan to stop eating, sooner or later. If my parents were to let me, at least I might get better or I might not, but I can't carry on like this. THERAPIST: What do you mean? P: I think that if I stop eating again and I am seen by a different doctor from the one in the clinic ... J have proved already that I can't eat anywhere else, that I only eat because they force me too. All they manage to achieve is that I hate them more and more. Maybe I am unfair in hating my parents more and more. I tell them so. The only time I shut up and said I was sorry was when I saw my father crying. D.M.: That got to her; it touched some chord. . . . I t is difficult to understand what she is talking about now. Carry on, please.

But now Ifeel old to start anything. Two years have gone by since the year of the pre-university course. How old will I be when I finish if I start something now? I can't stand being at home one minute longer. D.M.: She w i l l always be two years behind somebody. After whom? Behind whom? Who are those people who are two years ahead of her? She does not know, but she does know that she'll feel at a disadvan­ tage of two years because this is a race. Ps: She has two siblings, and she is some years younger.

12

S U P E R V I S I O N S WIT H D O N A L D MELTZER

D.M.: It is possible, but the really important subject here is the way she visualizes it: in a linear way; as a race where one of the horses or the riders has fallen down and two runners have gone past, so however hard he tries he is not going to catch up. This challenge contains the concept of victory. If you challenge your persecutors and leave them behind, you are a winner. This is the claustrophobic attitude—not so much the psychotic attitude but, rather, the usual adolescent competitive stance. It is the wish of the non-psychotic part to win, to be the winner, the most beautiful one, the cleverest, the one with the most talent; it is the wish to get all the prizes, etc. The feeling of this part is that the psychotic part has lost two years vis-a-vis the others and that it is its fault that she is defeated now, subjected, overcome by that psychotic part, and bound to remain imprisoned in the illness. It seems to me that the structure of the personality as it is revealed to you presents you with the following kind of strategic problem: to what part of the personality are you going to pay attention fundamentally? What is going to be the strategy? With most of the anorexics who haven't completely collapsed, who are not totally defeated by the illness by the time they arrive, the right way to proceed is to ally oneself with the part that lives outside in order to strengthen it and help it to understand the nature of the illness that the claustrophobic part, the one that lives inside, is suffering. In other words, you try to describe the ill part of the personality in a way that favours the splitting process, so as to establish a greater distance between the two parts, and in that way you allow the part that lives outside to form an alliance with you against the illness. By now, in the case of this girl, it seems that the external part that you could use as an ally is so debilitated as to be totally defeated, overrun by the claustrophobic dimension, which is clearly borderline psychotic. This non-psychotic part which is so weak cannot ally itself with you at all, and so the person who is talking to you, the voice you hear, is not coming from that part, but from the other one, the claustrophobic, psychotic one. What you are hearing is simply the expression of her rebellion against her persecutors; she is still defying them. Although we are saying that she is in a psychotic state and suffering from it, the psychotic part is not in pain because of the claustrophobia, but enjoying it—enjoying the battle for survival. From this rebellion against her persecutors she draws the pleasure of violence, rebellion, and challenge to the world. There is a great deal of swagger in her attitude. We cannot arrive at the conclusion, from everything that she

MAY

1993

LUCIA

13

says, that she is really suffering. She is i n battle, fighting, relishing the pleasure of the warrior i n combat. I think that the only way you are going to be able to relate to her, to get near enough to have a conversation, is going to be i n a ^sociologi­ cal^ way. I mean as if you were an interviewer interested from a sociological point of view i n approaching a young officer of the Croat militia w i t h the objective of knowing why he is fighting against the Muslims, trying to understand the motives of the battle—since nobody understands what the fight is about—so that both you and she can understand what the fight is about, who is fighting whom and why. It is a journalistic kind of approach, where you want to get to understand what is going on i n the front line. You'll be a journalist who starts from the basis that he has no answers and wants the maximum information about motives, reasons, and what the person he is interviewing thinks. Instead of assuming that you understand why, for example, she stopped talking to her parents, protesting or whatever when she saw her father crying, instead of assuming that probably seeing her father crying would cause her pain, you have to carry on asking questions as if you did not understand what is going on. Because what you want to know is what strategy she is using. For example, a general in the Serbian militia might not want to commit certain kinds of atrocities, certain crimes that w i l l be considered horrendous when they become public through the media, newspapers, television, radio, etc. Seen from the propaganda point of view, that kind of crime can cause strong rejection on the part of the international community. Maybe she thought she had gone too far, that making her father cry would mean that the rest of the family would join up against her. So do not assume that she stopped because it made her sad to see her father crying. It is like the general who says: "No more raping or we'll be on TV getting a bad press." Carry on, please. I get hysterical and go to sleep. On Friday I spent the entire day over in my head about not eating and leaving home.

turning

D.M.: Here you could, for example, ask her something like: "What do you really think about not eating? Describe what not eating really is/' You can express your puzzlement by saying to her that you under­ stand when somebody says to you, " I thought about eating"—to eat you understand, it is an action—but you don't understand what " I thought about not eating" consists of. It is a negative statement, thafs true. . . . She is going to hate you. Ps: That is going to shake her up.

14

S U P E R V I S I O N S

W I T H

D O N A L D

MELTZE R

J told my mother. She said they did not want me to leave, but that if I left I was not to come back when I got ill I could just die and leave them in peace. My father didn't use to speak to me; now, since I got ill, he does. He would speak to my brother and sister, but not to me—that's why I began to dislike him. He always blamed me. I remember once, when I was younger, my sister and I were playing with a record, it broke, and he blamed me. My sister always does that—she annoys my brother and me and then we get the punishment. My brother has got away, he fails subjects and nobody says anything. There was a time when he was play­ ing truant, going out with friends, and so forth. He made excuses; he said that he couldn't study because I played music very loud. So I ended up getting blamed. D . M . : There y o u have i t : her sister is the h i g h priestess of the satanic rite, the secret persecutor. The parents are v i e w e d as a little b i t s t u p i d , indifferent, insensitive. H e r brother is the delinquent one w h o is o u t of i t all; he has got free f r o m becoming an interesting object to torture because he is so indifferent to her; she has so little effect o n h i m that a torturer has no pleasure i n t o r t u r i n g h i m . I t makes n o sense. But she, she is n o t indifferent to torture; she wants to fight, to rise against the torturers. The other thing is w h e n she says: " I always get i t , I e n d u p being b l a m e d , etc.", w h i c h implies punishment, censure. . . . I w o u l d inter­ r u p t a n d say: " I d o n ' t quite understand, w h a t does it matter i f y o u get punished? W h y does p u n i s h m e n t matter to you? W h a t is i t that y o u m i n d about being punished?" Because i f she can see that her brother is i m m u n e to punishment, that i t has no effect o n h i m , w h y does she w o r r y about it? W h y isn't she indifferent to punishment? It is n o t at all clear, a n d y o u c o u l d make i t clear t h r o u g h y o u r questions. I n this k i n d of political fight i n the claustrum, w i n n i n g is equiva­ lent to b e i n g right, a n d losing to being w r o n g . A n d so any subject w h e r e w h a t matters is b e i n g r i g h t or being w r o n g becomes fascinat­ i n g . She lives that fascination intensely and has got trapped i n that k i n d of fight. This type of person is irresistibly d r a w n t o w a r d s the w o r l d of politics, the L a w , litigation, etc. I t is Kafka's w o r l d , the w o r l d of The Trial a n d The Castle, w h e r e judges decide w h a t is r i g h t a n d w h a t is w r o n g , just a n d unjust, even i f their decisions can be considered totally arbitrary. These k i n d s of people have a fantastic ability i n the use of language to argue a n d w i n , even w h e n they use i t incorrectly to their o w n advantage. That is w h y , w h e n y o u ask t h e m to clarify things that

MAY

1993

15

LUCIA

you don't quite understand, they can't resist the temptation to explain everything. In the process of doing so, which matters so much to them, they get into a terrible muddle with language, knotted up. So when they are in a muddle and don't know how to get out, you stop them by saying: " I don't understand—what has happened?" I n this way, you make them conscious of the claustrophobic anxiety and you narrow the impression that you are i n battle with them, against them. You make them see the muddles, the knots, that they are trapped in, and that it is not a question of you challenging them, but of asking them to explain things to you so that you can understand. A n d w h e n they get trapped i n their own knots and cannot find an explanation, you can point out: "Indeed, I can imagine, it is very difficult to explain, isn't it?" That's all. Carry on, please. Last year, when my grandmother

died, my uncle, who has Down's

syn­

drome, came to live with us. I was already not eating. When the rest of the family came home, they said hello to him but not to me. So I locked myself in my room . ..

D.M.: I w o u l d stop her there and say: " I don't understand—why did you want them to say hello to you? Why does it matter?" Ps: She is going to slap you! ...

and if they opened the door and said hello, I did not want them to.

D.M.: A n d you would say: "So, there was a reason w h y you wanted them to say hello." Y o u need to read Plato again to see how Socrates dealt with this kind of thing. LI: I don't know if it has anything to do with this case, some intuition perhaps, but I have been reading Plato in the last few weeks. Ps: M a i e u t i c s . . . . And

I fell upon my books, obsessed, studying,

were saying that I was studying

nothing else. My

too hard; I was too intelligent,

friends

etc. I said

that I was not intelligent, just hard working. For any subject whatever, would study everything

I

they could ask me questions on, the difficult bits

and the easy ones. I did not sleep in exam time. I was getting up at dawn to study.

D.M.: Again, instead of assuming that you understand, you could stop her and say: " I a m sorry, I don't understand—why were you making such efforts? Are they people you admire greatly, and are you trying to please them? Are they objects of devotion on your part? Why are you taking such pains?"

SUPERVISIONS W I T H DONALD MELTZER

16

J could see I was exhausted with so much studying. June, Drawing,

I failed one subject in

and since it would have been difficult to pass it in Septem-

ber I relaxed during

the summer.

whole day at the faculty,

But when I started year 2,1 spent the

without eating. I would go at 7 o'clock in the

morning

and go back home at 9 in the evening. I became exhausted

couldn't

study any more. I began to go to psychiatrists

The psychiatrist my decision.

and

and

psychologists.

told my parents not to bother me about eating, that it was

So I did not eat, I stopped studying,

I watched TV. I had a

good excuse because I wasn't feeling well I used to stay at the faculty so as not to have to go home. I became obsessed with my books.

D . M . : W e can see here the o r d i n a r y situation i n anorexia—the alterna­ t i o n between anorexia and b u l i m i a . Here the d i v i s i o n is between f o o d and s t u d y i n g . She needs to see that there is b u l i m i a here, w i t h refer­ ence t o s t u d y i n g . She is stuffing herself w i t h books, w i t h i n f o r m a t i o n . She stuffs herself f u l l of information-food, w h i c h , i n itself, is of n o interest to her. What matters is to be f u l l of i n f o r m a t i o n . Y o u c o u l d investigate here i f w h i l e stuffing herself w i t h books there w a s some­ t h i n g equivalent to t h r o w i n g u p . Carry on, please. In years 6 and 7 ofEGB not so drastically didn't

[GCSE

equivalent]

that I had to retake them in September,

mind a bit. But when I finished,

[Vocational

Training]

level equivalent].

sometimes

I failed

subjects,

but I failed and

my sister said I should go into FP

because I wouldn't

be able to cope with BUP

[A-

I said "Oh yes?" and studied hard until about the end of

last year. My parents also said that I should not take that course, that I wouldn't

be able to do it. My mother said that it was not that I wasn't

clever enough, but that it didn't go with my character. Maybe she is right But

I have proved to them that I can get better marks and pass

subjects

more

per year than my brother and my sister.

DM..: Y o u could stop her here a n d say: " N o w I understand. I n fact y o u have done all this o u t of rebellion, to show t h e m that they are w r o n g , that y o u can study, learn, and pass exams. Y o u derived a l l the pleasure f r o m being right, a n d p r o v i n g them w r o n g . The result is that w h e n y o u failed y o u r exams, y o u d i d n ' t live that as upsetting y o u r s t u d y plans b u t , rather, as a h u m i l i a t i o n . " I n the social structure of the claustrum, w i t h its layers of states and positions, claustrophobic anxieties manifest themselves p r i m o r d i a l l y as h u m i l i a t i o n a n d the constant danger of i t . O n l y later, w h e n they begin to understand the nature of the claustrophobic situation, d o they perceive that they are trapped b y the constant threat of being h u m i l i ­ ated. They have to get to understand eventually that they are trapped

MAY

1993

LUCIA

17

in a game that they cannot w i n except if they join the establishment, the system. To be able to w i n at that game she w i l l have to be like that kind of person, like her sister. The day I went into the clinic my mother said that I should not carry on with my course, that I had already proved what I was capable of. But what would I do then? I didn't know. Since I was little I had not had any other option in mind. My sister and my brother were going to be physicists, and so would I.

D.M.: The point is not that her sister and her brother were going to be physicists, but that any other option was discarded. Anything she might choose outside that would be ticked off as "stupid, silly" Unlike her brother, who has left, who has other alternatives, differ­ ent interest, such as going out w i t h friends, having a good time, she— w i t h no interests other than constant competition, permanent battle, w i t h her sister—is trapped i n the fight. Her only option is therefore to stuff herself w i t h books, fill herself up with information. From this viewpoint, gradually she can be led to see how she is trapped i n the snare of humiliation because she has no interests outside her perma­ nent rebellion against her sister. Another question is that as you listen to her, and ask questions, and gradually assemble for her the concept of the kind of w o r l d she lives in, she w i l l begin to feel the claustrophobic anxieties, and the idea of getting out of the claustrum w i l l emerge. She w i l l see i t but w i l l ask you: "How? I don't know how." And now it is like having wasted my time and not being able to do anything. ... Also, when I was going to the neurologist I was never on my own; my mother had to be there with me. He asked her to leave one day, but by then I had stopped eating. When I said to the neurologist that I couldn't bear being in my parents' house, he said that everybody who is studying has to bear it. How long would I have to bear it? Five years? But I am also scared of living without my parents. I think about getting a job, but I don't know how to go about it.

D.M.: This is like saying: " I don't know how to get out of this claus­ trum of the family, the home. I don't know how to be independent." My parents have always done everything for me. I was even embarrassed about going shopping. My mother would say, "Don't worry; Til do it for you." Even now I find it hard—J think I am going to look stupid.

D.M.: That is the worst anxiety: looking stupid. She cannot live out­ side, because she does not feel ready to manage i n the world; and she

18

S U P E R V I S I O N S WITH D O N A L D MELTZER

cannot leave, because she is afraid of looking stupid, she is afraid of the humiliation of it. At this point it is important to make the patient see that the world you live i n is a totally different world, with other values than being right and other dangers than being humiliated. You have to make it very clear that you do not live in this claustrophobic world that she lives i n . Carry on, please. J ask Lucia

to explain to me how is it that she has always functioned

delegating (to her mother), by following

others (doing what her siblings

by do),

or by setting challenges for herself ("they are going to see what I am capable of'),

but that she never has been able to think about what she herself wants to

do.

D.M.: A clearer way of explaining all this and telling her would be to point to her that the concept of doing what one wants doesn't exist for her, that there is no room i n her head for people doing what they want: following their heart's desire. Although it is not quite true that she has not seen it done: she has the example of her brother—not admirable most probably: going out, getting drunk—but she has seen it in him. He does what the hell he wants without a care for what anybody might think. Up to a point, her psychotic part also does that, but i n a debili­ tated, negative way. The only thing she does in the way of doing what she wants is not do anything—not eat, not study, not watch television, not go out, n o t . . . Carry on, please. T: Perhaps you didn't even know, you didn't know what food you

really

wanted. You only know that you don't want any of the things that you are now, but you don't know what you want to be. And you feel hopeless; you fear you might not have time, in spite of being only 20,

to find out how you

want to live. P: Deep down I do not want to have hopes, don't want to get cured. I could now study anything I wanted, but I don't want to. It is as if it were too late, as if I had already taken a decision.

D.M.: This is what happens when you talk to this non-psychotic part of the personality. She answers you that a collapse has taken place: " I am down; the part that you are talking to has been run over." It is better to talk directly to the claustrophobic part of the personality and tell i t that it is not aware that the world outside is different. Later on, the possibility of transference can be explored, stressing at that point that for her it is difficult to have an idea that, for example, you are doing what you want to do, that you don't do this work because you

MAY

1993

LUCIA



19

are t o l d to or are forced to d o i t , b u t because y o u w a n t to d o it, a n d that i f there comes a time w h e n y o u d o n ' t like i t y o u shall stop d o i n g i t . Continue, please. When I see the girl who was admitted to hospital with me—she is not there now, although she doesn't eat—I feel bad because I am not doing what I said 1 would: not eat. I feel awful She was notforced to sign a court order—as I had to do, saying that if I don't eat, my parents can throw me out And they'll do it It is easy for them to think of how much they suffer, but not of how much I suffer. I could fall down dead in the street. I only ask for a room, a place to be. DM.: A f t e r that brief expression of complaint f r o m the non-psychotic p a r t of the personality, w h i c h has collapsed to such a p o i n t i t barely exists, she comes back to the claustrophobic part, as i f the battle had been lost a n d she h a d succumbed to the threat. She is saying to y o u : " I lost, I lost the batde, I was forced to eat. H o w h u m i u a t i n g ! I failed, I was beaten/ A n d again at that p o i n t y o u c o u l d have interrupted her w i t h : " W h y d i d y o u n o t let t h e m t h r o w y o u o u t of the house so y o u c o u l d see w h a t life is l i k e o u t of the f a m i l y prison? W h y d i d n ' t y o u dare?" 7

L I : I d i d n ' t d o that D . M . : I t is i m p o r t a n t for her to see that there is a w a y o u t , b u t she is frightened, she does n o t have the courage. She k n o w s , has come to see b y n o w , that she is trapped i n a battle she cannot w i n . T o a certain degree a n d i n some w a y , her parents d o n ' t care any m o r e whether she lives or dies. C a r r y o n , please. J say to her that at the moment she doesn't feel loved, only a nuisance, and that her parents have love onlyfor themselves, selfish love, they love their own pain, and they are not interested in providing for her a room where she can put her suffering, where she can be understood, so that the things that cause her pain can be understood. DM.: A g a i n I w o u l d have said to her that i n her state of m i n d she n a t u r a l l y experiences her parents as people w h o do n o t care i f she dies—on the other h a n d , y o u d o n ' t k n o w whether they are like that or not. Consequently, she cannot w i n that battle any more. C a r r y o n , please. P: That's what I see, that they don't love me. When my father said here, the first day we came, that the doctor at the clinic had said to him that because of me they could lose their two other children, I felt very bad. Or like this year: it's their 30th wedding anniversary, and they say they are not going

20

SUPERVISIONS W I T H

DONALD

MELTZER

on a trip because of me. They can do what they like. They can't watch me all the time, and I am never going to give up. I don't mind what price I pay. I am scared of dying, but also of living and suffering as I do, as I suffer during the hour before I eat and the hour afterwards . ..

D.M.: She is becoming unsure about whether her final triumph over her parents—her dying—would be a real triumph. She is beginning to have doubts about whether her parents care one way or another. Then there would be no triumph. Carry on, please. ... knowing that they are listening behind the closed door in case I throw up ... all it does is make me try harder and harder, even if I damage my throat. I tell them that I shall try to throw up. Last Thursday after I left here I was at home; they hadn't left me a key, so I couldn't go out I was desperate, thinking what I would do to avoid eating, to throw up. I took some bottles of pills, I had a good look, I took some water, but I was scared that they wouldn't find me in time and dying frightens me. I say to my mother that I think about suicide, and she replies that lama coward. I tell them that it is me who is choosing to die, that it is not their fault, it is not my mother's fault, if I eat or don't eat, if I rest or don't rest, it is my fault ... There are hundreds of ways of telling lies, and I don't for a moment want to blame my parents for everything that's happening. I know they love me, but they have taken this on as a crusade. When they came to visit me they said that they wanted me to carry on with my studies; 1 had to ask them to leave. I highlight the struggle inside her between living and dying, the struggle between coming here for treatment, and going out and thinking about dying. And that when she leaves I have no power to stop whatever she might end up doing.

D.M.: This is the language of interpretation. Instead, I would have used the language of journalism: "Ah, very interesting. It seems you have discovered that you can't win the battle you are involved in. You can't win, for several reasons: firstly, you can't leave the field until you win, but you can't win because the definitive attempt would be death so as to make your parents feel the consequences of your efforts to die. However, it would seem that, right now, you have no evidence that it would be so, since they don't seem to care what you do; then, there is no victory." You are going to have months and months of this muddle, and if you don't have a strategy, some tactics, she is going to exhaust you. LI: I see

MAY 1993

LUCIA

21

Ps: As the session progresses I think she begins to show more feeling. She says at one point "I am afraid of dying"—there is a kind of development; she does say, "I am afraid of dying". D.M.: Why does that move you? She doesn't have to die. Why do you find it moving? Nobody is cutting her arms, poisoning her, not giving her food.... Why does she move you? It must be that you believe her. Ps: Yes, it is true she cuts herself with blades, and it is possible that she'll get hurt in this battle; but, on the other hand, she says that she is frightened of dying, and Ifindthat her saving grace. I don't know; it's just my feeling about it. D.M.: You are assuming that dying has the same meaning for her as it does for you, but you don't know what it really does mean for her. If you ask her, and she does give you an answer, it will be: " My sister will be delighted, will go mad with joy." And that has nothing to do with dying. LI: I agree. I feel that she might die, but when she talks about it I don't feel emotion in what she says. I don't see her frightened, or sad, or anxious . . . it doesn't move me. It worries me, but it doesn't move me. D.M.: People who have experience in this fieldfind,in fact, that there is no countertransference with these patients because there is no transference, no feeling, no emotionality. In a general sense they feel sorry, just as everybody feels sorry about people who are ill. But, professionally speaking, they are not moved; there is no countertransference. People of this kind use the therapist like they use anybody who is going to listen to them: just to be listened to, nothing else, without any feelings. And so when she speaks about her father and mother, she is not giving the word "parents" the sense that you give to the word; she is talking about judges. What she is saying to you when she talks about parents is this: "I am right, my sister is not." When she says that her mother offers to buy things for her or do anything because she herself is incapable of doing it, what she is doing is accusing her mother of weakening her, of fettering her growth. It is important also to point out to her that you have noticed that there is a part of her personality that does not live in the claustrophobic world, but that it is such a debilitated part that you cannot use it in the therapy, you cannot rely on it to establish a relationship. That part is fed up and tired of all these eating and not-eating stories, of the stuffing herself with studies... this part lacks vitality; it is not going to be of any use to you. Nor is it going to be of use to her at the moment. Carry on, please

22

SUPERVISIONS W I T H

DONALD

MELTZER

... like last Thursday, when she thought about suicide. But she is also scared of the possibility of remaining locked up in that world of hers of death and not eating and people arriving late to rescue her. In any case, I shall expect her on Thursday, and if she comes we'll be able to carry on looking at what is happening to her and help the person who is afraid of dying. [End of session] D.M.: This is the time to say: "Yes, you are trapped, this is where you are and you are not going to get out. I am w i t h you only during the time of the session. N o w I am going. You remain trapped i n the claustrophobic world. I shall come back on Thursday, but I don't live here, I don't live i n that w o r l d . . . . " It is better to say this than to put yourself forward as her saviour, because she is only going to use you as a witness i n her battle, her constant battle w i t h her internal and external objects. You must not show her an image of yourself as sav­ iour. Carry on, please. Session of Thursday, 22 April

1993

P: The last few days have been bad. I can't sleep. I had to buy some tablets that they prescribed for me at the clinic. But even with them, it is difficult; I find it very hard. Iam very depressed. I was with some friends yesterday; they had ago at me because I feel forced to eat. They called me stupid— what was the matter with me? they said. They also have a tough life, they have to study, etc.—what did I think their lot was like? At home, my sister was carping on again about whether I was thinking of studying next year, because one year doing nothing is okay, but two is too much. My parents said it was too early to say what I would do next year. And the group therapy on Tuesday was terrible. I said I did not want to get better and they told me that in that case I couldn't go to the group. D.M.: She is being rejected by everybody: friends, family, group. She only has you at this moment. You are the only one interested i n her. The others are interested i n action: eating, studying, going out w i t h friends. . . . You are the only one interested in her and i n thinking about her. That's why you are becoming more and more important to her. Carry on, please. I was terrified, because.also I had lost weight. And what if my parents find out that I am not going to go? I've been smoking a lot. I don't know how to tell my parents about the group therapy. They'll throw me out. I'll have to bring it up next Tuesday. I am looking for work. The things my friends

MAY

1993



LUCIA

23

said yesterday got me down. They told me I was selfish, that I should stop playing the fool; that I think only of myself. At home I hear the same things, that I am selfish. They don't believe what I tell them. T: What are you referring to? P: To their not believing me. If I say I am going to get some water from the room, they think I am going to hide food. In the clinic they told me not to discuss my weight with my parents, but if I tell them they are not going to believe it. And I had lost weight, but not quite as much as some other girls in the clinic ... D.M.: A t this point one has to try to create a transference frame w i t h you. I would interrupt her to say: " I don't know why they don't believe you, but I do know why I do not believe you. I don't, because everything, every experience you have, is seen by you from one point of view only: the battle, the argument, with the sole aim of being right, out of rebellion, etc. You see everything i n that way, everything re­ volves around the same subject. A n d so, as far as the facts themselves are concerned, I do not believe you. But I do believe you i n the sense of you being caught up i n this fight, imprisoned by it. For example, you tell me that your parents are this and that. I don't either believe it or disbelieve it. I don't know what is the truth. M y mind is open to any possibility. I am not very interested in whether they are like this or like that. What really interests me is why you see and feel your parents i n that way; I am interested in your way of perceiving them. That's w h a f s interesting." Carry on, please. . ., their parents are not doing to them what mine are doing to me. I get very uptight about all this. I shout, I react strongly any time. ... For example, I am watching television, my brother changes channel, and I scream. I understand less and less what they are doing to me. Other girls don't get from their parents what I get from mine. They want to get better; they want to eat. I think it should be my choice T: It looks as though you don't know what is happening to you, what you are doing. You just know that you are on a different channel. Different from yourfriends, from the girls who are also ill but want to eat and get better; a different channel from your brother and sister. . . . This also depresses you. You realize that the rest of the people are on a different channel and that you don't want to let go of yours, but you are having a bad time where you are. D.M.: Good, that is good, on a different channel, a different w o r l d . . .. P: I can't stand everybody talking to me about the same things—food, and

24

SUPERVISIONS WITH D O N A L D MELTZER

food. Or the fact that my mother has talked about it to everybody. Moreo­ ver, most people do not have a clue about what is happening to me. My friends say that it is just nonsense, I am stupid, and they can't understand how I managed to complete my EGB thinking as I do. But they will not make me change my mind: they can think what they like, I don't care. They wouldn't understand why I was against my parents. I don't think they know enough about my life to be able to say, as they do, "With such good parents as I have, and such a nice home, what am I complaining about? If only I knew the kind of parents some people have to put up with, etc." I don't care about their lives or whether they have a rough time with their problems—I just want to be left alone with mine. T: Your problem with your parents... . A problem where food seems to be an old bone of contention in your life with them, about which it would seem that there are many things we don't know. D.M.: This is another good moment, which I would grab, to say: "What is very clear to me is that the only thing you are interested in is carrying on i n that battle with your sister, where your parents are the judges, in permanent litigation. The other part of you that could possi­ bly take some interest i n the world, in developing, is so collapsed that there is nothing it can do at the moment." Carry on, please. P: My friends constantly nag me: come to the faculty, at least one day, and I say I don't want to see anybody, I don't want to re-capture the atmosphere of the old days, like in Valencia. I'd like to get away from everything— from the people I know, from home.... I feel unhappy if one day I don't manage to throw up or hide the food. I have managed to get away, up to a point When I was little I used to wish that a miracle would happen and everybody would disappear or that I would go to a different place. . . . I would close my eyes and wait, but then I would open them and everybody was still there. I still do it; I make a wish that everything should change, but nothing does. D.M.: Y o u could interrupt her here with: "Well, it has happened; it is true, through your wishes a part of your personality has disappeared from the external world as if by miracle, a miracle connected with infantile masturbation, and you have ended u p inside a world that is totally different. A world that resembles a prison, a concentration camp, where the only thing worthwhile is being right, surviving, win­ ning the b a t t l e . . . . Those are the only interests of that part of you that inhabits that world." Carry on, please. T: Where did you want to go? With whom?

MAY 1993

LUCIA

25

P: Anywhere except where I was. It didn't matter. I imagined that I was inside a film, in different periods and situations. T: Can you tell me some of the films that you used to get into? P: I don't know. I didn't have any special fantasies, it wasn't like when you listen to music and start to think about other things. No, it was closing my eyes and saying: somewhere else, anywhere, whatever, it doesn't matter, just so long as it is better, but I don't know what place.

D.M.: She wouldn't know what to say to your question, because those fantasies are really oneiric states, daydreams that she cannot define clearly. It is not like the case of latency children, who make up stories and things like that. Everything in her has this vague quality. Those fantasies are probably accompanied by some kind of autoerotic masturbation that doesn't reach a climax. It is a comforting situation, more specifically autoerotic. It is not very different from the use of the transitional object that Winnicott talks about: the dummy, the handkerchief, and the blanket that the child holds on to. Their purpose is to soothe through autoerotic stimulation of the masturbatory type, but it is only very loosely connected with fantasy. It is soothing autoerotism. However, when in that search to be soothed and through the autostimulating caresses the fingers begin to find the orifices, and particularly the anal orifice, the fantasy of getting inside the object immediately takes shape and the situation of projective identification becomes very concrete. For this process to occur, there has to be a previous one of sensual stimulation, of seeking to be soothed, which invariably leads to the fall into projective identification. These preliminary fantasies are fundamentally negative: their purpose is to reach a world without ideas, without sensations, without fantasies; a sort of soporific state—that is to say, a very primitive state of mind, very autoerotic. But when they fall into projective identification, then the shapes change and the internal world and the shape of the fantasy of it become very concrete. This negative state is the state of the non-psychotic part of the personality, the part that only wants to lie on the bed, stroke herself, fall half asleep, listen to music, start to dream.... The other part, the ill part of the self, is already inside; it has fallen into a state of projective identification and keeps very little contact with the non-psychotic part, which is by now collapsed. That part is full of energy, rebellion, vitality, and it plans to fight the entire world. LI: I want to ask you a question: this autosensual, autoerotic shelter—

26

SUPERVISION S WITH D O N A L D MELTZER

could we think of it as being not necessarily psychotic but, rather, immature or defensive? D.M.: No. It is a collapsed type of state. It is the part of the personality that has slumped, caved in, that is establishing contact with you, but it has no therapeutic potential whatsoever. She listens to you as if listening to background music. It is worthwhile to try to show her the contrast between these two aspects of her personality: the non-psychotic part that has caved in and has no energy, and the psychotic part full of energy and vitality, but impossible to work with because it has not established any type of transference with you. I think that the only worthwhile thing you can do now is to describe the world that this part lives in, so as to diminish in that way the pleasure in the combat and increase the feeling of claustrophobia, of being trapped inside. Carry on, please. T: What would be the best thing for you? P: I don't know, maybe to be on my own. Not to have to do anything or call anybody out of a sense of obligation. Not to have a rough time.

D.M.: It is a merely negative answer. 77 You have a rough time when you need somebody and have to call them; when you have to ask them to help you to go somewhere else, away from the situation that causes you pain.

D.M.: There is going to be quite a change now. What you have just said to her is going to make her behave differently. P: (Silence) Also, I can't do anything now without being controlled, watched.

D.M.: She has just turned over on her bed and is going to show you the other side. She is changing channel. . . . J can't pick up a book without being asked what am I reading, or what is the video I took from the video club. I am always under pressure. When I leave here my mother will ask me what 1 have been talking about, what I have been told, and the same thing with the group therapy. I couldn't tell her what had happened, I had to lie. I was not sure I would be able to, I so much wanted to cry, but I managed—I said everything had gone fine, etc. Sooner or later they are going to find out... and I wouldn't want to be at home when that happens.

LI: She is referring to her parents finding out that she was told in the group therapy she would be thrown out since she did not want to get better.

MAY 1993

LUCIA

27

T: It would seem that you feel that if you need mummy you cannot have privacy, your own feelings, your own relationships; that if you need somebody you are going to have to accept being watched, having all your thoughts and fantasies under someone else's control. Perhaps you feel that I am going to ask that from you too.

D.M.: It is not just possible, it is natural. . . . I am sure she is going to see you in that way, and what you have to do is distance yourself from the way she is going to see you. P: I feel that when I need something, I can't explain to anybody. I told a friend of mine what is happening to me, and she did not understand. Nobody seems to understand, and everybody tries to find out what hap­ pened but not why. My sister was going around telling everybody that I wetted my bed. I was embarrassed andfurious. One day I told my parents, and they said it wasn't such a big deal, why did I take it so badly. But I don't go around telling my sister's secrets, particularly if she doesn't want me to. But she says that a friend of hers has a brother who also wets his bed and she talks about it So what! What do I care! I am not interested in other people's business, just mine! T: You are afraid of confiding in people, of explaining what your difficulties are because you are convinced that it only serves the purpose of satisfying people's curiosity, their taste for gossip, and you will be embarrassed and your privacy will be broken. Neither can you find a mind interested in understanding the reasons for what is happening to you; so in order to protect yourself you close yourself up. Perhaps you don't trust me either, and you might ask yourself, what does he do with the things I tell him? What will he use it for? Helping me, or gaining prestige among his colleagues by discussing my case?

D.M.: It is good that you should tell her that she sees you just like one of the others, collecting material, information, to show off what a marvellous therapist you are. For as long as she is in that state of mind, she is not able to imagine anything different. Carry on, please. P: (Silence) Sometimes when people tell me that my parents have a rough deal with me and I answer that I am going to leave home, they all think it is revenge, that I want to hurt them; they don't understand that, if Heave, it is not to get my own back, it is because I can't eat, I make them suffer, and they would be better off without me. My parents themselves say that, even if they then ask me not to leave. I would prefer not to, but I have to because I don't want to eat I have to hide a hunk of bread in my trousers. I can't help it, and I don't feel guilty. I don't want to be told, when I am

28

SUPERVISIONS W I T H

DONALD

MELTZER

having supper and I say I can't eat this or that, "Look, your uncle is getting upset."

LI: It's her Down's syndrome uncle who sits there, and when he sees she doesn't eat he gets nervous. Yd rather leave, because then they would he less worried than they are now, they wouldn't have to be on top of me. My friends were saying, "Don't you see that your parents would feel worse if you leave?" and I said, "No, it's worse if I stay."

D.M.: Making other people feel guilty is her weapon i n this battle, which is an endless battle, since she doesn't succeed in making them feel guilty but continues to think that maybe she'll succeed i n making them feel guilty. You can join those two things: the non-psychotic part that wanted to escape miraculously to a different place and the psy­ chotic part that has found a different place, but so terrible that it is worse than the one she wanted to escape from. What was insufferable i n the place that the non-psychotic part wanted to escape from were relationships; and what is terrible about the w o r l d of the claustrum is that everything revolves around the struggle for status and hierarchy. The method used to establish tyranny consists of people making one another feel guilty. As part of the aristocracy, parents try to make their children feel guilty about not being obedient; and children—the patient—make the hierarchy feel guilty about being so authoritarian. Ultimately, the fundamental point is how boring, useless, and lack­ ing i n interest all this conflict is. Now at last you can make the distinc­ tion between interesting things, about which one can think passionately, and things that only excite physically—i.e. that provide only the excitement of the battle. Carry on, please. If I left they would feel sad and sorry, but they would get used to being without me. Just like they got used to it when I spent two months in hospital. Truth is, I still haven't readjusted to being at home again, eating there; doing the things I used to do, seeing my mother, or my father, or my brother, or my sister getting uptight. It is as if nothing had changed since I left the hospital, except food. But I still think the same way; I thought it would be different, but it isn't In the group therapy, the nurse said that my parents couldn't give me punishments, physical or psychological, but that's what they do; they force me, and I do not want to do anything because I am forced to. They have always forced me, consciously or uncon­ sciously: don't go to this place or that place, because of this, because of that.

MAY 1993

LUCIA

29

D.M.: What you see here is that the part that lives outside is completely defeated as a result of feeling that it doesn't love and it is not loved. This inability to love has led her to experience a total lack of interest i n life and relationships. Eventually there will come a moment when you'll want to explore with her that unloving external world, but for the time being there is no possibility of doing so because her whole preoccupation, her interest, is centred around that world of tyranny and resistance to tyranny. Carry on, please. T: You are telling me about how you suffer, and make others suffer, and try to avoid it by getting away. You feel helpless because it is not that you don't want to, you can't. You feel ill at ease because in two months you have not managed to change the things that were wrong in your life. D.M.: This is true when w e speak about the non-psychotic part of the personality that feels incapable of loving; it is this feeling of helplessness that has defeated her. The time spent in hospital has been a waste of time because she has not managed to get out of the state of claustrophobia or start to feel love. Carry on, please. ... Your attempt to solve all your difficulties in a split second has failed. This makes you feel impotent. But you can't change so many things in two months; you need time, a lot of time . .. and help. P: To win, one needs energy, and inclination, but I lack the motivation to fight— what for, if it is just going to be the same as it was before I fell ill? . . . 7 don't see a future; I say I am afraid of dying, but I am also afraid of living. What am I going to do? D.M.: I n order to help her understand her situation, we have to see that here is a girl who has become ill. There are reasons to think that the conflict about not loving and not feeling loved has a long history, dating back to her early infancy, but at some point i n these last two years she has become ill, has fallen into projective identification. We can see quite clearly what happened: in the context of the continued conflict about not loving and not feeling loved, she became exhausted, began to w i s h for a miracle, and fell into masturbation. There she found herself in the state of projective identification, i n a world of eating and being forced to eat. This has been the dominant theme in the last two years. What seems to be happening is that in the splitting process that took place, all the vitality went to the part that fell into the projective identification, while the other part was left weakened, sunk. In order to do some kind of work, you cannot use the non-psychotic part,

30

SUPERVISIONS

WITH

DONALD

MELTZER

which is outside because it lacks strength and has no vitality. Since all the vitality is in the other part, and all the strength resides there, you'll have to bring out of the personality that part, which is in projective identification. Her history tells us that that vitality has been operating since her early childhood, trying to force her parents to prove their love for her, as when she used to throw herself from the table, expecting to be caught. Occasionally we can find an extreme form of this in the case of young women whose fantasy is that the only way to have proof that a man loves them is that he should commit suicide for them. This ex­ treme position has its place in literature i n Goethe's The Sorrows of Young Werther, where the only way the young man finds of showing his love is to kill himself so that he w i l l remain for ever as the loved object i n the eyes of his beloved. Ps: There is also Dracula, a film that this girl watches so frequently, where the woman gives herself up to Dracula, abandoning her wom­ anhood and entering a terrifying world. D.M.: The main point in all this is that the Romantic agony is a form of sadomasochism; it is the Romantic form of sadomasochism. I can't remember now the title of the opera where the woman demands that the man do exploits that w i l l prove his love for her, the kind of exploits that put his life in danger. I n the process of accom­ plishing such feats, several men lose their lives. I n Shakespeare's The Taming of the Shrew, the opposite happens. When Katharina demands that a man tame her because she is a w i l d animal and has to be subdued, Petruchio does not follow that path; instead, he starves her; he makes her go so hungry that he finally succeeds i n subduing her. This is an anti-Romantic m e t h o d . . . . Carry on, please. I see the other girls, with a future, they study, but I don't feel like doing anything. What am I going to do for the rest of my life? Stay at home and watch videos. T: You feel that on your own you don't have enough strength, that you need help because you are not going to find a cure for your illness by looking back. Back there, there is the Lucia that wetted herself, Lucia with her quirks and her obsessions. Going back means continuing to be ill, as you always were. And what you need is to be helped to move forward, to pay attention to what there is in you that is really ill and needing help. [End of session]

D.M.: You could have explained i t in a more concrete way by saying that i n the past there was a Lucia that wanted proof of being loved

MAY

1993

LUCIA

31

and, when she despaired of ever reaching that objective, she collapsed. However, her illness began w i t h the wish for a miracle, the miracle of finding a wonderful, peaceful, place, but instead she fell into another world of tyranny and submission. A l l her vitality and strength are being spent in this world where there is only uninterrupted war. What she needs is to be helped to get out and go back to the world where love relationships are possible, where somebody can help her to learn to love and to be loved. I n her case, this is going to mean being a baby again, because this struggle to prove or want others to prove to her that they love her began there, very far away, i n the beginning of time. You have to make i t clear that you have a rescue plan i n mind, but that i n your rescue plan you don't figure as the knight i n shining armour or St. George or whatever, going into that internal world, slaying the dragon, and getting her out into the light of the external world. A l l you are going to do is wait for her to come out of that world where she is trapped. You cannot go i n to rescue her; you can only wait for her outside. It is going to be d i f f i c u l t . . . .

2 (MAY 1993)

Dolores A doll's story: bidimensionality, adhesiveness, and submission in flight from the aesthetic conflict Rosa Castella

I

Information from the first interview, 15 November 1993

' have called this patient "Dolores" because she is full of pains. When she first asked for consultation she explained that she was given my name .by a psychologist Dolores is a brunette of medium height, with a head of medium-length, curly hair. She has the look of a doll, or of a little girl of 2 or 3 years. She comes wearing a short skirt that gives her a very childish look.

D.M.: Does she move like that too? ROSA: Yes. She explains that the reason for coming to see me is that she feels constantly anxious and doesn't know what to do to feel better. She is a university graduate and works as a teacher. She says she has a sound theoretical knowl­ edge and can explain things well to her students, but as far as what is inside her that's a different matter. She teaches half-days; she has a job in a secondary school and also owns a company.

D.M.: So she does three things: teaching, half days at a secondary schopl, and mnning a company? R: No, just two: teaching and mnning a company. It was disconcert32

MAY 1993

DOLORES

33

ing to me seeing this businesswoman who looked so much like a little girl. The first thing she talked about was her work She is studying for a Master's degree, doing her subjects little by little. As far as her family life is concerned, she says that there is an important fact, which is that her parents did not get on well. Her sister is twelve years older than she. Her father did not want any more children, but her mother convinced him and that's how she was born.

R: This is what her mother has told her. About her birth she says that it was quick and without problems, and she has not been told anything very significant about her childhood other than that she was shy and found it difficult to talk, but when she did she expressed herself properly. She has always been her mother's favourite; she has always felt that she is the most important thing her mother has. Her mother has always protected her. Whenever she had a problem, her mother sorted it out for her before she even hid to do anything about it. This was her mother's reaction to any problem she had, either at school or anywhere else. Her mother doesn't get on with her husband and has tried to make her daughters see her as a victim; but when my patient grew up she could see that this wasn't quite true, that her mother had problems too. Her father is more distant, and it is easier to clash with him. Her mother is more seductive; she knows how to bring people round to her point of view. Her father is a lorry driver, her mother a housewife. She went to a convent school, was a reasonably good student, and got her best marks in Maths and Sciences. When she finished secondary school and had to choose a university course she chose Biology, under her mother's guidance. She herself would have preferred to study something else but gave in to her mother's advice. She describes herself as a quiet person who is not running her own life* She failed Biology, and that discouraged her. Three months later she got married to a young man who had a business in agricul­ ture, and they went to live in Lerida. Her husband's work kept him awayfrom 6 o'clock in the morning till 11 at night. In order to bear her husband's absence she started to study for another degree. Although she missed her husband to begin with, little by little she lost interest in him. She found a job and went to live by herself. She got quite depressed. Sometime later she found a job in Barcelona and returned to her parents' house. That was difficult because they saw her again as their little daughter. This caused some problems that have now been solved. She has kept quite an independent life.

34

SUPERVISIONS WITH DONALD MELTZER

Her parents do not share a bedroom, and she says that if it weren't for her and her sister they would not live together. The patient finds this very unpleasant and would have preferred it if they had separated. It was her mother's influence that made her take a dislike to sexual relations.

R: It would seem that the mother used to tell her that it was disgusting and worthless. She never had an orgasm with her husband; this worried her, and she went to see a sex therapist. He was quite a peculiar professional who had a special therapy for each patient. He told her to masturbate; they became friends, and he used to talk to her about his problems. She left the treatment after a year and now reaches orgasms by masturbating, but never in the sexual act or through caresses from a partner. She has had some love affairs. At the moment she is going out with a man, Miguel, who is separated and has two children. She does not like this. Her mother doesn't like the man because she says it is not a good idea to marry a man who has children. She finds herself repeating the things her mother says.

R: This is all a summary of our first interview. She has been with me for a year with two sessions a week (Tuesdays and Thursdays). She comes regularly and is usually on time. She is always in pain. If she misses a session it is because of a physical problem. At onetimeshe had a long sick leave, but in spite of medical examinations the cause of the pain was not found. She explains those pains in an interrogatory way, as if asking what they can possibly mean. My fantasy is that she is looking for a medical dictionary that would explain what each pain means. I find it difficult to treat her because of her habit of bringing topics on which I am supposed to give an answer, rather than talking about herself. For example: Why does her stomach hurt? Why does she feel jealous? And so on.

R: Her jealousy was an important subject, because she was jealous of her husband's children and couldn't stand being with them. Her sessions are very poor. What she says is reasoned and sequential. Fantasy and spontaneity have very little place in them.

D.M.: You can see this too in what she tells you about her relationship with her mother, that her mother sorts out her problems, her mother thinks for her. What she tells you about her childhood is not what she remembers or knows or feels, but what her mother has told her. She seems to have a very adhesive relationship with her mother, not a projective-identification relationship but an adhesive-identification one. She is amused to realize that she thinks and says the same things as her mother, and that she dresses the way her mother used to

DOLORES

MAY 1993

35

dress her when she was little. She is like a doll. I suppose she got married because her mother told her it was time to get married. Her pains are not hypochondriacal but, rather, of the obsessive type; they are a means of keeping her mother interested by saying: "Oh mum, I've got a pain here" and her mother would say, "Lefs see what it i s . . . / ' She doesn't want you to find a solution to her problems, but just talk about them and be interested in them. She wants to make you interested in her. Her emotional life is rather flat, dull, and inconsistent. She is prob­ ably quite boring. Let's see if we can find in the material some possibility of develop­ ing an analytic relationship instead of repeating the same adhesive relationship that she has been having with her mother. You w i l l not get an analytic relationship going through her cooperation because she doesn't know the meaning of cooperation. Seeing that I don't answer her questions, she says that she is "working through" her problems and spends the session on one subject, associating very little and without explaining spontaneously what comes into her head. When I tell her that she has to let herself go and talk spontaneously about what comes into her head, she says she doesn't understand what I am asking and feels lost and disorientated. I am aware that I have not got sufficient information about what is going on in her. The first session I have brought is an exception with regard to the information she gives; a normal session is more like the second and third ones.

Session of 2 April 1993 She arrives on time. P: My back hurts today ... it is something psychic .., the pain moves up and down . . . like blood pressure. . .. I don't know if each place means a different thing; fear ... in the pit of the stomach, I don't know, I was in pain when I got up....

R: She is slightly unhappy because I do not confirm what she says. P: Maybe I had a dream. ... I remember very little ... just the image of a naked woman . .. she was blonde, neither fat nor thin. . . . She was laughing and I was looking at her.... I remember she was explaining to me that she had sexual relations with another woman. .. . She was very happy . .. and I asked her: "And you have no regrets ?" and she said " I have a great time". I felt jealous.

36

SUPERVISIONS WITH DONALD MELTZER

T: Jealous of the homosexual

relationship?

P: Jealous of being able to have a homosexual relationship... jealous of being able to say such an intimate thing out loud,.. I envy people who can say what they feel I don't know,... J haven't felt attracted to other women .. . although I have to say that when I was going to that sex therapist because of my anorgasmia, my erotic fantasies when I masturbated were feminine. . ,. At first there were only feminine figures. . . . 7 imagined two women having a sexual relationship ... then men appeared. . . . J didn't feel included... I Just watched. D.M.: They were voyeuristic masturbatory fantasies. Now as I said that, I remembered something that happened yesterday. Teresa (a friend) came to work with me, and I had a panic attack; she helped me to think about what was happening, and we arrived at the conclusion that I am always frightened of my feelings and of showing them. I admire homosexuals who can say what they really feel . . . Re­ cently I have started to meditate about what my body feels... . D.M.: N o w you can understand the nature of the dream, which is the expression of her jealousy towards you. She is envious of the fact that you can relate to yourself as a woman, that you can feel your own body and be cheered up by the sight of it, whereas she cannot, and w h e n she masturbates she has to look at other people as they have a sexual relationship. The corollary of all this is that she also envies you because you enjoy your work, even when you are working with her, knowing as she must do how very boring she is. She perceives that there is something happening between her and you, very different from what there is between her mother and herself. What there is between her mother and herself is that her mother is very happy with her dolly-baby who does whatever she wants, a dolly-baby to act out her fantasies, a girl who does whatever her mother wants her to. But if Dolores feels that you experience a different kind of pleasure doing the work that you want and try to do, and that she is the object of your interest, this can be a totally different experience for her. It would seem that for some time she has been surprised and irritated that you didn't give any credibility to the method used by the sex therapist, and by the fact that you didn't tell her to do anything in particular; a very differ­ ent procedure from the training that therapist gave her, telling her to do this and that, to masturbate, etc. . . . You are only interested in the type of person she is and in how she relates to you in this room. She

MAY 1993

DOLORES

37

realizes that and sees that you obtain pleasure from something that is inside you, and she feels that she does not obtain pleasure that way. This is what makes the difference between you and her, and therefore there is no adhesive relationship between you. So what the dream is saying is that she perceives that if you are the kind of person who is capable of enjoying masturbating your own body, then you must be the kind of person who can enjoy using her mind. That's totally new for her. P: 1 was thinking yesterday about how to get better in every way. R: This comes up frequently; she is constantly making projects, resolu­ tions, and programming her time. P: I had the question of religion in my head. .. and then the thought came to me that I should read the Bible... and I got frightened.... I had a mental picture of being possessed by spirits.... I didn't sleep well, and when I got up this morning I said to myself: Really! Are you frightened of being possessed by spirits who will do as they like? What you have is a board... a plank of wood inside ... you have things inside, you feel them and they frighten you.... D.M.: Let's see. What does this board mean for her? R: The board was something oppressing her, not letting her bring

out what was inside her. The religious question w i l l be understood

later

D.M.: Can one assume that this is an interpretation?

Ps: Do you think that it can have something to do w i t h the Tablets of

the Law, since she mentions the Bible?

R: No, she was talking about a wall, something that oppressed her.

P: Do you know, this fear I have of spirits comes from the time when I went to see a medium. .. that ruined my life.... I went to see her because there was a boy I liked who didn't take any notice of me... and she said: "That boy is not for you... but I know one who will love you. Go to Lerida to the pear-picking... and you will find him." I went where the woman said. .. and I met the son of the agriculture firm The medium said to me that 1 was provoking the spirits to make the boy ask me to marry him ... he was the one I got married to. ... I have told you already that it all went wrong later on. Whenever I went to see her to tell her that my marriage was not working, she threatened me, saying that if I dared to walk out horrible things would happen. . . . After four years I decided to break with my husband and with the medium.... J thought it would be better to walk

38

S U P E R V I S I O N S W I T H D O N A L D MELTZER

out than to carry on. I also broke away from the world of religion, and now sometimes I feel that I want to think about it again. Last night I linked religion, spirits and fear.

D.M.: That's how she got m a r r i e d . . . the medium played her mother's She role, told her where to go: "Go to pick pears", and there he was is really furious because you don't tell her what to do, you don't say: "Go to Lerida to pick pears" [Laughter]. A n d so she feels that you are having a good time, enjoying your work, masturbating your mind at her expense, enjoying your body as a therapist, and not doing at all what she wants and is asking you to do, which is tell her what to do. T ; You dreamt about a woman who expresses her feelings and talks about her relationship with another woman. I think you are saying in your dream that you would like to be able to express here, with me, what you feel; that you are interested in finding somebody to confide in, but, at the same time as you want that kind of relationship, you arefrightenedof what I might do. You are asking yourself whether I am going to respect your freedom or threaten you if you try to do something different from what I want It is as if you wanted to find a fairy-medium who would solve every­ thing but you were frightened of finding in me a threatening witch­ medium.

D.M.: That is true but not the core of the matter. She wants you to be that good mother who tells her what she has to do. She suspects that any mother who is like that is a witch-mother. You seem to be some­ thing different, but she doesn't really know what you are doing. Why do you enjoy what you do? It is a mystery to her. She thinks that you are enjoying yourself but seems to be saying: " I can see you enjoy your work, but I can't imagine how you can have a good time w i t h me since I am such a boring child." P: Thinking about what you said, I remember now that the other day I had a dream where I met a small woman who said she was my therapist She had a round face, full offreckles, she did not look like you, she was about 50 and a bit, and I was saying to her: "No, you are not my therapist... You aren't" T: Perhaps you are afraid that I might be somebody different and will confuse you....

D.M.: She is furious with you because you don't do what she wants you to do: tell her what to do, etc. . . . On the other hand, she is aware that she is very attached to you in a different way from how she is

MAY

1993

DOLORES

39

attached to her mother. But she cannot make out what is the nature of that attachment, the more so because she realizes that there is nothing that w i l l seduce you and lead you to do what she wants you to do. She is perplexed. H o w can you enjoy yourself when she does not find herself enjoyable? Why is she so attached to you if she is not able to enjoy this work that you like so much? It is a puzzle for her. If she continues asking herself questions and wondering, one of these days she w i l l finally start to think.

Ps: It is the beginning of the development of the epistemophilic i m ­

pulse i n the aesthetic conflict. She is beginning to ask herself questions

about the therapist, more questions.

D.M.: Mrs Klein calls it the curiosity to see what is inside the mother. When I talk about aesthetic conflict, I mean wondering if external beauty corresponds to internal beauty, if inside there is the same beauty as outside. It is clear that you are attractive to her while that little round woman w i t h the freckly face is not.

The blonde woman i n the dream expressed what she had inside, and this patient finds expressing what one carries inside unheard-of, incomprehensible. P: I suppose so ... but my back is still hurting. R: She seems to think that her backache should disappear immedi­ ately if an interpretation is given that explains the nature of her pain. D.M.: This matter of pains that can be solved i n a few words has to do w i t h the world she has lived i n where things are done according to some rules, to an order: her mother's rules, the laws of the Church, etc. It is a bidimensional type of world, it is her world. I n this world, emotions and feelings don't count much; things only have a descrip­ tive category. For example, if people are lucky they may have an orgasm, but the feelings are not described. The capacity for epistemo­ philic instinct or curiosity has been exhausted i n her through voyeur­ ism, in looking at other people and masturbating w i t h the fantasies of the sexual relationships of others. She has done this instead of being interested in other people, instead of being curious about why other people have sexual relationships, why they get married, etc. She is, in fact, looking at other people like a "voyeur", and this, of course, is not the epistemophilic instinct. R: What Dr Meltzer is saying now reminds me of the lack of feelings that can be observed i n her relationship w i t h her partner; i t is as if there was no interest i n him, just " I am alright".







40

S U P E R V I S I O N S WITH D O N A L D

MELTZER

D.M.: The transference situation at this moment is fundamentally negative. "You are not like her mother, not like the witch, or the sex therapist.. /', and she feels very attached to you, but she doesn't know what is happening to her, she doesn't understand w h y you are so fascinated w i t h her when she is tempted to leave and go to anybody else. However, she is beginning to be intrigued by her own transfer­ ence, curious about what type of person you are. A n d that is transfer­ ence. Lluis's patient was not estabUshing a transference, she did not show any interest i n him; she was using h i m as a representative of some type of institution—a psychiatrist or a psychotherapist, it was all the same—but she had no interest i n trim. This patient is interested i n you. Perhaps you are the first person she has been interested in in all her life. Carry on, please. Session of 13 April 1993 R: This is, in fact, the first session after the Easter holiday, because she let me know that she would not be able to come to the first scheduled session, for work-related reasons. She arrives on time. P: I am worried because I have to make a decision about whether to take Sociology as a subject or not.... On the one hand I think I should face it and study, but on the other it seems unattainable.,.. Oh! I would have to do so much work to pass it R: She has failed this subject twice, and she organizes herself to study for it i n between a very tight timetable and getting up early. I talked to the subject teacher in Lerida and we are going to meet soon, but on the phone he already discouraged me. He said: "This is a subject with no mystery to it, you just have to study it." And I thought: "Ialready do that and I fail." Also, I think that I am an expert in Methodology and I shouldn't find it difficult, but... I see it as unattainable! T: What is unattainable? P: Everything... understanding myself... knowing where I am going.... I am disorientated . . . an image comes to my head, of being in a large room, moving about by touch.... I bump against the walls. ... I cannot find the exit. T: Today is your first session after Easter, and you are worried—maybe you

MAY 1993

are frightened analysis.. ..

DOLORES

41

that in spite of my help you cannot manage "to pass" this

P: Yes, it is the first time after Easter and I haven't said anything about the holiday. I have been away with Miguel and the children [the couple and his children]; the first few days I was all right, then I began to be consti­ pated, and when that happens I become very introverted, I don't talk, I just shuffle along. T: It is as if you were telling me that you have put something of yourself in your motions and you are afraid of letting it out, but keeping it inside would make you feel uncomfortable, disorientated, locked up in a claustro­ phobic situation.

D.M.: You could have interpreted immediately that she is incapable of realizing what the problem is, which is that she has missed you—she is saying that she missed you. She feels that you are the type of person who, when you miss somebody, you can say to them, " I have missed you". But she belongs to the kind of people who don't know that they've missed you, and the only thing she can say to you is " I was constipated". She wonders w h y she has missed you, when after all, who are you?—only her therapist. She asks herself, "Why did I miss her if I was w i t h Miguel and the children?" P: Yes, I always have problems with my digestive system J have told you ... sometimes it is in the pit of the stomach, other times it is constipation. I am worried ... in these last few weeks I have not done any of the things I set for myself. .. you know ... the diet, swimming, studying... and today I have to start again; I have to get serious with myself.

D.M.: When she talks about these rules of hers—thafs to say, her periods—what she is saying is that there is something else she doesn't understand about you. You don't seem to follow any rule, you just tell her what you think, what comes to your mind. What rules are you following? A n d although it doesn't look as if you follow any regime, you seem to be a happy and serious person, too. H o w can one be a serious person not following any rules, a regime? She doesn't under­ stand you. What kind of animal are you? T: It is as if you were telling me that you have abandoned your rules for staying well, maybe your feelings, and today you come here disorientated and confused. P: Yes, something like that; the last day I came I was in good spirits and happy with the session; the first day after Easter I told you I couldn't come

SUPERVISIONS W I T H D O N A L D MELTZER

42

. . . today

I found

impression feel

it difficult

to come.

...

I don't

know.

that a long time has passed, and I am sorry

. . . I have the

to say that I don't

anything.

D.M.: She is happy with the session; what, in fact, she is trying to say is that she would like to find something to hurt your feelings. She asks herself: "Am I happy to come to the session? Why do I want to hurt her?" She is confused and disorientated by this; she wants to love you and she wants to hurt you; she notices that she has feelings towards you, but she doesn't know where to classify all this. She can't explain it to herself. of 20 April

Session She arrives

15 minutes

I tell her about a session for a different

1993

late. when I am not going

to be able to see her, and we look

time.

P: I am late, and I don't know why I am so late. I don't feel too well. I have my and since I don't feel well I would have preferred

period,

had a dream

and I don't

why I mistrust

everybody

pain in my stomach. . . . or with Miguel he is not paying

I began to think about

I feel

to defend

. . . I don't

myself...

from

that I

anybody

...

know how to say no . . . I don't

and I am frightened

they might find

.. . here, too, I am afraid

. . . I am afraid

of clouds

of being

A pyramid

. . . if the light goes off... up...

out

of not being

attacked,

built

be rigorously

only

with

examined

to make demands

explaining

I fall

and the

to the ground

A would like to build a solid pyramid my things.

Other

.. . every thing from

T: I think that you see me as something going

is fear, and I have noticed

know how to defend myself...

my opinions

have to keep myself would

when I am alone

I don't feel it when

is being made to do what they want me to.. .. I feel as if I am on

a path full fall.

else....

late.

.. . maybe I see them as my enemies "attack"

that when I had the

to me.

.. . my partner.

how to defend

able

out is

people....

be that I don't

my mother

to rest. . . . I've like to find

and it goes away

in my stomach

T: Like here with me, by arriving

know

what I would

and he is doing something

myself from

P: It must

it...

I get it frequently

attention

The tightness distance

remember

dangerous

people's outside

. . .I won't

suggestions is

dangerous.

and harmful,

that I am

on you and not understand

it in the hope that I'll understand

that

you, but you are

you. I have told you about a

MAY 1993

DOLORES

43

change of time; maybe you wanted to say something against it, but you don't know how to defend your opinion. D.M.; The image she gives is that she would like to build a pyramid where she could live in isolation. What you don't see there is that she is saying she would live there like a mummy. I t is the image of an Egyptian mummy locked i n the pyramid, with all her belongings, just as they used to bury them, but dead, of course.... She is disorientated as to what kind of relationship she is having w i t h you. She is trying to say: " A h ! This is just like w i t h my mother, or w i t h the sex therapist", but in fact it is something completely different. She feels lost, frightened, and flooded by you i n a way that she finds inexplicable, something which is not the same as listening to a teacher, or what one does at work, etc. It is quite different: you radiate a type of vitality, sexuality, and other similar signals that make her feel i n ­ trigued, and she doesn't want to feel that because she doesn't want to experience that kind of emotional turbulence. But she feels incurably attracted to you and to herself. Naturally this is the beginning of the possibility of thinking about herself and taking an interest i n this being intrigued, etc. She started with you a year and a half ago. It is not a lot; we still have to see if she is able to cope with this kind of impact, because she is very much a child. Perhaps she cannot tolerate it. She is like a virgin falling i n love with you, and this is not easy to bear. I think that we have to bear i n mind the idea of the configuration of the aesthetic conflict and the mistrust of the object emerging as emo­ tional impact. It's the essential conflict between what can be perceived outside, and has an impact, and what is to do w i t h the inside, which one can only trust from the evidence and one can never possess. The question one asks oneself when perceiving aesthetic beauty is whether there w i l l be something inside that corresponds to that beauty. It is a state of terrible mistrust. The only possibility of keeping her i n analysis, and not losing her because she marries Miguel and never returns, is to talk to her as you would do to a baby and explain clearly the situation of the aesthetic conflict. It is the situation of the baby that feels so impacted by the beauty of the mother and the irresistible attraction it generates, which he cannot bear, that he believes he won't be able to bear living without mother's beauty. It is a panic situation. One has to explain this clearly; otherwise, it is very possible that she won't be able to bear an experi­ ence like this.

3

[FEBRUARY 1994]

Andres The rhetorico-critical vs. the admiring-lyrical perspective: egocentricity and negativism in hysteria Llufs Farre

T

his is a 39-year-old patient who came for consultation in a state of deep anxiety consciousness

cerebral aneurysm tendency

at the age of 33

(he traces it back to a temporary

loss of

six years before, diagnosed as being due possibly

but not confirmed clinically).

to a

He has death-related fears, a

to depression, and difficulty in communicating

fested specifically in losing the thread of the conversation

with others,

mani­

easily and not being

able to look at the face of the person he is talking to—not the eyes in any case, especially

if the person is a man. If nevertheless,

eye contact is made, he

suffers deep mental turbulence, gets totally disorganized, experiences feelings

they were protruding in the direction of the other person—his anus.

extreme

of shame, strange tingling, and tickling sensation on his lips—as if mouth, and his

This causes him to think that he might have homosexual

tendencies,

which he is unable to recognize, saying he has never felt sexual desire

towards

men.

D.M.: He is a very introspective man, is he not? Lmfs: Yes, he is very introspective. This situation affects all spheres of his life, particularly his work, where, as the person

responsible for sales in his firm,

he is reduced to dealing with all

matters by phone, so as to avoid direct contact with clients and suppliers alike. At a distance he is an excellent communicator, 44

effective and

persuasive.

FEBRUARY

1994

ANDRES

45

D.M.: It is an interesting case. So all this began at the age of 26, i n fact. LI: A t 27. D.M.: Six years before. LI: Yes. D.M.: So when he says that all this happened six years before, is that six years before he was 33? LI: He means six years before he was 33. D.M.: A l l right. So he was LI: 27. D.M.: 27 . . . and at 33 he comes to see you. . . . Now he is 39. Okay. Since his aneurysm was diagnosed he has had migraines, which begin with a "click" in the area of the front parietal lobe and develop into complete incapac­ ity for any activity for several hours. He finds no enjoyment in any relationship and only feels understood by a friend he's had since he was young, and with whom he now shares the management of firm he works in. His friend is remarkably tolerant, has a positive attitude to life, and is hopeful in the face of adversity. He has been married for thirteen years but is not happy with his wife, although he ac­ knowledges her goodness and courage to bear him. D.M.: This sounds as if we have got a hysteric i n our hands . . . Historical data Andres has one brother and six sisters. He is the youngest of the boys and the fourth sibling. He has fond memories of his childhood in Castille. He was a good-looking child, his grandfather's favourite, who, in the old patriarchal style, used to take him for rides around the farm on his horse. An idealized world with only one perturbing element in it, which comes through in the narrative of that period: it was a recurring dream that lasted years; in it "he would see himself running at top speed along corridors, stairs, and rooms in the school followed by a hearse carrying a coffin." During the treatment he said once that maybe it was his mother who was in the coffin. D.M.: One moment, please; let's look at t h i s . . . this dream, this type of dream, occurred throughout that idealized period typified by his r i d ­ ing on the horse w i t h his grandfather. Is that correct? LI: Yes, and i t carried on for years. D.M.: Good. About the school—was it a day-school or a boarding­ school?

46

SUPERVISIONS W I T H

DONALD

MELTZER

LI: It was a day-school. A convent school. D.M.: Good. A convent, allright.This hearse had a coffin—that's to say, in the dream it was occupied by his mother, without doubt—or was it that during the treatment he came to suggest that maybe his grandmother was in it, that he wasn't sure, that perhaps ...? LI: No, it was his mother—he thought it was his mother. D.M.: Okay. Because of his grandfather's expensive life-style, the farm was lost and his parents had to emigrate to Barcelona. His father worked in what ever jobs he could find and used to spend a long time out of the house. They lived in a modest neighbourhood, and when Andres and his siblings made a racket his mother used to get exasperated, and she would faint and fall to the floor. This terrified him. She often threatened them that she would throw herself out of the window. These memories left a strong mark on him.

D.M.: She was another hysteric. . . . At what age did he live that change in the family? LI: He was 6.

D.M.: Six years old. Fine, And how did his grandfather spend all his

money? It is not clear, is it?

LI: No, it isn't clear.

D.M.: Gambling? Playing cards? Through bad management? A dissi-

pated life?

LI: It would seem that he gambled, but mainly he was careless. He

lived on his rents, and what he was really doing was selling his land

little by little to pay for his comfortable life-style.

D.M.: Bad administration, eating into the capital. A capital that he had

inherited. Do you know at all how many generations had lived on

those lands?

LI: I don't know, I only know that it was a large farm, that it belonged

to his maternal grandfather, and that there were five or six siblings.

D.M.: But before his grandfather, how many generations had lived on

those lands?

LI: It is not known; I do know that the land had come through the

maternal grandmother.

D.M.: It belonged to the maternal grandmother and his grandfather

had frittered it away through bad administration?

FEBRUARY

1994

ANDRES

47

LI: Yes.

D.M.: O.K. He was probably a good-looking man. .. .

LI: Oh yes! Very good-looking. Very successful w i t h women. Andres

says that all the women i n the house, including his mother, adored

him. They were like his servants.

D.M.: Is your patient attractive? He was when he was young; is he still

attractive?

LI: No, he is not good-looking, but I find him pleasant. He doesn't think much of his physique, but he is a pleasant-looking person.

D.M.: Is he vain?

LI: No. D.M.: This friend of his who runs the firm w i t h him seems to be a very

steady person, reliable, I suppose.

LI: Yes, completely. Absolutely honest. D.M.: O.K. Very good. He remembers his anger in puberty as his body began to change. He began to feel ugly, he was losing the harmony he had loved so much; he felt clumsy, he couldn't playfootball with the agility he had been admired for. Since then, he hates his body, particularly his face; he thinks his lips are too big, "like a suckling baby's lips", he says. He admires his father's slimness and poise and is repelled by his mother, who looks like him. He also despises in his mother her fragility and incontinence that lead her to fall to pieces at the smallest difficulty and to see threats everywhere; he adds to this the fact that she can only appreciate his brother's successes. He hates and admires this brother and feels small beside him. He is ashamed of having had sexual contact during puberty with him. The beauty of both men and women has a great impact on him, and this makes him even more ashamed of his appearance, which, not­ withstanding his own attitude to it, is in fact pleasant. D.M.: Which of his brothers is that? He is younger. . . . LI: His only brother. The eldest boy, he is 42. D.M.: Three years older, 42.. .. LI: Yes. D.M.: The rest are all girls. Okay. LI: Yes. Since the loss of his child-like body he often takes refuge in omnipotent fantasies, such as having an immense fortune with which he manages to do

48

SUPERVISIONS WITH DONALD MELTZER

good things for the poor and humiliate the rich, or possessing personal admired by everybody. His motto is: "Caesar or

gifts

nothing."

Though he was a good student, he gave up his studies to defend his left­ wing ideals, started to work from the bottom rung of a firm, and from there he engaged in intense political activity. Later on with two friends

he set up a

company, without bosses or labour hierarchy, which in the present crisis in its sector is managing to survive though precariously.

He finds it hard to play a

more directorial role there because that is experienced by him as an abuse of power.

D.M.: Oh! Let's stop and think for a moment. He is an interesting young man. Let us see: what happened to the third partner? You talk here about two friends w i t h whom he set up the company, don't you? Where is the third person then? LI: One is the friend we mentioned before; the other one is a fellow traveller from his political days. It was with them that he set up the company. D.M.: Is that one still there? LI: No. They have broken up. Andres kept his long-time friend. The other person left the firm. D.M.: A l l right. A n d this self-managed company is not doing very well at the m o m e n t . . . and he thinks that part of the problem is that he is not taking on more of the weight of ninning the company, not making himself heard more, because of his difficulty when he has to look at people, when he has to relate directly, and so on. Is that the case, or does he think that they are going against the trend and are being swept away by capitalization and privatization? LI: Both. D M . : He is a reflective and interesting man. He is also intensely sen­ sual: his formative background is marked by tremendous vanity and homosexual or feminine orientation towards his father, his grandfa­ ther, and his brother, towards good-looking men. It seems that he has nothing to say about his sisters, although he has six; he seems to put them all i n the same parcel, as a block. Although he shows attempts at being attracted by feminine beauty, he has very little to say i n favour of the women i n his life. He doesn't seem to know much about his sisters' personalities. On the other hand, it is more typical i n women and effeminate men to complain about puberty and be nostalgic about the passage period. This nostalgia plays an important role i n the pre­

FEBRUARY

1994

ANDRES

49

anorexic phase, and it is then that it can be seen both in boys and in girls, although it is less frequent in the boys. When did his grandfather die? It doesn't seem clear. LI: It is not clear to me either, many years ago, maybe when he was

about 15.

D.M.: Good. Okay. He doesn't mention his grandmother.

LI: No.

D.M.: No.

LI: His grandmother died six years ago.

D.M.: His parents are still alive?

LI: Yes.

