The Challenge to Psychoanalysis and Psychotherapy

France, Part 2

An infant in treatment
The following case history will illuminate some of the foregoing points.

St. is a twelve-week-old baby girl who is brought to me on a hot summer day. Her parents ask to see me immediately for an anorexia which panics them.

The family history is as follows: from their marriage, arranged in order to enable St.’s mother to escape from her own mother who reproached her for not knowing how to take care of her five younger sisters, a first baby is born, who is now ten years old, and who was, for a while, anorectic. After they returned to live in France, which the family had left because of the father’s obligations, the couple separated. Then, the young woman came to ask her husband to cancel their divorce and to live with her again, which he accepted because ‘it is easier for fathers to see their sons when they live with the mothers’. In order to seal this reconciliation, the young woman wanted a child, which the husband didn’t wish to have. Finally, he accepted and predicted many difficulties if the baby to come was a girl. ‘This hindered my imaginative life,’ (sic), said the mother.

The baby was anorectic from the moment of its birth. She was not breastfed and spent hours suckling her bottle. When she was twelve-weeks-old, St. was, nevertheless, clever like a devil when she made her mouth mucosis function and when she functionalized her oral auto-eroticism by taking her comforter between her thumb and her forefinger and putting it resolutely into her mouth.

That day, at the end of the consultation and on my prescription, the mother gave her her bottle, which she drank quite quickly. Everything then went well for approximately two weeks. But things became dramatic again after the summer when we began, the mother and myself, to conduct a psychotherapeutic relationship. She came alone with St. and her husband would only call me to reproach me for my failures. The mother herself was aggressive and pretended that I didn’t want anything else but to prove to her that her baby didn’t need to eat.

In fact, St., although slightly pale and weak, developed quite well. But the mother was fully occupied with her meals. Each day she gave her six bottles—each lasting 90 minutes—and St. was immobilized on her back on the couple’s bed. She tried to make her swallow by using the nipple like a pump. The last bottle was given at 11 pm, which prevented the father, who normally retired early, from going to bed and forced him to remain seated in front of the television, which he hated. Then, exhausted, husband and wife went to bed, separated by the baby which mother placed between them like a spade—which testified to their sexual separation. The father began to complain more, announcing that he would leave me his wife and his daughter and would go away with his son, thus completing the plan he had to give up when he renounced his divorce.

St. continued rather well, but she didn’t eat. Her mother presented her to me, seating her on her lap. The baby would move away from the mother, lean towards me and never look at the mother.

Little by little I learned the long story of the allegoric curse which St. and her mother suffered from (that mother suffered the reproaches of the baby’s grandmother: ‘You don’t know how to take care of your sisters.’ They were five girls. This is what led her to marry. Her husband, a specialist in father-son relationships, probably had his own reasons to predict misfortunes if she had to take care of a girl. But mainly the great-grandmother had abandoned the grandmother, who, being a twin, had killed her little brother when they were born. We understood that this curse had hindered the imaginary life of this young woman during her pregnancy).

After several months the young mother told me that St. was better and that she herself didn’t dream any more. I hadn’t heard that during the first consultation, although she had mentioned nightly nightmares which reproduced the drama of the bottles. She told me of this dream before the recovery of St. and the disappearance was significant: she was giving the bottle to a child, not her daughter. Maybe it was her son. The experience was terrifying. But what made her wake up with terror was the fact that a hand, detached from a body, came from behind her to seize the bottle and throw it to the ground, where it broke with a crash. What is this hand, what is its identity that neither she nor I have ever determined? The hand of the mother performing the curse, the hand of a father preventing her from identifying with a child of her father-husband, her own hand carrying her masturbatory guilt? In any case, it was the hand-tormentor in charge of carrying out the high works of her fantasies. And, after this dream disappeared, St. began to eat normally and developed well. Or her appetite, which had reappeared, made the nightmare disappear.

This observation shows us the effect of multiple interactions, that one has to understand on several levels:

The mutual behaviour level: a mother with nerves on edge because of a baby’s behaviour, who knows remarkably well how to practise its orality, and of a husband who checks her.

