DOING THINGS DIFFERENTLY

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 Tavistock Clinic Series
Margot Waddell & Jocelyn Catty (Series Editors)
Recent titles in the Tavistock Clinic Series
(for a full listing, please visit www.karnacbooks.com)
Addictive States of Mind, edited by Marion Bower, Rob Hale, & Heather Wood
Borderline Welfare: Feeling and Fear of Feeling in Modern Welfare, by Andrew Cooper &
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Gillian Miles
Consultations in Psychoanalytic Psychotherapy, edited by R. Peter Hobson
Contemporary Developments in Adult and Young Adult Therapy. The Work of the Tavistock
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Creating New Families: Therapeutic Approaches to Fostering, Adoption, and Kinship
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Engaging with Complexity: Child & Adolescent Mental Health and Education, edited by
Rita Harris, Sue Rendall, & Sadegh Nashat
Inside Lives: Psychoanalysis and the Growth of the Personality, by Margot Waddell
Living on the Border: Psychotic Processes in the Individual, the Couple, and the
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Looking into Later Life: A Psychoanalytic Approach to Depression and Dementia in Old
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Making Room for Madness in Mental Health: The Psychoanalytic Understanding of
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Consultancy, by David Armstrong, edited by Robert French
Reflecting on Reality: Psychotherapists at Work in Primary Care, edited by John Launer,
Sue Blake, & Dilys Daws
Short-Term Psychoanalytic Psychotherapy for Adolescents with Depression: A Treatment
Manual, edited by Jocelyn Catty
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Debbie Hindle & Susan Sherwin-White
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The Anorexic Mind, by Marilyn Lawrence
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Caroline Garland
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Thinking  Space: Promoting Thinking about Race, Culture, and Diversity  in Psychotherapy
and Beyond, edited by Frank Lowe
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Care, edited by Andrew Briggs
Understanding Trauma: A Psychoanalytic Approach, edited by Caroline Garland
Waiting to Be Found: Papers on Children in Care, edited by Andrew Briggs
“What Can the Matter Be?”: Therapeutic Interventions with Parents, Infants, and Young
Children, edited by Louise Emanuel & Elizabeth Bradley
Work Discussion: Learning from Reflective Practice in Work with Children and
Families, edited by Margaret Rustin & Jonathan Bradley
Working Below the Surface: The Emotional Life of Contemporary Organizations, edited by
Clare Huffington, David Armstrong, William Halton, Linda Hoyle, & Jane Pooley
Young Child Observation: A Development in the Theory and Method of Infant
Observation, edited by Simonetta M. G. Adamo & Margaret Rustin

C&H_book.indb 2 23-Feb-17 12:29:44 PM

 DOING THINGS DIFFERENTLY
The Influence of Donald Meltzer
on Psychoanalytic Theory and Practice

Edited by

Margaret Cohen & Alberto Hahn

K AR N AC

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 First published in 2017 by
Karnac Books
118 Finchley Road
London NW3 5HT

Copyright © 2017 by Margaret Cohen & Alberto Hahn

All contributors retain the copyright to their own chapters.
The rights of the editors and contributors 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.

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: 978–1–78220–434–3

Edited, designed, and produced by Communication Crafts

Printed in Great Britain

www.karnacbooks.com

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 CONTENTS

series editors’ preface ix

about the editors and contributors xiii

Introduction
Margaret Cohen & Alberto Hahn 1

 1 Doing things differently:

an appreciation of Donald Meltzer’s contribution
Margaret Rustin 5

 2 The relevance of Donald Meltzer’s concept

of nipple-penis confusion to selective mutism
and the capacity to produce language
Maria Rhode 21

 3 Point–line–surface–space:
on Donald Meltzer’s concept of one- and
two-dimensional mental functioning in autistic states
Suzanne Maiello 35

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 vi contents

 4 Autism reconsidered

Donald Meltzer’s concept of dimensionality

in clinical work with autistic patients
Suzanne Maiello 56

Does the meta-psychological concept of dimensionality

refer to a geometrical or a topological model?
Didier Houzel 66

A response
Jeffrey L. Eaton 75

 5 Dimensionality, identity, and security:

finding a home through psychoanalysis
Louise Allnutt 81

 6 The isolated adolescent

Carlos Tabbia 95

 7 Supervision as a space for the co-creation

of imaginative conjectures
Clara Nemas 108

 8 Keeping tension close to the limit:

from latency towards development
Monica Vorchheimer 119

 9 Donald Meltzer’s supervision

of psychotherapy with a psychotic child
Jeanne Magagna 127

10 The second life of dreaming

Jeffrey L. Eaton 153

11 On having ideas:
the aesthetic object and O
Meg Harris Williams 166

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 contents vii

12 Degrees of entrapment:
living and dying in the claustrum
Pamela B. Sorensen 176

13 Trapped in a claustrum world:

the proleptic imagination and James Joyce’s Ulysses
Mary Fisher-Adams 188

Gaudete: a response to Mary Fisher-Adams

David Mayers 206

14 A mind of one’s own:

therapy with a patient contending with excessive
intrusive identification and claustrum phenomena
Tara Harrison 210

15 Battered women lose their minds

Cecilia Muñoz Vila & Nubia Torres Calderón 222

Concluding thoughts
on the nature of psychoanalytic activity
Alberto Hahn 233

references 237

index 249

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C&H_book.indb 8 23-Feb-17 12:29:44 PM
 SERIES EDITORS’ PREFACE

Margot Waddell & Jocelyn Catty

S
ince it was founded in 1920, the Tavistock Clinic has developed
a wide range of developmental approaches to mental health
which have been strongly influenced by the ideas of psycho­
analysis. It has also adopted systemic family t­herapy as a theoretical
model and a clinical approach to f­amily problems. The Clinic is now
the largest training institution in Britain for mental health, provid-
ing postgraduate and qualifying courses in social work, psychology,
psychiatry, and child, adolescent, and adult psychotherapy, as well
as in nursing and primary care. It trains about 1,700 students each
year in over 60 courses.
The Clinic’s philosophy aims at promoting therapeutic methods
in mental health. Its work is based on the clinical expertise that is
also the basis of its consultancy and research activities. The aim of
this Series is to make available to the reading public the clinical,
theoretical, and research work that is most influential at the Tavistock
Clinic. The Series sets out new approaches in the understanding and
treatment of psychological disturbance in ­children, adolescents, and
adults, both as individuals and in families.
It is a kind of publishers’ lore that collections of conference
papers seldom make a good book. Doing Things Differently: The Influ-
ence of Donald Meltzer on Psychoanalytic Theory and Practice, however,
is in itself “different”. As this conference proceeded and with no

ix

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 x series editors’ preface

pre-planning, the papers submitted somehow arranged themselves

into several quite distinctive threads in the development of Donald
Meltzer’s thought, whether in relation to young and latency-aged
children, to adolescents, or to adults. In so doing, they further elabo-
rated some of his most challenging and original concepts and built
a coherent body of what that thought had inspired—something of
immense suggestiveness.
The conference, held at the Tavistock Clinic in 2015, was convened
by Alberto Hahn, Margaret Cohen, and Jonathan and Catrin Bradley to
mark the 10th anniversary of Meltzer’s death. It was an impressively
international event, with contributions from North and South America
and from several European countries as well as England, in particular
from the Tavistock Clinic itself. All the participants knew Meltzer,
and most had been supervised by him, in some cases over a period of
several years. This made for a very powerfully positive atmosphere—a
“work group”, in Bion’s terms—that also pervades the pages of this
book in a very special and rare way.
Overall, one of the most striking and moving aspects of the book
is that the chapters, in their very different ways, come together to
express what could be called something like “the generation of
meaning”. They are testament to the space for the “co-creation of
imaginative conjectures” that one contributor describes—a process
at the heart of what Bion thought of as the growth of the mind, the
developing a mind of one’s own, so compelling and so enabling for
the contributors as well as for all the readers. For threading their
way through this book are countless examples, some fleeting, some
deep and extended, of intellectual and psychic “growth”, in the true
sense of the word. Meltzer shared Bion’s distinction between K and
–K: the distinction between supposedly learning about the self and
others, about life, even about psychoanalysis, through “cleverness
or competitive ingenuity”, and that which we can risk through our
own experience. This latter is clearly voiced in one of the chapters
in terms of, “if we could stop trying, then ideas would develop us”.
As we can see here, the way in which Meltzer taught and the actual
content were inseparable: we hear of his wit and humour, his often
surprising turns of mind and phrase, his surpassing originality, and,
as the contributors here collectively attest, the presence of some-
thing as elusive as “clinical intuition”, learned not through trying to
define the indefinable but through the nature of the insights found
here in the case material presented. Meltzer was opposed to what he
described as any kind of “apostolic succession”, and his approach to

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 series editors’ preface xi

lecturing and supervision, the fruits of which are so apparent in the

book, was, as he once said: “Does my way of seeing things help you
to see them your way, only more clearly”.
The chapters build upon his struggles to understand and to work
with some of the most opaque areas of mental functioning. As is
clear, the work is ever-evolving, always in a state of becoming. Some
of Meltzer’s collaborators were on the Tavistock staff at the time and
some within the student body. Together, they shared the challenging
puzzles of the Clinic’s work with extremely disturbed young children,
especially those on the autistic spectrum. The fruits of this collabora-
tion are vividly expressed in the chapters on one- and two-dimensional
mental functioning, for example—and dimensionality is indeed, on the
whole, an immensely complex issue in psychic development generally.
Other chapters have expanded upon a concept that emerged much
later in Meltzer’s thinking: that of the “claustrum”. Examples and
clarifications are drawn not only from clinical cases but also from the
wider culture of literature and film, in which the inner realities of the
claustrum world are elaborated and described to enormous effect.
Further light, both theoretical and clinical, is thrown on the meaning
of the “aesthetic object”, on dreaming, on latency and adolescence, on
selective mutism, and on both having a mind of one’s own and losing
one’s mind.
Overarching all is the stress on the immense significance of obser-
vation, directed as much towards the self as towards the other. Indeed,
Meltzer himself stated that, “This power of observation, outward and
inward, is the fountainhead of Bion’s originality.” These words could
have applied with equal weight to Meltzer himself, also struggling, as
he put it, “to find a conceptual framework for assembling meaning-
fully the masses of new observations”. In our view, this capacity shines
throughout these pages. In the present rather dark intellectual climate,
one that tends to eschew painful or complex areas of thinking and is
averse to not “knowing”, to uncertainty, even to truth itself, we hope
that Doing Things Differently may be something of a beacon.

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C&H_book.indb 12 23-Feb-17 12:29:44 PM
 ABOUT THE EDITORS AND CONTRIBUTORS

Louise Allnutt is the Lead Child and Adolescent Psychotherapist at

an inner-city CAMHS, working with children with disabilities and
other developmental difficulties. She supervises, teaches theory, and
co-convenes the autism workshop on the Child Psychotherapy Train-
ing at the Tavistock Centre. Her clinical and research interests are
centred on psychoanalytic approaches to understanding trauma and
the development of early interventions for children at risk of autism.

Nubia Torres Calderón is a researcher and Associate Professor at

the Psychology Department of the Universidad Javeriana in Bogota,
Colombia. She is currently lecturing to pre- and postgraduates on the
psychoanalytic emphasis in the Master’s Degree in Clinical Psychol-
ogy. She is a member of the Colombia Psychoanalytical Society and has
worked for some three decades on research and intervention in cases
of family abuse and projects for psychic development in community
spaces in the city of Bogota.

Margaret Cohen is a child and adult psychotherapist in private prac-

tice in London. She worked in the Department of Psychological Medi-
cine at Great Ormond Street and then in the Neo-Natal Intensive Care
Unit and Paediatric Oncology at the Whittington Hospital, London.
She has written about prematurity, among other subjects, and has
taught at the Tavistock Clinic, the Anna Freud Clinic, and in Italy.
xiii

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 xiv about the editors and contributors

Jeffrey L. Eaton is a graduate and faculty member of the Northwest-

ern Psychoanalytic Society and Institute and a member of the IPA.
He is author of A Fruitful Harvest: Essays after Bion (2011). He has
a particular interest in the treatment of autistic states and was the
recipient of the 10th International Frances Tustin Memorial Lecture
Prize in 2006.

Mary Fisher-Adams is a psychoanalyst with the British Psychoanalytic

Association and is a training analyst for the Association of Child Psy-
chotherapists. She edited the Journal of the British Association for Psycho-
therapists from 1999 to 2005. She works in private practice in London.

Alberto Hahn is a fellow of the British Psychoanalytical Society and

works in private practice in London, teaches psychoanalysis at the
Tavistock Clinic, and lectures abroad. He translated, from the Span-
ish, Leon Grinberg’s Introduction to the Work of Bion (1977) and is the
editor of Sincerity and Other Works: Collected Papers of Donald Meltzer
(1994). He also edited, with Margaret Cohen, Exploring the Work of
Donald Meltzer: A Festschrift (2000). He has written a number of clinical
and theoretical papers, among them “Observation and Intuition in the
Psychoanalytical Situation”, “On Complaining”, and “The Nature of
the Object in the Claustrum”.

Tara Harrison, following a career in opera, trained as a psychoanalytic

psychotherapist at the London Centre for Psychotherapy, now part of
the Psychoanalytic Psychotherapy Association. She works in private
practice in London.

Didier Houzel is Professor Emeritus of Child and Adolescent Psychia-

try at the University of Caen in France and a Full Member of the French
Psychoanalytic Association. He was the recipient of the Sixth Annual
International Frances Tustin Memorial Prize in 2002. He worked with
several Kleinian psychoanalysts, including James Gammill in Paris,
Donald Meltzer in London, and Frances Tustin in Amersham.

Jeanne Magagna received her doctorate from a joint programme of the

University of East London and the Tavistock Clinic. Recently she has
served as the Head of Psychotherapy Services at Great Ormond Street
Hospital for Children, and as Consultant Psychotherapist at the Ellern
Mede Centre for Eating Disorders. She started and headed, for many
years, the Centro Studi Martha Harris Observation Courses, involv-

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 about the editors and contributors xv

ing an MA from Tavistock Clinic and Child Psychotherapy Trainings,

in Florence and Venice, Italy. Her professional interests include pre-
ventative work with infants, eating disorders, and self-harm. She has
taught, either in person or by Skype, on most continents. Her publica-
tions include editing or jointly editing Universals of Psychoanalysis in
the Treatment of Psychotic and Borderline States (1994); The Silent Child:
Communication without Words (2102); Intimate Transformations: Babies
with their Families (2005); Understanding Your Nursery Age Child (2014);
Psychotherapy with Families: An Analytic Approach (1981); and Creativity
and Psychotic States in Exceptional People (2015).

Suzanne Maiello is a child psychotherapist and adult analyst in

private practice in Rome, a member of the ACP, and a founder mem-
ber of the Italian Association of Psychoanalytic Child Psychother-
apy (AIPPI). Donald Meltzer and Frances Tustin were among her
teachers and supervisors. In 1997 she was the recipient of the First
Annual International Frances Tustin Memorial Prize. She is the edi-
tor of Gioco e linguaggio (2012). Her English publications include The
Sound Object (1995), Prenatal Trauma and Autism (2001/2015), Song-
and-Dance and Its Developments (2000), and Prenatal Experience of Con-
tainment (2012).

David Mayers is a training and supervising therapist in the Psycho-

analytic Psychotherapy Association and an honorary research fellow
in Psychoanalytic Studies at the University of Kent. He has a special
interest in the relations between the works of W. R. Bion and Samuel
Beckett.

Cecilia Muñoz Vila is a psychologist at the National University of

Colombia. She studied sociology in Santiago, Chile, in Münster, Ger-
many, and at Cornell University, in the United States. She trained as
a psychoanalyst and is member of the Colombia Psychoanalytical
Society. She lectures regularly on the Master’s Degree in Clinical
Psychology at the Psychology Faculty of the Pontificia Universidad
Javeriana and does research into the critical analysis of the media, the
history of childhood, mourning in childhood, child abuse, and the
abuse of women. She has written “The Old Ones—Testimony” (1984),
“Childhood at the Beginning of the XX Century” (1991), “Requiem
for the Dead Children” (2002, with Ximena Pachon), “Psychoanalytic
Reflections” (2011), and “Psychoanalytic Clinic: Twelve Case Studies
and Some Notes on Technique” (2014), among other publications.

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 xvi about the editors and contributors

Clara Nemas is a Senior Member of the Buenos Aires Psychoanalytic

Association, an IPA Child and Adolescent Analyst, and a Member of
the IPA China Committee. She is on the Editorial Board of the Interna-
tional Journal of Psychoanalysis and has published papers on Kleinian
and neo-Kleinian theory and technique.

Maria Rhode is Emeritus Professor of Child Psychotherapy at the

Tavistock Clinic and the University of East London. She trained at
the Tavistock, where she was supervised by Donald Meltzer, and is a
member of the Association of Child Psychotherapists and an Honor-
ary Associate of the British Psychoanalytical Society. She has lectured
and published widely, predominantly on childhood autism, and was
awarded the Frances Tustin Memorial Prize in 1998. She is currently
working on a pilot early intervention project for toddlers at risk of
autism..

Margaret Rustin is a child, adolescent, and adult psychotherapist. She

was head of Child Psychotherapy at the Tavistock Clinic from 1986 to
2009—a time during which it was possible to expand the training and
to support many new trainings elsewhere. She continues to teach at
the Clinic and in many other parts of the UK, Europe, and the wider
world, and has a private practice in London. She has written on many
psychoanalytic topics and has recently completed, with her husband
Michael, Reading Klein (2017).

Pamela B. Sorensen is a child psychotherapist. She is the former direc-

tor of the Under Fives Study Center at the University of Virginia, in
the United States, and currently lives in Virginia, where she teaches
Kleinian theory and provides case consultation.

Carlos Tabbia qualified in philosophy and psychology at Argen-

tine universities and has a doctorate in psychology from Barcelona
University in Spain. He is a founding member of the Barcelona
­
Psychoanalytical Group and a training analyst of the Catalan Asso-
ciation of Psychoanalytical Psychotherapy (EFPP). He sees adult
and adolescent patients in his private practice and is a lecturer
and supervisor in Spain, Argentina, and Italy. He has published in
psychoanalytic publications in Argentina, Great Britain, Brazil, Italy,
and Spain.

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 about the editors and contributors xvii

Monica Vorchheimer is a training and supervisor analyst from the

Buenos Aires Psychoanalytical Association (APdeBA), Argentina; she
is a full member of the International Psychoanalytical Association
and of the Latin American Psychoanalytic Federation, a member of
the European Federation of Psychotherapy, and honorary member of
the AAPPIPNA, Spain. She is a professor at the University Institute of
Mental Health, of the Buenos Aires Psychoanalytical Association. She
has been awarded the Bleger (1998) and Storni (2001) prizes by the
Argentine Psychoanalytic Association and the Liberman prize (1999)
by the Buenos Aires Psychoanalytic Association. She has a long expe-
rience of treating individual patients, families, and couples and has
published various papers in Argentina and in Spain, where she has
also worked as a psychoanalyst, supervising and teaching.

Meg Harris Williams is a writer and artist (www.artlit.info). Her

books focus on the relation between psychoanalysis and literature,
and include Inspiration in Milton and Keats (1982), A Strange Way of
Killing (1987), The Apprehension of Beauty (with Donald Meltzer; 1988),
The Chamber of Maiden Thought (with Margot Waddell; 1991), Five Tales
from Shakespeare (for children; 1996), The Vale of Soulmaking (2005),
The Aesthetic Development (2010), Bion’s Dream (2010), and The Becom-
ing Room: Filming Bion’s Memoir of the Future (2016). She teaches and
lectures widely in this country and abroad and is editor of the Harris
Meltzer Trust (www.harris-meltzer-trust.org.uk).