D.M.: It is very surprising to see how women have been swept away

from his life. And they have a small daughter who is not mentioned

either. He has a 2-year-old daughter, does he not?

LI: Yes.

D.M. We can work out that she was born during the course of the

analysis.... How did he receive her?

LI: Very well, because he was desperate to prove that he was not

sterile. They had been trying for ten years without success.

D.M.: Was he thinking that maybe it was because of his wife? What is

she like? Have you had a description of her?

LI: His wife seems a warm person, full of courage, who recently has

been getting very annoyed with him because of his difficulties in

solving problems; she looks after the little child very well—the child is

beautiful, vivacious, intelligent, and is admired in the entire neigh-

bourhood. Both the mother and the grandmother look after the little

girl; she has plenty of stimulation and talks a lot. Andres is in love with

his daughter, although he fights with her a lot.

D.M.: What has the mother studied?

LI: She trained as a social worker.

D.M.: She is a social worker? Does she have a job?

LI: Yes, but in the difficult economic situation in the country she is

only able to find temporary work.

D.M.: Did they meet at university?

Li: Yes.

D.M.: Was she also left wing?

50

SUPERVISIONS W I T H

DONALD

MELTZER

LI: Yes, I think so. D.M.: Yes, good. Okay. Development

of the treatment

We have done six years of analysis, the last three twice-weekly. He put up some resistance to begin with, stating financial problems that were partly justified. At the moment those problems are real, and we have had to fit our plan to his situation. He is a great arguer. My relationship with him has always been difficult, particularly the handling and treatment of the transference. My pointing out separations and interruptions to him was always answered with: "That is what psychologists usually say in such circumstances" Nevertheless, he has improved noticeably during these years: his mi­ graines have disappeared, and he has stopped compulsively reading the obitu­ aries in the newspapers.... Ps: Excuse me: with regard to the obituaries, was he looking for something there? LI: No. He read them daily. Ps: Was he looking for somebody? LI: He was looking for references about people who might have died from a cerebral aneurysm.

... he re-started and finished the studies he had abandoned, his relationship with his wife improved, he was able to have a daughter when he thought he was sterile, he solved his severe nicotine addiction, etc., but he complains that the treatment has not solved the basic problem that brought him to analysis: his conflict about communication, the spoiling of relationships through his eyes, which makes him feel deeply ashamed, as well as feeling that he is a homosexual and that he ruins the links he has with people. Hefeels that here is something in him more powerful than himself that makes him express uncon­ trolled emotionality. Not only is this shameful to him, but it also unsettles people and makes them feel uneasy. His complaining and persistent contempt for therapeutic progress were discouraging for me for some years.

D.M.: One moment. Let's think about all this for a minute, lefs see what he is complaining of. He seems to be the kind of person for whom the most important word in the vocabulary is "but". LI: Yes, yes. D.M.: "But" . . . which means—as is the case in many hysterics, and he

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is a hysteric w i t h strong compulsive features—that the operation of negativism is very important. It is like our Labour party: it is always i n opposition and actually hardly ever wants to be i n power. They are critics: some people are at their best as critics—they are very good at knowing what it is that doesn't work i n other people, and also in themselves, in their own lives. They are people for whom a critical eye, an observing eye that sees the defects, constitutes the essence of their relationship w i t h other people. It is what they do best. It would seem that the focus of his analysis, since his life has improved i n most aspects, has concentrated on that function: the way he uses his eyes. It would seem that those eyes start to function i n that critical way, as when he looked at himself in the mirror during puberty and d i d not like what he saw. I presume that it was then that he realized what the difference between the sexes was, when he saw himself locked inside a body w i t h some inadequate type of masculin­ ity. This, which presented itself to his eyes, was where he would have to spend his entire life. Ps: But, why was it inadequate? D.M.: Because, according to him, his mother only had eyes for his older brother—only he counted. She could only see his brother's suc­ cess. A n d what happens to h i m w i t h his eyes is that he only sees the successes of men, and sees himself as an inadequate man rather than as an adequate woman. His wife seems quite an adequate woman. What does she look like? Is she attractive? Pretty? LI: I don't know; I get the impression that she is not very beautiful, but very pleasant. D.M.: He doesn't talk a lot about her? He doesn't describe her physi­ cally? LI: No. There was only a period during which he said he felt rage against her breasts. D.M.: In what state of mind d i d he marry her? LI: He has never described it. I have the feeling that he married her on the crest of the wave of Left-wing exultation in our country, out of a desire to live together because they shared ideals rather than because they were i n love. D.M.: Companions that live together . . . comrades, soldiers of the Left marching towards final victory . . . over somebody [laughter]. One be­ side the other rather than facing each other, looking at each other. It

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was side by side, not face-to-face. She has been a good companion, side by side, but she is beginning to get fed-up. Now that she has a baby, Andres is not a great companion for her. He is not her baby; she and the entire neighbourhood only have eyes for the baby, and it is even happening to him—he has eyes only for this baby. It seems that in the past he had those critical eyes and that left­ brain, he had critical eyes even to detect the problems of the Left. He is very critical of everything, probably. He used to be very skilful i n mental rhetoric. This skill is still considerable; it is linked to those particular kinds of eyes that see everything critically, contemptuously. We are beginning to have a view of this person w i t h some kind of division i n his mentality and two pairs of eyes. One pair is critical and rhetorical, and the other pair is lyrical and admiring and is now cen­ tred on his daughter. A division in his personality is beginning to show, which took place around puberty in his history. It would seem that before puberty he was beautiful, admirable, and lyrical, and that after puberty he became critical and rhetorical, somebody who finds fault w i t h every­ body, even w i t h himself. But there is one exception: his friend, the partner w i t h whom he has set up the company, whom he exempts from all criticism and who, if we go by your description of him, has an exemplary character. We often find this kind of history of a Golden Age where there was a New Atlantis that lasted for some time and that came to an end, i n general, with the birth of the following sibling and the picture of the mother feeding the new baby. But how did he take his wife's pregnancy? We know that it was a relief to him after such a long sterility. Did he not have even the faintest suspicion that his wife had found somebody more fertile than he? How did he experience the growing of his wife's womb, the devel­ opment of the pregnancy? LI: On two different levels. With great hope, joyful to see that he had solved that situation of infertility on one level; while on another level there was the eternal "but": "What sort of a father is the baby going to find? I am so irked by my problems. Will I be able to bring up a child i n these conditions?" D.M.: Okay. So it seems that the baby i n the uterus was already a very real person for him. Do you know to what extent his Left-wing ideology was Marxist? LI: Yes, he was in some way linked to Marxism.

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D.M.: I w o u l d have thought so. He seems to be a genuine Marxist; by that I mean that i n the Marxist cosmology there is also a golden era before capitalism when the whole world is conceived as being made up of simple peasants tilling the land and living of it. There was no government nor d i d they need it, happy as they were minding their own business, ploughing their land. Marxist ideology contains the expectation of the arrival of a new Golden Age where we shall all be able to live again without intervention or government, looking again after our own land. The historical process is seen as something that moves in a circle. This is the ideology he has tried to put into practice in his company . . . very interesting. It is the golden age when there were no differ­ ences, when he could observe everything from his seat on the horse next to his grandfather and they were both the owners of everything they saw. Moving gracefully and beautifully through a world where all conflictive differences had been ehminated, particularly the differ­ ences between man and woman—except that there was a "but", some­ thing about his mother's breast that did not fit i n and bothered him, and also something he could perceive about mother's mortality that did not fit into that idyllic scene either. What happens w i t h hysterics is that all of them, at least as I see them, are would-be novelists, and the histories of their lives, as they are written up i n their minds, read like a good novel. Sometimes it is a Gothic novel, other times it is a romantic one, or a tragedy i n the style of Dostoevsky. But there is always a feature of intense egocentricity, absolute egocentricity, that makes all the secondary characters revolve round a single central character. LI: One of his great frustrations is that he is not a good writer and can't write just anything that occurs to him.

D.M.: As his analyst, you don't have to believe that story. What you

have to be interested i n is how he has distilled from the experience of

those days the necessary features to build this particular history.

The central line of his history is the end of the Golden Age, an end that w i l l have been announced by the arrival of puberty or the loss of that farmland. It w i l l always be external factors that have brought about the decline and fall of the Golden Age. From the point of view of periodicity, it is interesting to notice that his mother had two girls i n a row after him, w i t h a six-year gap between them. Since he was 2, a baby girl appeared every six years. A n d now he has a baby daughter.

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To understand a hysteric like the one you are presenting, you have to ask yourself the same questions you would ask to arrive at a distinc­ tion between what makes a novelist good or bad. The essential differ­ ence between a great novelist and a mediocre novelist is a difference i n symbolic formation. The first one forms—builds—his own symbols, whereas the mediocre one only organizes in a particular way, and for entertainment, the common symbols received from the culture of the community that he lives in. The result is that the characters of mediocre novelists are always stereotyped, and those of a good novelist are really people. The difference between these two types of people, i t seems to me, is that the apparent richness of imagination of the mediocre novel­ ist is not at all richness. It is only the richness of multiplication that is fundamentally created through the function of the negativism that says "but" to everything another person thinks and produces its own ver­ sion of whatever it may be. Critics and bad novelists have a lot i n common, which is that they always have "a better version". A better idea, but never their own ideas: they always improve on other people's ideas. It is interesting to read what Socrates says about the Sophists. He seems to have great admiration for the apparent richness of ideas of these people, but he immediately sees that they are not upholding their own ideas but following the ideas of others and teaching how to oppose them; and their method consists in that. The method followed by the Sophists is "how to oppose other people's ideas". One can learn a lot from reading Gorgias, where Socrates proves Gorgias wrong i n the most polite and amicable way. He belies Gorgias's rhetoric. I think that one can learn a lot from this work about how to treat a patient like this one. I am sure that he is challenging you w i t h his rhetoric, inviting you to do something, to respond. It is not like that anymore. Now, together w i t h his wife, his daugh­ ter and his friend, I am one of the few people worthy of affection i n his life and thanks to whom it is not a desert. He despairs that I might still provide any more relief for him than I have done already, but says that without me he would be totally ruined.

Session of 10 January 1994 (first session after Christmas holiday) He is silent for some four P:

minutes.

You know, it is paradoxical that although I cannot get you out of my head, I wouldn't want to be here today.

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D.M.: There you have it! I didn'tfeel like coming. I would have -preferred not to.. . .1 wouldn't have minded leaving it for a bit longer. And why all this? This is a good time to draw up a balance sheet When I do that, only the negative things come to my head, everything that doesn't work ... I see myself with the things I haven't got, Ifeel empty because if I don't have I do not exist... I know it is not good for me to turn to omnipotent thoughts, thoughts about I am this and I am that, but I can't help it If I don't do that, I feel very unhappy. All this time I have been turning over the things you said to me on the matter. But remembering doesn't do much. I feel unhappy, I don't have any of the things I would like to have, and I am not any of the things I would like to be.... All I see is what is not working.... Maria is right when she says I am a permanent malcontent I cannot bring anything here, I can't think of anything else. That's why I would have preferred not to come..,. D.M.: There it is, as if it were a presentation of his position, a challenge to you that says: "This is what I am like, I can't help it and I am protesting. I am like this, what can I do? If I don't behave i n this way I feel very unhappy." "Oh, you feel very unhappy? I see. So, this is the way you are happy? Okay. Fine." You can say: "Your way of being happy is to unload your unhappi­ ness on other people, w i t h that attitude of Imts', negativism, and criticism, of rejection of anything they might offer you." And he might say to you: "No, no. It doesn't make me happy, but at least it makes me 'not-unhappy'". Okay. [The patient carries on for some time repeating insistently the theme of emptiness, uselessness, and dissatisfaction. He talks slowly and uninterrupt­ edly.] P. I remember now that when I was 8 or 9 I felt like that already; maybe it had been happening before.. . and then I only wishedfor bedtime to come, because there I could give free rein to my omnipotent fantasies and ma­ nipulate reality through them in a way that would satisfy my wishes. D.M.: Masturbation. Okay. LI:

Yes.

D.M.: " I could manipulate my penis and my fantasies through mas­ turbation, and I couldn't wait to be in bed. I don't know at what age it began." A n d you could answer him: "Probably at the age of 2, when your mother gave birth to the sister that follows you. That's when you

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began to make your mother the container of your unhappiness, and you are also acting that out with me, with your negativism and criti­ cism. You are unloading all your unhappiness into me, as if that were the best thing you can do to achieve something that might be called happiness. The only fault with that method is that you weren't quite able to spend your entire life as a little Hamlet inside your shell, king of infinite space; the snag was that it brought you bad dreams in which you thought you were killing your mother. Now, i n your relationship w i t h me, you are systematically killing my interest i n you. In your thoughts and your dreams, you are constandy and inevitably perse­ cuted by this idea that I am getting fed up w i t h you and I am going to put an unsatisfactory end to the analysis...." Okay. I don't know. I am restless when I am like this!... I don't know how to explain it to give you an idea, but I can't explain it with words. I don't know, 1 am not making sense, I know, but I can't do it, I don't know how, I am getting into a muddle. D.M.: Yes, "You are being followed by the hearse w i t h the coffin inside again." T: Perhaps you want to tell me that in this time that I have been away from you, although you've had me in your head my presence there has not worked, and neither have the memories of our experience together worked enough to stop you from feeling empty. And so, when you didn't have me, you didn't feel like somebody with something valuable inside that gives him the right to exist. This is the state that leads you to an experience of dissatisfaction that can never be filled except by dropping everything that is inside you and doesn't work, and putting in its place fantasies where you get everything you want, like when you were a child and went to bed and manipulated reality with your mind, and probably your genitals by masturbating.... D.M.: You have told him everything. You have said: "You are com­ plaining about your technique of projecting in me your dissatisfaction, including me i n your 'buts' like an object that cannot satisfy you. In fact, you are not happy with all this, and all these attacks against me i n masturbation during my absence make you feel terribly restless and regressed, back at the coffin on the hearse. You are full of anxiety, not so much about the possibility of me dying during the holiday, but that I might think to myself: 'God! I can't face having to go back to work w i t h that man. A l l the benefit he has had from analysis has not given h i m any knowledge, any feeling of gratitude; everything is a constant moan, moan, moan, and I can't bear i t any more.'"

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His answer would be: "You are threatening me." A n d you could answer: "No, I am only warning you that this is the road you have chosen, on which you are travelling, and the reason w h y you are so restless is because that is how you w i l l end, that is the end of the road." As well as making him see this kind of frustrating march for what it is—the destruction of his analysis—I think it is also necessary to inter­ pret his ideology, interpret his theory that there was once a Golden Age where he was a golden boy until something terrible happened. He has to be shown the evidence that there never was a Golden Age in the analysis and that therefore there is no reason to think that there ever was a real Golden Age i n his youth. What is true is that on the surface, he was a rather egocentric, imperious, and grandiloquent child, while in his dreams he was a persecuted boy—grandiosity on the surface and persecution underneath. I n other words, he has to be shown that what he presents as a sort of historical split, before and after the Golden Age, is i n fact a geo­ graphical division, that because of the projective identification his mind was divided into two different aspects. During the day he was riding on the horse with his grandfather, and from there he enjoyed the identificatory aspect of the projective identification. A t night he suffered the projective aspect, locked up i n the claustrophobia, run­ ning, followed by the coffin, rurming through corridors and walls. It's the claustrophobic part. A n d this is what he has at this moment. He has still got it, but he is more aware of the description of his life situation. He has everything in his life, everything he needs to lead him to happiness, but he is u n ­ happy. A n d he is unhappy because it is claustrophobic. He is being followed by being trapped i n himself, which is i n fact due to the differentiation between fentLnine and masculine. He is trapped having to be a man when he yearns to be a woman. Let's see what he does w i t h all this now. It seems that he is taking a minute's silence, a triumph on your part to make h i m be silent for a minute. He takes the time to reorganize his rhetoric. Lef s see what he does now. Also, I would like to insist that the masturbation is an attempt to preserve the grandiosity of the identificatory part, but as soon as he falls asleep the claustrophobia w i t h all its persecution appears. P: (Long silence) You see? Iam still worse, more disorganized.

We cannot

attack a way of acting that 1 only use because I am at the end of my tether. I don't do it for fun. If I turn to it, it is out of sheer necessity,

because I

don't know what to do; such is my desperate situation. . .. You see? But

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now I say this without conviction; in the past I would have rebelled against you—my irritation would have overflowed, and I would have said all sorts of things to you. Now it is as if I had no strength, as if I were resigned to the fact that it has to be like this. And it seems that you cannot understand that what I do is just taking refuge, a desperate way to defend myself when I am incapable of doing anything else.

D.M.: He is a sophist. His sophistry is quite impressive, and your being able to silence him for a minute before gathering his weapons and reorganizing himself to answer you has been an achievement. He is saying; "You have managed to stop me from bursting out. You have beaten me; I am on the floor. . . . So weak and small now!" And you could reply: "Yes, your grandiosity has diminished. N o w you realize that as far as your emotional life is concerned, you are helpless and impotent and you need help. You can ask for help, but what you don't seem to be able to learn is that when you need help you should say 'please . You also have to learn to say 'thank you' when it is given to you. There is that possibility." 7

LI: Well, I fear I was too soft in my r e p l y . . . . T: And now you felt that I was accusing you of spoiling the good memories of our relationship, the things you learnt, the things you were given, keeping only in your end-of-year balance the things that don't work, and maybe you are trying to say to me that this way of behaving that you turn to in desperation is a childish method, maybe a very young child's method, from a time when one doesn't yet have the words that explain the pain at mother's absence, and father's, and when the memories that one has in one's head cannot carry on working for long and they stop working. It is a shelter that you turn to in order to feel protected in the absence of memo­ ries that work and make you feel secure.

D.M.: Yes, you almost tell him. You are saying to h i m that what this child needs is to learn not to masturbate to go to sleep, and that what he has to do is cry calling for mummy and daddy to come. This brings to mind something very important, more important, I imagine, i n Catholic than i n Protestant countries: the question of saying sorry. I n psychic reality i t is not necessary to say sorry, since forgiveness is a grace. The grace of forgiveness is redundant, and recognizing that he has been forgiven is a precondition for the child to be able to lament the grandiosity in his tyrannical behaviour. The "please" that I mentioned before, asking for a favour, is not equivalent to a confession of "mea culpa", "forgive me", and "please, can I do it?" but a communication that leaves to one side the secretive

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part, which is what the child was doing before; he was doing it only as a secret. In this "please", there is a communication. For a patient like this to realize that the fable of the Golden Age is nothing but rubbish, he'll need to understand that what made him so irresistible to mummy and probably to daddy, although I don't know if he was so attractive to his grandfather, was his helplessness, his impotence, like a little bird flapping its wings. This is what had the energy that compelled mother's services to it. And now we are getting to this point. P: I am not saying that it isn't as you say, but how can I explain it to you? I know that all this is absurd... but I have this sensation of..., how could I explain it? Of being like that deformed monster that knows that if he appears in front of people he can't possibly be loved by them.

D.M.: What he is saying is that when this baby stands there with a nappy full of pooh his mother is going to say: "Aaaaggggh, how disgusting!" This is how I feel. I know that the relationship I might establish with anybody will immediately be spoiled, because no sooner do I see them than my face will show all those feelings of shame, hopelessness, and useless­ ness .. . and I'll have to withdraw into my omnipotent feelings, into thinking that none of this would happen if I had a beautiful body or if I were sufficiently pleasant, if I was able enough to relate to other people. And this happens here too, although it would seem that I am resigned to it, to this feeling of not having anything to contribute.... I don't know how to explain it any better, I can't do it; they are just sensations, but I can't help having them....

D.M.: Yes, everything is there; it is very good. T: You feel that when you appear here, in front of me, something has hap­ pened that turns you into a monstrous person, somebody who cannot be loved by me. You also know that this has nothing to do with what you might think about the experience of our relationship. But you do know that it is something that belongs to the field of feelings that cannot be translated into words but have the quality of turning you, in my eyes, into a monster.

D.M.: No, no, that is not totally true. Do not get diverted; he is telling you to stay with it. He is telling you that he wants to show you this monstrous baby with a hole in his face and another one in his bottom. That is what he is bringing. P: (Pause) Do you know? It made me think that what you were referring to

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could perhaps be defined as fragility. It is the feeling of being somebody extremely fragile, made useless by this fragility and unable to avoid showing this extreme fragility to others. Then I experience this tremen­ dous shame. T: You fear that I might not be able to lovefragile children, children who have a bad time when left alone. You are afraid of turning up after a holiday and presenting yourself in front of me as somebody who was not strong enough to bear the separation with courage, and this might turn you in my eyes into somebody who cannot be loved. This has been happening session after session, week after week, but you and I know that this feeling becomes particularly strong when, like in this case, the separation is longer Time is up.

D.M.: Yes, very good your explanation, but the type of love we are talking about is the love that is awoken by the needs of the baby. It is not that mother sees the beauty potential in this little monster; what she sees is his neediness, and this moves her, it moves her to feel love. The use of the word "love" here is rather blurred because what we are talking about is maternal love, which is grace, pity, compassion, capacity for sacrifice, forgiveness, the capacity to do whatever when she sees that the child needs it. It is something to do with her own maternal, feminine nature, rooted in her animal nature, the result of history, of millions of years, written in her . . . something very powerful. LI: It is something I try to convey to him, but I don't quite succeed. D.M.: True. You find it difficult to get it through to him, but you have to, by working for a long time with this material. It is going to be difficult to bring him in and for him to admit that it is not the love of a man for God, or the love of a man for a maid. It is, if we are going to use the word love, maternal love, the love of a mother for a child who is crying, who has done a pooh, is dirty, smells bad, and needs attention. What it needs is really compassion, pity. Here, too, the word pity is better than pain. This man reminds me of a patient of mine that Catharine [Mack Smith] considers my great triumph. A woman that everybody used to hate—they fled from her. She had done nine years of therapy before, which she had abandoned. She came to me in a very defiant mood and stayed a total of eight years. The crucial point in the treatment came in the third year when she said to me one day: "And on top of it I feel useless, as if there were nothing I was good at." And I said: "You are useless." This comment was pure countertransference because in each

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session I felt as if I had a crying and dirty baby. It was unbearable, each time she arrived at the session I had to prepare myself to think: "God! I've got to put up w i t h this woman." It was like having a baby who has always got a nappy full to the brim with pooh. The patient took about two years to digest that comment, and then a marvellous change took place, a marvellous evolution. Maybe the climax of the change was when she retook her maiden name, giving up her married one which had given her a certain status, that of a married woman—whose hus­ band, by the way, had abandoned her because she was unbearable [D.M. laughs]. It was truly one of the most remarkable and profound changes i n personality that I have ever had the opportunity to see i n a patient: from being a beast to becoming a person one truly loved. Quite extraordinary. The change happened through the dismantling of this historical construction, this historical split, that often presents itself. I n her case, it was a history of having been an unwanted child; her mother never loved her, and later on she became a psychotic. Then everything was constructed like an inevitable history that was being imposed on her. We have to reject this historical construction, simply reject it. A n d once you dismantle it, the change takes place. Sometimes I am rough in my approach, i n my way of treating the patients. When they present this historicity they are locked i n , this "what can one do, it is the weight of History" etc., I more or less say to them: "Listen, I do not believe i n the inevitability of Hitler, I do not believe i n historical inevitability, I don't swallow that." What is a bit more difficult to dismantle is the myth of the patient about the Golden Age, because to a certain extent you also go into it. You say: "Oh yes, it must have been marvellous, riding on a horse with grandfather, strolling along the farm. . . ." But all this is no more and no less than grandiosity. These patients do not thank you for analysing their grandiosity. What they don't realize is that it is achieved at the expense of other people. When he was sitting on the horse with his grandfather, it was at mother's expense, who was down below, on the floor. It has been very interesting.

4

[FEBRUARY

1994]

Margarita Egocentricity and attachment to infantile gratification: irritability, competitiveness, and servility Rosa

T

Castella

Data from the first interview

he patient, a 47-year-old woman, was referred to me by the psychia­ trist she had been seeing for thirteen years. Shefirst went to him when she realized that her husband had fallen in love with another woman. When he felt able to break that liaison, he suggested a reconciliation. As a trial, they went on a trip to Salamanca with their three children. Driving at night, he fell asleep at the wheel; they had an accident in which he and their eldest son died while she and their daughter suffered cerebral concussion. Nothing happened to the youngest child; a boy. She has not been able to take all this on board; she had done the minimum, just to survive. She realizes that everything is neglected .. . uncared-for. She took the children to a psychiatry department to be looked after; they've been having psychotherapy since then.

D.M.: Were they in psychotherapy before the accident? ROSA: N O , after it. Her daughter has left it now because she says her therapist was not able to help her in her last depression. The boy goes from time to time. D.M.: So these psychotherapies have lasted thirteen years. 62

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R: Yes.

D.M.: How old was the patient when the accident happened?

R: 33 or 34 years old, I think.

D.M.: And now, how old are the children?

R: I think the girl is 20 years old and the boy 18.

She feels ill, is not sleeping well, wakes up easily, constantly feels pains in her stomach; nothing she eats agrees with her: salt, fruit, etc. . . . To feel okay she has to follow a strict diet, hut when she is anxious she can't stop eating. She constantly needs to go to the toilet, but no cause has been found for her constant need to pass water. Everybody makes her feel special because of her problems, while she herself feels she is not understood; she goes to see a homeopath, to whom she tells everything. She also has to go to the gynaecolo­ gist because her breasts swell up. She had all these problems before the accident She was ill for two years after the death of her mother, although no cause was discovered.

D.M.: How old was she when her mother died? R: 22,1 think. D.M.: Before she got married? R: Yes. She has pains in her back, for which the only effective remedy is yoga. Regarding her family life, she says that she comes from divorced parents who had both been married before; she and her sister are the children they had together. She is four years older than her sister. She feels humiliated because she cannot achieve an orgasm.

D.M.: Does she have another husband or a lover? R: When she came to treatment she was completely alone—she is the sort of woman that doesn't have friends—and at that time she was getting on well with her children. She is not on good terms with her family either (her sister and half-sister), or with her mother-in-law or anybody. We started a treatment face-to-face, with one weekly session. She could not afford any more. Ifeel that the treatment has been a failure and that the reason is that any interpretation becomes a conflict and produces great irritation in her.

D.M.: How long has she been in treatment for? R: Five years.

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D.M.: Once a week? R: Yes. During this time there have been many problems i n her exter­ nal life—problems at work at the beginning, then she was i n a relation­ ship w i t h a married man that lasted four years (this man had separated from his wife, with whom he had a child who was still a baby). There were many conflicts, and the relationship ended. She has also been i n trouble w i t h the tax office for non-payment. All this made it difficult to find the space to talk about the fact that the treatment was not work­ ing. I finally found the occasion to tell her about this, and I suggested more sessions, on the couch, and talked to her about resistance to interpretations. We set a date and agreed to put the treatment under observation until then. D.M.: That's to say, couch and two sessions. R: Yes, that was the plan, but we had to carry on w i t h just one session, because she had to pay part of her salary to the Inland Revenue. D.M.: When did all this begin? R: A year ago. D.M.: Good. You are doing once-a-week analysis on a woman w i t h terrible external difficulties and a multiplicity of somatizations that don't seem to have any link to any physical problem and who has had bulimic tendencies all her life. We can see that her social life and medical life are indistinguish­ able, mixed up—she likes to be listened to, she has a psychologist, a homeopath, a gynaecologist, a yoga teacher . . . R: A psychiatrist. D.M.: Oh! She has the full stable, a complete set of work beasts. .. . [Laughter] So you have had four years of disappointments and frustration w i t h her. Let's see what's happening . . . I get the impression that the Inland Revenue office has more of a chance of getting something than you do. What does she look like? R: She is a woman of medium height, slim; she seems to think she is very attractive to men, but I feel some kind of rejection towards her. D.M.: Men find her attractive? R: The man she had a relationship with did . . . D.M.: Yes, he must have found her attractive to separate from his wife for her. What's his financial situation?

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R: Very bad; when he divorced he had to pay alimony to his wife and

still made payments on the house, so he was living w i t h my patient

without contributing any money.

D.M.: He wasn't working?

R: Yes, they both work in advertising. His post is more senior than

hers.

D.M.: What kind of advertising?

R: I am not exactly sure what he does. I think he is a director, but I am

not sure what his job consists of. She works editing advertisements.

D.M.: She sounds like a production editor; they probably met at work.

R: Yes, they did, but it is important to know that this job was given to

her when her husband died so that she could support herself; it wasn't

on personal merit.

D.M.: So her husband worked i n advertising too.

R: Yes.

D M . : Very good . . . let's see the session.

Session of 5 August 1993

(last session before the holiday)

She arrives on time. When I go to get her from the waiting-room, she comments that she is not feeling well, that she has had to eat quickly, and that it is so hot.. . . When she enters the consulting-room she goes to the fan and stays there for a few minutes, with the fan on her face. She lies on the couch, pulls her T-shirt out of her trousers, undoes the buttons on her trousers, and pulls her zip down a bit. She remains quiet for a few minutes, as if "letting the air stroke her". D.M.: Is this normal? (Laughter) R: I have never seen anybody doing so many things before a session; she can go to the toilet—which she does nearly all the time—she can stay there for a while, flushing the chain or not. Sometimes she goes to the toilet at the end of the session. Once, when she came into the consulting-room, she began to take her clothes off. I asked her what she was doing; she said that she had put a vest on and she was uncomfortable, so she was taking it off. I left her to get on with it ... [Laughter]

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Something that is quite curious, too, is the importance she attaches to an small problem. For example, eating quickly becomes a serious problem. . .sh can arrive late because she has been cookingfish and hasn't had time to wa her hair, etc. .. .it is as if the most important thing for her was to look after herself. D.M.: She is like a cat totally preoccupied with her comfort. She sits down, licks herself. Okay. Summary of the session

She complains about stomach pains; says that she has felt unwell recently an doesn't know what to do, that in a few days she will go to Dr Gimenez (the homeopath) to see if she can give her something. She says she is very anxiou about going back to work this weekend, that because of her problems with Maria she is not happy, and that she knows shouldn't take these things so seriously. D.M.: Who is Maria? R: A colleague at work.

She tries to explain that people who can talk well and with whom you can ha an exchange of opinions don't make her nervous, but that this woman is something else; she talks about Maria as somebody who wants to take her place, win over her; she says she shouldn't let it affect her, she should take n notice

T: You seem to be saying that it annoys you to be affected by what goes on around you and by havingfeelings. P: (Silence) Probably, yes. [I am surprised—this patient never accepts my interpretations]. D.M.: I think this is probably an important interpretation. This patient manifests a general irritability that makes it difficult for her to tolerate anything that is in the least annoying: she just throws it out, expels it, and here at this moment she has began to think that maybe it is important to tolerate things and not to be constantly irritated sending out spikes that expel the things that annoy her.

She begins to explain something very long and rather muddled about her sca ofvalues, connecting it with something we had talked about previously abou her feeling like a "pariah" and only sometimes like a "person". I try to get her to be more precise. In her view, there is a world ofpeople who only have "goodfeelings", and she admires them. She thinks this ideal world exists, and sometimes shefind

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"marvellous" people who don't need to be rich, just "decent and honest"; sometimes she feels like them and sometimes she realizes that she is full of revenge and resentment, and this makes her feel like a "pariah" I tell her that maybe this ideal world that she is looking for doesn't allow her to "digest her experiences properly, know herselfand be able to accept that inside her there are good and bad things, good and bad feelings ." She agrees; she says that sometimes she can think about what I am saying, but what she can't bear is people with less knowledge trying to teach her, like Maria. I say that maybe she feels that I am giving her a lesson. ...

D.M.: Yes . . . she seems to be listening to you now. R: Yes . . . in this session. D.M.: Yes, it is not usual, but it seems that here you have been able to get in touch; she is interested in going back to Maria, but for the time being she is with you. She is silent and says that she cannot forget what happened with Joan and that I didn't help her; that he was abusing her. (She cries)

R: The patient is angry with me because according to her I did not help her not to lose this man. D.M.: Joan is her lover? R: Yes. The kind of help she had expected from me was that I would be by her side but without interfering, giving her hints about how she should behave with this man. When I interpret this, she says I am not helping her, I am against her. J say to her that thinking back about that ideal world she had told me existed, maybe she saw me as an ideal therapist, she overvalued me, and when she realized that I can't solve everything she gets full of resentment and anger.

D.M.: You are trying to show her here that the split or idealization has turned over. Before, you were one of those people she idealized, and now it's the turn of the other side: now you are somebody who wants to harm her. She talks about having celebrated the birthday and saint's day of one of the children. They invited several friends; she was voith younger people and explained something in a didactic way so they could understand, but then she noticed that her daughter seemed a bit distant and thought that maybe she explains things with an air of superiority.

D.M.: She is manipulating you, by talking about the lessons; she is

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coming round to saying that you are lecturing her. First she says you didn't teach her when she needed it to keep Joan and put up with him, and so she was cross with you; but now she is also cross because you are giving her lessons with—in her view—an air of superiority. I say to her that sometimes she loves being this "ideal little teacher" but that she can see that this puts people at a distance. She says with a laugh that she had again had a dream where she had sexual relationships with women, and that she doesn't know what it means, she doesn't feel homosexual She adds that she went to see her sister but got there late, at 9 o'clock at night, but they had only just arrived themselves; and that she went to visit her brother-in-law, of whom she is very fond, but he went to bed because he was ill She saw her niece (the one she had trusted so much and who had hurt her so much), and she was very happy with herself because she had "stood her ground" and had not kissed her on going in or on leaving. She explains that when they were talking, her niece had asked her what she did when she was not working, which had seemed like a virulent attack to her, and she had replied with another virulent attack: she had said that she "lived". She adds that she stayed watching a film with her sister, and when it finished she felt that she was being thrown out and that her sister had only used her "to pass the time while watching the film". Here she went into an explosive attack against her sister.

D.M.: One moment—she hasn't told you the dream, she has only told you about the dream. R: She tells it later. D.M.: So that at this moment instead of telling you the dream, she diverts to her relationship with her sister, her brother-in-law, and her niece—a relationship where there is a deep split between the brotherin-law, whom she loves, and her sister and her niece, towards whom she feels virulent. The problems about feeling superior or inferior seem to be closely related to competition for the man. She tells me an anecdote about a traffic warden: she informed him that one of the street lights was broken, and when the traffic warden gave her a rude answer she put him in his place; she had been overjoyed at "being able to put him in his place". The dream was that she "was in bed with her niece who put her finger on the patient's vagina. This excited her and she wanted to kiss her on her neck, which she did." This dream had made her very excited and she was afraid she

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would like

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wake up and, as usual, would just feel like going for a pee, but it

wasn't

that She says

their finger

that this dream on her vagina

reminds

her that Joan or her husband

when they were

had put

impotent

D.M.: You have to take the dream and the associations as a whole. She is expressing her revenge; she feels resentful against her brother-inlaw who went to bed because he felt ill, without wanting to spend sometime with her. It is a dream that expresses revenge on men and says that by putting a finger on the other woman's vagina women can give each other the same or more pleasure than men, who after all are just impotent. So one gets the impression that her relationship with women is, first of all, competitive, but when she is disappointed with men— which does inevitably happen—then she falls into a relationship that is not inevitably homosexual but consists in mutual masturbation. What I see in this patient is a very primitive personality, mostly concerned with her comfort, bodily comfort. She is preoccupied with those small pleasures and pains, more than with her relationship with people, which for her is a marginal question. One observes competition, preoccupation with her own body and that of other people, but very little preoccupation with the emotional relationship with people. So the interpretation you gave her, which she accepted, is surprising. It seems that at that moment she was able to listen, and she shows the start of her ability to notice other people and to perceive their impact on her, instead of simply pushing it out with irritation, as she always does. What she is expressing paints a picture where you, her therapist, is in a community of people who have good feelings towards one another. The question we should ask ourselves when she has those good feelings is: does she realize then that there is somebody interested in her, who is patient with her—that's to say, somebody with qualities that have nothing to do with "coming in handy" or "being useful"? That is to say, does she realize that they are qualities, not services? I tell her that there is something control devalued

of the situation,

that excites

particularly

and needy, and that maybe insofar

the ideal therapist,

she feels

her a lot, and that is being

if she feels

ends. She leaves without

person

in is

like her niece or Joan, and that

my interpretations

inside

ing me. The session

the other

as we talked about me not being

that I am impotent

today she has let me introduce

that

paying

me.

her, without

reject-

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MELTZER

1993

In the last session she attended, I interpreted to her her desire to be a prosti­ tute and let somebody else take care of everything. She explained herfinancial situation (she has to pay 2 million pesetas [about £8,000] to the Inland Revenue, and the future looks bleak). For her, being a prostitute and getting money was a way of being recognized. D.M.: It is quite clear that she considers you a prostitute: not only does she think i t , but for her you are a prostitute. You work for money pretending to love; you don't offer your body but you simulate love. I t is totally clear for her: you are somebody who prostitutes her mind. At the next session she called to say she was running late and if she came by taxi she would arrive after the hour. D.M.: Which confirms what we said before: she w i l l have to pay although she didn't come; you are a prostitute doing business. Session

of 3 December

you

1993

She arrives on time. She has a lovely smile on her face. R: This patient often smiles beautifully at the beginning and at the end of the session. The smiles are totally unconnected w i t h anything that went on in the session; she often says thank you on the way out. D.M.: Her usual mechanical smile. Good, okay. P: I don't know what the time is. Is it time? T: Yes. P: I am going to take my shoes off; they are hurting me. I've put them twice in alcohol, and they are still hurting me. So many disasters to explain! I am fed up ... (Silence for a few minutes) Yesterday I was angry and exhausted. .. .lam all over the place with this timetable. I am taking tablets to sleep again. It doesn't suit my stomach. I go to sleep late, I sleep five or six hours, I wake up with stomach pains.. .try to go back to sleep.... I get up late. lama slave to the house. I used to be able to have Wednesday free, now lama slave, I can't go to the Athenaeum, as I would have liked. D.M.: What is the Athenaeum? R: It is a cultural centre where they give talks. Yesterday I managed to go into town. I bought cheese and two cotton T­ shirts in the Corte Ingles. I feel a complete slave; I do not find any

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satisfaction in my children. I have conflicts with Pedro, and Luisa

doesn't

talk to me.

DM.: Who are Pedro and Luisa? R: Her children. Pedro did not have any jumpers or socks. I was going to use my

widow's

pension to buy them for him, but because I get it some months in arrears I would be getting August's

pay now, and since that's the holiday month, it

is less money; then there is the telephone bill...

just as well that Luisa

warned me. You see, she has this friend in America who has cancer, and she called but Luisa wasn't there so she had to call her back and that meant the telephone bill was huge. Until recently I used to get up late, at about 11 or 12 o'clock in the morning,

and so sometimes I could sunbathe. Now,

lems, I get up at 4; on Monday

with all these prob­

it was 6 o'clock

DM.: Is that morning or afternoon? R: It is 4 or 6 o'clock in the afternoon.

(Laughter)

T: You are saying to me that you don't feel well, you are short of money, you have to meet payments, and what you do is stay in bed. You haven't told me what happened

last Thursday

when you couldn't

come. It

would

appear that the more you need help, the less you come. P: I had not digested my food properly when I woke up. I got up and made lunch for Pedro...

then it got late. If I get up before that, I get a headache.

Pedro works in the morning

(as a decorator).

week because this business of giving

I make him lunch twice a

them money and letting them make

their own food doesn't work; they buy ready-made meals. I feel trapped. I would like to live downstairs,

and they could look after themselves,

though .. . Luisa does do the washing T: I think you are feeling very sad.

al­

up.

...

P: It's this wretched weekend timetable. Look, on Saturdays

I have to get up

at 5 o'clock and I arrive home at 12, then I need time to feel sleepy. I wash, I put my creams on, I take a sleeping tablet. At about 2 I fall asleep, and I have to get up at 8.30 because I have to be at the studios at about 12. Sunday

On

I get depressed thinking about the week I am going to spend at

home. When I get back, I put on the Perry Mason series, a series from when I was young; at 2 or 3 o'clock I fall asleep. Sometimes I think about going away and leaving the flat as it is, but at the moment I can't bear to see it like that. I don't feel motivated. It is still not right. Because Pedro is working

he can't finish

everything

we had

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planned; we still have to peel the paper off in the room; it might take him two years to finish.... R: There is always something wrong w i t h this flat. There are always things to mend; it's like a flat where a bomb had exploded and can never be totally repaired; it's like trying to tidy up something that is never finished. P: I can't rely on them; I can't understand why they want to hurt me. T: I think that what you are saying is that there is still a lot of work to be done in your mental flat. P: (Starts to cry) I am not feeling well again; I thought I had got over }odn but I realize I am worse than I was. I think he must be with his wife. f

D M . : She is like a girl during puberty: I haven't got a boyfriend; all the other girls have boyfriends A n d if you ask her, w h y don't you have a boyfriend? She'll tell you that she doesn't like any. (Laughter) P: It must be because Christmas is coming. He'll be with her. I used to say to him that when the phone rang and there was nobody on the line, it must have been his wife who wanted to know if he was there. There are no calls now; she must be with him. T: We have talked many times about you believing that certain impressions you have are true facts. You know that somebody was ringing, but you don't know who it was; maybe now you torture yourself imagining some­ thing you can't be certain about P: Really? What do you bet? (In an aggressive tone) You say I mustn't think like that, but I am convinced that it is so. And the dreams agree. "He was in the next room and I said to myself 'let him be'. I got angry with myself and I thought I should not be so slavish, I grovel too much." D.M.: This dream is a reference to her brother-in-law, who went to the next room; it was as if she were saying: " A n d I am so considerate and nice I don't bother him when he is in bed, but when I turn my back this woman w i l l get into bed w i t h him. A n d you are like them, like those other women: no sooner I turn my back than you'll be getting into bed w i t h him. Tart!" You are interpreting to her that one thing is to observe and another to fantasize and what you get is the slam of the door as she closes it. I t is as if she were saying: "You don't fool me! I know what you are looking for! You are trying to make me grovel even more, but I am servile enough. To get somewhere in this world you have to be aggres­

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sive, and make men get up and do everything. Have you forgotten that women can give one another pleasure w i t h their finger?" Is there another dream? R: Yes, there is another one. P: Another dream was that " J was kneeling on the sofa and he was sitting down and we caressed." The strangest one of all was that "we were in Luisa's room. I was with a little boy and next to me there was a woman friend of mine, I don't know who she is; I had a small boy in my arms and I was bouncing him up and down. She was saying to me: 'Look how good you look when you relate to people'. I looked like that baby's mother, I was playing with him, throwing him up in the air and kissing him. I thought that if I kissed him a lot maybe I would have an orgasm." D.M.: This is a very interesting dream because i t reflects her partial­ object relationship to the penis that makes i t indistinguishable from a baby, so that if you play w i t h h i m and stroke h i m and move h i m from side to side i t can give you an orgasm. It is as if she were saying, the finger is as good as the penis. R: This reminds me that i n the last session she explained that she had seen a film where a woman was looking after a baby and she had felt sexually excited. The woman in the film looks perhaps a bit like you .. . although she is younger; she is 20-something. The baby was wrapped up in clothing, I don't really know if there was a baby.... I've had a strange idea .... maybe it was a penis but not a real one; it was a free relationship, with nice games, an affectionate relationship. . . . D.M.: She is saying that being a prostitute is perhaps something nice, quite natural, great fun Luisa's room is quite nice now; I am going to have a go at her, she works on Friday and Saturday nights; she goes out every evening; she doesn't study; she reads a lot, but she is in a world of her own. T: I think you, too, are like your daughter in her own world, locked in it; sometimes you get excited, masturbating, looking after yourself like a baby, who is my patient-baby too, but there is a baby there. And you think of the penis, as if explaining to me that your problem is that you don't know how to deal with yourself, how to relate to yourself or to others, to be an ideal mother who allows money to be spent on the telephone bill when there is no money, who grovels and lets others spend her money, who is

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servile, on her knees, or putting other people in their place when you are on top; while I seem to be a 20-year-old young girl, an inexperienced young girl

D.M.: True; I think you cover all the material with that interpretation. P: I haven't thought about these things... . What I do feel is that you are like the others, like my parents, who didn't know how to help me, and I can't forget that instead of being on my side when I had the problem with Joan, you could only see my problems. I haven't felt helped. T: It is as if you thought that the relationship here is that of a baby with her therapist, and that I am the only person responsible for what happens to you. P: But he was a good person, although he abused me. From a rational point of view I would not want to have Joan in my house again, but I am still sentimentally attached. T: It is as if you were saying to me that you would like to get me out of your life but, on the other hand, you are attached to me by your feelings. P: Look, you are like my parents, who paid more attention to other people than to me. I would go to my mother complaining that some people were nasty to me, and she would find reasons, "don't take it like that". We got some new neighbours and their daughter had problems with those same people, but her mother said to her, "don't go out with them any more"; then I took advantage of that opportunity and didn't go out with them. It's like the time my father had to defend my virginity. Do you remember that time when to defend me my father had to resort to his machismo? He should have put a stop to it before. Do you remember that when I was 10 or 11 years old I had a urinary infection and could hardly do a pee and because my mother was working so much she asked a tart to take me to the chemist? My mother was everybody's mother except mine, and that tart was like a lost daughter that had to be protected. She took me to the chemist with her man; I saw that the chemist said something confidential to them. . .. I am sure he was saying that it could be a venereal disease. I knew they were gossiping about me. He gave me some medicine but said I had to go to the doctor. They trusted them at the chemist, they gossiped about me. She would have liked to say to me, you are more of a tart than me! They didn't think about me. They were crafty. One day they said to my father that I was not a virgin, and my father knew it was not true. He stood up for me. T: It is time.

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D . M . : She is a very simple person. The interpretation that y o u gave doesn't reach her; i t doesn't get t h r o u g h , because she w o u l d have to t h i n k a n d she is n o t capable. A n y therapeutic benefit that she m i g h t obtain w i l l come t h r o u g h the process of projection and introjection. She is the k i n d of patient for w h o m interpretations are a waste of time. That m e t h o d doesn't produce any results; she is g o i n g to receive i t w i t h negativism, refuting i t or a r g u i n g it. W h a t one has to do is t h i n k o u t l o u d about the type of difficulties she has. Y o u d o n ' t have to teach her; y o u s h o u l d show p e r p l e x i t y about her problems. Y o u can explain that i n that state of unhappiness and continued lack of satisfaction, she finds satisfaction i n masturbation because that has a certain relation­ ship w i t h the penis. A finger o n the vagina excites her, makes her feel better, b u t also makes her feel like a tart. The reason for this is that the fantasies she has i n masturbation are always about getting something f r o m m e n , a l l o w i n g t h e m to use her body, b u t not l e t t i n g t h e m see that she gets pleasure f r o m i t . She behaves w i t h y o u i n a similar w a y , n o t letting y o u see the pleasure she gets f r o m y o u r interpretations, y o u r interest, f r o m the w a y y o u r m i n d penetrates her. A n d the reason she gets so m u c h pleasure is that she feels that she has never f o u n d that type of interest f r o m anybody. She is always so f u l l of complaints and unhappiness that she has managed to drive e v e r y b o d y away. A l ­ t h o u g h there is a genital relationship because of the masturbation, the relationship is oral; she is, i n fact, the type of baby that sucks a v i d l y b u t always moans and p a r t of the m i l k d r i p s o u t of her m o u t h , so she is never satisfied and, i f she is, she is not going to let y o u see it. The last t h i n g she is going to a d m i t is that w h a t y o u do for her gives her pleasure a n d that because of that she is very attached to y o u . So, i n the same w a y as w i t h Lluis's patient, Andres, i t is i m p o r t a n t to get t h r o u g h to her the attraction y o u feel towards her, her neediness; that she is a baby w i t h a m o u t h w i d e open, and that y o u f i n d her neediness attractive—that is her attraction. N o w , c r y i n g babies like this t h i n k that i f they d o n ' t m o a n they w o n ' t get attention. The couch is really i m p o r t a n t because i t establishes a great difference between this rela­ tionship a n d others. I n the others she s i m p l y evacuates, b u t here w i t h y o u she feels y o u r interest a n d , because y o u feel i t , i t shows; and, a l t h o u g h there is a struggle, i t is a struggle for the relationship. I w o u l d advise n o t to take u p a stance as i f " l e c t u r i n g " her; neither does i t seem appropriate to interpret to her. The best t h i n g w i l l be to t h i n k out l o u d , s h o w i n g y o u r interest and l e t t i n g the processes of projection and i n t r o ­ jection between y o u operate.

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The anecdote of the street l a m p is instructive: i t w o u l d seem that this patient thinks that for things to w o r k y o u have to shout at the traffic w a r d e n , that that's the o n l y w a y something w i l l be done. One has to be prepared to p u t u p w i t h a lot of i r r i t a t i o n o n her part; she is the type of baby w h o doesn't give y o u any joy, b u t there is no d o u b t that little b y little she w i l l let go, and the change w i l l happen. I a m sure the first years were wasted time, because sitting u p a n d seeing y o u w e r e too m u c h for her. She is not excessively p a r a n o i d ; there are possibilities of development, b u t i n a slow w a y ; i f y o u p u s h , she'll kick. F r o m an intellectual p o i n t of v i e w she is n o t a n interesting p a ­ tient, b u t she is interesting technically. H e r material w i l l always be p u b e r t a l material, juvenile; y o u are going to have to f i n d a balance between being f i r m and gentle at the same time.

5

[FEBRUARY 1994]

Eduardo On passivity generated by voyeurism Carlos Tabbia

C

ARLOS: I have brought Eduardo here twice before; he is that 31-year-old engineer who lives w i t h his parents....

D.M.: A n d whose father is also an engineer. C: A n d his brother too. A l l three work together. His mother is an orthodontist w i t h her own dental practice. His grandparents own a well-known art gallery. D.M.: Okay.

C: But now they've done something strange. He and his father have set up one company, while his brother has a separate one. D.M.: A l l right. Was i t done amicably? C: Yes, i n fact they all share the same office divided into two areas, but I don't quite understand what's happened because I never know what is the truth w i t h this man: he is so excitable and manic I never know what is the truth. D.M.: H o w long has he been w i t h you? C: A year and a half D.M.: H o w many sessions does he have? C: Five a week. He is a lonely young man; his only relationship is the 77

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analysis, more or less. He forms relationships w i t h manic people that last about three months. He creates great loneliness for himself i n this way. D.M.: What does he look like? C: He has a babyish look. He is tall but very thin; his face is like a baby's face. He can arrive wearing very striking clothes but takes them off when he sits on the couch, and he curls up like a small child. The first time I brought his case here we saw a structural split: in the top part, the baby was producing great fantasies, great thoughts, monuments; i n the bottom part, he had homosexual relationships with his brother (which did happen in adolescence). It is very difficult to get him to listen to me; when I talk to him he seems to fall to pieces. For example, we w i l l see i n the material a "factory-like" output of names— which I find curious—where everybody has the same name. There was a time when everybody was "Carlos"—Carlos and Carla. Now everybody is called "Eduardo", like him. Very strange. At the mo­ ment, all women are called "Elena" or suddenly they are all bank employees. As a result of which, there comes a time when I don't know who he is talking about. D.M.: Okay. C: Only recently I found out that he was only breast-fed for a month, that he cried a lot, and the paediatrician said that the baby was hungry. This is what his mother has told him. These sessions are from the 25th of November and the 17th of January. The week before the 25th of November I told h i m about the Christmas break, and I said also that the two national holidays (6th and 8th of December) would be optional. Session of Thursday, 25 November

1993

The patient's code signal for me to open the door is three rings, hut he rings only once. When he comes in, he says, " I forgot the code." He looks confused. He lies on the couch. P: I had a dream. I dreamt of "the black girl that sings in 'The Earth' [a pub]. She was naked; I remember her breasts. She was talking to me; I managed to get her attention." I ask him to tell me the dream again, with more detail. P: "It was dark, the background had curtains like those ones [in front of the

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couch there is a large brown curtain closing the room off from outside; it is this curtain he is referring to]. I see her naked back. The atmosphere is very intimate. I see her breasts from up here [pointing to his chin]; I was looking at them from here, they were round and separated" D.M.: Is she lying down? Is he looking down? C: I am not sure; she was standing up, and he was looking down. Ps: F r o m where was he looking down? C: From her chin down. Ps: I see. C: They were too close. When he talked about her breasts, he made a gesture indicating that they pointed outwards. D.M.: It was separated, oh! Pointing outwards. P: "Chocolate colour skin. A suggestive image, like a Picasso drawing; the voluptuousness of fatness. I had what I wanted: a close intimacy, but I do not fantasize about going to bed; I was paying attention to her and she to me." Before, I had had a persecutory dream. What I was going to talk about before I talked about the dream was that at the town hall a man and a woman were at their computers; the phone rang and they didn't pick it up; I was annoyed; then one of them answered it but carried on looking at the computer. .. .It annoyed me to see them doing two things at once. My father can't, neither can I. Orlando [a friend] is with his pizzas! Frank [an employee in the studio] does his own thing. (He speaks in a tone of outrage) D.M.: I don't understand. What is this business about Orlando and his pizzas? C: That everybody does their own thing; like the employees who were not answering the phone—they were not interested. His friend Orlando is busy with his things. They do their o w n thing. D.M.: But what does he do with the pizzas? C: H e sells them. He has a business. D.M.: Yes, but what is his role? Does he physically make them, or does he sell them? C: Both. He makes them and sells them. He has machines. D.M.: I a m interested i n finding out what he does, not what his com­ pany does; what he does with his hands and his head, what his hands do.

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C: Orlando is a businessman, he employs people; sometimes he makes pizzas with his hands; they are packaged and exported. I didn't really spend time finding out what Orlando does. D.M.: All right. And Frank? C: He is an employee. D.M.: Employed by himself and his father? C: Yes. D.M.: What does Frank do? C: His job? He is an IT technician. D.M.: All right C: But my patient is outraged . . . "he does his own thing", he says. D.M.: But these descriptions he gives do not seem to be of people who do just what they want, what they feel like. C: They all seem to be working people. They do their own thing. D.M.: Okay. He is presenting this in contraposition to the dream where he and the girl were paying attention to one another, but here these people are only paying attention to their work (computer, telephone, pizzas) but not to him. What he is saying is that when you and he are in contact, that experience of paying mutual attention takes in his mind the form of him looking at naked, chocolate-coloured, breasts (yummy, yummy, nice chocolate); and you are a singer who normally—because that is your job—sings for everybody but here you are singing only for him and he likes that. Eduardo also has another idea, which is that those breasts and that naked body that tastes of chocolate have been created for him by some Picasso-like person. T: You are beginning to establish a relationship between the breast-analyst and yourself, which you find interesting; there is a meeting area, but it is broken by the announcement of the holidays.

DM.: True. P: (Pause) I was thinking about Rodolfo [Rodolfo is an Argentinean engineer who worked with them in the studio; there was some work-related conflict and there is now a court case] Everything in the court case will hinge on the negotiations. I am not bothered. It used to bother me when he teased my father. I never liked Rodolfo from the moment he joined us; he is not a good person.... Yve lost the thread.

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T: You are angry with me because I mentioned the holidays, which are going to interrupt your relationship with the analyst. Rodolfo-me, I think, means trouble and lies, and you don't like that. P: I am going to see Elena today. I thought we could play with her friends and then say to her in her ear: "I want to make love to you" or "Why don't we go and make love?" Justfor laughs. I don't know why I thought of that. C: H e does this apparently with his girl-friends; he goes up to them and says, "let's do such and s u c h . . . " .

T: It is partly that you don't know how to digest the news I have given you, so in order to get excited and create confusion you talk about sex. D.M.: It seems that you can't get h i m to listen to you. It is as if you were saying: I am talking about my holidays, not yours; because I a m going on holiday, I am not saying into your ear: let's go on h o l i d a y . . . . I was talking about my holidays! Your holidays? What is that? The interpretation that he "creates confusion" is very important. It is not that he is confused, but that he creates confusion as a defence. C: Yes, just to muddle things up. Ps: To blur things, yes?

P: My uncle talked about going to Rome, it would be nice but going with my parents is a bore (Pause) It is a pity I turned down the IT course. [He had been offered a course] T: It is a pity that you can't come here tomorrow to put order in your mind. P: On December the 12th I shall go with Eduardo to the bike circuit to practise. It is good fun. (Pause) I have to come here again tomorrow. (Pause). Riding my motorbike in the mountains—what will I look like coming out of a bend? 1 am going to collect the photos my brother took [from a shop nearby]. I was wearing Eduardo's glasses [his friend], poofter's glasses; they covered myface. I don't like it when myfamily look me in the eye. I imagine that it is the last photo ofme and I am going to die. My cousin Eduardo had a picture taken on his motorbike a few days before he died. I don't like my sad expression. T: You said it before: the brown curtains separate things. From tomorrow onwards, you will be alone and it makes you sad. P: If anything happened to you I would be very upset. I don't even want to think about it. Before, during a period when Ifelt very insecure, I used to control people according to how they dressed; I am calmer now. When I leave here and go home, I pass a house with balconies; they might fall down ... on somebody's head.

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T: You are afraid that the breasts-balconies might fall and the relationship will be lost, then your head will feel a lot of pain. P: I can't see a solution; I can't imagine not being afraid. Elena is a real case! Nice. An advertisement for a film: "When a woman finds the man of her life without meeting him" Morbid: meeting somebody by phone; because you can't see her you imagine a lot more; I get the impression that she likes me.

D.M.: He seems quite aware that the idea of you going away is unbearable for him; the balconies might fall on top of you. He can't bear thinking that you'll leave this room, go away and go into the world, and then turn up like the man in the film, the man at the other end of the phone that the girl falls in love with without knowing him, just through his voice. These types of relationships are not based on observation of the other person; they are based on fantasies about being observed by the other person. As when he says: "What do I look like when I come riding out of the bend?" It seems that Eduardo killed himself on his motorbike some days after he had his picture taken on it. What will I look like when I am dead? He gives the impression of being such an egocentric person that he is not just living and acting for the outside but observing himself, on the screen, on the television. He lives his life as an object for other people and for his own observation. It is a type of voyeurism. This mental state is typical of the period between puberty and adolescence, where the obsessive thought is: "I wonder how I will feel when my mother dies, I wonder if I will cry when my father dies, what will I look like at the funeral?" You talk to him about your holidays and his answer is: "Oh yes, I wonder, what will I feel if the balcony falls on top of his head?" This type of displaced voyeurism from observing other people to observing oneself moving in the world is certainly a type of narcissism. This displaced voyeurism—characteristic of the shyness of puberty and adolescence—generates passivity and vanity. The anxiety to obtain somebody's attention, as we see in the dream, is quite immobilizing. It has a pregenital infantile root in relation to feeding, to mother's attentions, to the breast, and to feeling abandoned in those moments. This makes it a terribly sticky position that will not move forwards easily; it will last a long time, and it will be difficult to obtain changes because he is immobilized by the passivity generated by the voyeurism. It is very difficult to make contact with a patient like that, because although the patient is on the couch, he is also on the screen on the couch, and he has a strong sensation of you looking at him and he is busy watching

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how you see him. He is really occupied in seeing how the public is reacting; it is truly a type of vanity and adolescent and pubertal narcis­ sism that generate passivity, where one is an object not a subject, other people's object, desiring only to be other people's object of interest. He does not generate action, or it is silly action, like when he sees the woman and says to her "let's go to bed"; he is playing the role of bon vivant or something of the sort, but if the woman said okay, let's, he would wet his trousers. The reference to the film where the girl only hears the voice of the man she falls i n love w i t h has to do with when he is on the couch: he can't see your face, only hear your voice, and the same thing is hap­ pening to you: you hear his voice; you are both talking on the phone and having your own fantasies (he laughs). Catharine sings a very funny song about the Venice Carnival, called "Take Your Mask Off"; the last line says: "Put your mask back on" (he laughs). But these people actually fall i n love by phone, and if they can keep that up they do not need, do not want, really, to know the other person i n real life; they prefer their fantasy relationship through the phone to being disap­ pointed by reality. We can see that this patient is very similar to Lluis's one. They have the problem of the eyes; of looking at people face-to-face, not knowing what i t is like, how people see t h e m . . . . What is central is the capacity to idealize and keep an idealized image of the object and of the self in the eyes of the object. I n this patient, there w i l l probably also be a golden hero i n some part of his mind for whom he is still yearning; maybe i n his case i t has something to do w i t h the chocolate-coloured breasts he describes. Session of Monday,

17 January 1994

C: This is the first session of the second week after Christmas. In the first week he had come to Monday's session, missed Tuesday, come on Wednesday, arrived late on Thursday, and come on Friday. D.M.: Okay. P: Yesterday, while I had a nap I had a dream: "In a street in a village there was a fair; the king and queen—Juan Carlos and Sofia—were there. There was a raffle stall, and they did a test for the queen, with a crane: a man picked her up [he makes a movement with his arm as if picturing a large mechanical arm picking the queen up and taking her somewhere else]. I look on in surprise. I speak to the king who is in a stall, the sort where they

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make "churros"; he is higher up than me. I am on the street side; I can't remember what we talk about but we were on friendly terms. We walk towards my car, which is parked down the street; we talk about good cars—Ferraris. He asks me what car I have. (I have got an Audi, which has been parked here since Thursday's session.) I point it out, but by mistake I point out a red one that wasn't my Audi but a Seat Panda." I have got a headache, I drank a lot, I was out at a dinner last night. Toni is going to Canada. He was the only person I knew there. We went dancing. I met an older woman, 40 years old. I drank and smoked some dope, it relaxes me and I can be myself. I danced with her, she played along with me. Toni told me to go. I did, then came back, danced, took no notice of her. When I left I went to a sauna [brothel]; the girl couldn't make me come; I took off my condom and I came. It was 6.30.1 called Paul and went to see him. He had been with an American. We didn't do anything dangerous: I sucked his and he sucked mine but we didn't come. Then the car wouldn't start, the terminal on the battery was loose. I drove fast, I was thirsty. It was a strange weekend. On Saturday I called Elena, then Eduardo, but I didn't go out. I woke up depressed. My mother came to tell me off. D.M.: Who is this Eduardo? C: His friend.

D.M.: But there was an Eduardo who died.

C: A cousin.

D.M.: That was a cousin, but this is a different person.

C: He has yet another cousin, also called Eduardo. I don't know if it is

true. D.M.: They come i n groups of three. Yes, and this last weekend they were i n groups of three, so we can start. Ps: Who did he start the weekend with? D M . : With Toni. Toni was going away. With whom did he go danc­ ing? C: With Toni and a girl. D.M.: Then he met an older woman, about 40. So he is drinking, smoking, being masturbated and sucking. It was a weekend of drink­ ing, getting drunk. . . . But nothing dangerous! C: That was on Sunday. On Saturday he didn't manage to go out w i t h anybody. He called Eduardo and Elena and didn't go out. It was on Sunday evening that he went to that party and d i d all that

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D.M.: " A n d m y mother came to tell me off." Mothers are so unreasonable. Okay. T: During the weekend the mummy-analyst is not available to look after you with words, so you look at daddy's penis-churro, sucking Paul's like a desperate baby. The confused baby sucks a penis, confusing it with a nipple. D.M.: It is interesting how the queen has been made to disappear; a crane picks her up, quite simply, and brushes her off the scene. What can it mean? What you say to h i m here is a good interpretation. What you are doing is annoying him just like his mother: " M y mother tells me off." It is quite a change from those chocolate-coloured breasts of November; i n between there has been the Christmas break and so on. His mother is being betrayed here, she is reduced to telling off; the crane comes and sweeps her off. It reflects a collusion relationship, in collusion w i t h the father, humouring him against the mother. Wh o is Toni? Is he his brother? C : A friend, an acquaintance from the faculty. D.M.: H e is not his brother. C : M y patient has a company with his father; he looks after his parents' money, gives money to his father but not to his mother. D.M.: Your patient? C : Yes, m y patient, he doesn't give his mother money. D.M.: I see; he has become the controller of the family's money in collusion with his father. It is quite nice in the interpretation when y o u call h i m "desperate baby": "Sucking Paul's penis like a desperate baby." P: 1 have the feeling this morning that my zoishes are not coming true. I am confused. I took risks with my motorbike. Eduardo has a very powerful motorbike ... you can't overtake it. ... [Here he gives me a detailed account of a ride in the mountains] This morning everything was getting jumbled up. I wasted the Monday morning D.M.: Although he has told you before that i n that drunken Sunday there wa s no danger, here he explains a bit his fear about whether there wa s some danger or not w h e n he says that Eduardo got killed on a motorbike and he has been riding a motorbike in a dangerous way. He is referring to things that are dangerous, though he might deny it. TRANSL: Carlos clarifies that the Eduardo in this narrative is a friend, but there was a cousin Eduardo who died in a motorbike accident.

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D . M . : W h e n he says, " W e d i d n ' t do a n y t h i n g that m i g h t be danger­ o u s " , i t is i m p o r t a n t to ask oneself, w h o was r u n n i n g the risk? I n this case, i t was the queen w h o was i n danger; the queen was there, a crane came a n d took her away. W h e n the boy a n d the father collude, mother is i n danger ( i n relation to her husband a n d to her son): there is an emotional attack o n her.

T: The feeling of loss comes when daddy takes mummy away and you are defeated and sad. D . M . : This interpretation doesn't capture the true meaning of w h a t has been h a p p e n i n g to h i m . W h a t happens is that w h e n the analyst-daddy goes o n h o l i d a y and takes the analyst-mummy, the c h i l d can't tolerate i t a n d w h a t he does is to t u r n the situation r o u n d (as he does i n his behaviour and i n his dreams): he takes d a d d y o n h o l i d a y ( m u t u a l l y sucking each other and h a v i n g a great time), leaving m u m m y to stew i n her o w n juice. W h a t catches h i m b y surprise is the fact that he doesn't feel w e l l o n M o n d a y , A s M o n d a y arrives, y o u have become the m u m m y that annoys h i m , that tells h i m off a n d cannot stand the c h i l d g o i n g away w i t h d a d d y ( " w h y do y o u take m y husband away? W h y do y o u always go away?") Y o u are n o t the m u m m y w h o is telling h i m off b u t the one w h o w e n t w i t h the analyst-daddy, a n d he has n o t been able to tolerate being alone like a c h i l d , so he w e n t o n an escapade. There is w i t h this patient a p r o b l e m about differentiating between w h a t is internal and w h a t is external, w h i c h is also a question of differentiating between a historical and a geographical part, because w e see quite clearly i n the dream h o w he and d a d are i n the f a i r g r o u n d (a representation of entering m u m m y ' s rectum to have a great t i m e — d r i n k i n g , a n orgy) a n d the external mother is s i m p l y lifted to make her disappear. H i s statement that there is n o danger denies the true danger to his m e n t a l health, his sanity. The idealization of the past that w e saw i n Lluis's patient appears here i n the shape of a n ideal relationship w i t h father i n an idealized past that has led h i m to being an engineer and w o r k i n g w i t h dad. I n order to be able to clarify the geographical alterations, i t is necessary to clarify anal penetration: i t is not the p o l y m o r p h i c sexuality of sucking a n d masturbating b u t the anal penetration that changes the scene that is b e i n g l i v e d f r o m one happening i n the external w o r l d to one t a k i n g place i n a n internal w o r l d . This, w h i c h does really happen, w i l l have to be localized and s h o w n to h i m . That is the step: f r o m l i v i n g an external event to an internal one. The ignorance about anal masturbation i n the psychoanalytic c o m m u ­

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nity used to be so great that when I wrote that article/ twenty years ago, it seemed something completely new, as if suddenly I had opened a Pandora's box and was talking about things that didn't exist, as if I were making i t up; and they still tend to treat it or see it i n the same way (he laughs).

They never thought it existed, i n the same way as it never occurred to Freud that Hans was saying something important about having been i n that box with his sister. It simply didn't occur to him. It is very similar to how psychoanalysis is being blamed for all the perverse sexuality that seems to have flooded the world, as if i t had never existed till now, as if oral sex had never existed and now psychoanaly­ sis is being blamed for having invented it. P: This is incredible. Quite funny, I am surprised it is happening. Is it happening now because I didn't see it at the time, or is it something I always dreamt? I am impatient. I want to find somebody that I like to be with. T: You are looking, but from a state of confusion; you are lookingfor a nipple but it gets confused with a penis. P: I was thinking about Paul's sex-aid. I asked him to put his fingers in my arse; he brought a sex-aid. .. .

D.M.: This is really good, Paul w i t h the sex-aid i n his bottom (he laughs); this is very good, very good. C: Is it? D.M.: Very good. C: What is very good? D.M.: Finish reading the paragraph. . . . That morning my mother was talking to me from the other side of the door; maybe she noticed what I had been doing—I don't care any morel People can't read your mind. I don't care if she is annoyed! T: You are saying that mummy should not get annoyed with you because you confuse a nipple with a penis.

Ps: I like this bit where his m o t h e r . . . . D.M.: That's the whole point.

1 "The Relation of Anal Masturbation to Projective Identification/' International Journal of Psycho-Analysis, 47 (1966): 335. Also: The Claustrum: An Investigation of Claustrophobic Phenomena (Strathtay: Clunie Press, 1992).

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C: Yes, I was thinking about that. D.M.: You say to him: Mummy should not have got annoyed that you confuse a nipple with a penis, but really you should have said that you don't understand why his mother is annoyed about only being needed as a bottom. P: Yes. I am also sad because of you, as if I had failed you. D.M.: True. Betrayed, betrayed; she has failed him as a mother. T: Not failed me, but you are not distinguishing between mummy's nipple and daddy's penis. P: I don't understand. I know what the difference is. I don't know what you are referring to. D.M.: Now he turns all stupid. C: Pardon? D.M.: He has not understood. He doesn't understand anything. T: You werefrustrated; the girl didn't take you up; you did with a man what you wanted to do with a woman. The breast-churro was up there in the caravan, and since mummy wasn't there you moved in daddy's direction. P: I thought I was a homosexual. I liked the girl—a tart—but I was having a good time with her. D.M.: Passively, using his passivity. P; J shall have to call Elena to invite her to dinner. I was thinking about Elena now, and I was getting wet. Elena fucks the men she likes. D.M.: She is also a whore, and one can be passive w i t h her. Ps: She is passive because he is also passive w i t h her. P; Am I timid, insecure? T: When mummy isn't there, then the big idealized daddy appears with his big churro-penis and you feel small, a Seat Panda, insecure. P: I don't see the logic of it. When mummy isn't there... but mummy is also an idealized queen. I find it funny. There is an ad on TV about bread rolls—one shape turns into another one; it is like the Audi turning into a Seat Panda.. .. D.M.: There you have the mechanization of the relationship w i t h the partial object. That happens because he doesn't understand that one part of the object (part-object) is interchangeable for another; it is simply a different model. C: A n d so he says it is difficult to understand, doesn't he?