The imaginary level: the remains of the trans generational history of the mother have been put into latency. As in child psychotherapy, she will be able, little by little, to tell me what she knows concerning what prevents her from succeeding to be the mother of the girl.
The fantasy and the unconscious desire level: linked to her oedipal wishes,
where the baby is inscribed.

In this type of therapeutic consultation the baby is facing us and takes part in work on a three-fold level: the real, the imaginary and the fantasmatic level. Many years ago I wrote that a baby cathects its mother before it perceives her. Today I would add that it is able to proclaim her a mother by its existence and its capacity to mobilize latent thoughts and fantasies. On the other hand, the mother includes her latent thoughts and her fantasies in her maternal care.

A series of hypotheses strongly articulated on recent research enables me to remain a psychoanalyst in these consultations, which put into play the interactions and transactions between the baby and the mother:

  1. The importance of synchronization, harmonization and trans modal tuning between these two partners. They then begin to exchange emotional ties, as is testified by the capacity of both to organize a ‘decontextualizing’ complicity concerning mimics and tonicity. In fact, Darwin influenced Freud and was the first to note the young monkey’s capacity to recognize emotionally the value of small changes in the maternal mimicking (Emde 1981).
  2. Affects cling to what mother and baby can represent of their interactive continuity—the former with her fantasies and her object investments and the latter with what it can ‘pre-represent’ of a relationship which is sometimes discontinuous (Pinol-Dourriez). The affect is hungry of representations and, at the primary level of perceptive or proto-perceptive identity, the baby can anticipate its mother’s behaviour. To introduce the affective intetaction at the level of these early exchanges leads us to make the mental life of its two actors intervene. Psychoanalysis may have something to say in order to understand the origins of interactions. It remains to be seen if the theory of anaclisis and of instincts can still be accepted (Lebovici 1983).

A few remarks to conclude
As we have just seen, the study of early interactions leads the psychoanalyst to be interested both in the interpersonal field which unites the mother to the baby of her pregnancy wish—that is, to her imaginary baby—and in the intrapersonal field which becomes readable in her fantasies, which cathects the child of her maternity wish, the child she gives to her father.

This remark leads us to examine the ethnic problems which we have studied under the title of ‘intergenerational transmission’. There, events can be seen looming which have a metaphorical bearing, and which lead to value the Freudian theory of the deferred action. This means that the biographical reconstitution, as patient as it may be, reaches the dignity of a history that has been experienced only when the catastrophe has taken place to give a meaning to what normally would not have had any.

Psychoanalysts who learn about their colleagues’ investigations into the interactions know that they will not be able to content themselves any longer with their work on the material of the typical cures only. They know that they will have to work on the reality of interpersonal conflicts and on the force constraining to the repetition of intrapersonal conflicts which are forcibly repressed.

The observation of early interactions also leads us back to recognize the importance of biology and of the advances in the psychophysiologic studies of animal and human behaviour. But the understanding of the causative chains poses an epistemological problem: the advances of the neurosciences allow us to specify some neuroendocrinologic mechanisms of behaviour and to act on certain sites, which certainly does not allow us to conclude an identity between the action on these sites and the nature of the disturbances which are observed.

The origin of behaviours can be understood only if an idea is reached on the birth of mental representations, on the organization of object relations and on the mode of organization of fantasies and of intrapsychic conflicts. These are psychological aspects of the biological study of man (Cooper 1985). It is possible that Kandel (1983) foretold a predictable future when he wrote: ‘The birth of an empirical neuropsychology of cognition may lead to the rebirth of scientific psychoanalysis’. . . .

Thus psychoanalysts, widely used as an instrument of knowledge of the problems of human culture, having re-thought its neuropsychologic theory, will remain the necessary discipline which can discuss the role of the unconscious in man’s behaviour and his productions.

The place of psychoanalysis in French culture
In England psychoanalysis is transmitted outside the university, while in the United States it is inscribed in the language of everyday life. It is only probably in France that it still plays an eminent cultural role in the human sciences—it appears as a contribution for comprehension and remains a privileged tool, whatever the analogies to which such a frequent, rather analogical, recourse may lead.