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C&H_book.indb 18 23-Feb-17 12:29:44 PM
 DOING THINGS DIFFERENTLY

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C&H_book.indb 20 23-Feb-17 12:29:45 PM
 Introduction

Margaret Cohen & Alberto Hahn

I
n February 2015, the Donald Meltzer Development Fund organized
an international conference at the Tavistock Clinic in London with
the attendance of 120 participants. This conference was the response
to a frequently expressed wish for a reunion in which Meltzer’s ideas,
teachings, and clinical insights could be pored over, where exchanges
could be—as indeed they were—stimulating, and which could provide
a place in which his work could be celebrated among colleagues from
all over the world.
In organizing this conference, our motivations were several. We
wanted to meet up with old friends and colleagues, but we were also
aware that, whereas when we were training, Meltzer was a lively force
in our thinking, people training now receive his teaching because it is
implicit in so many of the older child psychotherapists’ backgrounds.
Furthermore, we realized that many of the papers came from people
who had been supervised or taught by him.
Although there is systematic teaching of Meltzer’s thought at the
Tavistock Clinic, there is only an occasional mention of his work at the
British Psychoanalytical Society, with no systematic reading. One of
our motivations was therefore to set up an event that would interest
the trainees and younger members of our profession. Also, from the
beginning we wanted to continue the work of harvesting the rich crop
that has come from his teaching and written work, and the papers

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 2 margaret cohen & alberto hahn

presented at the conference bear witness to the fact that he remains a

very lively force in our thinking.
The title of this conference, “A Mind of One’s Own”, proclaims
a basic attitude of the psychoanalyst, who needs to rely on his—or
her—own personal experience and capabilities, which, with the aid
of his internal objects, allows him to engage with the distressed mind
of his patients with a very personal brand of curiosity, commitment,
and devotion. This job, which is isolating but never lonely, compels
the practitioners to gather at meetings that take place regularly all over
the world. These meetings provide an occasion for exchanging ideas,
seeing ideological comrades, criticizing and discussing the finer points
of individual bits of research that can be shared in a kaleidoscope of
languages, and celebrating the work of one of the most original, crea-
tive, and much loved analysts in the United Kingdom.
We regret it was not possible to publish all the papers presented
at the conference in this book, but editorial restrictions forced us to
make some choices regarding the content and various lengths of the
papers, in order to compile a faithful sample of the proceedings and
to give you, the reader, an experience of the breadth of subjects that
were being discussed. This book is a distillation of papers presented
in the three-day programme of the conference and has been compiled
to reflect a sequence of thinking that contains a true sense of develop-
ment, of work in progress.
The enlightening scene-setting of our first chapter by Margaret
Rustin is followed by three further chapters and one panel that deal
with issues of dimensionality in primitive states of mind, with distin-
guished contributions from Maria Rhode (United Kingdom), Suzanne
Maiello (Italy), Didier Houzel (France), Jeffrey Eaton (United States),
and Louise Allnutt (United Kingdom). Directly related to dimension-
ality is the subject of isolation, which is examined in Carlos Tabbia’s
(Spain) chapter on adolescence. There then follows a most interesting
study on the nature of clinical supervision by Clara Nemas (Argen-
tina) and two clinical chapters on developmental issues by Monica
Vorchheimer (Argentina) and Jeanne Magagna (United Kingdom).
The topic of dreaming is addressed in Jeffrey Eaton’s chapter, “The
Second Life of Dreaming” and Meg Harris Williams (United Kingdom)
contributes a theoretical chapter, “On Having Ideas; The Aesthetic
Object and O”. This takes us straight into the other important subject
that was discussed at the conference—namely, the claustrum. Pamela
Sorensen (United States) uses two films to address the “degrees of
entrapment” of life or death in the claustrum, and Mary Fisher-Adams

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 introduction 3

(United Kingdom) presents a thorough study of James Joyce through

his Ulysses, which is described as a claustrum world and how the fear
and dread it can produce leads to a proleptic imagination that keeps
the claustrum dweller imprisoned and paralysed. This is paired with
a brief and brilliant critical commentary by David Mayers (United
Kingdom) in his contribution, “Gaudete”, which was delivered as a
response to Fisher-Adams’s paper at the conference. The third chapter
on the claustrum is by Tara Harrison (United Kingdom) and contains
a lively clinical example of a claustrum patient.
The final contribution from the conference shows the vicissitudes
of claustrum patients, with a focus on battered women. This chapter,
by Cecilia Muñoz Vila and Nubia Torres Calderón (Colombia), clearly
shows the ultimate application of this diagnostic category to a seldom-
addressed subject in the psychoanalytic literature: that of abused
women and their abusers.
Over and over again, we are reminded of what fertile soil Meltzer’s
thought is and how it seems to enable and encourage practitioners to
go on and have their own ideas.

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C&H_book.indb 4 23-Feb-17 12:29:45 PM
 CHAPTER ONE

Doing things differently:

an appreciation of
Donald Meltzer’s contribution

Margaret Rustin

T
he title of this chapter is intended to draw attention to aspects
of Donald Meltzer’s ways of working which characterized his
practice as a psychoanalyst and which, I think, are important
in appreciating his originality. Of course, such observations arise from
one’s own particular perspective and may not be in accord with the
recollections or understanding of others, and it is obvious that doing
things differently—which I am interpreting, in part, as Meltzer’s char-
acteristic commitment to doing things in his own way—means that
there will be conflicting views about whether such differences have a
good outcome. This chapter is not going to address the institutional
conflicts that were part of the historical picture—in fact, I am sure that
I am quite ignorant of much of this history. Instead, I hope to describe
things that I have observed both in the years of some personal contact
with Meltzer and in reading his books and papers over time, things
that have struck me as enlightening and interesting, or sometimes
maddening and frustrating features of his work, and which arise from
his personal style as a writer and analyst. Perhaps, also, I am going to
be doing something rather different from other writers who address
his ideas, since their focus is more usually on his clinical contributions.
The themes I want to follow are these: the central relevance of child
analysis and the unity of child and adult analysis; the value of work-
ing in a clinical group with colleagues; the revision of ­psychoanalytic

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 6 margaret rustin

theory; joint research and writing projects; his discovery of infant

observation; the commitment to a wider psychoanalytic culture; and
the particular contribution to the Tavistock child psychotherapy train-
ing. As you can see, there are overlapping areas implied in this selec-
tion, and this is inevitable. I shall use examples from particular books
and papers to try to demonstrate what I am getting at.
Let me start with a word about the British psychoanalytic context
in which Meltzer was working during and following his years of
analysis with Melanie Klein. This was a time when the discoveries
of child analysis were greatly valued and when the interest in early
mental development was closely linked to psychoanalytic research
into serious mental illness. Child analysis and the efforts to analyse
schizophrenic and other seriously disturbed patients by W. R. Bion,
Herbert Rosenfeld, and Hanna Segal, among others, were taking place
simultaneously, and, in some instances, analysts were involved in both
these areas. It was also a time when the post-war development of the
NHS gave hope that psychoanalytic ideas could influence community
mental health in major ways, and the establishment of the Tavistock
Child Psychotherapy training in 1948 was part of this. There were
strong links between the group of mainly Kleinian analysts who were
also trained as child analysts—for example, Isobel Menzies, Elea-
nor Wedeles, Doreen Weddell, and Athol Hughes—and the Tavistock
training. Meltzer’s lifelong interest in the continuities of psychic life,
and his confidence that analytic techniques could encompass work
with disturbed young children and the full range of adolescent and
adult pathologies, grew very naturally from this fertile period of
psychoanalytic exploration and simultaneous ambitious engagement
with new institutional developments.
His unusual talent for and interest in theory-building combined
with his original clinical imagination made for the powerful integra-
tion of theory and practice seen in The Psychoanalytical Process (1967).
One of the particular features of his writing is that whereas the more
standard form of communication in psychoanalysis is via individual
scientific papers, and of course he wrote many such papers, it also
came naturally to Meltzer to write books. Of course, these were some-
times based on a lecture series, but the fact is that a book-length piece
of writing takes in a much wider horizon; this appealed to him, I think,
because it involved following things through. Just as an analysis has
a beginning, middle, and end, and requires substantial time for its
development, so writing or reading a book is a process in time.
The Psychoanalytical Process is exemplary in rooting the ideas pre-

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 doing things differently 7

sented in clinical detail, and the chapter that describes the process in
an individual session with a 4½-year-old girl seen in analysis from the
age of 3 is a very powerful example of Meltzer’s approach. The case
was presented for detailed discussion in a seminar of child analysts
and psychotherapists (reminding us, incidentally, of how closely these
two groups worked together at that time), and the clinical material
is presented in a carefully descriptive form, recording all the child’s
activities, verbalizations, facial expressions and so on, but, strikingly,
including nothing at all about the countertransference impact on the
analyst. Indeed, Meltzer is explicit in stating that he “leaves problems
of countertransference aside as private to the supervisee”. I think
this method, even though it is clearly different from contemporary
practice, where a group discussion of the clinician’s feelings about the
patient, and indeed contributions from other group members about
their own emotional reaction, would be expected, draws attention to a
fundamental idea underlying Meltzer’s conception of psychoanalysis.
This is that if the therapist is truly to be working at the appropriate
depth to deal with the infantile transference, an analytic process also
has to be ongoing for him or her, either in the form of continuing
personal analysis or in the self-analysis that has to be the outcome
of a good-enough analytic experience. The model of training as a
psychoanalytic therapist which is based on personal analysis, clinical
experience, and intensive supervision is thus seen also as the neces-
sary cornerstone of an ongoing professional life. I think it is important
to remind ourselves of this, because although professional bodies now
demand evidence of continuing professional development (CPD) as
part of continuing fitness to practise, the question of what this really
requires of us is a serious one. The tremendous intensity of the training
years is often seen as exhaustingly demanding, something from which
people can crave a rest even if they are simultaneously aware of how
much the quality of their clinical work is linked to that intensity. The
Psychoanalytical Process makes a strong case that this level of engage-
ment is integral to the capacity to continue to work psychoanalytically.
Meltzer uses the clinical material presented to clarify what he
thought actually constituted psychoanalysis. From the patient’s per-
spective, it is a question of the evolution of the unconscious in the
context of the availability of a transference relationship. From the
analyst, the contribution required is the provision and maintenance
of the setting (that is, the psychoanalytic setting in the sense just dis-
cussed about the dedicated state of mind of the therapist in relation
to the task) and a steady commitment to “working through”, Freud’s

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 8 margaret rustin

­ rofound conceptual contribution to understanding the idea of pro-

p
cess in psychoanalysis (1914g). Meltzer emphasizes that an adequate
setting depends on “devotion” to the psychoanalytic method together
with curiosity (a lively dose of the epistemophilic instinct, one might
say) and argues that these two factors together sustain the tolerance
of mental pain required of the psychoanalytic therapist. His discussion
of “working through” differentiates two aspects of this process. The
first is to do with the attempt to build up insight in the patient, which
involves understanding the difference between infantile and adult
modes of experience and acknowledging the distinctions between
internal and external reality. The second concerns the modification of
anxiety, following Klein’s central emphasis on the interpretation of
infantile anxieties, which Meltzer develops in the direction of the aim
of psychoanalytic therapy being the growth of introjective identifica-
tion with a thinking analytic mind, which can support the patient and
prevent regression. This would be his understanding of what might
constitute the “resilience” so beloved in contemporary discourse.
In The Psychoanalytical Process, Meltzer’s conviction in the continu-
ity and coherence of child and adult analysis is particularly vivid, and
the developmental nature and function of analytic work is the central
point. What is also impressive in the notes included in the appendices
are the areas of theoretical work which he is exploring at the time and
the hints of those to come. At this time, his thinking is, naturally, linked
not only to Freud, Karl Abraham, Klein, and other predecessors, but
also to his contemporary colleagues—Bion, Rosenfeld, Segal, Esther
Bick, Roger Money-Kyrle, Betty Joseph, and Sidney Klein—whose
work he cites in ways that illustrate the lively intellectual group-life
of the Kleinians in that period. It also suggests just how much was
lost when the dialogue between Meltzer and many of this talented
generation of analysts came to a halt.
The enormous task he then took on to draw together his theoreti-
cal understanding of the Kleinian clinical approach and its roots in
Freud’s clinical papers, and to take his readers on into Bion’s thinking,
also marked the period in which his contribution to the Tavistock train-
ing was at its height. I remember rather clearly Mattie Harris speaking
of her recognition of the gap between the clinical teaching offered to
those of my generation in the late 1960s and the theoretical curriculum
that accompanied that. When I enquired, truly puzzled about this,
why we did not read Klein’s Narrative of a Child Analysis (1961), she
said something that amounted to “You wait!” The strengthening of the
theory teaching that Meltzer’s systematic lectures provided cannot be

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 doing things differently 9

overestimated, and of course it massively influenced the curriculum

of the observation course, the shape of which was gradually develop-
ing during the 1970s, as well as the theory teaching within the child
psychotherapy training. What was so important about this for child
psychotherapy was the way in which clinical practice was so clearly
a present preoccupation in theory teaching done in this way, and the
to-and-fro between child and adult analysis and theory and practice
gave new potential for clinical experience in work with children to be
theorized. I think we can be confident that the significant theoretical
contributions later made by child psychotherapists—including, for
example, Gianna Williams (1997), Maria Rhode (2013), and Ricky
Emanuel (2001, 2012), who all shared this experience—grew from
these roots.
Such possibilities were also closely linked to the impact of Bick’s
method of infant observation upon clinical practice (1964, 1968). The
naturalistic observation of very early states of non-integration, the
theory of the centrality of growth of a psychic skin, and the elabora-
tion of second-skin defences were an important part of the work being
done with autistic children by Meltzer and the group with which
he worked so closely—presented in Explorations in Autism (Meltzer,
Bremner, Hoxter, Weddell, & Wittenberg, 1972a, 1975)—and was also
the background to Frances Tustin’s work (Tustin, 1981). Just as in The
Psychoanalytical Process the seminar group studying child analytic
cases was the site for discovery, so in the autism book the shared
discussion of the cases followed in such detail by the group was the
heart of the project. Meltzer’s capacity for theoretical writing was
nourished by this contact with a rich range of cases which allowed
him to delineate, again on a developmental model, the very particular
forms of failed and alternative mental development which character-
ized autistic states of mind.
Meltzer’s published work is full of creative collaborations—with
Esther Bick, with Meg Harris Williams, with generations of analysts
and child psychotherapy supervisees in England, Italy, Spain, and
beyond, and with Mattie Harris. It is to a lengthy research paper
(Meltzer, 1976b) written in conjunction with her that I want to turn to
provide an example of why these co-operative efforts are so important.
The Paris-based OECD, a UN body, commissioned a report in the
1970s that would offer a psychoanalytically based theoretical model of
the links between child, family, and community and serve as a basis
for social-psychological research and, indeed, clinical research about
forms of intervention (Meltzer, 1976b). The report has not been used

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 10 margaret rustin

as fully as its intent warrants, and it is not an easy document to digest,

but I think the differentiation it describes between typologies of family
culture remains provocative and enlightening.
The first section of the report outlines the central position of the
concept of mental pain in psychoanalytic discourse: “Whose pain is
it?” they write. This, of course, is the question we usually start with
in any new referral, allied to the question of “Why now?” An elegant
exposition of basic concepts—anxiety in its various forms, self, part-
object, combined object, omnipotent phantasy, mechanisms of defence,
and so on—follows. Because of the importance of Bion’s definition of
“learning from experience” and the crucial value given by Meltzer
and Harris to such learning, there is a careful account of different,
more limited or distorted and disturbed forms of learning. The life-
space model is then introduced, with reference to the contribution
of temperament, internal objects, adult and infantile elements in the
personality, and family organization. Use is made of Bion’s distinc-
tion between basic assumption and more reality-based “work-group”
functioning, and of his 1970 description of the difference between com-
mensal, symbiotic, parasitic, and paranoid orientations to define the
nature of the links between family and community (Bion, 1961, 1970).
Familiar themes such as the matter of relationship to time appear:
timelessness, oscillating and circular time, which all undermine the
awareness of linear time.
The breadth of application of these and many more familiar build-
ing blocks in thinking about family and community cultures is what
is so striking in this report. One can imagine what a challenge it pre-
sented to the policymakers and researchers to whom it was, in part,
directed; despite clear accounts in the report of unconscious phantasy,
transference, and countertransference, without personal experience of
psychoanalysis it is hard to imagine that they could grasp all these
complexities. However, for clinicians there is a cornucopia of ideas.
Meltzer’s naturally theoretical psychoanalytic thinking and philo-
sophical interests marry with Harris’s literary background, her expe-
rience of infant observation, and her vast range of clinical experience
with children and families at the Tavistock. The evocative finesse of
the writing reminds us of their shared breadth of experience as both
child and adult analysts. This conjunction is what makes for such a
compelling shared focus on the internal and external world.
When they wrote this report, family therapy in the UK was just
starting to develop. It would be a major but intellectually fascinat-

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 doing things differently 11

ing project to explore whether the ideas they proffer about family
functioning might map onto the totally different discourses of family
therapy in some ways, or whether the psychoanalytic recognition of
the centrality of the unconscious makes for quite divergent perspec-
tives. One could make a similar suggestion about the more recent but
psychoanalytically much closer discipline of couple psychotherapy.
Has this benefited from this earlier work? In James Fisher’s writing
about work with couples, we have an excellent example of the poten-
tial for imaginative integration (Fisher, 1999).
There is not space here for a full presentation of their typology of
family cultures, but to remind us or whet the appetites of those unfa-
miliar with the report, I will pick out some examples. The structures
described are being tested against the crucial functions that Meltzer
and Harris ascribe to the family. These are set out as pairs:

»» promoting love / promulgating hate

»» promoting hope / sowing despair
»» containing depressive pain / emanating (spreading) persecutory
anxiety
»» supporting thought, thinking / creating confusion.

The atmosphere evoked by each of these phrases also suggests to

me that these categories are helpful and accurate descriptions we
can use in pinpointing the valency of a clinical session. They refer to
phenomena we can observe in the transference and countertransfer-
ence and can also perceive in what we learn of our patients’ internal
and external experience, from lively dream material at one end of the
spectrum to the most prosaic of sessions at the other.
The fundamental question is whether the family organization is
promoting the development of each of its members according to their
respective needs and potentials, and the same question can be asked
of the wider community’s relationship to the families within it. One
can see that the model therefore has wide implications at a political
level. For example, it could be said that recent and, tragically, ongo-
ing events in Greece and, indeed, elsewhere in Europe confirm that
austerity conditions imposed upon a society cause unacceptable levels
of damage to family and individual development. As I find myself
moving between the applicability of these ideas to both the analytic
session and our experience as citizens, I think I am demonstrating why
this paper has meant a lot to me.

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 12 margaret rustin

The forms of family that Meltzer and Harris denote are:

»» couple families, which Meltzer and Harris believe promote develop-

ment through containment of dependence and anxiety;
»» matriarchal or patriarchal families;
»» gang families, in which, they suggest, negative identifications are
predominant;
»» reversed families (meaning when family values are in defiant oppo-
sition to more stable community values).