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Ps: Of course. P: The Audi seems like an erect penis and the Seat Panda aflaccidone. C : A t this point I feel lost, confused. D.M.: Here? C : So I start to explain to him J talk to him about the image he has inside of mummy and daddy. P: One has to build characters? (., .) It seems like "The Death Trio". C : Is it a film? D.M.: Yes. It is also "The Four Horsemen of the Apocalypse", and this is the risk of Aids, death, the motorbike, etc. This symbol formation has for h i m immediately the meaning of a symbol of death. It means that when you think about mummy and daddy you are going to have to think that some day they w i l l die. "Oh! I don't want to think about that; I don't want to think about i t . " C : Yes, i t is true; he is very frightened that something might happen to his dad. T: When you lookfor me like a mummy and I am not there, you start to look for me like a man and you have an erection to tell me that you are not so small. D.M.: Drunk. When he was in fact still drunk. P: Yes, it is true. Today I am exhausted; I was thinking about yesterday's dinner; I was happy there although I didn't know anybody; I remember the impression I made as I went in wearing my white shirt and my long black coat Toni is nice. Somebody was playing jazz on a sax. [He talks about the origins of jazz] I played Beethoven's "Clair de lune" on the piano, without any mistakes; it is so beautiful to master an instrument to be able to say something to somebody. D.M.: The beauty of the object—it being possible to talk about beauty and to have communication w i t h the beauty of a woman and then go back again to the chocolate breasts and the possibility of being i n contact w i t h one or the other, person to person. But he can't do that, he can't handle that, because if you tie yourself to living people you have to realize that they w i l l die too. That is a truth he cannot bear. A n d if you can't bear that, it takes all the meaning out of life. This is material from the threshold of the depressive position; it is crucial material. Very good, truly marvellous. P: ... My life has no meaning because I can't play an instrument.

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T: Your life has no meaning because you feel small since dad has such a large instrument—sax, crane—that he takes mummy away and you are left admiring dad's penis-instrument. D.M.: True. P: I imagined my parents naked. I have seen my father naked, but not with an erection. D.M.: Yes. Y o u have a right to imagine that; you have a right to imagine your parents like A d a m and Eve leaving the Garden of Eden but y o u have no right to imagine them having sexual relations—that you cannot imagine; as soon as you imagine that it has turned into a pornographic image. Ps: Very nice. D.M.: Beautiful. So A d a m and Eve's expulsion from the garden means having knowledge of good and evil, knowledge of life and death.

6

[JULY 1994]

Eduardo Living in anal grandiosity Carlos

Tabbia

T

his patient is the 32-year-old engineer who works with his father. I am still lost with this patient, because he talks without any punctua­ tion; the things he says have no meaning for him. He can say in the same tone of voice: "I sacked a 63-year-old employee because I didn't like him and then I went to bed with a girl but ended up in bed with a boy." Tuesday

P: Yesterday myfather was extremelyfidgety; he had been putting pressure on me to change the name of the company. He was nagging me to get the rubber stamps produced.. . . But that makes mefeel contrary. He sent me to have some papers signed in Pueblo Nuevo. I saw there were some triplex apartments still for sale, so I thought: what shall I do with the money I earn? I am thinking of leaving home. In Xavi's house everybody says hello to him; they all know each other; I liked the district, there are veryfew cars, just lorries, it is outside the Olympic Village so it is quieter. Also last week my father was anxious about some work we was behind with, but we weren't really. I had a strange dream: "A worm was getting up" (it sounds like a dildo, I read some publicity about it); "it was of different sizes" (like a cobra rising) "it was an upright worm stuck to the floor with a sucker." I felt anxious. Yesterday I met a boy who has been 91

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operated on for a twisted ligament; today I remembered that I touched the ground with my knee when Ifell off my motorbike and it hurt; did I break something? My kneefeels okay now. Yesterday the girl who does ourflat went to the set where they are shooting a soap. I don't like being on TV. She has blue eyes. She invited me to go with her. She has goodfriends. On another shoot I went to I had a good time. I went with my cousin. We were extras in a San Juan dance in the harbour; three girlsfought to go out with me. T: Was fighting over you part of the plot ? P: They were trying to get me to dance with them. T: You are showing me a devalued image of yourself: a worm sucking like a sucker, and you feeling like a proud worm. P: But the girls didn't know who I was! I feel happy when I do things of my own: a project, winning races; I enjoy being good at things. Bosch said I should run in the world championships. T: The fantasy is: an excitedfather who makes you big through your bottom. P: I understand now. I thought my father was boring and jealous; 1 was talking to Mario and said that myfather should do the drawings instead of telling me off about it: "Don't make my life a misery just because you are stressed/' My father says to me: draw a straight line, a circle.. . . I don't know where he wants me to draw and he gets angry; he does that with me because he knows me. I say to him: tell me what you want me to do and Til do it. It is good for me to learn from my father's experience. It is as if for thefirst time I was listening to my elders. One of the few things I have got left is a father with a name in his profession; I can't do better than being my father's scribe. There are other things that I find satisfaction in: dancing, riding my motorbike. My father said: "Do whatever you like but be the best" He is a very limited man; he leaves very little space for the creativity of the team; he is surrounded by mediocre people and so he stands out D.M.: Here we've got a dream that we have to work with, and this tiresome speech about his relationship w i t h his father and what makes that relationship with his father, which you have interpreted. What seems to be correct is that according to the dream he sees himself as a long faecal filament coming out of his father's bottom; one part of i t stays stuck to his father's anus, but the rest of that filament has quite a lot of freedom to act, to go riding his motorbike, to go out w i t h girls, to buy an apartment. The question is if the truth of the psychic reality is precisely the opposite of that: that he sees his father rather as the faecal

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filament coming out of his own anus, an important father, w i t h a good name, and being able to defecate a father like that gives him a position, a standing in the world. The image is of a small child still in the period of sphincter control, sitting on the toilet, passing a motion, and the mum, sisters, all the women are saying: How marvellous! What a good shape! T: Your retain your father in your bottom and degrade him; inside your bottom everything is degraded. DM.:

Good. . . .

P: I remember that an hour ago I got some shit out with my finger, I remembered it when I heard: retaining your father. The other day we talked about me "being at the mercy of other people". Bosch wants me to enter the race. You tell me that I stare at myself, that I like being looked at. It is true that I like to show off, not win races. T: You don't like learning from your father so much as having him inside your bottom. P: And how do you deduce that? Now that you say that, this morning, in bed, I woke up at 2 (p.m.) happy to have discovered something but an­ noyed that Jaime [his accountant] had called me at 12 o'clock. My life at the moment is total seclusion; if I am not careful I'll end up watching TV like myfather, a terrible life; I see them killing themselves day by day. I've been meeting people lately, I had not been to the Ramblas since I was attacked by a drunkard; I used to go with Antoni—with whom 1 had a homosexual relationship after I had one with my brother; he was in-the army; I am more relaxed now when I go to the Ramblas. In dance clubs one can talk to people. My mother doesn't like crowds so she just watches TV, she doesn't see people. Yesterday I saw that one can relate to the neighbours; I'll try to buy a flat over there. Myfather will be glad because it can be set against taxes, so I'll be helping him that way. My brother does not collaborate. He and my father are not getting on; it is because of that business with his partner; to be independent he depends on his partner; my mother doesn't know what to do. I was afraid you might say it is a mad idea, like the Sarria one. [Eduardo had decided to move his studio to a different building, thinking that he would get it almost for nothing, until he discovered how much it would be and gave up] DM.:

Is there a relationship between Sarria and Tabbia?

CARLOS:

Come to think of it. . .. But I didn't see it at the time.

.. . The truth is that it wasn't worth it. The studio is all right as it is. My parents were fighting today for the TV remote control.

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D.M.: What is happening here? When one sees this confession about having taken faeces out with his finger, one links it i n some way to his parents' fight for the TV remote control. The fantasy he has in his head when he introduces his finger i n his bottom is that dad and m u m are fighting for his faeces. The fantasy is that his parents live vicariously through him; he is the one who relates to people, they just have their TV. C : True. Last week he was saying: my mother is stupid; I am going to buy her a BMW, or maybe a sailing boat for my father. Parents are like little children watching TV and eating peanuts! D.M.: The truth of what is happening seems to be that the only way he can go through life is as an extension of his parents, i n projective identification with part-objects, most probably his father's penis and also almost certainly his mother's bottom. What we also need to know is if he also saw you talking to your neighbours. I mention this because of the paragraph that says: " M y mother doesn't like crowds and so she just watches TV, she doesn't see people. Yesterday I saw that one can relate to the neighbours " The problem is finding the transference i n material like this. It seems that you are seen as one of these people w i t h whom he has homosexual relationships, and either he exploits you or you exploit him; or it also seems that he wants to find in you somebody from the external world with whom he is trying to have a transference relation­ ship. His idea of being useful to his father, which means being useful to you, is to buy a flat and set it against taxes—the accountants' mod­ ern fiction: you can spend more than you earn but it doesn't matter because you set i t off against taxes. The fantasy there is that cheating on the government, getting away w i t h not paying one's due taxes, is the primary aim in life. It is a distortion of dependence, where instead of recognizing that you depend on your objects, you are generous and you give them something, you allow them, for example, to fight over the TV remote control inside your bottom. I t w i l l end i n financial, economic, and psychic ruin, Anorexics suffer from this too, particu­ larly the ones who suffer from the bulimic variety where they eat and take emetics and laxatives. They are so preoccupied w i t h seeing what comes out of them that they can't see that nothing is going in. There is a moment here when he talks about his father trying to teach him, when he says draw a straight line, a circle; the way he talks shows that he is not listening, he doesn't hear what his father is saying. It is like when you say to a young child "Tie your laces u p " "Laces, what

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laces?" "Your shoe laces" "What shoes?" It is negative stupidity. [D.M.

re-reads the last thing the patient had said and reformulates it: "remote control, button on the remote control ofhis bottom"] T: You are very excited today ruling over your parents, and then you feel like a worm, proudly lifting itself up on what it possesses. P: A dildo. I remember I used to put one on a stool and sit on top so as not to have to use my hands. I got some publicity about a dildo that had a sucker. I could see the triplex apartments in my head; it was a proud apartment; I was getting excited. T: You stand up on yourfather's erect triplex; your mother and your brother are merely secondary characters in the TV series that you invent.

D.M.: These are the father's genitals really; it is as if it were something more adhesive than intrusive but it is probably projective identification. It seems very adhesive because it is not fundamentally severe. When he is talking about the triplex apartments being a proud house, he gives you an idea of how he conceives the genital structure of the father. What is this dildo with a sucker? C: It is a plastic penis with a sucker that sticks to the chair, and by sitting on it he masturbates. D.M.: Let's see this anal configuration. On the one hand there are the fingers that get into the bottom to extract the faeces, which seems to correspond to his parents arguing about the TV remote control; on the other hand there is the uplifted worm stuck by a sucker with freedom to move about, but anchored. This uplifted worm . . . seems to correspond to the triplex apartments that give him an anchorage in the world, and it is equivalent at the same time to the dildo he uses to masturbate. The final conviction seems to be that his emotional life centres around his bottom. P: While you were saying that I thought that the girl was nice, she had books. I haven't read a lot but what I have read has left a deep mark in me. I stand in front of a bookshop like in front of the menu at a restaurant: I don't know what to choose. I was astounded when I saw all theforeign-language dictionaries the girl had in her house. T: You cannot learn from yourfather; all you do is put the triplex (dictionar­ ies or a selection of thoughts from your father) in your bottom where they turn into an erect worm.

D.M.: Yes. One can see here that his bottom is feminine and attractive to dad. In that bottom he collects dictionaries and books, and he sees

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and describes it i n a manner that is indistinguishable from his mouth in a restaurant, and has the same function: a place for introjection. What he is saying is: " I haven't read a lot but the few things I've read have left a deep mark i n me, I put them inside m y bottom and there they are, they haven't come out." You understand h i m well and follow him i n that fantasy, he tells you without any embarrassment.

Friday of the same week He arrives twenty minutes late. P: I fell asleep; I was tired and although it was late I stayed in bed five more minutes. D.M.: A t what time is the session? C: 10.15 a.m. The Monday one is at 2.45 p.m., and he gets up to come to it; it is his first activity of the day. D.M.: Very good! He'll do well! P: Why am I cross with you ? I had the feeling that you were not helping me. While I was getting dressed I thought it was the holiday. I went to sleep at 7.30. I was talking with my parents. At 7.30 I had a meeting with my parents' administrators. I reminded them of what we had talked about The administrator suggested that I should be the chairman of the Resi­ dents' Association. TV The chairman is usually the owner of one of the flats, right? P: No, there have been women too. [He talks about some expenses incurred by his father to do with the building, which at the time I didn't understand; later on I saw that it was something to do with the air conditioning.] T: Do you mean that there was a meeting of the Residents' Association yesterday? P: Yes, the meeting opposed my proposal. T: And that made you angry. P: Very angry; it was discrimination against my father. But it serves him right because my parents don't go to those meetings, they used to send Arnaldo—who lives in the building—and he was very good at setting people against my father [he is referring to some expenditure on the building by his father without approval from the Residents' Association]. If you don't do it that way the association never does anything.

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T: Like yesterday, you want to rule my head and that of your parents, hut you feel that we don't let you, so you get cross and arrive late. P: Well, the point is that there is a skylight in the studio that gets cracked because the neighbours throw stones; they should put a plastic cover on it. My father paid 700,000 pesetas and now he is not getting it back. T: You get very cross because they don't do as you say. P: I get very cross that they don't see it my way. T: You dislike the fact that I don't think like you. P: No, it is different. They get annoyed because myfather takes a quick and professional decision so they don't pay the workmen. T: You talked with your parents about all this till 7.30? P: No. We have to leave the building because there are a lot of repairs to be done on the outside and we would have to pay a considerable amount I saw widespread rejection in the Residents' Association. The administrator was not on my father's side. T: There are enemies everywhere. P: Yes, yes. No, not enemies, no, vested interests. I got my own back on the new chairman. My father takes decisions without consulting the Associa­ tion. T: And you want to function like your father: deciding where your parents should live. P: No. My father doesn't want to live here, my mother does. She thinks that if myfather lived alone a tart would rip him off. My mother is happy to go if half of the proceeds from the sale of the flat is assigned to her. I told my father not to worry, D.M.: Is there some possibility that his parents might be thinking about separating? C: His mother expressed the desire but has not done anything about

it.

D.M.: It is the continuation of the subject of his parents fighting for the

TV remote control, his faeces, and he is saying: "just a minute, just a

minute, there has to be an equal share, you w i l l both get the same."

T: It seems as if you were giving yourfather directions. P: No, I told him that my mother would accept half T: You are giving directions. P: No, I am not.

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T: Then supporting him because he cannot think for himself. P: They don't speak to each other, they don't communicate. It is difficult to talk to my mother. I said to her: do you want to keep the flat? T: You are concerned about their spare time and think that you have to give them directions. P: Yes, true, but I told my mother that I had sorted things out in the studio, and that I come here without consulting anybody, and went to the Resi­ dents meeting. Then they listen to me! T: This is an odd kind of speech: you are worried about your weekend; you treat your parents like little children so as not to have to see that you are frightened at the arrival of the weekend. D.M.: I think that there is something here about the truth, about his anal introjections; he is penetrating i n order to see what is going on, and this is the transference to you: as he penetrates he organizes a grandiose fantasy where he is sorting things out, setting order, distrib­ uting. He has been saying no constantly to everything you were saying. C : Before we go on I would like to comment on something that repeats itself: i n the middle of the week he spends time talking about every­ thing he w i l l do during the weekend, on Friday he retracts, and finally he doesn't do anything. P: (Pause) I shan't go to the track [the race that Bosch had suggested] or on my motorbike [he bought a very expensive motorbike but doesn't use it]. D.M.: A n d where does he get that money from? C : He took i t from the company's money and registered the bike under the firm's name. D.M.: I n order to pay less tax. That's the way it goes i n companies: you must never show profit, you build and you build but you keep i t empty of money because if you show benefit you w i l l have to pay taxes.

J want to go and see the flats with my father and some other flats by the same architect. You should leave aflat afterfifteen years and we've been in it a lot longer; it's better to leave. T: It is as if you were dad's partner buying the nest. Mum can stay on her own; that way you avoid feeling alone with regard to mum and dad. P: Yesterday when I came backfrom the meeting I wanted to go out to dinner with my mother; you can't go out with both of them, because they are not talking to each other; my father wants to leave.

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T: Maybe you want to come out ofyour parents' head, where you are a sort of mental guidefor them. P: I was surprised; I said to my mother: I want to live well. I said to my mother don't you think that if your mum had treated you better it would have been betterfor you? It would be betterfor me if you two didn'tfight. T: You are frightened because you feel responsible that your parents are fighting as a consequence of your directing their minds and setting them against each other.

D.M.: It is one of those situations where you can't help thinking that the parents are a bit mad, but the madness is not clearly visible because there is so much money. The money is hiding the grandiosity in this family; the whole situation is charged with grandiosity; one thinks of . the TV series Dallas, with millions of dollars up and down. C: Is this patient a psychotic? D.M.: No . . . it is difficult not to be grandiose when one is rich. C: He is a poor 32-year-old young man, an engineer with some potential, but he walks about bent like an old man. When he comes to the session, which is the only thing he does, his hair is still wet from having just got up and showered. D.M.: He is his father's messenger boy. I think you have to find this boy in the transference; it is not very useful to follow him in the grandiosity of his external life. To examine him in his relation with his father is to see him in the projective identification, and then you can't do anything. The role played by the Residents' Association in this material is important, I think; it seems that they are a body one has to consult. Everything he describes is action:; his father does things without permission, without consulting the residents; his father and mother do not communicate; his motorbike is mere action; in the whole communication he presents to you, the only element he insists on is that he should be told, consulted, and there should be communication in the Residents' Association. Did somebody suggest that he should be the chairman? C: The administrator did. D.M.: When you say to him that the chairman usually is one of the owners, he answers no, there have been women in the chair. Total lack of connection. It is difficult to establish real communication with him; he goes a different way and answers your comments with negatives. C: The only way I have of making contact with him is if I talk to him as a very little baby, but it makes me uncomfortable having a big chap

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like him and talking to him in that way; he goes all soft, just like a baby, changes his tone of voice; the rest of the time he goes into that expansive behaviour of describing, narrating.... D.M.: Oh yes? Why does it make you uncomfortable? C: Because he is a big man.... Isn't it a farce? I wonder. D.M.: No. Most probably that mummy-and-daddy language suits this boy who is still in the phase of sphincter control, terribly interested in what comes out of his bottom or what goes in through his bottom. It is true he is a great confusion creator, and it is difficult to understand what he is talking about, because he says to you that he was talking with his parents until 7.30 and when you repeat "you talked to your parents until 7.30" he replies "no, no".. .. You really don't know what he is saying; it is important to force him to be specific about what he is saying, describe it better. Because once you make him describe exactly what he is narrating, then with factual knowledge you can say: "How stupid, that is a lie!" In a way you have said that when you say: "there are enemies everywhere"; "paranoid rubbish"; but he slips away, you lose him: Not enemies, no—vested interests! For example, when you say to him: "You are angry because they don't think like you", he wriggles out of it. "No, no, they are angry because my father acts without consulting anybody." What he is telling you is nonsense, rubbish; a lot of rubbish comes out of his mouth, and you can take that and tell him clearly: "you are undifferentiated, confused." For example, in this passage when you say to him that he is directing his father's mind, and he says "no, I told him that mum would accept half" and you say "no, you are directing, controlling" and he answers "no, I don't direct", you can extract that in the transference he is guiding you, controlling your mind; he is not giving you sufficient evidence so that you can form your own judgement, but telling you what you have to think, programming you. He is a difficult type; the grandiosity that people get from having the possibility of manipulating large quantities of money is a big impediment. He reminds me of a patient of mine, a wealthy homosexual who three years ago got involved in a charity project and I thought: good, he is going to lose all his money, and he did—he lost his money and began to get better. He was depressed but better, and little by little he recovered everything, and as he recovered his money his arrogance came back, his independence, his grandiosity, his homosexuality, his perversity, and so for the time being we've had to stop the analysis. He livesin a grandiose world, the world of art; he

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is an art dealer. His skill consists i n accumulating the pictures he has bought from artists, and his game is betting on works of art. Part of his grandiosity consists i n the fact that he thinks he is an artist. C: M y patient, too, he says he has brilliant ideas. D.M.: It is very difficult to penetrate, to move, this aspect of grandios­ ity when the person lives i n a world where that counts and accrues success. Being i n the public eye is what is important, what people deal in. C: But i n this patient I think that the reality is not quite that: i n fact, i n his studio there is no work. D.M.: The world of money is not real, it is not there, it is a fantasy; half of it is a fantasy; art dealers can say they have millions i n pictures, like my patient, but it is all a fantasy, like all the bridges you have built or are going to build. . . . Fantasy comes along, pulling i n all those who want to believe in it. The dream of the beginning, a beautiful dream, is telling you that he is the w o r m stuck to you, you are the dildo, he has got you stuck to h i m for five sessions a week, he comes here, mastur­ bates, and you have no option. C: Yesterday he brought material related to that—I would have liked to bring it here today—and at the end he was saying that he would like to have a homosexual relationship w i t h a man of about 50, w i t h expe­ rience, and he shouldn't be a man who is drawn into a relationship w i t h a young homosexual through excitement, but that i t should be somebody of 50 who has chosen men as his option. That's the type of man he would like to have a sexual relationship with. D.M.: He is saying i n that communication: " I w o u l d like it if you enjoyed this as much as I do, being stuck to your chair five times a week while I masturbate, I would like you not to reject it, to like it, to find pleasure i n these things and together we would transform i t , conceive it as a great aesthetic experience." Unless you stick very close to the transference you get lost i n this labyrinth. You have to say to him: "being used as a piece of faecal mass in your bottom is not a great aesthetic experience for mef" Of course, this kind of interpretation implies a threat; it is saying, "you are not going to use me i n that way indefinitely", but I can't see a way of avoiding a threat in an interpreta­ tion of this kind. It is true that the patient is going to experience it as a threat, that you are going to feel threatening, which is true, you are: you are threatening his grandiose way of life. A t the beginning it can

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be interesting to see this configuration, but as the time goes by and you see no progress you stop being interested. I wonder if there might be a thought disturbance, because when you say to him, "doesn't the chairman have to be one of the owner­ occupiers?", he answers, "no; there have been women chairpeople".

7

[JULY

1994]

Montse Incontinence and omnipotence in the world of the infant: coming out of the claustrum Rosa

Castella

I

supervised this case with Donald three years ago. The patient is a 35­ year-old woman. After that supervision Ifollowed Donald's suggestions: explaining to her in the first place that she lived in projective identifica­ tion, that I was a visitor to the claustrum, and I described to her the world she lived in. The next day she brought me this drawing. As we'll see later on, this is a woman who writes, paints, etc.. . . She has a very creative side. These are the drawings she used to do before; I brought them so that we can appreciate the change. In the second place I started to treat her like a little girl, explaining that I was her mummy-therapist and she my patient-child. Soon afterwards she brought me this drawing. 1

D.M.: It is an unpretentious drawing—a normal one for an 8-year-old girl. Another thing that Donald advised was to increase her responsibility for her self-aggression. She had tried to commit suicide twice before; she had thrown herself in front of cars and had had to be admitted to hospital with concussion.

The case is described further in D. Meltzer & The Psychoanalytic Group of Barcelona, Psychoanalytic Work with Children and Adults (London: Karnac, 2002). The drawings mentioned are no longer available. 1

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From that point onwards I had in front of me a little girl full offears. She still sleepwalks, getting up at 3 o'clock in the morning, delirious, although it might just be masturbatory fantasies. In her delirium she is always some marvellous character, such as ambassador for peace, or the person Mandela has chosen for some important mission and he sends her money. Or she gets the most votes in the European elections, etc.... This happens at night when everybody is asleep, and the storylines vary according to the political events that attract her attention. DM.:

What is her actual work?

Rosa: She is a graduate and has worked as a librarian. At the moment

she is unemployed.

D.M.: Okay.

Soon after I followed Donald's guidelines with her, her grandmother and a cousin who was the same age as me died withinfifteendays of each other. Her cousin died in a matter of a few days from a brain tumour. Montse got worse, cried, and went into a guilt delirium: blaming herself because she was bad, that she was bad because she hung her clothes with plastic pegs instead of wooden ones. Another thing she used to say was that we had to pay for th boat orfind the yew tree. She used to say this without reference to anything totally disconnected and suffering visibly. She has been in hospital three times, always because there was somethin that proved that she was not so powerful and could not control the externa world—for example, the death of people. There was also her not wanting he brother to have a child, because that would deprive her of the special privilege place she had with her mother, so she would give the couple books or invite them to the cinema to distract them from making love; but her sister-in-law got pregnant, and that proved that my patient did not control the situation, so she burned herself as a punishment. She came to sessions with burns on her arms, to the point that the psychiatrist decided she needed to be admitted t hospital as she repeatedly burned herself and she had high temperatures. DM.:

How does she burn herself?

R: W i t h the hot coffee-maker that she has just taken off the stove—she presses it against her a r m . . . .

She wants to control the world; she wants everything to be as she wishes; al that she knows about real life is of no use.... She is unaware of the month we are in or the time ofday, but she doesn't care; she knows but she doesn't care Recently she has been wearing leather bracelets, and she shows them to m and says: "Look how many precious stones!" And I say, no, it is leather. . .. She is alwaysfightingto try to get things to be the way she wants. She has ha

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a drawing phase, a poetry phase, and now she is on short stories; she doesn't just read them, she writes them as well She would associate poetry in the middle of a session and I would connect them to the situation in hand and to feelings; she would deny that and say that the important thing in poetry is the form, never the content She has also made connections to short stories, which I interpreted. Now she is writing her own stories; they are well written, in a very poetical language. Before I started seeing her, she used to write without any punctuation and the writing lacked connection; now her writing is very beautiful Her flat has taken on a very important role in her life, and she spends a lot of time decorating and beautifying it She is more in contact with her feelings and has a closer relationship with her mother. Her mother is more in the picture now; they see each other more frequently. Her mother makes her eat, she is interested in her; she is being a mother. The patient also has more physical contact with her husband, but there is no sexual contact—she takes him by the hand, she goes near him. I have brought two stories, but I don't know if we'll have time to read them; maybe the best thing will be to sum up the theme of the last one since I refer to it in the session that we are going to see. She gives it the title "Another Version", and it is another version of the story of Adam and Eve. In "her" version, Adam was a man who abused Eve, then the serpent wooed Eve, who left Adam to marry the serpent. Perhaps we could start to look at the session. I see this patient three times a week. She is married, has no children. Session of 3 June 1994 P: You've made me wait a lot... ! T: Bad Rosa! R: This answer of mine has to do w i t h a discussion i n the group supervision about the fact that this patient never wants to talk about anything bad i n her. It was suggested to me that I should stress the occasions when she experiences me as being bad so as to open a door for her to talk about her bad side. It has worked well; she is now more able to talk about her violence and bad side. D.M.: Okay. P: Can I ask you a favour? Only one. I have to go to sign prescriptions and I have to be in Villafranca early.... J would have to catch the 6.45 train but to do that I would have to leave at 6.25. So that it doesn't happen again next week, I'll ask them to change me to Thursdays. Can I?

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R: She is on very strong medication; the prescriptions are given one at a time so that side-effects can be followed up. That's w h y she has to go frequently to get them. T: Can I? R: I don't answer her, because sometimes she lies and I am waiting to hear more. P: Leave at 6.25? Or a bit earlier (In an accusing tone) Also you see it is already later than it should be... T: Bad Rosa! You made me wait two minutes! P: Yes, two minutes! T: That bad Rosa! P: What do you mean, two minutes! Tve had to wait a quarter of an hour. T: Your session is at 10 to and it is 5 to now, and we've been herefor a little while already, so you can't have waited a quarter of an hour. P: Oh yes, oh yes. T: The thing is that you prefer to insist on the time instead of saying: "It felt long waitingfor you. P: It felt extremely short! Oh well... I don't know. ... Do you know what has happened? I wet my bed.... J went to sleep at 1.15, woke up at 4.30, and I was completely wet. At 8 o'clock I called Manuel softly and said to him: "Manuel I've done a pee .. ." (very sweetly). .. . We got up and turned the mattress upside down, and changed the sheets.... T: A little girl who wets herself.... P: It just happened! I don't even realize it! I don't know what to do! T: Like the words that just slip out of you here—it was two minutes and y ou said a quarter of an hour. You just talk without thinking; words slip out.. . . P: My wee slips out. It is embarrassing! They made me go to sleep in outpatients today; they said I was too excited to do anything.... J slept on Snoopy's blanket. ... R: She goes every morning to an occupational therapy clinic where they do activities: drawing, crafts, music. She always wants to leave before it is time; she does things very quickly and finishes before the others. She has very little patience, so they say to her she can stay on and have a sleep.

.. . At the clinic they are organizing a camping trip for three days in September but I am not going; I wet myself! There is a woman who comes on Fridays; her name is Montserrat, she teaches us singing and I sing a

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lot.... I've changed the sheets, washed them, then I looked at the room— it was so beautiful! T: You are telling me things about yourself that you are not happy with, but in the end it is as ifyou were saying: "Look at the beautiful things in me!" P: Listen, lam going to run in the European elections.... T: It seems that you are trying to cover up the things you are embarrassed about by putting yourselfforward as a model to others. P: Manuel says to me: "You wet yourself everyday!" (She laughs) What with thefact that we don't make love and I wet him ... the poor chap ... he is going to end up feeling desperate.... Today we get the keys for the new shop. We are going to have two premises in the end; they are linked. ... It is going to be the biggest bookshop in Villafranca, and it is not rented, we have bought it. Manuel says we shall soon see how it goes; we'll be short of money the first two years and then we'll be okay. However somebody told Manuel that one can see in the first six months whether it is going to work out or not. ...Ifit doesn't work out we shall leave one of the premises. ... Tonight we are having dinner with our two partners. Manuel wants us both to go but I might stay at home, because I don't fancy a sandwich, and if that's what we are going to eat... . T: You are explaining to me that you could take the risk of doing something new; it would be an improvement, but there is a girl who wants to eat what she fancies, and that stops her from growing up.... P: You see.. .1 went to the toilet just before I left Villafranca, but as soon as I got to Barcelona I had to stop in bar X to go again.. . . T: You camefull of things you wanted to tell me, since this is the last session before the weekend, and you were afraid that you might "wet" me, that all the words would come out of you and you wouldn't be able to contain yourself.... P: No, no ... not you, but I do get Manuel wet... even his pyjamas, and I said to him: "I am sorry old chap. .. ." It was 4.30; I needed a shower when I woke up ... the lot. . . . This is not right. .. . What am I to do? Everything happens so quickly. ... T: Maybe you should think about what you say, contain it in order to say it correctly. P: Look, we have to go to a wedding. .. . But my mother doesn't want to go; the invitation says "morning suit" How ridiculous! My mother says: "They are shit", "they are show-offs".

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T: I suggested something that you should do, which you don't do, and then you remembered the invitation. Maybe when I say something you don't like you would like to answer: "You are shit, you are a show-off." P: No, no. I didn't say that. ... Listen, I see Mandela every day, and he is doing a campaign for me to collect money to get me to stand for the European elections Will you vote for me? T: "How I love to think that I am wonderful when I don'tfeel right.

P: Look, I bought these rings, I thought I had lost one and I bought this othe one. Then Ifound it. Now I have one on each finger.... T: "How I love to show off. ... And to think that you see me full of riches. P: You are very well dressed today; I don't like pink but still....

T: "I don't like Rosa when she realizes that I make upfantasies to impress he and she talks to me as if I were a child who wants to be a mummy."

P: Look, I had straightened up my fringe but it has gone curly again, it is a mess now. When I get back from collecting the prescription I shall go on my terrace and get the hosepipe and have a cold shower in my pants and bras. Manuel has forbidden ii though. It is great to go under the cold water! Fuaaaaa .. J Then I hose down the terrace, and if he asks "Did you have a shower?" I'll say "No, I watered the plants."

R: She does what she likes everywhere.

T: So, you are telling me that you are determined to do only what you like— I can say whatever I like, you still will do as you please. P: Look—you, Manuel, or Alberto can say what you like, I don't care. When I don't have to go to the clinic any more, I am going to adopt a baby, whether you like it or not. T: You are being "Adam" now.

R: In the sense that in her story Adam wanted to do what he liked and was not kind to Eve, P: What did you say? T: That you are being Adam. ... The boss; she who must be obeyed, who thinks that there is only one important person and that is she. P: Oh lovely! Carry on laughing at me!

T: I am not laughing. There is a superior Montse, who want us all to obey her, who won't be told what to do, who wants to impose her will on other who doesn't care is she wets us, but who has also written a story where Eve leaves Adam. Montse knows that if she behaves like Adam, being

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rough with people, she jeopardizes her relationships with them, with Manuel P: I also do pi-pi when we go camping, so what! Mercedes has said to me that there is still a long time to go before September and perhaps I'll be calmer.... T: It would be good. It would certainly be a good thing if you were to calm down and think about what you

do....

P: What have I said? Did I say something? T: We are well into the session

now....

P: But I haven't said anything yet... J don't like very much this lark of you being a psychoanalyst or whatever. T: You don't like Rosa the psychoanalyst. P: I like having fun with you. T: What do you mean by having fun with me? P: You letting me stay here, in a little corner... [she points to the space next to my armchair], and I would take you in my pocket, and then during the train journey I could take you out and then put you back in my pocket T: We would be stuck together; we would not separate; the weekend is coming up.... P: (Alarmed) The weekend? T: We won't see each other for a few days. . .. P: Why? (Anxious) Are you going to have problems again?.... say that?

Why do you

R: I had an unforeseen operation and was unable to see her for a few days; I gave her very little notice. D.M.: These are the problems she is referring to. . . . When did she start wetting her bed? R: Recently. D.M.: She is behaving like a very little girl. R: In the last sessions new anxieties have appeared, money for example. How much is this worth? How much is that? How much do I charge her? Does she have to pay me the same in short months or not? And so on. T: We are not going to see each other until Monday and it seems that you would like to take me in your pocket, which means that you have no desire to separate from me. It also means that when I talk to you "in a psychoana­ lytical way" you realize that I see things differently from you, that I am

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differentfromyou, that we are not "stuck together". ... Then you say: "Down with psychoanalysis!" P: Well, I don't like it, I don't like psychoanalysis, I find it stupid. ... According to Woody Allen, in psychoanalysis one always talks about sex. .. . And I... I have been there, done it (in an arrogant tone) ... I have gone past that phase, I am over it. ... T: Goodness me! You really are wearing your morning suit! P: (She laughs, amused) Those are my lines!... that reminds me, I have to find an excuse not to go. Manuel doesn't want to wear morning suit; my mother has sent her excuses already and I have said to her, "Save me! Find an excuse for me", but she said, "I have made mine; you can find your own" I will say: "Look, half of our employees are on holiday and we are getting a shop ready for July, which is when the wedding is, so we can't come." Til add a bit to make it sound just right: "I love Jorge as if he were my brother, I love him to bits, but I just can't go to his wedding." Does it sound okay? T: Yes; a little girl is asking mummy for help and mummy says: "Grow up" ... and it seems that when you want to, you know how. P: Yes. I know I have to go to the clinic, and come here and go to Alberto's [her psychiatrist]. This time I am going in the morning, so it is not going to clash with my coming here. But the truth is that I have made the change on my own with Alberto, so that Manuel doesn't have to come with me.... R: The change she has asked her psychiatrist to make is so that she can go without her husband who tells the truth and she feels that she cannot say what she wants to say, so she prefers to go alone and handle things her own way. T: What you told me about having to go to sign prescriptions, is it true or not? R: She is trying to tell lies, which everybody can see for what they are. They are little girl lies that don't fool anybody. P: Yes, of course it is true. I have run out of tablets for the weekend. At the chemist they will let me have one lot without a prescription but then I have to take them to the NHS one. I went to have a massage yesterday; it was wonderful. .. . Is that green book a new one? What book is it? I do think it is new. R: She knows to a tick what I have on my shelves; she detects any change. . . .

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T: "What is this new thing on my therapist's mind?" P: Don't go to the beach this weekend. There are jellyfish; the beach is very dirty. T: "What waters is my therapist going to swim in?" "What semen full of life will wet my therapist?" P: You gave me a phone number once from Maresme. Do you have a house there? It is very ugly round there.... Why don't you buy a house in the Costa Brava? T: You place me in the ugly Maresme with a dirty beach Maybe you need to turn everything that surrounds me this weekend ugly so as not to feel jealousy. Rosa full of dirt— that way, it is easy not to feel jealous. Rosa attacked by Montse's wee. P: Yes. I do wee far too often. Manuel is beginning to get tired. ... He said today: "There is nothing we can do." I don't know if it is the orange juice that I drink before going to bed or the milk ... even though I go to the toilet before going to bed.... (Pause) What are you looking at? T: I am thinking about what you said ... since you talk so much I need time to think P: But I haven't said anything! T: Pardon? P: I said I don't say anything ... it is you who talks all the time; you don't shut up.... T: It seems that you didn't like what I said to you and you need to say: "It is you who can't bear the wee wee-words." P: Montserrat came to the clinic; she looks like you. I talked to her about medicinal herbs; she said: "You sound like an encyclopaedia." (She recites a verse on the properties of some herbs)

R: This Montserrat is a teacher in the occupational therapy clinic. T: It is as if you were saying: "How I would like it if you said the things Montserrat says instead of what you say! That would be so nice!" P: Exactly. Why don't you? I always make an effort for you, like straighten­ ing my fringe, for example, but it was so hot in the train it has frizzed already. We still have those old trains; we haven't got the new ones with air-conditioning... my hair is frizzy again. T: It is as ifyou were saying to me that when you have to accept that you are interested in me, that you think about me, that you need me, and that you

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do things to please me... [she interrupts me; I can't understand what she says] P: .. . Why don't you do the same for me?

R: Whenever I tell her that she needs me, she gets very annoyed. T: "I would like it if you felt the same way as I do" you are saying to me, and f

I reply that I am interested in you. P: In what about me? T: In your mental state. P: Even now that I am the least serious patient? T: I never said you were the least serious patient...

P: Alberto [her psychiatrist] told me I was his most serious patient He is stupid.... T: It is as if you said to me: "If you tell me that I am not that least serious patient that I would like to be, I shall say: Rosa, you are stupid." P: I will only say it once. T: "I insult anybody who doesn't tell me what I want to hear." P: Why does Alberto say that to me? He tells me I take the most medicatio out ofall his patients; if the others are silly and don't take it, I am sorryfor them.... T: You are sorryfor yourself.... P: No. I am sorryfor the doctor who has to sign my prescriptions, because of all that extra work.... T: I think it is something you don't want to think about, you don't want to think that you need help. ... If you were more able to think that you need help, you would pay more attention to what I say, you would listen more....

P: But, you don't say anything.. .. Today you've done your hair hippie style, just like a hippie. ... And now I am going to have to take the train and go to Villafranca.... And be hot again.... Since I haven't got my card now, I shall buy a second-class ticket I'll get in the first carriage and be the first to arrive. I'll walk quickly along the Ramblas without stopping to say hello to anybody so am there quickly to sign the prescriptions. And then.... 7 don't know, I haven't got gazpacho, I don't know what I am going to eat, a salad, so I don't have to go to have a sandwich later The thing is, you see, because Manuel is going to pick up the bill he takes our partners to a bar so dinner isn't so expensive. He is so cheeky. Tight­ fisted. ...

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T: It would seem that the session isfinishing and you are telling me that I am cheeky, that you would like more than I give you, and that in fact I don't give you a lot, just scraps.... "The weekend is coming and you leave just some scraps for me." P: I shall tell Manuel that you said he is tight-fisted.... T: I didn't say that. What I am saying is that you think I have given you just scraps .. . it is as if you were saying: "I am not satisfied with what you give me, I would like more sessions, to carry on. P: No, I told you I wanted less sessions, I decide.... T: We did it this way because I thought it would work.... P: Because I asked you T: I thought about it and accepted it.... Our having come to an agreement doesn't mean that you decide.... P: I decide.. .. T: You are being Adam again. ... You love playing Adam, but this means that things don't go as they should: when you are sharing a bed you wet yourself, you attack the truth with your wee, the truth that we had been discussing and on which we had come to an agreement. P: It slips out, I can't help it!. ... T: It is time P: All right, next time I'll say I'll go on Thursday. . .. T: On Thursday? P: Yes, so that I don't have to leave here earlier Ps: Did she leave on time? R: A bit earlier. D.M.: You have a true baby who doesn't stop talking; she is incontinent, omnipotent. If what you wanted was to get her out of the projective identification you have done it. What you have to do now is describe to her how a baby sees the world. This case reads like a baby observation; it is lovely. It seems that at the moment you are mummy, Manuel is dad, and Montse is allowed to get in daddy's bed but without having intercourse, although dad is quite permissive and lets her wet the bed. It is quite clear that the idea of getting in bed and doing wee and being between mummy and daddy is to stop daddy from wetting mummy with his semen, which is why she tells you not to go to the beach.

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The question she is asking herself is whether she is a good baby or a bad baby, and what she answers is, "I am a good baby and you are a bad Rosa", and the criteria she uses to evaluate good and bad are very simple: if you are present you are good, if you are absent you are bad. So long as it is she who decides whether she comes or not, she is good; but when you are not there, you are bad. But it seems that she is beginning to see that she is not such a good baby. She is really making a lot of work for Manuel; she doesn't let him make love. It would seem that she is imagining leaving Manuel because she likes Alberto; she is imagining leaving Adam (Manuel) to go with the serpent (Alberto) who gives her pills (apples). When she says that Manuel is tight-fisted and you interpret that she thinks that you are tight-fisted because you don't give her more sessions, you are making an absolutely correct interpretation. There is a really important moment, when she says to you that she could take you in her pocket and then take you out. She says it with absolute innocence. It is an attempt to introject you; in a certain sense she is accusing you of not allowing her to, because you still have your own life outside. I think you should talk to her about the mysterious things that the baby doesn't know about, doesn't understand, that she has inside her a space that she calls pocket, and that she would like you to occupy that space but she doesn't know how to do it. She thinks that if she can choose what she puts in her mouth, she will also be able to choose how to put you in that space. Explain to her that she does not understand what is the maternal breast and what this breast can do if permitted to come in. R: When I talk about the maternal breast, the patient shows disgust and rejection. D.M.: Yes. Does she feel disgusted by meat and similar products? R: She doesn't like eating; she mostly eats gazpacho and green salad, but she has not said specifically that she is disgusted by meat. D.M.: Gazpacho is a vegetable soup, isn't it? Do dairy products make her sick? R: She doesn't mind milk now. D.M.: What the patient doesn't understand about the breast is that it is made up of breast and nipple; the nipple is inside the baby, and there it builds something like a pocket. You should tell her that. Because what she does is, that instead of listening and sucking from you she talks and talks, trying to feed you with her constant chatter.

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I have a patient who suffers from thought disturbance; he is on his second marriage to a woman twenty years younger than him. One evening a friend invited them to an old-style discotheque where people danced in couples, like in the old times. Being younger than him, his wife did not know how to dance that style, but she was willing to be shown. By the end of the evening he was exhausted. That night he had two dreams: in the first one, he was exercising and sweating in a gym,

sweating and sweating, so he lost half ofhis weight. He wentfrom 190 pounds to 90 pounds. In his second, there was a glassfishtank whose measurements were very precise: 3 feet long, 2 feet tall, and 6 inches wide. (These may not

be the exact measurements the patient gave me.) Inside the tank there

was no fish but on one of the sides there was something small, a bit like a nipple or a penis, that injected in the water a clear liquid that was regulating

the degree of acidity. The patient and I made a quick calculation of the specific weight of the water, and the result was the same as the weight he had lost in his gym session in the dream: 90 pounds; that is to say, the sweat had filled the fish tank entering through that valve which was the nipple injecting liquid in to ensure the right degree of acidity for fish life. This patient is always showing me how I should do things, how I should conduct the session; he gives me lessons on Bion . . . (Laughter)

He had spent a year at the Tavistock when he was in England, and in his opinion if you have been to the Tavistock you know all there is to know about Bion. He is the perfect image of the baby feeding the breast: "This is exhausting! And irritating too, teaching one's wife to dance!" That's why I think at this moment one has to describe to her the baby's grandiosity, the baby's need to control the world. This case of grandiosity is different from Carlos's patient, Eduardo, which is primarily anal and more complicated. This is the oral type. The key element in this material is the moment when she wants to put you in her pocket and she doesn't know how to do it. You can say to her that if she lets you talk and she listens to you, you will know how to put yourself in her pocket. But, of course, if you allow her to have you in her pocket, she won't be able to go behind your back to have a liaison with Alberto and sleep with dad; she will have to be your baby, and babies do not control mum and dad if they want to have more babies.... This case is completely different from Carlos's patient, who is addicted to anal masturbation and seems perverse. I think that in your

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case you should underline the grandiosity i n the transference. The grandiosity that manifests itself i n the transference is an extremely important subject. M y homosexual patient, about whom I talked be­ fore, treated me for many years as if I were his employee, his account­ ant M y patient suffered from thought disturbance and was convinced that he had to show me how to conduct the session so I should know what to do. Your patient is convinced that she has to control the world so it doesn't go mad. What she understands by the world going mad is that if we stopped controlling it there would be mad reproduction, like i n the jellyfish, more and more; more babies and more babies. It is similar to the idea some people have that a particular population is tWrdking about reproducing madly and so it is necessary to control the world's population. Carlos's patient's grandiosity consists i n obtaining maximum pleasure from his bottom and avoiding at all costs getting his hands dirty; and while that happens down below, he can preserve the aes­ thetic experience because his hands do not get dirty, his fingers do not smell. It also appears i n the motorbike races, which are a variation on his anal masturbatory pleasures. Another variation was being pen­ etrated anally by a homosexual soldier, a friend he used to have. The best way for me to get near a patient when they go into grandiosity is to prove to them that grandiosity represents a lack of imagination; it is poverty of imagination. Daddy is omniscient for the baby; the baby cannot imagine that there are things his dad does not know. What comes i n the place of imagination is proliferation; when there is no imagination, people put proliferation i n its place. The difference in the internal world between the child and the adult is that, for children, internal objects have the meaning of knowing everything, and they are represented as the bookshop, the dictionaries, etc. . . . When psychic reality and the qualities of the internal objects are denied, these are transferred to the external world; any knowledge becomes knowing the secrets of sexuality; and for young and latency children, discovering the secrets of the sexual relationship means knowing everything. When they start to have sexual relations w i t h penetration, they discover that this wasn't everything, that they didn't understand everything, and that a mere sexual relationship does not produce the effect of a loving sexual relationship. It is here that prolif­ eration, like the variations of perversion, is so attractive. Thafs why my homosexual patient gave long dissertations on the aesthetic value of homosexuality, which were a sort of description of the beauty of his

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own genitals, their creativity and capacity to produce sensual pleas­ ure. . . . To better clarify the distinction between the internal objects of adults and children, and between analyst and patient, one can advance the idea that adults don't know how they make children, but they do. The denial of psychic reality nowadays takes the form of astonishment at the human creation that is the computer, where proliferation is completely confused w i t h creativity. What we are asking about here is the difference between pure science and technology. Pure science cre­ ates on the basis of creative imagination, whereas technology is simply a proliferation of information. So, to approach grandiosity, first we have to find i t i n the transference, then we have to ask the question: Who has the creative capacity? Who is the creator i n the analytic situation? The analyst? His internal objects? It all comes down to interpretation. How can we know if an interpretation is correct or it isn't? A n d the answer is that we cannot know; it is a question of intuition. When the patient asks you where do you get that interpreta­ tion from, all you can say is that you have been gathering this and that, and that there is a mysterious process i n your imagination which has given this result: the interpretation. It is then that you ask yourself what is the dependence i n the depressive position. I t is the patient's infantile dependence on the internal objects of the analyst. It is with that that the analyst feeds the patient-child: the breast and the nipple go inside, and they create in the patient a replica of the relationship of the analyst w i t h his internal objects. That is to say, he is sharing w i t h the patient the knowledge created i n the human mind step by step for at least thousands of years of evolution. A t a genetic level, this process has taken thousands of years to be written i n the genes, and that is where i t is, i n the genes. The development of the mind, on the other hand, has only evolved i n the last 20,000 or 30,0000 years, and it is a non-Darwinian, non-genetic evolution that takes place through symbolic transmission. We are, i n fact, only a few generations away from the cave men, but even so we have to recognize that i n the development of the mind there is the capacity to communicate.

8

[JULY 1994]

Francis Arrogance and grandiosity in oedipal triumph Llufs Farre

T

lhis patient was 42 years old at the time of consultation three years ago. He had been addicted to alcohol and to cocaine and had been i treatmentfor three years in a drying-out centre, where he was advised to go on "analytic treatment". He started that one year before he came to m and stopped it abruptly after six months because he had started to have an emotional relationship with his analyst During the course of that treatment he suffered periods of confusion and of persecution and, at one stage, symp­ toms that he describes as depersonalization to the point that "both the analy and myself were paranoid". The analyst who referred him to me advised therapy twice a week in order to avoid the kind of unwanted regression and disorganization that he had suffered in the previous treatment At the presen moment there are difficulties in his relationship with his partner due to her jealousy about the money he assigns to his daughters and his wife -whom he is in the process of divorcing—as well as the fact that she dedicates her time to her children and they don't see each other during the week. They are no living together yet He is an economist. He sees his daughters, who are 13 and 18 years old, very little. He is an only child. His parents died some twenty years ago. He idealizes his relationship with his mother in thefirst years of his life, particularly at age

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4 years when, due to an illness he contracted, he spent a year away from Barcelona with her "without myfather". He was scornful of the young nurse whofed him because his mother did not have enough milk. This nurse, a single mother, had had to abandon her own child in an orphanage. He always felt defiant towards his father, whom he describes as being hard, strong-headed, and haughty and who never missed an opportunity to make him look ridicu­ lous. "He always helped me. He might hit me, but he never left me in the lurch." When he was young he would pull his hair out, which made his father despair of him. Being scolded or hit did nothing to make him drop this habit They took him to a psychiatrist, but he soon interrupted his treatment because "myfather read a book by Freud about a child whose case had been conducted by hisfather, so he decided he was also able to do mine. Myfather was a bit like that, a know-all." He says he hasn't read psychoanalytic books, but he con­ stantly interprets what he does, dreams and thinks from a psychoanalytic point of view—fundamentally an oedipal point of view. At age 13 he was sent to do his secondary education in England, his father's country of origin. He did not enjoy the boarding-school and failed in his studies. That failure was soon overcome when he came back to Barcelona. He started to drink when he was an adolescent working in his father's business: "I felt more secure." His intelligence, boldness, and use of alcohol and other drugs led to his involvement in state-of-the-art technology where he was quite successful, and in businesses which are now going through a rough patch due to the economic crisis and to thefact thatfor three years he did not take care of things due to his lamentable state. At the time he came to me, he was dealing with his debt to the Inland Revenue, the seizure ofhis assets, and the financial demands of his wife. I see him three times a week. His fee has been aligned with his economic situation. He still attends group therapy sessions for alcoholics and is very gratefulfor the help he received there. Occasionally he spends weekends at the rehabilitation centre. Lluis: I am now going to present two sessions, from May and June of this year. D.M.: His father died. He doesn't have siblings. His wife has left him, his money slips away; his analyst escapes, but there is still you and the rehabilitation centre. F i n e . . . . LI: I am not sure if it was clear, but I want to stress that his second partner is his ex-analyst. D.M.: Well, one assumes that that is implicit in the analysis.

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Session of 30 May 1994 He remains silent for a few seconds Ps: What day is this session? LI: Monday, D.M.: Let's call his partner his paramour. Okay. P: I had a dream but I remember very little about it. It was about me going back to my wife. D.M.: His real wife? LI: Yes. ... She was very happy with me; it wasn't at all similar to the way she has been behaving lately with all that business of the court case. LI: His wife is suing him because she wants 1 million pesetas a month i n alimony for her and their daughters; she alleges that he has a property fund worth 1,000 million pesetas. The truth is that he does not have that money. D.M.: The break up of the marriage came about because he fell i n love w i t h his analyst? LI: No, no. The sequence of events is as follows: after many years of alcohol addiction, his wife throws him out. He spends three years i n treatment i n a centre. The person i n charge refers him to an analyst; he falls i n love w i t h the analyst; and then he starts treatment w i t h me. ... I don't know, Ifelt sad, things could have ended differently.. .not like this It is not that Ifeel guilty as used to be the case, but it is a pity that our relationship has ended like this. I was talking about this with Marta. LI: Marta is the name I have given to his ex-analyst. ... And she didn't react like in the past either, when she always said that for me my wife was more important than herself, but she did say thai I was still sufferingfrom"Stockholm syndrome". D.M.: What is the "Stockholm syndrome"? L I : It is something that was observed in hostages, which is that after a period of time they end up agreeing with those who are holding them, w i t h the kidnappers. D.M.: What's the reason for the name? LI: I t has to do with a well-known case of kidnapping in a bank in Stockholm, when the hostages spent a long time i n captivity and this phenomenon was observed.

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.. . I don't know.. .. Maria is better now, but as I said to her, she needs to go into treatment because she can't carry on like this. She says she realizes that she cannot live in a couple because she is not happy; she ends up suffering a lot. I say to her that she has to follow some treatment, go into psychoanalysis, with a change of therapist, ofcourse, because it is obvious that things are not working, seeing that she is still like this after ten years. Something has to change. LI: As an analyst she was in analysis herself, at least that is his version of it. It seems that she has interrupted it or finished it, I am not exactly sure. D.M.: What is the dream? LI: He only says that he saw himself going back to his wife and she was happy; he doesn't explain any more. P: I have said I could talk to you and see if you can suggest somebody. But she told me to wait; she still has to think about it. But, as I said, she can't carry on in this way. And she has not been going to sessions for quite some time now. (Pause) Last night they were shozving The Exorcist on TV. I had to turn it off. That kind offilmfrightens me; carrying the devil inside is something that has always frightened me a lot.... T: It would seem that you want to warn me about the danger of paying attention only to otherpeople's difficulties—like Marta when she works as a therapist—while one's own mental set is not connected and so you can't see the images that come from inside. This can lead to getting stuck, to letting days and years go by, and to a failure of the treatment However, you also tell me that the reason is that there are disturbing images, very frightening images, inside. Therefore, you started to look at your dream but stopped talking about it and went and placed yourself in the position of a therapist discussing a case with a colleague. P: Because there was nothing else in the dream ... just that my wife had an angelicface, like a child. I always saw my wife as a child, no differentfrom my daughters, as if she were just the eldest... D.M.: It would seem that that was his moment of happiness. T: From what you have just been saying one could deduce that your wife has behaved towards you more like a devil than an angel. The girl in The Exorcist is a fairly old girl, but a girl nonetheless who has the devil inside her and defies the authority of the exorcist. That sort of image frightens you.

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D.M.: You have seen the film, then? Is it directed by Polanski? LI: Yes. D.ML: I t seems that he is trying to organize the generations. He is sending you Marta, and you are daddy. He is sending mummy back to daddy, and he w i l l go w i t h his wife and their daughters because they are all children. He is allowed to have sexual relations w i t h one of them, not with all of them. Back to happiness, because happiness i n his life was being in the sanatorium with mummy.

T: Today you have presented yourselfas a good advisor suggesting to Marta­ the child that she let an analyst-exorcist help her. But, as in your dream, your wife is in an angelic position that does not seem to fit in with what she actually does. This makes me think that behind that angelic presenta tion of yours today there is another face that is not so angelic and is frightened.

P: (Pause) I now remember a dream I used to have when 1 was young. "I would go through a tunnel between bales of straw or between bushes, lam not sure, and as I went in I wouldfall into a hole and end up in hell. Then somehow I was able to get out. This was in a country landscape, as if the tunnel were inside a country house. And now I remembered that when I was little and my parents left me on my own because they went out, I used to build a sort of tunnel with the sofa cushions and get inside and listen to the radio. D.M.: That is the masturbation chamber. T: When you were little? P: Yes, well, I don't know how old I was. I suppose about 5,6, or 7 years old. T: And they left you alone in the house? P: Well, not alone, with Amparo, I suppose. Yes, with Amparo. LI: Amparo is the nanny. D.M.: Is her real name Amparo? LI: No, it is related, but that is not her real name. T: So when you were little and your parents went out, when mummy and daddy went together leaving you in the care of the nurse, you used to do some manoeuvres consisting in building your own hut, providing your­ self with a speaking set, and telling yourself that that replaced mummy and daddy. And this is connected with going into the tunnel and maybe rather thanfalling it was sliding into hell, an omnipotent place where you felt strong in the face of the fact that mum and dad abandoned you in Paradise because they had things to do

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D.M.: It seems that he has denied that the tunnel was inside Amparo. He has denied that he was left in a situation of sexual relationship with Amparo. P: Among alcoholics it is often said that drinking is like being in hell, but you don't realize it until you come out.... [As usual he parades his extensive knowledge about alcoholism, the patients' resistance, and the fact that it has to be understood that they are ill, etc.] D.M.: You could use this same speech he makes to you about alcohol­ ics not knowing where they are until they come out, to describe the state of projective identification, the misery of the state which one doesn't see until one comes out; it is the misery of deprivation, of being without, it is not the misery caused by persecution. I think that the dream is different, because it has to do w i t h sending Marta to you. T: So alcohol and drugs have been the tunnels where you have tried to tell yourself that it is okay to be alone and you can do without dad and mum's help.. .. And you have had a dream in the lastfew days, after a week when it has been difficult for me to see you regularly, a dream where behind the angelic girl there is the one dominated by the devil, the infantile aspect possessed by the devil that comes today not as a needy patient but as a therapist dealing with the difficulties of another person. To fall into the temptation of these manoeuvres implies, in any case, a false aspect, which is to assume that one can come out of hell easily, as your dream shows. You know very well that it is not easy to come out of drugs. P: My father was always humiliating me, finding that everything I did was worthless. .. . [He again elaborates on how his father went about in life being a know-all and never missing an opportunity to put him down] T: You feel that being in need is equivalent to being humiliated; a paltry little angel compared with the immense power of daddy-god. And so the resort you turn to is to rebel against dad-god, build your own private hell with the cushions, the radio, the drugs, and tell yourself that it is the same thing. And this is what you do here when I am not able to see you. P: I always told myself I'd rather turn to drugs than ask my father for help. At least then one felt one could organize one's life. And, of course, when drugs agree with you, you feel fantastic. T: You'd rather be a devil of some renown than a little angel waiting for mum, dad, and me to come back. Moreover you are not conscious of the bad treatment and suffering in that hell, because in the "Stockholm syn­

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drome", as you said, there is confusion about the qualities of the place where you are held and of the people holding you. He remains silent for a good while—something unusual in him. [End of session] D.M.: I am not sure you capture this session correctly. Had he been drinking or taking drugs on the days when you couldn't see him? LI: No. D.M.: I think he feels that you don't appreciate him. Okay. Let's see the next session. LI: This is the Wednesday session. Session of 1 June 1994 He arrivesfiveminutes late. He remains silent for a few seconds.

P: I have been feeling very anxious since Monday... and I don't know why. I don'tfeel okay; I have a feeling of having failed.... 7 went to buy clothes for my youngest daughter, and although if I ask her she says she is all right, she always looks miserable to me, and I get upset, I can't help it. also had a rough time with the business of the court case.... You have to be very bloody-minded to act like my wife has done. ... Everybody says so—even the court clerk, who took my statement, a girl, couldn't believe the things I was being accused of. Maria is all right now, she has put las week behind her; she hasforgotten all her paranoias, and it is as if nothing had happened. But she is not okay and still can't make up her mind tofind a therapist. She can't carry on like this. In spite of all the anxiety I haven't sat down for a minute; I been in negotiations about nine apartment blocks in Castellon; I've got things going. But I still feel a failure; I think about my daughter and what she might have gone through; I think about my alcoholism; about my wife who is ill, everybody said she was ill.. .. Ps: Does he mean his wife? LI: Yes, his first wife.

P: I am thinking about Maria's situation.... Well, you see, it is differentfor me nowfrom how it was some time ago when I would have slumped under feelings of guilt; now I am not like that, but I always think I could have done more, and if I had behaved differently maybe what is happening now wouldn't be happening. D.M.: This is very important: the step from feeling guilt to feeling

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regret; it is a small attempt, a first step towards entering the depressive position. P: Marta is always criticizing the husband of a patient of hers who was in the centre with me. She goes on about how it is his fault and he doesn't do enough, when everybody knows that at least in the first year it is more than enough to ask that he shouldn't drink You can't askfor more in just one year. ... I don't know why, but I am very anxious, and I have this feeling offailure. D.M.: This is w h y he says to you that in the first year it is more than enough if he doesn't drink. I think that in the previous session you didn't appreciate the effort he made not to drink when you couldn't see him that week because of your difficulties. He made an effort that you didn't see. T: I think you are saying to me that you have made good progress in one year of treatment, but that even so you can't help thinking that you should do more, and should even solve things that do no depend on you, such as Marta's decision to get treatment or not to get it. You expect a lot from yourself . .. P: I always think that I should have done more, that it was my fault that things turned out the way they did.... D.M.: What you are picking up here, and he is giving you, is his movement from a feeling of guilt to a different one: the start of feeling regret, charged w i t h a certain grandiosity, as when he says: " I should have done more"—I should have done everything. But the patient is not aware that you see this movement. T: I have the feeling that you prefer to feel guilty, because that also means that you could have done more but didn't. That's to say, you were able but didn't act like an able person. I imagine you cannot bear to think that you didn't do more because you were not capable, you did not have the necessary power. D.M.: N o w you are picking up his grandiosity. P: (Short silence) I have never explained to my daughters that I was ill, that I was an alcoholic, and by so doing I have allowed them to get the wrong kind of idea about me. D.M.: He is deluding himself; this is self-delusion. Everybody knew what was happening to him, but he still thinks they didn't. T: You were never able to tell little Francis that in fact he was Utile and his mind was ill and he couldn't do more than he was doing.

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P: We always end- up in the same place: my pride, my refusal to accept But did not walk into alcohol addiction, I did not know. . ..

T: Proud Francis, as we saw in the previous session, didn't know where saying to himself "Yd rather drink than ask myfatherfor help" would lead him. And so he drank, and always after he had drunk he thought he could do more than he was able to. When, however, he asked dad to help him h felt that dad humiliated him.

P: But when I started to drink I did not intend to become an alcoholic. I neve thought I would turn into one.

T: When you went inside the tunnel you did not suspect that there was a hol and you would end up falling into hell D.M.: Here you are recovering your position, which is that i t is not that you have humiliated him but that he felt humiliated. In the previ­ ous session, you placated him a bit and what in fact happened was that he felt crushed. P: (Silence) When you said that, I remembered something I didn't tell you about the dream, there was a man there. . .. T: A man? D.M.: What dream is he talking about? The last one? LI: The one where he says he used to get into a hole and fall down. He says now that when he got to the bottom there was a man there. P: Yes, somebody who didn't have anything against me, I suppose, but he didn't love me either.... Then I would get out of there, arrive back at the tunnel, and come out

T: A tunnel is an open place, not a prison that one cannot come out of .. . [I am thinking aloud]

P: You've made me think about a programme I saw on TV the other day about two brothers who lost their mother when they were young and the have both dedicated themselves to scuba diving. . .. I used to do scuba diving some time ago, until I had a frightening experience and I never went back to it You get an extraordinary feeling offreedom, a paradox really, because you have assisted breathing, so it would seem logical tofe freer outside where one can breath unassisted. It must be the oxygen or something, but it is like being drunk.

T: Those brothers lost their mother when they were very young, and it would seem that you want to suggest that they were trying to recover her in an underwater environment You didn't lose your mother, but it seems that

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you want to talk to me about this environment where you could breathe unassisted and which gave you that feeling of being free and drunk. ... What was it that made you leave scuba diving? P: One day, when I was quite deep down, my oxygen regulator started to malfunction and I wasn't getting any air. . .. I began to panic. LI: (To Translator) Can you explain to Donald that he uses the phrase "Forgetting my lines", or "losing my papers", a lot. The phrase is full of meaning for the patient, and it refers to his failure. I say this because it is related to what is coming now. T: Francis was fine in mummy's underwater environment until the um­ bilical regulator that supplied oxygen from the placenta failed, then he panicked, he began to drown in alcohol, started to get drunk trying to reproduce that state of freedom, potency, and sufficiency of the underwater milieu. ... He began to forget his lines. P: (Pause) I've just remembered something my mother used to tell about when she gave birth: my father wasn't there, because at that time, in the postwar period, there were lots ofpower cuts and he had to take advantage of the times when the power was on to work. T: Maybe you are referring to some moment when you felt that it was your birth that gave yourfather light, life, and the means to work, instead of it being his work that allowed you to have access to the light of the world. P; He is silent for a few moments. [End of session] D.M.: This interpretation is very good, i n the sense that you have found a way to correct his grandiosity, his infantile omnipotence. I think you have recovered your position, although I think you would have hit the nail on the head harder by saying that his mummy threw him out, like his wife who left him, and he threw himself into a relationship w i t h his ex-analyst, like when he used to go into the tunnel, and that the way he is trying to come out of this projective identification is by sending you Marta, and that sending Marta to you has the meaning of a child's desire to reunite his parents; and that what he seems to be saying to Marta is that she too had an inadequate analyst, so she has to look for the right one. Which is why he is sending her to you as the best analyst. How old was he when he went to the sanatorium? LI: It wasn't a really a sanatorium; it was a hotel in a place where the

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air was very healthy. I n those days, people who were ill used to be sent

to places w i t h healthy air, places in the mountains usually.

D.M.: He would have been kept i n bed, bed rest.

LI: Probably n o t D.M.: His conflicts seem in the realm of oedipal triumph, taking his mother away, just for him, and to achieve that he had to fall ill, be under threat of death, but he did not die. What happens w i t h infantile omnipotence, which we saw before i n Rosa's patient, Montse, and at a later stage i n Carlos' patient, Eduardo, is that it prevents them from' understanding, and therefore they cannot obtain an adequate concept of maternal devotion. A small child cannot understand that he is, i n fact, the receiver, the container of a genetic process, a very primitive physiological process which is very similar to what happens w i t h birds i n the nest, that the only thing they have to do is open their beak and that forces mother to put a w o r m in there, some food for them. I n the primitive state, everything is forgiven to the infant automatically; what is automatically forgiven is that he makes a mess, he dirties the nest; the little birds have their mouths open and they are eating and shitting at the same time This is what happens i n toilet training too, a time when the adults manifest great pleasure at seeing the faeces. Mothers are much given to this kind of manifestation, thank God. This happens in the oral phase as well as i n the sphincter control and the oedipal phase. I n my view the consequence of these situations and of the ones that follow on is that they make splitting and idealization possible, and thus they make a space for the overcoming of the overwhelming aes­ thetic impact of the mother's breast Splitting consists of a top part where the mother is feeding and a bottom part where the father is defecating. The result is the split, the division, of the mother into an idealized breast-mother and a defecated bottom-mother. If you place these three cases in developmental sequence, we can see that Rosa's case is peeing on daddy, Carlos' patient is producing beautiful faeces that thrill daddy and enslave him, and Lluis's case is falling into projective identification and meeting a man who doesn't love h i m and from whom he has to escape. Lluis is approaching the problem from the confusion angle, and I think this is right. The confu­ sion is that m u m is angelic and dad infernal; i t is very easy for me to please m u m but impossible to please dad. The infant calls all this "pride", and these three angelic faces—those of his daughters and his wife, who is also included i n the dream—are also remains of an ideali­

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zation that took place i n order to overcome' the aesthetic impact of the mother. The problem w i t h splitting and idealization is that the impact of the aesthetic object gets damaged, dirtied in some way, and this is a hindrance for reaching feelings of humility, while the opposite ones— feelings of possessiveness and pride—are achieved. The same thing happens w i t h Rosa's patient: this girl is expecting Rosa to feel ever so pleased w i t h her peeing on her husband, as her daddy. She does not understand why this action of hers produces as a result her wanting to put Rosa i n her pocket, as if she were some belonging of hers, so she can go everywhere with her. If you follow these patients' confusions you w i l l see that they are fundamentally confusions between good and bad, due to some splitting and idealization along a path that finally leads to integration, to the eventual union of breast and nipple. It is only when the combined object is achieved that the patient can experi­ ence feelings of humility, which are linked to dependence. Acknowledging his arrogance towards his father is only one part of the story; the other part is the confusion that his mother rather likes this arrogance towards the father. This dependence is clearly seen when he tells you about his diving experience: he got scared. I don't think it is quite correct to say that the shortage of air represents a fault in the umbilical cord; I don't think that falling into projective identifi­ cation is the same as being a baby i n the womb. They are two different worlds. What is happening now is that he cannot jump any more into that tunnel the way he used to and feel at ease w i t h himself. His stock of grandiosity is going down because his objects are coming together. The moment you say something in the least humiliating, his objects separate again, immediately, and you see the father who never misses a chance to put him down and the mother who loved him and took him to the sanatorium w i t h her. So you have recovered a little bit the position you lost i n the first session, and this interpretation you give him is very apt, except for the comparison w i t h the umbilical cord, and it draws out of h i m an an­ swer that contains the following information w i t h the following mean­ ing for him: " M y father was not there when my mother gave birth to me, but he was not there either when I was conceived." It seems that he is saying to you: " M y mother used to say that she was really also my father"; that is to say, that m u m is saying to him: "That man down there is not your father, shit on h i m ! " Nowadays one doesn't hear of too many cases of analysts getting involved w i t h their patients.

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TRANSL: It must happen i n Barcelona only

D.M.: It happens everywhere—but we don't hear about it (Laugh­

ter) Had you planned to present these three cases together?

Ps: No.

D.M.: It is a beautiful sequence, Rosa's case first, then Carlos's, and the

third one Lluis's.

9

[FEBRUARY 1995]

Eduardo The construction of delusion Carlos

Tabbia

duardo is an engineer, like his father and one of his brothers. He is 34 years old at present.

D.M.: How long has he been in therapy? CARLOS: T W O

years.