Finally, should one consider psychoanalysis as the ‘dynamic’ base of psychotherapeutic approaches and as an auxiliary tool in the field of the human sciences? This is what the increasing place of our knowledge in neurobiology would lead us to think.

A note on the abuse of language
Certain texts written by psychoanalysts are quite obscure and their style is so affected that they become incomprehensible.

This is the case for Jacques Lacan’s Écrits. Those who are among the initiates—or who boast that they are—assume a knowing look when they refer to the ‘Master’s’ thinking. Lacan displayed a certain contempt for listeners unworthy of following his thinking. He loved to play on words. His followers know, for example, that Lacan referred to Saussure’s theory in linguistics. Saussure, in his Course of General Linguistics, contrasted the ‘significans’ to the ‘signification’. When he suggested the aphorism according to which ‘the unconscious is structured like a language’, Lacan promoted an excessive breaking up of words. Thus, when he dissolved his group a short time before his death, he said that he wanted to continue. He wrote ‘Je suis un père severe’ (I am a severe father), or ‘I persevere’, in a play on words. Lacan also said that he wrote in the language of the unconscious—an absurd notion for someone who claimed kinship with Freud, especially since Freud thought that the unconscious could be known only through its verbal derivatives which adapt themselves by becoming dormant and remain available in reserve in the preconscious. The word representations that are stored in the preconscious can be retrieved by affects in search of representations and it is their latent meaning that the analyst attempts to penetrate. The analyst is, of course, less interested in the shapes these representations are given.

The caricature of this form of language implies an extraordinary addiction to the use of jargon in vogue among certain French psychoanalysts who think it is not necessary to be understood by those who listen to or read them.

The issue of psychoanalytic writing is further complicated by the problem of translation, such as translations of Freud, which in France and elsewhere manifest substantial difficulties that are sometimes made worse by the pedantry of certain psychoanalysts.

Generally speaking, metapsychological writings are very obscure. They sometimes bring to mind Metapsychology: who Needs It? by Meissner (1981). What seems to be more important is to refuse to subscribe to points of view that reduce the psychoanalytic cure to a fiction. Instead, one should be willing to reconsider certain parts of Freudian theory that were built on the neuroscientific concepts of Freud’s time, while still upholding the brilliant aspects of his theory. Hence I suggest we take into account two matters: first, theory can be developed from clinical experience. This approach, which goes from clinical work to theory, is essential. Second, an initial theory is, of course, necessary. For example, ‘believing’ in the existence of the unconscious allows one to gather evidence of its existence. This is a rule common to all scientific research. Psychoanalysis does not escape Popper’s (1935) demands on the scientific status, which prescribe that any scientific hypothesis be abandoned if it is disproved. What distinguishes psychoanalysis is that it would disappear if the hypothesis of the unconscious were to be abandoned.

It seems necessary, therefore, to distinguish the fundamental aspects of psychoanalysis from those that express Freud’s desire to be a ‘biologist of the mind’ (Sulloway 1981). Psychoanalysts who treasure their isolation and insular separation piously want to hold on to Freud’s metapsychological apparatus. But, to take a single example of this piety, the impulse theory corresponds to a ‘hydraulic’ conception of the functioning of the nervous system (Lebovici 1983, 1986). This approach is out of dateone has to take into account, willingly or not, research on the interactive systems in the theory of the functioning of the nervous system as well as of mental life.

Current research on the subjectivation process (the development of the self) may indeed lead to work at the interface between the neurological self, which establishes itself according to the principle of the self-organization of the nervous system (Bourguignon 1989) and which constitutes ‘the biological unconscious’ on the one hand and the psychoanalyst’s self (Hochmann and Jeannerot 1989) on the other. The origin of the latter can be grasped by focusing on very early representations of maternal care (and the care of the newborn’s important figures) through extraperceptive, but nevertheless sensory and emotional, experiences which will develop into scripts through repetition: during the second iteration of the ‘differed action’ these scripts will be ‘retro-said’ in narrations that were prepared in ‘narrative envelopes’ (Stern 1992). In summary, the psychoanalyst who knows how to use his creative empathy should hear a language completely different from the one our ‘scholars’ hear. Why did Bion, who knew, as the mothers did, how to use his reveries to ‘detoxify’ the baby’s first projections, want to mathematize his theory? This is a point where his followers offer no convincing argument.