All of these non–couple-based families, in different ways, fail in the

fundamental task of “bringing up” the children and supporting the
growth of adult states of mind.
Holding these different family structures in mind may also enrich
our work with parents. The importance of working with parents is
much more readily acknowledged nowadays, including in the formal
research literature, than it was before the 1970s. I give one example to
indicate these possibilities.
I am thinking of a couple I heard about whose clever 7-year-old
son, Adam, the older of two children, had considerable difficulties.
He was offered individual therapy in the light of his striking imma-
turity, his extreme intolerance of his sister’s very existence, and his
own awareness of and longing for help in dealing with his paralysing
anxiety when faced with any kind of choice.
As I heard, in supervision, about these parents, I could see that,
although they were intellectually committed to talking things over
together and to sharing responsibility for their children, both practi-
cally and emotionally, they did not really manage to come together in
a way that contained their son’s massive infantile outbursts. Neither
they, nor he, felt that they could cope with his level of dependence
and unpredictable waves of anxiety, and he would become wholly
despairing in his collapsed melt-downs. They felt humiliated and
persecuted by this repeated scenario, particularly when it was enacted
in full public view, and also very angry when they felt it was aimed
at their efforts to provide good experiences for him and resulted in
these being spoilt.
At the beginning of the work, the father viewed the sessions not as
involving thinking about his own contribution to the unhappy family
situation, but as oriented to the therapist’s conveying his understand-
ing of their son. This was allied to the implication that it was the
mother’s upset that should be attended to: she was the one who could

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 doing things differently 13

not cope with Adam, whereas he could come in and calm things down.
Mother’s difficult family background, in contrast to his own, was sug-
gested as the reason for her vulnerability to becoming overwhelmed,
and she agreed with this. Gradually, this somewhat grandiose pater-
nalistic stance—the patriarchal family, as described by Meltzer and
Harris, including the harshly scathing and belittling scolding of Adam,
and the denigration of his wife—began to show cracks. The criticism of
the other adults in Adam’s life who were not felt to be good enough at
their jobs—including his teacher, cricket coach, and babysitter—gave
way to a realization that these others were offering the boy a great
deal of support and that the view of things that only he as the father
of the family really knew what was what and could be relied upon
was a distorted one. At this point the work with the couple felt quite
different, in that both now seemed more on a level with each other
and both were able to voice their worries and despondency about their
frequent failures to contain the children. As the unbalanced dynamic
between mother and father shifted, it was also interesting to note that
the younger sister began to feature differently, not only as the victim
of her brother’s aggression and greed for space, but as having her own
difficulties in being so easily able to set him up to be in the wrong.
The transference manifestation of all this was an initial idealiza-
tion of their therapist in which he was seen as possessing something
akin to patriarchal authority and omnipotence. I think he was prob-
ably also secretly feared for the harsh criticism that was forestalled
by concealing the extent of their helplessness and rage in the face of
Adam’s distress. Later came some of the secret denigration, behind a
polite exterior, of anything offered by anyone else, and a difficulty in
attending sessions regularly. However, it was possible for the therapist
to speak to the couple about the impact it had when there were longer
periods of time between sessions, whether planned or unplanned,
and for them to see that these tended to coincide with an escalation
of trouble in the family. This awareness that these meetings had some
meaning for them led to the shift I have briefly described. The couple
of parent worker and child therapist—not always an easy one to hold
together—can, of course, be a potent representation of the couple func-
tioning to which one hopes parents may aspire, and this was both an
area of potential splitting and of its modification in this case.
There are natural connections between the work on family func-
tioning and Meltzer’s major study, “Sincerity” (1971), in which he uses
three of Harold Pinter’s early plays to tackle the topic of truthful emo-
tionality and its perversions. As some readers will know, I too have

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 14 margaret rustin

felt inspired by dramatic texts to explore their meaning psychoana-

lytically, and no doubt this is one reason I am drawn to mention this
remarkable essay (Rustin & Rustin, 2002). But there is another link to
be made with the OECD report I have just been describing, for in both
of these pieces of work it is clear that Meltzer believes in the potential
for a psychoanalytic contribution to understanding society and culture
as well as in the responsibility of analysts to use their knowledge to
write for a wider public than the still tiny British psychoanalytic world
of 1970. Very little publication outside the specialist journals had yet
taken place at that time. The value he gave to the original Imago
group, which included philosophers, art historians, and others, and
its later revival, which mirrored this interdisciplinary approach, also, I
suggest, arose from his belief that psychoanalysis had much to receive
from elsewhere, as well as much to offer, the potential commensal
link noted by Bion. There is an obvious symmetry between this idea
about where growth comes from and Meltzer’s clinical emphasis on
our necessary dependence on allowing our internal parental objects to
enjoy intercourse in their own private space. Noticing these recurring
elements in his thought has helped me to have more of a sense of the
whole. Initial reading of any of his books or papers usually involved,
for me, an experience of not understanding a good deal of what was
being said, and this feeling of ignorance, combined with one’s aware-
ness of the sophistication and complexity of his clinical thinking and
his large range of reference to philosophy and literature, can have the
effect of making one feel excluded rather than invited to think fur-
ther. Those of us who were privileged to have personal contact with
him were encouraged to find that he could make it clear, in his wry
way, that he did not see himself as superior to us struggling ones far
beneath him.
There are touching words at the end of the Pinter essay as he for-
mulates his sense of what it has meant to him to do this very detailed
work on Pinter’s text:
I do, therefore, in retrospect, think that the method of investigation,
of testing upon works of art some of the subtle impressions regard-
ing the emotional atmosphere of human relations drawn from the
consulting-room and daily life—this unusual method has been a
fruitful one. I feel more convinced that this particular aspect of
atmosphere created by fluctuations in sincerity and its corollary, inti-
macy, throws a useful light on the processes by which understanding
grows—or fails to grow—between people. I find my conception of
sincerity, phenomenologically, sharpened for use in observation of
myself and others. I feel a greater tolerance of failures of sincerity in

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 doing things differently 15

others and particularly a sympathy for those caught in unsincerity.

I can understand why sincerity is so powerfully attractive, for good
and evil, in the eminent joyousness of the complete person and the
charisma of the psychopath. [Meltzer, 1971, p. 284]

Meltzer’s enjoyment of the exploration of many areas of cultural life

was, I think, very important in fertilizing his theoretical imagination,
as he acknowledged so directly in these words. One simple instance
of this is a delightful short paper, entitled “Positive and Negative
Forms” (1970), in which he describes a variety of forms of mental
space. These are building blocks in his conception of the geography
of the mind, a construction that he found so helpful in his thinking.
That word “geography” brings to our minds both the physical spaces
of our external world and the ways in which man lives within this,
his cultivation of and assaults on nature—the human geography of cit-
ies, travel, political boundaries, war and conflict, and so on—and the
geography of the natural world we and other living creatures inhabit.
This proved an apt model for the description of the inner world. In this
paper, Meltzer writes about internal and external space and what is to
be found within each domain. In a few pages of vivid examples from
dream material in which buildings are central, he shows how these can
be differentiated and how different areas of the internal maternal body
can be discerned, and he hints at how intrusive phantasies can create
confusion between inside and outside and self and object, a theme to
be developed later more fully in his book The Claustrum (1992a).
I was reminded of some vivid recent material from an 11-year-old
girl presented to me in a seminar as I re-read this 1970 paper. Melt-
zer says that it is from adult patients that he mostly learned to think
about the meaning of space, but here is a small contribution from child
psychotherapy:

Lucy, the girl described to me, spoke one day of how she had had
an individual music lesson at the end of the day, thus managing
to avoid a disliked final class lesson. The music department was
in the basement of her school, but her form room was right at the
top, so in preparing to leave school and come to her session she
had to go up to collect her belongings. On the way to the tube
station, she realized she had forgotten her purse and Oyster card,
so she ran back to look for them. She located the card, though not
the purse, and then hurried back to the station, managing to arrive
only seven minutes late for her session. The time was filled with
complaints and real misery about how hungry and thirsty she was,

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 16 margaret rustin

because she had had no time or money to buy her usual snack.
Her dry mouth and her empty tummy filled her mind, and she
made her discomfort seem absolutely visceral. Her therapist felt
it was really hard not to offer at least a drink of water. This was a
post-weekend session not long after a holiday break, so the thera-
pist spoke to her about how painful it was to find that what she
wanted was not within her reach. This led to more details about
the lost purse. Lucy wondered at first about it having been stolen,
but because they had previously been able to work on her paranoid
fear of things being stolen from her, which in reality were things
she herself had lost, her main idea was that she had left it in the
lunch room. She then explained that she had chosen the” extra”
choice at lunch, one not covered by the already-paid-for dish of
the day, and in fact she found she hated it and therefore hardly
touched it, hence now being terribly hungry, and hence having had
to take out her purse to pay for it. “If only”, she said, in an infinite
regress, “if only I had had the ordinary lunch, I wouldn’t have lost
my purse, I wouldn’t have been late in arriving here”, and so on.
More associations about things she loses or damages followed this.

I think we have here a picture of how the evasion of being an ordinary

one in the group of children, and being able to be aware of being one
of the whole family of patients, is brought about. Lucy tries repeatedly
to make special individual arrangements. These take her down to the
basement, to the one-to-one music lesson where her music is what is
listened to. When she goes up to the top and rejoins the others, she
becomes aware of feeling empty and hungry. One might say she is
flooded by painful infantile feelings, but her resentment about having
to wait and to share interferes with her looking after herself properly
and further deprives her of what she needs. Here the inner spaces of
the school with their different emotional significances to her, and the
journey which reminds her of having to come from outside to her
session, all combine to bring her in touch with a serious problem she
and her therapist are working on.
The sequel to this was interesting: the next day, when she had no
session, particular circumstances at school enabled her to see herself as
very special indeed. The following day she felt too ill to go to school
(a totally exceptional thing for her) but well enough to come and tell
her therapist about the triumph of the day before! This had almost
obliterated any memory of what had happened earlier in the week, but
not quite. The real pain of this child’s confrontation with the empti-

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 doing things differently 17

ness of her efforts to escape reality, both internal and external, became
starkly visible in her recognition as the session proceeded that the ease
of not having to get up in the morning and go to school and instead
to stay luxuriously at home in bed also meant that she was bored and
lonely, missing her friends, and dying to get to school tomorrow, just
as she had been very keen to get to her session despite exceptionally
nasty weather. She was, in fact, both provocative and persuasive in
her delighted seductive tricks to ensure that she continue to occupy a
princess position, and her therapist struggled to resist colluding with
this. Her sessions in earlier years were absolutely filled with princesses
and their amazing wardrobes and the undoubted superiority of vari-
ous imaginary realms. At times it was tempting to shoot her down,
and both therapist and supervisor could feel this desire to puncture
Lucy’s narcissism harshly. But giving in to this pressure would doubt-
less have served to make her redouble her efforts to protect herself
from a very cruel and superior superego, of which we got an occa-
sional glimpse in her extreme anxiety about being in quite ordinary
trouble with adults.
Now, to return to the 1970 paper about mental space: it is fascinat-
ing to find that Meltzer’s final example is from architecture itself, in
the form of an architect patient’s description of his planned building.
This vignette provides us with a glimpse into the workings of Melt-
zer’s clinical imagination: he sees the building the patient describes
as showing him the shape of his patient’s inner world, and simultane-
ously he alerts us, his readers, to view the buildings of our external
world anew. He reminds us that a sensitive appreciation of both natu-
ral and man-made worlds, as of the riches of art and literature, is what
makes for an imaginative response to the language of the unconscious.
While a grasp of theory and technique is needed for good analytic
work, it is surely clear that psychoanalytic education should embrace
a serious engagement with much that is studied in other disciplines,
particularly the arts and humanities, if it is to flourish.
Meltzer’s interest in so many spheres of human endeavour is, of
course, linked to his enjoyment of collaborative work, including his
work with non-clinicians. One of the ideas implicit in his model of
atelier training was that an atelier could have more porous boundaries
than the clinical trainings within professional training bodies and thus
could benefit from freer intellectual interdisciplinary dialogue, as in
the Imago group I mentioned earlier. Certainly, it was explicit that he
favoured non-traditional scientific backgrounds as a good basis for
psychoanalytic training.

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 18 margaret rustin

Now this preference for fluidity involved a fair degree of dislike

of almost any institution, which he mostly saw as in part damaging
the very things they were supposed to be sustaining. However, his
long partnership with Mattie Harris included a division of labour in
which she continued to build an institution—namely the Tavistock
child psychotherapy training and, more broadly, the child psycho-
therapy discipline as a whole—while he made a major contribution in
devoting himself to a long period of intellectual work presented at the
Tavistock. The lectures he gave on Freud’s clinical papers, on Richard
week-by-week, and, later, on Bion—the work that came together as The
Kleinian Development (1978)—are testament to very detailed and care-
ful reading of the texts he discussed. While one of the limitations of
some of his writing is the paucity of scholarly cross-references which
can help the reader orient him/herself to the argument, in this work,
he could not have been more precise. Remembering this period of his
teaching and the later similar structure of the presentation of Dream-
Life (1983), I wonder if the Tavistock context, which allowed for more
open audiences (current and past child psychotherapy students, staff,
and interested others) at these lectures, was helpful to him. In other
words, was there, perhaps, a fruitful conjunction between the kind
of group Meltzer wanted his ideas to reach and the one available at
the Tavistock, which served to support very sustained and rigorous
efforts on his part? The devotion to child analysis, which the study of
Richard demanded, found a home among child psychotherapists, who
continued thereafter to give pride of place to psychoanalytic writing
in which clinical experience was the basis for theorization.
Meltzer had many original ideas, and wrote a great deal. In this
chapter I have selected some of those that, I think, have proved most
influential, while recognizing that there are others that I could have
chosen. To conclude, I offer a brief summary.
I give pride of place to his elaboration of the concreteness of the
child’s internal world and of the relationships between the internal
objects of phantasy. Closely linked to this is the emphasis on the
lifelong interaction between infantile and more mature aspects of the
personality—the baby and child in the adolescent, all of these in the
adult, and none of these defined by chronological age but the nature
of their relationship to reality. The way in which adult mental func-
tioning can be seen at times in a young child is one of the wonders
of work with children, and the light thrown on work with adults—if
one can be alive to the many ages within the patient—is immense.
How can one understand the significance of holiday breaks in clinical

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 doing things differently 19

work unless one can see, in the mind’s eye, the baby put down after
a feed? How to make sense of the existential anxiety and confusion
of identity stirred by the awareness of there being more than just one
patient unless we think of what we learn in infant observation about
the terrifying loss of identity involved for a young child when a new
baby appears? “Who am I if I am not mother’s baby?” is a shatter-
ing question. Meltzer’s sensitivity to these early terrors, which were
so much at the heart of his close collaboration with Esther Bick, has
influenced technique greatly and engenders the capacity for analytic
kindness in the face of the depth of infantile dependence that is evoked
by the transference relationship (Meltzer, 1960).
Alongside these broad themes is the interest in dimensionality
and its special importance in working with autistic children and
autistic phenomena. The particular early development seen, I believe,
in autistic children with their vulnerability to too-early depressive
anxiety (too early for them to manage, that is) is also linked with his
later revised model of child development and the introduction of the
concept of aesthetic conflict. Here he suggests a pre–paranoid-schizoid
phase in which the pain of the early encounter with mother is what
pushes the infant into a more schizoid state as a defence against the
too-muchness of the beginning of life outside the womb (Meltzer &
Harris Williams, 1988).
I think we do see some babies in infant observation or everyday
life of whom this description rings true, and we certainly encounter
similar moments in clinical work, but I would suggest that the range of
states of being and states of mind at the start of life is quite consider-
able. One account of the beginnings of life is not likely to encompass
the complexity we might reasonably expect.
The distinction between different forms of identification—projec-
tive, introjective, intrusive, adhesive—to which Meltzer devoted much
attention remains vital, and this takes us to the investigation of claus-
trophobic anxieties and the phenomena of the claustrum (Meltzer,
1992a). In supervision of child psychotherapy with the many quite
disturbed children now seen in clinics, this is, I believe, alongside the
idea of the “gathering” of the transference, the single most useful of
Meltzer’s concepts. I find myself explaining his theory to bewildered
therapists who are suffering the experience of being with a child who
seems inside something while they remain irrelevant outsiders. His
technical suggestions about how to find a position from which one
can make useful observations, muse aloud, make contact with a child
who feels inside his or her object have often proved useful. Of similar

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 20 margaret rustin

clinical value is the paper about temperature and distance (1976c),

which I have always felt to have a background in infant observation
as it brings alive the extreme vulnerabilities of the baby self and the
responsibilities of the therapist to respect these.
I should like to finish by expressing the hope that continuing
engagement with Meltzer’s ideas will provoke fresh lines of inquiry in
psychoanalysis today. It is painful to see that his isolation from most
of the psychoanalytic community in Britain during the later years of
his life has led to the neglect of many of his contributions. I think, in
parallel, that it is painful to see that his own enrichment through dia-
logue with other creative analytic thinkers in the UK was cut short. I
am heartened that, in more recent years, this division of ways seems
less absolute. The greater internationalism of psychoanalytic thought
may be creating new sets of connections and can, perhaps, undo
damaging splits, and there may be less need for new generations to
repeat the divisions and ruptures of their predecessors, although this
will always be a risk.
Another factor that I think may be proving helpful is that the
increasing scholarly potential within child psychotherapy, in which
the clinical doctorate development has played an important part, does
demand proper attention to the literature of the field. It has been a
pleasure to read some of the completed theses and note the theoretical
exploration and integration taking place. What I think we must aim
at is a culture that values work in progress, and what we must hope
for is that the desire for development, rather than nostalgic regressive
impulses, will dominate.

Note
This chapter is based on a version previously published in the Journal of Child
Psychotherapy, Vol. 42 (No. 1, 2016), pp. 4–17. Copyright © Association of Child
Psychotherapists, reprinted by permission of Taylor & Francis Ltd, http://www.
tandfonline.com on behalf of the Association of Child Psychotherapists.

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 CHAPTER TWO

The relevance of Donald Meltzer’s

concept of nipple-penis confusion
to selective mutism and the capacity
to produce language

Maria Rhode

M
y aim in this chapter is to explore the bearing of Donald
­Meltzer’s concept of nipple-penis confusion, firstly on selec-
tive mutism, and secondly on the articulation of words. I
suggest that this concept has great explanatory power, as it seems to
be capable of subsuming phenomena that Meltzer (1986a) described
in connection with the Theatre of the Mouth as well as the traumatic
experiences that can be implicated in selective mutism. It also provides
a framework for linking these two areas to the child’s character.
I begin by outlining the concept of nipple-penis confusion and then
refer to Meltzer’s proposed conditions for language development,
supplementing this by discussing the child’s ability to take psycho-
logical ownership of the organs of the mouth. This is necessary for the
production of speech and is a process that Frances Tustin’s work on
autistic children’s experience of the mouth allows us to understand to
some extent. I shall distinguish different ways in which the paternal
part-object can be implicated in traumatic experiences, as these often
seem to be the trigger for selective mutism, and contrast various
identifications that seem to influence how children may respond to
such experiences. I shall also suggest that it may be useful to extend
some of Meltzer’s formulations on the motives in play in nipple-penis
confusion by considering its manifestations on these more primitive
levels of trauma and adhesive identification.

21

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 22 maria rhode

Meltzer referred to the concept of nipple-penis confusion from

his early writings onwards: it belongs, I think, in the lineage of
Melanie Klein’s statement that the secure internalization of the first
good object can be interfered with if the paternal part-object is too
much in the foreground too early in life (Klein, 1932).1 In The Psycho-
analytical Process (1967), he mentions “the zonal confusions such as
nipple=penis=tongue” in the context of the attempt “to seduce the
object into [a] mutual idealisation and closed system of mutual grati-
fication” (p. 30)—that is, in the context of eliminating the distinction
between the feeding relationship and adult sexuality. In a 1974 paper
on “The Role of Pregenital Confusions in Erotomania”, he reports
the treatment of a woman patient who dreamt that “she and another
woman were in rivalry for her lover, lying in bed on either side of
him. She was horrified to see that both had dark erect penises instead
of nipples [. . . her mother’s nipples are in fact dark . . . and had been
erect . . .]” (p. 332). Meltzer saw the confusion as the patient’s response
to weaning, in which “she was now turning away from the breast to
the father’s penis and entering into a fierce competition for control and
possession of that object, thus invoking a confusion between nipple-in-
mouth and penis-in-vagina to obviate the experience of weaning and
relinquishment”. In Sexual States of Mind (1973b), a patient’s dream is
understood as showing that “the penis and breast . . . are united as a
combined object” (p. 118). The nipple-penis “is interested in the little
boy’s mouth and bottom, and becomes the homosexual penis when it
leaves the breast”. Along similar lines, he writes in The Apprehension
of Beauty: “Splitting of the nipple-penis from the breast, which gener-
ates an eroticized penis and an envious breast-with-a-hole, seems to
be the most serious impediment to development; while the paranoid
distrust secondary to the confusion penis-feces-nipple which results
in the malignant nipple undermines mental health” (Meltzer & Harris
Williams, 1988, p. 62). There are further references to the nipple-penis
confusion in Adolescence (Meltzer & Harris, 2011) and, no doubt, others
that I am not aware of.2 In supervision he often referred to it, usually
in the context of the baby’s phantasies about whose presence inside
the breast was implied by the protruding nipple.
As I understand it, these formulations concern a level of develop-
ment at which weaning is a painful event that the child may refuse
to accept, but not an existential catastrophe in which parts of the
mouth are felt to be lost. This (adhesive) level is, however, important
for the understanding of children who may have achieved adequate
symbolic capacity, but not the psychological ownership of their mouth

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 nipple-penis confusion and selective mutism 23

that is necessary for voiced, articulate speech. I would like to suggest

that extending the reach of Meltzer’s concept of nipple-penis confu-
sion so that it encompasses that level can be fruitful in attempting to
understand some selective mutes as well as the fluctuating capacity
for correct articulation, and in locating both within the wider context
of characterological conflicts.
Meltzer did not himself write about that aspect of the experience
of the nipple that is central to the child’s acquisition of psychological
ownership of the various parts of the mouth, with all the implications
that this has for the capacity to produce articulate speech. Winnicott
(1963) first pointed out that the realization of being separate from
the mother, occurring before the infant had developed the equip-
ment to deal with loss, could mean that “certain aspects of the mouth
disappear[ed] from the infant’s point of view along with the mother
and the breast”, whereas the same loss later on would be confined to
“a loss of object without this added element of a loss of part of the
subject” (p. 222). Tustin (1966, 1972b) showed that it was specifically
the loss of the sensations generated by the nipple that led to the (illu-
sory) loss of an essential part of the mouth: her little patient John was
amazed that the “red button”, as he called the nipple, was not part
of him but “[grew] on the breast”. Tustin (1986b) subsequently wrote
that the child with autism had the experience of a breast that was
broken and, because his mouth was equated with the breast, felt that
his mouth was broken also. This is a much more concrete level than
Meltzer’s formulation concerning the envious breast-with-a-hole that
is formed when the breast and nipple-penis are separated; but both
statements imply that development—whether it is a matter of bod-
ily integrity or emotional stability—is compromised or does not take
place where it is felt to be at the expense of the mother figure.
In his chapter on mutism in Explorations in Autism, Meltzer (1975d)
focused on five factors that he thought were necessary for the produc-
tion of language. These included “the capacity to form dream thoughts
suitable for transformation into language” (p. 193), the identification
with speaking figures, and the desire to communicate with other
human beings who are recognized as separate. Such factors are con-
cerned with the child’s object relations. But Meltzer also mentioned
vocalization, which is necessary if the capacity for language is to show
itself as speech. He proposed that children with autism could remain
mute even when they had moved towards three-dimensionality and
when projection and introjection were playing an increasing role,
because “pre-genital oedipal jealousy interferes with the verbal coition