He lives with his parents. His father's office is in the same building, on the ground floor. Eduardo does not work. He is on the office staff, but at the moment there is not a lot of work, some, but not a lot. He does not want to work as an engineer. In August he went on holidays with his parents. In October he had a car accident; he was sitting in his car and it was hit from behind; he suffered neck injuries. He has been on sick leave since November. He has a relationship with a woman who is older than him; they see each other once a week and have sexual relations. He has lost all hisfriends andfeels very lonely. All he does is to come to therapy. Wednesday

session

P: I dreamt that "I was in a house with Marcela's grandfather and two of her friends that I don't know. It was a curious place; it was her birthday; the house was on different levels; the terrace overlooked the road, it had a railing; there was a table with some chairs. I was with Marcela's grand­ 131

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father but the party was downstairs; it was as if I had been left out of th party, as if I wanted to join in in a distant and respectful way because she has an unjustified grudge against me for finding herself caught in a situation that she cannot get out of Marcela, her parents, and her siblings are downstairs, probably annoyed at me being upstairs. Her grandfathe takes a liking to me and we have a good time. He says: 'you are the onl one of all her boy friends who has responded to me, the only one I've bee able to have a decent conversation with'. On one side of the terrace ther was a striking staircase; it was spongy and luminous; there were plants on it Marcela was in the room with her parents, celebrating her birthday; everybody was there except her grandfather, who was with me. I joined th party, though I was not expected to, I seemed to be unwelcome; herfamil must have thought I had hurt her. This was apparent in the atmosphere: was sticking my nose in and putting my head into the lion's mouth. I don't go into the living-room; instead I go for a walk—a place like the Terrasa Ramblas—with coaches parked against the traffic to allow passe gers to get down into the centre of the Ramblas. I see people from the faculty who have come to Marcela's party; the coaches are empty, they brought the people to the party. I am riding my motorbike slowly, from Escudillers Street or Paseo de Colon so as to end up at Marcela's party. There are two cars in front of me; one is a limousine blocking a more ordinary car. I leave my motorbike to meet the peoplefrom the party. Ne the Liceolgo into a barfull of transvestites and whores; the atmosphere is very seedy. I see an odd scene: the room is very high, it has a false ceilin with suffused lighting; an old woman is climbing some shelves on the wa carrying a blowtorch in her hand; the shelves are made ofplaster, and the break as she climbs them; she carries on, though, and manages to light th ceiling; it looks like a gas heater. I deduce that the heating is done by gas the false ceiling, as if the ceiling were a horizontal radiator. When she comes down I see that the place is a bar for homos and transvestites. I order a Fanta, and when I see the atmosphere is not suitable I decide t leave. Some customers move close to me, like little spiders. I take my pur out because I don't want to show my wallet (where I think I have 2,000­ and 5,000-peseta notes). I see I have some coins. They are making me fee uncomfortable; they are being provocative. I look for the coins because want to leave." In the gym where I go you have to put a 100-pesetas coin in to get the key. Something unusual happened yesterday; it is important, so I am going to tell you: a letter from the Inland Revenue arrived; they are going to do a check on my parents. I thought it was the solicitor's revenge. What do they want from us? Do we have it? No, so the solicitor must have it. I

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decided to ask him immediately. His secretary looked flabbergasted when she saw me; I waited twenty minutes; I thought that, with a bit of luck, the person coming out of the room would be somebody I knew and it was: N.N., the design engineer I most admire, came out We have a high regard for each other. He was very nice to me, so the solicitor was also nice [Eduardo had sacked him after an argument). I asked him for the docu­ ments; I don't know how much it is going to cost but I felt calm. A million? It is like buyingfive years ofpeace for a million. When I was little my mother used to threaten she would hit me, but she never did. If I managed to make her hit me, then I calmed down. I also saw it as the end of a cycle: what else could happen? Streamline the office. T: Could you please be quiet for a while so I can think about all this? D . M : What kind of compensation is he getting for the accident? C: He is going to ask for 2 million; 1 for the accident and 1 for the days he has had off. He w i l l say—to justify the amount—that they've had to hire a replacement, but he will put down the name of an old employee P: (He adds immediately:) Ah, I remember somethingfrom the dream: when I was going downfrom the terrace, Frank appeared—a complete wanker— "he let off a large banger that makes a lot of noise. I am almost deafened, and then I am in Las Ramblas." T: It seems that it is a complicated and difficult thing for you to be near people; you walk into the party and Frank appears; there is an explosion or cars blocking the way. You are coming down to the party or going up towards the Liceo, moving to the middle; all this makes me think that the food for your mind has to negotiate many obstacles. P: I remember that when my cat had parasites I had to take a syrup because I stroke him and kiss him and then I bite off my cuticles. T: Sometimes you eat things that don't agree with you. P: When I stroke him and then bite my cuticles I eat the parasites. D.M.: Do you have any idea of why Marcela left him? C: It was never clear. He likes to think that he left her; the reason for the separation was never clear. The relationship finished three years ago, but he talks about her as if he could call her any time, as if she depended on him; we are supposed to think that she goes to parties where he is going to be, or that she went out with a neighbour of his so as to be near him. D.M.: This is related to trying to get near Marcela but not succeeding.

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What stands out is that he always tries to calm his mind; this peace of mind is achieved by placating his persecutors. One gets the impression that at the moment you are his strongest persecutor and that by placat­ ing you and getting some peace of mind—since you are his back­ ache—he'll have a chance to get near Marcela. Deep down he suspects that i n order to get near Marcela he'll have to stick his head i n the lion's mouth. Thursday P: I dreamt about Marcela in a patio or a garden; she was walking on one side, full of light, and I was at about a metre and a halfaway (unable to get closer). He returns to the subject of the solicitor and N.N., who lost a son who was fond of heavy rock music; he fantasizes about going near N.N., who loves classical music, to make him listen to heavy rock so that he can recover his relationship with his son. Here he says that there are only two people he admires: N.N. and me. D.M.: In the previous dream it was clear that he was being pleasant to Marcela's grandfather on her birthday in order to be near her, but i t didn't work, because her grandfather was so pleased he wanted to keep him with him since he was the only one who listened to him. C: He cannot have a normal relationship with his mother; she com­ plains that he is unpleasant to her; he doesn't have a good relationship with his father, either. Thursday of the following week P: (Brief silence) I was thinking about weight-lifting and about the pain I get in my neck when I do it. I didn't understand why it hurt when C5 and C6 hurt, but I can see why it is now: the trapeziums stemfrom the base of the skull. . . . I didn't go to physiotherapy this morning, instead I went for a walk.... (Silence) [This session is differentfrom the preceding ones; there are lots of silences today] I stayed at home, took down the curtains to re­ use the material and make them up again in a way that will screen us from the neighbours but still let the light in. C: He is in the process of moving to the flat that his mother's sister— who died many years ago—used to have. He is slowly emptying the flat, changing the curtains. His aunt's clothes were still in the ward­ robes.

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T: I see you controlling what the neighbours can and can't see, how much light can get in, as if you were taking care of what can and what can't get into your mind and what I say to you, to make sure that what goes in is not excessive for you and that things go in a little at a time. P: It began this morning. I was okay, normal, and my head didn't hurt, but when I wanted to take the curtains down I got a headache and my back began to hurt T: Notwithstanding the fact that you do have to take care of how you move, what your answer means is that I have to be careful with your ability to understand or with your internal movement P: (Silence) My mother .. .1 went to "House of Blankets", which is cheap; I took them there to be made up. I thought they felt rough to the touch because they were dusty. The shop assistant read my mind; she said I should have washed them first My mother said she washes them every month: why was I taking them there, she said, and was I going to sell them later. I can't take a single step without her criticizing me. She got annoyed when I asked her to leave the room the day the decorator came. ... [He called in a decorator to give him an estimate and another one to choose the colour because he felt incapable of choosing a colour] She was cross for a few days. She says I treat her badly. The same thing happens here; I am sure you are going to say something too. T: Something rough. You are gentle and I have to treat you gently because you find me rough when I talk to you; rough seems to mean that I don't understand you, I don't care for you, and specially that I don't pamper you. P: Yes. I am really confused now. I don't know, yesterday ...ifl went back to work again maybe it wouldn't hurt, but how can it hurt just because I take some curtains down. Maybe ifl sat properly it wouldn't hurt, but the doctor said one of my discs is cracked and I may have to have an operation. (Pause) T: You feel that lama daddy that wants you to work. P: I am afraid that that theory might be correct, but it might confuse me, because I don't think it is right to spend the whole day with a headache and feel unable to do a number of things. I am not going to have an operation; I'll do proper exercises.... After I readforfifteen minutes I get the pain; it used to be after I had been studyingfor two hours. Maybe I can postpone the operation for ten years. . . . I want a second opinion. (Silence) I am thinking of the commission my father has received to repair the structure of the bell tower in a Romanesque church and some windows that are in

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poor shape.... I would do something more daring than what my father is planning to do; I would put in some triangles of stained glass. ... I can just see the shafts of light from inside. (Silence) I was thinking about Xavi's father, he phoned us . Carol called me too, and Hugo, the one who used to kick cars when his headaches were giving him trouble. Carol called me, but I suppose it was Xavi who had asked her to call Domingo's the only one who hasn't called yet. [The phone rings in next room] That must be Domingo. Damn! Everybody is calling me. I got a fax with the details of the IT systems. I knew they were very good. I sent a fax back to thank them. I also got a letter from Italy with information about motorbike spares. T: From the moment you told me that sometimes I am rough and you asked me to be gentle, there have been all sorts of references to people calling yo people remembering you. This is like a warning telling me how I should treat you, with great care, because you are like a work of art, like a Romanesque temple that needs a lot of attention to make sure that the restoration is done properly, so that your mind can be repaired properly because things are in poor shape; because a Romanesque temple has been built in a particular way and has to be handled carefully. It is a way of telling me that you are little, maybe fragile; big like a temple but put together in a particular way; you are a work ofart that has to be pampered P: (Silence) I was confused this morning because when there are so many things to do at the same time, one gets dizzy. I was thinking how many parts a curtain should have; my father would say it has to go in modules. Three? Four? Too formal. Five? Movingfrom four to five we went from seriousness to happiness. I'll have five, and seven in the living-room.

T: If I treat you like a valuable work of art, with tender loving care, you would be happy to come here five times a week and sometimes you would like to come seven times.

P: (Smiling) That is it! I'll have five and seven. [He talks about the distance between the curtain panels] ( Silence) I was thinking about magnetic resonance: I'll go to see other doctors. I don't understand my mother; she doesn't tell me about things that are important; they showed an operation on the tele and she didn't tell me, but sometimes she calls me in for silly things. A man said that since he'd had the operation he was all right. I can't breathe through my nose, my bone is twisted; I knocked it riding on my pushbike, and maybe I damaged my neck muscles. An operation on my nose and one for my back would sort me out. I also have problems with a side muscle and in my lumbar region. At this rate I shall be rigid.

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(Silence) I just imagined quite a funny thing: I am used to sounds being muffled because I have a carpet on the walls; I took it off, but I could hang heavy curtains in a maroon colour and call it "Edward's jazz club". A singer once called me Edward; I had never been called that before. ... Then my friends could come and we could have fun. T: It is also a way of telling me that if you mend your ceiling, your head, your structure—those points that hurt—then you will be able to live inside yourself more comfortably, with less lack of harmony. C: He has spent a long time in pain. D.M.: He likes being i n pain. He doesn't have to work; he gets money. Is the pain i n his neck related to movement? Maybe it hurts more when he has to climb stairs. C: No.

D.M.: I think he is i n the process of becoming a transvestite. T: The last few days he came to the sessions wearing leather trousers, a leather jacket, leather boots with heels, and his hair combed over hisface in a very feminine way. He said that when he was taking clothes out of his aunt's wardrobe he tried on a pair of yellow corduroy trousers that were his mum's and a jacket that belonged to his aunt; he kept both. D.M.: Going back to Marcela, the image is of a young boy ruxtning after mother w i t h the purpose of getting i n through the anus i n projec­ tive identification. The kind of accident he had i n his car—somebody hitting him from the back—also plays a part i n his fantasy: he experi­ ences it as a homosexual assault that has turned him into a woman. C: Yesterday he said to me that he associated a comment of mine i n hHe session w i t h a friend of his who used to sodomize him. D.M.: Has he had homosexual relationships? C: Lots of times; he also masturbates anally w i t h fantasies that a black man w i t h a large penis penetrates him. D.M.: I n order to gather all this material into the transference you are going to have to refer to his curiosity about your wife and your sexual life. What did N.N/s son die of? C: A motorbike accident. D.M.: He is very identified w i t h that boy; from being N . N / s son he has turned him into N . N / s daughter. With the change of curtains and the sending of faxes . . . he is acting like the wife of a famous man. What is the colour of the leather suit?

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C: B r o w n . D . M . : H e is psychotic; he lives completely immersed i n his fantasy w o r l d . I n his fantasy the accident has made a p r o f o u n d change i n h i m , like i n the Schreber case, one of Freud's patients. The p r o b l e m i n the transference is not just that he has m o v e d f r o m b e i n g N . N / s son to being his daughter, b u t also y o u r daughter t u r n e d i n t o y o u r w i f e . H e is the y o u n g w i f e of an older, distinguished m a n . Daughter-wife. C: I n the first dream, w h e n he describes the w o m a n going u p the w a l l w i t h a b l o w t o r c h , he says that the ceiling was like the one i n m y consulting-room, a little b i t higher maybe. D . M . : Getting close to Marcela means getting inside her m i n d to be able to be and feel exactly like her. It is to be a transvestite; he produces that feminine caricature b y dressing u p i n w o m e n ' s clothes. H i s be­ h a v i o u r w i t h Marcela's grandfather i n the dream is one of feminine seduction. The architectonic details of the dream are projective i d e n t i ­ fications about the value of w o m e n . The most i m p o r t a n t t h i n g is that spongy w i n d i n g staircase w i t h plants on i t . A t that p o i n t there is a delusional transference, as there is i n Schreber's case i n his relation­ ship w i t h G o d ; he is g i v i n g y o u pleasure. H e is g i v i n g y o u constant erotic sexual gratification. H e does not listen to y o u r interpretations; he receives them as penetrations that give y o u pleasure, and he listens to t h e m to give y o u pleasure. A difficult transference situation. C: H e has isolated hrmself f r o m the external w o r l d completely; a l l he does is come to the analysis. D . M . : H e is d o i n g his analysis i n a totally delusional w a y . There is a phrase for w h e n an actor finishes his performance: he is enormously pleased w i t h y o u r performance. The audience were thrilled. A t the b o t t o m of a l l this there is his father's w i s h that he s h o u l d go back to work. C: H e says that going back to w o r k w o u l d mean facing a l o t of things w h i c h , for the time being, he can't face; and a l t h o u g h he d i d say that he w o u l d go back to w o r k i n a week's time, he can't face u p to i t . D . M . : I t w o u l d be going back to w h a t w e say about listening to y o u r interpretations instead of enjoying t h e m erotically. Let's look at y o u r interpretations to see i f w e can f i n d something that w e can use. The first t h i n g y o u say is, can he please be quiet for a m o m e n t to let y o u t h i n k , a n d he speaks again immediately. Y o u interpret to h i m that his approach gets complicated for different reasons, and that one is Frank and his bangers. Y o u interpret correctly, saying that going to the p a r t y

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looked like going down to i t instead of going up to the Liceo. You tell h i m that it seems he finds it difficult to take food for his mind. Straight away he talks about worms and parasites. Marcela was shining i n the garden; he was some one-and-a-half metres away from her. He admits there was friction between N.N. and his son with regard to heavy rock versus classical music. N.N. was not available for homosexual seduc­ tion; he could only be seduced by a daughter. When you touch on the subject of the curtains, you tell him that their main objective is to stop the neighbours from seeing inside. This is comparable to his difficul­ ties in understanding what you are interpreting about the obstacles he finds to take food for his mind; he has to wait too long. You tell h i m that he is warning you that you have to be careful w i t h him because he is very tender. He mentions his mother and her rough way of dealing with him. You interpret correctly that he wants you to pamper him. A l l the elements are here i n your interpretation; on the one hand you are the father who wants him to work like a child, and on the other hand you are the father that pampers him like a daughter. This is related to the genital operation he would have to have to change his sex, but he is not keen. He would be prepared to have an operation that would give him large breasts, as he imagines he would do w i t h the Romanesque church. C: Last week he had a sexual relationship with a friend. He managed to get his friend to suck his nipples. D.M.: He is not interested i n the breasts as beautiful objects; what he says is: " I can imagine what those two shafts of light must be like from inside." He reminds of one patient who saw an inner patio where the sun always shone. This is followed by a string of people phoning him, sending him faxes. If you are a woman with those two objects that are so beautiful inside, where there is a light shining and rivers of light come in, if you are that woman, everybody wants you, seeks you, calls you. This is the fantasy of a girl i n puberty who thinks her older brother w i l l lend her all his friends; she w i l l be their lover, and one day the king's lover. Madame Duvarry Sevigne. A l l the material is there; what you have to show him i n the transference is that there is a conflict between, on the one hand, seeing you as the hard-working father who wants Eduardo to go back to work and, on the other hand, an elderly father who wants him to be his daughter and eventually his lover. That grandfather he visits on Marcela's birthday, who says to h i m that he is the only one who listens to him, is direct transference: you are the forgotten grandfather and he is the only patient who pays attention to

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you w h e n you talk. The detail of the internal lighting of the Roman­ esque church, repeated i n Marcela's shining, in the stairs that seem to be lit from inside, and in the old woman climbing the ladder with a blowtorch to light up the ceiling, and his realizing then that he is in a bar for transvestites, are part of his anal fantasy: he feels illuminated w h e n he lets the air out from inside him, but he doesn't want to boast and show his large pile of faeces, he only wants to let out a few little pellets; it is his fantasy of anal masturbation. When you begin to talk, he perceives it as if you were penetrating him anally: it is air that you let out and it penetrates h i m and lights him up from inside, and then he shows you what a magnificent Romanesque girl he is. Like in Freud's Schreber case, the only quality his God had was that He could understand the dead but not the living. His associations with N.N.'s dead s o n . . . this delusional material is very interesting if you look at what is behind: his narcissism and his object relation; when he sticks his fingers in his bottom and lets out air, his fingers smell of roses, the sound is musical, and there is a scent of flowers. C: Once he passed a motion i n a bathtub full of water, D.M.: It doesn't seem useful to show to him the meaning of his delu­ sions unless you can take h i m to the concreteness of the transference to see them. When you ask him to be quiet because you need to think, he experiences it as if you were saying to him: close your mouth, open your bottom, and let me smell your fantastic faeces; and this is exactly what he does. You want h i m to work, and you work for him, this is not a romance; so then he remembers Frank and the bangers exploding. Although the material is very interesting, I don't know if you can get anywhere with it; he doesn't seem harmful, but he is very mad. He is thinking of having his penis removed, his vagina enlarged, and his breasts made bigger. He is a good patient if what you want is to study the delusional systems and how they are created; they are truly made out of bits of shit stuck together, like plasticine; they are beta-elements bound together. It is a marvellous description of how delusions are built. Later on Bion modified it slightly w h e n he said that the delusional systems are not created by beta-elements bound together but by growths of emotional experience of no use for the alpha-func­ tion. Reversal of perspective. It would be a production of beta-ele­ ments with bits of ego and superego; it manifests i n the patient in his looking for the coins in his purse. Fantastic material. Don't expect to cure him; if you can stop h i m from removing his genitals, you will

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have done enough and can feel satisfied. It is incredible to see the way he manages to get raped from behind. It was easy to understand how Lluis's patient managed to get raped while hitch-hiking, but to get raped from behind in order to receive 2 million is a sign of great intelligence!

10

[FEBRUARY

1995]

Carmela Social anxieties as an obstacle to intimate relationships: a Cinderella's story Rosa Castella

\he patient is 32 years old; she is married and has a 19-month-old hoy. She comes from a working-class background; her father works as a bricklayer, and her mother is a housewife. She is an only child. D.M.: Y o u say she is an only child? ROSA:

Yes.

When she talks about her childhood she says that her mother used to leave her alone when she went to do the shopping and would laugh at her when she found her crying on her return. Mother is described as a mistrustful person who reacted to her daughter's problems by telling her that she was stupid. Of her father, she says that he was closer to her emotionally but he was led by his wife. They have often had to move house for work-related reasons; for my patient this has meant changing schools and friends; she used to find she had a block and would fail her exams, although she did sometimes pass comfort­ ably. In our first interview she talked about the gigolos and prostitutes in her family. When she was a young woman, her parents moved away from her to live in a village; she felt abandoned. She graduated in Medicine and Psychiatry and is now studying English. She has worked as a shop assistant and has also sold fish; she finally found work as a doctor in a private medical centre. She

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was doing

143

CARMELA

both jobs until some patients

saw her selling fish and

never

returned. She was feeling

sad and depressed and thought she would always be a

failure as a doctor when she was referred to me by one of my colleagues, was her

who

supervisor.

She started on one session a week, and now she comes twice, on and Thursdays.

Mondays

She has been in treatment for about three years.

Evolution

of the

treatment

The first sessions used to end with her having a headache and feeling

ex­

hausted; she nearly always cried. There have been changes in her external life: she became pregnant soon after the beginning of the treatment and had a good pregnancy

and delivery. Her relationship with her parents has improved.

is now working in the psychology

She

unit of a medical centre.

D . M . : H o w l o n g has she been m a r r i e d for? R: Six years, I t h i n k . But her relationship

with her husband

has deteriorated since the birth of

their child. She is always exhausted, has frequent

headaches, and feels sad.

She doesn't dream much; the dreams I bring here are some of the few she has had.

September

1993

"There was a film director. He was short of an actor for one of the parts. They offered it to her. The film was shot in a desert, on a beach, there was dog pooh and she had to lie down there. They cleaned it up for

her."

D . M . : W h a t does i t mean that they cleaned i t up? R: They cleaned i t away so she c o u l d lie d o w n . "She saw a black-and-white

photograph in a newspaper; she was with another

woman; they were smiling. They were wearing wigs with plaits; it was for a musical

October

comedy."

1993

"She was waiting for a patient who was due at 7 o'clock. The whole flat was upside down. It was her present flat. She had forgotten that she had a patient. When the person arrived, she kept him waiting while she tidied

up."

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April 1994 In this session, we proposed the change to twice a week The dream: "She was in the consulting-room, also her therapist;

the room was different and

the therapist looked like a model with long black hair and

sent her away ten minutes before the end of the session, saying

that she had

other things to do; she took her clothes off in front of the patient, down to her knickers, which were big like the ones old ladies use. She was

surprised."

D.M.: We have an image here of the importance of how the therapyhas replaced the sexual relationship with her husband, but her attempts at identifying with you do not seem to have been successful and she is muddled. The implication of this is that the internalization she makes of you is very different from you as an external person: you are this model with long black hair and a rather irregular technique. Your sexual life is old-fashioned, demode, like the bloomers old ladies use. There is a reference here to something pornographic, following on from the theme of the photograph in the newspaper. Okay. Session of 12 December 1994 She arrives

on time. Before she lies down she says: "1 had an easy

(there is a train strike on). "I even found a place to park." She seems She lives outside P: Well...

journey" happy.

Barcelona.

I don't know...

(Very quickly, as if her mind had gone blank, she

laughs) This week has been very hectic. It was our son's

birthday,

and my

parents came to celebrate it; we went for lunch to Olot, to a cheap restaurant

there that serves good food. We had been there before, but I had

almost forgotten. she said;

Dolores is pregnant for the second time; she called us,

I want to celebrate it before the holidays";

she is very direct; she

can talk about herself with no fuss.

R: There is a bit of a muddle here. Dolores is a friend who has got pregnant and she wanted to celebrate it, but my patient wanted to see Eulalia with her husband on that day, just them. Dolores, however, had beaten them to it and invited all of them together, so that the meeting with Eulalia had to be postponed. J had thought about calling Eulalia to invite them to dinner are feeling

to see if they

a bit different; you know that they have been a bit

distant

recently, and I had persuaded Julian [her husband], although he is feeling a bit

"tired".

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145

R: Julian is "tired"; let's say that he is hurt by the attitude of Eulalia and her husband.

When I called Eulalia, she said that Dolores had beaten us to it, so she suggested that we should all go out for dinner together and then the four of us could meet after the holidays. We had a good time. Toni had a new van and we ended up all together in it, but Jose Luis is a spoilsport; whenever we get together he falls asleep. Maybe we all pay too much attention to him; if you invite him he comes, but he behaves in an odd way, he falls asleep and makes everybody uneasy. At the end of the meal, Eulalia asked us all round to her house; she said that maybe there wouldn't be enough to eat, but we all offered to help and said we would fetch drinks from the bar opposite. It was dark by then, and I thought I should go to fetch Marc, who was at his grandparents; Toni came with me; when we returned Jose Luis had fallen asleep; he was snoring incredibly loudly. Eulalia said he was very tired because he had played in a football match, but the very moment Dolores and Toni left he woke up. One doesn't know if for him we are second-class friends; I have the feeling that he avoids me. I wasn't comfortable. I would have liked to speak with him— I know he was thinking of applying to the Institute of Psychoanalysis but wasn't sure that they would accept him, like me; now it seems that he has applied and has been accepted, although he is 42 years old! I was on the other side of the table; he knows that I had also asked for information, but he didn't talk to me, and I didn't say anything either. He was a bit boring. T: You seem happier and more talkative. There is a part of you that would like to enjoy things and be direct like Dolores: she talks about the things that make her happy and asks her friends to celebrate it. But there is another part of you, the part that we call Jose Luis, that stays closed, asleep, distant. We have seen that that Jose Luis part makes others suffer, as if they were second-class friends, particularly Julian, who is "tired".

R: This is something we have been working through in previous ses­ sions.

P: Yes .. . yes, you are right; I feel livelier when I am busy. Dolores is hyperactive, she talks nineteen to the dozen; she is always involved in some complication, but at the moment she is tired, she wants to be at home, and Toni says he is delighted because that way he has her by his side and they can be together more. T: It is as if you said that sometimes Carmela is at a distance from the relationship, and sometimes she is in touch with the others, with Julian, here, with me....

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P: Julian is happier and I feel more spontaneous. We went to the Mercat of Sta. Llucia and I have made a Nativity scene. I had never done it before; spent till 1 o'clock on it I went to the Mercat with my parents. Because they have lived awayfor so long, I thought it would be nicefor them to se it; my father said he knew it, but you can't take his word for it, because sometimes he says things just to look good. We bought somefiguresfor th Nativity, but there were so many people we couldn't move and Marc got tired of being in the pushchair. He was too much for us; we ended up in the Puerto OUmpico because my parents didn't know it either. I've put a lot of work into the crib; it looks good now.

T: You tell me that your parents' visit gave you pleasure, that you built a crib, and that you are happy with the way it has turned out Maybe what you are saying is that ifyou felt that you belonged to a family, you could also make inside you a Nativity where everybody gave each other a han where they shared their life, and then you would be happy .. .in the end

P: He is happy, but I know that after a few days I'll be distant again. It is almost as if I had become sexually castrated after having Marc, like the Virgin Mary; I don't know what's happened to me since he was born, I have let myself go. I look at myself and I don't like what I see; I can see I have bags under my eyes, I have the face of a bitter person, as if I had los my sensuality and eroticism, I don't know how to dress, I go to the supermarket and don't know what to buy.... T: It is as ifCarmela were not conscious of her needs....

P: Sometimes I see myself listening to you, or I say to my patients something that you have said and I think: How cheeky, you could apply it to yoursel T: Yes. It is possible to have an analysis letting things wash off one's back and keeping oneself at a distance. ... P: I see I have changed, but not at a deep level.

T: Yes. You've had a son, you are looking after patients, but somehow you don't seem to believe that things can truly change, and it seems that thi last crisis originated in the summer when you heard that I was not a member of the Institute. You were talking today about wanting to ask Jos Luis how he went about getting into the Training at the Institute.

P: Julidn and I were talking about last summer and the holidays and my depression. Our summer holiday was unbearable, and it coincided with the business of the Institute. Julidn said that I was very angry. The thing is that I arrived andfound that the apartment—cheap, it's true—was full ofdirt; they had given it a quick brush up, but I had to clean it from top to bottom. There were cobwebs, spiders—I got bitten and had to go to the

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doctor's, and Julian was being lazy; I got very cross. I saw myself spend­ ing the entire holidays working, bearing the burden. It was my first holiday in an apartment; we had always gone to hotels before; I would have preferred to go to Morocco for a holiday. The whole thing rested on the fact that you are not a member of the Institute and I didn't know that there were people working as psychoana­ lysts who are not members of the Institute. T: So you felt that instead ofgoing to an Institute-hotel with everything laid out for you, you were in an apartment-analysis where you had to work and maybe you were scared that I might inject poison into you like the spider and harm you. P: I began to have again the feeling of being outside, when in fact I started therapy in order to be inside. I have spent my life avoiding situations, and now when I finally begin to work, have supervisions, and personal therapy—which cost me a lot—you not being in the Institute made mefeel that I was again on the outside, or worse. Now, if I want to get into the Institute I'll have to leave this, with the added problem of not knowing whether I'll be accepted or not. I imagine they are people with experience, and who am 1? Nobody. Maybe this is an aspiration well above me. They are people with the kind of poise I haven't got. It is as if a little voice was saying: where do you think you are going? Do not dream. T: It seems to me that you idealize the Institute greatly. Everything good is there. It seems like a retelling of the story of Cinderella: there are some kings, some queens, some princes and you are determined to carry on being Cinderella, thinking that the work we do here is tantamount to cleaning stoves. P: I think I probably looked ridiculous talking to you about the Psychoanaly­ sis Review meeting with Dr X. The idea ofgoing into the Institute when I had never even been able to imagine it must have something to do with the work we do here. I wouldn't have thought ofit on my own, and Ifeel that the work we do here is not rich in content, because I am the sort of patient who "shuts up". I have a shell that doesn't allow me to change internally, I am a really difficult patient; nobody has it easy with me, neither Julian nor you. In short, I think that if I am not getting better it is not yourfault, it is mine. T: You say that you do not think this work is like cleaning stoves, but judging by the way you talk, the kings—the ones that know—are in the Institute, and the rest are second-class people, including me.

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The session ends, and on the way out she starts laughing and says: "Have a good day!" D.M.: She is working. She has a good head, she is using it, and she is ashamed of having tried to find out things about you behind your back. She still has the burden of this family of gigolos, prostitutes, and madmen. Social anxieties are still very strong i n her, but in fact i n her personal life she is doing much better—she feels better, better w i t h her husband, but there are still problems relating to her sexuality. The problem about her sexuality is clearly expressed in the first dream you have talked about, where there is this division between elitism associ­ ated to the cinema industry, the cinema people, and then the quality of the beach associated to the dog faeces. You are right i n identifying the Cinderella factor in her: her idealization of the aristocratic social class in the sense that they do not do dirty things, like sex, for example. The problem is the confrontation between anxieties of a social type and the difficulties of intimacy. She is the sort of person who likes to keep on top of things and has problems when she discovers her atti­ tudes towards you, when she denigrates you, because she seems to feel that she is ungrateful when one considers all the benefit she has obtained from the treatment. She is basically a person of good character, but with problems because of her history, where sexuality is anal, and for that reason she has become denigrated by the torture, although all this cannot be seen clearly in the material. Okay. She was livelier in the following session. She seemed to be looking forward to Christmas and the preparations for it Session of 2 January 1995 (first session after the holidays)

She arrives on time. She comes in smiling and wishes me a Happy New Year. I notice she has deep bags under her eyes. She asks for a change of time for family reasons. P: I am not well; it is still the same. I don't know, it hasn't been too bad recently, but I am not well On New Year's Eve I invited my parents to dinner; it was a simple meal: a grill and canapes. It wasn't a lot of work, but I wasn't in the mood, it all seemed too much effort During the holiday, we bought a new cutlery set and a tablecloth with a Christmas motif; my husband wasn't too convinced, but he accepted it in the end, although he said it is the kind of tablecloth you can only use once a year.

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But it was irksome: he is on a diet, so there are things he can't eat; I wanted to do a traditional meal, but it didn't suit him because ofhis diet. I had to do a dish of meat and onions when I had wanted to put some prunes in; he always has to have it his way. T: You are coming today after the Christmas break and ask me for a change in the time; we are, in fact, still on holiday. I think that you found it hard to come, and you feel that like Julian I get my way. P: Yes. Ifound it hard having to come—I've got everybody at home. Julian is on holiday; he wants to prepare an exam and got nervous about not having enough time. I said to him that I didn't understand how the two hours it takes me to travel and do the session could make a difference, but he said it did, and when I was leaving he wanted to take the baby to his mother, I was against it because if he leaves him with her, she feeds him and I don't see him until 6 o'clock. In the end I said that I would sort it out and take him to my parents'—that way, when I return from here I'll look after him. He wanted to make love and was hugging me, but I wanted to get away; it felt claustrophobic. I remember one occasion in a campsite in the Costa Brava when he also grabbed me like that and I wanted to get out of the tent but it was freezing outside and there was a terrible wind. I spent the entire night going in and out. T: It seems that you had to make an effort to come here; maybe you feel that I make you do things that you don'tfeel like doing, but going awayfrom me is to be in a cold and unwelcoming place. P: I thought about the difficulty ofcoming here in the last session, but in the end I decided not to mention it, because fifteen days without coming would be too many days. The other day we thought that we should go to buy some toys, and we asked my parents if they wanted to come; there is a big toy supermarket in Montigala. They said yes, and, of course, we hadn't thought about that, but when he saw all the toys Marc wanted to take them and since we wouldn't let him he got impossible. In the end my parents had to take him outside. We could hear him crying while we were trying to buy. Julian wanted to finish as soon as possible; apparently they walked Marc round to greet the Wise Men three times. Julian wanted to buy him a bicycle, which we did; but going with Julian is really hard: he buys in a completely different wayfrom me. I look, I compare prices, and I go back ifI think that what I saw before was better. He sees something he needs, he tries it on, and he buys it He didn't want to look at the toys; he was going straightfor what he wanted, and I was saying to him that he didn't let me look. In the end we left and I was angry; I said, what shall we do with the toys? We'll

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leave them at home, he said, but he wasn't quite sure, because one of them was to give to his mum. I lost my rag; my father was patting me on the head saying: poor thing! In short, it is difficult to get on with him when it comes

to shopping,

I prefer to do it myself; that's what I do with

clothes, but for Christmas presents it would be too much to go on my

my own.

We had a row in the end, and he said things to me that hurt a lot The next day he asked me to forget normally,

it, but I cannot forget it; he doesn't talk much

but when he bursts he says very nasty things and then I think:

is it really like that? He got cross with me; he said that he earns

300,000

pesetas and that all the money I bring in goes out in therapy. I told him the next day that he had hurt me a lot. T: It seems to me that there is something

controlling

in you that

tolerate different ways of going about things; you also get offended

doesn't when

you are told the truth: it is true that he earns more and that for a long time you have thought that you shouldn't expect yourself household

to contribute

to the

budget

P: You see, he has a strong superego. I didn't want to clean the kitchen the other day, and I said I had a headache and would do it the next day; he insisted and ended up cleaning it himself T: It seems that all of us around you see that the kitchen of your mind needs tidying up and for that we need sessions, but instead of seeing us as being interested in your progress you experience us as having a strong

super­

ego.

D.M.: This is a very normal complaint in women, that you can't go shopping with men because they do not look, they do not compare, they see something immediately and they buy it. The complaint about men's sexuality is that they go straight to the point, straight to copula­ tion, w i t h no foreplay, dusted and done. (Laughter) These fundamental problems between the feminine and the mascu­ line, between men and women, are aggravated when social questions come into it, such as being elitist or being a peasant. Her husband is not sufficiendy refined for her, not high class enough, a bit vulgar, and that has implications for sexuality too, as if there was something dirty there, dog's faeces i n his sexuality. There is a problem of elitism, and you are right when you point to the aristocratic question in her. The superego image comes in here with reference to infantile masturbation and her parents' admonition against that activity i n her. In the back­ ground of that attitude we have her as the mother of her boy; for a girl like this having a child is what makes her change from being a girl to being a woman. And this change from being a girl to being a woman is

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also a change i n values; i t is passing from being a sexually desirable girl to an admired and respected woman. The anxiety behind this— very connected w i t h her child—is one of being very denigrated by him, as is the case nowadays w i t h children in treatment, i n the analysis of children who denigrate their therapist. That's why she doesn't want her child to see her doing menial jobs. They have this anxiety that children who always see their mother w i t h her hands i n the sink must see her too w i t h her bum i n the air cleaning the floor. A n d that, of course, is not being a Queen. However, what one hears most fre­ quently from the children is: mum does nothing—she has a servant and a cook! These are not problems that reflect great madness, they are not insoluble; they are, rather, something in the nature of hysterical problems. For this woman, for whom having a child was the change from being a girl to being a woman, giving i n to sexual desire would mean going back to being a girl, a masturbating girl who feels declassed, scorned, etc. When she places you in the strata of the "declasses" who don't belong to the Institute, it means that, for a part of her, when the session ends your sexual life begins, and the girl model w i t h long black hair changes to the older woman w i t h the old-fashioned bloomers that match old-fashioned sexuality. As she takes you down from the posi­ tion of Queen, you turn into the cleaning woman, the prostitute, and the declassee. But between these two positions there is the mother that works and you work for her: even during holidays and weekends you are working for her.

11

[JUNE

1995]

Eduardo Grandiosity on the wane Carlos Tabbia

E

duardo is the young engineer, 34 years old, who lives with his parents. I see him five times a week. DM.: How long has he been with you? C A R L O S : T W O years and eight months. Session of Wednesday,

24 May

1995

P: I dreamt that I "was in a large coastal cave like this, full ofseawater, and I swam inside like a dolphin. To go out 1 had to use a staircase with small high steps—15 centimetres high and deep—the staircase turned at 45 degrees, the slope was rough and difficult, with worn-off round pebbles, and very narrow; it was made of the same kind of material as those blunt slabs you find on beaches; it was wet. I went up through a very narrow tunnel I got claustrophobic, I couldn't bend my knees. D.M.: I don't understand why he couldn't bend his knees. C : Because the place was very narrow, the staircase was like a tube. I had to ask him a few questions to understand this dream. . . itfelt very oppressive; there was just enough room to move, brushing against the wall and risking slipping and falling. I had gone to have a 152

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swim and play with the dolphin; I was explaining this to the psychoana­ lyst: a blond, squat, and fleshy type, with a doctor's gown, a round face, and straight hair in a modern style. I was explaining the dream. I think I put on a towel or a bathrobe and was explaining how it felt coming out through that only exit, which was better than underneath the water where you can drown. The doctor interpreted to me: 'how many hours do you sleep each day?' Ten. 'Well, when you sleep more than eight hours you become dull like a piece of lard.' I was woken up. I threw the I Ching and it said something to me; the builders had just arrived. I went to have a magnetic-resonance scan done (he had had a car accident); I felt claustro­ phobic. When my brother and I were young, during holidays we used to get into a cave by crawling. In the swimming-pool at home we used to crawl through the bottom step of the staircase ... you can't do that now because the paint doesn't let you slide. I felt anxious this morning in the magnetic-resonance scan; they put you inside a tube, the whole of you as if you were in a vault in the wall. It lasted a long time, about an hour; the dream could be related to the anxiety of the magnetic resonance. The builder has been round but the acoustics have not improved. When I left here yesterday I went to the studio; my father doesn't go down there because he's got a broken leg [here is where I discover that hisfather has a leg in plaster]. I felt good.,.. C: The patient digresses i n multiple details, and i t is difficult to tell what is true i n his story. D.M.: There is a lot of fabrication. P: ... I wanted to start working again. Daniel said he has thought about me for a project. I got several ideas and I sorted them out. I told my father I liked his idea He was pleased. I shall do that viaduct with quite a lot of freedom; I am up to it! D.M.: What we see i n this dream is what is present i n the projective identification, this splitting between grandiosity and claustrophobia. The grandiosity is very agreeable and the claustrophobia very disa­ greeable, and the point of the interpretation is that you cannot have the one without the other. Playing w i t h father's penis is represented by his flattering his father when he talks about his project; he is saying, " i f you flatter father's penis i t won't bite, it won't cause harm because i t is i n fact a dolphin not a shark". The claustrophobic anxiety is not just represented in the possibility of slipping, falling d o w n the hole, but also i n the fear of this dolphin that might be a shark. It is quite clear that his other defence is to stay close to his brother and, i n association

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w i t h him, enter the mother, make an intrusion into the mother as a mutual project. The phrase would be: " I t was him who made me do i t . " Who is Daniel ? C: He is an engineer who works in the studio, same age as my patient, and who has become father's right hand because Eduardo doesn't work. T: In the dream there is this phase when you are playing inside mother for quite a long while with father's dolphin-penis; you want to leave that mental state but you fear the outside; you hesitate about going out because you fear the enormous impact of the outside; you are afraid of falling, slipping inside mother; you ask me for help in order to function differ­ ently, differentlyfrom the way you are used to. 'D.M.: Fine. P: I called Dari to arrange the weekend in a different way. Ill go to the south. C: I have no idea of who Dari is. D.M.: A girl? C: No. It's a boy.

Ps: This patient goes with girls and with boys? C: His homosexual activities have disappeared lately. T: You answer me that if you come out you explode and shoot off in the direction of the south. Inside you drown but outside you drown too.

P: I was thinking that I said to Paul that I was angry because they left me alone in Lloret. .. . They do it to me and I do it to them, time and time again, so I went back to work. I am not interested in Paul and Eduardo any more. ...ftis better to stay at home and sort out motorways and bridges. I remembered something that makes m*e angry.... I gave a piec offurniture to one of them and he paid me back with a dirty trick. I don't know why people turn nasty on me; I was thinking about the piece of furniture, why was Una hurry to get rid of it. No. It was not that I was in a hurry. That piece offurniture should have stayed there until I said so— myfather can't just tell somebody to throw it on a skip. T: You are frightened that I might hurry you up, like dad: " come out from

inside mum and go out to work", and you answer me, "leave me inside,

leave me inside".

P: I threw the I Ching coins yesterday; I was anxious because of several things: the business of being left there, in Lloret; it must be that I treat people very badly to be treated like that myself; it is something in me. My

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brother came yesterday; we thrashed things out; he was going to Paris and I was going to the south; he had a go at me because I live upstairs. My mother asked me to help her in the surgery; well, she can ask my brother; they allow my brother to say that I live in the house, when he rips them off and I have saved them millions! T: You are cross because dad-brother wants to get you awayfrommum's side. P: Yesterday myfather asked me to help him up the stairs when the steps are only 17 centimetres, he asks me everything. D.M.: What does that mean? C: That they are not too high.

D.M.: The father uses crutches. The son is a lazy dog. One doesn't

understand a lot. He treats you like the I Ching game w i t h the coins; he

manipulates you—like the coins—to see if he can get a forecast, I am

going to look at the portrait he does of you when he talks about the

psychoanalyst.

Ps: He describes him like a little pig.

Ps: Yes, but he has straight hair.

D.M.: Does that portrait look like Eduardo?

C: No. He is tall, s l i m . . . perhaps it looks like the description he gives

of his father: quite big, fat, and strong.

D.M.: A n energetic type then, the father.

C: Eduardo describes him as an arrogant person.

D.M.: You have a strategy problem; first you have to manage to get

him out of the projective identification, and for that you need to com­

municate. His anxieties seem to centre round the question of being

thrown out, abandoned, and deserted. That is part of the claustropho­

bic anxiety clarified in his being i n the rectum and being treated like

shit. What does he look like?

C: He is good-looking. A colleague of mine tells me that his mother is

very beautiful.

D.M.: There is a problem here—vanity. When the patient is good­ looking he can hide his fear of being treated like shit, of being shit but

pretty shit. There are no indications that mother is uncomfortable

about having him inside. The anxieties are always being pushed,

kicked out, by father; there is anxiety here w i t h regard to the narrow­

ness of the tunnel. There are also indications that say that so long as

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you don't try to go out, leave, it is a place where one can be, play, like in the swimming-pool at home. There are indications that his mother is quite happy having him as a parasite. We should concentrate on look­ ing at the figure of the dolphin-shark. He is well defended, he is a borderline psychotic. Doesn't his father ever get fed up and shout? C: No.

Ps: H o w come? Is he not aware of what goes on?

C: What is happening is that his friends realize that he is a pretty shit

and are leaving him.

D.M.: But a good-looking type is never without friends; he can always

find new ones.

Ps: A n d he has money.

Ps: Could one think that this case falls i n with the patients who, as

Bion says, try to place the analyst between two alternative interpreta­

tions, neither of which is satisfactory?

D.M.: No. I don't get the impression that he is the type of patient who

splits the analyst; he only projects the feeling that he is a shit, worth­ less, and that you are wasting your time. Session of Tuesday, 6 June

1995

(Monday was a holiday.) P: I am reading the notes from this morning's dream. I was waiting for R., his brother (who is dead), and his sister (he doesn't have one), in a bar. In the dream "both brothers looked very similar and R. '$ brother didn't know me, nor did his sister; she was a redhead; they laughed at her because she wasn't up to their level" Another dream: "there is a hacienda with a courtyard, it is an enclosed space; there was a vine covering the patio. There werefive or six of us sitting at a table. I grabbed a beer glass or a jar and smashed it on each person's head. A chap in a nearby table wanted to kill one of those five or six people, he climbed up the vine with a shotgun, maybe I persuaded him not to do it and he left on a motorbike." I had a good weekend; yesterday at 9 o'clock I arrived in Montserrat and went to see my cousin. I was sorry that I couldn't come here yester­ day. It was a fabulous weekend. Dari didn't come. I went by car. ... I raced; I had problems with the brakes; I did a good time. I was happy.... On Saturday I drank a lot.. .. On Sunday I got a better time; I could have got a better one. I am going to enter the twenty-four-hour race. I'm good enough. Going all the way to the racetrack in the south was punishing,

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but yoga helps me to get back to normal My right hand goes numb. On Thursday I shall go to the circuit here. I had problems with the oil I slept five hours in two days. T: You tell me about dangerous situations that you are in: the brakes, the oil, the tyres, things that go wrong. ... In the dreams—about which you say nothing—there are dead people, rejections, blows, assaults, as if you had been trapped in a hostile mental world. P: Ifelt uncomfortable thefirstday there, because they didn't dare ask mefor my motorbike; I was isolated to begin with. T: You transmit the painful sensation of being isolated. P: On Saturday, with some beers I felt okay with them. T: With blows from beer glasses on your head so as not to feel so lonely. P: Maybe. I couldn't sleep in the hotel; I massaged my body with the dildo, then I masturbated on my knees, thinking about the black man and Paul T: In the dream there is a man with a weapon who wants to kill you violently; it is the way to express the desire to kill the Eduardo who yearns for analysis. P: When I had problems with the brakes on Saturday I didn 't know if I would be able to stay there; I meant to come back on Sunday and I would have called you [in order to come on Monday to an optional session] but they brought me a new tyre. I couldn't decide whether to come or to stay. ... We couldn't change the tyre. T: The dream with R. and his dead brother and his sister who doesn't exist, does it suggest something? P: No. T: They look like representations of you: we have R., and his dead brother who would stand in for the dead session, the one that did not take place; his sister would represent the Eduardo that wanted to come, but R. was against it, he did not allow you to come. P: (Sighs .... silence) I was thinking about the cut-out on the motorbike which is probably what causes problems in the races, I was thinking too about the faulty transparent dome they delivered; they sent a new one but I didn't return the other one, so I have both. T: You switched your mind off. P: My stomach hurts. I have dyspepsia but have nothing to take for it. I feel sleepy; I didn't sleep enough; no, not true, thirteen hours. T: Sleeping now means turning into a dull piece of lard—that's to say, without thoughts, like hitting your head with beer glasses.

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P: (Silence) When I left there I was happy because they looked after me we I thought of sending them a case of cava because they drink a lot.... They welded the chassis on my motorbike trailer.

T: It seems thatfor your mind this weekend was a disaster: the trailer, the oi and the tyre

P: No. I wasn't pleased with the tyres, but it would have been a pity not to go; it was a test of my physical limits. It would have been nicer if I had gone with more people, with more resources. I now remember that when was coming backfrom my cousin's house there was a broken-down car, I helped to push it. In my cousin's house yesterday I felt like saying to my uncle—who has a new car—that I wanted to talk about my mother because she had talked to him about separating from my father, but the haven't separated... that brother is my mother's father figure.

T: It seems that you were looking for your analyst in the hills since you had broken down and needed help.

P: Everybody called me today, that's why I went to the circuit in the south. I think I depend a lot on other people. I thought if they don't come to the south I shall go anyway, that way it will be clear that I am capable. I realized that I can go on my own. Ruth called me three times and Sara too the Czech girl, to go to a fashion show. Of course they call me because I have a car [the fashion show is outside Barcelona],

T; As you were confused, you couldn't distinguish between coming to the analysis yesterday because you needed it and coming because I needed you to come. And since you couldn't solve that confusion, you didn't come.

P: And when I was there I had to make a decision without enough informa tion. I was going to come back on Sunday to be here for the Monday session, but they changed my tyre.... T: But at 9 o'clock in the morning you were near Barcelona. . .. P: But how was I going to come? T: You could have called me.

P: But we had agreed that I would call you on Sunday. On Monday I was a bit blurred; at about 4 a.m. I ate something and slept on the road, in th car. I was knackered when I arrived. I thought I would come here and ring the bell at 11 [the time I had offered him]; but I felt different by turns at each hour: clear-headed, blurred... . T: The dream about R., the dead person, and the woman would represent your changing states of mind.

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P: Yes. R. represents the independent person; he knows what he wants and he gets on with it. I understand now. C: I n this session I tried to get h i m to focus on the reason why he didn't come to this session and so stop him distracting himself. D.M.: He is i n a panic situation during this weekend, and when you offer h i m another session he solves the panic, just as when he had no tyre left and was offered another one. However, the fact that he has been given another tyre does not solve the problem of not having brakes, but for him to be brought another tyre is an expression of friendship and he likes that. He w i l l send them a case of champagne to reward their show of friendship. It is a mistake to offer h i m a session— not from a technical point of view but from a strategic one. Why did you offer it to him? T: Because I saw him panicking at the thought of the weekend. He is now very worried about what he will do in August; sometimes he says he will go to Menorca, sometimes to Chile or he will stay put and work with his father in the studio. D.M.: He is not coming in and out of the projective identification but, rather, changing from being a man to being a woman, heterosexual to homosexual. In the dream, who teases whom? Ps: The brothers tease the sister because she is not up to their level. C: The redhead girl had been his girl-friend. D.M.: His feminine position doesn't make him feel very secure; he doesn't feel very secure. C: I n the previous supervision you said that it would be a therapeutic success if he didn't have a sex-change operation. D.M.: Yes. His femininity doesn't protect h i m a great deal i n that fantasy of masturbation regarding Paul and the homosexual black man. C: The Paul here is a different person. The black man is a homosexual who seduced the patient as he was coming out of a porno shop. D.M.: This masturbation on his knees on the floor is a passive position on his part, w i t h the fantasy that he is penetrated. C: He relates a fantasy where he has his legs up i n the air, as i n giving birth, and he is penetrated by the black homosexual. D.M.: A l l this material is quite suicidal; there is a great deal of dicing w i t h death, very dangerous things.

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C: He talks about having sexual relationships w i t h men and women without using protection, without worrying about AIDS. Ps: A n d there are the motorbikes. D.M.: H m . . . hm. Very slippery. When anxiety eats up his defences he builds another one; i n that claustrophobia where the shark turns into a dolphin, when he realizes that he has only just touched it up a bit and turned it into a dolphin he says: shark it might be but I am a girl and sharks do not eat girls because I am going to offer it my bottom to be penetrated; he just changes it constantly to slip away; he is a slip­ pery type, he wriggles away from you. The thing w i t h these people who play w i t h death is that each time they don't kill themselves they think they have wiped the slate clean, that there is no paranoia any more, or anxiety, but it is a desperate measure. They subject them­ selves (in the risk situation) to the judgment of the superego that spares them their life. You can see this i n gamblers who each time they w i n they forget all the times when they lost, the fear of ruin, the financial bankruptcy, and the suicide they would have to commit if i t came to total ruin. Thinking about what to do w i t h him, I would concentrate on analysing his feelings that he is worth nothing, that i n the end he is just a piece of shit that w i l l eventually be flushed down the toilet. This fear of being thrown away can be seen i n autistic children, they throw everything away, it is their fear of being thrown away; i n the last instance it means death or being thrown into the delusional system and becoming mad. in the first dream, one can see that he knows that the way to get out of the projective identification is to go back the way he got in. He says, "ah, but it is difficult because the steps are very high, the place is narrow, and you cannot slip under the bottom step because this new paint is not smooth . . . " , but he does know. The route of entry and exit in projective identification is anal; i t is lubricated masturbation—there is a lubricant to go i n and to come out—and when he is masturbating, his fantasies are of anal penetra­ tion; i n his anal masturbations, he is constantly penetrating himself. What you are doing i n the analysis is that you are taking away a bit of that lubricant, you are putting on a paint that is not smooth, you are making it more difficult. Ps: The penetration fantasy doesn't seem clear. . .. D.M.: The fantasy is that the motorbike is penetrating h i m anally; it is the shark and it w i l l not penetrate him but devour him. Taking the motorbike to the south is the fantasy of being an attractive girl w i g ­ gling her bottom and attracting all the homosexuals.

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Ps: Why do you say that he attracts homosexuals? D.M.: You can only attract homosexuals. This is to do w i t h his Oedi­ pus complex: he thinks that his father is a homosexual and impotent and that his mother is a virgin who is separated from his father, always unsatisfied, and that his father is greatly attracted to him because he has an attractive bottom. He experiences your interest i n his dreams i n the same sense. For him, analysis is the same thing: he presents to you the bottom of his mind, his dreams, the product of that mind-bottom that you find very attractive, like that redhead girl who was very attractive. Being attractive to you, offering you his dreams is his last defence against the autistic anxiety of being evacuated, expelled to the outside world of death and madness. The panic this weekend was that he thought he was going to act out these homosexual fantasies of death, of playing w i t h death or going mad. He is at risk i n two ways: either he is going to kill himself w i t h those defective motorbikes driv­ ing fast after drinking, or he is going to go mad i n a delusion of believing himself attractive like a girl, femininely attractive, believing his femininity to be irresistible. Your offering h i m that session rein­ forced his manic defences. Interpretations are probably not going to have any effect because he does not listen to you; when he says there: "R. represents the independent person; he knows what he wants . . . I understand now" . . . it breaks my heart. C: When he came to the next session, he said: " I really liked the end of the last session, what you said was nearly perfect." D.M.: Bottom; that's what he thinks his bottom is: a perfect round beauty. What he is saying is that the end of your penis and the shape of his bottom make a perfect couple. You have to make it clear to him that he is a shit, that he is worthless. That is what he is; it is what he feels and he lives i n fear of being flushed down the loo. He is useless; nobody uses him for anything; maybe he even causes harm to lots of people whom he disappoints, whose hopes he dashes. It is true Freud­ ian narcissism. He is i n love w i t h the image he sees i n the water. He is not even looking at the water and seeing his face, he is looking into the WC at the image of his bottom reflected i n the water. You have to ask yourself how long you are prepared to put up w i t h him. You have to make i t clear to h i m that he is worthless and that you do not have inexhaustible patience. To get h i m out of the projective identification you have to aim at diminishing his grandiosity; that is the most impor­ tant thing, and then the claustrophobia w i l l increase by itself. He is a good-looking boy who thinks that his mother loves him and protects

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him from all dangers, so he lives a charmed life. I wouldn't spend another year with a patient like this. I would interrupt the analysis, which is what I did w i t h a homosexual patient of mine, very rich, very grandiose. I interrupted his analysis, and he is constantly calling ask­ ing me to start again. [Dr Meltzer says it has to be thought out calmly.] He has made progress; there have been changes in his life; he has lost a lot of money, half of it on a grandiose project. He started by thinking that he was a great poet and artist; now he goes to art classes and finds it quite hard. His grandiosity is diminishing, but it has to be consoli­ dated. He is a parasite.

12

[JUNE

1995]

Eva Bisexuality and oedipal triumph: obstacles to intimacy in the ceremonial family Rosa Castella

T

^his is a 44-year-old patient who is a podologist. She has been with me for two and half years.

Data from the first interview

I have in front of me a girl dressed in jeans, a bit brusque and rigid in her movements. She says that she is coming to see me because she has things within herself she has to sort out, and she mentions: 1. That she is worried about how easily she gets angry with people who are not punctual. 2. That when she dislikes somebody she is never able to like them again, and when she has a conflict with somebody it is impossiblefor her to tie up the relationship again. 3. That she would like to sort out her sexual relationships. (She laughs) To feel an orgasm with a partner is for her exhausting. She feels that it is expected ofher to feel an orgasm to please her partner—it as ifher partner obliged her to have them. 4. She also says she is worried about the upbringing of her 9-year-old boy; she has been very liberal, unlike her ovm father. Her son still sleeps with

163

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SUPERVISIONS W I T H D O N A L D MELTZER

her; she was very, offended with her sister, who said to her that she does this because she is not in a couple. She explains that she is the third of five siblings:

the first three are women (aged 45, 43, 41), she is number

three,

then comes a man (aged 39) and then a woman (aged 38). All very close together. She is angry with her mother; she has a grudge against her for not having loved her enough. She was father's favourite, she was a fighter. suddenly

Father was a demanding

perhaps

man, dominating;

because he died

some months ago (before the beginning of the treatment).

About her education, she says that she was a boarder in a convent school away from the village where her parents and family lived; she did not want to go there but was forced to. Then she studied medicine and did her speciality

in

Paris, where she lived for some years. She has a son from a Frenchman

who had another lover at the same time.

They decided to come to Spain to have their child here, but afterwards partner returned to France. She talks about her rage at her parents' understanding

her

lack of

about her having a child without being married. (I notice great

rage and aggressive feelings.

She seems to me to be somebody

who is very

insecure in her affections). In the next session she explained orgasm by masturbating fantasies—something the beginning

that she had no problem reaching

an

and that she wanted to talk to me about her sexual

she had never done before—and wanted to do so before

of the treatment. These fantasies had a marked

sadomasochistic

tinge: for example, she goes to confession on the men's side, the priest touches her breasts, and the penitence he gives her is to make her have anal sex. she is the maid in a house where the head of the family

Or,

prefers her to all the

other maids and he gets excited when he sees her making the bed. Or,

while

half asleep, several men touch her at the same time, etc. She assured me that she did not think she was able to reach an orgasm without

this kind of

fantasy.

am going to explain some dreams before moving on to the sessions I have brought. I see her twice a week, on Mondays and Fridays. ROSA: I

Dreams from the previous session 1.

"I was in New

York airport, I saw the king and queen of Spain

going

towards a door, I slipped in unnoticed and followed them. Then I lost sight of them, I had an appointment with Inmaculada [her big mamma sister, as she calls her]. I couldn't find her but I did not despair as is usual in me. I just sat down to wait in the bar. She turned up in the end."

JUNE

1995

EVA

165

D.M.: Is she her eldest sister? ROSA: N O , no,

she is her younger sister.

2. " J was driving my car and I had with me an acquaintance la woman, the mother of a child who goes to school with her son], I turned round and found myself near my sister Mercedes house...." 1

R: This is the eldest sister, ".. . I had taken a different route. The woman got out of the car. I was in my sister Mercedes' house with Inmaculada [her other sister] and her mother. Mercedes was half asleep, naked, with her feet up on a table and her pubic hair shaved off. Her husband was making excuses for her/' D.M.: Inmaculada is the youngest sister? Ps: The big mamma, isn't she? R: Yes.

[She says she has heard on TV that the king and queen of Spain are in New York (Inmaculada is the sister who is always being a mum to the others).] 'Tfind my sister Mercedes shameless, she is the one who tells me her sexual adventures and she sends me her boyfriends...." R: In real life, this woman Ps: Is this her real name? R: No, I have chosen the names i n a, let's say, Uturgical way: Inmaculada for the " m u m " , and her real name for the other sister. Ps: Mary Immaculate. R: Well, it is not to the point, but as i t happens, i n real life, Mercedes is a woman who is always having extramarital affairs and brags about the number of men she has been to bed with. D.M.: Does she tell everybody, or just the patient? R: With her sister at least, there seems to be some kind of bragging. D.M.: A n d her husband makes excuses for her? (Laughter) R: I think her husband has a good idea, more or less, of what his wife is like, but he does not make i t difficult for her. M y patient explains that sometimes her sister involves her i n these affairs by sending her her ex-lovers, etc. D.M.: A good source of referrals. (Laughter) P: The shaved pubic hair makes me think ofanimals withoutfeathers; as you know I find them disgusting, you know I have a phobia of animals, especially the ones with feathers. ...

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R: A t home, her mother used to look after animals. D.M.: This is an interesting basis on which to build a phobia. Animals w i t h feathers are seen as animals that exhibit their sexuality, as was the case i n ancient Peru where the ceremonial dress of the aristocracy was made with feathers. I n English there is the expression "to put a feather in one's cap", which can mean to exhibit your sexuality like a whore. P: As far as the waiting treatment I notice

at the airport,

you know

that when I started

if somebody

I used to get very anxious

kept me waiting

that I have changed, I can wait for other people with a

that was impossible

for me to imagine

a few

P: Is Monday

minutes

a holiday

1995

early. She pays me for here in

confidence

before.

Session of 29 May She arrives

the

but now

the

month.

Barcelona?

R: She asks because she doesn't live in Barcelona. T;

Yes. Maybe

we could find

another

P: I shall look at my timetable

day for

the

session.

at our next session

and we can discuss

(There

are builders

at work above my consulting-room;

when I realize

cannot

hear each other, I invite her to move to a different

it. that we

consulting-room.)

R: So there's an accident here—there are workmen i n the flat above, they are hammering away, and it is impossible for us to work. The only way we were going to be able to work was by going to the other consulting-room. D.M.: What consulting-room? R: Lluis's. D.M.: Is it very different from yours? More masculine? R: It is more in an "empire" style. (Laughter)

No, no, it is more showy.

Ps: A n d you have to go through that room w i t h lots of books, don't you? D.M.: I n any case, i t was clear to her that it was your husband's consulting-room. R: She knows I work with another person. P:

I don't

remember

There telling

anything

is something

that

I dreamt. . . . worries

(Silence)

me, which

is that

my son off. I do it, but I don't like our relationship

I'm

constantly

being

character-

JUNE

1995

EVA

167

ized by my having to tell him off. I wouldn't like telling him off to become a constant habit in our relationship.

R: She took her son out of her bed a long time ago. .. .but he doesn't listen to me and I don't know how to deal with him. Our arguments are not about big things; he is just a bit absent-minded... like a child (there is tenderness in her voice). At the weekend I asked him if he had done his homework. And he said he didn't have any. Last thing Sunday evening I saw him working and he said he had forgotten but he did have to take something in for the following day ... naturally I get annoyed ... somebody gave him a message for me the other day in the Music Conservatory; well, he forgot to pass it on to me and he had the bit of paper in his wallet for fifteen days. His head is up in the clouds; when I tell him off about it he gives me examples of boys who are even more absent-minded than him, and I say to him that he has to look up to boys who are better than him. He answers back all the time. Another subject is tidiness; I went into his room last night and he had no pyjamas on; there was a shirt here, a pair of trousers there. I told him to get up and tidy it up. He said: "Now?" I said: "Yes, now." I can't get through to him. He is always dodging me. He is used to having me trail after him. T: You are talking about your untidy and cheeky son. Today you had to use a different consulting-room and you paid me. Maybe you are saying to me that you don't know how to tidy up your thoughts, maybe you are annoyed with the change but don't know how to show it in case you offend me. P: No... I don't mind about changing rooms. You are still here with me... about paying, yes, I do mind; you know I always do.. . . T: Maybe you are avoiding showing your feelings, your annoyance, like your son. P: Yes, avoiding ... typical of me. Do you remember that I told you I had a serious boyfriend and I didn't tell my parents for three years? Look, you know that I am extremely demanding in my relationships with other people. I feel I am laced into a tight corset and if I take it off I am scared that everything will spill out. I am afraid of my feelings. ... Also my relationship here with you is special... we are not on equal terms, and just to think that I could show my feelings but would not know what you feel makes me anxious. My job here is to talk and yours to listen, but you have the upper hand. In my consulting-room I give myself to my patients; I take risks, I have patients who love me. There is an old woman who brings me cherries.... There I enjoy giving of myself because I have a say in it. But here I want to be prudent; I don't want to invade you.

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(7 explained briefly to her the advisability of being able to talk about her fantasies and helped her to discriminate between showing her feelings and invading me.) P: Maybe you are right. I know there are emotional reactions in every relationship. It is typical for students to fall in love with their teacher, but I stay at a distance here. In my consulting-room, I give myself; here, I keep a distance. I adapt to the circumstances. Also, a rejection would push me back. T: You know that for the good of your treatment I must not show you my feelings. That is one thing, and you taking it as a rejection is another thing. Maybe the image of your son being aware that his mum can help him "tidy up" his feelings could be of help to you. P: There is no equality here. I find you very professional and a little bit distant. I feel that there is affection but I find you cold, and I don't know what to do with all this. Ifl have fantasies about you, I disperse them, I don't want them. I have been very open here. You must remember that I was like that from the beginning; I talked to you about my sexual fanta­ sies—you are the only person who knows about them. T; But you have dreams, and in the last session you dreamt that you had "slipped in unnoticed" behind the king and queen of Spain. That indi­ cates, perhaps, a desire on your part to "slip into" the mum-and-dad relationship, the relationship between the mum-therapist and her partner. P: Yes, I am curious about you, I notice things. I have the feeling that you have been ill When I think about it 1 notice that 1 am afraid of looking you in the eye; sometimes I force myself to do ii. It is not difficult for me to tell you what I feel about other people, but it is difficult to tell you what I feel here. I feel so constrained when I try to express my feelings here, and I get such a headache. . . . It is as if talking about my feelings would stimulate me too much, as if it were excessive for me. And also, you must not forget that I have been taught in my family not to tell intimate things to other people because when you tell things the danger is that they will be repeated. When I talk about my feelings it is as ifl were naked in front of other people and in danger of being used and thrown away. Also, when I was talking with my son I realized that I prefer other people not to know exactly what there is inside—that way, they can be jealous of it. T: You are taking refuge in a position of mistrust, as if the only thing that can come from other people is bad treatment and as if only by being secretive can you be envied, but you and me know that by doing that Eva feels very lonely.

JUNE

1995



EVA

169

P: Yes. I am very lonely and sometimes you know that I am tired of it.. .but you see, what we are talking about today makes me tense, it is like jumping into a swimming-pool; I used to not be able to swim, I am frightened, I am frightened of letting myself go.

f

T: It is as if you could not imagine that in the same way as there is a teacher who has taught you to move in the water, you also have me here to help you.

DM.: She is very sincere. She is frightened that you might get to appear i n her masturbatory fantasies. And obviously she got scared when she had an inkling that you had been ill. The relationship with her siblings seems to have replaced her emotional relationship with her parents. Her younger sister has been her mother, and from her older sister she has received projections of jealousy. There seems to have been a very close relationship between the siblings, the sisters i n this case, while the parents have been fixed into a sort of pose, desexu­ alized and de-emotionalized, turned into a sort of photograph of the king and queen. The family have been sequestered from the commu­ nity and have formed a unit very much apart from society, relating only between themselves. They feel quite paranoid towards the sur­ rounding society which they believe mistrusts them and is jealous of them since they don't know what is going on behind the walls of their house. R: This is true. Her father was the secretary of their village council and because of their position they had to pretend to be a marvellous fam­ ily, hiding anything that was not "presentable". D.M.: Obviously, she has not been able to let you into her intimacy; you are still in the position of the king and queen: the portrait of her parents hanging from the wall at a purely functional level. They are allowed ceremonial functions, representational, i n their role as king and queen, but they are not allowed to come into her privacy; they are only accepted i n order to fulfil a social role. She thinks that a certain secret has to be kept vis-a-vis society, because she thinks mat if the situation i n the family were to become known society could be very critical of her: for example, the whole question of her being a single mother, her son, the absent father­ lover—all of this could be seen as there having been an incest relation­ ship i n the family. She feels that she has revealed to you too soon the state of her genital, which is that of a bird that has lost its feathers, which is also the state of this little girl that has never had true feathers.

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She certainly places you too soon i n the place of her confidant, but on the other hand she has not acknowledged a private life i n operation in you; she only acknowledges you in a ceremonial, representational position. The things that worry her are incorporated into the content of the masturbatory fantasies, and these seem to be bisexual. The father­ confessor touches her breasts but at the same time wants to penetrate her anally as if she were a boy since she is doing her confession on the men's side. This is one of those cases where an intense bisexuality is really experienced as an absence of sexuality, as if each of the two dimensions were cancelled out by the other. This sexuality is so much at part-object level that it loses its emotional quality. Her only quality is excitement, which takes her to orgasms lived as masturbatory, w i t h ­ out the emotional quality of love. When she had her son i n her bed, and she humoured him gratifying his oedipal fantasies, she was pleased, she felt loved by him, but once she has started setting limits on h i m , frustrating him, she perceives that it is difficult to keep this kind of love and she is beginning to suspect that her son hates her; this gets through to her—she is not pleased. On the other hand, she is afraid that you might enter into her masturbatory fantasies, because she feels that then she would have to tell you, and you are going to feel hurt at having been included in her perverse fantasies. These could basically be related to your husband, where he would prefer her to you for her boyish quality and her boyish characteristics. That would offend you for two reasons: first because she would present herself as being sexually more attractive than you, and second because your husband would be a homosexual. Ps: This would be related to the fantasy she brought before about her being the maid i n a house where the boss prefers her to all the other maids and gets excited looking at her making the bed. D.M.: She really is very sincere and open, but also she is very reserved emotionally. Keeping up this defensive structure means so much ef­ fort, and she has to be so hard that she feels lonely and very tired. Okay. Summary of Session of 2 June 1995

She remembered vaguely a dream where "her mother admitted that she ha been wrong in her upbringing", but that is not why the patient reproaches her mother. This made her think of how different people are. She would have liked to have a more maternal mother, one who might have helped her to express he

JUNE

EVA

1995

171

feelings and physical affection more openly. She thinks that now it is too late, that it isn't the moment any more, that there are people who never grow up. She yearns for a solid mother to protect her and love her physically. At home, nobody kissed each other. She says she feels ill at ease with people because of her ever-present fear of displeasing them, which inhibits her, and that she is always scared of saying something irrelevant orfeeling pushed to act, so masturbating is a good thing for her because she doesn't have to think of anybody else. When she has to be with someone else, she feels anxious, like when there is a silence in conversa­ tions. She used to talk just to fill them up, and she felt that the other person took advantage. Now she is able to stand those silences because she is fed up with being the one who finds the solution. I asked her if she felt me too silent and leaving her to provide the solution. She said that she notices the silences less now, but that before she used to feel them as a demand, that she realizes that sometimes she behaves in a very servile way, that she does it because she wants to be liked, and that if she thinks she is going to have a good relationship she immediately imagines that something will happen, something black. She always puts herself in the servant's role. With regard to me, my eyes remind her of her dad's and make her feel respect; just with a look, her father could tell her what she should do. Later, when her father became old, she felt pity for him, she saw him as a failed man, but it was too late to re-establish a relationship that had been broken for many years. With regard to me she is very scared of disappointing me; I look so calm to her and I seem to have everything sorted out. I interpreted to her that it seemed she was idealizing me.

Session

of 6 June

1995

There was a long silence, and then she told me the following dream, in which she dreamt about me: "she saw me in a swimming pool of a mansion or a good hotel. The building had been refurbished but not too much. I was in the swimming pool dressed in an elegant blue swimming costume and as I got wet it stuck to my body. I came out of the swimming pool and took it off, very naturally, without showing off or trying to hide myself; then I put some knickers on. She saw in me the body of an old woman, wrinkled, but a woman who had accepted her growing old in a serene way. Near me there was a man who was in some way related to me, maybe my partner; he was a calm and peaceful man." There was another scene in the dream where "she wanted to go to the flat she had in Alicante; she couldn't find the street where it was [she has had this

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SUPERVISIONS W I T H

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MELTZER

dream before—she can't find the flat], she was half lost and she noticed that her watch was missing, which increased her feeling of insecurity. She went into an enclosed place, the inside of a pension where one could see an old man, served by a plump maid who put a bit of pate on his moustache." Associations: the flat in Alicante was very pretty, near the sea, with a garden, near the village; it is a flat she would like to have; it had old-time charm; it was not a new flat The maid is one of those servants dressed in black with a white apron; she does something that appears to be caring but is, in fact, a mockery because in the end she can do what she likes with the man; maybe it is similar to her in her servile attitude, which she uses to conquer the other person (sexual fantasies), and to some of her actings-out when she oversteps the mark in teasing somebody to be liked by them. She likes pate; it reminds her of the entrees in French cuisine where one tastes different things rather than eats a single dish. It is quite clear that the two hotels in the dream are not at all alike—one is grandiose, and the other is for homeless people.

D.M.: Here we have the content of her masturbatory fantasies and her triumph over you. She puts the piece of pate on as a moustache; it is her "French triumph", the game she plays to excite the old man, your husband, to incite him to fulfil his married duty with you, even if you don't very much feel like it. That is how she achieves, as a girl, the oedipal triumph with her father; she manages to keep the father's appetite for sex. The work of constantly keeping up that appetite is very tiring, because to do that you constantly have to simulate an orgasm . . . and that is very tiring; you have to build it with your masturbatory fantasies and that requires you to keep them functioning for a sufficiently long time. This is tiring, one is tired and wonders if he is not going to find himself too tired to finish his marital duty with his wife adequately. Keeping up the appetite has meant an effort leading to exhaustion and to the thing not quite working. The question is, what is the mental operation behind this triumph? In general it has its origins in puberty, when the girl feels that she is sexually very attractive to men in comparison to women and that men are truly attracted by girls, whereas with women they limit themselves to doing their duty. All this seems to be, quite simply, a classical oedipal complex, where she has triumphed over her sisters and her father and mother, relegating the parents to a type of relationship that is merely geared to a ceremonial type of function. Maybe it isn't true, but I get the impression that, unlike the British monarchy, in the Spanish one there seems to be sexual attraction between the king and queen.