Such a consideration touches on the analyst’s deepest attitudes. Those who consider that psychoanalysis is an endeavour independent of any therapeutic aim will tend to proclaim the glory of metapsychology. They will be commentators on ‘sacred’ commentaries, ‘religious’ men and women satisfied with their isolation, which, by definition, shelters them from the challenges and the vicissitudes of clinical work. Freud’s Essays of the 1920s are speculative texts, very interesting for understanding his evolution. Some show his philosophical inclinations, for example when the death instinct comes into play. Others offer us remarkable perspectives on his clinical work and his observations, like his description of his grandson playing the spool game in Beyond the pleasure Principle.

Neurology; biology
In France, certain analysts have opened a dialogue with neuropsychology. Progress in the investigations of the functioning of the nervous system, thanks to recent knowledge in the fields of imaging, microchemistry and progress in the analysis of the genetic map, allow satisfying answers concerning the normal and the pathological functioning of the nervous system: modern grids define pathological states through the behaviour they give rise to. Therefore, families of mentally ill patients request the mending of the ‘handicap’, ignoring, by the way, the meaning of this word, which certainly does not mean that the mental disturbances which are at the origin of this ‘disadvantage’ are definitely fixed but means that the patients and their families have to suffer a disadvantage.

The field of cognitivism, to mention only this example, defines modular capacities which, in Jacques Mahler’s terms, allow us to say that ‘the human being is born alive’. This statement does not, nevertheless, limit the human being to be only a brain. This is a very widely accepted remark in France.

How can one forget, for example, that the synaptic reduction process creates circuits which define the neurological self, and how is it possible not to remember that the definition of the subjectivation process is that of an interactive network where very early representations of maternal care are interwoven with the rudiments of the self or the ‘feeling of continuity of existence’? (This is Winnicott’s self.) In my opinion, the interactive and, sometimes, emotionally-tuned circuits are coloured by the parents’ unconscious fantasies which result from childhood conflicts on the one hand and from preconscious conflicts, in which the desire of pregnancy expresses itself, on the other. In the sequence of these interactions, ordinary events tend to form scripts. These scenarios define the intersubjective situation. ‘To be with’ forms the foundation of’ proto-narrative envelopes’ which survive through procedural, or even semantic memory, according to the most modern theories of memory. Indeed, these theories do not corroborate the Freudian theory, according to which the mnesic traces of the satisfaction of needs are reactivated because of the first separation experiences from the mother. In this case, it would be the mother’s absence that would result in the hallucination of the ‘maternal object’. Actually, it is much more the Freudian theory of the deferred action that justifies the neurophysiological theory of memory: similar circumstances which reproduce themselves allow to ‘retro-say’ the founding event of the initial scenario, which is recognized in a more or less similar emotion.

Thus self-reference, reassignment, circularity, etc, which are basic ideas of modern biology, allow serious thinking. In fact, the present apparent incoherence reflects a true order, which enables different theoretical approaches to become complementary. Such a conception justifies a trans-disciplinary approach, consistent with Freud’s theories. It is Freud who stated that ‘the ego is first of all a body ego’ and, in a note linked to this statement, ‘it can be considered as a mental projection of the body’s surface’.

Such a consideration invites psychoanalysts who are dealing with babies in interaction—mainly in fantasmatic exchanges—to specify, through their empathy, the nature of the subjectivation process without forgetting that the study of the self may be an element of ‘transduction’ between the psychoanalyst’s observations and studies on the wiring of the central nervous system. This is the conception accepted in France; it completes the approach of American ‘developmentalists’.

French psychoanalysts also remain valuable craftsmen in their increasingly necessary role of support with contemporary diagnosis and treatment techniques. Presently, they must accomplish an important task: to help the training of the ‘accompanying persons’ of patients suffering from genetic diseases and their families.

The existence of genetic disorders, of organic disturbances, must not be an obstacle to any form of a psychotherapeutic help if planned by a psychoanalyst. In fact, the living human being is not reduced to his functioning brain.