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 24 maria rhode

of internal objects, rendering them separate and silent” (p. 205). I sug-
gest later that the concept of nipple-penis confusion provides a way
of approaching this issue of “the interference with verbal coition” on
the concrete level of the organs involved.
Some children understand language well and can read and write
fluently but do not feel that the organs of their mouth are theirs to
use. Morton Gernsbacher (2005) has called this “oral dyspraxia”. For
example, Tito Mukhopadhyay, beginning when he was eight (Muk-
hopadhyay, 2000), has written a series of books in which he describes
in sensitive, lyrical detail both his relationship to other people and
his imaginative construction of the world. And yet he continued to
present as a classical severe autistic who never really acquired a voice.
Tellingly, one of his books is called How Can I Talk If My Lips Don’t
Move? (Mukhopadhyay, 2008).
Selective mutes are capable of “moving their lips” in specific situa-
tions and in the presence of particular people, but are quite incapable
of doing so with others. For this reason, they provide the perfect exam-
ple of the importance of strictly emotional factors in the production
of language. Non-analytic authors have described selective mutism
as a social phobia and have recommended a gradual and progressive
de-sensitization strategy. A traumatic incident can often be the trig-
gering factor, as it was with many victims of “shell-shock” in the First
World War. Judith Trowell and Israel Kolvin (1995) have carried out an
unpublished retrospective study in which adults who had been selec-
tively mute as children were interviewed and assessed on a variety
of instruments. These adults ranged from those functioning normally,
through those with a neurotic character structure, to a few who were
schizophrenic: clearly, selective mutism in childhood does not imply
a single pathway (though Jeanne Magagna, 2012a, 2012b, has sug-
gested that early problems with language development always point
to an impaired “bridge” between child and parents). But every one
of the interviewees stressed how overwhelmingly helpless they had
felt as children—a very different perspective from that of the adults
surrounding selective mutes, who tend to feel helpless themselves
and to see the child as controlling, withholding, and extremely power-
ful. Writing from a psychoanalytic perspective, Weininger (1992) has
emphasized selectively mute children’s fear of their own aggression,
particularly on the anal level, while Staehle (2007) has stressed the
importance of traumatic separation and Truckle (2006) that of trauma
more generally.3 My own anecdotal impression is that these children
often show the same intense, primitive bodily anxieties that we meet

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 nipple-penis confusion and selective mutism 25

with in children on the autistic spectrum—including a terror of falling,

of spilling out, and of losing parts of the body—though the length of
time during which such anxieties occupy the foreground of the child’s
experience may vary enormously.
Trauma of various kinds can be construed as though it were medi-
ated by the paternal element, which may be either intrusive or inef-
fective. For example, Britton (1989) proposes that where the mother
refuses the child’s essential projected communications, the child may
cling to the mother in order to survive and may instead ascribe to the
father the function of blocking these communications. This concerns
relational trauma. In Tustin’s “illusory trauma” of losing part of the
mouth (Tustin, 1994), it is the hard, masculine, sensation-generating
nipple that is felt to be torn away, so that the child’s mouth is left with
a hole in it. Where the child is intruded into by sensory impingements,
it can feel that loud noises, for example, are equated with a masculine
figure who comes between the child and the mother figure (this was
the case for a boy with autism I treated who would cover his ears if
a man came towards us as we went through a door; Rhode, 2004).
Where a catastrophic event has occurred in external reality, this can
feel as though the boundary between the child’s inner world and
outside events had become too permeable and needed reinforcing
(Britton, 1994)—as though that aspect of the paternal function that
separates the child from the mother, and internal reality from external
reality, were not working properly. This means that external reality
can seem as though it were simply the child’s reflection, which makes
it too dangerous to engage with. Velleda Cecchi (1990), for example,
describes the case of Marella, a normal 2½-year-old girl whose parents
were “disappeared” by the Argentinian secret police in the middle of
the night and who was found cowering, wet, soiled, and mute, in a
state of autistic withdrawal from which she emerged only gradually
during analysis. Cecchi conceptualizes this, persuasively in my view,
as the need to withdraw from an external world that seemed unable
to withstand the child’s worst impulses.
Findings such as these make it plausible that the relationship
to the nipple-penis should be an important issue in children with
selective mutism, given that a traumatic event often triggers their
symptom and that they typically experience extreme helplessness.
The child’s own identifications will obviously play a central part in
shaping this relationship. For example, I have discussed elsewhere
(Rhode, 2004) two boys with autism who had each suffered serious
trauma and whose material was very similar, but who responded

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 26 maria rhode

quite differently to treatment. An important factor seemed to be the

mothers’ relationship with their own respective internal fathers. The
first boy, who had a supportive maternal grandfather as well as a pre-
dominantly depressive attitude, dealt with his fear of doing damage
by equating himself with his very damaged mother. His chief anxiety
seemed to concern being separated from a maternal figure by the
intrusion of a paternal element: in that sense, he had some conception
of a good object and he did very well in therapy. The second child’s
mother had an ambivalent relationship to her internal father. This
child’s main fear was of being engulfed: he had no concept of a good
object, and his progress was disappointing. He identified with a hard,
traumatizing phallic element that showed itself, among other ways,
in the loud, vibrating noise he produced when he was anxious. The
following vignette, from the treatment of a different child, illustrates
how an identification with a traumatizing aggressor can play out spe-
cifically in the area of speech:

Anthony, a boy with quite severe autism whom I began to work

with when he was 6 years old, was able to speak in his own voice at
certain crucial junctures in his therapy (Rhode, 1999). On occasion
he could even speak poetically, hard though that was to believe or
remember as it was so totally out of keeping with his habitual mad
grimaces. Sometimes these grimaces were accompanied by frag-
ments of words; sometimes he remained mute. If he did speak in
sentences, it was not in his own voice, but in a repertoire of voices
belonging to a number of characters—notably the cruel man-eating
giant in Jack and the Beanstalk.
Anthony often lay under the couch growling menacingly as though
he were the giant. On one particular occasion, he retired under the
couch clutching at his genitals. I said that perhaps he needed to
be sure they would remain part of him, so he became a danger-
ous giant who made frightening noises from under the couch. He
immediately came out of his hiding place: he looked straight at me,
which very rarely happened, and said, “Will-ll-ll-lly—noise”. His
voice as he said this was exceptionally resonant, and he moved his
tongue energetically from side to side in his mouth.

Interestingly, Anthony’s tongue inside his mouth seems to be equated

with the giant’s genital inside a maternal space as well as with his
own body under the couch. It is understandable that such confused
identifications—and, in Meltzer’s terms, the equation of tongue and

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 nipple-penis confusion and selective mutism 27

nipple-penis within a context of violence—should lead to problems

in using the mouth consistently in line with its proper purpose as an
organ for the production of speech.
I would now like to illustrate some of these points with vignettes
concerning two boys with varying degrees of selective mutism. Both
had suffered serious trauma, and both seemed to equate talking with
concretely taking the nipple-penis out of the maternal object. They also
both showed a predominantly depressive orientation, and their mut-
ism seemed to be based on their identification with damaged parental
figures rather than on persecution by an “envious breast-with-a-hole”.

Ricardo: the healing power of a strong father figure

Ricardo was a young adolescent I heard about from a South American
colleague some years ago. At that time, Ricardo had recovered from
selective mutism and was speaking fluently and with gusto: it was
hard to believe that he had spent more than half his life completely
silent.

When Ricardo was just entering latency, he witnessed a serious

attack on one of his aunts who had surprised a burglar. Very
fortunately, she recovered from her injuries, but the violence was
vicious and must have been extremely frightening. Coincidentally,
Ricardo’s father died prematurely at about the same time, leav-
ing his mother bereft. Ricardo stopped speaking, and he did not
begin again for years. At that point, a family friend who acted as
a father surrogate and had shown himself to be a caring and reli-
ably protective figure let Ricardo know very forcefully that he was
no longer prepared to tolerate his not speaking. Ricardo began to
speak normally again virtually at once; his referral for treatment
was in connection with his general development, not with his mut-
ism, which did not in fact arise as a theme in the therapy. However,
I was very struck when my colleague told me about an incident
in which the boy drew an elaborate and very potent-looking erect
cobra, which he cut out and hid in one of the desk drawers. These
were equipped with prominent wooden knobs with which Ricardo
liked to fiddle while opening and shutting the drawers, so that the
constellation of the snake behind the knob seemed a convincing
representation of the nipple-penis. He responded with pleasure
and amusement when my colleague commented on what a sexy
snake this seemed to be.

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 28 maria rhode

I would hypothesize that the traumatic attack on a woman that

Ricardo had witnessed, together with his father’s premature death
at about the same time, must have been a catastrophic intrusion into
the resolution of his Oedipus complex. More specifically, it would
have conveyed the message that any normal oedipal competitiveness
and assertiveness would have the cataclysmic consequence either
of killing his father or of summoning up murderous strangers. He
did not regress to the extent of Mariela, the little girl whom Velleda
Cecchi (1990) described; Ricardo was a few years older at the time of
the double trauma, and his reality sense as well as his speech would
have been better consolidated. He did, however, spend the following
years in a state of mutism and substantial withdrawal, in which he
may have been identified both with his dead, mute father and with
his overwhelmed, depressed mother. My guess is that the male fam-
ily friend’s combination of care and assertiveness made him feel that
it was safe to show the masculine qualities that the developmental
thrust of adolescence was in any case strengthening, secure in the
knowledge that there would still be a healthy snake hidden inside
the maternal object with which his own tongue could legitimately be
seen to be identified. I want to emphasize again that the concept of
nipple-penis can account both for intrusive trauma to the child and
also for damage to a mother who has lost something vital. Ricardo’s
snake behind the nipple-knob seems an example of a well-balanced
constellation in which the father-element supports the mother, and
hence the child, without intruding.

Harry: growth that leaves a hole in the breast

Harry, a 5-year-old boy who never spoke at school and whom I saw
for assessment, similarly seemed frightened that he could take the
nipple-penis out of the mother figure, with disastrous consequences.

He wanted to do a drawing but felt unable to help himself to one

of the felt-tipped pens in a pencil case. When I wondered whether
he was worried about leaving a gap in the pencil case if he did so,
he managed to extract a pen and drew a house. First, he said that
there was a ghost in the house; next, that there was nothing inside
it. He then became confused and said that there was no one outside
the house. Harry had been 2 years old when his father died sud-
denly, leaving his mother desolate, like Ricardo’s.

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 nipple-penis confusion and selective mutism 29

I understood the fact that there was no one outside the house as point-
ing to his own identification with his dead father, who should have
been inside. As far as his mutism was concerned, we could say that
his voiceless or tongueless mouth was identified with a mother-house
that contained no nipple-penis, and that Harry was frightened that it
was his activity and initiative that had removed the nipple-penis from
the breast. Again like Ricardo, this child was transformed when a man
came into his mother’s life.
I want to repeat that neither of these boys seemed to be relating
to the nipple-penis in a way that was hostile to the maternal breast-
object, and that both showed a considerable degree of depressive feel-
ing.4 This is likely to be important in terms of who it is that the child
predominantly identifies with—whether with the damaged parental
figure or, like Anthony, with the traumatizing giant. I shall return to
this question later.

The nipple-penis
and problems surrounding articulation
So far, I have tried to explore what the concept of the nipple-penis
may contribute to our understanding of selectively mute children
in relation to phantasies concerning the possession of the tongue
or the voice. I will now discuss several consecutive sessions with
6-year-old Andrew in order to trace Meltzer’s proposed sequence of
nipple=penis=faeces in connection with Andrew’s capacity for correct,
articulated pronunciation.

Andrew, who was seen non-intensively, had earlier shown some

features suggestive of autism. He did not, in fact, receive a diag-
nosis, and he came to take obvious pleasure in communicating
vocally, even going so far as to provide me with useful clues when
his pronunciation meant that I had trouble understanding him.
However, even in latency he continued to speak in sentences in
which the words were divided into syllables, but in which the con-
sonants were often left unpronounced5. Sounds such as “D” and
“T” seemed to present particular problems—sounds, that is, that
involve touching the roof of the mouth with the tongue—though
I knew that he was capable of pronouncing them correctly as I
had heard him do so. But this was inconsistent: he produced these
sounds at some times but not at others, and even the division of his

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 30 maria rhode

words into syllables was sometimes blurred, so that his sentences

could deteriorate into an inchoate jumble. Often this happened
in the context of his tearing up paper, manipulating plasticine, or
spreading the contents of his box or his own snot around the room.
This kind of behaviour struck me as an anally based move that was
meant to blur differences, and I thought of the accompanying blur-
ring of Andrew’s speech as an example of Meltzer’s Theatre of the
Mouth (1986a) in which the structure of his words and sentences
reflected the structure of his internal figures. My conviction grew
when, over several sessions, the deterioration of Andrew’s words
came together with play sequences in which he stuck his open
mouth to its reflection in the mirror while spreading saliva over the
mirror’s surface and the furniture in the room. I understood this
as an attempt to mark the mirror and furniture with his own body
fluids—to assert his bodily continuity with them and me—while
at the same time establishing a narcissistic, adhesive partnership
with his own reflection. This pointedly excluded anything like a
nipple-function that could have served as a boundary between his
mouth and the breast or bottle.

A few sessions later, Andrew accidentally broke the bulb inside a

metal wall lamp by fiddling with it so that it fell on the floor. He
was obviously shocked. I said that I thought he had not meant
this to happen, even though perhaps he sometimes thought that
he should be able to fiddle with anything, particularly with things
inside other objects that might feel to him like people who man-
aged to have a place inside me. He repeated “Broken” several
times and wanted a “man” to replace the bulb immediately.

At the beginning of the following session, we had to wait together

outside until the caretaker let us in. After some of his customary
attacks on the physical integrity of the room (he always seemed
reassured when I could prevent these from getting out of hand),
Andrew staged what looked like a primal scene with two large
cars and one little one. Sometimes the little car was the excluded
one, sometimes one of the large cars was, and Andrew kept swap-
ping over which car represented him and which represented his
father. At the end of this sequence, he indicated that he was one of
the large cars, while “Daddy” was the little one. Then, turning to
the lamp, he gestured as though asking whether there was a new
bulb. I said that it hadn’t yet been replaced, and that perhaps this

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 nipple-penis confusion and selective mutism 31

made him feel worried. “Broken,” he said, “I broke it” (notice the
correct syntax and pronunciation). I agreed that he had, though I
repeated that I thought he hadn’t meant to and had been shocked
when it happened.
Andrew now fitted his mouth around the rim of the lamp, and
produced considerable quantities of saliva that spread over the
lamp’s surface. Then he repeated, “broken” and fiddled with his
mouth, his chin, and particularly his tongue. I said that he was
worried about breaking the bulb inside the lamp, and that now, if
his mouth wasn’t joined up to the lamp or to me by means of his
own spit, he seemed to feel that his tongue and chin were broken
too, and it was hard to speak properly. He responded with some
more fingering of his chin and the organs of his mouth.
He then curled up on the couch and whispered “Mummy” in a
tiny baby voice, pretending to be a baby who was crying. I said
that he was showing me a baby who was missing his mummy and
was feeling very sad. Towards the end of the session, he became
absorbed in switching the lights off and being able to switch
them back on, saying, “Dark”. I said how important it was to feel
he could stop things being dark inside me. In a later session, he
fingered his mouth while doing this, and I said that he needed to
make the light come back on: that if my eyes seemed dark, perhaps
it made him feel his mouth was broken.

I would like to emphasize several points. First, I think that encounter-

ing the firm paternal boundary of a closed door that was then opened
by a helpful (male) caretaker probably reassured Andrew considerably
about his omnipotent capacity to destroy rivals. This would have been
particularly important after he broke the light bulb without at that
moment meaning to. Feeling reassured that it was safe to engage in
oedipal rivalry (as in the game with the cars) probably contributed to
his ability to produce correct syntax and pronunciation, as though, like
Ricardo and Harry, he needed an intact breast with an undamaged
nipple in order to feel that his mouth was unbroken and that he could
make proper use of his tongue. The material about the lights suggests
a link between maternal depression (which he seemed to interpret as
the consequence of his own capacity to break the Daddy–nipple–light-
bulb) and his variable ability to speak correctly. I would see this as an
example, on the concrete level of tongue=nipple-penis, of Meltzer’s

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 32 maria rhode

proposal that problems concerning vocalization can be linked to an

interference with the “verbal coition” of parent figures.

Andrew’s sadness and depressive concern were followed in the

very next session by a major negative therapeutic reaction. For the
whole 50 minutes, he relentlessly attacked the room, particularly
“Daddy-like” elements like the door-stop protruding from a wall.
His articulation was very deteriorated: it was only after some time
that I thought I could recognize the words “In my bum” amid the
incomprehensible jargon in which unrecognizable syllables flowed
into each other. When I repeated the phrase, he began to pronounce
it more clearly. We appear to be witnessing Meltzer’s proposed
sequence in which the nipple is confused with the penis, which
in turn is confused with faeces in the bottom within a context of
general deterioration (here, specifically in relation to language).
In the following session, Andrew referred (in his idiosyncratic
pronunciation) to daytime and night-time, and said that he would
sleep in his mother’s room or in mine. He then fingered the lamp
again and said clearly, “I broke it”. Again, straightforward oedipal
rivalries seemed to imply catastrophic consequences.
Like Meltzer’s (1974) erotomanic patient, Andrew then seemed
to turn to a fierce competition for the penis in a genital context.
Lying upside down on the couch, he presented me with his bot-
tom and sang a favourite song in a muffled voice that obscured
the separateness of the words: “My name’s Isabel, dance with me/
On a Tuesday morning” (he had no session on Tuesdays, but had
often indicated that he should). I said that he was being a girl,
Isabel, inviting my husband’s penis to come out of me and into his
bottom, so that there should be no one in his way. Forcefully and
articulately, he asserted, “Boy!”

Andrew’s material seems to me to illustrate clearly, in relation to

language, the tongue–nipple-penis–faeces confusions that Meltzer
delineated. I think, however, that, like Riccardo and Harry, he was
fending off an unbearable depressive fear about the state of a maternal
figure rather than just the pain of weaning: his syntax and articulation
temporarily became normal when he could feel reassured about the
Daddy-nipple’s ability to survive his oedipal attacks and my capacity
to follow some of his tricky behaviour. Thinking about such material
in relation to nipple-penis confusion has the important advantage of

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 nipple-penis confusion and selective mutism 33

linking concrete experiences concerning the organs of the mouth to

aspects of the child’s developing character.

Concluding remarks
To sum up my argument: I have tried to illustrate the power of Melt-
zer’s nipple-penis confusion as a conceptual tool in the attempt to
understand two cases of selective mutism as well as the way in which
the clarity of one child’s pronunciation varied with his state of mind.6
Meltzer’s original formulation applied, I suggest, to a level of experi-
ence where weaning might be a source of pain that the child rebelled
against, with various characterological consequences. In contrast, the
children I discuss seem to be preoccupied with the loss of the nipple
as an existential catastrophe, as delineated by Frances Tustin, and I
think that it is useful to extend Meltzer’s concept so that it includes
this adhesive level. This allows concrete experiences in the mouth to
be linked with such ideas as “the verbal coition of internal objects”
and to be situated within the context of the child’s developing char-
acter. I have also proposed that the concept of the nipple-penis can
encompass the fact that trauma of one kind or another, which is often
a trigger of selective mutism, can be construed as being mediated by
the paternal function.7
The rivalrous appropriation of the nipple-penis (as Meltzer
described it and as shown in Andrew’s material) can be contrasted
with the identification with damaged parental figures (as with Ricardo
and Harry). The question of whether the child identifies with a dam-
aged parent or with a phallic aggressor appeared to be linked in two
autistic children with the degree to which of the mother’s own internal
father was supportive and could serve as a “buttress” (S. Klein, 1980;
Houzel, 2001) to the maternal function. This may well apply to differ-
ing identifications in selectively mute children.
Juliet Mitchell, who has stressed the identification with a dead
mother figure in mute, shell-shocked soldiers of the First World War
(Mitchell, 1996), has also reminded us that the hysterical aphonia with
which Freud’s patient Dora came to treatment is often overlooked
(Mitchell, 1998). She points out that it returned temporarily after the
end of treatment and suggests that Dora was identified with a dead
father who was therefore mute: “in Dora’s dream, it is her mother who
writes to Dora in Dora’s dream-absence, telling her daughter that she
can come home, as her father is dead” (p. 129). In fact, Dora’s second

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 34 maria rhode

episode of aphonia came on after she had seen Herr K knocked over
by a carriage—an obvious parallel to Ricardo. This implies, I think,
that descriptions on the level of the nipple-penis can be relevant to
patients such as hysterics whose functioning is apparently much more
advanced than that of many children with selective mutism. Again, it
is the degree to which Meltzer’s concept is capable of unifying many
different phenomena, conditions, and levels of experience that makes
it so useful.