JUNE

1995

EVA

1 73

Ps: Well, the king is an attractive man. D.M.: What is his reputation among women? Is he attractive to women, does he have a lover perhaps? Maybe that is why this dream about the airport i n New York is well chosen to represent this desexu­ alized ceremonial function. But, of course, what happens is that by triumphing oedipally as she does, she deprives herself of the maternal quality that she wants and wishes to have. R: I n real life she used to do a "siesta" with her father, and not just with her mother's approval but on her advise: "Go on, go w i t h him to have a siesta." D.M.: It does seem as if mother relegated her to this role as maid: "Go on, go and masturbate the old man." The masturbatory fantasy gets complicated because she has to masturbate the old man and help h i m to get an erection but she has to avoid the ejaculation that must only happen w i t h mother. You have clearly invaded her masturbatory fantasies through her dreams, and very soon you w i l l see that it begins to come out. Ps: Could the change of consulting-room on that day have played some role in all this? D.M.: Yes, certainly, i n a similar way as getting her i n dad's bed. It simply helped to put forward the heading of these dreams. What really is important is the transition from her partial-object sexuality to whole object, from a meeting of genitals to a meeting of minds The mentality of pubertal girls is not very attractive. Ps: You think that is a pubertal girl? Do you think that she knows something about this internally? D.M.: Yes, she is still a girl; she has not become a woman yet. A n d she knows she has not developed into a woman yet, which is why she has sought treatment. Is she, i n real life, better looking than her older sister? R: She was always diffident because she is a brunette while her sisters are blonde, like her mother. To begin with, she was the odd one out, the dark one, the ugly one, but as she grew up she realized that she is not bad looking. D M . : Is she pretty? R: So-so. The only thing is that she doesn't make herself up; she doesn't take care of her looks. She says she doesn't know how. D.M.: H o w old do you think she imagines you to be?

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Ps: I n the dream she sees the therapist as an old and wrinkled woman, doesn't she? D.M.: Well, that is the dream, but how do you think she sees you i n real life? This is important. It is a nice case. Ps: I wanted to ask a question about with the intrusion into the con­ sulting-room because of the builders working upstairs. The question would be: is it better to stop the session or, as in this case, to look for an alternative? D.M.: Any change of consulting-room is going to cause a disturbance in the treatment, which is equivalent to the situation of the child who sees his mother getting ready to go to an evening party. I have ob­ served i n my consulting-room that the mere fact of drawing the cur­ tains a bit more than usual in the window that overlooks the garden, which is nothing special, has, on some patients, the effect of mother buttoning up her blouse a bit more so that the patient cannot see, like before, the marvellous garden outside, which, as I said, is nothing to write home about. It is as if mother had buttoned up her blouse be­ cause she has realized that the child was looking intensely at her breasts. Ps: What should one do then? D.M.: Analyse it. It is all grist to the mill. A patient of mine in treat­ ment at the moment, who is a student in the Training Course for Child Therapists at the Tavistock, decided, very bravely, although I had warned her against it, to attend a seminar I was giving to the first-year students. When she came to the session the next day, she was crying, and she continued crying during the entire session. The meaning of her tears was that she had lost Catharine. She attends Catharine's seminars i n Oxford, and she had never seen us together until the day she went to the Tavistock seminar. It was a shock to her, and her tears had the meaning that she had lost Catharine. It was all related to the fact that when she was a year old she had come w i t h her mother from Australia to Europe. Her father had remained i n Australia, where he was a prisoner of war. When he was liberated after four years and was able to join them, it had the meaning for her of losing her mother. Three days later she was crying and crying i n the session. She is a very controlled woman, w i t h a very split personality; on the one hand there is the happy 14-year-old girl, and on the other hand a very authoritarian governess who has been brought up i n an posh school, and this constant see-saw between the gay 14-year-old girl and the

JUNE

1995

EVA

175

authoritarian governess came to a halt leaving only the whirlwind of an emotional shock. The split became present suddenly after that inci­ dent. She has a 20-year-old daughter, who is very attractive, and she has made a total split whereby all of the gay, pleasant, attractive side belongs to her daughter, keeping for herself only the role of confidant of her daughter i n her sexual adventures; she is, i n this way, trying to protect herself from the loss of this type of relationship between a mother and a daughter. These are all different ways for the oedipal conflict to manifest itself, hiding behind it the feeling of the terrible loss of the mother.

13

[JUNE

1995]

Roberto Chaos, guarantor of the clandestine: paranoia in the world of the borderline psychotic Uufs Farre

R

oberto is 24 years old at the time of consultation. The colleague who referred him to me diagnosed him as suffering a depression with suicidal thoughts since the death of his father a few years back. Physically, Roberto is a well-developed young man, who could even be called handsome if it were not for his rigid expression, his cold and fleeting eyes that at times are truly piercing as they take in every detail of the consulting-room, and his scornful and arrogant disposition. His use of lan­ guage is characterized by cruel cynicism and a coarse destruction of meanin through his associations based on spatial or sound similarities or on any othe purely contingentfeature; this leads to endless word games that he consider the mark of his undeniable wit and uses to seduce people, although it soon becomes stupid and boring chatter. He talks in a monotone voice, blunt an forceful. He makes no hypothesis, his sentences are maxims, and anything I might indicate is completely ignored. His bearing, attitude, and speech evok in me images of the Nazi youth in historical documentaries. He says he accepts the offer of help because he is very depressed and has n desire to live since his girl-friend left him recently. He feels overwhelmed b jealousy, imagining Maria going out with a different man, and he spends his time plotting how he couldfind him and kill him—and then kill himself He comments that he spends hours and hours in front of the television. If his mother goes away at weekends, he stays in the house for two days eatin 176

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ROBERTO



pizza and spaghetti, in his pyjamas,

in front of the television.

He

quarrels

with his mother and his three sisters, with whom he has always been in competition, particularly woman

with the eldest He considers his mother to be a good

but a bit absent-minded,

too talkative, and without

a clear idea of

limits. " You can't tell any of them anything in confidence because they blurt it out to the first person they meet."

The issue of confidentiality

or secrecy

about what he tells me has marked our relationship from the beginning: take notes? Could anyone get hold of his case history?

Do I

etc.

When he talks about his father he says, " i t was a dirty thing he did to go and die", at the same time as he expresses boundless admiration towards him. He says he was his father's favourite and is proud of having been into a secret his father told him: to be the custodian of a jewel for his sister, to be kept until she decided to get married. This jewel is more valuable than anything his father ever gave to his mother, and when Anna decided to get married, after his father's death, he gave it to her. Another thing he mentions about his father is that he used to frighten him on purpose when he was little; sometimes the frights were terrifying. For example, he might be i n his room alone and he would hear the door handle slowly turning while his panic increased; then sud­ denly his father would appear. LLUIS:

Ps: To surprise him in the masturbation. LI: Now he does the same thing. He might walk around the house so silently that nobody is aware of his presence. Sometimes he makes his mother or his sister jump out of their skins. P: "He always said that I could do whatever I liked, but that I should

know

that if I did this or that I might as well not even try to go back home."

LI: His father would say to him: "You can do what you like, but you know what is going to happen later." He would say: " I want to go on a trip this weekend", or something like that, and his father might an­ swer: "Fine, but then you mustn't come back home." Roberto keeps his room in complete chaos; he piles up papers

everywhere,

"that way nobody can find my things if they go into my room. It is the best system I can think of for hiding

things."

Since he started the treatment he has had two girl-friends,

and the out­

come of those relationships has been similar to the one he had with Maria: it starts with a seduction phase supported

by his wit and a free-minded

ap­

proach on the surface ("live and let live"),

to be followed by a demanding

and

scrupulous

control of his partner and an absolute intolerance of any

restric­

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tion to the relationship on account of his partner's studies, exams, etc. If this happens he goes looking for any girl to have sex with and then tells his partner about it, "because I have always liked to defend the truth above everything"; his partner then breaks off the relationship. He is then invaded by feelings of depression, jealousy, fantasies about killing the girVs future partner, and himself too, etc. He has a girl-friend whom he calls up in order to have this kind of sexual relationship whenever he feels abandoned. This girl lets him do whatever he likes because she is in love with him. He usually engages in sodomy with her and then feels dirty and repelled by her, particularly when at his request she even does fellatio on him after he has penetrated her anally. There was a period during the treatment when at weekends or during summer and Easter holidays, the orgies of pizza, spaghetti, and girl-friend followed one another. In the treatment he went through a period of intense argumentation against any of my interpretations, but we have now entered a phase where he listens more, and admits that he needs me, and at the same time he wants me to understand that he suffers in my absence and has more control of himself during weekends and separations. I see him three consecutive times a week. This was the only possible arrangement that took account of his timetable and my availability.

D.M.: So you see him . . . LI: Three days i n a row: Tuesday, Wednesday, and Thursday. D.M.: When did you start to see him? LI: A t the beginning of 1992. Approximately three years ago. Session

of 30 May

1995

P: Apart from the fact that I slept with my cat last night, I also had a dream. I recorded it. "Rita's parents found me in bed with her. I got very nervous, and so did she. Her mother stayed very calm because some time back I had caught Rita's younger sister doing the same thing. I assured her that nothing had happened, that we were just naked in bed. Her father was more nervous ... me too." Yesterday, Rita ...

D.M.: Who is Rita? LI: Rita is his latest girl-friend. They have only just started going out together, they are just friends. .... was talking to me about the boy she likes. I told her not to be passive, to go for him. Last weekend she found out that one of her friends has caught him. I told her so. Rita said that I was a wizard at guessing, but I said no, I wasn't, it was just common sense.... J have an exam tomorrow.

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179

I spent the weekend in the house we have in the mountains. It was lovely there, I sat down to study but was distracted all the time, looking at the landscape... At was so relaxing I hardly did any work and I didn't want to come back. However, I had to, because I had to vote. T: As well as looking at the landscape around you, what comes to mind in relation to your dream? P: I could associate it with being caught with your trousers down—that is to say, in an embarrassing situation. Also, both times I went out for a walk in X at the weekend I would have liked to get hitched up with one of the girls there, even ifl didn't understand their language. 1 was afraid of feeling lonely. However, with all the books in there it is impossible to feel lonely. I don't know how to explain it. My most interesting conversations at the weekend were with my cat and with a neighbour I bumped into when I wentfor a walk. Ifelt a bit lonely. I would have liked to have been with somebody. But if that had been the case they would have had to adapt to my diet and my timetable. T: What do you mean? P: Thefact that I eat when I want, what I want. If you are with someone else, you have to relate to them. And this can lead to problems. You might want to study or to have supper when the other person wants to do something else... although when I have been with someone else I've had a good time. With a girl-friend, for example, but of course then the brief is quite different, then I don't stand around looking at the forest.... T: Being with somebody, like being here with me, means having to adapt to my timetable and to the times when I can offer you my food. Maybe you would prefer to be on your own, but then there is loneliness and you also miss the interesting conversations. P: Something happened today that has made a great impact on me. I heard the news this morning that the son of Lola Flores [who had been a popular flamenco performer] has committed suicide. I could say, "well, he is just a gypsy, a bohemian ...", but it seems that because ofhis intense sensitivity the death of his mother had meant a lot to him. It has made quite an impression on me. In cases like this it must be terrible to know someone with a problem of this kind, for the person and for those around him. T: A sensitivity that you imagine as being capable ofproducing such unbear­ able pain that suicide is the best way to end it, and that pain makes an impression on you. So much feeling at the loss of a person who is so importantfor someone else... . P: I have at timesfelt admiration towards the kind of character infilms, or in

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real life, who receives a heavy blow and gets up again as if nothing had happened. If I got that kind of knock I would be flat out Being sensitive is an inconvenience; you risk getting hurt a lot. T: You risk being hurt by life and by death as the people you love or need disappear. P: I think that death brings hope more often than pain. I ask myself: "What are you going to do in the future? What can I do? Will I spend the rest of my life in the tannery?" Because I can well imagine that one of these days we shall have an anti-leather law because of the ecology issue.

Ps: What does he do? LI: He makes leather goods. I have a profession, but I am incompetent What will I do? It is then I think that if I die I will stop suffering. Death isn't such a bad thing. T: When you feel that you are an incompetent child who can lose his mum or his therapist-dad—like last weekend, when you felt lonely—and who feels that he won't be able to survive, then you might think that death would rid' you of the pain of loneliness, like Lola Flores's son. But you feel at the same time that it would be something terrible not just for yourself but also for those around you. P: You say that it would be terrible... but it isn't. If I were a believer I could say that I would find my loved ones over there... but of course, I can't say it, I am not a good believer. T: This side of death there is the loneliness of the weekends when you have to bear the absence. The other side of death, the security of company... but you don't quite believe it. P: (Pause) The curious thing is that I miss somebody but I don't know who it is. If somebody took a picture of me and they told me that there was a gap, somebody missing, and they asked me who it was, I wouldn't be able to say. .. .1 have been going out with lots of girls, but I don't know. T: You admit that there is some loss in you, like all the girls that you went out with and then lost, but you cannot put your finger on it, it is a nameless emptiness. The emptiness is inside me, but where does it come P: It is quite obvious.... from? I am not empty, not in my entirety; I am not an empty person Where does this feeling come from? T: You are asking me to identify the objects in your mind and to tell you what or who is missing.

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ROBERTO

181

P: You have more experience.... But of course I don't know.... A pertinent question would be, is it the emptiness of having lost something or is it that I never had it? Because if it is something I have lost, then it should be possible to fill the void, but if it is something I have never had, then I am lost.. . .It is as if I didn't have one of my hands and I said to you, "I don't know what it is that I haven't got, whether I have lost it or never had it." But if I can recover my hand. ... Not having it I couldn't use it, but at I suppose it is a person I have least I would know that I needed it gone out with girls to fill this void; I have tried to get a prosthesis in the place of my hand. At least I would know what the problem is, but now.... Ps: Having a prosthesis i n the place of his hand is a metaphor? Is i t a metaphor that you construct for h i m sometimes? LI: No. It is a metaphor that he constructs here. T: You just know that this constant to-ing and fro-ing from girl to girl is a vain attempt at trying on different prostheses that don't quite fit properly and that in no way can replace what you lost or never had, something in some way related to your hand. P: Maybe you know what it is, you are more experienced, you have the qualifications, have seen lots of cases, like a doctor who has seen lots of cases of appendicitis... maybe you have a theory. I know you have always resisted labelling what happens to me, but maybe you know what is wrong with people like me, you have the experience, and although you have often told me that each person is different there must be similarities. T: You feel impatient, and it seems that you find it difficult to tolerate that I might be like the photographer waiting patiently for the lights and shad­ ows to appear on the developing paper before being able to identify what you say is missing in you. P: You see, I don't like the contemplative method. Do you know the joke about the coconut? There is this person on an island, and they ask him what he feeds himself on; he replies, on the coconuts that fall off the trees in the wind. But what if there is no wind for a period, then what? [End of session] D.M.: It is apparent that he has lost the capacity to masturbate as a way to console himself; this is most probably the result of three years of analysis. He is accusing you of it, at the same time as he asks you— who has the experience and the knowledge—to teach h i m something new to fill that empty space i n his Ufe. This is another borderline psychotic who seems to have a mental age of 15 i n spite of being 24. He

182

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idealizes the total chaos in his room as a method for keeping secrets; he knows that the fellatio and sodomy that he subjects his girl-friend to form part of the life of shit and rubbish he lives in; and he knows perfecdy well how he gets i n there, in his rectum, to eat his own faeces: he gets i n by eating spaghettis and pizzas while watching television— that is his diet, his mental diet. He suspects that he is wasting his mental energy and his intelligence. What kind of studies had he followed? LI: I n the field of Economics.

D.M.: How long has he taken over it?

LI: Some seven years.

Ps: Although he has been working at the same time, hasn't he?

LI: Yes.

D.M.: The problem with these clever chaps is that they have no inter­

ests, nothing interests them. They have used all their abilities on al­

most exclusively defensive objectives, and their egocentricity has been

in the way of taking an interest in anything in the external world,

while at the same time it has also stopped them from realizing how

dependent they are. The secret he keeps from his mother and his

sisters is, how dependent he is on them; and he keeps it a secret

because if they knew about this dependence they would have great

power over him. That power would put an end to the wittiness and

cleverness w i t h which he tries to defend himself. These intelligent

defences, his ingenuity, seem to be built basically around his verbal

skills, which are aimed at creating idealizations; i n that way he covers

his faeces with a bit of tinsel.

Obviously he is not incapable of admiring a potential teacher like you or his father, but actually allowing them to teach him something is a different matter. The core of the paranoia is that it understands dependence as implying submission, and for this young man submis­ sion equals sodomy. This type of boy is not at all incapable of creating strong ties w i t h women—quite the contrary, they can create very strong ties w i t h them, but what happens is that their approach is basically a tactical approach in the relationship. Girls call him a wizard; that is the role he plays: one of omniscience and ingenious manipulation to take them to bed, to make them sub­ mit, to get them to do whatever he likes ending i n complete submis­ sion. A patient of mine, i n treatment for five years, has this central core. This boy finished at Oxford with a first-class degree, a very high

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183

mark for Oxford; but the girl he had fallen in love with told h i m that he did not deserve such a high mark because he had not studied enough, which I also had said to him. When he was with this girl he had a stammer, he was incapable of maintaining a conversation, when in fact he has the personality of a disc jockey, forever talking. I n fact, he had worked as a disc jockey i n the university students' union i n the eve­ nings and in the parties organized by the union, but had run away w i t h the money from the union. The girl kept him on his toes. From time to time she went to bed w i t h h i m but would not let him touch her, and they certainly did not have sexual relations. It is really a story that has quite a lot i n common with your case. There were lots of boys interested i n the girl because she is extraordinarily attractive. She was studying the same course as he, but towards the time of her finals her mother died. She continued to keep this frustrating relationship w i t h him, but her sexuality seemed to take an increasingly nymphomaniac form and she started also to brag to him about her relationships with other men. She was not able to sit her exams, and last year, when they were both involved in a research project with monkeys, she didn't allow h i m a sexual relationship but she did a fellatio for him. He was convulsed by this and had a dream. He dreamt that "he was part of a police operation to arrest a group of terrorists among whom there was one girl. He had caught the girl and was leading her to the jail but she had a 'chip' i n her hand, like the one all the other terrorists had, to blow themselves up if they wanted to. She activated this 'chip' and exploded; she killed herself but blew off his head at the same time. For some mysterious reason, i n the dream, after she had died, the girl was stroking and sucking the neck of his blown-off head." In slang the word used for fellatio is "a blow job", but to blow is also to inflate and to explode because the verb to blow up is equally used to indicate inflating and exploding. This boy has truly become a mindless person, without a head; he is unemployed, he works occasionally as a typist; his dream is to run away, disappear, and we have just had two weeks of sessions where he says nothing at all. He is depressed at the moment, and one has the work of reconstructing a head on his shoulders because he has discov­ ered that he is not really interested i n doing anything, and therefore there is nothing to do, nothing to use one's life doing, etc. A n d so he has become lazy, a sort of playboy, obsessively interested i n that girl, fleetingly interested in sports and things of the sort, etc.

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I think that your patient's experience with his girl-friend, the anal penetration and then sucking that penis that is dirty w i t h faeces, corre­ sponds to the torn and cut-off head of my patient. His dependence on you is very intense, and he is hoping that you w i l l teach him. I think that what you have to teach h i m is that dependence implies love and vulnerability, which are very different things from masochistic sub­ mission. In these two and a half years you have been trying to establish the possibility of doing some work, and he is only just now beginning to do it. He has overcome his secretiveness and he is dependent on you and hoping to be able to learn vital things about life i n the external world. The problem now is how to help him to find the maternal transference: i.e. that it is not going to be dad who w i l l teach him how to get girls that w i l l suck his penis, but mum who w i l l teach him how to suck the nipple i n order to feed himself. You are going to see appearing i n the material his terror at this moment at the possibility of his mother dying. You w i l l have to get this out, bring i t out from the transference. Has he got his degree now? LI: Yes. D.M.: Good, average? LI: Average. D.M.: These extremely clever boys use up all their ingenuity i n ma­ nipulating other people; they are basically delinquent. I was seriously worried about this patient of mine because I thought he might commit suicide. The material coming out now seems to be fundamentally his dependence and anxiety about his mother dying and his desire to be taught These clever young men are usually self-taught, " I can do that too" is their answer to any job. Good. Lunchtime.

14

[APRIL

1996]

Agnes Latency, lies, and lack of emotional contact: acting out against the establishing of the analytic situation Rosa Castella

T

his patient has only just started analysis, and I am already worried because she acts out a lot: some days she does not turn up, quite often in fact; other times she calls me on her mobile phone at the time of the session to say she is in such and such street, it would take her some time to arrive, and she would be late, so she won't come. She doesn't talk about cutting off the treatment, but she constantly does this sort of thing. The sessions I have brought today are the third and fourth in the analysis. When she called for thefirstinterview, she used the "tu" familiar form; when she arrived she had a cigarette in her mouth, continued using "tu", and asked me if I was not going to do the same; she wasn't pleased with my use of "usted". In ourfirst interview her mobile phone rang. This telephone has an important place in this woman's communications: she uses it to let me know that she is not coming to a session, and it is the phone that keeps her in touch with her lover, who lives in Madrid; they might call each other twelve times a day to control one another. She is a tall, attractive, and beautiful woman, with something about her that makes her seem amusing. When she was 16 years old she suffered an attempted rape that was mi consummated. Because of this, her parents put her in a boarding-school, as the person who had tried to rape her was a neighbour.

165

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The patient is 36 years old and is separated from her husband. She has a son aged 16 who lives with her, a brother of 46; a sister who is 44; then comes the patient; and then another brother, aged 34. The 46-year-old brother was her mother's favourite, and the patient was her father's favourite. When she was sent to the boarding-school she felt displaced, and she insists that what mattered to her was not the attempted rape but losing her place in the family environment because of that. D.M.: Was it a convent? ROSA: Yes, I think so.

Ps: Was the rapist young? R: Yes.

From that time on she fell out with her father, and her conflicts with him continued until the time of her marriage at the age of 19 and the birth of her son at 20. Soon afterwards she separated from her husband because she was bored; she has had different partners who always end up being unfaithful to her. At present she has a relationship with her boss. Ps: Is he much older than her? R: No, not a lot.

D.M.: Was he her boss first or her lover first? R: First he was her boss. Before that the patient had worked w i t h her older brother, who is an optometrist, but she also fell out w i t h him and they don't talk to each other any more. At the moment she is a repre­ sentative in a commercial firm, but her working conditions are bad, she has no job security, she is on commission. The reason for consultation is that she always has to face the same problem: her partners are unfaithful to her and she doesn't know whether it is because she is controlling, obsessive, and sometimes unbearable. She is in a relation­ ship with her boss now; she found some bills from a restaurant where he had gone with another woman, and this has caused her present crisis. She comes twice a week, Mondays and Fridays. Session of Monday,

18 March

1996

This is the third session in the treatment She arrives on time. She rings the bell only once, though we had agreed she would ring twice. She talks terriblyfast during the whole session. I find it difficult to think about what she is saying. P: Say something to me. Where were we? Let me see. .. . Iam still apathetic

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AGNES

187

about my work, cross with my son, and I am wondering whether it is fair to complain about our children for not studying when I didn't do it either. I am worried about all this; I am probably not the generous mother I would like to be. This morning my son looked at me and asked me what was wrong; I said I could not be happy with him at the moment; he went off in a huff. He is constantly seeking attention, but he is all over the place, he doesn't concentrate, he leaves everything lying about; maybe I should be on top of him more. He stands in front of the television when I am watching it and I can't see; Jose told him he was annoying me, and he went out slamming the door.

R: Jose is her boss.

P: In the end I tell myself that I can't let him ruin my day. His birthday is the 28th of December, so he was one of the youngest ones in his class. He went to a nursery school first and then to School X, which was in the same building as my parents'flat, and as I was working there it was convenient for me. He had to repeat Year 1, then he did Years 2 and 3. They asked me to take him to a different school because he used to annoy the other children, and he was badly behaved; it was a Catholic school and they only wanted winners. Now he goes to a progressive school; it is a split-off from School T Last week I got a phone call saying he won't be able to pass grade 8, and he still carries subjects from grade 7.1 have got him a private tutor and a psychologist. He didn't go to his Social Sciences evaluation. It is a disaster. When we were on our way to the airport this morning we were talking about him. Neither Jose nor I got further than second year ofBUP. I think that with all this business of the separation, this child.. .. I don't know. I also called his father; he wasn't worried about the boy's marks. His father is that kind ofperson: even if you are with him, it is as if you weren't; he is either at his computer or sleeping. He is a man with a very private world; he has not remarried after our separation. Jose says I should take my son to a state school and stop spending so much money; he says too that he has two children and is also separated and one of his children is a good student but the girl doesn't do a thing. I got suspicious again at the weekend; it was last night, when Jose went to sleep. T: You arrive here and don't use the agreed signal; then you want me to ask you questions when you know that it is up to you to talk about what goes through your mind. You talk to me about an untidy child, who is interfer­ ing and calling for attention, who is more interested in that than in studying; and you also tell me that you get suspicious when your partner

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MELTZER

goes to sleep. I think that you are bringing here something that is very untidy; you are seeking attention from me by not ringing the bell twice as agreed, and by wanting me to ask you questions. It is as if you were saying that if you don't feel my attention on you—that is, if I don't talk to you, you might experience it as me going to sleep and then you would not trust me. P: I hadn't thought about it that way. Well, look: wanting you to ask me questions is not because I want to know if you remember, ii is just something I do to break the ice. A few days ago I was thinking: I've had a few sessions but my son doesn't seem to matter to me; my therapist might think that I don't care a hoot about him. T: You are very concerned to know what goes through my mind.

P: Well, I suppose that if you don't understand me you will ask. My son suffered the effects of the separation and then of my emotional instability with all my partners. I have spent the weekend sleeping. We didn't make love until last night. It must be that because I have been so nervous with all the business ofJose, all myfatigue showed at the weekend. I also had a two-and-a-halfhour siesta, and after we made love I stayed awake because I had slept so much, and went back to thinking about the 28th of Decem­ ber, turning ii over again and again. I know it was three months ago [She explains in great detail all the threads of how she found out that he had gone to have dinner with another woman and then to bed with her. She links up the whole narrative.] R: When this patient first arrived, she was i n a constant situation of doubting the faithfulness of her partner, and she was forever turning these thoughts over in her mind. She was trying to find out if he was faithful, and it was at that time that he came to spend a weekend in her house. The date of the 28th of December that she mentions in her last paragraph is when she discovered the bills that proved that he was not faithful. D.M.: Those suspicious thoughts that come into her head—do they appear when she is sleeping with her partner? R: Yes; they had made love and he had fallen asleep, and that is when she got suspicious again. T: It would seem thai you like turning thoughts over instead of using them to think; you are turning over and over in your head something that causes you pain.... P: Maybe it is a defence; that way I can be angry with him, keep a distance

APRIL

1996

AGN£S



189

and not suffer, not be so naive. I had a dream. [She begins to tell it and it is very muddled; I say that I don't understand

it and she tells it again]

"Jose and I were in a hotel; I went out because I had to see somebody who owed me money. I went to a restaurant called Pep, but it wasn't

that belongs to a friend of mine

his restaurant,

it was more like an old one in

Pedralbes that used to have a bower with tables outside( do you know

it?).

The man who owed me money paid me in small change, like the change my son brings me back; he said to the restaurant owner,

Til come to spend

fifteen days in your house; Xavi said okay but did not seem interested at all As I left the hotel there was an optician's on my right, and another one on my left; there were three old men, one of them had a goatee; they looked like village doctors or businessmen.

They said to me that Jose was not in

that hotel and I should go to a different one. I arrive at the hotel and find all the chambermaids dressed in green by the bar in reception; one of them calls me and gives me a key, number 306; she says it is the room key. The keyring is like a sponge in the shape of a melon, and the men tell me that Jose had said to them that I would have to give him back my

engagement

ring. I get indignant thinking that he has been talking to them about our intimate affairs, and I think: who has he been talking to about our prob­ lems? Because he is a very open man and he has surely talked about it to somebody." trusting

I really think that this dream has something to do with my not

him.

D.M.: This patient moves constantly from her son to her partner; she seems confused; from the way she talks, it is not clear to me whether she is talking about her lover or her son. R: One thing she said and I forgot to put down was that, i n fact, she does not have an engagement ring at all. P: The woman

he went out with was somebody who had said to him she

would give him a "cuddle";

and then he leaves his hotel at 7.50. He tells

lies to his clients, and he is probably telling me lies, too. But I have spoken with his secretary to check what he was telling me; men are cowards, very brave, although sometimes

lama

and I should take my son to a state

not

coward too. Jose says I come first

school

T: We should carry on talking about this dream, although we have to end here now. As she leaves she says: " I am going to have no money left after paying for two sessions, and I won't be able to

travel!"

D.M.: She is all over the place. R: A n d I ask myself how can I help her.

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D.M.: By insisting on establishing the analytic situation, as you are doing. By asking her to explain things twice, asking her to repeat her narrative and then putting her communication i n some order that is clear to you. And by asking her: "Who are you talking about now? About your lover? About your son?" Because she is very confused and she is going to create confusion i n you if you don't stop her. She is a very promiscuous woman who gets bored i n relationships and moves from one to another; she is a travelling saleswoman, she seduces her bosses easily. Although not everybody likes this type of person. Okay. She did not come to the Friday session and did not let me know. Session of Monday, 25 March

1996

P: I know I didn't come; look, I suddenly thought I would go to Madrid and when I was there I remembered about you, but I didn't have your tel­ ephone number. I got back from Madrid this morning. Since what I am most worried about is Jose, I'll tell you about it. On Monday I wasn't clear about the things he was saying. Tuesday was a holiday in Madrid. On Thursday I went there; I arranged for my son to stay with his father, and I called Jose to ask him to fetch me from the airport at 8.45. It wasn't convenient for him; he had a lot of work the next day and would not be able to be with me. R: I have to explain here that her lover lives i n Madrid and she lives in Barcelona, and their way of keeping i n touch is via the mobile phone or by flying backwards and forwards. He has two children and is separated. He left his second partner because of m y patient, but she does not want their relationship to be a reason for moving. I n this couple, they are constantly travelling. Ps: Does he own the business? R: It is a French franchise, and he has the post with the most responsi­ bility. P: I am having problems "down there". T: What do you mean by "down there"? P: Vaginal problems, infections, and things of that sort. I got cystitis last time I was with him, then infections and itchiness. I have these discom­ forts sometimes; I go to the gynaecologist, and he can't find anything wrong; I've spent a fortune. In the end I decided to go to the NHS, but finally I went to a different gynaecologist. Nothing shows up, but both he

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and I are feeling itchy. His penis gets sore and he gets spots; an antiseptic like Roselin helps him. (She speeds up and I can't reproduce the narrative with any exactitude; I think she said that during the time when she thought he was faithful she did not have any infections.)

Ps: Who did not have any infections? R: She didn't. She had the fantasy that he might pass something on to her if he had been with somebody else. She was conveying to me that they both felt itchy but there was no infection. P: This time we had a five-minute "quickie" [her word for sexual relations]; he put it in and took it out. Later on he called me on my mobile and I said to him: "I am not well, again". [Laughter] I have never had a sexually transmitted disease. The first time it was an "in and out". I called my gynaecologist and said I am not well. He said it was a honeymoon cystitis, "You don't say", I replied. The last doctor I saw took a swab, and he said I had a tendency to inflammation of the uterus. I get these problems when he "stays in" a bit longer. I have this soap that is very refreshing and I find that it helps. But I am still suspicious; he called me from his mobile and said I hadn't called him; then he called me again and said that he had had lunch early. He went out to dinner with some clients and said he would call me if he got back early; he didn't, so I had the phone off the whole day....

R: This as her revenge, she says. (She talks non-stop about her journey to Madrid and how she scrutinized every message from him, checking the times, where he was, if he was lying; she talks about how she looked in his wallet and found a bill, how she saw he had been to a hotel, and site checked with his daughter and his secretary; she checked his timetable, his calls on his mobile, the ones he made from Italy; then she talks about having got a call to say her son had fallen over; all of this very quickly, jumping from one subject to another.) P: ... In the end that night he arrived later than he thought he would, I don't know whether he had been drinking or bonking; we had a row, and he said we should break up because he was feeling under pressure. Then, because we are both taking slimming tablets, we couldn't go to sleep and I started to cry, I cried a lot; I looked dreadful the next morning; it was a long night, and we started to talk about what we were doing wrong. He is annoyed with me because I go through his things; but he, too, started to say he wanted me to account for what I do.

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T: You tell me that when you and your partner make love something happens that makes it unsatisfactory. You very much want to know if you can trust your partner, but you also tell me that you behave like somebody who cannot be trusted: you look in his diary, you spy on him and try to get information through other people, etc. I don't know if Jose is faithful to you or not, but what I do see is that you have in your mind problems that turn a good relationship into a bad one. Let's look, for example, at your relationship here with me and see how it can get contaminated. Do you remember how you said goodbye in the last session? P: No. T: You said you would have no money left and wouldn't be able to travel Let's analyse what happened when you said that. You and I agreed that you would come to two sessions, we looked for two days to fit in with your work; at the time, you seemed happy with our agreement and thought it wa$ good as it allowed you to travel and still have two sessions so that I could help you. We don't know how, but you are saying that I seem to have become the guilty party, the baddy who is after your money. P: Yes; my father says the same thing. I know I don't behave correctly, I shouldn't look in his wallet but he leaves it lying around and I can't help it, I look in it. I know that something is not working; I was wrong about the bills I found, I accused him and it was my mistake, like the telephone calls: I thought he was calling another woman when it was me he was calling. Look, I have a friend that I love a lot; we have always been good friends, and although it may sound strange between a man and a woman we are just friends. We went away together at the weekend, my son came too; everything was fine, we were peaceful and happy, but on the way back I started to argue because it seemed to me that I had done more work in the house than he. He said to me: "After eight years of friendship I have discovered something today—that when everything is going well you find something to spoil it" T: We'll have to find out why you spoil your relationships. P: Yes, I realize that I go too far; do you remember I told you that I didn't think Jose was staying in Madrid because some relatives were visiting him and that I felt suspicious? Well, it was true; they did go to visit him. T: It is time. On the way out she says: "Do you think you'll be able to get me out of this situation?"

D.M.: She is not just a rather unpleasant girl; you will have to talk to her as if to a child and get her to cooperate to establish the analytic

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situation; you have to say to her that you realize how easily she lies, and point it out not in a punitive way—you have to do this without punishing her—but pointing out that if she does not have money to pay you, she can't have it to go to Madrid either. It is useful to say to somebody who lies so easily that it doesn't matter to you anyhow, because you don't work w i t h her information but w i t h what you observe about her mental processes. There is a very important phrase you have to say to her, which is that you don't believe what she says but you don't question it either. This phrase w i l l allow the establishing of the analytic situation. People i n her life are interchangeable for her. This person she tells you about, with whom she and her son went away for the weekend, and w i t h whom she is just friends—you must not believe it, because she can say that making love is not having a relationship since all he did was put it in and take i t out; these are things she can say to herself, and it can be an example to us of how she lies to herself; she doesn't realize that she tells lies, because she also has her own language for things, such as "quickie"; they are the people who say they do not steal—they borrow is what they say to themselves when they take something: " I didn't steal i t , I was going to put it back." I think it is very important to establish the analytic situation and to make it clear to her that you are not listening to the facts but to the way her mind operates. I think that the masculine figures get con­ fused, mixed, and that one doesn't know if she is talking about her lover, her son, or her friend. Her attitude towards her body is also similar, so that when she says "down there" anything related to her mind would be "up there"—approximations, just approximations. The first thing I would do w i t h her would be to get her to go more slowly and to repeat. I think that you w i l l lose her i n the first holiday; she is not going to get involved, she does not have personal ties. She seems to have some knowledge about psychoanalysis, such as de­ fences, etc. . . . but she is a very superficial person. She has been separated from her husband since her son was a baby, and there have probably been a series of men since. R: She has told me that there have been three or four. D.M.: Don't believe it! (Laughter.) She has no interest outside sex, money, and business. She is used to travelling and staying i n hotels, being available; the world of business is full of them—they are semi­ prostitutes who are bored. Ps: I find a lot of the things you are saying very interesting, Donald, but when the patient says: "Say something to me" and then again " I

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am just talking to see if you remember", it reminds me of the beginning of the dream when she says: Jose and I were in a hotel and I went out because I had to see somebody who owed me money. This feeling of "owing" makes me think of the mistrust when faced with a nipple that one cannot quite join, looking at a nipple and remembering that it owes you something; because of this she leaves Jose, she can't stay, and she can't have a relationship, because she has the feeling that in any case that nipple owes her something and she cannot establish a good relationship with that part-object. D.M.: One could also say that she is not careful with the truth and therefore mistrusts others. It might turn out to be a nipple problem with very early development, but normally this configuration is related to the end of latency. This secretiveness and mistrust happen at the same time and are related to masturbation by opposition to the sexuality of the parents. What we have here is the hypocrisy of the latency period, whose natural tendency is to lie because that is the preferred way to avoid emotional contact. She gives the impression of being a child in that latency period, dad's favourite girl. R: I want to ask about her long dream at the end of the session. When a patient has long dreams like this, sometimes I focus on a fragment that I consider significant, since trying to interpret the whole dream seems too hard to me. What is your opinion? D.M.: It is not an interesting dream because it is made up of anecdotes; there is no symbol formation in it; there is no differentiation between outside and inside. When did she tell you that she did not have an engagement ring? R: After telling the dream. D.M.: One fact that will be important to explore with her is whether she wants an engagement ring or she prefers to maintain a situation of uncertainty in the couple. I thought that what the doctor said about honeymoon cystitis was a joke, because for her it was not a honeymoon. Is she a very lively person? R: Yes, yes, but exhausting. D.M.: She is a storyteller with nothing of value and no interests. R: One gets the impression that you don't know what she is going to come up with next—one day she comes, next day she doesn't, another time she calls on the phone. D.M.: If you want to get rid of her, it is easy: you put up your fees, and she won't trust you again.

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Ps: I see this strategy of coming, not coming, phoning as an attempt on the part of the patient to see if the therapist is going to stay in her place and is capable of taking care of her, as if she were assessing her. D.M.: Let's go back to the beginning. It is not that one doesn't know what she is going to come up w i t h next: we do know, you know that you cannot trust her. She is assessing Rosa, that is true, assessing her like you do with a maid or a hairdresser. She has criteria for assessing and knows that here one tells the truth, but because of her character she cannot believe that anybody is telling the truth. She is the type of girl who attaches herself emotionally to the old servant because they have no other emotional life than being servants, like the "nurses" in Russian literature; those kind of people attach themselves to persons who have no other emotional life, no other relationships. R: Because they feel secure w i t h t h e m . . . .

D.M.: Yes, it is an attachment to an object that one can feel secure with;

it is the nearest thing to an inanimate object.

R: A dog?

D.M.: A teddy bear.

Ps: I n the last instance there is an element of superiority i n the rela­

tionship.

D.M.: Yes.

Ps: It is dependence on a denigrated object.

D.M.: It is the partiality of a part-object. Teddy bears, dogs, cats, dol­

lies. Here we have the British Company of Teddy Bears.

Ps: If such a company exists, it must mean that there are lots of people

like this woman.

D.M.: I think that the business community is full of them.

Ps: But it is somehow terrible, as if there were no hope for them.

D.M.: They are people who are driven by social pressures. What w i l l

the neighbours say? A n d when they attach themselves to their chil­ dren, they also ask themselves, what w i l l their children say. I n time, the impact of the relationships and what they receive from them makes a mark, and when they reach middle age they change; one could say that they seem to have "settled". Their character gets fixed in the last period of latency when puberty gets added on. They remain i n this combination for a long period of their lives, until the last moments of middle age; i n the middle of it they "settled", still being imperme­ able to intimate relationships but becoming more ethical, more serious,

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less superficial. In analysis they are very disappointing because of that very thin coat in their character, that superficial quality that makes them worry always about social values, and one is surprised when underneath all that there is some kind of expectation or suicidal worry that manifests itself in the idea that they are going to die young, of an ordinary illness, and that they see this as a relief. The suicide takes the form of traffic accidents when they are drunk, and I think that this patient can have this kind of oversight; however, if you manage to centre her in the analytic situation and be disciplined, then interesting things can happen, and what usually does happen is that she can get very attached, she can become very dependent. But their partners find these patients quite unbearable; if the partner is an understanding person, they find themselves constantly in the role of a masochist because they get taken advantage of. Their obsessiveness does not translate into being good, obsessive, housewives; most of the times it takes the form of controlling other people. At times they also get into financial tangles because they waste money; lacking foresight is part of their obsessiveness. Like children in the latency period they have the tendency to go as far as they can, and one has to stop them. You mustn't allow yourself to get into a position where the patient says to you: 'Tve been using the familiar 'tu' here for six months and you haven't said anything, and now you want to stop me." The American habit of using first names as soon as you meet someone is spreading everywhere; this habit has its roots in the form used by slave owners to address their slaves. When someone uses a person's first name with­ out knowing them, there is an air of superiority in it.

15

[APRIL

1996]

Pilar Masturbatory addiction in the manic-depressive organization: secrecy, manipulation, creation of confusion, and delinquency Llufs Farre

P

vilar is 27 years old; she has been with me since January 1996. She was referred to me by her psychiatrist as an urgent case. She is striking both physically—she

is 1.80-m tail, has a very good figure,

dresses like a

because of her mixed and confused way of talking. She portrays

model—and

two alternative images of herself in the first interview: a worried, and disorganized provocative

16-year-old

and seductive

adolescent during the interview

model on the catwalk as she says goodbye.

reading of this first paragraph of the presentation comments

turbulent,

itself, and a

about the many temptations

[The

leads to a series of jocular

that working with this patient

might

bring.]

Lmfs: I need to clarify that this second image is not present any more .in Pilar; she appears rather as the confused and anxious adolescent. She was distressed as she said in thai first interview: strange things have been happening 'crisis':

"Since

I was raped

to me. Soon after it happened I had a

she spent a month in a psychiatric hospital where she was diagnosed

as manic depressive

. She even had to be tied to the bed, she said. She used to

incite the other patients to violence against their carers; she spent her time swearing and saying obscenities or spitting at whoever was looking after her. The following

year she suffered a new crisis and was hospitalized against her

will for three weeks. At the moment she receives drug treatment and attends control sessions at the psychiatrist

who referred her to me. "

197

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P: After I was raped and I got over it—it was horrible, he was saying to me [she is referring to the rapist] that if I didn't do what he said he would kill me—after I got over that feeling of being about to die I thought I could do anything, I felt totally strong. One day, I was in the airport, I wanted to go to Seville and I had another crisis. As I stood there I had the feeling that I understood everything, that it was all clear, like a puzzle getting com­ pleted. I started to see colours, an enormous eagle in colours, everything was clear and beautiful, and I began to feel that I was drifting off..that I was going to die, I couldn't breathe. I found myself surrounded by people asking me what was the matter. I said could somebody hold my hand because I was passing out J woke up with a lady doctor next to me; she calmed me down, told me to calm down.... Now I am confused; I used to think before that I could do anything, now I am frightened. ... At the time of my first crisis my father said I had disappointed him.. . . Because by the age of 14 I was living my own life, at 16 I went to the States to work as a model I have always been very forward in everything. Never been frightened of anything, always going to the limit, even in sensory experiences such as lying down as if I were dead, relaxing to the limit, like when I was doing theatre. I tried to commit suicide recently. ... I have hurt myself and other people a lot I got very paranoid in my crises; a face, a look, and I would think that it meant what I wanted it to mean. I have always imagined things, always pushed imagination to the limit. .. . But I don't recognize myself now ... I have been very stubborn and always done what I felt like doing. ... Now I am not all right anywhere. ... Before I was able to do anything, I had always felt I was the pretty girl, the clever one, everybody said so, since I was very little. ... Maybe I am not so clever. ... I don't know. Pilar has a brother who is younger than her. Given her confused narrative, it is perhaps thinkable that she has had a sexual relationship with him. She says she is "very much in love with him". Her parents are separated but have both found new partners. After her second crisis she lived for a time in the old family home with her mother, who kept an eye on her; at the moment she is living with her mother and her mother's partner, David; she works in their bar to earn some money to pay for the treatment. In the last sessions she seemed veryfragile,frightened by her violence, in terror at the thought that she might lose control and even "lose her head", ashamed of the way she is, afraid of "becoming mad or of being a psychopath like that man in Scotland [she means the psychopath that committed a massacre in a Scottish school]. I am scared in case my medical report says that I show 'psychotic behaviour'/'

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199

I see her twice a week, Tuesdays and Thursdays. Next, there are two consecutive sessions from the middle of last month. D.M.: She seems a manic-depressive person. Okay. Session of 12 March 1996 The session starts with a few moments of silence. P: I don't know where to start.... On Sunday some fantasies came into my head, ideas about leaving everything, escaping, disappearing. ... I am a bit of a "victim" when it comes to going away and giving explanations; I would leave a letterfor each one of them, onefor myfather, another onefor my brother, and onefor my mother; but all different, I wouldn't write the same one to all of them. . . . I imagined myselffar away, not physically because perhaps I would be in the same town, but I don't want to give them any more trouble, I don't want them to have a rough time because of me.... Since I can't give them anything big, which maybe they expected of me, then it is as if there is no meaning . . . I don't know.... T: And how did you imagine this going away? P: I didn't think about packing a bag and going somewhere Ididn'tthink about the practical side, rather as if I had already taken the step, made the decision. But I haven't got the courage to do it On Sunday, as I came out of the cinema with myfather, his wife Aurora, and her daughter Belen, I was happy; then I had to catch the train to go home, and Sunday night is dreary; the station is very narrow and dreary too; and I didn't want to go back to that neighbourhood, that atmosphere, the bar, the people who frequent it. . . . J suppose there is always something I can learn from the situations I find myself in, but I would like to learn more than that; of course one can learn things in the bar but I am not interested in that.... I am always curious except there.... Anyway, it is Tuesday today and I have worked two days there.. .. All I think of is that it will be night-time and I'll go to sleep. Ifindit hard getting up in the mornings. T: You don't like being outside thatfamily atmosphere where there is dad, his wife, a daughter, while you feel lonely, moving away andfindingevery­ thing dreary, perhaps like when you leave here and you have to spend the whole weekend on your own until today arrives, Tuesday, and you can come back here. P; Yes; I feel that they have a fuller life, more interests. ... But with my mother and David the subject is always the bar, the money; everything ends there. Today David said to me, "Look what it says in the newspa­

200

SUPERVISIONS W I T H D O N A L D

MELTZER

per!" and he showed me the news of a hoy who was living in his girl­ friend's house and ended up raping her sister and her mother. And I say to myself: "Why is that interesting?" He was laughing, but I feel that this hurts me. I feel sort of very vulnerable because Ifeed myselfon what I see and do during the day; I am the things that I do during the day and I don't want to end up having that kind of character and being part of that atmosphere. I want to have a different view of life; I feel stifled, claustro­ phobic when I think that my whole life can end up like this. In the year 2000 I'll be 31, what will I have achieved? I wonder if I'll have had a child by the time I am 31. T: I seems that you feel trapped in an atmosphere, in an environment, that you cannot get out of. What is stopping you? Is there some reason why you can't be in your father's environment? P: It is only a once-in-a-while kind of relationship. I don't live with them, I live with my mother and myfather, 1 mean, David.... And of course they make the rules. When I want to call afriend, I have to do it behind David's back to stop him getting at me, as he did once before. I don't want to give him explanations; I don't want him to know about my private life. It is more peaceful now, I am doing what they thought was good for me, and everybody is happier.... But I will get tired and when Ifind something I shan't carry on living with them. ... And David will feel that I have betrayed him; he thinks I am going to stay on in the bar and that he will be able to retire. I don't want to feel tied up.... Ps: That he might retire and she would stay on at the bar? LI: That's right Ps: What type of bar is it? LI: It is a neighbourhood bar, where the clients are the neighbours, the people who work i n the area, building workers, etc. . . . they serve meals . . . it is that kind of bar. It is i n a working neighbourhood, on the outskirts of the town. Ps: I wonder if that father, or rather that David, might be using the girl as a decoy because of her b o d y . . . . LI: There is that possibility. D.M.: I think that is very possible, but she is also relating to him in a manner that w i l l turn him into a potential rapist. Ps: The news i n the newspaper is a provocation on his part, saying that he could rape her. When he gives her the newspaper to read, he seems to be preparing the ground for later action.

PILAR

APRIL 1 9 9 6

201

D M . : Yes; I agree. Okay. . . . I don't want him to be my boss; I will work for somebody but I don't want it to be David. I was living with my father and Aurora when 1 was admitted to hospital After that they said they couldn't manage financially and also my mother wanted to look after me; and I was pregnant and nobody knew.... T: You were

pregnant?

P: Yes; I told my mother, and in the third month we went to have an abortion.... My father doesn't know any thing about it. It was the second time already. So I was told I couldn't live on my own. And Belen, who is a diabetic and didn't live with them, had tried to commit suicide, so the question was if Ricardo [her brother] and I were going to live with my mother [there is a confusion of people and movements here, from one house to the other, I can't follow it]. Then there was the business of the telephone calls, the fights between them, between my mother and David, who kept calling her while she was living with me asking if we were both having orgies in the house together. He gets a bit excited sometimes. ... He was saying that my father wanted to separate him from my mother David shouts a lot at my mother, he says all kinds of things to her in front of everybody. Then one day he called me and said I was a cocaine addict, a nymphomaniac, and I don't know what else.... And then he told me that either 1 got different friends or he would kill me or get me killed. My mother hears all this and says nothing; I can't forgive her for that I can't bear all this (she cries). All those arguments! I never know what to answer, when the row is with me or when it is with somebody else; I get very violent Then I forget these things, you see. He said it was the last chance he was giving me, I had to learn the job, he would set up a bar for me and he would retire. . . . J think that these are fantasies: they can't afford to retire, and I don't want to be a part of their fantasies. But at the same time I would like to behave well towards him, and that he should love my mother But that's the way he is, and my mother is scared of him. The other day when I got the idea of leaving ii all and going away I thought about Monica, my uncle's girl-friend; he is my mother's brother, and Monica's daughter is my godmother—a family muddle. . . . We had problems with my godmother because Monica doesn't want to see Tomds, I mean Monica junior—they both have the same name, it is a bit of a muddle. Monica and Tomds came to see me one day, they had spoken to David and I could see she was looking down her nose at me, dropping hints here and there about people who had come out of drugs, but the thing is that although I might have smoked a joint once or twice or I might have

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taken a tablet occasionally, I have never been a drug addict. And anyway that's my private life, so long as I don't hurt myself or somebody else.... / am not Miss Perfect but I don't have to explain all the details to everybody. She was saying to my mother that she should let me be, that I should fend for myself, and that my mother should go back to David instead of looking after me. I suppose she finds that natural but I was feeling abandoned, I also felt that I was hurting everybody (she cries) D . M . : Where i n the session does this happen? L I : I n the m i d d l e , more or less. D . M . : One can see she is also very secretive a n d m a n i p u l a t i n g , so y o u ' l l have to get a clear criterion that y o u w o n ' t be able to w o r k w i t h the i n f o r m a t i o n she brings y o u ; she is quite a n expert at creating confusion: y o u can see that w h e n she talks about h o w she h a d thought about g o i n g away a n d leaving different letters for each person. She is i n d i c a t i n g to y o u that she w o u l d be saying different things to every person; each one w o u l d look for her i n a different place a n d they w o u l d n ' t f i n d her. So y o u ' l l have to make i t clear to her that y o u are not g o i n g to w o r k w i t h the i n f o r m a t i o n she gives y o u , because there is a l o t of confusion i n her. So she says she has h a d t w o pregnancies a n d t w o abortions . . . apparently. L I : Yes. D . M . : Y o u have to say to yourself: " W e l l , possibly . , ." Ps: W h a t d o y o u mean b y possibly? Isn't i t certainly? D . M . : I say possibly, n o t certainly, because w e d o n ' t k n o w i f i t is true. . . . I f y o u go to a back-street abortionist, t h e y ' l l d o a n abortion for y o u whether y o u are pregnant or not. Let's carry on.

T: You felt you had been so bad that nobody wanted to look after you.. ..

P: It is as ifl didn't deserve it. Then she hugged me, and said that they were all very worried about me, but in a tone that meant: "Make an effort to be as you were before" (she cries). Especially the things they were saying to me about drugs seemed so, so hard In that neighbourhood drugs are a big problem. But the people they were talking about are either dead or they are real addicts. David's son was a junkie, but my own experience has been nothing compared to that sort of thing; I've had friends who have died of an overdose. I don't know what's the difference, but there must be a difference; maybe. ... One of the people who died of an overdose was with me at school; I don't have any closefriends who are hooked on heroine

PILAR

APRIL 1 9 9 6

or cocaine, that's not my kind of thing...

203

7 have a different view, I hate it

when somebody tells me that they have injected themselves or taken I don't know how many tablets. Yve never been the sort of person who takes drugs, lots and lots of drugs. I am not greedy for them and I don't like people who are. Yve been most fond of joints, but not all the time. So you see, when they identified me with the drug scene I felt that it was very, very hard

And I feel

guilty.

D.M.: Here too w e can see that she has her o w n definitions; she lets you know little by little; you find it hard to take it on board, but the truth is that she is also involved i n the drug world. She defines it this way and that way, but in one w a y or another she is talking about a chaotic world, a part of her life really catastrophic. I a m convinced that until y o u mention masturbation in these conversations, and talk about it, you are only talking about incidents and anecdotes. Y o u suspect that there has been incest between her and her brother; it seems to be correct, it has most probably happened. It might have been her way of masturbating during adolescence, she probably asked her brother to masturbate her. Her w a y of life is immersed in such chaos that if you do not talk openly about masturbation i n her life, it is as if you were talking about the weather, really. Okay. T: It hurts you to be thought of as incapable of developing, and to be identi­ fied with hopeless cases and failures', it would be like saying that it is a waste of time to dedicate any effort to you and it is better to leave you alone to stand on your own two

feet....

P: The thing is, I also think I won't be capable.. . . I used to feel that I could do anything

I liked, I tried everything

but not properly.

. .. But now,

anything I try to do can be labelled as my illness; the other people seem to be saying: "Poor girl, she does her best. ..."

But I don't know what my

illness is, and what I am allowed; what I can or can't do, or whether what I do is a result of this imbalance or not. .. . Just as I don't know what my head is like—I can be euphoric and I can be depressed. So I never know if an idea Yve just had is realistic, or bleak, or too euphoric. I never know what the happy medium is, I never did, and now even less so. .. . Before this last crisis I used to use my illness as an excuse to do whatever I liked. . .. But I don't have a clear idea

....

D.M.: Y o u have to talk to her about what the centre, the core, the heart of the problem consists of, which is her addiction to masturbation in one shape or another, and you also have to say that she has had this addiction since adolescence. Y o u can find here what is usual in the

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204

masturbation fantasies of manic-depressives: revenge fantasies, sadis­ tic fantasies, like the ones she describes in relation to her stay i n the hospital when she spent her time swearing, spitting, and stirring the other patients against the carers. Okay. TV You need a great deal of help from me in order to understand boundaries tainty

are, because without

them you haven't well enough

that your head is working

what your

got the slightest

cer-

to be able to tell what is

healthy from what is ill. But since you have used your illness to experience yourself

without

very frightened

any boundaries,

doing whatever

you pleased, you are

that you will now be the poor girl who is a lost cause and

who won't be able to conduct her own life any better than she has done up to now. [End of session]

D.M.: Yes, she has realized that she has fallen into a trap; she has been using her illness as an excuse to do what she wanted and treat people as she pleased, and now she sees that people are, accordingly, treating her like an invalid. I don't mink that being nice and gentle with her can be the way to attach her to the analysis; she can interpret it, rather, as a seduction on your part, a seduction with sexual connotations. You are going to have to be very straight i n the way you speak, maybe even hurtful, without any concession to sentimentality. Let's carry on. Session of 14 March 1996 In this session, as she followed

me out of the waiting-room,

she turned

the

light off. I pointed this to her, and she said: "Oh, it's just habit. It's what I do at home: I turn the light off when I go out of a room." P: I had a dream—and

this happens

to me when I am talking

to somebody

too, that a subject comes into my head but I don't dream about it till some time later. I've had funny entertaining,

dreams for about a week; they are like films, very

there are strange things in them, and I have a great time.

Last night I dreamt about Snowflake..

..

LI: Snowflake is an albino gorilla, probably the only one i n the world, who lives i n the Barcelona Zoo and is a kind of "public figure" in the town. "..

. . He was coming with me to the beach; it was the afternoon, it was

raining

a bit. Nobody

person-like—it

seemed

surprised,

he was an animal

but

very

must be because of all the tests they have been doing on

him recently; they treat him like a person.

..."

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LI: This gorilla has recently been ill, he has had check-ups by several specialists: vets, doctors, a whole lot of people; he has even had an intensive-care unit installed just for him.

"... we went to a drinks stall and sat down" Before the dream I had been talking with Benito about zoophilia and how one can understand it, depending on how sensitive people are. In the dream "I had gone to bed with Snowflake and it seemed normal; people were not surprised. I was also thinking about the USA, there were lots of things mixed in." ,.. I have always dreamed about famous people but they are normal people in my dreams—"oh look, that's John Wayne"—as if nothing could be more natural. In the dreams I remember with famous people in... .lam usually not one of the famous; I am just a man or a girl. Once I was a girl who had two children.... Sometimes I see my dreams as if I were watching a film, but sometimes as if I were one of the characters. There was a dream that was quite funny: "I was on a horse with John Wayne and Robert Redford, we were riding towards a warehouse, and there was Julia Otero [a TV journalist and presenter], she was going to interview us.". . .It is a dream from about seven years ago

Ps: She was on the horse with both of them? LI: She was on a horse, and John Wayne and Robert Redford were also on horses. Each on their own horse, riding to the warehouse . . . then she went on and on, I stopped her to say:

T: This dream was from a long time ago, but what does last night's one suggest to you? P: I think the thing about Snowflake is funny, but at the same time I thought that if I told somebody they might think: "this girl sounds like a zoo­ philic." In the dream, when they asked me if I had gone to bed with Snowflake, I pictured him being excited. But I did not get excited thinking about him being excited. In the dream I felt rejection rather than attrac­ tion. It wasn't so much the actual fact of being in bed with the animal, it was rather that the people were talking about it. .. . Last night I also dreamt that "I was walking in the street and somebody was getting into a car, it was raining, I was going to be the only one left there, then a long, two-seater Vespa came by ... and also, at a different moment, before Snowflake appeared, I had a trial motorbike but someone else was riding it because I didn't know how. I was very put off by this and wanted to ride it myself although I am not a great motorbike fan." I used to enjoy telling my dreams to my friends but I have lost the taste for it lately. A month ago I had a dream where "my brother, Benito and I were playing inside an

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aeroplane; we flew through fog and suddenly there was a lorry and the driver was frozen inside the cabin, somebody was saying that the lorry was floating because of something to do with decompression" I think about my dreams and the reason for them and where they come from, bu I don't consider them very important Otherwise you can get obsessed by your dreams, as if they were premonitions; then what I remember is not so much the dream but the feeling around it; these dreams that are like films relax me, they calm me down, they amuse me. It is like when I turn the TV off and I carry on sleeping, dreaming about what I saw on the TV or I dream about a film that I make up.

T: You are talking to me about how you organize your films, these film-like dreams that help you pass the time, amuse you,fill your head with images but do not help you to think. And so nothing of what is in your head is of any importance, you are empty of meaning; there is no "why" and no "where from". ... You also tell me thai it annoys you not being able to drive and having to be driven by somebody, like here.

P: Yes, but thinking about that is like what happens with zoophilia: I find it disgusting; thinking about the act is disgusting, it's like taking fondness too far. Like when I play with my mother's dogs, I stroke them, I touch them, but of course I don't touch their genitals, I don't take my hand down to their intimate parts, although I think there are people who do, I don't know what they can like in it What strikes me about my Snowflake dream is that I wasn't thinking about the sexual aspect—that was what the other people in the dream were thinking. I just thought about sitting at the table with him, eating; he would be like a humanized animal, with all the privileges he does in fact have, which are more like a person's than an animal. That is what I like best, the transformation. But of course, I cannot imagine myself in bed with Snowflake (she laughs louder and louder). It is funny to imagine this situation from the outside and think that somebody could see me explaining to a psychologist something lik this (she laughs a loud and noisy laugh). There has been so much talk lately about necrophilia, paedophilia, zoophilia, so much talk about it tha I don't know, one can be perverse and imagine oneself in a situation like that It is as ifin my imagination I can think about the excitement this can produce in someone, but the more sensual caresses, the part that is mor sexual, the excitement, is partly what disgusts me more. .. .

T: You imagine yourself here, and you probably obtain pleasure from think­ ing that perhaps you excite me with the things you tell me; perhaps you imagine that in this way I can get truly interested in you, and that you

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will receivefrom me the treatment that is accorded to human beings; that you will be noticed by the strange things that you say and talk about, and you will become important to me through them, as in the dreams where you are in the company offamous people. D.M.: She gets more excitement from the thought of what other peo­ ple might be imagining about what she does w i t h you. It seems that for her other people's voyeurism is important. When she was in the psy­ chiatric hospital it would seem that she specialized i n goading the other patients to insult the institution's team of carers; this seems to be an important feature in her. I would go back to the beginning of the session, the moment when she turns the light off and follows you to the consulting-room. It is a reference to what the people who have been left out, whose light has been turned off, might be thinking; what will they be thinking about is what goes on between her and you in the session. This probably has its roots in her parents wondering what she was doing w i t h her brother, what was there between her and her brother; and it refers, too, to her mother wondering what was there between her and her father. . . . And it refers to her also, asking herself if she has been the cause of the family break-up, which was perhaps the case. She does not seem to be interested in exciting you but, rather, in exciting other people's imagi­ nation about what she might be doing w i t h you. A n d this guffaw that appears here is very important: i t is the laugh of the stirrer, of the mischief-maker. Ps: It is sadistic laughter. The triumphant laughter of the person who has everything. D.M.: It is a form of sadism, related to the projection of voyeurism and curiosity. Okay. P: I don't think that's my intention. In the dream people didn't turn round to look at Snowflake, he was just a monkey. In the John Wayne story there was no audience, just three people, and I was a boy. It is true I dream aboutfamous people, but there is no applause, or crazy behaviour, orfans. ... If I dreamt about famous people and we did something normal and people noticed it, then there would be that satisfaction. It is as if I got inside them and inside their fantasies. And I could pick famous people closer to me, from this country, instead of John Wayne and Robert Redford, whom I hardly like. What I like most of all is the plainness within the eccentricity, like a dream where Elvis Presley, whom I don't like either, went into my room and we had a relationship. What was amusing was

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SUPERVISIONS WITH DONALD MELTZER seeing Snowflake from the outside, like a "sketch" or a "gag";

this is what

I liked. I don't talk about all this to impress you; the fact is, these extreme forms of sexuality scare me because I seem quite perverse, and it frightens me. I feel coy about this kind of conversation.

That is why the other day

when I was talking with Benito about the interview with a zoophilic who had left his girl-friend for an animal I felt disgusted; and instead of disgust I feel...

then I think about it

I wipe it out of my head immediately, I am

7 was talking with Benito about the relationship I have with

repelled....

my mother's dogs: sometimes we are alone, we play, we run, They come on top of me, I had never felt affection for dogs like I do now. And of course I think that there are people that end up loving them; I don't know, 1 think, I would like to think that I would never be with Chuss, the dog; I wouldn't have a sexual relationship with him, but on the other hand I like to stroke him, to play with him. But I am frightened boundary,

something

of not being able to mark a

that happens to me with people too. It is clearer

where the boundary is in the case of the dog, but In the case of a friend, if I like him and I feel peaceful and nice, then I don't know if that is the relationship or I am in love and then I want to have a sexual

relationship.

But then what happens is that the people with whom I feel the most free and natural and protected are not the ones I get excited with in bed. This happened with Xavier and with Aitor....

I don't remember the first time

we went to bed; this always happens to me, I sort of get comfortable and relaxed, and I only want to stroke and hug and kiss a bit, but no more than that. Perhaps I am morbid and I like strange situations,

but always

with

the certainty that I know that person or that I think I can control it up to a point. T: You are referring to something eccentric in relation to what you do with limits, limits between animal and human, between you and the others, between one class of feeling and another; your desire to test those limits and the pleasure you derive from it and yet at the same time the confusion you fall into when the differences are wiped off. You might live inside other people or in other people's fantasy, as in the case of David's plans for you that you mentioned the other day. Then you don't know who you are. You are probably telling me that here, too, you are going to have difficulty in finding the limits of our relationship. [End of session]

D.M.: This is very interesting, this question that when she goes to bed with somebody, what she likes, what she wants, is simply to be treated like a baby, to be stroked. But that what excites her, what produces in

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209

her this manic and hysterical guffaw, is what the people outside will be thinking and wondering about what she might be doing with the dog or the gorilla or her analyst. . . . Those people are surprised, ex­ cited, "shocked" She probably thinks she is a witch, and it would be important to bring all this out onto the surface, make it evident, together with the masturbation, and it is an anal masturbation. There is a lot of work here. Y o u are not going to get very far with her for the time being; there will be moments in the sessions when she will spit at you, insult you, attack you. In order to temper the intensity of the acting of this inverted oedipal situation, you w i l l have to bear in mind all the time that, while she is with you i n the session, she is thinking that your wife is listening on the other side of the door, or looking through the keyhole, and that she is very curious and is fanta­ sizing about doing with you what she thinks the patient is doing. Does she lie on the couch? LI: Yes. Ps: That would be the oedipal triumph, is that right? D.M.: Yes, achieved through curiosity. For her, a psychoanalyst is as good as a gorilla: an object to be sexually tantalized. When you work in a psychiatric hospital and a beautiful manic-depressive woman comes in, you see how everything gets turned upside down; the place be­ comes hell because this type of patient mixes in a whole series of actings, from tantalizing and insulting to goading other patients against the team, etc. I am fully convinced that what is central to manic-depressive states is the theft of the nipple-penis from the breast and its parading it to everybody, bragging about it. I n the case of this girl, both nipples­ penises have been stolen—they are represented by John Wayne and Robert Redford. By the way, what was the tide of that film with Robert Redford and that other actor, I can't remember his name, the one who played Billy the Kid? LI: Paul Newman and Robert Redford. Yes. I n Spanish it [Butch Cassidy and The Sundance Kid] was translated as Two Men, One Destiny. They die in an ambush in South America at the end of the film. Ps: A n d there was a woman with them, too, wasn't there? Ps: Who helped them, didn't she? LI: Yes.

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D.M.: The feelings of power that she seems to have in these manic states of over-excitement are directly related to the possession of the nipple-penis. LI: Yes; she said that she could see an enormous, shining eagle and that it was as if all the pieces of the puzzle suddenly fitted together, and then she was drifting away, drifting.... D.M.: She is very good at describing these things. Did you record this material? LI: No. Perhaps I correct it a bit later on; I remember as much as I can, naturally, but she expresses herself very well; I think the text is quite faithful to her words. D.M.: Do not forget those two abortions, those two alleged abortions. In one of the dreams she says she has two children. LI: Yes. D.M.: She is obviously an intelligent girl who has not been able to do anything with her intelligence. Do you know how far she got in her studies? LI: Yes. She did Year 2 of BUP. After that she started travelling, working as a model, earning money, etc. Ps: Does she still work as a model? LI: No. D.M.: An intelligent girl who has done nothing with her intelligence. Ps: This working as a model could also be related to her inciting to voyeurism, could it not? D.M.: Possibly The catwalk. Ps: In front of my consulting-room there is a modelling school. There are two flats joined by a catwalk, and female students are constantly filing past. As I leave my consulting-room, sometimes I come across a fashion show. (Laughter) D.M.: This leads directly to pornography. Ok. Time for lunch.

16

[APRIL

1996]

Eduardo Reduction of perversion in an "Oblomov" type Carlos

E

Tabbia

duardo is a 35-year-old engineer, he is single; his father and a brother are engineers too, and his mother is an orthodontist; they are all alive. He is in the fourth year of his analysis, five times a week. Introductory

notes

The material thatfollows consists of two sessions from a month ago. Butfirst I would like to say something about the patient's present situation, which is probably related to a change of attitude on my part. He is more depressed, and he admits that he doesn't know how to work, that he lacks knowledge as an engineer, and that it never was his chosen profession; sometimes I get the impression that there are suicidal ideas floating about. He has spoken to his father about being disorientated and not knowing what to do about his work­ ing life; his father told him to stay close to him and he will teach him how to work. In the associations thefather seems to be showing more interest: he asks Eduardo why he doesn't go to work, where he spends his money; he has also enquired about Eduardo's work from the person in charge at the office. But Eduardo works himself into a manic state of excitement; for example, his father has been asked to give a paper at a conference in the university, and Eduardo has offered to write it for him.

211

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SUPERVISIONS W I T H D O N A L D MELTZER

His mother seems unbalanced and isolated at the moment. A fortnight ago my patient narrated this story: in the flat there were some clothes from the 1960s that belonged to his mother that she never wore, so without telling anybody he threw them away; his mother met him in the street, and, in front of several people, among them the girl he is going out with, she made a scene and insulted him. She gives the impression of being at her wits' end, judging from my patient's narrative. Session of Tuesday,

19 March

1996

P: I was very worried; I did something wrong,... you are going to get annoyed with me. My father said that he wasn't feeling well and he wouldn't go down to the study today. I stayed in bed. Yesterday when I left the session here I went to the office, there was some paperwork to do, the drawing program had to be changed. ... At 8.30 I stopped working and started photocopying a motorbike manual till 11.30, and while I was doing that I thought about languages where.,. CARLOS: And here he starts one of those endless speeches w i t h all the details about what languages the manual is written in; he begins to get very excited; he makes that kind of speech very often but I am cutting them down. T: You are wasting your time. P: Yes. I called Rita but she was going to bed, and Albert [a friend who owns a restaurant] said "what have you got to eat? I'll come right away!" (it was past 23.30). When I was going out I thought I hadn't arranged that very well. ... I took a motorbike spare part to Santiago. T: You are still going round and round. P: I do what I can. T: Going round and round. (The patient stayed silent.) T: You haven't said anything to me so far, except showing me that you go round in circles fruitlessly; it is probably related to the news about your dad being ill; you seem worried about it. P: Yes. 1 have begun to think that he is not eternal. I am not sure about investing in the office, because of what would happen if he weren't there. I don't think our clients are going to trust me, or even the office perhaps. This worries me quite a lot; I would still like to have some time to myself. C: His father was 70 recently; this made him think, it made him realize that his father was getting old.