Notes
1. Klein thought that premature erotization led to a harmful confusion
between oral and genital experience and, indeed, to confusion more generally
(Klein, 1957, pp. 195, 197–198). A body of literature exists on the relationship
between the male and female elements of the primitive combined object, which
falls beyond the scope of this chapter. This literature includes S. Klein’s suggestion
that the baby first experiences the masculine element as a necessary support to the
feminine element before it comes to be seen as an intrusion into the mother–baby
couple (S. Klein, 1980). Similarly, Houzel (2001) has emphasized the necessary
“buttressing” function of the masculine nipple; he differentiates the “nipple link”,
which he thinks is operative “proximally”, from the “penis link”, which operates
over longer distances. Birksted-Breen (1996) distinguishes between the narcissistic
phallus and the “penis as link”, which provides triangulation and promotes the
structuring of mental space, while I have suggested (Rhode, 2000) that primal,
essential splitting can be interfered with when it is confused with damage to the
developmentally necessary early conjunction of male and female elements.
2. Lubbe (2011) has posted a helpful review of Kleinian and post-Kleinian
theories of sexuality.
3. Since the paper on which this chapter is based was first written, Pozzi
Monzo, Micotti, & Rashid (2015) have published an account of selective mutism
that includes individual and family approaches as well as a literature review.
4.  In contrast, I have heard from a colleague about a girl who seemed con-
cerned to hide her capacity for speech as well as her interest in sexual mat-
ters—themes that appeared together in her sessions—as though trying to avoid
retaliation by her female therapist, who was also pointedly excluded from the
child’s close relationship with her father.
5.  This is a feature that I have seen in a number of children; Geneviève Haag
(2004) has called it “démutisation en voyelles” [demutization in vowels].
6. Carlos Tamm (2014) has recently documented the parallel between the
capacity of two boys with autistic or psychotic features to use language correctly
and the nature of their “mental landscape”.
7. It can also encompass cases in which words are felt to be produced by
objects inside the mother (by babies as well as by a father), whose existence the
child wishes to suppress by magical means (Rhode, 2013): these are beyond the
scope of this chapter.

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 CHAPTER THREE

Point–line–surface–space:
on Donald Meltzer’s concept of
one- and two-dimensional mental
functioning in autistic states

Suzanne Maiello

“In the early days, there was great pleasure in doing what my
teachers taught me to do and finding out that they were right. . . .
But then . . . there comes a time when you cast off from the pier
and into the open sea and are on your own . . .”
Donald Meltzer, “A Review of My Writings” (2000)

Dimensionality and the human mind:

Edwin A. Abbott and Donald Meltzer

T
owards the end of the nineteenth century, Edwin A. Abbott
published a satirical narrative with the title Flatland—A Romance
of Many Dimensions (1884). This modest little book did not
achieve great success at the time. It was discovered almost forty
years later after Einstein’s formulation of the theory of relativity and
the introduction of the concept of time as the fourth dimension of
three-dimensional space. The story is about a two-dimensional world
referred to as Flatland. Its inhabitants are geometric shapes. The main
character is a square. He receives the visit of a sphere who takes him
to three-dimensional Spaceland. The revelations of Spaceland open the
Flatlander’s mind to new and unexplored lands. His research is ori-
ented both forwards towards increasing dimensions, and backwards
to Lineland and Pointland.
35

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 36 suzanne maiello

After his initiation into the third dimension, the native Flatlander
explores in his dreams the one-dimensional and even a-dimensional
world. The one-dimensional country of Lineland is inhabited by a
“multitude of small Straight Lines . . . of the nature of lustrous
points—all moving to and fro in one and the same Straight Line” (p.
54).1 For the Linelander, “the Straight Line . . . constituted the whole
of the world, and indeed the whole of Space. Not being able either
to move or to see, save in his Straight Line, he had no conception of
anything out of it. . . . Outside his World, or Line, all was a blank to
him; nay, not even a blank, for a blank implies Space; say, rather, all
was non-existent” (p. 55).
Eventually, Abbott’s dream-explorer is taken to Pointland, “the
Abyss of No dimensions” (p. 92), whose sole inhabitant is a point:
That Point is . . . confined to the non-dimensional Gulf. He is himself
his own World, his own Universe; of any other than himself he can
form no conception; he knows not Length, nor Breadth, nor Height,
for he has had no experience of them; he has no cognizance even of
the number Two; nor has he a thought of Plurality; for he is himself
his One and All, being really Nothing. [p. 92]
Abbott was a philosopher and mathematician, not a clinician, but his
was a free, critical, and creative mind. When he published Flatland,
he did not intend to write a psychological treaty. At that time, Freud
had not yet developed his interest in psychopathological phenomena,
but it seems that thoughts around the functioning of the human mind
were in the air.
Donald Meltzer does not seem to have come across Abbott’s Flat-
land. He never refers to this satirical little book. Although the intentions
of the two authors were different, there are striking similarities in their
descriptions of the functioning of the mind in terms of dimensionality:
they both explore the narrowing effects of two-dimensional mental
functioning and the ultimate breakdown of mental dimensionality
altogether. Today, Abbott’s description of Pointland evokes the notion
of the astronomic black hole, which had yet to be discovered when
he wrote his Romance of Many Dimensions. An astronomic black hole is
described as what remains after the catastrophic breakdown of a dying
star with great mass. Space-time collapses over the star which then
disappears from our universe (Kaufmann, 1977). In Abbott’s prophetic
vision, Pointland is close to this absolute unthinkable nothingness.
Autistic mental functioning seems very close to that of the inhabit-
ants of two-dimensional Flatland and one-dimensional Lineland, and
autistic children even seem to know about the ultimate a-dimensional

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 one- and two-dimensional mental functioning 37

nothingness of Pointland. Their existential terrors are linked to this

kind of absolute void. Tustin’s little patient John referred explicitly to
a black hole in his mouth when the red button (the nipple) was gone
(1972a). Can we imagine that these children’s one- or two-dimensional
mental functioning represents a retreat from dangers threatening them
from both sides? On the one hand, the endless falling into the a-dimen-
sional abyss of the black hole, and, on the other, the threat of anni-
hilation anxieties which would accompany the emotional experience
of separateness implicit in three-dimensional mental functioning. The
two extremes seem to meet, blocking the child in his or her internal
Flatland or Lineland.

Abbott and Meltzer in dialogue

Abbott wrote at the time that the Flatlanders cannot see properly, they
have only one eye, and eye and mouth are one and the same organ.
(In autistic two-dimensional functioning, there is no binocular vision,
and the centre of the original trauma, which led to the breakdown of
the primary three-dimensional mental disposition, seems to be located
in the mouth). The author writes that, in Flatland, shapes “move freely
about, on or in the surface, but without the power of rising above
or sinking below it, very much like shadows” (1884, p. 4). Meltzer
describes this state as “being on one side or the other of a paper-thin
object” (1975b, p. 226), which is in “effect an object without an inside”
(1975e, p. 18).
In Abbott’s Flatland, life is monotonous; symmetry and regular-
ity are the guarantees of safety. In Meltzer’s Explorations in Autism,
“Circumstances which threaten this changelessness would tend to be
experienced as break-down of surfaces . . .” (1975b, p. 225, emphasis
added). Abbott’s Flatlanders—the author actually refers to the female
inhabitants of Flatland, but this would open a socio-historic parenthe-
sis, which is beyond our immediate concern—are “wholly devoid of
brainpower, and have neither reflection, judgment nor forethought, and
hardly any memory” (1884, p. 15, emphasis added).
According to Meltzer, two-dimensional functioning perceives and
appreciates only
. . . the surface qualities of objects, but its aims will necessarily be
curtailed by an impoverished imagination, . . . The reason for this
limitation of thought and imagination would reside in the lack of an
internal space within the mind in which phantasy as trial action,
and therefore experimental thought, could take place. Furthermore,

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 38 suzanne maiello

the self which was living in a two-dimensional world would be

impaired both in memory and desire, or foresight, for the same reason
. . . it would be unable to conceive of enduring change, and therefore
of development—or cessation. [1975b, p. 225, emphasis added]
Meltzer introduced the notion of the dimensionality of mental life
in Explorations in Autism (Meltzer et al., 1975). It is a concept that we
could not do without today, an open metaphor that embodies and
gives shape to the mystery of mental functioning and, at the same
time, invites us to expand and explore its intrinsic potentialities.
The notion of the dimensionality of the mind develops the spatial
representation of Klein’s internal world with its objects and is akin to
Bion’s concept of container/contained. Meltzer maintains that, in normal
development, “the feeling of being adequately contained is a precon-
dition for the experience of being a continent container . . .” (1975b,
p. 226). His notion of dimensionality has a solid clinical base in work
with autistic children who have lost precisely the potential of three-
dimensional mental functioning, which is the conditio sine qua non both
for the experience of separation and separateness, with its wide range
of intense emotions, and for the development of symbolic thinking.
The clinical material and the drawings of an autistic child demon-
strate this little boy’s initial two- and even one-dimensional mental
functioning, as well as his struggle, supported by the sensitivity and
firmness of his psychotherapist, to move towards the third dimension
of the mind with its threats, its dangers, its surprises, and its frighten-
ing, painful, enlivening, and passionate emotional potential.

An autistic child’s struggle

to emerge from a two- and one-dimensional world
Emilio,2 a highly intelligent child with a diagnosis of autistic spectrum
disorder, began his three-times-a-week psychotherapy at the age of
4½ years. He was verbal, but used language almost only echolalically,
repeating the same words or short sentences endlessly with a high-
pitched mechanical tone of voice that flattened any possible emerging
meaning.
Emilio was the first child of a young couple. The pregnancy was
normal, but during labour, according to the mother, “the baby was
sleeping, did not want to come out and had to be pulled out with a
vacuum extractor”. He sucked the breast voraciously, which scared the
mother at the beginning. From birth he slept in the parents’ bed with
the nipple in his mouth. At age 6 months, the mother tried to introduce

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 one- and two-dimensional mental functioning 39

spoon-feeding, which Emilio refused. From that time, the baby would
close or avert his eyes and cover his ears if anybody approached him.
Around that time, mother had to resume work. Every morning, she
took the local train with baby Emilio on her lap. The mother left him
with her parents, who lived almost an hour away, and brought him
back home on the same train in the evening.
When he was 15 months old, mother decided that it was time to
wean him, but she seemed unable to imagine how to manage this
change. So, she covered her nipples with Band-Aids. From one day to
another, the potentially ever-present breast became a no-access breast.
Emilio touched the Band-Aid strips and said, “Bua–bua” (“sore–sore”),
but after a week the breast seemed “gone” from the child’s memory,
and Emilio did not search for it again.
It was only when he started nursery school, at the age of 3, that the
parents began to worry seriously about his development. Emilio was
withdrawn; he did not play with other children, he flapped his hands,
and his speech was echolalic. For one year, Emilio had two-weekly
sessions of psychomotor therapy. After a follow-up consultation, the
clinic suggested psychotherapy.
From the beginning of his life, Emilio seemed to have experienced
the nipple as an integral part of his mouth. Had he managed to exclude
any awareness of differences between presence and absence, and any
perception of otherness from his experience? When partial weaning
was started, Emilio covered his eyes and ears, obliterating the distance
senses—sight and hearing—that open the mind to undeniable three-
dimensional experiences in the external world. He may have clung to
the exciting tactile sensation of the nipple-in-the-mouth, which still
continued at night. It is possible that he had shut out any awareness
of the existence of in-betweenness in the dimensions of both space and
time and had withdrawn into a pathological delusion of uninterrupted
adhesive union with the mother:
In an attempt to re-establish the primary situation of flowing-over-
at-oneness, which had been agonisingly disturbed by experiences of
sensuous disconnection from a sensation-giving “mother” who had
been experienced as part of the body, auto-sensual reactions are set
in train which bring about the delusion of fusion with a sensation-
object. [Tustin, 1981, p. 22]
When Emilio entered the therapy room for the first time, he acknowl-
edged neither the separation from his parents nor the therapist’s
presence. His behaviour was robotic and so was his speech, yet, in
that very first session, he was able to represent the catastrophe of the

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 40 suzanne maiello

breakdown of his potentially three-dimensional mental container: he

made a rudimentary archway with building blocks, which he called
“bridge”. He then took another block, said “choo-choo”, and moved
the train perpendicular to the archway. It could easily have passed
underneath and crossed over to the other side, but the train hit one
of the pillars, thus causing the archway to collapse and bury it under
the blocks. The therapist commented what had happened, and Emilio
repeated over and over again, “train make bridge fall, all broken”,
while he endlessly reproduced the scene.
The monotonous, ritualized repetition of the same action and
words, which had been meaningful initially, was an aspect of Emilio’s
obsessive autistic protection manoeuvres, thanks to which he tried
to blot out the emotional impact of and contact with the catastro-
phe of the dimensional breakdown. Meltzer writes about the crucial
importance of the awareness and capacity to conceive of orifices for
three-dimensional mental development. Emilio’s archway was both a
boundary, which created a spatial structure on the flat table surface,
and an opening. His vocal “choo-choo” announced the train’s origi-
nal intention to move through that opening which connected the two
sides of the wall. Meltzer writes in his comment to Shirley Hoxter’s
little patient Piffie: “The nipple, which is required as a go-between
[between] the baby’s mouth and the content of the breast, in itself
implies separateness as well as ‘togetherness’” (Meltzer et al., 1975,
p. 176, emphasis added).
For Emilio, crossing the threshold of the archway had not been
possible. It would have entailed the experience of three-dimensional
space, with its limits and differentiations and therefore the experience
of otherness. But he had set the scene. This was prognostically encour-
aging. The archway and the train could be seen as a representation
of the traumatic experience of the tearing apart of the baby’s mouth
and the mother’s nipple, which had contributed to the breakdown of
three-dimensional mental functioning.

Two- and one-dimensional mental functioning

and the breakdown of the differentiation of shapes
Emilio’s first drawing (Figure 3.1), which he produced after four
months of psychotherapy, bears witness not only to the catastrophe of
the collapse of the third dimension, but also to the breakdown of the
functional differentiation of shapes and the notion of dimensionality
altogether.

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 one- and two-dimensional mental functioning 41

Figure 3.1

Emilio first drew a small blue square at the bottom of the sheet,
then a large pink shape, a “bubble”. Around the bubble, were
knobs, which he called “clicks”, and various other protruding
shapes. On the upper side of the bubble, he added a larger blue
bulge, which he called “shoulder”, and to the left a big long purple
protrusion, which looked like a tongue, but he said that it was a
“throat”.

Emilio had a notion of the body parts that he had drawn, but neither
their position nor their shape had a consistent formal identity nor felt
meaningful. What he drew were part-objects, unrelated both to one
another and to the body of the bubble. The clicks look like sticking-out
nipples—might they correspond to Tustin’s patient John’s buttons?—
over which Emilio may have needed command. The sticking-out
shoulder corresponds, more or less, to its anatomic shape, but with
the tongue-shaped throat everything seemed to have become more
confused: there had been a breakdown of differentiation between
the convexity of tongue and nipple, and the concavity of mouth and
throat. With this drawing, Emilio seemed to have found a way of rep-
resenting an even deeper level of the primary catastrophe that he had
shown with the archway and the train, where what had collapsed had
been “only” the potential of three-dimensional mental functioning.
In this drawing, the breakdown seemed to have occurred at an
even more primitive mental depth. If nipple and mouth become

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 42 suzanne maiello

c­ onfused in their basic difference of shape in space—convexity versus

concavity—the catastrophe seems to reach almost cosmic dimensions,
the star being swallowed in a black hole and disappearing from the
very universe of what is conceivable. Emilio’s confusion at this level
not only involved basic graphic shapes, but had a linguistic coun-
terpart, which showed his intelligence and sensitivity in the middle
of the dimensional and formal confusion. At first, Emilio had used
the correct Italian word for shoulder, “spalla”, and had pronounced
it correctly, but then he changed the sound of the word to “smalla”
(which has no meaning). “Spalla” has a hard daddy sound, “smalla”
has a mummy-softness to it. If we try to transfer the shift of sound
into English, “shoulder” might have become “zmoulder”. Was there
something dangerous in the hardness of sticking-out bits? Had there
been a flicker of awareness of differences in both visual shape and
sound shape, which had to be confused again immediately in order
to avoid once more the threatening awareness of differences in the
mouth-nipple configuration?
At this point, Emilio turned the drawing upside down. The shoul-
der and the throat, as well as the neighbouring protrusions and clicks,
which had stuck out from the upper part of the (pink) bubble are now
hanging down from its lower part. Everything is upside down.

Emilio added two long thin (reddish) shapes to the drawing, which
pointed downwards to the low edge of the sheet of paper, without
reaching it (Figure 3.2). To explain what they were, he said “reggi,
reggi”. “Reggere” means to support, bear, hold, sustain. The child
had felt that the big pink bubble seemed no longer able to sustain
itself, but it was unlikely that those two fragile added supports
would really be strong enough to carry its weight.

The breakdown of the differentiation between convex and concave

shapes revealed the depth of the topographic confusion in the child’s
mind, which went deeper than the mere breakdown of the third
dimension. It was as if the spatial category of dimensionality itself,
with its structuring function, had broken down, leading to what we
might call an a-dimensional world of shapeless shapes. In normal
experience, different shapes have specific functions in the encounter
between mouth and breast at the part-object level. They acquire a
stable meaning in a three-dimensional mental configuration, thanks
to the acknowledgement of betweenness, which allows for the experi-
ence of an encounter, a reunion, between the empty concave mouth

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 one- and two-dimensional mental functioning 43

Figure 3.2
that searches for the convex nipple to fill the empty space and create
the condition for the arrival of the nourishing milk.
Emilio’s upside-down drawing showed not only his spatial confu-
sion, but also conveyed his dawning feelings of utter helplessness,
which the omnipotent illusion of the initial magical clicks was no
longer able to keep at bay. The drawing of the following session seems
to confirm this (Figure 3.3).
It is black to begin with. No soft pastel colours any more. Emilio
produced a shape reminiscent of the pink bubble. The little blue square
of the first drawing was now replaced by a sharp black prick. Emilio

Figure 3.3

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 44 suzanne maiello

started colouring the inside of the bubble, but soon gave up. The hap-
hazard black scribbles seem to say something about the child’s utter
disorientation and hopelessness.
There were no clicks any more, only the sheer weight of primary
depression that Emilio had shown in the first assessment session with
the bridge that had collapsed under the impact of the train and buried
it under its broken parts. Could Emilio’s experience of catastrophe
even be linked back to mother’s anxiety around the voracity of her
new-born baby? A ferocious predator meeting a fragile bubble-breast
resulting in the breakdown of the baby’s primary experience of dimen-
sionality? Or even further back to the birth scene, with the mother
imagining that the baby was sleeping and did not want to be born?
Tustin (1994) writes about autistic disorder in terms of a two-stage
pathology, the unbearability of separation being the second stage of a
preceding state of undue adhesive unity.

The long walk towards the experience

of three-dimensional space and containment
About one year into therapy, Emilio started building two intersecting
railway tracks with flat building-blocks, forming a cross shape on the
play table (Figure 3. 4). The cross structures space, becoming the basis
of a coordinate system through which every single point in space can
be reliably identified. Tustin (1981) underlines that the appearance of
a cross-shape in the clinical material of an autistic child is, literally, a
crucial moment in the child’s psychic development:
Many . . . children have shown me the importance of the stage when
they use a vertical line to intersect a horizontal one. . . . As straight
lines are brought together to intersect each other, the child begins to
bring together basic sensuous contraries . . . [pp. 156–157]

Emilio seemed to know that this was where a reparation of the catas-
trophe needed to begin. He placed two “trains”, which consisted of
one thicker building-block each, on the two arms of the cross. Each
train moved on its own track. No crashes occurred at the cross point,
because the two trains never moved simultaneously, but there were
no encounters either. The trains were identical, but Emilio accepted to
identify them as the Emilio-train and the Francesca-train, respectively.
One day, his train was about to fall off at the far end of his rail. Emilio
was precipitated into a state of panic. The terror of endless falling into
bottomless space, which had been counteracted by transforming the

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 one- and two-dimensional mental functioning 45

Figure 3.4

world into a Flatland-surface or a Lineland-line, hit the child once

more with annihilating intensity.
In the next session, Emilio’s experience of being suspended at the
rim of the abyss at the end of his rail may have induced him to build
two shelters at the two ends, one for each train (Figure 3.5).
For the first time, Emilio had produced a three-dimensional object
with an inside: the basic shape of a container and, in Virginia Woolf’s

Figure 3.5

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 46 suzanne maiello

terms, of “a room of one’s own” (1929). Emilio had a long way to

go, but it looked as if the preconception of a third dimension of the
mind had revealed itself and become imaginable and representable.
The shelters had doors, which were sometimes open and sometimes
closed. The trains could be either inside or outside. The very expe-
rience of the opening and closing of a door (or sphincter) entails a
momentary awareness of an inside differentiated from an outside.
Meltzer does not hesitate to assert that, with the discovery of body
orifices, “the entire view-of-the-world rises to a new level of complex-
ity, the three-dimensional one of objects, and by identification, the self,
as containing potential spaces. . . . The potentiality of a . . . container
can only be realized once the sphincter-function has become effective”
(1975b, p. 226).
With this arrangement, Emilio had, in fact, set the scene for the
first tentative experiences of existing and moving in three-dimensional
space and, at the same time, of existing as a separate being. There
were two trains and two shelters. When his anxiety grew, especially
when a holiday was approaching, he would put the shelters right at
the cross point, so that they touched each other at one corner, and the
doors were tightly closed to prevent the trains from coming out. The
original unbearable annihilation anxieties, which had brought about
the autistic two- or one-dimensionalization of Emilio’s immature mind
at the beginning of his life, could now be experienced and tolerated
for brief moments as separation anxieties that he survived as long as
he was safely enclosed in the womb-like shelter.
But the day came when being shut in the shelter became, in itself,
a source of anxiety. Weeks later, Emilio built only one shelter, put the
train inside, and closed the door tightly. The therapist’s perception in
the countertransference was that of being enclosed and suffocating
inside a coffin. When she asked Emilio what the train was doing in
there, he said “Dark . . . sleep”. He looked at the closed shelter for
some time and then said in a whisper: “Train . . . scared.” The shel-
ter no longer had a protective function, but had become a prison, a
claustrum (Meltzer, 1992a). Projective identification had started func-
tioning, mental three-dimensionality was dawning. Emilio opened
the door, took out the train, and stroked it lightly with his finger. The
formerly enwombed train had been born from the darkness and had
encountered Emilio’s tender, comforting maternal presence. The once
sought-for continuity of an undifferentiated primal union had become
a frightening prison. Emotions could be felt and had been expressed
in human language.

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 one- and two-dimensional mental functioning 47

The rail-cross, the trains, and the shelters were arranged in every
single session over many months in an almost identical configuration,
but occasionally with minimal variations. There were also endless
stand-stills and, again and again, the risk of stereotyped repetitions
that denied meaning to what had been represented, with the child’s
mind withdrawing from the communication with his therapist and
from his train and rail-cross activities. In those moments, he escaped
physically to the window and stood there, sometimes for most of the
session time, lost in an unreachable no-man’s land. From the window,
he could see the local trains arriving, stopping at the nearby station,
and moving on again. He seemed to lull himself and to dissolve in
their sound and repetitive motion, to-and-fro, in both directions. No
contacts, no crossings. There was an addictive quality to his with-
drawal at the window. The therapist was reminded of the time when,
from the age of 9 months, and for almost a year, Emilio had been
taken on daily train journeys with his mother. At that time, his autis-
tic manoeuvres may have allowed him to shut out the experience of
separation from his mother, who left him with his grandparents for
the day; he would take refuge in the rocking continuity of a delusional
sensuous union, enveloping himself in the sounds, noises, and vibra-
tory rhythms of the moving train.
The movement of change was slow but eventually undeniable.
Physical three-dimensionality had become part of Emilio’s experience;
the shelters offered a reliable protective function, the trains occasion-
ally met at the cross point, and the opening and closing of the shelter
doors, with the trains going in and coming out, had brought about
basic differentiations in Emilio’s mental configuration. The scene was
set for the discovery of the vicissitudes around traumatic experiences
in the mouth and oral aggression, which, as suggested by Tustin, are
invariably connected in some ways with autistic withdrawal. The
first intentional representations and the first moments of pretend play
appeared in Emilio’s activities.

The emergence of oral aggression

Emilio’s parents reported that he had become increasingly fussy about
food. In his sessions, at that time, he had discovered and started using
the cooking utensils, which were part of the material in his box:

He took the kitchen-pot and made the gesture and the hissing
sound of lighting the gas flame under the pot. He put the l­ittle

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 48 suzanne maiello

mummy-figure in the pot and “cooked” her. When she was “done”,
he gave the doll to the therapist to eat, but warned her that the
mummy was very hot and would burn her mouth. He also cooked
the children, including the baby, and occasionally banged the
mummy doll on the table with rage. He took a piece of string that
had represented a strip of Band-Aid in an earlier session and tied
it around the boy-doll’s neck, saying that his neck or his throat (it
was not clear) was sore.

After a long time, the child seemed to have taken up the confused
and confusing throat/tongue issue of his first drawing again, but
at a new, emotionally more intense and meaningful level. At this
point, “an internal space within the mind” seemed to have devel-
oped in the child, “in which phantasy as trial action, and therefore
experimental thought, could take place (Meltzer, 1975b, p. 225). Dur-
ing this “cannibalistic” kitchen period, in which mothers and babies
alike were cooked and eaten, Emilio had become able to project
his emerging, burning-hot, oral phantasies into the therapist, who
was made to feel the scorching emotions connected with his abrupt
weaning at the age of 15 months. From one day to another, mother’s
nipples, which had filled his passionately sucking mouth since he
was born, were gone. By that time, he must have had a mouth full
of teeth. Was he terrified that his voracious mouth had bitten off
mother’s nipples? At the sight of the Band-Aid strips on her breasts,
Emilio had said at the time that they were sore. The disappearance
of the nipples had caused the abrupt rupture of the baby’s highly
eroticized delusional continuity of the breast-mouth connection,
leaving him with the “black hole with the nasty prick” feeling in
his mouth. Had the sight of those mutilated flattened breasts, which
had lost their powerful, dark protruding part, contributed to the
final breakdown of the third dimension in the child’s mind, a pro-
cess that had started much earlier, at the latest at the time of partial
weaning when the baby covered his eyes and ears when approached
by a person perceived in his or her otherness?
There must have been a mixture of unbearable pain, despair, and
guilt, which entailed not only the breakdown of any differentiation
between mouth and nipple, but at the deepest levels of spatial experi-
ence, the collapse of the preconception of the encounter of opposed
and complementary concave and convex shapes. Mother’s nipples
and the child’s mouth may have disappeared in one cosmic existential
wound, a great black hole.

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 one- and two-dimensional mental functioning 49

The orientation in space

and the projection of three-dimensional visions
A new period began during which Emilio produced a long series of
drawings in which he represented a duck family. These drawings bear
witness to his new-found capacity to move in linear motion and to
conceive of structured three-dimensional space, which he was able to
project on paper.
He had made great progress in the use of and orientation in space,
and his graphic figurative capacity was surprising, although stereo-
typed aspects persisted and were expressed in the endless repetition
of almost identical stamp-like duck drawings. Three of these have
been chosen to show the gradual transformations that occurred in his
use and subdivision of space, which led to further differentiations and
the emergence of new contents. It is important also to note Emilio’s
new capacities in the use of colours. Not only is his way of colouring
more vigorous, but the sea is as blue as it is in the illustrations and
he is careful in respecting contours. Above the surface, he colours
with black pencil only, but under the waterline there is a meaningful
emotional progression from the uncoloured white drowned duckling
to the alive orange fish and finally the multicolored aggressive sharks.

In the first drawing (Figure 3.6), Emilio began by outlining the big
duck’s beak, then he drew its head, eye, neck, and body. Next came
a duckling. The child was pleased with what he had produced
and said, “mummy and son”. Two more ducklings followed in a
row and, finally, a fourth one was added underneath the mummy

Figure 3.6

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 50 suzanne maiello

duck. Only then did he notice that he had not drawn the waterline.
He drew it from left to right, in the direction of the ducks’ swim-
ming motion. The line began at a low level and moved upwards
towards the birds with the clear intention of supporting their
bodies. However, he did not quite succeed in his intention, and
the ducks remained floating above the water line. Emilio noticed
this and vigorously filled the gap between the ducks and the water
with black pencil. He clearly wanted them to be supported by the
water line. Pointing to the fourth duckling, he said that that one
was “under water” and added “eyes burning”. (Was the experi-
ence of the distance between him and the mother duck too painful
to be looked at? Or did he simply remember summer holidays and
the salty sea water? In either case, there was a mental association.)
He coloured the water carefully, paying attention to the contours
of the under-water-duckling. When the therapist asked him, hav-
ing intuitively grasped that Emilio’s new capacity for orientation
in space allowed new meanings to emerge, if that duckling had
fallen into the water, Emilio replied: “Drowned.”

This was Emilio’s first figurative drawing. It has an unmistakable

stereotyped quality, typical of the drawings of autistic children, which
suggests a kind of mechanical two-dimensional cartoon-learning of
repeatable shapes, perhaps the graphic equivalent of echolalia. The
therapist imagined that the drawing reproduced shapes that Emilio
had seen or drawn before, but some elements were connected with
his dawning experience of existing in real space. Top and bottom are
distinct. A line separates the air from the water, which has to sustain
the ducks. They are swimming, moving in space, from left to right. The
drowned duckling is not in a row with the others but separated from
the mother duck by the waterline—“under water”, as Emilio said him-
self. He does give the impression of beginning to be in touch with the
fear of dying related to the separation from the mother at a part-object
level, which has now become thinkable, and he is able to represent this
by projecting his death anxiety into the drowned duckling, without the
representation escalating into nameless dread any more (Bion, 1962a).
Emilio had started drawing the mother duck from the beak, which
was somewhere high up. Could that beak be connected with the
unreachability of mother’s breasts after the abrupt weaning, and with
his very first drawing—the knobs and clicks that were stuck on the
surface of the pink bubble? At the time, those protrusions had lost
their function in the tongue-shaped throat, which revealed the gen-

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 one- and two-dimensional mental functioning 51

eral confusion between convex and concave shapes. Of course ducks,

like all birds, are confusing, because their nipple-shaped beak is their
mouth. It seemed, however, that now the child was ready to explore
this puzzling issue.
He had re-evoked his weaning experience, which had been the
object of his intense cooking activities. In the following two drawings,
he explored oral issues at an increasingly higher representational level.
For months, he had produced a countless number of duck drawings.
Repetition often led to a loss of meaning, but over time, important
changes did occur. This showed that the unconscious mental processes
that had been set in motion during moments in which three-dimen-
sional functioning of the mind was becoming more bearable continued
to develop in the child’s internal world. Oral phantasies came to the
fore again with more and more urgency and needed to be represented
in his later duck drawings.

The first thing Emilio did this time was to trace the waterline,
which was straighter and less hesitant than in the first draw-
ing. Space was clearly divided horizontally into an upper and a
lower part. There were again five ducks, the big mother and four
ducklings (Figure 3.7). On the whole, they looked more solid than
in the initial drawings, and their bodies were in contact with the
water. Their necks were coloured in black and the mother’s neck,
in particular, was quite big. Emilio added little wings to each duck,
but there was not enough space for the last duckling of the row. Its

Figure 3.7

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 52 suzanne maiello

body was nothing but a tiny annex to its black throat, and it looked
rather miserable. It seemed to be lagging behind and was not really
part of the family. From its position, it could not see the mother
duck properly, because the duckling in front of it was too big.
But in this drawing Emilio added a new element: two little fish
swimming under the surface. Their shape and colour reminded
me of Nemo, the cartoon fish who gets lost in the ocean after its
mother’s death but is found in the end by its father. Both little fish
in the drawing have a big round eye with a clearly drawn pupil
and an eyebrow and, under the eye, a smaller, uncoloured circle.
Emilio explained that this was the mouth. The eyes are quite elabo-
rated, and the mouth is empty. This drawing, too, was replicated
almost identically for many sessions.

Under the water, where in the first drawing there had been a
drowned duckling, there were now two colourful living fish. Did
Emilio gradually come to life? And did two-ness become more and
more thinkable? Were there signs of the primary split, of a primary
differentiation whose first signs had appeared with the intersected
train rails and had developed further with the horizontal line on
the paper, which structured space by separating the upper from the
lower part? Separation and differentiation seemed no longer to coin-
cide inevitably with trauma and death. The duck family above the
water line is rather stereotyped, guaranteeing possibly an illusion
of continuity, but in the under-water-world new elements became
visible. Fish have no beaks. They have mouths like people. In this
drawing the mouths are empty. But the eyes are quite elaborate.
New explorations became possible as shown in the last of the cho-
sen duck drawings (Figure 3.8).

This time, Emilio moved the water-line higher up on the page.

Was this intentional? Did he have a project for which he needed
more space in the under-water-world? The ducks seem to have
lost some of their importance. They look rather undifferentiated in
their black-and-whiteness, except for the mother’s long, seductive
eye-lashes. The fourth duckling, which looked lost and poorly in
the previous drawing, is more like the others and seems to be part
of the group of siblings. At the same time, the distance between
the ducklings and the mother has increased. Here again, there are
two fish under the water. They are bigger and much more colour-
ful and more differentiated than in the previous drawing. For the

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 one- and two-dimensional mental functioning 53

Figure 3.8

first time, their mouths are not empty, but coloured in red and
protruding from their faces. Emilio said that they were wicked
monster-fish. They ganged up to attack the mummy-duck from
underneath and wanted to eat her. They were sharks, Emilio said,
“mother and son, a big shark and a small shark”. He then drew a
green and a red circle in front of the open mouths of the two fish.
These circles were lanterns, he explained. (In a parent meeting,
the therapist was told that he had been to the zoo and had been
impressed by so-called lantern fish, which have a large luminous
spot on top of their head.) In his drawing, Emilio had moved the
“lanterns” down from their heads and placed them in front of
their mouths. Was it there that something had to be illuminated?
He commented that the bulging red shapes that emerged from the
mouths were “the tongue”.

The lanterns in front of the fish mouths reminded me of a patient

of mine, an autistic little boy, whose material Meltzer supervised in
the late 1970s. When the child began to have some idea of an inside
distinct from an outside, he began to draw tunnels which he coloured
in black. One day, he drew a human figure inside the tunnel and
explained that the man was “l’operaio della luce” (the light workman).
His job had been to hold up a yellow lamp to help people see in the
darkness.
Emilio seemed to need an extra light to support his search for clar-
ity about the internal space in the fishes’ mouths. On the water surface
of Emilio’s drawing, a peaceful duck family was swimming in a row.

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 54 suzanne maiello

But under that surface, a very different, but more genuine internal
world began to be representable: voracious sharks, mother and son,
were conspiring against the unsuspecting duck mother. Emilio had
developed an internal world with internal objects, which could inter-
act with each other. The primary split allowed for idealization and
denigration, and for a vengeful alliance against the formerly idealized,
but emotionally indifferent duck mother.
There was a story with a dramatic plot. But this was only part of
it. Thanks to the fish lanterns’ illuminating function, Emilio could
begin to explore and sort out the confusions caused by the break-
down of three-dimensionality in his traumatized baby mind. Now he
could observe and notice the difference between concave and convex
objects and also acknowledge their different locations and functions.
The lantern was placed so that it could illuminate the oral cavity, the
tongue in the mouth and the implicit teeth of the mother–child couple
of sharks. The acknowledgement of the difference between tongue and
nipple—the two similar protruding shapes that were confused initially
at the part-object level—became the object of a realistic quest once
Emilio had realized that the fullness of the tongue could not replace
the emptiness caused by the disappearance of the nipple. In fact, the
mother-son gang of sharks was about to attack the unsuspecting duck
mother from underneath. She did not know, but the shark mother-and-
son knew and had a plan.
The deceptive idea of the oneness of mouth, tongue, and nip-
ple, which had protected Emilio from the catastrophic experience of
his weaning, could be abandoned and his oral rage overtly directed
towards the maternal object. Oral aggression, hitherto submerged,
could now come to the surface, not only in his representation of cruel
oral phantasies in the cannibalistic kitchen scenes, but also, at a more
abstract level, in his drawings and in the accompanying meaningful
verbal narrative.

In conclusion
The core of autistic one- and two-dimensional mental functioning
lies in the inability to conceive of separation and separateness. But
the dream of a primal one-ness must be abandoned for two-ness to
become possible. Two-ness implies an internal migration: it implies
leaving behind, at the most primary level, what Meltzer has called the
“romantic object”. This migration is the prerequisite for the emergence
of a space/time between self and other. It is this very betweenness

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 one- and two-dimensional mental functioning 55

that contains the germ of three-dimensionality, with the possibility

to set in motion both projective and introjective identification and
to abandon the pathological terrorized clinging to two-dimensional
imitative adhesiveness or to one- or a-dimensional thoughtlessness.
This process is the prerequisite for the emergence of a mind of one’s
own, with its potential for creative thinking and, at the same time, for
the discovery of new “enriched objects, which the very relinquishment
makes attainable” (Meltzer & Harris Williams, 1988, p. 27).

Notes
1.  All page numbers for quotations from Flatland refer to the version available
online at www.feedbooks.com
2.  I thank Emilio’s psychotherapist, Francesca Bevilacqua, Rome, for allowing
me to discuss her patient’s material and drawings.

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 CHAPTER FOUR

Autism reconsidered

Donald Meltzer’s concept of dimensionality

in clinical work with autistic patients

Suzanne Maiello

A
t the age of 8 years, Donald Meltzer accompanied his parents
on a trip to Europe. The young boy was deeply impressed by
the beauty of historical buildings on the old continent and
wanted to become an architect. Later, as a psychoanalytic thinker,
Meltzer continued to use his gift for spatial design by conceptualizing
and interpreting psychic phenomena at the meta-psychological level
in terms of dimensionality. Following on from Klein’s notion of an
internal world inhabited by internal objects and, later, Bion’s concept
of container/contained, the scene was set for the emergence, in 1967
(well before Explorations in Autism) of Meltzer’s spatial notions of the
geography of the mind, of geographical and zonal confusions, and, later, of
the compartments of the internal object and the claustrum.
In Explorations in Autism, the idea of dimensionality of mental
functioning became the central notion from which Meltzer’s theo-
retical formulations were to spring and expand. He introduced the
chapter on “Dimensionality as a Parameter of Mental Functioning”
by stating:
It is of interest with regard to the psycho-analytical method that
altered views of life-space found expression in the interpretative
work long before they came as theoretical realizations. [1975b, p.
223]

56

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 autism reconsidered 57

Has psychoanalytic theory not always grown out of the experience of

pioneering clinicians, which allowed it to expand and deepen earlier
conceptualizations, and sometimes outgrow them? In Explorations in
Autism, the reports of psychoanalytic work with autistic children by
members of the research group precede Meltzer’s conceptual formula-
tions on the reduction of three-dimensional mental functioning to two-
and even one-dimensional states. Years later, he linked this back to
Klein’s “Notes on Some Schizoid Mechanisms” (1946) when he wrote:
“It was largely by the extrapolation of her implicit model of the mind
that we developed such concepts as dimensionality, dismantling of
the senses . . .” (1986b, p. 122). Our attempts to imagine and describe
invisible mental processes inevitably require the use of metaphor.
Meltzer’s metaphor of the dimensionality of the mind has become a
ground plan with enormous creative potential. It was never meant to
be viewed as a static, saturated concept, but invited and continues to
invite further developments, such as the exploration of the effects of
psychic movement, which implies the experience of both limits and
direction in the spatial dimension and of both finitude and rhythmicity
in the temporal dimension.
An important theoretical issue is whether or not Meltzer views
one- and two-dimensional mental functioning as stages of normal
early psychic development, to which there would be a regression in
autistic pathology; or, alternatively, whether one- and two-dimen-
sionality represent massive defensive strategies to ward off the inevi-
table emotional turbulence connected with a primary potential for
proto-mental three-dimensional functioning. This would include the
experience of space, time, and relatedness, without which there can be
no thinking and, to anticipate Meltzer’s later formulations, no aesthetic
experience of the beauty of the world (Meltzer & Harris Williams, 1988).
In two-dimensional autistic functioning, in which objects are
“experienced as inseparable from the sensual qualities that can be
apprehended of their surfaces, a conception of the self must neces-
sarily be limited. . . . The reason for this limitation of thought and
imagination would reside in the lack of an internal space within the
mind in which phantasy as trial action, and therefore experimental
thought, could take place” (Meltzer, 1975b, p. 225). This is Meltzer’s
implicit answer to my query. Let us just evoke the emotional intensity
of a newborn baby’s first encounter with the breast, his search for the
nipple, his mouth’s passionate latching to it, pulling it inside, and his
vigorous sucking which calls for the milk that he never had before.