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213

T: You want to spend some time on your pooh: looking at it, admiring it, painting it, etc., it is a waste of time but it is worrying you more and more; going round in circles or talking endlessly is the equivalent of playing with useless things. P: Yes. I thought that everything seemsfruitless to you; I was thinking about painting my motorbike, and while I waitedfor Santiago to come I took out a magazine that had a very beautiful and elegant Honda Fireblade. [One of the three bikes he owns now is a Honda] T: Ifind that the way you waste your time isfruitless,but I don't think that having hobbies is fruitless. P: I waste time because I see that things have to be done one by one; I can't get far. Programs become indispensable .. . (he talks on and on) T: Your dad's work is being done by Daniel and the girls; meanwhile you are thinking about the programs. You divert to secondary things and get more and more lost, and then you'll tell me thai there is no ink or that the doormat is old; you are talking to me about secondary things, and mean­ while the work is not getting done. P: I worked on the motorway this afternoon. ... My father had a good idea, or rather a mixed one, which is to have bull's-eye windows, but I didn't like it when I tried it; it looks poor, basic. What I want to do, because the model maker is going to askfor it although he still doesn't know, is to do ii in 3D.

C: I find this striking: "the model maker is going to ask for it although he still doesn't know": it is a kind of psychotic functioning; it is as if he knew what they are going to say to him. T: Do you mean that you couldn't do what your father asked you? P: Yes. He likes it but I don't. It is not well worked-out. T: You lookfor marvellous things and you end up doing nothing.

D.M.: That is the crucial point. P: I have periods like this and periods when I do good things. I have now just thought I could have triangles on the wall instead of bull's-eye windows. It will be better T: You are chattering; you start doing a pooh very quickly, your ideas don't last long; you immediately turn them into faeces and start playing with them. P: My, my! I feel that I am getting worse, that I am putting up a wall between you and me; I just thought ofsomething but I am not going to tell you because it is another lot offaeces.

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SUPERVISIONS WITH D O N A L D MELTZER

T: What you said about the wall between you and me is true. You get angry when I don't admire your pooh, but I would be a swindler ifl told you that I like your faeces. You are intelligent, and you know that you can't do anything with pooh.

P: I was thinking about motorbikes and the people at workfrom the point of view that everything is sterile, and I also thought about Rita, who is the opposite, she is fertile; and I remembered Jose, I see him every two or three months, he is 40, he says: "I have one who is married and she is the very best there is"; he hurts my feelings when he talks like that. 1 would be incapable of talking like that about Rita after thinking about her. 1 see her so devalued when Iforce myself to talk about her. T: You are confessing your sadness at the way you devalue so many things: women, yourfather, work, your mother, and the analyst when he wants to entertain us with his marvellous pooh-speeches that mean nothing at all. You are quite capable of talking on and on without saying anything— that's why I cut you off. And so your sensibility is hurt, it suffers when it sees the way you treat things. (Pause) Moreover, if you don't work and your father dies, what will become of you? P: I was thinking about him and about his brothers who are dead, and that we, his family, are his descendants. T: Who for the time being are not very promising; one cannot have high hopes for you. P: I don't see myself doing anything useful, I can see myself doing things that are not valued. The world values concrete things. . .. T: Now you are telling me that when you masturbate you are putting up buildings. P: I don't know how to put up buildings. T: I know that P: But I can tell when good ideas have gone into a building. I don't do little concrete things. T: Your father—whose work does not fall apart—is a mediocre person with very few ideas! P: My father chose criteria that are valid, criteria that the profession and the clients value; nobody builds better than him with those criteria, but he doesn't mess with classical engineering constructs whose history he knows nothing about. T: There you go again, throwing rubbish at your father; when you have proved yourself in action, then you can talk.

EDUARDO

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215

P: (Silence) When I was 20 or 23, looking at the physical world, I could see that the world of humans didn't interest me. . .. The basic thing is elemental physics. T: Youfeel so angry and jealous at the work done by human beings, like your father and me here with you, that you say it is better to look atfaeces going round and round in the WC. That's elemental physics; that's more impor­ tant than the work done by parents. P: I imagined that when I finished coming here the world would begin that day,fun would begin too, I'd befine that day; but it is also true that when I was at school I used to tell myself that I would be okay once I was at university. I am doing the same thing again. I am having a hard time, maybe because things seem hard. I've always had bad moments. T: This is a hard moment because I am being hard on you, telling you that your values are wrong; there is no value in pooh, but the work that dad, mum, and I do does have value. D.M.: You are telling him that he is worthless, that when he plays with pooh he is pooh. It is an invitation to get better or to kill himself. I t reminds me of an occasion when at last I told a patient that she was useless; for about a week she was firing off like a volcano, but from there on things began to get better. Session of Wednesday,

20 March

1996

P: I worked on the service area for the motorway this morning; I gave in to my father's idea of the bull's-eye windows. D.M.: What are bull's-eye windows? C : They are round windows, like the ones on ships. P: I got an idea for a drawing yesterday; he liked it, but I touched the computer cable with my foot and the current went for a few seconds. T: What can that interruption cause? P: Nothing, because I had just "saved". I have a battery that I don't use ... [he talks about that problem; I don't understand it but decide not to ask] I bought a motorbike magazine on my way to the restaurant; I saw some­ thing interesting, a trip to Cyprus from the 3rd to the 7th [that was Easter—I took twelve days of holiday]. (Silence) T: You worked, you collected ideas, modified them, and came up with a valuable project that you are likely to find satisfying. It does you good to see what you are capable of, but at the same time we have the kick on

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SUPERVISIONS W I T H

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the cable, which is the equivalent of destroying your work, although on this occasion nothing happened. The kick is probably a representation of your excessive words, of your excessive talking. I did not understand what is wrong with that regulator; now, if I ask, I run the risk that you will get excited and flood me with words, but if I don't ask I don't understand. P: (Rapidly) The regulator is made up of three elements: feeder, switch and exit cables ... one summer . .. about a year and a half ago . .. T: You are beginning toflood me. P: ... its function is not to feed but to store. T: It stores, it doesn't feed. It is incredibly interesting because it is what happens to you. You store, but you do not feed yourself in proportion to what you store. P: Ifeed myself? T: It is interesting: you have a lot of words, but you think little. When you talk you flood with words but without much meaning; that's why I am afraid of your flooding me with words, which has almost happened al­ ready.

P: (Silence) My brother came yesterdayfor supper. My mother wanted to talk about her surgery, and my brother said thai he wasn't going to take care o it, thai she should sell it. I know that she does not want to sell it, that's th most important thing. I said: she doesn't want to sell it so she should take better care of it. My brother replied: "don't do cheap psychoanalysis." I said to him that I am the one who is always there while he comes once month, and he has the cheek to tell me that I do cheap psychoanalysis. H says that he doesn't want to be her little agent, and he doesn't want to computerize the surgery, although that is what he knows best of all.

T: You are showing me a cooperative, hard-working Eduardo who looks after his parents andfeels that that is good, but next to that Eduardo there is th Eduardo-pooh who talks and contributes nothing, and that is represented by your brother. P: At least you gave the pooh bit to him. T: But it is a part ofyou.

P: My father told me to help my mother. I have a vision: she wants me to accept what she thinks. To sanctify what another person says is not to hel them. She asked me to pay her again; I can't pay her what I was paying before. It is clear that my motherfloods my brother. I told her afew things If she took care of the surgery we would all be better off. The place is no

EDUARDO

APRiL 1996

217

doing well because some people are sticking their finger in the honey pot. I told her I was not going to help her to make money without effort; here (in the analysis) we saw that I did it for me but not for her. T: Mum and dad depend on what comes out of you, they feed on the baby's faeces. P: True! My father doesn't want to take decisions because it hurts. I got rid of Thomas for him. My mother has somebody else who does that job, so that person can take care of it. T: Babies cannot feed the parents.

DM.: What did Thomas do? C: He was a partner i n the father's business. D.M.: What is the relationship between Thomas and the mother? C: None. She has a different partner in her surgery, who lines his own pocket. P: Maybe

I am not such a baby. If I am a baby then they are fetishists.

Thomas was a fetish that cost him a lot more! He wasn't just paid too much; he didn't do anything for the office. I put together the present team.

C: He sacked nearly the entire previous team and hired new people. And this is what counts; I chose some of them for their voice, I am very intuitive about that; maybe he didn't do this little thing. Maybe the people in the office see me as a parasite, but they all know I chose them!

DM.: What does he mean by fetish? C: A parasitical relationship: mother doesn't look after the surgery, and the partner takes advantage for his own good.

D.M.: Maybe there is more egotism than appears at first sight, on the

surface, i n mother's attachment to her partner as a penis, as a fetish.

C: The mother had a kind of erotic relationship w i t h Eduardo; she used to go to talk to h i m when he was i n bed, when he was 15 or 16 years old, and she would touch him and talk to him until the early hours of the morning. T: A parasite chooses the best fruits,

the best trees, to parasitize them.

P: Thomas used to infect other people. My attitude is not contagious. I was thinking about the last study project I took part in, three or four weeks ago. My word! It was quite a feat; I had never worked like that before. Cristina and other people handed two lots in. They didn't seem as tired as me or to be having a crisis. I have been looking ahead to August and I see that I have wasted weeks already. I am sad about the

August

SUPERVISIONS

218

WITH D O N A L D MELTZER

holiday. Looking back after you have worked allows you to have fun and see the things that are pleasant. T: It is what we were saying: a timefor work and a timefor rest; there is time for rest if there is work. C: I say this because during work hours he is thinking about his motorbikes.

P: I've been thinking lately about the possibility of redesigning the motor­ way; Ym thinking about using computers; one can get a lot from them in spite of their limitations. Yve got to study it again; Yve got to work on that. You tell me that I should learn from myfather, but that can be learnt in other places; however, my research cannot be done anywhere else. That is a seam I discovered four years ago. T: What seam? P: Reducing all types of complex surfaces to simple figures: triangles.... T: A sphere represented by infinite triangles? P: Yes. T: That may be so in the office, but the seam that you have been discovering in the last four years in the analysis is the understanding of the triangle formed by Eduardo, mum, and dad. Properly understood that triangle can be very beneficial for your mind. [The doorbell rings once] P: You can explain that to me another day. It is quite abstruse. With your lot, psychologists and psychoanalysts, it is like when I explain a project to another engineer and he doesn't understand it.. . because it is so cryptic. T: Your conflict about your parents' creativity, which you denigrate a lot, is what stops you from being creative. D.M.: You are having a go at him, attacking him. You are telling him that all this talk, talk, talk is a way of feeding his parents w i t h faeces, and he answers you: "my faeces taken as a penis are quite acceptable to my mother/' And he comes back to his relationship w i t h his mother as a challenge to you, a relationship of possessiveness with the mother challenging the father. His father says, "you have to learn to use computers, stay by my side, I ' l l teach you", and he answers: " A h , I have intuition!" His intuition is that the oedipal triangle can be used i n infinite ways to create a sphere. Unfortunately i t is true that the way some engineers and architects build spheres is through triangles. He has moved to a situation of challenging you as dad. Most probably behind this there is an accusation against father that he is so busy w i t h his spheres that he does not satisfy the mother's needs; he admits,

APRIL 1 9 9 6

EDUARDO

219

though, that just like Thomas he is nothing more than a fetish for mother, and yet that's the best thing mother can find for the time being. It seems that somebody is going to have to install a computer, computerize the surgery, because at present you cannot run a surgery without a computer; it is a hard-disc problem, they are going to have to call a professional to sort it o u t There are many architects who are actually proud of their creativity and intuition and who look down on engineers. Maybe Le Corbusier is one of those architects who are very proud of their intuition; the "Marseilles block" is a residential block where each house is interchangeable, moveable. It is a sphere of activ­ ity where art and engineering have come into strong conflict. He is feeding on that kind of conflict, he is relying on what he calls his intuition. You have come up against a situation that could become an impasse, a cul-de-sac. He has put you in a situation where you w i l l probably have to say that you do not believe i n his intuition because you have no evidence i n the analysis of that intuition, that what you see i n the analysis is that he is slow to understand something. So far you have concentrated on the paternal transference and on his desire to feed you w i t h his faeces, but maybe you w i l l have to concentrate on the maternal transference and his desire to satisfy you with his faeces. It seems that the situation is that the mother values the surgery—it represents something valuable for her and she wants to continue run­ ning it—and he knows that in order for the surgery to function it has to be computerized; his brother, who knows about computers, refuses to do it. The implication seems to be that he cannot employ, use, pay his brother to do it; he is going to have to learn it himself. This is true with regard to the surgery and to his father's office; today, he has to learn to use computers; drawing a motorbike is no substitute for learning to use a computer. The next step w i l l be his masculine vanity about his faeces, and there, too, taking Rita for a ride on the motorbike he has just drawn is not an adequate substitute for proper lovemaking. Ps: I n that line of thought, throwing away mother's dresses, which is taking decisions that are not up to him, is somehow like a substitute for sorting out the computers i n the surgery. D.M.: When he throws away the dresses, he is throwing away his mother's memories from her marriage i n the sixties. His motorbike is a fetish to him. He can offer it to his girl-friend as a fetish, and he thinks it w i l l satisfy her. Your way of dealing w i t h h i m at this moment is correct, completely frank and firm. I think he is a lot less perverse than he used to be; he is

220

SUPERVISIONS W I T H D O N A L D MELTZER

m o r e depressed, more w o r r i e d . He is not presenting y o u w i t h a threat of suicide, b u t there is some k i n d of inertia that does p o i n t to that possibility, and so I understand w h y i t worries y o u . The v i t a l i t y of people w h e n they are determined to be against learning f r o m experience is a strange phenomenon. People like this patient—people w h o have gone t h r o u g h the education system avoid­ i n g w h a t was difficult a n d d o i n g o n l y w h a t was easy—are masters at a v o i d i n g d o i n g the things that they t h i n k they w o u l d fail at. They b r i n g to y o u , they present y o u w i t h , fantastic arguments, completely cynical, to demonstrate that their i n t u i t i o n has l e d t h e m to a clear certainty about w h a t is really art and creativity. W h a t he is telling y o u is that one doesn't need to k n o w a n y t h i n g about the external w o r l d ; they tell y o u that w h a t can be created internally w i t h this marvellous i n t u i t i o n , w h i c h i n his case means masturbatory fantasies, is the o n l y t h i n g one needs, and w i t h that one can create everything. These people tell y o u that they have to prove the success or failure of that i n t u i t i o n they've had; they are incapable of seeing i t , pre-judging i t b y t h i n k i n g , i t has to be tested o u t i n practice. I n the case of an engineer, unless the b r i d g e falls d o w n i t means that i t is okay; the rest is a question of taste, a n d his taste is superior to other people's. T r u t h doesn't exist, every­ t h i n g is relative; i f i t doesn't fall d o w n , i t m u s t mean i t is good! But the question one can ask oneself is, h o w l o n g w i l l i t last before i t falls d o w n ? N o w a d a y s , i n architecture for example, the average life of b u i l d i n g s is between twenty-five a n d t h i r t y years, b y w h i c h time they are so decrepit i t isn't w o r t h repairing them. A n o t h e r t h i n g that hap­ pens is that the b u i l d i n g s that are designed are so unpleasant as places to live i n that people vandalize them, destroy t h e m . Ps: I was w o n d e r i n g w h y D o n a l d assumes the possibility of an i m ­ passe at this p o i n t i n the treatment, w h e n at the same time w e can see that he is i n a more depressive situation than before, and that his attitude and his perverse mode of functioning have diminished. D . M . : Because he is m o v i n g o n , looking for a final p o s i t i o n — i n the m i l i t a r y sense—from where he judges that he cannot be shifted; i t is a desperate movement because he is l o o k i n g for the terms of a peace negotiation, not a surrender. This negotiated peace that he is l o o k i n g for w o u l d contain the f o l l o w i n g terms: that father carries o n neglecting m o t h e r , leaving her, n o t t a k i n g care of her, a n d that he carries o n satisfying her fetishist needs, w h i c h is i n fact i g n o r i n g her feminine needs. That is w h y i t is necessary to take i n t o account, to give i m p o r ­ tance to, external reality a n d not just to the symbolic aspects; the

APRIL 1996

EDUARDO

221

external reality is that for his mother the surgery means a lot, that she wants to keep it, that it needs computerization, and that he doesn't know how to do it. C: I have brought a comment from yesterday's session because it illustrates this. Because of the speech his father has to prepare and their decision to write it together, the following information emerged. Approximately thirty-five years ago (which is Eduardo's age) his father wrote an article on "Creativity" in which he stated, "The essence of creativity is rigor and not imagination, from which one should stay clear"; however, at present he has changed his mind and says that the essence of creativity is "imagination and playfulness". So Eduardo asked him if he had learned the playful aspectfromhim; to which his father replied that he was quite a plagiarist and that of course he had learned it from him. Eduardo felt quite satisfied with that compliment, as he feels in general that his father is so absent-minded that, he only remembers him in his prayers. D.M.: That is a problem: he thinks that intuition is imagination. What Eduardo doesn't realize is that what he calls his intuition is masturbation infantile fantasy, that the thing he calls imagination is the fantasy of the pile of shit. It is the richness of the buttocks, not of the breast. That is the problem: he wants his father to admit that he, Eduardo, has really been the father of this family. You'll hit a moment of crisis if he doesn't commit suicide before. He will want you to admit how much you have learned from him; how much you have learned with him is not the same as how much you have learned from him. You are going to have interesting moments, a lot less boring than it has been so far. The way you'll get him against the wall is by analysing the maternal transference. What there is behind all this arrogance mixed with indolence is the projective identification with the breast. He is an "Oblomov" type—the type of child that is yearning to have a mutual idealization with the mother, feeding one another: mother feeds with the breast, and he feeds with his buttocks.

PART

II

1997-1998

17

[FEBRUARY 1997]

Claudia Latency, obsessive watchfulness, control, and emotional evacuation Rosa Castella

I

have brought this case because I find this patient very difficult; it is probably on account of her way of functioning, which seems to have a lot to do with rage. She is always enraged, hating, she cries a lot in nearly all the sessions, and generally I have the impression that she is always angry. She is 23 years old now. The two facts worth mentioning in her childhood, according to her, are that she has a younger sister and that her parents separated in a rather traumatic way. D.M.: When? ROSA: When she was about 7 years old.

The mother said to the girls that she was taking them to buy bread, and they never returned to the family home. My patient got very upset, because she realized that something was going on as she could see that their mother was taking them to the village where their grandmother lived and didn't explain things till later; my patient got very anxious. Her mother attended psychological treatment, and Claudia came to me two years ago because she said she had seen her mother becoming so mature she wanted to go through a similar process. At the time when her mother was looking after the two girls but still wanted to have sexual relationships, there had been some occasions when her daughter found her in bed with a man. This had had quite an effect on the patient. 225

226

SUPERVISION S W I T H D O N A L D MELTZER

Mother sent both girls to have treatment. The youngest accepted it, but Claudia cheated on the psychologist by spending the time drawing because she refused to be treated. Then finally her mother had a partner that Claudia could not accept, and a new baby, another girl. This was hard for Claudia, who spent three days without going to the clinic when the little girl was born; she only forgave her mother's present husband when he left her alone with the baby and her mother.

D.M.: But this is not her younger sister; this is the third one. R: Yes, the third one. She describes her mother as a meadow—that is the word she uses—something pleasant and relaxing; her father, on the other hand, makes her anxious because he is not reliable; he is just as likely to make her a present as he is to forget to pay her back money he owes her. When he was involved in a traffic accident, he wanted her to say that she was driving the car at the time so he wouldn't lose his licence. She doesn't know how to stand up for herself in this kind of situation. She hates it really, but she doesn't know how to react I am bringing two sessions, one from the 13th of September when we returned from our holiday, and one from a few days before the December holiday. She was on the point of abandoning the treatment because she said she suffered too much.

D.M.: Before which holiday? R: There was a holiday when she was really disconnected. These sessions are from the period between the two holidays. She gets worse before separations. She arrived seven minutes late for this session, but any contretemps or little problem is a tragedy for her. For example, being ill and having to phone me is something terrible; it causes her great anxiety. She did not start her periods till very late. I think she had had some, but at the time she came to see me she was not having them, and she hated being a woman. She is constantly complaining of stomach pains, constipation . . . and it is all described as a tragedy. In fact, everything is like that. Session of 13 September

1997

She arrives seven minutes late. P: I am sorry I am late but I took the train going the other way by mistake. I found myself in Les Corts and I had to come back; it took me this long to get here.

R: There is a lot of tension in the voice.

FEBRUARY 1997

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227

I am not feeling well R: Now, this woman has a degree i n chemistry, she works i n the university. To apply to get a grant she wanted to get a better mark in a particular subject where she had got a B to begin with. She got the grant; what follows leads up to that. . . . I am not well; I was studying and looking at the time. Then I arrived late anyway. I am not well, I have a cold sweat all over, a headache, constant anxiety, I have hurt myself, and tomorrow I have an exam. ... (She cries) It is an exam without any risk and I thought I would be quite calm about it but it is not so. I am eaten up with anxiety. I suppose that what makes me anxious is spending the whole day studying; it annoys me. By June I was already fed up and then they postponed the exam. You know I got a B but that is too low for a grant. I have to get an A+ for that... R: She says all this with a force, a rage that I don't know how to describe. . .. The grant I have at the moment is 70,000 pesetas a month and I want to apply for a 150,000 one, but for that I have to take this exam and get an A+, that's the only way to up my average. But I am not sure I'll get it; of course, getting a good mark isn't just goodfor this year but for the others too, because I'll be able to apply for other grants and the average of this year will count there. But it isn't completely certain, and although I don't feel like studying, if a different person were in my situation and wonder­ ing whether to take the exam or not I would recommend them to take it, although it is terrible. T: It seems that you are worried, about the exam apparently, and you seem to have come here against all odds, under obligation, and as if this was a terrible exam. P: I've had enough.. .. (Begins to cry) I don't know what I like (cries more). Even if I didn't do the exam I would still be feeling terrible (continues crying). [I pass her a Kleenex. She blows her nose] I am bored with studying; I know I passed but I am still nervous. I have to get an A+ to stay in Barcelona .,. R: Her family are not from Barcelona. ... to be able to do my PhD and not need my parents any more, so that I don't have to askfor more money. One of the reasons why I wanted to do just one session is because it costs a lot of money to come here ... R: When she first came, this girl wanted to do lots of sessions. A t that time I d i d not have any free sessions and she had an exam, but two

228

SUPERVISIONS W I T H D O N A L D MELTZER

months later she was able to do two sessions. Then she began to want only one and to feel that two sessions were like a kind of prison. D.M.: The bit at the beginning when she takes the train i n the wrong direction has to do w i t h her having great difficulty fixing her attention. She is trying to concentrate so obsessively on something that she cannot concentrate on anything other than concentrating. You get an image of a truly defeatist person. ... although it is possible that even if I had the money I would find it hard. I make a great effort (there is a lot of tension in the voice) and I arrive late in the end (she cries). Everything revolves around coming here, I have to be careful not to agree to meet people at this time; I am watching the clock all afternoon (She is furious) T: I think that what you are telling me is that you are experiencing coming here today not as coming to get help from me but, rather, as me taking something vital from you, being demanding and persecuting you. And all this perhaps happens because there is a Claudia who would like not to need anybody and turns this situation of me helping you into a demand from me. And so it is not that you need me but that I make demands from you. P: (Starts crying) I sensed this afternoon that I would cry when I came here, that it would all come out wrong. It started with bumping myself against the corner of the cupboard; I was crying and laughing at the same time, it was odd. It doesn't usually happen to me, I was with Ernesto.., R: He is her boyfriend; they live together. ... he laughed; I didn't hurt myself badly and I was crying and laughing at the same time. I don't know what you are saying to me but 1 feel a dreadful rage against myself. All this year since I started coming here I've been able to do without taking laxatives, I was getting my periods and beginning to be in good form. R: I n the first year of analysis she started having periods. Then i n the holidays she stopped. (Anxious and furious) Now I am not having periods; I am still consti­ pated, I have put on weight, I am flabby and fat. Because of all this having to study I don't do any exercise although I told myself I should, I have just been lying in front of the television. R: She is a girl of medium height, rather slim, w i t h beautiful green eyes; sometimes she has very aggressive hairstyles—a ponytail, for example, and the back of her head shaved. T: It would seem that when you don't feel that I am persecuting you, you

FEBRUARY 1997 start

CLAUDIA

to persecute

realizing

yourself

that although

P: When I was leaving

by seeing

you find

only the bad side of things,

it hard to study you are in fact

the last session

229

I thought

about today's

without studying.

one, I

thought

I would not be able to speak, because I don't even know how to be here, and if I wanted myself

to go deeper into things

I feel disappointed.

nothing

. . . . I just feel rage, the moment

I have the feeling

in the end, everything

I came here, 1 have no periods,

I am on laxatives,

my breasts get swollen,

and my belly too. I feel like sending

Wednesday

I had a sort of daytime

coming

explaining

here and she—who

my thoughts

everything

packing.

dream

or a fantasy.

knows

how to do these

to you; that way I didn't

need a machine

homeopath T: I think efforts felt

again

you exaggerate We know

and

lie to yourself

We have had our first that you have always

have to explain

is good

when

you say

holiday found

that all

your

break, and you

have

separations

in you, or in us. You get into a state of mind maybe because it makes you angry

well you need somebody

to help

them. I

to me; I would

up.

but it seems that there is a part of you that likes to destroy yourself,

my

things—was

Now I shall have to go to the

to get more tablets. I am fed

lead to nothing.

ill again.

to read my thoughts.

and Last

It was about

don't know how to put it and I don't know what is happening probably

for

I do is wrong. I feel I am no better than before

my stomach mother

I see

that I put in a lot of effort

to accept

difficult

everything

that

where you

abuse

that in order to feel

you.

D.M.: She gives you a lot of information about the way her mind works, and I think it would be useful to look at it in some detail. On the one hand she is always looking for an explanation, which to begin w i t h is the money, but one can see that she is not convinced because she says: "Even if I had the money I would still find it hard to come." When she says, " Everything revolves around coming here, I have to be careful not to agree to meet people at this time; I am watching the clock all afternoon...", we can see her way of describing how she tries to concentrate on what is important, but ends up concentrating on concentrating. You interpret to her mainly her hatred of being dependent, which is certainly true. But on the other hand she is very attached to her mother, to you, to Ernesto She speaks about having had a premonition that she would cry here, that nothing would go right, and then she bumps against the cupboard and cries and laughs at the same time. She laughs about the omniscience of her prediction and cries out of pain. She admits that there has been real progress when she says that she stopped taking laxatives and that her periods returned. These are kinds

230

SUPERVISIONS

WITH

DONALD

MELTZER

of indicators; as if she did not have a mind to describe her feelings, her desires, her anxieties, etc. and she had to use symptoms as indicators of progress, as if she were outside herself and not inside. She is somebody who operates a lot better at a level of body sensations that she can observe as if she were outside herself; she talks also about when her periods stopped, when she was constipated, fat, etc. etc. That is how she. feels, because she observes her body like a doctor observes a symptom. We are dealing w i t h somebody who is not capable of operating at an emotional level. She operates at a very sensorial level and at a level of scrutinizing herself from the outside. When she says, " I would need a machine that could read my thoughts", that is exactly how she behaves w i t h herself: like a machine that reads thoughts. You also have proof that she has a way of avoiding emotions getting to her mind: she evacuates immediately i n her rage, her tears. . . . She is a great evacuator of emotions before they reach her mind and can be transformed i n order to be used to form symbols, dreams, etc. . . . You have found yourself answering her tacit demands from your countertransference: giving her a Kleenex, reassuring her that she is making progress, etc. What you suspect, and it is probably true, is that she is a masochist and that getting hurt is an erotic pleasure for her. You also suspect that although she sticks adhesively she is also intru­ sive and identifies projectively. So she has a complicated character structure, and it is not worth paying attention to all these symptoms one by one. The only thing worth paying attention to is her evacuation of emotions, of feelings. . . . When she laughs and cries as she bumps into the cupboard, we see clearly that with that laughter she is trying to get rid of the pain before she can experience any emotional reaction to it. We can also see that these enormous variations i n her menstrua­ tion are connected to the fact that having a baby is something unthink­ able for her. Her mother is the one who has babies, like you, but not her, she doesn't; she is still a little girl. Okay. Let's carry on.

Last session of December 1997 R: She is nearly always dressed in the same way: blue jeans, and her hair as I described before. This time, however, she has her hair in a bob, a bit shorter than usual. D.M.: A n d more feminine clothes?

FEBRUARY 1997

CLAUDIA

231

R: No, no. She takes her hair-band out during the sessions and spends the whole time fingering it. P: I was really feeling bad in the last session. My periods came the next day. I was so bloated, I get like that sometimes and I have the feeling that it gets worse when my period is due. Other times I don't see that correlation. I felt bloated and fat; I feel like that now too, but not so much. R: I took this opportunity to ask her i f her periods were regular now. P: More regular than they used to be but they are late. They tend to be every thirty or fifty days. T: Perhaps when you come here you are able to bring out everything happens inside you, you feel better...,

that

P: No, I didn't mean that I feel better today, just that in the last session I was very bloated and nervous. Like that day when I was coming back from Figueres in the evening. I arrived in Barcelona an hour before the session and I got very nervous. When I finished here I went back to Figueres; then the next day I went to fetch my mother from the hospital; my grandmother was there, then we came back to Barcelona. I was in Figueres today but I came back earlier to go to a meal with my colleagues from the faculty. T: You tell me about a lot of movement but not about feelings. R: I said this to her because I was surprised about this business w i t h the grandmother i n the hospital. P: I don't know, I don't feel okay. I came from Figueres by car with fifteen minutes to spare. I shall be in Figueres the next few days, then in Girona for Christmas. Ernesto wants us to go to Ikea. R: A large department store. I shall stay in the laboratory because I have to analyse some samples, and I'd rather be here than in Figueres. I will spend a couple of days with my father; we'll probably go skiing one day. I don't really feel like going, but if I don't go with him I won't be able to go. D.M.: So far she has been expressing herself i n geographical terms, and that probably answers your words about the w o r l d she lives in. You say to her, " you get into a state of m i n d where you abuse yourself", and she answers that interpretation of projective identifica­ tion, of masochism, that you make. She is divided between the world of her mother and grandmother and the world of her father and skiing. T: Today is the last session before the holidays, and you tell me that you are going here and there, but you don't say anything about what you feel. Maybe that is how you avoid feeling.

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MELTZER

P: I don't know how Ifeel I only know that I don 'tfeel like doing what I have to do. I don't feel like doing anything. (Silence) I don't know how to describe it,... I don't feel all right, just that I am fat and I annoy myself. My trousers are tight on me, Ifeel bloated; I bought a -pair of trousers that were two sizes too big, and they still feel tight. I weigh 52 kilos; when I was thinner I was more nimble and I felt better.

T: It would seem that you feel that in your life there are only things that annoy you, like the weight ofyour body, thefamily reunions at Christmas. It seems that you get hooked on those problems and don't allow yourself to think of anything else. P: I don't like myself any more! When am I going to change? I don't know how to change. R: She is furious the whole session, as always. Ernesto and I cannot go anywhere, and we arefed up ofgoing to Figueres. I go to see my mother and my sister and after two hours I've had enough. We go to see Ernesto's father and he just says stupid things. I dislike not having my routine—and then, all those dinners! (Silence and intense anger). R: Holidays for her mean not being able to keep to her rhythm of diet and so on, to empty her bowels, etc.... so that anything can become a tragedy again. D.M.: She tries to regulate everything. That is the obsessive side. T: You are saying that one of the things that makes you fed up and ill is our breaking the normal rhythm of sessions.

P: There have been so many changes these lastfew days: Figueres, then here; I can't explode with Ernesto. ... At least I've got you here to bear me. Ernesto had a lot of work and I had a terrible time, I had to leave some equipment in the lab that had to be switched off. I told Teresa but she d not remember. It is equipment that is worth between 5 and 6 millions and if the liquid runs out it breaks. Fortunately Emilia saw it and it was all right.... lam not in the moodfor talking.

T: Perhaps you think that ifyou don't come herefor a few days, something in you might break; but perhaps you would rather mistrust everybody, including me, than think that you need the liquid that others have to help you feel better. R: This is to do with the equipment. One of her dramas is that she has to use some equipment to create a certain reaction, and the worst thing that can happen is that i t might not work w i t h precision. On Ihis

FEBRUARY 1997

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occasion she had to leave, and she asked somebody else to keep an eye on it, but that person forgot, etc. . .. D.M.: This is probably related to masturbation, this kind of obsessive watching and concentrating on watching; it is typical of latency chil­ dren, who watch their hands to make sure that they do not masturbate. . . . Her anxiety about the equipment getting broken is not so much an anxiety about suffering a collapse (a crisis) and becoming psychotic, as a fear of a masturbatory orgasm. Does she give you a picture of her sexual life with Ernesto? R: Yes, yes. This woman, who d i d not accept being a woman—for want of a better word—would not go out with boys; then little by little during the treatment she has begun to relate to Ernesto. It was very difficult for her to have a relationship or even get near having one, and last year she got into a situation of hatred and rage because he wanted her; she was extremely a n g r y . . . . But now she doesn't talk about i t . . . . I assume things are going better. (Laughter) DM.: I would think she is the kind of girl who sticks adhesively and only wants a man in bed to hold her but doesn't want a sexual relation­ ship. People who are so sensual and who at the same time watch their masturbation so closely are terribly sticky. They sleep holding the pillow, their husband, or a teddy bear i n their arms. Their rage is like the bark of a dog: it barks because it is frightened. To put up w i t h this, one has to ignore being barked at because they bark at everybody and they wag their tail at the same time, like dogs. She clearly says: "How can anybody love me if I hate myself?" This translates as: I abuse myself and this is my only pleasure in life, how can I find somebody who w i l l want to abuse me and still not abandon me, who w i l l not reject me after abusing me? So the problem is how to find a faithful sadist. This is a real problem i n puberty, because the first step towards falling i n love i n adolescence is to abuse one another, to ridicule, humiliate, pinch, punch, pull one another's hair . . . if this is mutual there is the possibility of progressing to affection, but it always begins w i t h this mutual abuse. That this mutual abuse and apparent hatred are determined by the function of attraction is evident i n the fact that they cannot keep away from each other, and that whenever they are together they touch, hit, pinch each other. . . . Likewise, when she comes to see you she takes the train in the wrong direction, when she is w i t h Ernesto she bumps against the cupboard and hurts herself. That is the quality of her relationships, something ending i n hurting when you are hurt, and crying or laughing, evacuating all the emotions. So

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the indication that she is capable of progressing towards a more oscil­ lating relationship is represented i n that geographical dimension where she is with her mother and grandmother i n the hospital or skiing w i t h her father even if she hates it. . . . It is an indication of progress, progress towards a more unstable geographical orientation, instead of that adhesive sensual level where there is no development. It is very important to promote her observation of herself from inside since she observes herself so much from outside. R: She had a dream where Ernesto arrived without telling her first and what happened was that she did not know what she felt. She was annoyed at the surprise but she did not know what she felt, and this is how i t is with her, anything that is a feeling is sort of . . . D.M.: That happened to Ernesto, not to h e r . . . . I n the business of the grant, she sounds as if she were talking about a lottery. She doesn't seem to experience it as a competition with the other students to be the one who gets the grant but, rather, as a lottery, a question of luck, good or bad luck. It is difficult to imagine that she may understand things She is outside an intellectual field, things that depend on memory slightly depersonalized; she does not seem capable of thinking about herself, unless it is thinking what she would say about herself if she were somebody else. I think it is an interesting therapeutic problem, w i t h a lot of possi­ bility of development; that development is stuck now, and it depends completely on the therapy i n order to advance. It is interesting to see that since she is quite a bright girl, she has noticed that her mother has benefited from having therapy. However, thinking that depends on feelings and intuition is something that she is not able to do. R: As far as these dreams of hers are concerned, I haven't done any­ thing i n particular, but would it be appropriate to point out to her that maybe she is dramatizing excessively, and to make a connection be­ tween all this evacuation of hers and not being able to feel? D.M.: Yes, you must encourage her to contain her evacuations and take time to feel. One of my patients is a great evacuator and he doesn't talk— that is to say, that what comes out of him is a jet of words—and so one has to say to him, please be quiet and think about it. He had a nice dream where something hurt his eye, so he drew his tongue out to soothe the pain in his eye, but . . . he then could not put his tongue back i n its place. I said "Hurray! You have to hold your tongue!" R: Thank you. D.M.: It has been a pleasure.

18

[FEBRUARY

1997]

Abelardo Passivity, exhibitionism, and voyeurism: absence of interests and of object relations— impasse Llufs Farre

belardo is 20 years old; he comes to consultation accompanied by his mother. He is of medium height; there is nothing particularly JL ^remarkable in his physical appearance, which is nice enough, but something about him repels me. His mother is a small woman, with pleasant features, a little bit shy but pretty and lively. His father is 54, a weaver; his mother is 53 and is a housewife. His sister is 26; she is single and she is studying medicine. It would seem that his mother had a miscarriage, but it is not clear to me whether it was before his sister or between her and him. LLUIS: These are the first interviews I had with Abelardo i n the second half of November. After that I saw him twice i n December, and then he left— I shall explain why later—to reappear again after Christmas. I have also brought the last session, so we have the first interviews and the session from when he returned. First

interview

P: I used to have a problem, which was that I made nuisance phone calls saying dirty and stupid things and I also used to expose myself sometimes. We went to the doctor and they said that it was an illness and. ... 235

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Mother: The telephone thing began some years ago; it was not serious then but now it is getting worse— he insults people and says he can't control himself; he has started to expose himself in the streets a bit—so you see... We have to try and see what we can do. He has been reported several times, and now we have to go to court because a device has obviously been installed tofind out where the calls were comingfrom. So let's see what we can do to sort out this silly behaviour. He used to be a normal boy and we never had any problems with him. P: The telephone business started about two years ago, and about two or three months ago I started exposing myself T: You said he used to be a normal boy who had never had any problems before... . MOTHER: I meant that he never did things like that; he went to school like everybody else. He has always been a bit nervous, since he was born, but nothing else. T: A bit nervous? Mother: He took a long time to cry when he was born, and he spent a long time in the incubator, shivering all the time, and then any little thing irritated him; he would get annoyed and would not stay still.... He never stopped. T: What was the birth like? MOTHER: He was born at term, low in weight, 2 kilograms, which is why he was put in an incubator. He did not cry for a long time, so they thought there was probably something wrong with his heart. He was in hospital for forty-seven days, and there he caught a virus and had severe diarrhoea. He didn't have any other problems after that, but we still had to take him for check-ups to the hospital until he was five. When I went for check-ups they couldn't hear his heart when I breathed. He was purple when he was born; I thought he was dead because he didn't cry. The placenta was very small, the umbilical cord very long, and he hardly got any food or oxygen—that was why he was like that. Then, as he caught that virus in the hospital he went down to 1.4 kg. When we took him home after 47 days he weighed 2.7 kg. He was not well, he had a temperature, but apart from that he hasn't had any other prob­ lems. T: Except for his nerves. MOTHER: I had to exercise him because his hands were closed into a fist, and even now he shiversfrom the moment he gets up until he's had breakfast

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After that he is all right [Abelardo shows dislike at his mother's comments and he whispers something like there is no need to go into such detail] He needs to be told, so he can understand what is happening. I used to open his hands and his legs too; it was like doing exercises, to get him to move. When he was 4 months old he coughed for a whole month, but they couldn't find anything; they said that maybe it was whooping cough, but he hasn't had anything since then.... Mother continues, then she says that she could not breast-feed him. "You see, he was born in X and they took him to Y in Pamplona, so I couldn't breast-feed." She couldn't be with him; she saw him through a glass. f

... When they handed him to me the doctor said "this child needs love"; he told me to wake the baby up if he didn't wake up himself I used to wake him up every three hours to feed him; he only woke up for that. So he was a peaceful baby. ... Whenever I went to the hospital I found him crying. He changed a lot once he came home. And then when I put him on savoury food he didn't like it, he was always a bad eater. Now he eats well P: For the last two or three years, or a bit more. MOTHER: I was always trying to get him to drink some milk. They could never find anything wrong with him. Until he was 12 he would take something to school—a doughnut, for example—and put it in the bin. Now he eats well... They have done some tests on him and they've told me that he is very clever, but he has never liked studying and has left it. P: I left when I was in first year of BLIP and also when I went into vocational training. MOTHER: Then he took a cookery course and got an allergy on his hands—not while he was doing the course, later, when he went to work. We don't know what caused it. T: What was it? P: I got spots between my fingers and around them: the more I scratched the more it itched, and then I got cracks and I couldn't even close my hands. (At present he works in the textile industry, like his father; he is a cutter. His contract has run out but he has been promised that he will be taken on again after a couple of months. It is one of those "rubbish" contracts that we have now in Spain where they take young people on a low-paid contract for three months, then they let them off, then after a month they hire them again, and so on.... } Mother: He is a good worker though, as he was at school—he was always there on time. But then at home he wasn't the type that revises and

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studies, just the bare minimum. He has signed on to learn to drive, but he is not studying for it at home. The thing is, he does have a good memory; he has a good memory for faces. T: When did all this begin? Mother: This began. ... Well, he knows more about it than I do (Abelardo makes a face). All right, I shall go now, he doesn't want me here; he can explain it all better himself (Mother gets up and leaves. Abelardo starts talking quite spontaneously.)

LI: I want to say that he talks very clearly. I would even say that he has a sophisticated command of language—which one would not expect, to judge from his uncouth appearance and the scant education he seems to have had. D.M.: Does his mother perceive him as a rude and ungrateful boy? LI: No, not at all. His mother stresses that he is good boy, a hard worker, and that she does not understand how he can do these things. She says he is a good lad, she is worried, she doesn't understand. D.M.: She knows about the calls? LI: Yes, and she does not understand it. D.M.: She thinks that he is a good boy, has a good memory, and does his work seriously. LI: A n d is generally well liked. D.M.: And it is not the case that she is bringing h i m to consultation— on the contrary, he comes of his own free will, and why he comes w i t h his mother is something we don't know. LI: We shall see later. D.M.: We have to be patient. P: Since adolescence or puberty, I had the idea that the number of my masturbations was too high, by comparison with what my mates said. In my case I used to do it three or four times a day. I was surprised when I compared with other people. The thing about the telephone, at the start of adolescence, started as a joke—J used to call a girl that my sister knew; I would phone her and say something stupid, she would hang up, and that was it. [He says he might do this to a couple of girls in one day, and they would hang up and that was all]

D.M.: So it didn't start with obscene calls, he just said stupid things. LI: No, no, he said obscenities. He calls them "stupid things", but we w i l l see later on.

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P: The year I was doing my cookery course I had more free time, and it coincided with the erotic lines boom [he is referring to what was called the "hot line" that started at that time in Spain], I began to make calls just saying stupid things, nothing else, but when the bills began to arrive my parents fitted a device so that I couldn't

make any more calls to those

numbers. I sort of regressed and began to call girls in Y

that I used to

know before, and I would say things that were more obscene and got really annoying

with the person who took the call This went on and we started

to have problems,

so my parents fitted something

else so that no calls

could be made, we could only receive calls. And two years into this, girls started coming to our house to complain about my calls. Then I didn't do it for a year, but as soon as they took the device off the phone I made calls again. And turned into T:

now, about three months ago, this thing with the phone has exhibitionism.

Exhibitionism?

P: Because my sister is studying

Medicine

I know what it is called, even if I

don't know what is happening

to me. I have looked in some of her books,

maybe out of morbid curiosity;

I know that is what I have.

T: And what is ii that you have? P: Either from the terrace or from the balcony I expose myself to only if I find them attractive—and ning—it

girls—but

in the street too. Not at the begin­

used to be just from the balcony—but

recently I have done it in

the street and always to girls that I find attractive. And what is worse is that I have even done it with people I know—I girls I know by sight or very superficially.

don't mean friends,

but

The things is, you see, how can

I put it, a 30-year-old girl or, even better, a 26-year-old one

...

LI: 26 is his sister's age. ...

who to begin with I didn't find attractive, after seeing her from the

terrace time after time, ends up being attractive. often has made my desire As he talked, his "psychopath" interview.

. . it is as if seeing her so

grow. aspect decreased. We agreed to have another

As soon as he was out of the door his mother opened it and came in

without waiting to be asked. She looked very pale, visibly

anxious.

D.M.: Had she been listening? LI: No, she was too far away, in the waiting-room. She says she does not know what to do about Abelardo—

he hardly goes out of

the house, maybe out offear, he only goes in and out of the covered balcony, he seems very nervous, she thinks that he does not sleep—they

don't know what

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to do, whether to tell him to go out or not, to scold him or not. They are confused because he has two sides: they know that he is a good boy who

won't

do anything evil, although what he does is not nice and very unpleasant; he is well regarded at work and everywhere else because he is so generous and cares about other people, he belongs to

S.O.S. Against

Racism and to a lot of things

of that sort So they don't understand his behaviour and don't know what to do.

LI: S.O.S. Against Racism is an organization against xenophobia try­ ing to integrate African immigrants who come to work in Spain. He is an active member of the organization, and he takes part in demonstra­ tions and support action. He is also involved i n Greenpeace and all kinds of things like that. Second

interview

He comes alone. P: Apart from the problems I have now, it is true that I have always been quite rebellious, so to speak. I am defiant at home, I get on well, and all that but I answer back at the slightest provocation. general

I am always involved in things, like

war in Bosnia, and so on. ...

S.O.S.

I am like that in Racism,

to stop the

I am quite demanding at home with

my

parents, with my mother certainly. They have to do things the way I like them; food for example. I know my mother said that I eat well but I am very demanding, it has to be the way I like it,. . . variety in the meals,.

..

they know what I like and what I don't, and if they serve what I don't like I get cross, not terribly cross, but still ... Apart from that, relations with my family are normal,.,. T: Good,

good, normal

normal?

P: I mean that when we argue it is about normal things—for normal, 1 think, to have an argument about arriving out alone or with friends;

example, it is

late, or about going

I think it is worse if you don't argue. I have had

arguments about going out with friends because I prefer to go on my own to certain things, like S.O.S.

Racism. ...

we had a constant battle about

that T: What do you mean? P: I mean that, now, after all this and after my. friends disappeared...

have little by little

because my parents weren't aware, but in fact I was going

to meetings and conferences at S.O.S Racism on my own, and they always asked "Where are you going? And why are you going on your own? what is that?"

...

And

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LI: It seems that his parents find it strange that he goes on his own to this sort of thing, eccentric in their view, instead of going to the kind of place that boys of his age go to. It worries them that he doesn't go to discotheques, and that instead he is interested in doing things like protesting against French nuclear tests and that kind of thing. P: ... I used to say to my friends, "Tomorrow I am going to such a place ...", and I didn't wait to see if they would come, I would still go. There was a girl in the group who also would just say what she was going to do, and that was it. It was simple to me, hut my parents found it strange. T: Do you think there might be a reason for that? P: Maybe because at the beginning I didn't dare to tell them about all the places I was going to; because when your friends go to a disco and your parents ask you, it isn't normal either to tell them that instead of that you are going to a place where they talk about the French nuclear tests. ... And now, what with all this problem, I am sort of agreeing with them and I don't like it. But this is the battle I used to have because I still don't understand why my mother worried if I arrived home late; maybe if one day I have children I'll be the same. . ., But I don't understand her worrying about me going to a place I enjoyed going to. And also, you see, I used to make friends there, in S.O.S. Racism, although I have to say that I am not the sort that puts down roots and stays in a place for ever.... I used to go to other places on my own, too. T: It seems that people find it strange when others go about on their own, and you end up agreeing with that point of view. P: Yes, surprisingly. I fight for...

I am surprised, because on the other hand the thing that

LI: Here he goes into a lengthy speech. He is surprised at the disparity of the things he does.... Let's move on. .. . but before my parents became aware of the problem I had, I was already annoyed at the other things. There is one question I really find annoying. Which is that they don't just ask if I am going to S.O.S. Racism, they also ask why, and "why don't you go to the discotheque with friends? And why go there, is it worth it?" They don't forbid anything with that kind of question, but they annoy you with all those questions; it isn't just asking where are you going. . . . So one has two options: either not answering them or inviting them to come and see.... I didn't say anything about the girl in W the other day. I met her at the village fair where my father comes from, she was the first girl I kissed for more than fifteen minutes.

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D.M.: A fifteen-minute kiss? LI: He says, "We kissed for more than fifteen minutes." We don't know if it was a fifteen-minute kiss or fifteen minutes of kissing. It was a three days' affair. So I would be having lunch and I knew I would see her later and we would be kissing. She is my first girl; the problem is she lives in W and I live in X , and with that distance it is not easy to keep up a relationship. I had very bad acne when I was an adolescent and because of that I couldn't get close to girls. Now I see that both the telephone calls and my exhibitionism are a serious problem; it puts me at odds with society, and little by little I am an outsider—that's why I thought I would have to see how I could stop it before I am totally isolated. (We took into account the financial difficulties of the present moment and decided to have one weekly session. The episodes of exhibitionism lessened in the first few sessions—it probably used to be once a day and now it was once a week. A striking feature in him is his very strong smell; the whole consult­ ing-room isfilled with it, to the point that I have to air it before seeing the next patient.)

D.M.: Does he still have acne? LI: No, it disappeared. D.M.: Has it left any marks? LI: No. D.M.: Does he ever talk about his bad smell? LI: Not until I started to talk about it. D.M.: But did he know? LI: I don't know, but he has started to acknowledge that he washes very little.

Ps: Is it underarm smell or general transpiration?

LI: I would say it is the underarm, so strong! In brief, he doesn't wash enough. And he looks dirty, as if he hadn't had a shower for two weeks. D.M.: These great masturbators usually smell bad. He is the kind of patient that has a period i n his treatment when he smells bad and the other patients complain. I don't usually smell very good, especially because I smoke; when you smoke, you don't notice smells so much. Okay.

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243

Abelardo talks about how he tries to contain his impulses with almost behav­ iourist methods, and about having made an agreement with his father: if his exhibitionism stops, his father will help him to go and visit his girl-friend in W over the long weekend at the beginning of December. He asks me to postpone the session of the week after that because, given the distance and the fact that he will be travelling by train, he would be late. I find it reasonable and agree. He does not come to the session, and his sister leaves a message saying that he won't be back until after Christmas. So between the 7th of December and the 7th of January a month went by without sessions. The following session is from the 7th ofJanuary. He arrives punctually at the time we had agreed and on the agreed day. D.M.: I don't understand how you had come to that agreement. Ps: When had you agreed on starting sessions? LI: In December. I saw him for two sessions before the long weekend

at the beginning of December.

D.M.: So he cancelled all the sessions before Christmas.

LI: Yes.

D.M.: So this second interview we have read, when is it from?

LI: This followed immediately after the first one, i n the middle of

November. What I didn't bring here are the two interviews after that,

when he spent all the time talking about his efforts to control himself,

the pact w i t h his father, etc.

Rosa says I should clarify something that is not i n the material, about the time when this boy was born and he was placed in the incubator and then i n intensive care because of his infection. His mother and his sister—who was small then, maybe 6 years old—used to visit h i m and see h i m through glass in intensive care; his mother says that every time, they found him crying. Now let's look at the last session. Session of 7 January 1997 He smells bad when he arrives. He starts talking; it is a long speech. P: I think the last day we saw each other was the 3rd of December. I went to Santander on the 4th. Alba came to fetch mefrom the station. We went to her house; I talked with her father and her brothers. Her father wanted to know me; he was very keen. LI: He had told me that he called Alba and said: "What do you think if

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I come to see you and I find a pension to stay i n and we can see each other " And she had said: "Stay with us, no problem/' ... We spent the whole afternoon talking and then we went to sleep, each in our own room. On Thursday Alba still had lessons; she said I could go with her—she had a session on the cinema and I would pass unnoticed. Nothing worth mentioning happened. In the afternoon I wanted to teach her to play the guitar; her mother left, I asked Alba if she would let me do that thing that she knew I wanted to do. She said no, she was fond of a boy who lives in Valladolid and who comes to her village from time to time, that she was in love with him and so she didn't want to hurt me. So we left it at that and I took her to her karate lesson. When we went back home I tried again. I asked if she would let me kiss her, just once; she agreed so long as I didn't fall in love with her. At night I thought that perhaps it would be better it we stopped and just remained friends; after all, it is not as if I have a lot offriends here.. .. Next day we went to Y . We kissed on the train; she didn't know the place very well, and we both wanted to find a park to kiss. We wanted a place where nobody could see us; I didn't want people from her village to see me kissing her. People talk a lot, and if we appeared to be just friends and then they saw us ... they can gossip no end about her after I leave. When we came back we went to play basketball, and in the evening it was like the day before. The next day we went to X and it was just like in Y the day before. X is beautiful. We had lunch at her cousins' house, and on the way back we didn't stop kissing. It was great We got to her house just as the football match was about to start; I had made that a condition because it was a match between Madrid and Barga. Her brother went out and I was alone with her. . . and with a Madrid-Barga match! What a terrible choice! (He laughs) Of course, it is not as bad as if she lived in one place and you are in a different one and there is a match and you have to choose. Anyhow we started to watch the match; she gave me a kiss, but she realized that I was concen­ trating on the match and giving instructions to the players and all that.

LI: He is a very keen football fan. He knows everything about foot­ ball—the referees, the players, techniques. . . . He usually stands i n front of the TV set as if he was the coach and he talks: "come on! get i n there! stop him! etc, .. ." Although she didn't want to interrupt me she started to unbutton my shirt and I said okay but keep your head down because I want to watch the match. I was a bit rough and she got slightly cross. We watched the match till the end. Barga lost, to my great sadness, but I had never been cheered

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up better. I went to my room, which was hers until I arrived; she caressed me a bit then she went to her room to change her bra I think; she put on one that she thinks is nicer; she came back, took her T-shirt off and we kissed for a while; I kissed her breasts and nothing else but I didn't need to (with emphasis); then we thought somebody was coming, we separated quite scared, she couldn't find her T-shirt, she was just standing there, she didn't even think of hiding in the bathroom which was just in front Terrible nerves for a few moments. Then it turned out it was the neigh­ bours' door. In the evening we went out with some friends of hers, and when we came back I wanted to kiss her in the hall downstairs but she didn't like it in case somebody saw her; so we hid in the space behind the lift, and she called the lift down so that if a neighbour upstairs wanted it we would be alerted. The fact that it worked out and that we were in a place where nobody could see us made me think later on that it probably wasn't the first time she used this system. She had planned for us to go out to the mountain the next day but I could see that it wouldn't be possible, given the hours that family keep. To cut it short, Alba got up at 1 o'clock; I woke her up with her mother's permission. I said to her in sort of code language, Red Indian style: "The other day match lost me not sad, yesterday match lost me not sad; now girl lost me sad." We went to the cinema and again the same thing; she said to me: "You haven't lost me, okay?" And she let out a tear, maybe because I was going back the next day. We went back home and there was nobody there. That was a marvellous house! And we got started again. The next day I was going back and she had to go back to school; I went to say goodbye to her in the schoolyard. She took me away where her mates wouldn't see us. She missed the next lesson, though it wasn't my sugges­ tion. We said goodbye and she said to me that if I stayed there and the boy from Valladolid stayed in Valladolid she would choose me. It wasn't much of a consolation you must admit Just think if the boy turns up and I am there, that would be three of us, not a pretty business. ... It was a nice goodbye. I came back, Alba phoned me the next day, and she said that her father had seen us when we were kissing goodbye and that he had told her off, not because of the kiss but because she missed a lesson.. . . Later she wrote me a letter and said that nobody had behaved so well with her but that it was an impossible situation so it was better to remain friends. I haven't ruled out going to live in Santander, let's wait and see. If I want her, from what she said, I would have to go live there. I warned her that I was not in love with her but with being able to go out with a girl.. . (emphatically). I can

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also ask a girl in S.O.S. Racism to go out; she is not very attractive, I don't like her really, but we get on ideologically Right, I have told you a long story ... those five days was the Madrid-Barga

speaking.... the most important thing of

thing and the fact that I chose to

watch the match; of course it is true that she was there—if I had had to choose between being in one place or another, then I don't know. For me the way we were together was enough; that was enough for me.

LI: What comes now is my first intervention in the treatment. T: The most important thing in those five days is the match you play where in your fantasy you tell every player what they have to do. And your game is being in love with having somebody to go out with, somebody who is interested in you. You are not at all in love with the work I proposed that we could do together; you are in love with knowing

that somebody is

interested in you, like me. Once you have that, you don't need

anything

else. That is enough, and you can decide to go away and let me know when it will be convenient for you to do the same thing with me.

...

LI: I insist on "the same thing", as in "the same thing he had been saying to the girl". P: (Interrupting

me) That is the same thing I said to the girl—that

I would

never dedicate all my time to her. I told her when she got cross about the football. And I told her again the last day. .. . Of course it is true that what she said to me made me suffer, the business about the boy from Valladolid, but she was confused the last day, she didn't know what to do and I had to tell her that I wasn't ideal, that I had my bad moments too, that I could get cross too, shout, make her suffer..

..

T: You tell me that you are very good at turning things around. The same thing happened to you with Alba: knowing my conditions in our relation­ ship made you suffer at the beginning—imagining

me interested in other

people and looking after them, knowing that at other times, other days, at other moments in the week I am not going to dedicate my time to you. But soon into the relationship

exclusively

it pleases you to see that I am

interested in you and you get satisfaction from confusing me, leaving me for a month without news while all that time you imagine me thinking about you and about where you are. In that way you put me in the position of the one waiting, instead of it being you who waits until I have finished

with that third person from Valladolid or from Barcelona.

Then

you are idealized, you are the one controlling the game, although in fact we have to clarify that it is not like that, that you can get jealous and cross with me for making you wait, and you even fear that I might get angry at you standing me up and decide not to pay attention to you any more.

FEBRUARY

1997

He is silent until the end of the

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session.

DM.: You seem to be interpreting this relationship with Alba as an enormous acting out. I don't think i t is correct, I don't think he is i n a transference relationship w i t h you and acting out w i t h Alba, I think i t is simply his character: he does with you the same thing as w i t h Alba. This is the way he relates to human beings. He also has a way, as we know from what his mother says, of appearing to be a very agreeable boy. But as he has said i n the last few days, he has secret plans on which he is always working. His secret plan w i t h Alba is for her to stroke his penis and masturbate him, and his secret plan w i t h you is to turn you into a voyeur of that relationship. That way the possibilities of a transference relationship emerging are paralysed. A l l you can do is describe what you are doing and his secret plans. The opportunities here could lie i n the fact that, while he is very confused he might suspect that you are not and you have a way of understanding these things, and that w i l l stimulate h i m to see you as an object of transfer­ ence, as somebody who understands. As I said to Carlos, he resembles very much the boy i n the article I have written for Lucy and Carlos' book. He is a 25-year-old boy who has been with me six years and who illustrates the experience of treating a voyeur, who is happy to place the therapist i n the position of voyeur of his voyeurism. It is worth pointing out that he went through a period of smelling bad; I didn't realize this until Catharine told me that when she passed by the door the smell was terrible and that the patients had said that the room smelled bad. It was a revelation to h i m to know that he smelled, and he began to pay more attention to his hygiene. But he realized that taking care of his hygiene insofar as bad smell went did not make a difference until his masturbation stopped and his voyeurism disappeared into his dream life. Then he began to have night emissions nearly every night and he couldn't remember his dreams. It was always very difficult to keep up the transference. He went through a very long period when his voyeuristic interest centred around a very beautiful girl, to whom he couldn't even get near since his passivity was so strong that he couldn't get sexually near anybody. He always expected somebody to go near him. This girl began from time to time to get into bed w i t h him but without allowing him any type of sexual contact. By then, he had stopped smelling, like when the masturbation stopped, and his pornographic fantasies and reading of 1

1 " A n Adolescent Voyeur", in D. Meltzer & M. Harris, Adolescentes, edited by L. Jachevasky & C. Tabbia (Buenos Aires: Spatia Editorial, 1998), pp. 207-212,

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pornographic literature went into his dreams. But this girl had other boy-friends and he was constantly spying on her, following her move­ ments and those of her boy-friends. . . . The girl was apparently a student i n his university; they were part of the same group. They both finished their degrees, and he got a first-class degree although he didn't do any work, but he is a clever person. He is a good talker and has a good memory, and with those two things one can get a top degree i n Oxford without having to work too much. Moreover, he was not doing a scientific degree but what we call Human Sciences, which is like an invitation to talk on and o n . . . . The girl was furious with h i m and told him that he didn't deserve it, because her boy-friend who was a very hard-working student had not got a first-class degree. The girl's mother died at that time unexpectedly; it didn't seem to affect her very much, although he thought that they had been very close. [A telephone call breaks the dynamic of the session, and there is some confu­ sion while Dr Meltzer answers the phone and the rest of the participants in the meeting discuss the case.] Ps: Maybe all Abelardo's telephone calls were fantasies. LI: No, no, they were not fantasies. The boy has several court cases coming up. Ps: No, I mean that the things he said were fantasies. LI: He has never said what he really said—he would just say to me: "I said dirty things." Ps: Maybe he says "son of a bitch"? or LI: No, by dirty things he means obscenities. I haven't asked for a detailed account. I am not going to be a voyeur of what he did, I have just deduced that he would say things like: " I f I show you this . *." " I l l put it here or there . . . " etc. One day he said in one of the sessions thai he started to call on the phone a woman who does the cleaning in some offices opposite his house and that she humoured him, so when she went in to clean at the solicitor's office he would take his clothes off and stand in front of the window. He was running wild; they were playing a game and calling each other: "Are you coming or aren't you?" etc.... Ps: It is like a film.... If you tell this to the young Spanish filmmakers they'll make a film. D.M.: As I was saying, after the death of her mother this girl began to brag to h i m about her sexual adventures w i t h other men and he started to go mad. Then one night she got into bed w i t h him and

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sucked his penis. This made him explode. He became obsessed imagining her sucking everybody's penis. A certain paranoid transference began where he suspected me of having secret contact with this girl. He didn't accuse me openly, but he did accuse me of trying to make him mad. We spent a year when he would spend a long time silent and give me hostile looks. It was a terrible year. Then he started a PhD thesis, realized that he was not interested, left it, managed to get accepted as a student in Medicine, although he had no interest in it until something quite strange happened: at the beginning of the analysis, in the first years, his hero had been a fiction character, Cyrano de Bergerac, and because of that he had had a desire to be a writer, a poet, etc. but had not done much to achieve it. Now, as he began his studies in Medicine, a new hero gradually appeared: it was William Osier, a real doctor, quite famous in America, who had come to England and become very well known as a doctor. As it happens, Catharine lives in Osier Road. Being a voyeur I suppose he discovered that Catharine lives in Osier Road and works in the consulting-room next to mine in Alexandra Road. Another thing he started was rowing. He has the physical build to be a rower, not a big rower, but he started and became fanatic about that sport; he trained methodically until he got a place in the second team at Oxford University. Between those two things—his interest in identifying with William Osier, whom he acknowledges in connection with me as an American who came here and made a name for himself, and rowing, which is a new activity for him, doing something athletic to improve his physical condition—he started to take an interest in his Medicine studies. His pornographic dreams began to remit, but he was in a true state of phobia towards that first girl and he feared meeting her or seeing her since they both had university friends in common— although she lived in London now, not in Oxford—and he couldn't help coming across her at parties and so on. He was truly phobic. He has recently found a different girl-friend, with whom he is very much in love and who in his mind is a kind of vestal virgin who would never dream of sucking a man's penis or even think about a thing like that. So this boy of yours seems to me to be in that category of passive voyeurs, exhibitionists who smell bad, who are waiting for women to unbutton their blouse. I think that like my patient he also suffers from not being interested in anything in spite of being well adapted and capable of doing what is expected of him. I think this is a very central problem, the lack of interests and, in a way, the lack of object rela-

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tions, as we saw in Carlos' patient—who operates at a very sensual, very passive level, wanting to be other people's object of desire so that it is they who run all the risks of disappointment, dependence, rejec­ tion I found it very difficult, with my patient, to find the transference and not to be used, as yours has begun to use you, as a voyeur of his voyeuristic exploits. There were only some bits of exhibitionism in my patient. The daring with which yours has gone into all that acting out with his obscene phone calls and his exhibition from the balcony makes me think that he is a lot more psychopathic than mine. But his great fear is that he might fall in love. He is afraid of falling in love, of the impotence of being linked lovingly to someone. He sees it as absolute torture, probably because he cannot imagine anybody as the object of such love without abusing the power that that position con­ fers on them. And maybe that fear is based on reality since, when this type of person falls in love, they do it in such an abject way that they invite tyranny.... And they are tyrannized. There is a comic programme I saw on television where one of the sketches is about a man who is constantly telling his wife off, criticiz­ ing her, trying to humiliate her. At one moment she just looks at him with a stony face and says: "You never gave me an orgasm "—this deflated him completely. I think that you have a long and hard task ahead with him, but interesting. He has given you a true television programme for you to watch. If you ask him something about it, you will get the same type of answer he gave Alba: "Move your head. . . . " He will immediately humiliate you and accuse you of voyeurism. He is also a very clever and devious young man . . . and he likes his deviousness. The only psychotic thing I heard about my patient was that he embezzled money from the university. He had a position of trust in what is called the common-room, a meeting place for students of a particular college; he was in charge of entertainment, and for that he had a certain amount of money available to spend on bringing bands to come to play, etc.... He took funds from that and spent it as a sort of impresario on bringing out a pop record; he hired the musicians that came to play at the college, they composed a song and arranged it, and he made it possible for them. In his fantasy he thought he would make a real fortune with the record, but in fact it was a complete failure. I know it sounds psychotic, but I don't think it is. I think it is, rather, an absence of values and ethics that forms part of passivity.

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It is very possible that you will get to an impasse with your patient. It has taken me years to establish something like a transference rela­ tionship of some substance with my patient. Carlos has not managed it with his patient. I think you have a good opportunity with this boy, because he has confused his parents but I think he has quickly realized that he is not going to confuse you. There will most probably be a rather paranoid transference in him, in the schizoid-paranoid position. His voyeurism and exhibitionism will go underground, and there will be a rather paranoid transference. Then you will have to fight against his secretiveness. In any case, I think there will be an interesting period of some years before you have a real feeling of making progress.... Aren't you all starving ...? (Laughter)

19

[FEBRUARY 1997]

Eduardo Not so much a pervert, more a voyeur and a fantasist Carlos

Tabbia

\his is the patient who is an engineer and who has a brother who has just had a son. This material makes mefeel embarrassed, but it is what J L . was there was when I recorded it.

Ps: We call that embarrassment on someone's behalf. I bring material from the week before the Christmas holiday and some notes from yesterday's session where he complains that the analysis is making him suffer a lot.

D.M.: How often do you see him? Five times a week.

CARLOS:

Tuesday

session

He arrives 10 minutes late. P: I had things to do near the university. I changed the car battery in the Corte Ingles, and I had to go round quite a way just to pay. A woman came to order some drawing plans.but she likes the ones other firms do. I tried to get information from her to see what kind she wanted. We talked about horoscopes. Her husband sends her to fetch drawings so that she doesn't get bored. I told Rita ...

252

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253

C: Rita is his partner at the moment, and she has a daughter. He doesn't want to commit himself in the relationship because of that daughter. It is a very brutal relationship; he might call her suddenly at 3 o'clock in the morning and she comes. I talked to Rita about my meeting with this client, and she got cross; she says I am naive. Ps: I can't see the connection between this and what he said before. C: Rita meant that my patient is naive about a client who asks him to

prepare drawing plans for a business, then starts to talk about horo-

scopes, and he swallows that.

D.M.: So Rita thought that he was flirting.

C: Which is quite usual.

D.M.: Yes.

She left I wanted her to leave. [She had spent the night in his house] I dreamt that "I was in a room where G.'s son had been. [G. is a business­ man and a client at Eduardo's father's office] The room had a bathroom. I had balls offaeces going down but they were not coming out, I took them out with myfinger. There was a silk shirt on the bed. The balls were loose. A cleaning woman from the hotel came in andfound me in there with the little balls. One fell on the shirt and made it dirty. I was in the toilet, I hadn't shut the lock on the door; when the woman came in, the room and the bathroom joined into one and the faeces were lying about" Another dream: "There was a bottom and in the space between the coccyx and the anus there was a little hole that got bigger and bigger and one could see there were more holes through which one could see the internal organs. A doctor was saying that the liver was loose and that the patient had to go to the theatre. That was as big as a maternal claustrum. It was dreadful to see that person so unprotected." Eva [an ex-girl-friend] was operated on for a growth in her coccyx; she had a big hole after the operation. I saw a film about a person who fucked dead people. A friend of mine, a medical student, told me that there were two corpses in the morgue; one belonged to a thin man and one to afat woman. The students made bets on who was going to fuck her. The fat woman had had several operations; she obviously did not heal well, she was all broken up; one of the students said "let's do a vaginal irrigation"; they inserted formol with a dropper and it came out through all the holes. C: A feeling of revulsion made me want to stop him.

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D.M.: Yes, he truly is a dirty boy. T: The image of the woman, of mother, is all broken up inside you; women have a bad reputation and that leaves you in a serious situation. To be accompanied by a dead mummy makes you feel very ill. (The alarm clock in the patient's mobile phone rings. He says nothing about it.) P: I was thinking about my mother and her surgery, and that I didn't like my father's drawing plan. [Father and son had drawn different plans and argued about them; in the end the father's plan went through] The en­ trance to the surgery is not right. Now they can see that my idea was better. People would crowd in by the entrance. It is difficult to speak with myfather. I detect that I can't convey to him what I see. He has too many unanswered questions, not enough data; he talks angrily and doesn't listen. T: (Feeling upset and annoyed) The analyst-mother—me—should turn a deaf ear to dad who takes me away from you (because of the holiday), should open my doors to you only and make sure that dad is kept away. It is clear that you don't fulfil your desire to get inside the analyst-mummy by sticking your finger in your bottom, and that, quite on the contrary, you hurt yourself and increase your mental disorder, which is represented there by the space with loose organs. P: It also has to do with the fact that since Rita had her IUD fitted she is unbearable; she keeps bleeding. T: The IUD is the holidays that stop you from being inside me. (A telephone rings in my office, next to the consulting-room.) P: (Smiling) That call was your wife telling you to call her when the session is finished. T: Mummy calls daddy, and you don't like that. D.M.: He is triumphing over you because you are a slave to your wife, whereas the girl is his slave and therefore he is more "macho" than you. To expel Rita is the measure of his machismo: to be capable of dismissing, of projecting, is for him truly a sign of power. And the dream began with h i m not being able to expel those little balls of faeces, so he has to stick his fingers inside and get them out, he gets dirty and gets everything dirty. He is the unpleasant sight, the dirty and disgusting picture that mummy finds when she arrives i n the baby's room i n the morning and he is in his cot completely dirty and there are little balls of faeces rolling everywhere—something which is not unusual i n a 9-month-old baby.

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Ps: Is it the mother who has that dirty image? D.M.: This is at an age when a baby is using nappies and is suffi­ ciently big to be toilet trained. He can put his hands on his bottom and make everything dirty in his anger at being left alone because mum and dad are in bed together. This faecal mess is his revenge on mother, but he has a way of turning this revenge against mother into triumph over dad because he can turn mother into the slave who has to clean this mess. Correspondingly, when his girl-friend is bleeding he dismisses her: go get yourself cleaned up! In your case you are your wife's slave because she calls you and tells you what you have to do when the session finishes. All this is based on a very infantile conception of omnipotence, of power, it is the power to command, and that power is based on his capacity to make a terrible mess with his faeces, which mother will have to clean up. This is his design, better than his dad's—what he does with his anus is better than what dad does with his penis and testicles—and the evidence is that mum has to come and clean it up; you see him five times a week and you are his slave. Wednesday

session

P: I should have planned the things I had to do on Monday, I was one sketch short. I didn't go to the Residents' meeting. [He, rather than his parents, attends the meetings of flat-owners; he fights with the other flat-owners there] Daniel [an employee at the studio]) didn't hand me the notice. I am like this because of the holidays. I got a call from the university building site; they had painted one of the pillars in Ferrari red and then something else in Bugatti blue. It looks very good! We'll do the rest in Fiat yellow because I like that. My father had planned everything centimetre by centimetre, but they moved things by 5 centimetres, so the whole lot was going to have to come off! I suggested a solution. It was encouraging to see that there are things I can do!