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 58 suzanne maiello

What happens in the Theatre of the Mouth (Meltzer, 1986b), long

before the baby starts lalling and babbling? The milk enters the oral
space on one side and is swallowed on the other. A sphincter function
is implicitly present. A primary rhythm develops. The lips organize
themselves around the nipple to form a tight circle, but then there is
the dynamic inward pull. The act of sucking itself can be described
as a realization of a preconception of three-dimensional functioning.
Incorporation is the physical precursor and counterpart of introjection.
Esther Bick describes the experience of the “nipple in the mouth as
the optimal object” capable of “holding the parts of the personality
together” (1968/1987, p. 115), a kind of forerunner, we might say, of
an internalized psychic backbone.
Meltzer’s concept of dimensionality of the mind, with its double
aspect of space and time, is not only a creative metaphor of nor-
mal mental functioning, but represents a precious tool for a deeper
understanding of autistic states. Three brief clinical examples of
autistic children may bring to life specific aspects of one- and two-
dimensional autistic functioning and describe the existential struggle
of these children when they begin to face their three-dimensional
psycho-physical potential and experience the intensity of the emo-
tions from which they had protected themselves with their autistic
manoeuvres.

Tommaso:
the discovery of linear movement
and three-dimensional space
Tommaso1 was a severely autistic 4-year-old child without lan-
guage when he began psychotherapy. He spent the first months of
his treatment running aimlessly around the room. At some point,
however, the corridor that led from the waiting room to the therapy
room became a meaningful space of transition. The child began to
experience between-ness. He wanted the therapist to walk beside him,
but he allowed her to do so at her own pace. Differences began to be
noticed and accepted. During the sessions, he started hiding behind
an armchair and then re-emerge, and he spent months engaged with
repeatedly placing a small box inside a larger box and taking it out
again. One day, he discovered the reflection of his face on the win-
dow pane. He had seen it for a brief moment, although he blurred
his image immediately with saliva.

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 autism reconsidered 59

One day, he was lying on the floor at the therapist’s feet, looking
towards a corner of the room. He then crawled to that corner.
Lying on his back, his eyes moved upwards from the floor, all the
way to the ceiling, along the line where the two walls meet, and
then followed the horizontal lines along the ceiling. Suddenly, he
turned on his stomach, made masturbatory movements and then
got to his feet. He stood there motionless, his eyes lost, while his
urine began to form a puddle on the floor.

Tommaso’s autistic defences had diminished. He began to experience

the concreteness of physical three-dimensional space, and possibly for
a moment of himself existing in that space, when he actively explored
the boundaries of the room. But the emotional experience was over-
whelming, and his fragile psychic container broke down again. His
eyes got lost in space while his self liquefied, his body froze, and he
disappeared in a one-dimensional nowhere.
This session, however, was to represent a turning point in Tom-
maso’s therapy. For the months to come, he used a small stick to
“measure” the therapy room in all its dimensions and directions, again
and again. The Latin “dimensio” means “extension”, and the term
includes the activity of measuring. The stick helped the child to get
some realistic and no-longer omnipotent control over external space.
His measuring activity was not a stereotypical repetition any more, but
an exploration which he could allow to become a mental experience.
Only a few months later he began to form and utter his first words in
the inner space of the Theatre of the Mouth.

Rosetta:
the dimension of time—from endlessness
to finitude, from dismantling to rhythmic coordination
Rosetta began three-times-a-week psychotherapy just before the age
of 5 years. Her verbal language was echolalic. In the fourth year of
our work, she began to be aware of the alternation of presence and
absence. The reality of rhythmically structured time began to dawn
upon the little girl’s mind. The alternation of yes-days, when she came
to therapy, and no-days, when she did not, could be acknowledged.
When differences can be experienced, three-dimensional mental func-
tioning is on the way, as a conquest, but also as a threat of renewed
existential catastrophe. The little girl’s material shows her struggle to

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 60 suzanne maiello

overcome the autistic need for sameness but, at the same time, the
ever-lurking temptation to deny endings and dismantle consensuality,
in order to prevent the catastrophe of the emergence of overwhelming
emotions.
Rosetta was 8, and was going to school, when she began to sing
nursery rhymes in the session and needed me to sing them with
her. She no longer used our unison to obliterate separateness, but to
reinforce her capacity to bear it. She particularly liked a rhythmical
song about the days of the week, which were named in sequence
and accompanied by clapping. This is how she learned to count. Her
learning process was imbued with emotional turmoil around pres-
ence and absence, meeting and parting, beginnings and endings. She
had known the names of numbers before, but in the past these had
rarely been connected with the here-and-now experience of reality.
She would start to count real objects, but then lost touch with them,
continuing her counting until she would lose herself in the high range
of senseless numbers. Stopping would have represented a boundary,
an ending, including the end of the one-dimensional illusion of infinite
continuity and sameness, where all-ness and nothingness coincide.
In the entrance hall of my office there are five spotlights in a row.
During that same period, Rosetta noticed them for the first time. She
started counting them: one, two, three, . . . and raised her fingers as
we walked to the therapy room. However, at the end of the corridor
she noticed that the last number that she had pronounced did not cor-
respond to the number of her raised fingers. There had been no shared
rhythm between voice and hand. When she noticed the discrepancy,
she used to give up.
Meltzer writes: “It seems likely that . . . the first leaps of imagi-
nation were of a myth-making variety, enacted in song-and-dance”
(1986a, p. 184). When Rosetta first tried to count the spotlights, there
was no connection yet at the level of song-and-dance between her
“singing” voice and her “dancing” fingers. However, something in
Rosetta needed to explore this most primitive proto-symbolic myth-
making level of three-dimensional mental functioning. At this point in
time, dismantling was no longer an unconsciously sought-for strategy
against consensuality, but was experienced as a failure. The day came
when Rosetta’s voice and fingers met in a shared rhythm: the vocal
five coincided with the raised five fingers of her open hand. She was
beaming. She took my hand to lift both our arms in triumph, and we
had to sing Beethoven’s Ode to Joy together.

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 autism reconsidered 61

João:
a haphazard mental topography2
In one- and two-dimensional mental functioning, shapes are both
reversible in their formal configuration and unreliable as to their posi-
tion in space. Autistic children often seem to ignore the basic physical
laws of gravity. They may walk on tiptoes and feel to be floating in
unstructured space, where not only does nothing have volume or
boundaries, but where up and down, front and back, left and right
are interchangeable. Meltzer illustrates the two-dimensional mental
functioning of an autistic little boy by describing his drawing of a
house with a door on one side of the sheet, and another house with a
door in the same position on the other side of the sheet:
. . . the child demonstrated his experience of a two-dimensional
object: when you enter by the front door you simultaneously exit
by the rear door of a different object. It is in effect an object without
an inside. [1975e, p. 18]
Front and back coincide.
A drawing by an autistic child will illustrate the interchangeability
of spatial vertices in this child’s mind: up/down, left/right, as well as
the indifferentiation of shapes themselves—convexity/concavity, and
the haphazard quality of movement in and through space. Nothing is
grounded anywhere. Every potential space-structuring and meaning-
conveying shape or movement is reversible. Since there is no mental
container, there is no meaningful memory and, therefore, no base for
anticipatory phantasy or expectation.
João was born prematurely and spent the first three weeks of
his life in an intensive care unit. He was not breast-fed. He vomited
after feeds and underwent gastric surgery shortly after his arrival
home. At the beginning of his five-times-a-week treatment, he was
2 years old. He had no verbal language and seemed fused with
his mother’s body. From the age of 4, he started to produce draw-
ings which were replicated endlessly throughout the sessions. At the
beginning, they were just scribbles. Later, some became more struc-
tured. The child was powerfully attracted by the steep, high moun-
tains that rise from the city of Rio de Janeiro: the Corcovado with
the Christ figure on top, and the Sugar Loaf. João used to repeat
their names and draw their shapes endlessly. Figure 4.1 is the last of
an endless series of identical drawings produced during one session.
João was now 9 years old.

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 62 suzanne maiello

Figure 4.1

João first drew the outline of the Corcovado mountain, with a

tiny vertical pole on a little pedestal on top, representing the statue
of Christ, and a town, a tight cluster of buildings, at the low end on
the left, underneath the mountain outline. He then turned the sheet
around by 180° and drew another mountain line (Figure 4.2).
It was again the Corcovado, this time without the statue. João then
drew the Gávea stone, a large rock in that neighbourhood of Rio de

Figure 4.2

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 autism reconsidered 63

Janeiro, with natural geological formations that look like eyes, nose
and mouth. Maintaining the sheet of paper in this second position,
João now drew a roller coaster which ran downhill on the steep slope
of the first Corcovado, which was now upside down. Thin lines on the
vehicle represented the arms held up by excited people.

Comment
Considering the drawing in its first position: there is a steep, high
mountain shape with a rounded top and a short vertical line point-
ing upwards. It seems difficult to reach that top. (In reality there is a
cogwheel train that goes up.) João’s town is a cluster of stone blocks,
which lies under the horizon. At the part-object level, might we won-
der whether at the deepest depths of this child’s unconscious mind
there could be a surviving preconception of an unreachable breast
and nipple, of which he had experienced no positive realizations.
As a baby, he had vomited the milk contained in the bottle that had
replaced the absent breast.
Considering the inverted drawing: the animal-like shape is a pet-
rified creature that adheres tightly to “mother earth”. There is no
nipple on this second mountain, but, according to the child, it is the
Corcovado again. A roller-coaster runs down the steep (inverted)
slope of the first Corcovado. What would have been uphill in the first
position of the sheet of paper is now downhill. The saving nipple of
the first mountain is unreachable once more, this time because it is
buried under the inverted horizon line. What is visible of the people
on the roller coaster are just the very thin lines of their arms rising up
in excitement. There are no passages, no openings leading from one
side to another, no orifices with their both separating and connecting
function. The awareness of orifices, as Meltzer suggests, ushers in
three-dimensional mental functioning.
If we tentatively turn the sheet back to its original position (which
João did not do), the Gávea stone is upside down and stuck to what
is now the skyline (Figure 4.3). Perhaps he is at risk of falling off?
The second Corcovado is no longer a mountain, but has turned into a
deep pit. And the roller-coaster on the first Corcovado would now be
hanging over an abyss, with the people head down, at risk of hurtling
into nothingness, unless they were glued, from underneath, onto the
surface of the slope.
João seems to represent dramatically the non-orientation and the
disorientation of his movements in space. He tries to protect himself

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 64 suzanne maiello

Figure 4.3

from devastating precipitation and annihilation anxieties with the

mental autistic strategy of two-dimensionalization; a mountain and an
abyss become interchangeable, and every experience is flattened and
loses its potential emotional meaning. His material shows the crucial
role of dimensionality, not only in terms of the normal primary need
to feel one’s existence as a defined psycho-physical entity in space
and time, but also in terms of a reliable spatio-temporal orientation,
which includes the capacity for linear movement (up or down, left or
right), the differentiation of convex and concave shapes, as well as the
acknowledgement of the force of gravity.
For object constancy and links between objects to develop, there
must be a minimal awareness of selfness differentiated from otherness.
In one- and two-dimensional mental functioning, there is no inner
space available to contain internal objects. Endless repetition is meant
to replace introjection, and petrification represents another fruitless
attempt to gain control over the world at the cost of shutting out any
human emotion and any living relationship.

Concluding remarks
Meltzer’s meta-psychological metaphor of the dimensionality of the
mind is a precious legacy, which not only maintains its meaningfulness
forty years after the publication of Explorations in Autism, but, being
an unsaturated concept with much wider implications, maintains its

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 autism reconsidered 65

full creative potential in view of further developments. In particular,

the general concept of mental dimensionality becomes an invaluable
Ariadne’s thread for those who are prepared to enter and seek orienta-
tion in the one- and two-dimensional sensual world of autistic minds.

Notes
1.  I thank Patrizia Ercolani for permission to present some considerations on
her patient’s clinical material.
2.  I thank Marisa Helena Monteiro for allowing me to present some considera-
tions on an aspect of her patient’s material.

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 Does the meta-psychological concept
of dimensionality refer to a geometrical
or a topological model?

Didier Houzel

T
he scientific exploration of a domain of experience supposes
the possibility of locating this domain within a space whose
internal structure can be described. Such an approach was ren-
dered impossible within the field of psychic phenomena by Cartesian
dualism for almost two centuries. Descartes (1641) opposes the bio-
logical body—which he defines as an “extended substance”, that is to
say, occupying a space and, thus, capable of being explored scientifi-
cally—and the non-extended soul, which occupies no space and, conse-
quently, escapes any form of scientific study. A century later, Kant still
affirmed that the soul was indivisible. At the very most, he admitted
a temporal dimension in the internal sense but rejected any possibility
of a “science of the soul”:
The theory of the soul can never become anything more than an
historical doctrine of nature, and, as such, a natural doctrine of inner
sense which is as systematic as possible, that is, a natural doctrine of
the soul, but not a science of the soul . . . [1787, 4:470–471]

Admittedly, critiques of these dualistic points of view, which ruled

out a priori any possible psychology, were rapidly formulated: Leib-
niz (1714) for Descartes, Herbart (1824) for Kant. Nonetheless, it is
true that the scientific study of the human mind had to wait until the
second half of the nineteenth century to begin to see the light of day.
How are subjective phenomena to be inscribed within an extended
space whose contours and internal structure can be studied? It is my
contention that the adventure began with the book of the great Aristo-

66

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 autism reconsidered 67

telian ­philosopher, Franz Brentano, entitled Psychology from an Empirical

Standpoint, published in 1874, a time when Freud regularly followed
Brentano’s seminars. I am not going to dwell on the work of this author,
but I would like to cite two hypotheses that he makes which, it seems
to me, deeply influenced Freud in his exploration of the mind: the first
is that, if subjective experience appears to us in its immediateness and
disappears almost immediately from our conscious awareness without
our being able to grasp it and explore it more deeply, this same experi-
ence can reappear in memories where it acquires temporal and spatial
qualities that allow us to situate it and to explore it. Freud would recall
this proposition when he said, in 1893, that the hysteric essentially suf-
fers from reminiscences (Freud, 1893a). Brentano’s second hypothesis,
from which I think Freud drew inspiration, is that psychic phenom-
ena are characterized by their intentionality, thus distinguishing them
from physical phenomena, which respond to a causality. This notion
of intentionality can be found in Freud’s work in “cathexis”, but this
time extended beyond conscious phenomena to the preconscious and
unconscious.
Freud based his study of the mind on a topography, from the
Greek word topos signifying “place”. We are all familiar with the two
topographies that he proposed: the first, conscious/preconscious/
unconscious; and the second, Id/Ego/Superego. It is the Freudian
topographies that are at the origin of the concept of psychic space.
It seems that Bion (1965) was the first to utilize the term “space” to
describe the psychic world, although for Donald Meltzer the notion
of inner space had been presented implicitly in the work of Melanie
Klein. Bion speaks of space for thinking and emotional space (1965, 1970).

Meltzer’s model of dimensionality

I propose now to examine Meltzer’s model founded on the geometrical
notion of dimensionality, before considering to what extent topology can
help us to gain a better understanding of what happens in the world of
autism to which Meltzer applies this notion of dimensionality.
Watching Meltzer listen to clinical material, one sensed that he was
exploring a landscape aroused in his own internal psychic space. His
way of thinking referred chiefly to a spatial model, in direct line from
Freud, who described the psyche as a tripartite space and Melanie
Klein, who described the infant’s unconscious phantasies as scenarios
taking place upon the stage of the mother’s body, a space containing
desirable or threatening objects. But, for Meltzer, the spatial model is

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 68 didier houzel

more than a metaphor: the mental space is a real space, governed by

other laws than those governing physical space; a true space where
you can move around and discover unknown and unexpected recesses.
Several meta-psychological concepts stem from Meltzer’s explora-
tion of psychic space: the geography of phantasy, the compartments of
the internal mother, and the dimensionality of mental functioning. My
particular focus is on the latter. I question the use Meltzer made of it in
Explorations in Autism. Meltzer describes a bi-dimensional functioning
in an autistic child as follows:
The child cannot for any length of time experience the distinction
between being inside and being outside the object. Looking into the
therapist’s eyes can be immediately transformed into looking out-
side of the window. But the moment of triumph over (say) the birds
in the garden as the excluded outside-babies, immediately turns into
enraged fist-shaking and banging the head on the window, and then
to burrowing and banging the head on the therapist’s chest. The
outside-babies have suddenly turned into the triumphant inside-
babies, and triumph of the child turns to puzzled rage.
One child showed us the answer in a single stroke of creative
intensity. For months he had drawn doors and gates, usually with
complex wrought-iron grills. Then gradually rather Victorian gothic
houses took shape. One day he painstakingly drew an ornate house
seen from the front on one side of the page, a house in Northwood,
while on the other side he drew a back view of a pub in Southend.
Thus the child demonstrated his experience of a two-dimensional
object; when you enter by the front door you simultaneously exit
by the rear door of a different object. It is in effect an object without
an inside. [Meltzer, 1975e, p. 18]

The problem is that, in a bi-dimensional space, you cannot enter or exit

by a door: you cannot go across a surface. It is very difficult to imagine
life in a bi-dimensional space, in which there are only lines, semi-lines,
and segments of line. The novelist Edwin A. Abbott (1884) described
such a world in his wonderful short story Flatland.
Although I acknowledged that Meltzer’s spatial metaphor was
highly relevant to understanding the subjective experience of our
patients, I thought it necessary to investigate the psychic process
beneath these metaphors.
Soon after reading Meltzer’s description, I read a paper by two
mathematicians, Thurston and Weeks, about what they called tri-
dimensional manifolds (“manifold” designates here a generalization
of the notion of surface whatever the number of dimensions). They

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 autism reconsidered 69

described a special manifold called a “three-torus”. To build a three-

torus, you must take a cube and stick its superior face to its inferior
one and its right face to its left one. In fact, it is not possible to achieve
such a building process in our three-dimensional Euclidian space. It
is possible only in four-dimensional space. It is not a problem for a
mathematician, however, to use his imagination to project himself
into a space with any number of dimensions. In a three-torus, life is
as follows:
Look at the back wall and the line of sight passes through that wall
and returns from the opposite point on the front wall. What you see
is a copy of yourself from behind. Look to the right and you see a
copy of yourself from the left; look down at the floor and you see
the top of your head. [Thurston & Weeks, 1984, p. 108]
It is strikingly similar to Meltzer’s description of the autistic bi-dimen-
sional space, but the model is different. Meltzer’s is a geometrical
model based upon the concept of dimension: the child constructs his
or her internal world by successive additions of one spatial dimension
to another; time makes up the fourth dimension. By contrast, the three-
torus model is a topological one based on the concept of orientability
and non-orientability.

A topological model based on

orientability and non-orientability
Topology is the mathematical discipline that studies the bijective and
bicontinuous transformations that are known as “homeomorphisms”.
Bijective signifies that, between the elements of two sets, there is a
one-to-one correspondence; each point of one of them corresponds to
one point, and one point only, of the other, and vice-versa; bicontinu-
ous signifies that the transformation occurs without tearing or sticking.
Orientability means that a Cartesian-coordinate system remains
unchanged on the surface (manifold), whatever the displacement it
is submitted to. When the coordinate system changes, the surface
(manifold) is called non-orientable:
An abstract surface (i.e. a two-dimensional manifold) is orientable
if a consistent concept of clockwise rotation can be defined on the
surface in a continuous manner. That is to say that a loop going
around one way on the surface can never be continuously deformed
(without overlapping itself) to a loop going around the opposite
way. [Wikipedia: orientability]

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 70 didier houzel

The more common non-orientable manifolds are the Moebius strip, the
Klein bottle, and the projective plane.
I have noticed that some patients become disorientated when
there has been a discontinuity in the psychoanalytic frame and may,
for example, experience difficulty finding their car after a session.
Working with autistic children has inspired me to hypothesize a non-
orientability or a loss of orientability of psychic space, which I hope
to illustrate with the following extracts from my work with an autistic
boy.

A clinical illustration
Cyril’s analysis began when he was 3 years old. For the first two years,
I saw him three times per week; then, when he was 5, this increased
to four weekly sessions. He had been diagnosed with autism. Cyril is
the elder of two boys: his brother is two years younger. His parents are
from a cultured background: his father is in an intellectual profession,
while his mother had been in higher education but, currently, does
not work. A deformity of the uterus made her pregnancies difficult,
and she only conceived Cyril after three miscarriages. This pregnancy
was a time of great anxiety, during which she stayed mainly resting in
bed, and the baby moved very little in utero. Her impression was that,
by remaining very still, he was protecting himself from the uterine
contractions that she experienced as being threatening to him, given
the very little space that he had. So, from the beginning, she found it
extremely difficult to conceive of herself as a good container for her
baby and even sensed herself as a threat from which he had to protect
himself.
Cyril was a quiet baby. His sleep soon settled into a regular pat-
tern. He was breast-fed for six weeks, but this was very brusquely
interrupted due to an infection of the mother’s breast. Nothing was
noticed at the time of this sudden weaning. Cyril’s motor development
was delayed: he only sat up when he was a year old and did not walk
until he was 22 months old.
Mother’s second pregnancy began when Cyril was 15 months
old. Complications during the final trimester threatened to provoke a
premature birth, so she remained in bed until being hospitalized for
the last month.
Cyril’s parents first became concerned by his delayed motor devel-
opment, but they soon worried about his failure to develop language.