C: This is how the session began. Ps: And it carried on along those lines! (Laughter) C: He admires and owns motorbikes. . . . His father had designed a building in centimetres, and some of it had to be pulled down because the pieces that had been designed did not fit. D.M.: He is delighted to see somebody else who is incontinent, and so proud of the colour of his faeces: Fiat yellow . . . anal omnipotence.

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Friday

MELTZER

session

P: I dreamt about the kind of space that eighteenth-century painters used to paint. li was a granary, and there was a table, two girls, another boy and me. To begin with it looked as if we were two couples but I noticed that the boy wanted to be with me not with the girls. I didn't like that; it was not in my plan." I woke up quite restless. I fantasized—half awake—that "I got together with that bloke and then I was with a dead woman, like in the film; it was a dead body of a super-girl; if it weren't for the smell, and the repugnance and the risk of infection it would be arousing. You could move her anyway you liked without being observed." I saw a programme on TV about anal penetration; they said that 30% of women like it, others not so much, but that all men like it (to penetrate). They talked about the best positions: legs up or on all fours. The man likes it because he can see the woman, but not the other way round. In my mother's surgery there is a nurse who turns me on, it hadn't happened to me for a long time. It must be because she is a water sign. I thought about riding to the surgery dressed up as a cyclist. J,

T: Narrate and describe the dream, please. P: "There is a light at the back and at the front it is dark like here. There is a large armchair on the right. It is a large granary, there is straw about. The girls amuse each other. The boy goes to a bench at the back of the room, a bit like this couch. Then he makes his way towards me and I suspect that the wants to get friendly with me. I was annoyed because I wanted to be left in peace." T; At the beginning you were with the girls? P: Yes, at the table, talking. I didn't want to take part in their conversation, which was very lively. T: What did the boy look like? P: He was tall; he had an attractive face, younger than me. It reminds me of another image of a boy on the title page of a pornographic magazine. A revealing image: seedy expression, relaxed position, and a man sucking his penis. I thought it was a terrible face; he was totally homo. The boy in the dream was not like that. He reminds me of Julio, a schoolmate with whom I travelled to Portugal at the beginning of my analysis. T: When the holiday separates you from the granary-analysis-breasts-girls, you withdraw and want to be left in peace, but very soon a lying part of you invades you suggesting something like, "anything goes". You cannot resist that part; it ends up invading you and leaving you in a degraded

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situation: dead people, faces, and pornography. The hoy in the dream is that part ofyou that wants to take you towards the dead people, the faeces, and the pornography. P: You've just given me the key to understand Marcela. There was some­ thing I didn't like; there was something degrading in her sexual relation­ ships. Not with me because I didn't let her. But she tried. I just picture Duci's little cunt [Duci is his cat] when she is on heat; the dog, Huk, is quite happy. We have to keep them apart! Which I did. T: The boy in you is easily manipulated by excitable aspects: a little cunt, the boy in the dream, a film about fucking dead people. It is as if you were easily seduced. P: Yes, I am easily seduced. I enjoy the sensation of how they try and seduce me but I don't allow myself to be seduced. I was thinking about the black man whose house Lwent to. He started seducing me in earnest; when he started to suck my fingers I thought what would it be like if he did that with my penis. And it happened. I learnt, but I have not done it with a man; if I did it with a woman however. ... The nurse at the surgery is very dishy. Her father is an engineer and he admires my father. But there is another girl in the surgery and my mother likes that one. She wants to pair me off with the daughters of her friends, very annoying. Rita said that her brother is going out with a girl who is not much of a beauty but that her mother (Rita's) is happy because she makes him happy. Why doesn't my mother feel happy about Rita if I am okay? She hasn't a clue about what stage I am at; she has got a fixed idea of what I have to be. Yesterday I spoke with the woman who is a doctor and wants to set up a small sanitation business; she said that my star chart shows no limits. T: This is what appears in the dream: you look at women, at mother's breasts, and at your own penis and you say that it is the same as mother's nipple because everything is possible, and so there is no difference between men and women; it is as you say: your star chart shows no limitations. That is madness. Dead people (non-life), faeces (confusion), pornography (de­ graded things). That is the world that is waiting for you if you think that there are no limits. P: Death? Why? T: There is no life; you wondered about the risk of infection. It is a suicidal fantasy. The fantasy that there are no limits can lead to death. P: I know. T: How do you know?

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P: One can understand a lot from what that girl said. There are no limits when you are planning things, but when you are on your motorbike you can fall off. There are limits. If I go back to doing races ... although it is not flat out, the limit is there. I also thought about homosexuality. Some men like men; every man—even if he is not a homosexual—finds at least one homosexual attractive. It worries people because is has happened to everybody. But one cannot be man and woman. There are limits.

D.M.: You are not going to get him that way, talking about the danger that can lead to suicide, etc, because he has a stratagem to induce others to do dangerous things, and he only does what is safe because he is really quite satisfied with his fantasies. He doesn't really want anything, he just likes to fantasize and look for people who w i l l mas­ turbate him; he doesn't even masturbate himself, he is too lazy. He is quite happy watching his tomcat doing it to his pussy; he is more of a voyeur and a fantasizer than a pervert. Maybe he doesn't even stick his fingers i n his bottom, but he likes to think about it. The advantage of fantasizing is that it doesn't smell, because dead bodies and things like that, of course, smell bad . . . yuk. . . . He couldn't be more superficial, he is paper thin, the only way you w i l l get at him is by making him realize that he is just i n his cot, not i n mum and dad's room, that he doesn't know what happens i n that room, he cannot even imagine; he is just a baby who doesn't know what goes on i n the world. He is a very spoilt child; there is money at home; he is given a position but nobody really cares whether he does anything or not. Perhaps there is something lovable about this little boy who goes through life full of dirty thoughts, but nobody cares. There is no pressure on h i m to grow up and develop. His environment is entirely indulgent. He is a little boy who once got very dirty w i t h his own faeces, and when his mother found h i m like that she got so angry that he has never done it again. Then he discovered that you can easily get another child to do i t for you and you can enjoy it vicariously, in fantasy, and look at it as a voyeur. You don't need to do it yourself and get into difficulties. It is just like his motorbikes. He fantasizes about being a motorbike rider, but he isn't, really, he doesn't take any risks, and there is no way you can w i n a race like that. "But it is not flat out. The limit is there. I thought about homosexuality. Some men like men. Every man—even is he is not a homosexual—finds at least one homosexual attractive. It worries people be­ cause it has happened to everybody. But one cannot be man and woman.

There are limits." And he respects those limits and doesn't take any risks, or so he thinks. He thinks that he takes part i n life that way—in

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fact, he is obviously completely outside life, still in the cot like a baby that hears the sound of the sexual relationship of the parents and imagines his revenge on mother by shitting everywhere but doesn't do it. He is contented with his fantasy life. C: Sometimes I ask him: "What did you do today?" "Nothing." D.M.: Nothing, nothing. Now, for how long has he been coming to you? C: Four years and six months. D.M.: It is time to tighten the screws. You can't let him carry on enjoying telling you his dirty dreams, his dirty fantasies, having a good time at your expense and thinking that you enjoy looking at mem, or even enjoying the idea that you find it repulsive, and that you are a mum that gets cross at his faeces. I think it is time to tell him that your indulgence is coming to an end, that he has made no progress, as far as I can see. He is not a naughty or harmful boy, but he doesn't do anything either, good or bad. What he really admires is the man who sucks penises, penetrates bottoms, and catches AIDS, but he doesn't want to catch AIDS. He also admires racing drivers who win motor­ bikes races; sometimes one of them gets killed. He has been a disap­ pointment to his parents, but that has been the case from the beginning. He has gone through the education system without failing but also without success in anything. He learnt to be obedient on the surface but finds satisfaction in his fantasies and his voyeurism. That short clinical description I have written for you1 is of a boy like the one here, who on the surface is successful but who doesn't learn anything. C: Yesterday's session began with him saying that he was thinking of a lot of things but wasn't going to tell me because if he did I would say that they are farts, and my explanations make him feel worse. He is tired of the analysis, which is lasting too long, and perhaps it has to be finished. D.M.: Yes, goodbye! C: What we had this week was me telling him that he is mad and that this can be seen in the fact that nobody takes notice of him. I point out to him that he talks but nobody takes notice, so he replies: "It worries me that my word is worth so little; impotence hurts me. It is clear to me

1

" A n Adolescent V o y e u r " , i n M e l t z e r & H a r r i s ,

Adolescentes.

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that I am not mad; what worries me is that people should say that things are otherwise/7 D.M.: I think that you have not managed to influence him by frighten­ ing him with suicide or madness. The only thing that might touch him is that in the transference he hasn't the slightest idea of what is hap­ pening between you and your wife. Not only he doesn't know what is happening in mum and dad's room, but he cannot even imagine it; worse still, he cannot conceive that he is incapable of imagining it. The emptiness of his mental life is full of pornographic fantasies. C: In the still-life dream with the two girls and the boy who ap­ proaches him, etc.—could that boy who suggests a sexual encounter with him be conceptualized as the more narcissistic part of his person­ ality? D.M.: It doesn't matter. I don't think any attempt on your part to treat all this as object relations will affect him. They are not object relations. He fills his mind at a purely sensual level, like bulimics fill their stomach. He would do anything to avoid the consciousness of a vacuum. He is an empty person and he cannot really imagine how to fill his mind; it is an empty mind. However, it would seem that nobody has taken much trouble over him; he has been a kind of little dog in the family, people stroke him, and so long as he doesn't pee or do pooh on the carpet everybody is happy. He has been kept as a pet, and since apparently he is quite good-looking, women feel attracted to him, like to a little dog, not a man, a little dog. This is not your playroom, it is your study, the place where you work, and you do not keep him as a pet. You have tried to help him; he seems incapable of any intellectual or emotional answer to your work, and it is time to stop him. And since he is getting tired of the analysis, he is not going to find it hard to stop. You have to put forward a date. With a person like this, by ending you leave an open door, so that as he goes out he realizes he is outside something, and he might want to come back in. The combination of money and homosexuality produces this type of patient. I had a similar kind of patient whose analysis I interrupted. He pleaded with me to continue. I see him once a week, but nothing has changed; there is no development, except that I think he is more aware of being outside life and he begins to see life going on around him. His grandiosity has diminished almost down to zero; he has begun to feel a bit claustrophobic, and he is still asking me to increase the sessions and I still say no. He has been in this state of suspension

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for two years, and something very small has occurred as far as grandi­ osity goes: i t is drying out. He is completely non-interesting, like Eduardo. The patient that I have written about for you is different. He began to feel that he was going mad and that he had no interest i n anything, that he was an impostor, a fraud. Little by little he began to feel like a little shit, and that women were not attracted to him, that he had no friends, that I was bored w i t h him, and that his mental life was reduced to masturbatory dreams (emissions) and pornographic dreams, which he couldn't remember; he would wake up i n the morn­ ing and his bed was wet. Ps: Dr Meltzer has been talking about patients i n a state of grandiosity or i n the claustrum, and it is good to describe them, but there are sometimes patients like this one who carry on parading their grandios­ ity and don't get better, and maybe the last resort in technique is to put them outside to make them react I say this because I have had some patients like that, and I have done that. Something has got going, they have come back and asked.... D.M.: Interruption is the last resort. Impasse i n psychoanalysis is much more frequent than people want to recognize. Ps: The case I am bringing worries me i n that way. D.M.: The ending of analysis through mutual idealization is very, very common. It is negotiated, like peace in the Middle East; the two parties negotiate the ending. I n the past there were treaties, called "peace w i t h honour", to save honour. The Second World War was the only occasion i n history when there was unconditional surrender; but even there the Allies did not manage to carry victory to the end, since 20 years after the end of the war Germany and Japan once more became economic powers. Development comes from creating new ideas; it is not possible to negotiate w i t h bits of territory or billions of pounds to pay nations. As long as analysts continue using and adher­ ing to the central concept of conflict, they are trapped i n talking about conflict between good and evil, between life and death instincts, and underlying that notion there is a military idea resting on military values. The only possible end w i t h that kind of military values is a peace negotiation w i t h honour and a bargaining on the price, a prob­ lem of quantities, merely quantities. The new idea i n psychoanalysis is the idea of the combined object that Mrs Klein discovered. The com­ bined object generates an atmosphere and ideas that are totally alien to the Old Testament, to the old military guard. Nor is this idea manifest i n the New Testament; Jesus is not a combined object. The New Testa­

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MELTZER

m e n t still talks about G o d the Father, and w e ' v e spent 2,000 years t r y i n g to beatify the V i r g i n M a r y b u t she is still not allowed to have a sexual relationship w i t h G o d . I t is v e r y curious to see the Renaissance paintings of the A n n u n c i a t i o n : i n most of t h e m the V i r g i n looks f r i g h t ­ ened, w h i l e the A n g e l has an expression of delight. Y o u have to concentrate o n the combined object. Y o u w i l l have to concentrate o n h o w patients t h i n k they k n o w all about love, like c h i l ­ d r e n i n latency, because they have learnt something i n a book about the mechanics of the coitus. O f everything that I have w r i t t e n , some­ t h i n g that is not read and remains totally ignored is the chapter o n p o l y m o r p h o u s a d u l t sexuality. W i t h a boy like this, one always has to bear i n m i n d that he cannot imagine or conceive that he is not able to imagine w h a t happens i n m u m a n d dad's r o o m . A n d , of course, there is the p r o b l e m of psychic reality: y o u w i l l have the p r o b l e m of differentiating transference to y o u r person i n the external w o r l d — d i f f e r e n t i a t i n g y o u as a person i n real life f r o m the qualities of the internal object i n the transference. The last p r o b l e m that one has to face i n analysis is that of disappointment or disillusion. The disappointment, particularly as regards the mental qualities, comes f r o m the fact that the patient has seen y o u as some­ b o d y w h o understands, and that q u a l i t y of u n d e r s t a n d i n g everything is the q u a l i t y of the t h i n k i n g breast, w h i c h really understands—that is, an internal object that, since childhood and t h r o u g h o u t the relation­ ship w i t h one's parents, is a transference relationship. There is an interesting movement i n America where i n order to absorb Kleinian w o r k i n t o A m e r i c a n scientific jargon t w o things have to be removed f r o m i t : psychic reality and the combined object. The most interesting articles i n this field were w r i t t e n b y T o m Ogden, w h o took K l e i n i a n theory and reduced i t to Hegelian dialectics, thus carry­ i n g o n w i t h the concept of conflict, i.e. dialectics. I t is so Marxist! So e m p t y of values, b u t v e r y clever, very convincing. I t is done w i t h great perspicacity, and i t is attracting a large f o l l o w i n g . Dialectics has a place i n every peace process i n the w o r l d ; i t is a b a r g a i n i n g process, a n d w h e n at last an agreement is reached i t is called the synthesis. Y o u m u s t come to the negotiating table w i t h o u t 2

3

2 Chapter 11, "Adult Polymorphous Sexuality", in Sexual States of Mind (Strathtay: Clunie Press, 1973). 3 For example, " O n the Dialectical Structure of Experience", Contemporary Psy­ choanalysis, 24 (1988): 27-45; "The Dialectically Constituted/Decentered Subject of Analysis", International Journal of Psycho-Analysis, 73 (1992): 517-526.

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your weapons, it says, but of course nobody goes to the negotiating table without weapons—they leave them at home, true, they don't take them there, but they have them. In Volume III of A Memoir of the Future, Bion says that it is possible to have true communication and debate and discover new ideas instead of engaging in pure negotia­ tions and peace with honour. In every field that doesn't manage to rid itself of military values, there is this perpetual fight! Y o u will only succeed in capturing this patient if you make h i m face his ignorance, his emptiness. 4

C: When that appears he feels persecuted. D.M.: Yes. He'll hate that state. A n d to prove to you that you are wrong, to deny it, perhaps he'll jump on his motorbike and get killed or catch A I D S ; he will try to deny that state of emptiness and igno­ rance. Is he good looking? C: Yes; he is tall, good looking; he can be attractive to women. D.M.: I suppose his father gives h i m quite a lot of money. C: H e manages the money i n the office. He has cars and motorbikes that are worth a fortune and he doesn't use. He is working a little bit now, doing some projects; he talks with interest about them, but I am not fully convinced. D.M.: There aren't many new ideas in modern art. I n architecture, for example, it seems good enough to know that houses will last thirty years. They will be knocked down after that, so it doesn't matter if they are not well made. C: 30 years is the age of this patient. D.M. That was a joke. Y o u must convince him that you do not find him funny, that a patient is not an empty joke. He is not nasty—he is nothing really—and it is unreasonable that you should have to listen to pornographic, dirty material like this. Once you have learnt to protect your mind from this kind of dirt (so as not to get dirty your­ self), you find it so boring that it is almost impossible not to fall asleep.

4

The Dawn of Oblivion, in W. R. Bion, A Memoir of the Future (London: Karnac,

1991).

20

[MAY 1998]

Lucas Seduction, grandiosity, and confabulation in a malcontent: the story of an insatiable mouth Rosa

Castella

\he patient is 35 years old, married, with two children. He is the fourth sibling in a family of six, with a gap of seven years between him and ~L the next sibling. During the time when he was the youngest in the family his father suffered from deafness, which made my patient experience him as an absent father; the mother and the children arranged their lives as they liked. Then his father was operated on, and two more children were born. This change was lived by the patient as being rejected; he distanced himself from his family and took a job, which for him meant triumphing over his father, who advised him to study. He did a series of temporary jobs and was finally given a post in the family business as administrator. There he felt looked down upon and not taken into account, and so he left. He started to drink and take drugs; he blames his parents' lack of interest in him for his drug habit; they are, in fact, not even aware of what has happened to him. He fell in love with a woman and promised her he would quit taking drugs. He came to treatment on the advice of his doctor because of his constant anxiety. ROSA: I n h i s f i r s t v i s i t h e s e e m e d restless, as i f h e c o u l d n ' t s t a y s t i l l .

At that time, his wife was expecting their first child, and he wanted to be a good father. He was still getting drunk and taking drugs sporadically and had

264

MAY 1 9 9 8

a fascination

with death, which

he explained

suffer. I feared he might commit

wouldn't

265

LUCAS

saying

that, once dead, he

suicide.

R: I have always been afraid he might commit suicide. He lives with his wife in a house given to them by his in-laws, satisfied with anything he has; he finds the town disgusting, is his only interest up usually

but he is not

and going away

His intolerance of any limitation to what he wants

in violence, and he is forever angry. Everything

action that has not been thought

ends

seems to turn into

through.

R: He loves rushing about impatiently; he drives like a maniac. Since he started his treatment, he has moved from being a rep in design to working in a firm that designs T-shirts,

graphic

to setting up a decorating

business, to making clothes and opening a shop -which

had to be closed down

almost as soon as it opened because of lack of capital—to being a rep in a food business.

In his present job he is in charge of sales of educational

videocas­

settes; he has already announced he is going to leave it

D.M.: He must be good looking to be able to move from one job to another. R: Yes, he is very seductive; he is attractive. D.M.: He not only moves fast, but also he has considerable grandiosity. His changes and decisions happen without discussing follow

them with me, and they

the same pattern: he starts a job and works all hours at it, becomes

demanding

with himself and with the firm; they do not respond; he moves to

another job.

D.M.: Nothing is good enough for him. His first child was conceived because "if we had stopped to think when

we

would be able to afford having one, we would never have had it"; his second, a girl, in the same way.

D.M.: That is his philosophy. His wife has been unemployed financial

situation

reduced accordingly.

since before the birth of their first child.

is rather precarious,

His

and his sessions and fee have been

At the moment he is doing one session a week.

they take their child to a private school in the mountains

However,

because "the air is

cleaner there"; this means they have to drive him twice a day.

DM.: "So that the child can breathe" is also part of his philosophy. He feels very claustrophobic.

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SUPERVISIONS W I T H

The treatment

DONALD

MELTZER

has been hard. It started

with a period of great

idealization

when he would write his dreams in a notepad so he could read them at will later on; in those dreams he identified with something body else appeared degraded. Interpretations

superior

while every-

ofhis

grandiose

world did not produce changes; we finally arrived at the conclusion

that they

were exhibitionist

and descriptions

dreams where his grandiosity

He also draws, sculpts, and

was the prevailing

subject.

writes.

R: He is an artist who is not allowed to be one. D.M.: He is a frustrated artist and frustrated world dictator. It is a type of claustrophobia. He is a dictator in the claustrum: he throws himself w i t h tremendous strength and vitality into a business mission where he wants to dictate, only to realize that the walls have not disappeared. He gets to a point where he feels such contempt for the people he manages, he has such low opinion of them, that he wonders what is the use of managing such poor wretches and he loses interest. I think that what you say is very important: his success i n his work increases his grandiosity and that in turn leads to degrading other people. R: Yes; it is like a mathematical formula. His dreams decreased and we were able to observe the thought processes lead him to take as unquestionable

reality the fantasies

We worked on this; an improvement

that

that come to his head.

seemed to take place, but it was, as

always, a passing

one, as he became successful

and undervaluing

of other people went up. He always says that my help leaves

at work and his

grandiosity

him as he reaches the street, that his anxiety is like an egg simmering

in the

water, and that he would like to break open and tell me what there is inside him.

D.M.: There is an interesting fantasy here, because as he compares himself to an egg in boiling water he means that there is a shell; that is all there is, the shell, and inside there is the yolk, the lovely yolk concentrated i n the egg. There is clearly a fantasy about being very creative, and in some way the boiling water steals this latent creativity. The water boils, and instead of him being creative and producing a chick he turns into a hard egg. Therefore, this means that his claustro­ phobia also takes the form that when he is working hard to cultivate his small world, he suddenly realizes that he is being exploited, en­ slaved, robbed of his creativity, boiling in the water. . . . It is an inter­ esting fantasy. His last dream was: "He was escaping; he came across a tribe that he suspected were cannibals;

they invited him to sit at the table; among

the food

MAY 1 9 9 8

LUCAS

267

there were human heads that had been cut off and that he was prepared to eat rather than being eaten himself" D.M.: H e could tell it was his wife and children that were being de­ voured.

Recently he has been saying he is not well; I notice his anxiety in the counter­ transference, and I find the sessions hard going. The last session before the holidays he had spent the time complaining about everything—his work, his wife, his in-laws, etc. .. . The holidays were not going to be any use; he was fed up and couldn't carry on.

D.M.; I a m trying to understand the nature of the p r o b l e m . . . . I think it w o u l d be really necessary to show him that it is this violence that makes the water boil around h i m and that yes, it is true, it robs him of his budding creativity; all the heat is lost through the violence and goes to the surrounding area. H e is like a stupid long-distance runner who goes to the front and sets an impossible pace, only to end up at the back of the field tired out. I n Shakespeare's Troilus and Cressida, there is a passage (III, 3:156-166) describing the front horse in a team, so proud thinking that he is at the head, pulling so hard from the cart, that he ends up exhausted. It is a nice description. What happens to this horse is that gradually it gets to understand, to see, that it is only a horse. A n d so Lucas is a man who could be passionate but wastes his heat on this hyperactivity, this excitement and superiority, etc. His philoso­ phy is carpe diem, grab the present moment because there might not be another chance, and therefore everything is out of proportion, not in keeping with his environment and with the feelings of other people; his egocentricity is quite monumental. I think this happens quite often in the puberty of these intelligent types who are first i n their class and w i n prizes, etc.—they can never forget those triumphant days, so fantastic. It is really a kind of stupidity. Ps: Could the image of the waste of energy in keeping the water boiling around him be thought of as a kind of strategy? Like a castle that has to keep a protective moat, because he feels as fragile as an eggshell? D.M.: Well . . . yes, he feels fragile i n a particular w a y because what happens with these pubertal children is that they glimpse their poten­ tialities and treat them as if they were achievements already. H i s grandiosity is built on this false sense of achievement. Catharine has a patient, the daughter of a patient of mine, w h o when she was 15 played the shrew in The Taming of the Shrew. She was incredibly sue­

268

SUPERVISIONS W I T H D O N A L D MELTZER

cessful at school and was turning into a shrew. She has never managed to escape the fragile shell of being a Shakespeare character. Ps: The first time this patient gets a job, he says to his father, "I've got a job", and his father says, "Study." It is what Donald pointed out—as if the potentiality were a reality, but his father told him that what he should do in fact was to study and prepare himself. D.M.: Yes, potentialities taken as successes. R: Yes, all the time. D.M.: By exhibiting his potentialities he manages to get into places where to begin with people take an interest in him, soon lost because he doesn't do things well. One of the problems in the countertransference, which you have to clarify for him, is that he behaves in the same way in the analysis: he arouses your interest by exhibiting his potentialities and then spoils the analysis. And, of course, he feels that, naturally, you threaten him with losing interest in him... at which he finally succeeds. One way to "catch" him in the transference is by interpreting that he doesn't understand the difference between the parents' love for their children and love between adults. He does not understand that parents love their children because they see in them development potential, the possibility that they'll turn into splendid adults, whereas he thinks that his parents are in love with him. He does not understand that you are interested in him; rather, he thinks that you are in love with him. Session of 17 April 1998

R: I wrote down this session, but when I read it I did not think it conveyed the feeling of violence—his way of expressing himself is very violent. It is the first session after the holidays. He arrives on time.

R: He is always punctual and usually five minutes early, extremely tense; but he arrives on time come what may. D.M.: By the skin of his teeth. He smiles and says he assumes I had a good holiday. P:

lamina

terrible state. We went for the day to Puigcerdd,

to the house of

some friends of ours, and being in the mountain was good. But I am in a bad way; I can't go on like this. I don't even feel right with my children; I do things that I regret later on. My son worries about death; I suppose it is

MAY 1998

LUCAS

269

normal; he was with Mercedes; his seems worried about the fact that the mother of a little girl he knows died suddenly. Mercedes tells me the things he confides in her, his worry about her dying, and I think how little I care about my own life. I am getting worse, I can't carry on, and I am reaching the limit of my suffering. The other day I got absolutely furious because if we leavefiveminutes late in the morning to take the children to school we hit bad traffic; I get so angry that it ruins my whole day. The kids weren't quick enough, I lost my temper with them, and then it is a nightmare driving through all the traffic lights in this bloody town.

R: The fact that a town has traffic lights becomes a drama for him! . . . J suffer, and I draw; my suffering comes out in my drawings. Mercedes likes them but not the suffering they talk about. I just wanted them to go and leave me alone; I am always tense, I work, then when I get home she is waitingfor me to give her a hand and I can t bear it any more; we can't make ends meet, it is getting worse and she is getting fed up. I have nothing left to give her, I tell her to lookfor a job but she has hardly sent off any CVs; she could pad out her experience saying that she has worked in our family businesses, but she won't. I leave in the morning, I hit the street. Why doesn't she do it too? Ifindit hard to get up and earn money; she does nothing, she just says she is tired. What about me? Am I not tired? While she stays at home! I am fed up of telling her that I do not want a servant And what about sexual contact? Not even once a month! All she can say is: we should change! But nothing changes here; she doesn't give me anything; she doesn't try anything. I do everything and I can't carry on. I am too tense and anxious. f

T: There has been a break. I made you wait and you are experiencing me like your wife: I don't give you anything.

D.M.: All this is transference to you. P: (Furious) I am fed up with everything; nobody gives me anything; you just spout words, theories! You talk a lot but don't say anything; it is ofno use to me; all your explanations, everything you say is useless, it is rubbish. Tablets, more tablets, they are no use, it is not natural; they wash over me, I hate them, I amfed up. I need something that doesn't come. I see my brother, my son, they are doing all right in therapy, but not me, nothing helps me .., and I can't bear all this tension. I told you once that what you have to do is hypnotize me. T: Hypnotize you? P: Yes; I told you once. I heard on TV that it is good. That's what you should do for me instead of so much theory.

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SUPERVISIONS W I T H

DONALD

MELTZER

D.M.: "Send me to sleep i n your arms and when I wake up everything w i l l be sorted out/' It is maternal transference. T: This is analysis, not hypnosis; you are free to go if that is what you think you want done for you, but since you are still in analysis we could think about what is behind your

lack of satisfaction

and your demand for

hypnosis. I think that you are saying that unless you are given that wipes out all suffering—and

something

that is impossible—you will always be

unsatisfied.

D.M.: I think you have to be more scrupulous i n the part-object rela­ tions to the breast. These are complaints from a baby that is expecting the breast to solve everything, expecting the breast to make him grow up from one day to the next while he sleeps. A patient of mine who was travelling on a train said to the ticket inspector: "Wake me up when we get there." Ps: Why is it that Rosa can feel so angry? Has she become boiling water for him? D.M.: No. The countertransference is that of a baby that expects every­ thing to be sorted out while he sleeps hooked to the breast, and when he wakes up everything should be different. He expects something from the breast that the breast cannot do; this is a very irritating form of ungratefulness. I would have said to him: "You are talking to me as if I had not fed you, but I have—what happens is that you waste it, you want something from the breast that it cannot do for you, something you call 'hypnosis', which for you means being put to sleep and find­ ing that everything has changed when you wake up." It is not only the child who is unsatisfied w i t h what he is given; it is also that he thinks you are giving something better to other people. He is a very jealous child. R: The feeling I have w i t h this man is that you could be giving h i m everything and he would still say you are giving h i m nothing . . . and he's been in analysis for five years. D.M.: He thinks that you are only interested i n the eggs inside you, the eggs that you are cooking, making them warm so that they de­ velop. It is as if he were saying: "You are not interested in me, and I am also an egg, I have a core of creativity that you are not developing." It is an accusation against women for being only interested in the babies inside them while they are pregnant, and they need to be able to develop them and bring them to be born; but once they are born, they just give them the breast and that's it, nothing else to do. He has two

LUCAS

MAY 1998

271

children with his wife and thinks that she doesn't work: "Being a housewife and having two children is nothing"; as far as he is concerned, that is just being lazy. It is a lack of imagination, a type of stupidity. . . . He also believes that you don't work: he pays you and you go on holiday. Session of 25 April 1998 P: The weather is turning hot, isn't it? (Silence) I want to discuss something with you (sighs)... well... I can see I have an incredible ability to give people advice when I am talking with them, but I ask myself, why can't I apply it to myself D.M.: It is like saying: " I am a great therapist; I really do give them what for." My brother has started up a shop, and he had an opening party; I was talking to him and giving him good advice, although I didn't like what he was telling me; it seems impossible to believe that he used to be my role model. But I am good at giving advice, I just can't help myself, I am always too quick off the mark. [He always tries to act quicker than it is possible] D.M.: H i s pre-emptying everything has to do with being satisfied with his potential and not realizing that there is a great difference between potential and real achievement. A n d that there is a difference between advising people and doing it oneself. T: You are telling me . . . P: (Interrupting) Excuse me, I just want to say that Alex, my son, has very little short-term memory; they make him do exercises but he hesitates quite a lot; other times he remembers okay. I just thought about how much we are doing for him, which wasn't done for me. But I don't know why I am so bad at retaining what we do here in the therapy; yet I think that even ifl can't see it, it must stay somewhere since I am so good at giving out advice. D.M.: H e illustrates it at the beginning of the session whe n he says, " I want to discuss something with you . . . well . . . " , and he doesn't know, he has lost his notes, his diary. What he calls advising people is a type of confabulation, of showing off, making a noise, because he doesn't remember; he had an idea but he has lost it. He begins to see the problem, and the problem is that he cannot retain what is happening here; as soon as he gets to the street, it is gone. He says that he

272

SUPERVISIONS W I T H

DONALD

MELTZER

thinks something is left: "yet I think.that even if I can't see it, it must stay somewhere since I am so good at giving out advice". He is talking about projective identification here: "When I get into your head or your breast I know everything one has to say." You need to interpret to him that he doesn't seem to realize that it is not his memory (his recollection) that he is gaining access to, but your memory that he is gaining access to and stealing from, like a thief. I n art, this is called plagiarism. Ps: I would like to ask something: Donald said confabulating, Crispina interpreted fantasizing. Is it psychiatric confabulation? D.M.: How does confabulation occur? And how is it a product of projective identification? In the first place he deludes himself, thinking that he is inside his mind, but in fact all he has done is invade yours and he is plagiarizing what he finds there. Confabulating is not like lying: lying consists in knowing what is the truth and distorting it w i t h deceit in mind; confabulating is a technique of self-delusion. Now, it is not difficult to observe the way it is done: the technique used is the imita­ tion of the mannerisms of the person who knows what they are talking about. The way this is done is a type of theoretical stratagem that is an imitation of forms: for example, when one says "That reminds me of something that happened to me", and once that frame of reference called "What happened to me" has been established, you can fill it i n w i t h anything that comes to mind, it doesn't matter, you've got the framework; it is a rhetorical, behavioural framework in which you can talk as if the thing had really happened to you. A characteristic formula used by comedians is: " A very funny thing happened to me on my way to the studio." Nothing funny did happen, i t is just an introduction to a joke, an empty introductory comic phrase that tries to be tunny, as if it really had happened. Comedians use i t constantly. Children i n p u ­ berty and adolescents, too, constantly say: " I t was such f u n / ' They call anything fun. As I say, it is not lying, it is invention, founded on the way that this rhetorical framework is inserted into the empty spaces and is filled with words Mrs Bick called it "the gift of the gab" and she used to give it as an example of building a second skin. 1

R: The conversations that the patient talks about are simply advice to his older brother, who is a failed musician, an outcast, who doesn't take any notice of him and does what he wants; but it makes him feel 1 E . Bick, "The Experience of the Skin in Early Object Relations/' in M. Harris (Ed.), Collected Papers ofMartha Harris and Esther Bick (Strathtay: Clunie Press, 1968).

LUCAS

MAY 1998

273

marvellous even if his words are useless: it is just appearance, nothing

changes.

D.M.: Is his older brother a confabulator too? To be a confabulator in

music is more difficult—although nowadays they call anything music,

just as they call anything art, because standard values have disap­

peared.

R: There is something here that needs explanation: the first four sib­ lings—one boy and three girls—lived a fatherless childhood as it were, because their father was deaf and they used to be the ones who de­ cided what to do: the school they were going to go to, etc. . . . They lived a fiction of being "adults" and "artists"; they played music, they painted; they felt important and superior, and this came to an end when the father was operated on and two more siblings came along, which proved that their father was not absent or impotent. D.M.: And then they began to realize that it was their father who was a good musician (laughter). This type of confabulation is reinforced by idealization on the part of the parents, who also treat their children's potentialities as if they were achievements already. I have a patient who is a great confabulator, and many years of analysis have been necessary to prove that what he said was not true. He is a confabulator who got a Masters at Oxford and has an important post at a broadcasting company. He did a PhD at Oxford. Throughout these years I have had to stop him and say: "Is that true?" And he answers: "What do you mean is it true?" To which I answer: "Don't talk to me about your PhD thesis—I know very well how you did your PhD thesis/' He chose for his subject the work of an unknown Russian writer, so obscure that nobody could supervise his work (laughter). Let's carry on. . . . This problem of confabulation is fascinating: they make themselves believe they are in a position of influence; they are all potential politicians; they use statistics constantly and confabu­ late with them. They say, "A recent study shows that . . . " ; it is a rhetorical framework that is used to be able to put in whatever they want, rubbish. Ps: Yes, in a recent popularity poll in Spain, they forgot to include Felipe Gonzalez in the list, and he is by far the most popular figure (laughter). T:

You can use therapy

to get the satisfaction

of feeling

other people or you can make it a part of yourself

superior

advising

because you need it.

D.M.: It is not that he makes it a part of himself; it is that he gets inside

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MELTZER

you as if he were the analyst, behaving like the analyst, imitating your mannerisms, getting inside your head and confabulating. You can see an illustration of this when he interrupts you and says, "Excuse me, I wanted to discuss . . / ' , and straightaway he starts to talk about his son He is about to realize that there is a problem that as the expert, etc can be seen in the transference, and he calls that poor short-term memory. His reasoning is that it must stay somewhere because other­ wise he wouldn't be able to give such good advice to people. "What makes you think that your advice is so good?" You will have to show him where he is getting the good advice from. Okay. P:

The image I have of my self is sometimes superior and sometimes

inferior;

you know I am afraid of people and I don't like to be shown up. T: P:

Yes, you are

fraudulent.

I don't want to be hurt; it is a defence. How does a normal person behave? I don't like to be shown up.

D.M.: That is quite correct; that is his technique, to act like a normal person, which is to act like a grown-up person. What I would say to him is that to feel inferior to a teacher is a prerequisite for beginning to learn; you have to feel inferior to the teacher to start to learn some­ thing. Lef s carry on. I am very sensitive and get hurt easily. Transparency

doesn't worry me so

much now, but I don't like to be seen as weak; I get my shell on before anybody can get to me.

R: This subject of transparency has to do with something he said happened to him when he went out in the street, which was that he thought that everybody knew who he was. D.M.: The shell is his shield, and he turns himself into an egg, into a hard egg. The key thing for me is that I need to succeed. If I act like a normal "Oh,

no! Time to go to work!"

person,

(in a mocking tone), I can't just be in the

middle bracket. I don't like conforming.

The image I project of myself is

that of a voracious, decisive and energetic person. At the moment I am in an impasse, unmotivated,

and it pisses me off to be doing nothing

(very

angry). But when I get active and use my creativity I get through a lot; I don't know how to do things unless it is at breakneck speed. T:

It satisfies you to be so anxious and to think that you can run faster than anybody else; you call that creativity and triumph, although it is arguable whether it is that; and in that race anything that is in the way gets treated

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275

roughly by you: your children, the therapy, and any help that is given to you. You are responsible for your anxiety; you play with it and then complain that nothing and nobody can calm you down.

D.M.: Yes: that is very good. P: When you mention my children I get nervous, I have set up this miserable life for myself because I have to bring money home. T: No. That is an excuse. P: Okay, tomorrow there is a meeting at the children's school—maybe Til turn up without any clothes on so they can hurt me. Look, when I first started coming here I was looking at everybody as if they were my chil­ dren; for a while I even felt affection towards people, but I infact find them a nuisance—the other day we were in a large department store, it was awful, I thought wouldn't it be nice if a nuclear bomb fell on it and there was just me left in the world. I think I would pay money to feel that, the emptiness, the echo, but all those bodies were following me and they still do, they are annoying. It is like this: lam in the street, on my motorbike, at top speed, and if a slow person gets in front of me I have to overtake them, doing mad things, breaking the law—it doesn't matter, just to get past them. I won't stay behind, I can't stand it. I haven't had a glimpse of my humour for some time now, I don't laugh, I am obsessed with aggressivefilms. Because of this lack of humour I don't relax. I would like to laugh and feel okay. T: You have managed to turn your life into hell. P: A friend of mine was saying to me that Heaven is up above, and down below, where we are, is Hell. (The doorbell rings.) Is it time? It has gone very quickly; it is not fair. The other day, at my brother's party, I got bad vibes; there was a slimy friend of my brother's, his ally, who was drunk, and I said to him: "Go away, drunkard." I realized I had no sense of humour; they are all people who are separated, and they pretend they are having a good time with their opaque laughter. I thought I didn't want to be like them.

R: I don't know what "opaque" means here; he tends to use words like that. Ps: He is so jealous! D.M.: He probably has the gift of the gab, and very patiently you are going to have to show him that he misuses language and, in his

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confabulation, takes it as fact. For example, from the incidence of one drunken person he deduces that everybody is drunk and1 that he is the only sober person in the world. Ps: Or that if the bomb falls where he is, he is going to be the only one

left alive (laughter).

DM.: "They pretend they are having a good time with their opaque laughter...." The opaque laughter is the eggshell He is developing a lot of insight based on self-observation, but he is still totally incapable of using it, because he is not able to tolerate feelings of inferiority nor acknowledge the amount of time he has wasted in his life. Instead of getting an education and learning a trade or profession, he has trained himself to be a confabulator. I would certainly concentrate on the importance of feelings of inferiority as a precondition to learning. R: And if he doesn't accept it? I have worked on this a lot with him, and I can't see any changes. D.M.: He is beginning to accept it, but he can't bear it; he thinks he can't bear it but he is starting to, and he can see that he is a disaster as a person, that he drives like a maniac, breaks the law, jumps the traffic lights. He can't bear to admit your superiority vis-a-vis him. Keep him in the transference. You could tell him that you can believe that there was a drunken slob at the party, but that is not what is happening here; here, he is lying to himself, enjoying himself with his opaque laughter. . . . And you have no doubt about it. In the first place he doesn't let you enjoy your work, and you certainly don't laugh at him in any opaque way. He can see that you worry about the way he is wasting his life, abusing his wife and his children, and failing in everything. I would also extend the concept of him not bearing, not being able to admit your superiority which makes him feel inferior, to include also not being able to bear the evidence that you forgive his bad behaviour, bad behaviour that manifests itself when he interrupts you, when he swears and uses bad language and acts like a tough guy. Yet, it is obvious that you forgive him and still see him, and it is not because of the money he gives you but because you feel pity towards him, towards that "precocious" poor child who has not grown up. One discovers that patients do not tolerate being forgiven; they want to be punished because that way they get rid of their guilt and can do it again. Being forgiven imposes on them the burden of their indig­ nity. The language of the depressive position is very powerful; it is the

MAY 1998

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277

language of inferiority and of not being worthy. Therefore when he catches a glimpse of his inferiority, he immediately begins to lash himself. And that is what he wants you to do to him: humiliate him, flagellate him, and truly satisfy his masochism. He would love that. And so, in a way, what you interpret is not so important as the music of the transference. The music of the Mater Dolorosa: that you really suffer when you see this kind of behaviour in your children, and you are offended by his swearing and his "fucking" all over the place. He makes you dirty, he doesn't use you appropriately like a toilet­ mummy; instead he soils the walls with his pooh. This language shows him the concreteness of his actings in the transference and shows what is unpleasant in the countertransference. It seems to me that this is the correct way to proceed, and I don't think that he is a hopeless case by any means. Alex is his son's name—and his daughter's? R: Vicky. The boy is Alex, the girl Vicky. D.M.: He is more worried about Alex because of the example he gives him. His wife is Mercedes, isn't she? I think he has genuine affection for her. He finds it impossible to admit that he has been a failure to her. Probably their relationship started with her having a high opinion of him and great expectations, which he has bitterly disappointed. He says that his son confides to his mother and that "he worries because the mother of a little girl he knows died suddenly, and Mercedes tells me these things, how he confides to her his worries about death", and " I think how litde I care about my own life and I realize that I have passed my fear of dying on to him. I am getting worse. I can't carry on." I don't at all think that he is a hopeless case; he is nearer to being a lost case because of his way of escaping, confabulating that he can't carry on, and because he has suicidal fantasies, fantasies about making the department store explode, etc. . . . According to you, he makes up excuses for himself. In a way, the centre of his psychopathology is that he is ineducable, and this has become the core of the transference; he also recognizes that he is ineducable in his relationship with you. We hear a lot about his father but don't have a clear image of his mother. Do you? R: When he was little he loved her a lot, he was the baby, but now he is furious, angry with her, he has nothing good to say about her. D.M.: I imagine that was the period when, as the baby, he was ideal­ ized not just by the father as a genius in the making, but also by his

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S U P E R V I S I O N S W I T H D O N A L D MELTZER

mother since his father was so pleased with him, but then father recovered his hearing, was disappointed with the children, and had two more; it was the big betrayal. He finds it unbearable that you don't idealize him and that Mercedes doesn't any more; she expects him to be a husband, not the baby-genius.

21

[MAY

1998]

Antonia Scientism vs. imagination, the mechanistic vs. emotionality: incapacity for symbol formation Llufs Farre

T

his patient

is 40 years

old. She started

twice a week. She got married She came to see me because

attempts

at forming

a couple—and

conflicts

with students.

of recurrent

during

She said she would

?

, also i n Z

She is the eldest

sisters.

nuns, PhD

of four

in their birthplace,

where she spent studies

in X

her at the beginning wards.

to terminate. night.

As

nine years

until

, she suffered from of her present

with

of depressive

crisis

.

should

she went to university. insomnia.

last year

and

This

became

advised during

279

was still

run by

pregnant;

her

troubling soon

which

complete

that period,

she need to telephone

LI: She was grateful for that.

secondary During

and disappeared

age 30 she had a pregnancy,

She got married

for

sent her to a boarding-school,

treatment

to lose blood, her gynaecologist available

what is wrong

there were no facilities

She asked me to stop the sessions

made myself

in X

to and

. She is an economist.

her parents

When she was around

beginning

like to know

related

about her work



Lmis: She was i n Y education

anxiety—always

There is a history

her years as a student

D . M . : Where i n X

a year ago. I see her

ago.

her lack of confidence

her, and be able to live life more happily. and anxiety

treatment

eight months

she

afterdecided

as she

was

rest for a fortand I agreed

me at any

point.

and

280

SUPERVISIONS W I T H D O N A L D MELTZER

She missed two sessions and called me to start again. When she came back, she seemed excited and as if nothing had happened; she said she was losing blood, she was miscarrying, and the gynaecologist had informed her that the scan showed that there was nothing in the womb. I am concerned at the way she describes her situation. Iam worried about the way she is facing the situation and ask her if her gynaecologist knows what is going on and if she knows what she has to do. We set a time for the following day, but she telephoned saying she was being admitted to casualty. She came back after Easter.

D.M.: All this happened before your Easter holidays? LI: Yes. . . . Before we move to the sessions, I have to say that this woman has a peculiar way of speaking. When she thinks about what is happening to her and she draws conclusions, it is as if she were speaking to a mathematician unfolding an equation on the chalk­ board—"And the result is ..."—but one can see that her deductions lack imagination and that their logical links are sometimes incoherent or aberrant, like a proof that doesn't hold together; nevertheless, she is able to string out a long argument resembling a chalkboard filled out from side to side and from top to bottom with mathematical reasoning but meaningless. D.M.: She is an economist, and all economists are statisticians. U: Yes, that's right. In many ways that fits in. Session of 16 April

1998

In the first session, the first thing she does is pay me back-fees and hand me a photocopy of our timetable for the next few months, to check that there are no errors, as we agreed.

LI: Here I need to clarify that since she teaches at a high level she occasionally has commitments such as giving a Master's course where the timetable was set before we started her treatment. We agreed that I would fit in with that as much as I could. Since she also chairs doctor­ ate-theses boards from time to time, we had to schedule sessions five months ahead. That's why she gives me her timetable to make sure we haven't agreed on times for the sessions that are already taken. P: I don't know where to begin.... Some things in the past fortnight would need to be commented on. I sent you a message that I couldn't come on the 2nd because I was going to have the operation. I was still bleeding so I went to casualty. I was told they would admit me without any more delay. I went in at 4 o'clock Javier was there too, so we went home to pick up a

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281

few things, have lunch, and go back. He didn't go in with me at 4 o'clock The way they do it is that they introduce something through the neck of the womb, which is very painful, then they left me in the corridor on a stretcher-bed; when they asked me who was with me, I started crying. I felt lonely; they took me upstairs to my room, I tried to control myself; Javier called me, and he realized that I was feeling weak so he came to keep me company and brought along the work he had to do. We both started working, to pass the time. I corrected some exams. I calmed down. I had felt so very lonely. Another thing I wanted to mention is that my parents arrived on Sunday. I came out of hospital on Friday; they stayed the whole week. Javier had been very affectionate with me when I was in hospital, but as the days went by during Easter he became colder and more distant. He got up, went to work in the woods, came back, ate, left again, came back to have supper with me and my parents and watch a bit of television, hardly talking, and then went to bed. The problem was not me but, rather, a sort of refusal to talk. One day, I was in the kitchen and my parents were in bed, Javier was out, I felt very lonely and cried a lot. Javier was not "involved"; my parents were there but doing things, not close to me. When I was in X I used to think that ii was because I wasfar away that I felt lonely. And yet now I had everything but still felt lonely. So I thought the problem has to be somewhere else. I thought that part of my problem is how much feeling lonely affects me. I was more and more convinced of that last week. One night I woke up frightened. I dreamt "I was in an orchard, crouching,.." f

LI: I have to say that these two are economists, both of them; they live in a rural area, some 100 kilometres away from Barcelona; there is a wood there, orchards, etc. Antonia's husband spends his time mainly working there, in the fields; he likes it. .. and Javier was looking at me; I was the earth and he was tilling it with a sharp object; something hurt in my heart." It was the distance between us, in a way. As if it were a punishment for my parents being there, breaking up our intimacy. The next day I woke up and started to read a book. My parents left, and our relationship started to improve. Javier began to touch me, and I felt all right and was able to sleep. I ask her to clarify the dream a bit P: "Each time he put the sharp object in the earth ii hurt me" ... the loneliness of the pastfew days hurt a lot. I felt vulnerable because I minded if people were taking care of me or they weren't. My happiness depends on

282

SUPERVISIONS WITH DONALD MELTZER that, and thai makes me feel vulnerable....

To return to the dream, "1 was

crouching and at the same time I was the earth. It was as if it was me who was putting the sharp object in the earth, I am not sure. In theory it had to be me because I was crouching,

but Javier was standing there,

looking,

and he too was putting the object in the earth." T: You could both put it in at the same time. P: " I could see the furrow on the earth, and each time I made it I felt a pain, as if in my heart." I ask her about the shape of the object. P: It was an implement

Javier has; imagine a screwdriver

with a curved

metal end and when you press on the handle it shifts up the earth He uses it to pull weeds. He shaped an old bit of iron into a U, and he uproots weeds with it. I ask her to associate. P: The next day I thought that what hurt me was the insistence on scratch­ ing and scratching the earth, as if each time I was burying the tool deeper and deeper where there were no more weeds and the earth was perfect, and I was just doing it for the pleasure of scratching; as when quite

innocently

and without there being any need for it one insists on scratching the earth and it does harm. [I can't help thinking of the curettage she has had because there was a weed and an empty space, but I think it is linked to the pain of the viable

pregnancy

she interrupted years ago which is underneath the surface of the more recent events. .. . However

I don't think she is up to facing this and I decide not to

mention it.] T: A lot of things have been stirred up inside you in the last few days, and not just superficial ones but also deeper ones. You have probably felt neglected because of my absence during P: Maybe,

Easter.

but I can't see it clearly. There is my old relationship with my

parents, a constant fight; my father is always giving orders and I find it hard to put up with "Do this, do that!", particularly when it is said with contempt,

as is often the case. On one of the last days my parents

were

with us, Javier was cleaning something out in the shooting range and I went down to see what he was doing; my father said: "Don't anything?

you do

Can't you help?" And I thought: "Here we go again!" I know

it is a small detail, but it shows a lack of respect towards other people. My mother has always been more considerate,

but one is already on the

defensive. You have the feeling that they are in the way and that they are in Javier's way. And I didn't know how to handle it Neither can I imagine

MAY

1998



ANTONIA

283

a week at home with Javier's mother. It is not as if my parents were a big nuisance but as if I had to pay for it. And also I felt constrained, serving two masters. It is what you have said sometimes about my servile attitude, my fear of annoying people, my parents as much as Javier. As if I were not able to do what I liked with my holidays. And then there is Javier not even stroking me, so you think maybe he is tired, but in the end you come to the conclusion that he doesn't love you. And I remember things about his past life when once the sexual relation­ ship was over, without any argument at all, he would finish the relation­ ship. Then you see that he is not saying anything. Then I thought that there is something that doesn't work in my relationship with Javier. I am always complaining; it's as if there is a wound. I don't laugh these days, I never laugh with Javier, but I can laugh when I am with my sister. It is as if I was afraid of annoying him. He was tense yesterday because of some work. I asked him what sort of a day he had had, and I also said: "Tonight you should call your mother, she was going to the doctor today." "I've called her already," he said. "And how did it go? Can she go out now, and come to X ?" "Idon't ask stupid questions," he said. I was talking in a light tone about the situation, but not nastily; but I got such an answer that I thought it was better to keep my mouth shut and not be taken for a fool. That kind of attitude makes you less flexible. I wonder if all these problems I create, and the fears and blaming him, is simply the result of my being tense because I don't want to give offence. This makes the relationship poor; everything becomes suddenly hard and tedious. ... I don't know if I am explaining myself well. T: It would seem that you are referring to a bad use of the tool, as if instead of putting misunderstandings right, giving relief and consolation, compan­ ionship, promoting happiness and hope, it caused suffering. P: This is too abstract for me. What is the tool?

D.M.: She is a little bit dense, a little bit stupid basically. Why does she need to ask you what is the tool? She is not very imaginative, quite poor when it comes to symbol formation. Okay. T: It seems that you are referring to the thinking tool, which allows us to stay close to the cause of pain so as to pull out the weeds and provide relief; that tool is used inadequately, or in a twisted way. It does not give relief—it causes more suffering. [End of session]

D.M.: You answer her in a rather abstract way. What you were saying to her referred to the meaning of the penis, and judging by her refer­ ence to a twisted way of thinking, and the way she complains, one is

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led to suppose that Javier does not use his penis with a meaning of giving pleasure, alleviating pain, providing comfort, helping to think, offering company; rather, he does it just to "cultivate", because he is so intensely interested, as well as her father, in "cultivating" her. I won­ der if the word "cultivate" also has the double meaning in Spanish of tilling the soil and making somebody a part of the civilized world. The big mistake in her life was that abortion she had, which now becomes present in the pain related to the tools used in her cervix and the discovery that inside her there is an empty space, etc. All this pain is making her remember that abortion, live it again, as well as the relationship that ended in that abortion. Why do you think sexual relationships ended in Javier's couples? Does she give any explana­ tion? LI: No, she doesn't. In the next session we shall see that she refers to it; it seems that Javier has mentioned to her that once sexual relationships end, he loses interest and he breaks the relationship, Javier has had other partners before Antonia. Ps: Does he have children? LI: No. D.M.: Do we know anything about the relationship she had that ended in pregnancy and abortion? LI: No, nothing; she has not said anything about it. It is something that belongs to the time she spent in X , living in a house with other students, where she had temporary relationships with two or three other people. D.M.: So in her life there has been a pregnancy and an abortion. . . . I think that she is somebody with very little imagination, much given to science and research, to mathematical subjects.... She handles statisti­ cal concepts well, and so one has to spell out meaning for her, symbols, in a very concrete way, because she herself is totally incapable of making the links, the connections. What she says about her husband— that once the sexual relationship is over he loses all interest—is prob­ ably not true, because when she can be present emotionally in front of him, as when he phones her after leaving her at the hospital and he notices in her voice that she is suffering mentally—that is to say, when he hears her sadness and need to be consoled—he is very capable of leaving his work and going back to her side. It is not so much that he goes away when the relationship ends but, rather, that he loses interest when the woman goes cold.

MAY 1998

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285

In the main, the patient you have here is exactly the opposite to Rosa's patient Lucas, because although she has achieved many things, the way she has achieved them is wrong since they eliminate all pleas­ ure and her achievement keeps all emotional meaning away. Her motivation is wrong, because she is so interested in placating the other person that the meaning of their answer is lost to her, it doesn't get through. And it is lost on her because she is only interested in placat­ ing, so much so that when she receives an answer she perceives it as the other person having been placated. That is the meaning she as­ cribes to it. The example through which in a rather humoristic way she gives you a view of how she perceives flexibility is that vignette where she says: "Tonight you should call your mother, she was going to the doctor today." "Yve called her already", he said. "And how did it go? Can she go out

There she is giving you a clear image of the way Javier makes love to her. It is a very practical and efficient way, where it is assumed and hoped that they will both reach mutual orgasm, but she will probably not feel pleasure in the act, not reach orgasm; she will be unsatisfied and without knowing if she has been used as a statistic; she remains out­ side the richness of the relationship, everything becomes hard and tedious. It appears very clearly there, but she lacks sufficient imagina­ tion to realize that that is precisely what she is talking about. We can then ask ourselves the question of what kind of lover is she, because here we have the evidence that normally the only thing she is interested in is answering everything in a mechanical, placating way, not showing her feelings; but when she does sometimes show them, we can also see that the other people can respond to them, as her husband does when he phones her in the hospital. This is also a problem of technique in analysis: whether one thinks that communicating is merely a question of language or whether one thinks that it also involves what one shows and not just the way one says something. There is a long tradition in psychoanalysis which maintains that one mustn't vocalize the countertransference, but it has never been said that one shouldn't show one's feelings, even so. Freud tended to think that he didn't show it, that he did not unveil the countertransference, he had the theory that he was like a blank screen—but when one reads the cases, it is evident that not only was it not so but the opposite happened: the countertransference is very palpable in each one of them. now and come to X

?" "I don't ask stupid questions."

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S U P E R V I S I O N S W I T H D O N A L D MELTZER

In the present case I see two technical problems: one is that maybe in your interpretations you don't make clear and precise references in terms of partial objects, and secondly that perhaps you are a bit reluc­ tant to show your feelings. Okay. Session of 16 April 1998

She always gives me my fees in an envelope. I noticed that she had paid me for the sessions she had to cancel because she was told to keep complete rest. I returned the money to her, reminding her at the same time of the conditions we had set out at the beginning of the treatment.

D.M.: Is this your usual technique? You don't normally charge pa­ tients who haven't been able to come to a session? Or is it that you think she has interrupted the treatment temporarily to obey the gynae­ cologist as a man? I am not saying at this point what is correct or isn't from the technical point of view; rather, what I want to know is what is your technique when there is a cancellation. LI: I always charge the patient, except—and I make this clear to them at the beginning of the treatment—when there is an extremely serious situation in their lives, such as having to go into hospital, a serious illness, a sad or tragic event in the family, as for example—this has occasionally happened—the death of a father or of a mother, etc. In these circumstances, where I have reason to think that it is so, I don't charge for the sessions missed, but not in any other circumstance for reasons of work or of a different kind. D.M.: This means you allow the patient to assume that the analysis can be interrupted, so, as the idea of the interruption of the analysis is there, the hours come back to you, they are hours you have available again, and so the patient doesn't think that he has a right to them. LI: No, no. It is not like that. The way I formulate it—I don't know whether it is right or wrong, it is the way I work—is that the contract I make with my patients implies that a time is going to be made avail­ able to them, and kept for them at all times, but that when there is a serious problem I am responsible for that time, I keep it for them without making a financial charge to them, given the circumstances they are going through. The patient knows, for example, that if the admission into hospital does not happen, they have their space. In brief, I do not take into account all the difficulties that can arise in coming to a session, but I do take into account exceptional ones, those where I presume that the patient will not be in a fit state to come, and

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I make those conditions clear right at the beginning of the therapy. This case, according to my criteria, was one of those circumstances to be taken into account. D.M.: But in this case you will also have to decide if the time is going to be taken into account; I mean, if one week or six months of interrup­ tion are going to be treated in different ways. LI: Yes, it is true. I also set that out at the beginning: when, for what­ ever reason, the situation is so serious that continuity is not possible, we would discuss how to proceed. In practice I have no experience of what would happen in such a case, it has never happened; whenever a problem has arisen, it has been for one or two sessions. D.M.: You are lucky, because in the case of patients who have to travel a lot for reasons of work they can be away for a long time. LI: In that case I charge the patient. I make it clear that it is only for serious health reasons, hospitalization, or that kind of situation. For example, two weeks ago, a patient could not come because his wife was giving birth, the baby was premature; the patient phoned me and said: "Look, I have to go to the hospital, I have to take my wife, the baby is arriving." It is quite simple, I don't charge for that session, but I would not apply the same criterion if he said: "Look, I am going to the States to do this or that course and it is going to last four weeks." That person will pay for those hours. D.M.: So it is the way you deal with hospital admissions or similar things.. .. Okay. LI: We were at the point where I said to her that I would return the money to her, and I clarified it by reminding her of the conditions we had established at the beginning of the treatment. P: I thought that because you were available, as you said, so that even if I was not allowed to move, I could phone you in case I needed to. ...

D.M.: Is that so? LI: Yes. D.M.: So you were available, and so she felt she had to pay you. ... That's why I included those days, without a second thought. .. . I wanted to mention two things to you. Two days ago, Javier mentioned that he met Maria [his ex-girl-friend] and that they arranged that he would go with her to see a house, near where we live. Marta mentioned to me that she wasn't sure about going to see the house, as she doesn't really see herselfliving alone in the country. Yesterday this business with Marta

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didn't seem at all worrying

or hostile, and I said so to Javier. But last

night 1 had a dream. I dreamt that 'T went into an office where there was a writing desk and that the two of them were coming out from under the table. I was left with a sneaking feeling that there might have been a sexual relationship going on in there." The dream ended

there....

D.M.: Under the table. . . . It is like saying: "Undercover; it was a business transaction." The matter in hand was they were going to look for a house for her.... .,.

The other thing I wanted to mention was something

this morning. retching,

that happened

We were in bed, it was 6.45, and one of the dogs had been

so Javier got up and then came back. We were just lying in,

talking, caressing each other, but nothing else, a sort of "1 like to hold you and feel you close, just embracing each other"; when we got up he asked me what was the thing that scared me about our relationship. I said that it was that we might get tired of each other, fed up, that it would lose its charm....

J asked him what scared him, and he said for him it was that it

might lose its attraction, especially

the sexual attraction.

Sex is very

important for him and he is scared that the attraction might go, and in the last few days, during Easter, there has been rejection. He said that when I was pregnant he found my smell attractive, and that when it ended I had a different smell and he didn't find it attractive.

D.M.: He is not complaining about her coldness, he is complaining about her smell, about her smelling different since she lost the baby. He is comparing himself to that retching dog; it is a confession Javier is making: he is saying that in the sexual area he is like a dog—when he sees a bitch he wants it. ...

and also my parents were there ...

or if I got fat or run down

physically, that might make me less attractive. So I told him that maybe he would be better off with somebody younger and more attractive; I said it without reproach or bitterness; I don't know up to what point sex and physical attraction are so important. I think Javier keeps count of the number of times we make love; he said that last year we were 30% down on the year before and this year 50% on the previous one. So he needs to masturbate....

D.M.: He needs to masturbate. . . . He is like a dog, and if he finds a bitch she can suck him! ...

He asked me, so I went down to the orchard to help him, but my head

wasn't in it, I was so sad I was crying. He asked me what was the matter and I said I was afraid of not being up to the mark in anything and being

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rejected at any moment. His comment was that I could take better care of myself that I don't bend, and my attitude is rather defeatist, "take it or leave it and "why don't we just leave it?", which is also what I do with my teaching, I leave rather than try to make things work. ff

f

D.M.: Again this sounds as if he is a very cold person who functions like a dog, but it is also true that when she is capable of expressing emotion it gets through to him, it touches him. However he didn't see those tears she shed as emotion; he saw them as a defeatist position, as if she were inefficient. I ask myself if the tears running down her face were a manifestation of her feelings, insofar as one could also ask if the different smell she had was a manifestation of feelings. . . . Tears running down her face can be just a physiological reaction, and in that case they cannot describe her feelings. Her feelings, from what we can see in the dream, clearly stem from some suspicion; they are incipient feelings of rage about Javier's relationship with Marta: "Why does Javier have to help her to find a house? She can find her own house...." And so I reach the conclusion that the tears running down her face are not a manifestation of her feelings; where her feelings are shown is in the dream. Okay. ... My fear of Javier was quite clear to me this morning, and also that my reaction to problems is to go far away. It is a long time since I saw it so clearly, although we had talked about it here many times.

DM.: Let's see what she is saying here... ." My fear of Javier was quite

clear to me this morning, and also that my reaction to problems is to go far

away." What does it mean that her reaction is to go away? It is not true—she stayed very close to him so that he could see her tears rururting down her cheeks, but she did go away from the field of her feelings. She stayed very distant from her own feelings, from those feelings that are inside the dream. Even when she tells you her dream, she doesn't talk about the feelings contained in them; she only talks to you about her suspicion, but not about her feelings. Her suspicion is that they have a clandestine sexual relationship which is covered up, hidden, under the table as it were, under the excuse of the woman's house. And she is enraged and totally disappointed. T: Going away in the external world when there are problems there, but also going away from your internal world when—as has happened in the last few days—a lot of things are stirred up in you, experiences such as the miscarriage, which are left under the table, emotions that you don't know if they are linked to them or not; then there are only tears and immense sadness.

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P: (Silence) I was thinking that the key to my relationship xvith everything is nearly in every case to keep a distance and erase emotion, but....

D.M.: You are talking to her about immense sadness . . . but in fact she has not showed such sadness; what she has shown are signs that another person might read as immense sadness. Somebody with great sensibility observing this could notice or suspect that the different smell after the miscarriage is a sign of immense sadness, but that is not what Javier says. What he says, what Javier is saying is: "ugh! It stinks/' In other words, what the dog is saying is: " I can smell that you are not on heat. When you are on heat you smell fantastic, when you are not, you stink." ... with the characteristic that I hide it not just from other people out of fear, but also from myself, and that emotion and that distance are recap­ tured in dreams or in uncontrollable fear, so to speak. And that is, I suppose, when I cover that lack of emotion with aggressiveness and rea­ soning. I was thinking that I am not conscious of it when I do it. Maybe yesterday and today I was looking to get your complicity in saying " I am the one in the right." Let me see if I know how to put it. In a session before Easter I was putting all the weight of my emotions in Javier, to explain away my notfunctioning, and you told me that I was not paying attention to what my emotions were pointing at. I had the impression then that in the tension between Javier and me I was partly in the right, and that he was partly guilty, and therefore it wasn't just me who would or should go away. Today I was looking to get you on my side in my criticism of Javier because of the importance he attaches to sex, physical rejection, etc. But I see now that the point is to see what I feel I don't know where I am going to, but it is as if I were coming here to see who is to blame: my students or me, Javier or me. . .. And, of course, that is not the point.

D.M.: When she says: "But I see now that the point is to see what I feel. I don't know where I am going to, but it is as if I were coming here to see who is to blame: my students or me, Javier or me. . . . And, of course, that is not the point", she is beginning to understand it: you are not a judge, as she thought before getting to this point; she is begin­ ning to realize that the consulting-room is not the court-room, that analysis is not a trial where a sentence is going to be given saying which of the two is guilty, and that the question is not guilt, she is beginning to realize that what has to be decided, what needs to be seen in the sessions, the point in question is not to see who is to blame but to understand the problem, and the problem is to see the difficulties she has to keep in touch, or get in touch, with her feelings. In Javier's case,

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one can see that when he doesn't find emotion in her, he turns into that dog that one can have physical excitement with, not emotion, and she doesn't find that sufficiently attractive; but there is also a problem in her, localized in not being in touch with her feelings, and because of it she can't manage to show them. And, of course, since Javier is not in analysis, there is nothing you can do for him, but with her this is the work you have to try to do: to find a way for her to be in touch with her feelings. Then, when we take all this into the transference, it is neces­ sary to understand why she feels offended that you do not charge her for those sessions when she did not come, though you had said to her you would be available in case she wanted to phone you. She is accusing you of giving too much value to money and, by so doing, transforming the relationship into a contractual one. We don't know whether this is true or not, but this is what has to be dealt with because it is what she is feeling: the fact that not having charged her for those sessions has the meaning that you are turning the relationship into a mere contract and, therefore, from her point of view, you are not taking into account what being away from you during the Easter period means for her and her mental state. I think that this lays out what her complaint against you is: that you are not showing your feelings towards her. I think that one of the ways in which you are veiling, covering your feelings, is by not being suffi­ ciently explicit about the part-object nature of her feelings towards you contained in the material she brings. Then, if Javier did not turn into a dog, he would probably be able to say: "You don't smell as if you were wanting me to make love to you." That is to say, it would be an acknowledgement of the signs of it, and not just that, also of the meaning of those signs for them. When the tears are running down her cheeks, her tone of voice is that of a statistician, it doesn't convey the meaning of great sadness. Let's see what you say to her. T: You are warning me that you are going to use what I say in order not to know what is happening to you, to reject almost physically, inside your mind, what has been making you suffer throughout Easter: the miscar­ riage, the curettage, and my absence, which prevented youfromtalking about what was happening; and also how you have distanced yourself from the people who, like Javier, might have asked you: "What is the matter?" (The patient stays silent.) [End of session]

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D.M.: You are keeping yourself behind cover in your answer, being very cautious, beating about the bush; what you are not saying to her and making her understand is that your absence is so important or that it contributed to her sadness as much as the miscarriage she had. Because it is not that she could not talk to you about her feelings, since she could have done so on the telephone, but it is an absence.... The meaning of the absence was contingent on the description of the mis­ carriage. What I am trying to say is that you have a way of staying "behind the hedge", of protecting yourself from the emotional impact of the transference relationship she establishes with you. "My absence which prevented you from talking about what was happening", you say. Your absence was one of the things that were happening to her at that time; it is not that your absence prevented her from talking about what was happening. It is not surprising that the circumstance of a miscarriage should overshadow for her the importance of the Easter break, but you must not collude in it. In the work between male therapists and women patients, the latter can always fear that the transference relationship might compete or even overshadow her rela­ tionship with her husband; however, the fact is that it is much more likely that the transference falling-in-love of the patient with you will strengthen her relationship with her husband, since it strengthens her capacity for love. The only thing you have to do is help her to under­ stand that the difference between these two types of love is essentially the difference between parental and conjugal love. In paternal love, there is an act of imagination: it imagines the future, the child's poten­ tialities, as we saw in the other case (Lucas), the potentialities for future development. I do not agree with Bion's view that in analysis "memory and desire" have to be eschewed. Maybe it is apt in the treatment of psychopathology, but I totally disagree with the formula­ tion of it—to eschew memory, perhaps; to eschew desire, no. I do not agree that one has to refrain from the desire that the person should grow and become the adult one can imagine him to be. To get rid of that desire is certainly not an analytic position. Probably what Bion was talking about—and essentially it was not very clear or compre­ hensible—was the difference between Freud's desire to cure symp­ toms and Melanie Klein's vision of promoting growth in children; given that Bion was never a child analyst, it is possible that he did not understand well, did not capture, that side of psychoanalysis—pro­ moting growth. When a patient falls in love with you in the transfer­ ence, one has the evidence of how her capacity to love has increased, become stronger, and how it does not in fact debilitate but rather

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tighten all the bonds in her life. But, of course, a patient with a male therapist is exposed to having to go through the experience of having her heart broken; in many cases, it is a necessary experience without which the humanity of those people will never take full shape. The depressive position cannot be reached without this experience of hav­ ing one's heart broken. The broken heart that happens in analysis is the same as the broken heart in normal family development: the disappointment, the disillu­ sion. And that disillusion, which is necessary and happens in ordinary family life as in analysis, is the disillusion that comes from realizing what is the nature of the transference, i.e. investing the analyst with qualities that he does not have and that are the qualities of one's own internal objects. The first disappointment in this process in the trans­ ference comes when one sees that one has endowed the analyst with a capacity for understanding that the analyst does not have; what the analyst can do is observe, think, and make approximations in an at­ tempt to understand the patient, draw conclusions; but what he cannot do is understand: he is incapable of doing so since the capacity to understand another person is not part of human nature. LI: I was thinking while I listened to you about what you said about me behind the parapet. I wanted to clarify that lately I have been worried about this woman; I have suffered. And I was wondering now to what extent this suffering has led me to place myself even more behind the parapet out of a certain fear of not being able to manage a situation that I saw as being one where this woman was going through a lot of pain; there is the fact that she is getting on in years, and there is the miscarriage and her history of a previous abortion, and a relation­ ship with her partner which I see as extraordinarily fragile; somehow I experienced her like a tight-rope walker, in great clanger of falling into the void. . . . This made me feel the need to go very carefully, maybe excessively so, because I was having a rough time on her account. This might have made me go behind the parapet, I don't know. . . . I don't know how you see it. D.M.: Yes, most probably it is true; I am sure that you are running the risk of having your heart broken. But you have had it broken before, so you shouldn't worry about it happening again. (Laughter) Ps: Does the tiger mind getting one more spot? D.M.: Lefseat.

22

[MAY

1998]

Eduardo A pleasant but disappointing liar Carlos Tabbia

T

he new development in Eduardo''s situation is the end ofhis two-year relationship with the girl he was going out with. She left him. Not much else is new in the external world. He is worried about his father's physical deterioration and is beginning to think that life is not eternal He is getting closer to acknowledging certain things but moves away immedi­ ately into reacting, playing the fool, and talking endlessly. I see him five times a week. Monday

session

P: It was a curious weekend. On Friday I went out with friends. called me from Madrid, he was with Sole. . .

Ricardo

(Sole is a girl Eduardo is beginning to court; she lives in Madrid. Eduardo says he is having sexual relationships with lots of women, having great success.) ... I was feeling sad and low; they said I didn't look the same person, but they were dull people so I began to exchange text messages with Ricardo on my mobile. I cheered up and went out on the town with the people I was with. We met a girl who is a bit of a lioness and is sort of going out with Ricardo.

294

MAY

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EDUARDO

295

D.M.: Does he know that your other surname is Leoni? CARLOS:

Yes.

. . . there was also another girl, quite sweet, but she did not want to come home with me, so I stood in front of the lioness with a spare helmet in my hand and she came with me; we went to her place; we were quite drunk, so I put a condom on but I couldn't feel anything, I took it off and carried on; I came, and then I went to sleep. On Saturday I went out with Nuria,

who

has just separated. She wanted to see me; we went to spend the night at my place. We slept in each other's arms until Sunday afternoon. When I am on my own I never sleep so deeply. At 8 o'clock I took her to her house, and I felt a bit sad. The only girl I have felt like that with is Sole; the others don't matter very much, neither does this one. I don't know her very well and she has two kids, so it is a bit complicated. It is as if a new vista of girls had opened up to me.

D.M.: How did he feel with Sole? C : He liked her very much. He fell in love, he was captivated by Sole, who is beautiful, intelligent, and sexy. D.M.: He spent three days in erotic activity with her? C : That was a different weekend. Sole is in Madrid. He has been going out with two women in the last week: with the lioness and with Nuria. I have introduced a technical change: I use the " t u " form now; I talk to him more as if he were a child, a 14-year-old. Sometimes, when he is so verbose, I ask him to look at me so as to make contact. T: What opened up to you was your loneliness as you left on Friday; you felt sad until you managed to touch somebody, to be in close embrace

with

somebody. It seems as if you spent the whole weekend looking for some­ body to rescue you from feeling sad until you came back today. Now

you

can look on what happened in the weekend as something

The

curious thing is to be embracing

curious.

someone.

D.M.: Not even like a 14-year-old boy; he is behaving like a baby who moves between mother and nursemaid. It is just skin contact. P: Yes, but somebody I like, because that girl on Friday was very she is always spewing filthy words about everything.

unpleasant;

. ..

T: It is quite clear that you weren't looking for a woman or a partner, just a teddy bear with soft skin that you can hug so as not to feel so lonely until you come to the session. It didn't matter whether it was the blonde girl, or the lioness, the separated one or the other one—they are all fluffy dolls for you not to feel so lonely.

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P: (Silence) There are two things. That girl I was with on Friday was just that. I was with Ferrdn and Pedro and they saw what a show I can put on (laughs); I get inspired when I am with them, I overreach myself. T: Putting on a show, you get people to look at you.

D.M.: He made a scene, put on a show. He was doing some kind of play-acting. P: Yes, the whole bar was looking at me. T: You need people to look at you, a girl to look at you, friends to look at you, mum and dad, somebody to look at you while I am not looking at you.

D M . : Like a 3- or a 4-year-old child saying, "Look at me, mummy, look at me". P: After I left here I was supposed to meet the other girl to fetch the results of the AIDS test. And the other one asked me for the address to go and have a test done, but I don't think she went today. (Silence) This morning I went with my father and Daniel [one of his father's colleagues] to see some works; it was a bore because there is somebody there that I don't like at all. After that I had arranged to meet Jocelynfor an English lesson, and then I went to the office where I started looking at what one of the girls was doing on the computer; I suggested a better way to do it, and it looked better. (Silence) T: You have jumped from the subject of AIDS to the building site to teaching that girl what to do.... It seems to me a very quick jump from one thing to another. P: Yes, I'd rather forget about AIDS until I've got the piece of paper in front of me. T: You'd rather forget the subject. P: Until I've got the paper saying yes or no it is better not to think about it. T: You don't want to think about how you risk your life; you were saying that you used a condom and then you said, laughing, that you took it off until you ejaculated. On the one hand there is an attempt at looking after yourself, but something to do with destroying yourself comes up at the same time. P: I don't know, at that moment.. . . T: And insofar as you don't know if you have the antibodies or not, perhaps there was an attempt at looking after the girl by using a condom, or at attacking her by not using it.

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P: (Smiling) I didn't think about that yesterday. Since she is a girl with a sound reference, I didn't use any protection, for her or for me either (silence). ... (Smiling) I was thinking that if the result of the test was positive I would have to tell a lot of people—would I then tell them straight away or maybe three months after I've been with each person? But three months of thinking whether to tell or not would be a right pain. The best thing would be to tell them because they might go with someone else.

DM.: What does he mean by a girl with sound references? Transl: One you can trust D.M.: And does that mean that in that case he doesn't have to look after her and she has to take care of herself? C: For him it means that she doesn't go with other men, so he is not worried. She is not like the lioness, who goes with anybody. Ps: Okehim. T: You are thinking whether you should tell or not, but when you say that you might have caught AIDS you say it with a smile; it is rather contra­ dictory to be thinking about that and smiling at the same time. P: It is to cover up that I am worried. T: What are you worried about, then? P: The fact that it might be true. T: And then? P: 1 am smiling now but it is not because I am not worried; it is rather as if the situation had changed. When I smile I don't think that I am smiling, it is as if you'd caught me red-handed trying to slip away, being naughty. T: Trying to slip away you can have quite a crash P: (Annoyed) I can't crash badly now trying to slip away. It is just a way of not thinking too much about the problem. T: Not now, but when you function in that way, taking your condom off, you are very close to having a serious accident. (Smiling) I think P: But I can't feel anything with a condom on (silence).... I am going to put a bit of lubrication inside the condom, at the end; it hurts otherwise; it is just not fair, on top of not feeling anything, it hurts. (Silence) The mechanic called me to say that the tyres haven't arrived; he kept me on the phone for twenty-five minutes, he wanted to buy some tyres I have; I was not in a good mood; he offered me a lot less than I asked for, so I didn't take his offer. I'll sell them myself. (Silence)

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SUPERVISIONS WITH DONALD MELTZER

D.M.: It is quite clear that when the condom is rolled up it is like a small tyre. He makes no difference whatsoever between bargaining with the mechanic on the price of the tyres, and agreeing with the girl whether he is going to use a condom or not. As if the small amount of money involved in the sale of the tyres were equivalent to the question of AIDS, of having it or not, of passing it on to the girl, etc. At this moment he is being completely superficial to the point of stupidity. T: You weren't pleased. P: I was thinking about that chap, he is a bore; I don't like the way he behaves. I wonder why on earth I still have anything to do with him.

D.M.: His level of understanding of what you are doing with him is paper-thin. ... He imports certain spare parts, you see, but the mechanic that I take my motorbike to can import them too. T: You don't like what we are talking about; you felt I was upsetting you by forcing you to get in touch with that feeling of anxiety about whether you are all right as regards AIDS or not. You wanted me to smooth that pain, that anxiety, and when it was clear to you that I wasn't doing that, you got annoyed with me. Perhaps you thought that I gained something by not setting you free from that suffering. P: (Silence) I was thinking about JP. He died of AIDS, he was an excellent maths teacher, and he got infected through using needles. He used to smoke a lot of hashish, and I was just remembering that peculiar smell of his.(Silence)

D.M.: This is a rather indirect way of saying to you that you smell. He suspects that you smoke hashish, that you are only interested in the money, and that you are a hypocrite. You should make it clear to him that he is insulting you, because he is so stupid he doesn't even realize it. I had a pain here in my shoulder this morning. According to the shaman it is a build-up of emotional problems. I was thinking that I enjoyed Satur­ day and Sunday because that girl is very nice, and she has all the good qualities: she is elegant, beautiful, has good manners, is good at her job, intelligent, clever; the only thing is she has two children. We had a lovely time. (Later on, when I read through this, I thought that maybe he was referring to his mother, who is good-looking, clever, intelligent, and upper-class.) She called her friend, who in turn called JJ, to say that she had enjoyed it

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with me. Felix called me to go and see Alive in Quico's house, with two girls who are nice. I was thinking about that; there was a chap there that I dislike.... (He is referring to the fact that this man refused to drink from someone else's glass, for fear of getting infected.) T: You are truly worried about having some fatal disease. Are you perhaps a survivor like the people in the airplane that crashed in the mountains? However, what you are facing now is your mortality—you too will die, from AIDS or something else. Time passes by also for you. P: I have been worrying about it for a long time; it used to worry me more before. When Rita left, I got involved again, then she asked me if I had got together with somebody else and said she would understand it; she would understand it, because she must have got involved with somebody else. T: You go out with lots of girls, with lots of teddy bears, and it is because of your anxiety at seeing time ticking by. P: What time? T: The time of your life. What are you doing with your life? P: Some girls, friends ofLuisa's, asked after me the other day—who was I, they asked. It was Nuria who told me, but J.J. had told me already. I thought: this girl is with me now, but what does she know about me? T: What do you know about yourself? P: Well....

It hasn't been easy for me.

D.M.: What day of the week is this session? C: Monday. D.M.: It is not any different from what is usual in him. . . . Lef s carry on. C: On Tuesday he got the result from his AIDS test; it was negative. Wednesday

session

P: I was thinking about Maud [the lioness; she is English}; I was with her on Saturday when I took my condom off. ... So I called her to remind her to have an AIDS test done; she got cross with me for calling her about that. . .. She said she would have one done. In the waiting-room I remembered that Maud said that blokes who fuck a lot use condoms, but she has a friend who got AIDS from a man who had not been with many women. I thought about the girl I was with on Sunday; she separated from her

300

SUPERVISIONS W I T H

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husband a month ago, I wondered what her husband's habits might be, maybe he passed something on to her. As I was thinking about her I remembered that when we were making love I took her hand and put it between her vagina and my penis, for her to touch it; she got very excited (smiles). I've just come from an IT class; there is an icon of a finger there to indicate that you can go to new pages, but you don't know what there is in them; that's what I was wondering about when I took Rita's hand to that spot, the limit between oneself and her, what does that mean for a woman, what is it that excites them so much. Ricardo came to see me from Madrid yesterday; his powers of observation surprised me; he is a music lover, he made some comment about my voice and Sole's which showed me that there are so many things one has to pay attention to. Sole was talking with her friends and when he gave her the mobile phone to speak with me her tone of voice changed, he imitated that inflection for me (smiles). He said that it showed she was mad about me (blushes). I said to her: why didn't you invite me that night? There was a clear change of inflection in her voice. I liked the way he observes sounds so closely. He told me that Sole is straightforward, full of energy, like a missile, clear and simple, and that it shows in the way she lives, with vigour. I said to him that reality is not quite so plain and simple, and that there are lots of rough patches, and that a plain personality does not adapt well to reality, that there can be conflict because reality is a lot less smooth. I am thinking about setting up a lab area with Sole and some good students; I would like her to run it, it would give our office more recognition. ... Some of the best engineers from the School of Engineering & Transport have made a name for themselves through taking part in competitions. That's the line I am interested in. T: And when does the missile explode? P: Hum, I don't know.

D.M.: How much homosexual activity has he had? C: This year he has been seeing transvestites; he takes them to his flat; the last time two of them mugged him in his own house. He is pen­ etrated, and there is mutual fellatio. T: You are following a downward trajectory, like a missile, and you are already talking as if you were a famous engineer promoting good students. It is not easy to understand: on the one hand, you are curious to know what women are like, what they feel, what they have inside, whether they have a virus, and then suddenly you say women have thoughts, they are intelligent, interesting. You express interest in getting to know reality

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and suddenly you turn into a genius promoting other geniuses. The change is so considerable; you get excited like the woman who was touch­ ing your penis, you get excited talking, and you are about to explode. You never will catch AIDS with this kind of auto-excitement, but you never will have the experience of meeting somebody, not while you are trapped in this endless talking. P: (Silence) I was thinking about a statement I have to write. We have lost a court case against the owners of the otherflats. I never thought we would win it. We have wasted money and time. We lost a grant; all because the chairman sabotaged a meeting I had called without consulting him or the administrator. The case has cost a fortune, and now my father's got enormous bills to pay. T: What would that statement say? P: It would explain the truth of the matter to the residents. DM.: It is not so much a question as a matter of fact. The statement would explain the facts of the matter to the residents. He wants to sell them the truth. He thought he was clever deceiving them, and it turned out that he was stupid. His idea in the end turned out to be stupid because he is stupid. C: Yes; that is what is happening. He organizes big projects; this court case is something he organized, and he makes mistakes. He is now in charge of his father's money, he places it on deposit, moves it from here to there, sometimes he wins, sometimes he loses. Can it be true? D.M.: His feeling that he is clever is based not just on what he can do with his mind, but also on his opinion that other people are stupid. T: Who lost the case? P: We did. T: Who? P: My father. T: So through your bad management your father lost out. P: (Arguing) My father was paying for the electricity in all the storerooms. T: Let me ask you, do great exhibitions sometimes end up in failure? P: No. I got to the nitty gritty. I sorted it out, and as always when I start doing the work I see the problem, and I see also that few people get to the heart of the matter because it is difficult. I like that, not many people can do it.. .. What annoys me is that after you've done all that work you have to go through the proper channels, the ridiculous formalities. ...

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D.M.: It is those formalities that will show that he is being dishonest, deceitful, etc. T: So you are saying that you failed when in fact you were

thinking...

P: (Interrupts me) 1 had done a lot of work! To hell with them! Let them pay! The problem was that we were paying far too much, but since they were so stupid let them go to hell and pay. Then Til show them how they could have saved a lot of money. I screwed up! I was so fed up! T: When did you screw up? P: One option would have been to carry on fighting to save my father money. (He repeats things; he is annoyed with the Residents' Association chairman, who, he says, is in cahoots with the administrator.) .. .1 was sofurious, to hell with them. I shall show them what a waste it is. On advice from my solicitor I stopped paying the Association dues. We have the legal costs to pay. I didn't achieve any of the things I wanted after all that work. (This feeling of not achieving anything is appearing regularly.)

Ps: Do you think all these girls that appear here are true? C : No. Ps: It is not so easy to pick up girls. D.M.: He boasts. It is boys bragging about the number of girls they've had and made love with. His feeling of being irresistible is based on having found a girl like the lioness who fucks anybody and makes him believe that he is irresistible. That is the prostitute's job: to make the man feel irresistible. What he calls working hard is planning how to deceive people. He feels betrayed when they get together and compare stories, and the other members see that their stories don't match and that he is a liar. He is having to face up to his failure more and more, even his failure in keeping up an erection— that's why he has to take his condom off: " I can't feel anything with it on." T: It resembles the missile: there is talking, organizing, saying things, and then suddenly an explosion and punishment; maybe it is related to the type of indiscriminate relationships that end up in AIDS punishment.... You start getting very excited, talking, masturbating or being mastur­ bated, you are euphoric and the explosion is dangerous and harmful.

D.M.: The truth is that he is probably becoming quite impotent, even

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in masturbation. More and more he needs to use perverse and homo­ sexual fantasies to masturbate; this is becoming quite frenetic. P: I was thinking about Rita's house. The English girl, Maud, was criticizing me because over here we make love without condoms; she said, how can you ask me to have an AIDS test when you took your condom off the other day? How can you say that to me? Only by assuming that lama good boy... if only you knew the things I've done you'd be really worried (smiles). T: And you say that with a smile. P: Yes, I find her stupidity funny. She thinks she is clever. T: She thinks she is clever, hut you ... P: (Interrupting me) I think I am stupid. T: Truly, you think so? P: Yes. T: Why? P: Because I am. Look, I am paying the price for some missing bit of me that doesn't fit. Sole called me yesterday, she.... T: What bit are you missing ? P: The one that is not missing in her. We haven't seen each other for three weeks, which have seemed like two months to me. A lot of things have happened to me because of that missing screw. T: What screw? P: I don't know, but it is not missing in her. Sole does not lack whatever it is that I lack, the reason I'm like this. The absurd explanation would be: she very much wanted to see me.... Ricardo noticed in her tone of voice that she was saying at long last I can talk to you. She is capable of living her life and containing that feeling. When I came back I very much wanted to get organized, and I was doing well; I started IT and English, I have control­ led myself a lot more than a fortnight ago; but on Saturday I went out with Nuria, a class act from a very good family, but I prefer Sole and yet I was with Nuria. It is difficult to accept that without concluding that something is not right. T: What is it that is not right? P: A need that I cannot contain. T: What kind of need? P: The need to feel loved; being able to assume that even if the person is not there they love me, they will wait for me.

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T: And you think that nobody loves you. P: I surprise myself every weekend. On Friday, for example, I was feeling very low in the afternoon, I didn't want to do anything, I was sad.... I made an effort and since I have a reputation as a number-one heartthrob, which is very flattering (smiles) I get going in the end, I cheer everybody up and have a good time. I was like that during the dinner until I spoke with Sole and noticed that she wanted to be with me, I got so excited, so happy. I transmit it. T: You feel happy when ... P: (Interrupting me) Someone loves me. T: Why is it that you don't feel loved? P: Maybe because I don't love myself (smiling). T: Perhaps. Is it true that you don't love yourself? P: Sometimes. Sometimes I am pleasantly surprised at myself. T: How? P: By the things that occur to me. T: And sometimes by the way you treat yourself. P: By my lack of perseverance. T: On the one hand by your lack of perseverance and on the other by the risks you take.... P: What annoys me the most is that when I feel unloved I feel so low, devoid of energy and of willpower. My father used to think that I was a good-for­ nothing because I lacked willpower, but when they put me onto the motorway services project and then the bridge they saw what I was capable of They find it hard to admit that I am the only one who could do that work. T: Here comes your grandiosity again: you are the only one who can do it Ithe patient still talks on and on]. As soon as you get in touch with the sadness offeeling down [he is trying to interrupt me; I ask him to wait] you start getting excited and end up as number one ... and then comes the explosion. P: What makes me sad is needing other people in order to do things properly. But the bridge did require a lot of people, and it had to be people who trusted me. In the end the work in the office had to follow the same direction. And when I say that I was the only one who could do it and that is how it turned out, I can see things clearly in my head, but other people had to be involved. Some of them helped, and some were a hindrance. But

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with Sole, I don't want to make that mistake, because she has incredible potential And she is in the situation I was before I started the bridge. T: With a difference. You said before that there is a difference between Sole and you, which is that she can have a thought and hold it but you can't. P: Yes, but she is 23 and I am 37. T: So apart from the difference in sex and in age, you are different in that she possesses a quality that for the time being you haven't developed, which is that because she is not so dependent on other people, Sole can be on her own, whereas you say that you can't, you say "I need people to stimulate me, to support me, to encourage me"; you fall apart, you say. She has her own stimulation and can do things properly. ... And I think that that is what makes you sad: seeing that limitation in you. P: (Silence) Yes.... That limitation stems from another aspect: the sensation that the world is big; this girl is 23, she comes from Alicante, she is finishing her degree in Madrid, and she is very competitive. That is a source of problems because I am not competitive, so I don't know how long I can bear it. I can't bear blind competitiveness like myfather's; he doesn't listen, he is not receptive.... Iam competitive but also receptive.... (He goes on and on) T: What are you doing now: is it thinking or is it competing with me? Are you trying to understand what I have just told you, or are you trying to prove that you are more intelligent than me? P: Actually, I agree with everything you said. T: Yes, but in what way? You immediately start to find explanations. P: You said that Sole has a quality that 1 don't have, and that means I have to think harder about it.

D.M.: There is no doubt that you are faced with the problem of his grandiosity that keeps collapsing. And it keeps collapsing primarily because he is in a hurry to get into action; to act out his aim of deceiving people is his objective. He likes to consider them stupid and that makes him feel clever. When they see through him, because he is so transparent, he feels betrayed, disappointed. All this is absolutely true in the transference. He is, as you say, tremendously competitive in the transference. He is competitive with you in a simple way, like a small child who says my penis is bigger than yours, it fucks more than yours, and that is the only thing that is important. That is his stupid, small child, definition of manliness. And especially at this particular moment it helps him not to see his homosexuality, his fraudulence, his boastfulness, his showing off, etc.

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He talks a lot, he interrupts you, makes long speeches, he is the victim of his own tongue, he talks on and on. It is not that his tongue confabulates or that it lies, but that it can hide the truth: this man hides the truth through language, he covers it, it becomes invisible; he var­ nishes or paints over the truth so that he doesn't have to see it and doesn't have to think about it. But all the while he is revealing the truth about himself: he is 37, he feels 67, like his father who is failing, becoming weaker, unable to keep up an erection unless he changes girls constantly, and even that doesn't help. He is finding that even using girls to masturbate him he cannot do it properly without calling forth perverse and homosexual fantasies. In the field of action, he is doing two things: one is finding girls who are prepared to go to bed with him, and another is trying to be an engineer and design things in his father's studio, such as a motorway or a bridge. Like many young engineers he is inclined to think that the ultimate value of anything one designs is an aesthetic value, that it is only a question of people's tastes, and that there is no criterion for a successful design and a successful piece of work. And yet in matters of design things have to be fit for the purpose for which they are designed; that is the first thing. It is not just a question of aesthetics. And in the second place, they have to be cost effective. But since he thinks that it is only a question of taste, of opinion, then he only has to deceive stupid people and in that way become a superior engineer, thanks to his ability to deceive. He is not able to see that in time people will come to realize what he is doing, will uncover his deceit, will find out his game because of the cost. It will cost too much since the building methods are irrational and will not fulfil their function or the work will fall down because it is badly done since the engineer has lacked precision, etc. In time, it is like taking his condom off in order to have more sensation on his penis, to have an orgasm; eventually somebody will catch AIDS, probably he will, too. In other words, he doesn't believe in reality, or that he is doing anything that has to do with anything real. I didn't understand the bit about the cost of the electricity, but one can see that he is cheating and has been caught. And yet he is very trans­ parent; it is equally transparent that he is incapable of maintaining a satisfactory relationship with a woman. With his charm, his sense of humour, and his boastfulness he can take a woman to bed easily, but soon she susses out his game because it is quite transparent; he cannot relate to people with the exception of offering women an erect penis, and even that is failing. So when he says, " I am stupid", he means I am

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a fraud, a liar, a cheat, and on the other hand he is also saying " I am an erect penis". How long has he been in analysis with you? C: Five and a half years. D.M.: We are getting to the point when you have to say to him that your patience is not endless. All this is true in the analysis; he is not capable of keeping an analytic relationship and making use of it, and this runs parallel to his inability to be an engineer, a lover, or a hus­ band; he is incapable, and it seems to be because his life is directed by his gift of the gab. It is a type of splitting in his mind where his tongue has its own life and he tends to follow it like a small child who follows his older brother. It is not that this tongue is a liar, but it has no respect for reality, it believes what it says, and it thinks that there is no crite­ rion that can prove that what it says is a load of lies. This in many ways is probably rooted in his disbelief in his father's expertise. But you cannot check his opinion about whether his father is an expert or merely a clever businessman with an ability to manipulate things. C: He has the reputation of a great engineer. His projects are impor­ tant and notable in Barcelona. D.M.: He might have a good name, but we don't know that he is a good engineer. However, the real problem is his mother; he doesn't understand her. His mother is a puzzle, a mystery. It is quite clear that he does not understand women, why women get so excited about men, or why they get so excited when somebody takes their hand and places it on an erect penis. He doesn't understand the division of women into two categories: 1. Those who are happy to have their hand taken and placed on an erect penis. 2. Those who resist it and are not prepared to get excited with a partial object. That is to say: those who use their own judgement. In any case he doesn't quite understand your relationships with women and what kind of women you have in your life. What does he know about you? Does he know anything? C: My wife sees children in the same apartment where I have my consulting-room; he has seen a woman—my wife—and children com­ ing in and going out. D.M.: It is possible that he has interpreted that this woman is your wife, and that you work together.

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C: Yes. D.M.: This is important really, because it implies the possibility that you two have talked about him. In that case he probably thinks that your wife is constantly saying to you: "get rid of him; you will never make a man of him. He is a perverse child with a dirty sexual mind and you will never turn him into a man." I think that it is quite important to establish the combined object in the transference situa­ tion, a combined object where there are contrasted opinions about him. What is his place in the sibling ladder? C: He is the youngest. D.M.: The problem of the disagreement between his mother and his father as to whether anything can be done with him is that "you cannot make a silk purse out of a sow's ear". In his relationship with women he is having to face the problem that women see him as he is and reject him. He is having to use his last card: putting their hand on his penis in order to excite women; that is the technique of a desperate man. His desperation is reaching critical moments. You have to gather all this in the transference . . . he has exhausted you. This crisis in the paranoid-schizoid position is very frequent in patients with a strong perverse disposition. One has to try to convince them that this kind of material not only doesn't excite you, it is boring. For you he is a bragging, masturbating, little child. You understand what he is like; you have seen that he had potentialities for growth and development and for becoming something different, because some­ where inside him there is potential intelligence, but like Rosa's patient he is uneducable, really. He relies a lot on the idea that he is entertain­ ing, but he isn't, he is repeatedly boring. It is useless to try to get closer and touch him with depressive anxieties . . . nothing touches him; he shakes them off like a dog shakes off drops of water. Making him think about AIDS doesn't get through. He gets rid of it by playing the fool. He is the type of child about whom it is said that he is always seeking attention. He wants attention.... But he does not distinguish between attention and admiration, because he doesn't realize that he is looking ridiculous. You could say to him that judging by the way he talks about all these dates with women it would seem that he thinks they are all whores and it is not possible to establish a relationship with them, or that all they want is a penis and he is the greatest womanizer in town, etc. You could say to him, it's as if you believed that these girls are nothing but whores and have no capacity for judgement. The truth is

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not that: they are young girls, and naturally they have hopes; in some cases those hopes take the shape of a certain promiscuity, of thinking that if you go to bed with many men, you will in the end find one. There are also others who are more prudent and use their own capacity to think. Based on what you observe in the consulting-room, you can be sure that nobody is impressed by him, except the other boys, like Ricardo, who believe in his stories. These days, in the present atmos­ phere, one finds a lot of adolescents who think they are irresistible and frequently change girl-friends because the girls tire of them quickly. Their tactic is to change girl-friend quickly so that it looks as if it is they who get bored. In the case we have here, the moment he begins to feel sad he turns into a party person, an entertainer. He is a sad, uneducable, small child who is being led by his bragging tongue; so impressed is he by it that he is open-mouthed before it, as he was before his brother when he was little. The fundamental thing is that women are a mystery to him. Any woman who seems to be intelligent and able to think frightens him. You have to make clear to him the reality of the worrying situation in the analysis: that he is a tedious, boring patient. A simple way of doing this is to reduce the number of times you see him. I would not see him five times a week. C: He says that coming to analysis is the only thing he does in his life and that the weekend seems very long to him. He says that he doesn't work or spend time with anybody. D.M.: So everything else he says is boasting, emptiness, boredom. C: Yes, sometimes I stop him with, "what are you saying?" I make him check what he is telling me. He realizes things and gets depressed. D.M.: I would make it clear to him that what he is saying is not entertaining. C: How can it be when it is a dramatic situation? D.M.: The combination of perversity and money is very hard to break. C: At the present moment, the money is not so obvious. D.M.: There is a lot of money floating around. C: Not really. Sometimes they haven't got enough to pay the salaries. He is beginning to see himself as somebody without a job, qualifica­ tions, or money. D.M.: When you say that he won the contract, do you mean that his father's firm got the tender? C: Yes, but the design was his own.

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D.M.: Is that a fact? C: The client stated that two conditions had to be met to do the project. D.M.: Nevertheless, it's the prestige of his father's firm that won the

contract; he wouldn't have done it on his own.

C: Correct. He says so. He says: my father is getting ill, he will die, I

don't know how to work, what will become of my life.

D.M.: Yet his father doesn't seem to get tired of him. It is difficult to

understand.

C: There are times when I feel like having a word with them. It seems

that they don't know what's going on.

D.M.: His father must know. Being an efficient engineer capable of

designing motorways because he's driven on lots of motorways is not

the same as being an experienced engineer. It is hard to imagine that in

designing this motorway he is going to solve difficult engineering

problems.

C: What he does, as was the case with the bridge, is that he has the

idea and then he finds the experts to do the work.

D.M.: He subcontracts.

C: Yes. He has just done a yacht basin, for which he found a naval

engineer who did the plans. He has the idea and then looks for people

to carry it out.

D.M.: He knows something about getting contracts in the industry. To

win contracts, two things are needed: first, to be a good salesman, and

second to be good at calculating costs, otherwise you can lose your

shirt. I don't find it hard to imagine that he is a good salesman.

C: This last week he was very anxious because he had no idea about

how to calculate costs for the motorway service area. He had also been

asked to do another project by the same firm, and that one was thrown

out because of its high cost.

D.M.: I shouldn't think he is a good calculator; I think he is a good salesman; he can boast and win people over. You cannot wait until he collapses. I have a homosexual patient who is a skilled confabulator and a great talker; he has been with me eight years. In his grandiosity he started a project that I warned him was a stupid project and would lose him his money. And that is what happened, he lost a million pounds because it was a badly conceived, idiotic project, but this has not

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touched his grandiosity, because although he is a building promoter he fancies himself as an artist. First he was a dramatic artist and he wrote plays—his great play was a re-writing of Shakespeare (laughter). Next his grandiosity consisted in his desire to be a poet; he wrote a two-hundred page poem in two weeks. Then he decided he would learn to be a poet. He was accepted in a "creative writing" PhD course at Oxford. Anybody with a first degree can, in principle, be accepted in Oxford; you only need to pay and then fulfil your supervisor's de­ mands. So for three years he was a PhD student in Oxford; he never handed in anything, never saw his supervisor, and finally he was thrown out. But during all that period he introduced himself every­ where as a PhD student in Oxford; he ate in the students' halls, etc. (laughter). Then the great project presented itself, a worldwide art project, for which he succeeded in getting drawings and numbered reproductions; he was going to make a catalogue of the reproductions and sell them at £50 each, etc. This ended up costing him nearly a million pounds. Now he has decided to be a painter; he has enrolled in the best art college in London; he attends lessons religiously but doesn't manage to paint anything. He is always busy with his proper­ ties and their adrninistration and his account books. I have cut down his sessions to one a week, and he pleads with me to see him more often; at the end of each session, he leaves saying: "Still not twice a week?" And I say: "You need to learn to do something with one hand because your other one is busy in the nut bowl", which is how they catch monkeys in India. His hand is in the pot and he cannot let go of the nuts, so he cannot get it out; he can't let go of his money, mostly received from his parents. His grandiosity is slowly coming down, but very slowly; for the last two years I have been seeing him once a week. As far as I know, his homosexuality has almost totally disappeared, but I never know if he is telling me the truth. His relationship with women is very peculiar: he is attractive to women, but he is asexual with them. He has now come up with a great invention with which he hopes to make a fortune: a public toilet for women that will allow them to pee standing up (laughter). He is sufficiently good as a businessman and as a salesman to obtain a patent and get in orders, etc. He can see in his mind a line of toilets for women, a kind of chorus line. What a pornographic image! (Laughter) So in the last eight years he has moved from re-writing Shakespeare to inventing this great public conven­ ience for women. C: My patient is not so grandiose!

312 ROSA:

SUPERVISIONS WITH DONALD MELTZER

There is a link between grandiosity and money . . . in my case

too. In mine it is not so much money as prestige. He earns 150,000

pesetas a month, out of which he pays for the analysis and has little left

to live on.

ROSA: Mine too.

D.M.: But he lives with his family and has no expenses.

C: He lives in an apartment that belongs to his parents, and he eats in

their house.

D.M.: He is quite well subsidized; he eats there, sleeps there, probably

doesn't pay rent or taxes....

C : No.

D.M.: It would be worth making an analysis of his financial situation

to show him that he is still a child that his parents subsidize. For a long

time now his parents have had no hope; he will not do anything, they

are just keeping him out of jail.

C : What would happen if one had a meeting with the parents?

D.M.: I don't know. It would be a bombshell. Even with a child you

have to proceed with care as far as seeing the parents, except if it is

they who ask, and even then. . . . The fact that you are talking with

your wife about him worries him. Somewhere there is a mother say­

ing: "Nothing can be done with this child. Leave him. Lefs find an­

other one!"

Ps: Is he the youngest?

D.M.: He is the baby. The baby.

C : So what age is he?

D.M.: He functions as if he were 3 or 4 years. "Look, mummy, look at

me." One of my patients is a great confabulator; her daughter fell

down recently in the playground in the park and broke a leg as she

was saying: "Look at me, mummy, look at me.

C : Is he a confabulator or a liar?

D.M.: I think he is a liar.

C: So it is not that he has a thought disorder but that he is bad.

D.M.: There is a famous book and a play, later made into a film, called

Billy Liar. He was a lovable liar. Lie after he. Boasting, boasting. An

agreeable liar.

C:

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Ps: All of these people are. D.M.: But, do you like Eduardo? C: Yes; I feel pity for him. D.M.: Yes, but do you like him? Is he a pleasant liar? C: He is an intelligent young man, and instead of living . . . he is so stupid. You had suggested that I interrupt his analysis, but I can't see how interrupting his analysis without a future.... D.M.: No. One only threatens to interrupt the analysis with those patients that refuse strongly to go into the threshold of the depressive position. He is far away from that threshold. Although as I said in the case of my writer-painter-artist-inventor-etc. patient, reducing the sessions has made his attachment to the analysis stronger, but his material or his cooperation with me have not improved. Reducing the number of sessions has strengthened his attachment, and one tends to think that by interrupting the analysis you would be taking away support points [as he moves each finger away from the window-sill) and he would fall over the brink. I wouldn't interrupt the analysis. I don't particularly like this patient of mine especially, but he is charming. C: Each time I bring him I feel guilty, because I am bringing a case that Donald doesn't like, but I am still faithful D.M.: I am not directly exposed to this man's charm. I would also like him if I were exposed to his charm. My confabulator—whose daughter broke her leg the other day—is also charming. The first time she lay on the couch, she took her glasses off and said: "When I take my glasses off I can have any man I want." Actually, she is quite ugly; in fact, she has had no success at all—she has been a total failure C: Last week I suggested that he sit up, just to snap him out of i t It startled him; he said: "maybe later on, but not just yet." D.M.; He doesn't want to see your eyes. C: We tried an experiment some time ago in order to cut him short, which was that he should turn around. He became a terrified baby; while he is on the couch he can say all sorts of things, but when we are looking at each other he appears like a frightened child. D.M.: Like a child who is being called into the headmaster's office. Naughty children. C: Dirty. D.M.: Dirty. Charming, naughty, young children.

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C : The other day he started spitting inside Sole's car, then he took his

shoe off and cleaned the spit off the roof of the car, Sole took his shoe

and threw it out of the window; so he was in Madrid without shoes

and he had to go and buy a pair. Later on he was able to admit that he

was dirty and he felt ashamed.

D.M.: Now he can see a dirty and naughty child. He won't leave

behind him a string of women with broken hearts. He is not a heart­ breaker, only a disappointing person.

C : He is attractive; women who are looking for a date take him to bed,

fuck him, and then throw him away like a dirty condom.

D.M.: True. He hasn't developed yet the technique of being the first

one to break off and dump them.

C : He is being left without women.

D.M.: I can understand why you feel this pity for him. He is a poor

man; maybe his father feels a great weakness for him.

Epilogue

Good luck

Donald

Meltzer

A

n opportunity like this is just an opportunity to talk and to find out what you are thinking. And what I am thinking is, as usual, a bit scandalous. I want to talk about history and mythology and how similar they are. I have discovered in the last year that there are at least three people who are writing the history of postKleinian analysis. The one I have read which I thought was pretty impressive is by Silvia Fano Cassese,1 and it was really a work of fiction, mythologizing my so-called contributions. It reminded me im­ mediately of War and Peace and the wisdom of Kutuzov, which con­ sisted of apathy and inactivity, allowing Napoleon to make all the mistakes and to create history through his mistakes. Well, my contri­ bution has not been quite as lethargic and inactive as that, but it has consisted of an invasion of a space that is really a mythological space— the space of the unconscious. If we freeze to death when we are there, it is nobody's fault but our own; and every time we try to treat a psychotic we are in danger of freezing to death, really—when we meet the coldness of the patient's response to our passion, turbulence, ex­ citement, and so on. It is a very corrective experience to realize that L e c t u r e g i v e n i n Barcelona, October 2002. introduction

to the Work of Donald Meltzer ( L o n d o n : K a r n a c , 2002).

315

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your own passion does not communicate to the patient, whose exper­ tise at resisting excitation and interest has been developed over the years, and you are confronted with this stonewall of indifference. Well this, strangely enough, makes for a kind of mythology of history, in which the analyst, like Kutuzov, manifests his inertia and allows things to happen in this space, with the patient or without the patient. And, of course, the amazing thing is that things do happen. They more obviously happen in the very young children, whose symbol forma­ tion is in action and is describable, and there is no guesswork about it—the child does crawl under the table, does disappear behind the couch; he does create from these flexible pipe-stems a world of phan­ tasy figures that are marvellously explanatory. With adult patients, of course, you have nothing to rely on but dreams—which are pretty good really, as far as their descriptive value is concerned, but it is still in the realm of guesswork; whereas the little children don't demand guesswork of you, they just do it—they show it. They don't have to say it; they show it. Now the mythology of psychoanalysis demands that we say it; and what we say, of course, is largely nonsense, but we do show things also, which is not nonsense. And what we show mainly is this passion of interest; and like the troops of Napoleon that are freez­ ing in Siberia and retreating helter-skelter to get away from the mis­ takes they've made, our patients also retreat from the frozen atmosphere that they've been themselves creating; and they leave us time to thaw out and to discover what's been happening to us and to them. So this unconquerable space of the frozen world of emotion is gradually reclaimed, and becomes the three- or perhaps four-dimen­ sional space of psychic life, and imagination begins to take the place of guesswork. Now it is at this point of transition from guesswork to imagination that the real—I use the term "creative"—work of psychoanalysis takes place. Reading a book that purports—and is in fact—a history of the movement of the post-Kleinian era of psychoanalysis, like Homer's Ulysses, is a piece of mythology; and when you find yourself one of the chief actors in this drama, you realize that you didn't know what you were doing; it waits for the historian to tell you what you have been doing and what it meant. And the historian is rather shameless about it. He creates a mythology with a sort of belief in its psychic reality. Of course, that is all dependent on the publishers being willing to publish the book. It doesn't become mythology until the publisher gets hold of it and puts it into print. And then the historians can really go to work on it to establish its authenticity. And in this process of establishing

EPILOGUE

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authenticity, you find yourself, as one of the actors in this drama, sort of mystified—is that what really happened? Did you really know what you were doing? And the answer is, no, you didn't know what you were doing—that is why something happened, because you didn't know what you were doing. It's like this talk: Alberto Hahn asked me what was the title, and I didn't know; I said, you have to wait to the end, to discover what the title was. Well, this is true of analysis; you always have to wait to find out what happens. Or, did nothing happen? This is where the mystery lies: something rather mysterious happened, and it happened in this space created by the analyst and patient, in this mythological space of psychic reality. The patient discovers experiences he has never had before, and he tells the analyst that he has never had this experience before; and the analyst believes him because he wants to believe that something has happened, which is really not definable, but has hap­ pened in the Bionic space of the absence of memory and desire—more correctly called ignorance—which requires a kind of relaxation and trust in the analytic process as something that has a momentum of its own and finds a means of expression that goes beyond words. The spirit of it. Like calling myself a trouble-maker: the spirit of it is fun. You keep telling your patients: this is fun; we're having a good time; we're playing a delightful game. Well, such it is. It is a Wittgensteinian game of language; a language game. A game that nobody wins and everybody wins; nobody loses and everybody loses—where these cat­ egories of winning and losing become meaningless. So if at the end of the game you are told that you have won—you are amazed. Well, the joke says you're not amazed; you're surprised. Yes, you're surprised. Like the Emperor's New Clothes, you're surprised to find yourself naked. But you're also amazed to find that this is the way the game is won. Like what used to be called Strip Poker—the one who is naked at the end wins. Well, I am here before you today as someone who has been ren­ dered naked by this process of divesting myself of the second skin, or third or fourth skin, or whichever Esther Bick would have it—that all this camouflage has been thrown away and you're no longer pretend­ ing that you are the general marshalling the forces against the wisdom of Napoleon. You discover that all you have been doing is reading dreams. And you said all along that you were quite good at reading dreams, although you didn't know what that meant, but that it had something to do with the patient's symbol formation, and your intui­ tive reading of his symbol formation, and attributing meaning to it all.

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Because the heart of the matter is the meaning. Well, here I am trying to mean what I say. That leaves the task of saying what you mean, which is more difficult. What one means to say after a lifetime of psychoanaly­ sis and publishing books, is a cri de coeur that reads, "Help!" Well that's it. The enemy is retreating—not from your wisdom but from their folly, from their having attempted to capture a frozen space and getting themselves frozen in the process. That's the kind of game you've been playing. Now the survival in this kind of game depends on what is called good luck. Good luck. And when you translate "good luck", it means, trust in your good objects. So now, by the end of this brief talk, I can answer Alberto's query about what should be the tide of the talk. The title should be—good luck. Good luck for the survival that you never could have planned, and which happened in spite of all your cleverness and ingenuity. Something that you eventually discov­ ered, and did not invent. Well I think I can look back over the history that Silvia Cassese has written, and agree that, yes, this is a drama in which I have figured as an actor, and it has been great fun, and it seems to have been a game that I have won in the sense of good luck and survival. But i f s no use wishing me good luck and long life, because I have already promised Catharine that I am going to live to 116, whether she likes it or not. And that's a kind of good luck. The button moulder won't get me without a scream and a fight. I have discovered things, of course, discovered things about myself really, which turned out to be also about other people. The main thing is the exploration of projective identification: the intrusive activity of entering into other people's worlds, uninvited, where you have suf­ fered the pains of claustrophobia, felt trapped, didn't know how to get out—because you couldn't remember how you got in in the first place. I think I can claim that I did not invent that; I really discovered it, in myself, and secondly, in my patients. Well it was enough for a life­ time—of fun. Philip Pullman, using his imagination, has developed those novels, his trilogy, about his mysterious space of other worlds and the myste­ rious knife that can cut openings into it. That was first-class imagina­ tive work; it enthralled the children, and it enthralled the adults of the world, and he was so charming and loving in his presentation of it that nobody felt threatened by it. Judging from last nighfs reception and gifts and praises and thanks and so on, one would think that I too have been sufficiently charming and lovable in making my imaginations known. But it wouldn't really be true to compare myself with Pullman, because he truly has manifest good intentions. His final intention,

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which appears in the third volume of this trilogy, is to do away with what Freud called the life and death instincts, and what physicists have called the second law of thermodynamics—that the world is running down. He has really abolished that pessimism in a way that all the scientists couldn't manage, and all the mythologists haven't managed. He managed it by inventing a technique for closing all the windows that you have opened. That is a law that psychoanalysts have to learn, it seems to me: to close all the windows that they have opened with their imaginations, through which the life instinct leaks away and forms the bedrock of pessimism. The world is not mnning down—I hope. Thank you. Comments and replies Floor: I was reticent to speak—it does feel like baring oneself in public, it is something very personal—but I havefound the courage now to say that Dr Meltzer changed all our lives; he certainly changed mine, I was fortunate to meet him when I was very, very young and very immature but well defended; and with the turbulence and passion of his work and his enthu­ siasm for psychoanalysis he changed our lives, changed therapeutically the minds not only of his patients but also ofall those who met him as teacher. Floor: lam Julia Corominas. I don't know ifyou remember me. I just want to say that although thirty years have passed since my supervisions with you for two years on Sunday afternoons, I still remember it as if it was today. I don't know where those thirty years have gone.

D.M.: Well I can tell you they've disappeared into my joints. They have left behind their calling-cards of age. The joke to Catharine that I am going to live to 116 is just a joke really. It is a lucky thing that time passes—that we don't have to understand what time means; it just passes. And it passes for everybody—it doesn't make any exceptions, as far as one can tell. Not for Ulysses, not for Meltzer, not for Freud. The button moulder gets us all in the end. That image of the button moulder, and having to get into the ladle to get melted down for the next series of experiences, is a rather beautiful image of the continuity of life. There are lots of people that I have encountered during these years of teaching whom I really can hardly remember, but I certainly can remember Julia Cororninas. I don't quite know why; there was something vivid and passionate about her that enabled me to come to terms with aristocracy. Having grown up believing that my parents were nature's aristocrats, and that I was the heir apparent, wasn't

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really borne out by my experience of the world as I emerged from childhood. But it was good enough to cover the area of childhood with a sense of security and pleasure. As I look back on my childhood, I can easily recover the experience of the aristocracy of my parents, and the way in which it seemed to me as a child that they ran the world for my benefit. Which they did. This optimism has never completely left me. It is for that reason that books like Silvia's about the Kleinian develop­ ment, the post-Kleinian era of psychoanalysis, seem to me quite fit­ ting—a new dynasty. Floor: A little while ago Dr Meltzer referred to the ineffable experience in the analytic situation. I just wanted to say that in these fifteen or sixteen years in which we have shared supervisions and theoretical study with him something ineffable has also happened, something that it is not easy to put into words but which has given wings to our emotionality. This means freedom, and for that we are very grateful to you.

D.M.: Geoffrey Chaucer,2 in talking about the human spirit, likens it to a horse that is so proud of himself that he forgets that he is just a horse, just one of the members of a team pulling the wagon. This kind of forgetfulness of your place in the world is not something I have been accursed with. I think I have always realized that I was in a state of confusion and that eveiything I had to say would have to be vali­ dated by other people—that I couldn't validate them myself; I couldn't really distinguish between whether I was discovering things or invent­ ing them. And I had a mortal fear of invention—tricky misuse of language for the sake of novelty and so on, a terrible sort of curse. Of course, with people like Kafka you can turn that curse into genius; but I couldn't do that; it would have just been a curse, inventing clever misuses of language. This is one of the ways in which the idea that it has to be fun in order to be genuine, authentic, has been a saving grace for me. It has been terrific fun. And I don't really mind if much of it turns out to be nonsense, eventually—which is bound to be. Philip Pullman's idea of closing the windows so that the vitality doesn't leak away seems to me to be a piece of real wisdom. One mustn't squander one's vitality. Mrs Klein called it establishing the analytic method. The only insurance we have against squandering our vitality is to follow the method. Of course, many patients will complain: but what do you mean, follow the method? Tell us how to do it and we will follow it. There is only one way to tell how to do it, and that is to show it in your Troilus and Criseyde. The Riverside Chaucer (Oxford: Oxford University Press, 1988), pp. 211-231. 2

EPILOGUE

321

own behaviour as the analyst. I am showing it. I am even showing it tonight. Stopping the leakage of the vitality. Floor: I would like to talk about my experience with Dr Meltzer. I met him many years ago, in Novara, and I remember that at the time, the end of the 1970s, 1 wasfascinated by his thought but did not understand a thing. So I took refuge in Martha Harris, in the observations. Then, little by little, there came a time when I could approach his thinking, and what remains of it is that there are very deep but very simple things in it, very old but very new. So it is easy to make contact with what he says. It is truly as if something miraculous had happened in my mind. DM.: Well, simplicity is certainly the hub of my thought. I was de­ feated in my university years by the realization that there were things I could not imagine, mainly mathematical. I did come to terms with that inability to imagine infinitesimal quantities, and I would think that ever since I have appreciated what was meant by "negative capa­ bility". The peacefulness of ignorance. It is, I suppose, a kind of reli­ gious passivity. Somebody else will have to do it, because you can't do it yourself. This takes you back to childhood again—Mummy and Daddy will do it; you can go to sleep. And you do. Thank God. Floor: Being with Dr Meltzer has been like experiencing the miracle of life, really. It is like experiencing the miracle of birth. He has filled our hearts with vitality. Wefeel alive when we are with him. Thank you, Dr Meltzer, for all these years. D.M.: Montserrat [the speaker from the floor], if I can remember cor­ rectly, has written a paper about the mystics in the history of philoso­ phy. And, of course, Bion has claimed to be a mystic. I don't claim to be a mystic; I just claim to be mystified. [It is pointed out that this paper was written by Carmen Largo.] D.M.: Was it? So it was not Montserrat. Well, whoever it was, I appre­ ciated that paper. Floor: Within deep song [cante jondo] there is an extraordinary myth; it is the myth of the "duende". Duende encapsulates the hidden passion, mys­ tery, and turbulence of a singer; a guitar player, or a dancer. Now there was a fabulous dancerfrom Jerez, completely illiterate, they called her the "macarrona". A party was held for her in Madrid, and during the lunch somebody played a Bach record, and this illiterate woman when she heard Bach said: "that dude has duende." It was a bit like that with me, coming from indescribable illiteracy regarding the work of Dr Meltzer, the day I started reading Dream Life, I said: "this dude has duende."

322

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MELTZER

D.M.: I am very pleased to hear somebody speak about duende, be­ cause Garcia Lorca gave a wonderful lecture about it, 3 and what I came up with—which you may not agree with—is that duende is the love of the matador for the horns. I can understand that. It is the flirtation with danger which has a great appeal to me, and I found Lorca's essay quite beautiful. Floor: It was I who wrote that paper on mysticism and psychoanalysis. I was afraid that Dr Meltzer might not like me saying that I felt him to be a mystic. So I am relieved. But it is true that what we have experienced with him has made us, as is the case in mysticism, see the beauty of the world, has made us feel very alive.

D.M.: Yes, I do want to emphasize the flirtation with danger as the basis of the sexual relationship. I wrote a little chapter, in one of my books, about the love and fear of horses.41 think that is really the last word I have to say about it—the love and fear of women. Floor: I wanted to remember very gratefully the experience with a little girl whom Doctor Meltzer supervised. She was my first training patient and she was a little girl of 3, and I was an enthusiastic and frightened student. In the first week of the analysis with her, at the end of the week, in my enthusiasm I began to say about something, "I think that you feel that I am a daddy who ...", and then fright took over me; I thought, this is nonsense, Vm not a daddy, and I stopped. And this little girl said, "Go on, go on, Miss Schama, about the feelings!", and I just wanted to say that I think I am still struggling about the feelings, in myself and in my pa­ tients, and I suppose in a very simple way it is about the feelings, and hopefully we are all continuing to struggle about the feelings. Floor: I just wanted to add my thanks, as everyone has done, but I am also sitting here curious and in a mystery too, because you talk of your parental objects, Don, and you give us wonderful metaphors to think about—going to sleep with aristocratic parents—and I was wondering if at this point in your life (because you have chronicled it early in your life) how you think about your own intellectual parental objects, such as Bion and Klein—how you put yourself to sleep in their presence. Just at this point, I would like to hear you think about them out loud ... how do you think of them; do you think of them? G. Lorca, "Flay and Theory of the Duende", in In Search of Duende (New York: New Directions, Bibelot Series, 1998). 4 Chapter 12, "The Shadows in the Cave and the Writing on the Wall", in M. Harris Williams & D. Meltzer, The Apprehension of Beauty (Strathtay: Clunie Press, 1988). 3

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323

D . M . : W e l l , I do always remember that w e came naked i n t o the w o r l d , and every time w e take o u r clothes off w e have the hope of leaving i t naked. B u t these seductive clothings slip o n before y o u k n o w i t , a n d before y o u realize i t y o u are f u l l y clothed again, a r m e d against sur­ prise. I have been extremely l u c k y w i t h m y teachers—with M r s K l e i n , w i t h Roger M o n e y - K y r l e . I a m reluctant to include Bion, because he is someone w h o m I haven't overcome m y suspicion of. H e was too clever for me. I d o n ' t k n o w if this answers Karen's question about m y relationship to m y teachers.

Floor: I hesitated in speaking here, because in many years of work I was accustomed to speak with Dr Meltzer intimately, and in the intimacy especially at the beginning of our relationship, it was a very particular dialogue; Meltzer doesn't speak Catalan, but Meltzer understood Catalan, and, something more difficult—he understood my English, at the begin­ ning, when I arrived in London. We've had time to express our gratitude for this particular intimate relationship. But I am very interested in reaffirming this gratitude here, especially for his writing, which has been a constant lessonfor me and for all of us, and because he has been so decisive in the expansion of psychoanalysis in Barcelona, through this psychoana­ lytic group. DM.: I t is very pleasant to hear that I understood Catalan. Certainly the idea of Catalonia has been a reality for me for a l o n g time r e a l l y — Catalonia's role i n the c i v i l w a r is v e r y v i v i d to me. To understand the music of language is m o r e emotional than to understand the w o r d s — the song and dance of language. The flamenco is, to m y m i n d , the epitome of the language of emotion. A n d like Lorca's evocation of the duende, the danger, the excitement of the danger, is so present i n the flamenco dance. The love of the matador for the horns; the danger.

Floor: It is indeed difficult to find a way to express gratitude to Dr Meltzer, because he knows how much we owe him. For me, personally, discovering that psychoanalysis was not that very serious and deep subject that it was considered to be was terribly important, and that to have a good time in a session with a patient was, perhaps—who knows—a sign that we had found a meeting ground. I want to say thanks to him in my name and in my patients' name. DM.: Yes, y o u have to make a certain transformation f r o m the mata­ dor a n d the horns of the b u l l , back to the culture of the horses, a n d the m a t i n g of the horses, i n w h i c h the stallion is i n constant danger f r o m the mare's hooves. She can kick his face i n , a n d sometimes does. That is m o r e real to me even t h a n the evocation of the duende a n d the b u l l

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with the horns. That is what I wrote about in that little chapter. The heels—these powerful heels.

Alberto Hahn (Chairman): Well I think that what we heard today is a very good sample of the deep feelings and thoughtfulness Don is capable of evoking in us. I think we too have been very lucky with our teachers, and I think that he probably knows that I want to thank him, lam sure, in the name of everybody here for his wisdom andfor being here with us over the weekend.

ANALYTIC

INDEXES



Index of central Acting o u t 247 Addiction, to masturbation, 203 Adhesive identification, 34 Adhesive relationship, 34,233 Adhesive sensual level, 234 Adhesiveness and analysis, 35 Adolescence: and competitiveness, 12 and puberty, 82,83 Adults and children, internal objects in, 116 Aesthetic conflict, 39,43 Aesthetic experience, 101,116 Aesthetic impact, and mother, 128, 129 Alcoholics, 123 Anal introjections, 98 Anal masturbation, 160 addiction to, 115 Anal sexuality, 148 Analysis: and adhesiveness, 34

ideas

and delusion, 138 idealization and ending of, 261 and military values, 261 Analyst: and internal objects, 117 kindness and seduction of, 204 and life and death instincts, 261 as sexually tantalizing object, 209 trapped between good and evil, 261 as voyeur, 247 and working from observation, 202 Analytical situation, establishing of, 190 Anorexia: and the battle of wills, 9,13,16,19, 24,28,31 and bulimia, 16 and the need for food, 4 and the position of the analyst, 4, 16 and psychosis, 10 325

326

ANALYTIC

INDEXES

Anorexics, 94

Anus, and emotional life, 95

Anxiety, social, 148

Attitude:

critical, 51

psychoanalytic, 4

Autistic fear of being thrown out,

160

Autoerotism:

and collapsed state, 25,26

and primitive fantasies, 25

Baby, mysterious things for, 114

Beta-elements, 140

Bidimensional world, 39

Bisexual fantasies, 170

Bisexuality, and cancellation of

sexuality, 170

Body, and emotional relationship, 69

Breast:

and bottom, idealized mother,

128

and nipple, combined object, 114,

129

stealing and displaying of, 209

Bulimia:

and anorexia, 16

and sensuality, 260

Buttocks, richness of, 221

Character, structure of, 230

Childhood, accidents and suicide

during, 5

Children, in analysis, denigration of

the therapist, 151

Claustrophobia:

and grandiosity, 161

and suicide, 5

and time, 11

Claustrophobic:

anxieties, 153,155

part, 57

trapped in a claustrophobic world,

22,26

Qaustrum:

death and the world of the

claustrum, 9,21

the threat of humiliation, 16,18

"winning and losing" in the

claustrum, 10,14

Combined object:

breast and nipple, 129

new idea in psychoanalysis, 261

Communication, and negotiation, 263

Complex, Oedipus, 161,172

Conflict, aesthetic, 39,43

Confusion:

creator of, 100

as a defence, 81

generating, 190

between good and bad, 129

secretiveness and manipulation,

202

Constipation, and longing, 41

Consulting-room, change of, 174

Countertransference, 21,60,267,270,

285

answering in the, 230

Creativity, and proliferation, 117

Critical, attitude, 51

Death, and the world of the

claustrum, 9,21

Defence(s):

intelligence and interest, 249

intelligent, 182

manic, 160

Defensive structure and loneliness,

170

Delinquents, 184

Delusion, construction of, 140

Delusional system, 140,160

Denial, of psychic reality, 117

Dependence:

on the denigrated object, 195

and the depressive position, 117

distortion of, 94

infantile, 117

love and vulnerability, 184

submission and paranoia, 83,182

submission and sodomy, 182

Development:

of the mind, 117

of new ideas, 261

ANALYTIC INDEXES Depersonalization, experience of, 234

Depressive position:

and dependence, 117

threshold of, 89

Desire, object of, 250

Differentiation, between inside and

outside, lack of, 86

Disturbance, thought, 115

Dreams:

baby an d orgasm, 73

being caught in bed, 178

being considerate, 72

birthday party, 131

black girl, 78

bottom, 253

child-wife, 121

as a defence against being expelled,

160

different therapist and consultingroom, 144

dirty, 259

Ernesto's, 234

finger i n vagina, 68

fish tank, 115

followed by a hearse, 45

going to bed with a gorilla, 205

granary, 256

health club, 115

hotel, 189

jealousy of the analyst, 35,36

John Wayne and Robert Redford,

205

king and queen of Spain, 164

about kneeling, 73

little balls of pooh, 253

Marcela's, 134

mother's mistake, 170

naked sister, 165

plump maid, 172

police and terrorists, 183

pornographic, 261

swimming with a dolphin, 152

and symbolic formation, 194

taking part in a film, 143

therapist dressed in blue, 171

town hall, 79

about waiting in a messy flat, 143

327

Ego and superego, bits of, 140

Egocentricity, 82,182,184,267

and hysteria, 56

Emotional contact, and lies, 194

Emotional impact, and turbulence, 43

Emotional level, inability to operate

at, 230

Emotions, evacuation of, 230

Emptiness, and ignorance, 263

E n d of analysis, in mutual

idealization, 261

Epistemophilic instinct, 39

Evacuations, containment of, 234

Excitement, and interest, 28

Exhibitionism:

voyeurism, and passivity, 249

and theft of the nipple-penis, 204

External, and internal, differentiation,

86

Faeces:

feeding the parents with, 218

food and relationship to, 9

and ingeniousness, 182

Falling in love, first step in, 233

Fantasy(ies):

anal, 137,139

and entry into projective

identification, 25,31

infantile masturbation, 221

living in a w o r l d of, 138

in manic-depressives, 204

masturbatory, 169,170,172,173,220

oedipal, 170

perverse, 170

and the world of money, 101

Feminine:

and masculine:

differentiation between, 57

problems of, 150

orientation, 48

position, 159

Fetish, 219,220

mother's, 219,220

Food, relationship of to faeces, 9

Forgiveness, and grandiosity, 58

Freudian narcissism, 161

328

ANALYTIC

INDEXES

Geographic alterations, 85,86

Geographic dimension, 234

Geographic division, 57

Geographic terms, 231

Good and bad:

baby's criteria about, 114

confusion between, 129

Grandiosity:

anal and oral, 115,116

in the baby, 115

and claustrophobia, 161,260

and splitting of interpretations,

156

and infantile omnipotence, 127

and lack of imagination, 116,117

and money, 101

and persecution, 57

and split in projective

identification, 153

in the transference, 115,116

Heterosexual, and homosexual, 159

Homosexual:

attack, and turning into a woman,

137

orientation, 48

Homosexuality, 100,116,258

and money, 260

Hypochondria, 35

Hysteria, and negativism, 51,54,55

Hysteric, novel of the, 54

Idealization:

and end of the analysis, 261

and possessiveness, 129

and splitting, 67,128

and verbal ability, 182

Idealized image, 83

Idealized mother, breast and bottom,

128

Identification:

adhesive, 34

projective, see projective

identification

Identifying, projectively, 230

Ignorance, and emptiness, 263

Illness, use of, 204

Imagination:

and intuition, 221

versus proliferation, 117

Impasse, 219,235,261

and establishing a transference

relationship, 251

In and out, of projective

identification, 160

Incest, 203

situation, 173

Infantile dependence, 117

Information versus observation, 193

Inside, and outside, nondifferentiation between, 194

Integration, and humility, 129

Internal and external,difference

between, 86

Internal object(s), 116-117,293

in adults, 117

of the analyst, 293

and external objects, battle with, 22

representation in children, 116

transference qualities, 262

Interest:

and excitement, 28

in life and love, 29

Interpretation(s) :

the language of, 20

as mysterious process, 117

as penetrations, 138,139

Interruption of analysis

as a last resource, 261

Intimacy, and ceremonial

representation, 169

Intuition, and imagination, 221

Jealousy, of the therapist, 36

Kleinian theory, and Marxism, 262

Laughter,

manic and hysterical, 209

sadistic, 207

Latency, 194,195,196

children in, 233,262

Learning from experience, opposition

to, 220

ANALYTIC

Lies, 193

and emotional contact, 194

Life and death instincts, analysts

trapped between, 261

Loneliness and defensive structure,

170

Love:

dependence and vulnerability, 184

and interest in life, 29

maternal love, 60

and provocation to suicide, 5,30

and tyranny, 250

Manic:

defences, 159

excitement, states of, 210

laughter, 209

Manic-depressive, masturbatory

fantasies in, 204

Manipulation, secretiveness and

confusion, 202

Masochism, pain and erotic pleasure,

229,231,233

Masochistic submission, 183

Masturbation, 56,57,75,203

anal, 101

childhood, and fantasies, 24,25,29

mutual, 69

obsessive watching, 233

and sexuality of the parents, 194

Masturbatory fantasies, 169-170,172­ 173,220

Marxism, and values, 262

Marxist cosmology 52

Material, dirty, pornographic, 263

Maternal deprivation, and Oedipal

triumph, 173-175

Maternal devotion, 128

Maternal transference, 184,219,221

Mind:

development of, 117

empty, 260

protecting the, 263

Mindless person, 183

Mother:

and curiosity, 39

feeding, w i t h faeces, 221

INDEXES

329

and toilet training, 100,128

Mummy and daddy:

language, 100

transference, 260

Narcissism, 82,140

Freudian, 161

and object relations, 140

Negativism, 75

and hysteria, 51-54

Nipple, 194

Object(s):

absence of relationship with, 249

beauty of the, 89

combined, 262

coming together and separating,

129

denigrated, and dependence, 195

of desire, 250

fantasy of entering inside, 25

inanimate, and safety, 195

internal, 116-117,293

mistrust of, 43

relations, and narcissism, 140

of transference, 247

transitional, 25

Oblomov type, 221

Observation, versus information, 193

Observing, from outside, 230

Obsessiveness:

and control of others, 196

and watching, 228,229,233

Obsessions, attention fixing, 229

Obsessive:

pain, 35

part, control by, 232

thought, 82

Oedipal fantasies, 170

Oedipal situation, inverted, 209

Oedipal triangle, 218

Oedipal triumph, 128,172

and maternal deprivation, 173-175

Oedipus complex, 161,172

Omnipotence, 127

anal, 255

and power, 250

330

ANALYTIC

INDEXES

Omniscience, and ingenious

manipulation, 182

Oral relationship, 75

Orgasm, masturbation and fear, 233

Pain, getting rid of, 230

Paranoia, 100

dependence and submission, 182,

184

Parents, as judges 21

Part-object, 88

emotional quality and sexuality of,

170

partiality of, 195

Passivity, absence of values and

ethics, 250

Paternal transference, 219

Patient, stopping the, 260

Persecution;

and grandiosity, 57

and misery, 123

Perverse fantasies, 170

Perverse mode of functioning, 220

Perverse sexuality, 86-87

Phobia, 166

Phobic state, 249

Pleasure:

in being right, 16

challenge, rebellion, and violence,

13

Pornographic dirty material, 263

Pornographic dreams, 249,261

Possessiveness, and idealization, 129

Projective identification, 57

with the breast, 221

coming out of, 127

entering mother's bottom and, 137

falling in, 129

getting out of, 113

in and out of, 160

misery of, 123

w i t h part objects, 94

split in, 153

and sticking adhesively, 230

Proliferation, and imagination, 117

Promiscuity, 190

Psychic reality, 262

denial of, 117

Psychoanalytic attitude, 4

Psychoanalysis, combined object as

new idea in, 261

Psychosis, and anorexia, 10,11

Pubertal children, 233

Puberty, 48,51,72,139,172,195

and adolescence, 82,83

Qualities versus services, 69

Rectum, mother's, entering, 86

Relationships, quality of, 233

Romantic agony, and

sadomasochism, 30

Sadism, and projection of voyeurism,

207

Sadomasochism, and Romantic

agony, 30

Satanic rite, 5,14

Schizo-paranoid position, 251

Schreber case, 138

Science and technology, 117

Secretiveness, confusion, and

manipulation, 202

Security, and object, 195

Seduction, and the kind analyst, 204

Sensations, bodily, versus feelings,

230

Sensuality, and bulimia, 260

Setting, changes in, 174

Sexuality:

anal, 148

genital and mental encounter, 173

of the parents, and masturbation,

194

part-object, and emotional quality,

170

from part-object to whole object,

173

perverse, 86-87

polymorphous adult, 262

Social pressure, and emotionality,

195

A N A L Y T I C INDEXES

Social values, and superficiality, 195

Sodomy, and dependence and

submission, 182

Splitting:

historical, 57,61

horizontal, 128

and idealization, 67,128

in the baby, 128

process of, 29

Suicide, 258,260

analytic attitude and possibility of,

4

love and provocation to, 5,30

preoccupation with, 196

as relief, 196

suicidal material, 159

Submission:

and dependence, 182,183

and paranoia, 184

Superego, and infantile masturbation,

150

Superficiality, and social values,

196

Symbolic formation in dreams, 194

Symbolic transmission, 117

Symbols:

emotions in the formation of, 230

and the novel, 54

Symptoms, as indicators of

improvement, 230

Therapeutic benefit, 75

Therapist:

jealousy of, 36

using the, 22

Thought:

disturbance, 115

obsessive, 82

Time, and claustrophobia, 11

Toilet training, 93,128,254

and the mother, 100,128

331

Transference, 18,26,50,91,140,268,

269,274,291,305,308

creating a frame for, 23

delusional, 138

grandiosity in, 115-116

and intrigue, 40

maternal, 184,219,221

mummy and daddy, 260

music of the, 277

negative, 40

paralysed, 247

paranoid, 249,251

paternal, 219

relationship, 94,262

Transvestite, 137,138

Truth:

and mistrust, 194

and relativity, 220

Tyranny, 29-31

and love, 250

Values:

absence of, passivity and ethics,

250

and Marxism, 262

military, and analysis, 261

Voracity, and interest, 16

Voyeur, and fantasizer, 258

Voyeurism, 82,259

and adolescence, 82

and epistemophilic instinct, 39

excitement to, 207

and exhibitionism and passivity,

249

masturbation and bad smell, 247

and passivity, 82

and working as a model, 210

Winning and losing, the claustrum and, 10,14

332

ANALYTIC

INDEXES

Index of main

Aesthetic conflict [Dolores], 32^*3

An attempt at analysis with a yuppy

[Agnes], 185-196

Anal grandiosity [Eduardo], 91-102

Analysis of an alcoholic [Roberto]

176-184

Anorexia and the claustrum [Lucia],

3-31

Bisexuality and cancellation of

sexuality [Eva] 163-175

Case of a woman who suffered

attempted rape [Agnes], 185­ 196

Case of a woman who suffered rape

[Pilar], 197-210

Change in the setting [Eva], 163-175

Dependence, submission, and

sodomy [Roberto], 176-184

Difficulties related to emotionality

[Claudia], 225-234

Establishing the analytical situation

[Agnes], 185-196

Excitement from projection of

subjects

voyeurism and curiosity

[Pilar], 197-210

Exhibitionism and obscene telephone

calls [Abelardo], 235-251

Hysteria and critical attitude

[Andres], 44-61

Idealization and denigration

[Margarita], 62-76

Intimacy and social anxieties

[Carmela], 142-151

Oedipal grandiosity [Francis], 118­ 130

Oral grandiosity [Montse], 103-117

Oedipal triumph [Eva], 163-175

Pleasure and comfort vs. emotional

contact [Margarita], 62-76

The analyst as voyeur [Abelardo],

235-251

Therapeutic strategy with an anorexic

[Lucia], 3-31

Voyeurism:

[Andres], 44-61

[Eduardo], 77-90

Index of diagnoses

Borderline psychotic:

["Eduardo" case] / chapter 11

["Lucia" case] / chapter 1

Hysteric:

["Andres" case] / chapter 3

["Carmela" case] / chapter 10

Latency ["Agnes" case] / chapter 14

Latency and obsessiveness ["Claudia" case] / chapter 17

Living in the claustrum ["Lucia" case] / chapter 1

Manic-depressive ["Pilar" case] / chapter 15

Psychotic ["Eduardo" case] / chapter 9

'We see ourselves as elders, not only in age but in the tradition of a nostalgia for the fora where professionals, craftsmen, workers of all kinds meet to share tools, knowledge, skills, a n d - ultimately - ignorance, the wellspring of t h o u g h t / Rosa Castella, Lluis Farre and Carlos Tabbia from the Introduction

This is a new collection of dialogues between three founder members of the Psychoanalytic G r o u p of Barcelona, Donald Meltzer a n d Catharine Mack Smith. It is a tribute to the 1 4 years of work carried out together in Barcelona a n d Simsbury, O x f o r d , and an invitation t o other clinicians t o share in the learning experience of talking freely a b o u t the vicissitudes of their daily work.

The transcriptions

are presented

unedited, excepting

grammatical corrections, in order to preserve the atmosphere of the meetings and enable the reader t o experience them fully. They cover subject perversion

matter such

as anorexia,

hysteria a n d

that arise in the course of clinical work and the

subsequent discussions envelop the whole range of the ideas of post-Kleinian psychoanalysis.

This broad spectrum is indicated

by the three separate indexes that end the book - on the central ideas, on^the main subjects a n d on diagnoses. This is an absorbing representation of the valuable work carried out over the years by these meetings a n d will provoke much thought and further discussion from its readers, perhaps even inspiring some to begin similar dialogues.

Cover illustration: "Re-thinking together II" by Lluis Farre

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