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 autism reconsidered 71

In addition, they noted behaviours that they described as “strange”.

Cyril would bang his head against the floor or against the wall, and
he would rock backwards and forwards. At around 20 months, his
parents felt that he was withdrawing from the world, that he was “in
his own bubble”; his interests were limited, for example opening and
closing doors and listening to music; he did not develop any symbolic
play; and he would take an adult’s hand to obtain what he wanted
and did not point.
Rather rapidly, after a few sessions, Cyril was able to pay attention
to my presence and communicate with me emotionally. It seems that
he had opened his mental space. A non-orientable space is always
twisted on itself. Opening such a space is like removing this twist. To
make it concrete I will use the metaphor of a boomerang: the encoun-
ter between a preconception and its object looks like a boomerang
reaching its target. If the boomerang misses its target, it returns to its
starting point, describing a curve twisted on itself. According to my
hypothesis, the possibility of creating an inner space does not depend
upon a constructivist process adding one dimension after the other.
Rather, it depends upon finding an adequate object that fits with the
preconception, giving meaning and orientation to the unconscious
expectation it entails.
Work with autistic children reveals a huge gap between the moment
a preconception emerges and the moment it reaches its target in the
transference. This gap is filled with terrors and persecutors, like the
“nasty prick” little John described to Tustin when emerging from his
autistic encapsulation.
As soon as he had opened his inner world, Cyril encountered these
terrors. The first was a terror of spilling out, as if opening his inter-
nal space threatened the loss of everything it contained; Cyril would
scatter everything he could find in the therapy room—pencils, paper,
toys—all over the place. However, quite quickly, he wanted to bring
things together and control the containers. In particular, he became
interested in the boxes of modelling clay and the lids that covered
these boxes. Shortly after this, he uttered the first word I ever heard
him pronounce: “lid”.
Second, Cyril had to face the terror of what Tustin called “the nest
of babies”:
In this phase, when the child is beginning to be able to bear the
awareness of a clear distinction between himself and other people,
there invariably develops a fantasy which I have come to call the

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 72 didier houzel

“nest of babies” fantasy. This is associated with the notion that there
are “special babies” who are given “special food”. [Tustin, 1972a,
pp. 177–178]

After our first summer holiday break, Cyril inaugurated a new activity:
he emptied his box of toys, threw away the pens and paper from the
table where I had put them, climbed triumphantly onto this table and
from there onto my lap, and exclaimed “big, big, big”. I first interpreted
this as his wish to grow into a big boy coming to see me and drawing
support from me. But then I realized that he was expressing rivalry
with the objects he had thrown away, representing the rival babies who
(in his view) had stayed with me all through the long summer break.
In a subsequent session, this aspect became clearer, as the following
extract shows:

Cyril threw the pens to the floor, then played with the water,
attempting to flood the whole room, in spite of my forbidding him
to do so. Then he threw all the sheets of paper from the little table
to the floor, and climbed onto the table saying in a triumphant
tone of voice “Grown up”. From there, he climbed onto my lap,
then back to the table. He picked up the pens, gave them to me to
hold for him, then threw them back onto the floor. With one of the
pens, he drew several long lines on some sheets of paper, saying
they were “little cats”. He then threw these sheets of paper to the
floor and went through the whole sequence again: climbing onto
the table, then onto my lap, then back to the table. He also made
as if to bite me.

Cyril then had to face the paternal figure as a powerful rival—the big-
gest baby, said Tustin—who threatened to separate him definitively
from the maternal figure. One day he arrived slightly early and saw
me walk in accompanied by a woman. Once in the therapy room, he
seemed furious, asking, “Why was there a lady? Where did the lady
go?” Then he told me, “You know, I could break your feet, your legs,
your knees?” all the way up to my head and my hair.
During the following years Cyril’s fantasies evolved into more
and more orientable scenarios, but with two kinds of preoccupation
according to the direction of the action. On a horizontal axis, the ques-
tion was this: how might he find the right way to join me in the trans-
ference? He expressed this through fantasies of the route he might
follow with the taxi driver who drove him to the clinic: which way
out of the ring road did they have to choose? How could they avoid

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 autism reconsidered 73

traffic jams or accidents caused by other cars crashing into the back of
the taxi? I interpreted these fantasies in the transference as connected
to his mother’s second pregnancy and his little brother’s birth which
he had felt as a violent intrusion in his maternal containing object
(the taxi). When he had such a fantasy he called for a policeman to
recover his own space in his containing object. The policeman seemed
to represent a good paternal protective figure.
On a vertical axis, the question was this: how could he slide down
from the top to the bottom, but not too fast and without too much anxi-
ety? To illustrate this, he used the scenario of sliding on a toboggan in
a swimming pool, which made me think of a precipitated birth. Cyril
put lights at the top of the toboggan to force people to wait before
sliding. I link this fantasy with an adult patient’s account of being at
the birth of his children: he noticed that, during the delivery, it was
necessary to slow down the progression of the baby’s head to prevent
the risk of a perineal tear. I interpreted this as the reclamation of a
protective paternal figure in the transference to prevent the psycho-
analytic process, which resembles a kind of birth, from going too fast
and roughly. The patient replied that sometimes he felt lost in a huge
space, without knowing which direction he might follow. I understood
Cyril’s scenario in the same way: he needed to reclaim a good pater-
nal object to help him get out of the maternal womb in order to be
born and to grow up without destroying his maternal container (the
perineal tear) or falling endlessly through space. I suppose that the
orientability of the psychic space relies both on the paternal elements
of the container and on the child’s identification with a paternal figure.
By contrast, non-orientability could be a defence against the primitive
agonies the child has to face when leaving the womb.

Conclusion
One of the most original features of Meltzer’s work is its spatial refer-
ence. He describes the psychic world in terms of spaces and the differ-
ent states of mind as linked to a shift from one space to another. This
spatial reference leads him to describe autism as a state with no dif-
ferentiation between an inner world an outer world. Absence of differ-
entiation hinders any possibility for projection outside or introjection
inside any external object and the chance of communication with it.
To describe this state of mind, Meltzer uses a geometrical model based
on the concept of dimensionality. But scrutinizing his clinical illustra-
tions of this model, one might think that a topological model would

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 74 didier houzel

better suit clinical work with autistic children or with patients having
an autistic enclave. The topological concept of non-orientability allows
for the description of spaces—whatever their dimension—in which
there can be no differentiation between interior and exterior.
In his introduction to Explorations in Autism, Meltzer writes:
In fact it will soon be clear to a discerning reader that we are in the
business of locating problems rather than of solving them. This is
probably really the fundamental truth about the human sciences in
general and psycho-analysis in particular. Thus we believe we have
located some very mysterious phenomena of the mind by recogniz-
ing them operative in very condensed form in the children treated.
[Meltzer, 1975c, pp. 4–5]
It seems to me that, by emphasizing this locating function of psycho­
analysis, Meltzer introduces the issue of a topological model of mental
apparatus. Topology was first called by Leibniz analysis situs, which
means analysis of the location of the elements studied in mathematics.
Autistic children teach us that we have first to clarify the problem of
location if we are to help them develop their own psychic space.

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 A response

Jeffrey L. Eaton

F
orty years ago, in Explorations in Autism, Donald Meltzer offered
eloquent testimony to the complexity of autistic experience
­(Meltzer et al., 1975). His keen formulations remain as valuable
today as when introduced in 1975. It was his capacity to capture and
describe complexity that I want briefly to highlight as a context for the
specific developments offered by Suzanne Maiello and Didier Houzel.
With his colleagues, Meltzer noted a number of specific features
about the children with whom they worked, including the child’s
often high intelligence; the factor of speed (they were fast to register
and slow to process experience); their openness to sensation (Meltzer
characterized it as “naked to the wind”; 1975e, p. 9); their sensitivity
to the therapist’s state of mind; and, finally, a primitive permeability
to the emotions of others.
Meltzer also described other features, including what he called
“an uncompromising possessiveness of the maternal object” (1975e,
p. 10), hyper-sensuousness, and a hatred of transience, leading to a
feeling of being persecuted by the awareness of time. All of these
observations, and many others that I have not noted here, help to
clarify the autistic and post-autistic states as witnessed in analytic
experience with children who are often difficult to comprehend.
With these features in mind, one can better appreciate the rich con-
tributions of Maiello and Houzel regarding the specific theme of
psychic dimensionality that is a particular instance of the complexity
Meltzer started to investigate.

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 76 jeffrey l. eaton

Maiello describes analytic work with three children—Tommaso,

Rosetta, and João—while Houzel brings the story of Cyril. All of
these are beautifully observed cases. Maiello introduces a particular
theme that captures my imagination: she sees the creative extension
of Meltzer’s concept of psychic dimensionality in what she calls the
“exploration of the effects of psychic movement”.
Henry David Thoreau wrote in his Journal that “All perception of
truth is the detection of an analogy; we reason from our hands to our
head” (2009, p. 76). This certainly seems true for Tommaso, whom
Maiello movingly describes as using “a small stick to ‘measure’ the
therapy room in all its dimensions and directions, again and again”.
She goes on to say that, “His measuring activity was not a stereotypi-
cal repetition any more, but an exploration which he could allow to
become a mental experience. Only a few months later he began to
form and utter his first words in the inner space of the Theatre of the
Mouth.”
I return to the idea of the Theatre of the Mouth at the end of my
remarks. Now I want to draw attention to Maiello’s suggestion that we
attune ourselves to the themes of movement in space and time. What
can attention to the child’s actual movement and behaviour indicate
about his or her relationship to psychic space and time? This focus on
movement is particularly important for the way that psychic realiza-
tions can arise from a body physically exploring in space and time.
Maeillo suggests that investigating space reveals elements of direc-
tion and limit, while attention to movement in time involves finitude
and rhythm. To this we might add the idea of cause and effect. Inves-
tigating primitive notions about cause and effect reveals themes of
arbitrary or random happenings versus sequential and constantly con-
joined events. When we add together the experiences of space, time,
and cause and effect, we begin to get a sense of the child’s orientation
versus disorientation in the creation of his or her picture of the world.
Deepening familiarity with the concept of dimensionality and its
extension into the observation of psychic movement in time and space
creatively enlarges the therapist’s capacity to begin to observe and
imagine the complexity of an autistic child’s construction of experience.
With these concepts, it becomes more plausible to track how this
complexity evolves through the influence of contact with the analyst’s
attention, emotion, and imaginative capacity for interpretation.
According to Maiello, “Meltzer’s metaphor of the dimensionality
of the mind has become a ground plan with enormous creative poten-
tial. It was never meant to be viewed as a static, saturated concept, but

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 autism reconsidered  |  a response 77

invited and continues to invite further developments.” I think we can

imagine how psychic movement has different qualities in one, two,
and three dimensions. One of the most important questions might
be, why is the child afraid to move at all? How much of the child’s
activity is designed to control or inhibit movement and its unknown
or anticipated consequences? Further exploration of Houzel’s (2014)
concept of “precipitation anxiety” could prove fruitful in this context.
The capacity to imagine different countries of the mind that are
created by different forms of psychic movement may be difficult for
those who have not been immersed in work with autistic or psychotic
children. Houzel brings a challenging and extremely interesting point
of view when he asks us to consider the difference between a flat bi-
dimensional world of surfaces and that which mathematicians Thurs-
ton and Weeks call “tri-dimensional manifolds”. Houzel quotes an
often-evoked vignette of Meltzer’s (1975e):
The child cannot for any length of time experience the distinction
between being inside and being outside the object. Looking into the
therapist’s eyes can be immediately transformed into looking out-
side of the window. But the moment of triumph over (say) the birds
in the garden as the excluded outside-babies, immediately turns into
enraged fist-shaking and banging the head on the window, and then
to burrowing and banging the head on the therapist’s chest. The
outside-babies have suddenly turned into the triumphant inside-
babies, and triumph of the child turns to puzzled rage.

This is highly condensed material and the particular details are very
important. Meltzer continues:
One child showed us the answer in a single stroke of creative
intensity. For months he had drawn doors and gates, usually with
complex wrought-iron grills. Then gradually rather Victorian gothic
houses took shape. One day he painstakingly drew an ornate house
seen from the front on one side of the page, a house in Northwood,
while on the other side he drew a back view of a pub in Southend.
Thus the child demonstrated his experience of a two-dimensional
object; when you enter by the front door you simultaneously exit
by the rear door of a different object. It is in effect an object without
an inside. [Meltzer, 1975e, p. 18]

Houzel takes issue with the conclusion that this describes an object
without an inside. In working with autistic states, one does encounter
descriptions of flat, adhesive states that are without an inside and that
seem to present purely sensation-dominated surfaces. This vignette,

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 78 jeffrey l. eaton

however, does not seem like a good example, because, as Houzel points
out, you cannot enter a two-dimensional space. There is no door to a
surface or a plane.
We should take such facts literally. Meltzer emphasized the con-
creteness of psychic reality. If you take the drawing literally, the child
gives much attention to doors and gates. These figures are drawn over
and over for months. If one looks at sameness, then one may feel there
is a repetition. If one looks at novelty, then one may feel that something
is being constructed, something is trying to be realized.
What kind of complex space allows the passage from a house in
Northwood to a pub in Southend? Is this an object without an inside?
Alternatively, can it be seen as an object with such a complex inside
space that it cannot be easily mapped or represented? I have observed
in my work with autistic children the ubiquitous presence of “por-
tals” (doors and gates) in many children’s material, which suggests
the challenge of managing experience both within and between very
complex spaces.
To describe the extraordinarily complex space that some autistic
children struggle to express, Houzel offers the imaginative conjecture
of what movement in such a complex space, represented here by a
three-dimensional torus, would be like:
Look at the back wall and the line of sight passes through that wall
and returns from the opposite point on the front wall. What you see
is a copy of yourself from behind. Look to the right and you see a
copy of yourself from the left; look down at the floor and you see
the top of your head. [Thurston & Weeks, 1984, p. 108]
Meltzer used the concept of confusional anxiety in relationship to the
capacity for thinking. Here, Houzel offers another crucial point of
view: the necessity to consider the function of “orientability” and “non-
orientability” as part of the challenge of the autistic child’s subjective
experience.
This idea has large implications for themes like the “presence” of
the object and the absence of the object. In what kind of space does the
child meet the object? What kind of space is created by the awareness
of the object’s presence and its absence? What kind of experience of
cause and effect is created when space (and time) are distorted and
disoriented? And, how is the child’s perception of an object influenced
by the nature of its space? These ideas offer practical help in following
the phenomenological experience of a patient’s material.
I would like to describe an experience with a post-autistic patient,
Steven, I have seen in analysis for ten years. The vignette I present

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 autism reconsidered  |  a response 79

comes from the first session after a three-week Christmas break. My

purpose here is not to demonstrate the analytic process between us,
but, rather, to show the representation in Steven’s material of the
complexity of the space that I think was triggered by the separation
over the holiday.

Steven, aged 17 at this time, enters the session and greets me cheer-
fully. Then he says, “Long time since I’ve seen you, Jeff.” “Yes,” I
say, “it’s been a long time.” He then asks me if I have heard about
the Charlie Hebdo shootings in Paris. Steven considers himself a
cartoonist and graphic artist. Over the years he has produced many
clever drawings and cartoons both inside and outside his sessions.
Several have been published in his school newspapers. Now he
tells me that he is starting to create a graphic novel, a project begun
over the break.

He takes several minutes to draw a stylized image. We are both

silent as he draws, though sometimes he looks up at me and makes
eye contact. He is sitting on the couch drawing on a small table I
provide. I sit next to him in my chair. When he has finished he gives
me a detailed explanation of the image. I will summarize what he
says about his drawing:

Test subject A wakes up in a windowless chamber. He does not know

what time of day it is, or what day of the week it is. There is no colour in
the room. The floor, the walls, the ceiling are all white and look the same.
There is one tiny grate in the wall, and in the grate is a strange-looking
wrench, on which is written one instruction: “this is the tool you need to
make your escape”. There is a door hidden in the room somewhere but A
doesn’t know where. If he can find the door, he can open it with the tool
and it will lead to another room just like this room, and there will be a
different tool to use to find a different door, which will lead to yet another
room. There is no way to tell how many times he must go through this
procedure until he finds a way to “the outside”. There are dozens of other
rooms if not hundreds or even thousands. There may also be other test
subjects and you do not know where or when they might appear.

This story seems to evoke, in all its details, something powerful about
Steven’s feelings when he is separated from me. Our sessions provide
him with a kind of orientation that can be suddenly lost over the long
holiday break, but now, rather than concretely living out this disorien-
tation and withdrawing into autistic and omnipotent defences, Steven

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 80 jeffrey l. eaton

can begin to symbolize his experience and present it creatively as a

graphic novel.
Now I want to return to Maiello’s discussion of “the Theatre of the
Mouth”. She writes:
Let us just evoke the emotional intensity of a newborn baby’s first
encounter with the breast, his search for the nipple, his mouth’s
passionate latching to it, pulling it inside, and his vigorous sucking
which calls for the milk that he never had before. What happens in
the Theatre of the Mouth (Meltzer, 1986b), long before the baby starts
lalling and babbling? The milk enters the oral space on one side and
is swallowed on the other. A sphincter function is implicitly present.
A primary rhythm develops. The lips organize themselves around
the nipple to form a tight circle, but then there is the dynamic inward
pull. The act of sucking itself can be described as a realization of a
preconception of three-dimensional functioning. Incorporation is
the physical precursor and counterpart of introjection. Esther Bick
describes the experience of the “nipple in the mouth as the optimal
object” capable of “holding the parts of the personality together”
(1968/1987, p. 115), a kind of forerunner, we might say, of an inter-
nalized psychic backbone
Bick also linked introjection with the discovery of inner space. In her
well-known paper, “The Experience of the Skin in Early Object Rela-
tions”, she wrote:
Until the containing functions have been introjected, the concept of
space within the self cannot arise. Introjection, i.e. construction of an
object in an internal space, is therefore impaired. [1968/1987, p. 114]
Can we imagine that, in Steven’s drawing, the wrench that opens a
secret door to a new room represents a fugitive nipple, experienced
as disembodied, not reliably linked to the part-object breast, to the
mother’s body, to her mind and reverie? Do these complex, disorient-
ing spaces express the attempt to construct a world despite the loss
of the primary cooperation formed by relying on an analytic nipple-
mouth partnership?
To the degree that this fragile couple has slowly been constructed
over many years in analysis, does the experience of the holiday break
revivify the unconscious memory of a primal separation as catastro-
phe? My sense is that when analyst and patient achieve the status
of a symbolizing couple, they can begin to work through such early
catastrophe in repeatedly more nuanced variations until the child has
a new relationship to time, space, cause and effect, and, most impor-
tantly, to self, other, and relationship.

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 CHAPTER FIVE

Dimensionality, identity, and security:

finding a home through psychoanalysis

Louise Allnutt

“Adoption is outside. You act out what it feels like to be the one
who doesn’t belong. And you act it out by trying to do to others
what has been done to you. It is impossible to believe that anyone
loves you for yourself.”
Jeanette Winterson, Why Be Happy
When You Could Be Normal? (2011)

Being at home
Dimensionality, identity, and security are concepts that I would
like to draw together and house descriptively as the experience of
“being at home”. In my view, one needs to have developed a clear
sense of the dimensions of space and your own place in it alongside
a strong and secure-enough relationship to oneself and others to
have the opportunity to feel at home, either in terms of “joining the
human family”, as Maria Rhode has described it (2008), or in terms
of being capable of making transitions and crossing thresholds into
different spaces without a sense of losing one’s own coherence. My
experience of working with one particular patient has highlighted
these issues at both a developmental and emotional level, but the
absence or presence of “at-home-ness” is something that I find lies
at the heart of many clinical relationships, sometimes in relation

81

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 82 louise allnutt

to oneself, sometimes in relating to others, at times due to con-

crete displacement and at other times through difficulties related
to misrecognition and misperception. My clinical experience with
a 2-year-old boy, who came for intensive psychotherapy for three
years, brought the experience of being “outside” and the develop-
mental problems of “homelessness” sharply into focus. It is some
of this clinical material alongside the theoretical ideas that one can
draw from Donald Meltzer, among others, that I would like to dis-
cuss here as an example of some of the processes one might traverse
in finding a home through psychoanalysis.
In essence, this chapter is an attempt to understand the relationship
between inside and outside. It considers how we develop a sense of
orientation in relation to our internal and external worlds and how
they take shape and link up. The brief examples taken from the first
few sessions of a psychoanalytic treatment of 2-year-old Joseph illus-
trate the predicament of a child who was struggling, both emotionally
and developmentally, to make sense of his place in the world and his
relationship to others. His early traumatic history was punctuated
with loss, separation, and maltreatment. I was particularly struck
by the way his emotional security seemed inextricably linked to his
capacity to orientate himself physically in the world and establish a
place of his own. Being able to establish such a place appeared to be
dependent upon a capacity to feel a sense of security inside, facili-
tated by the way in which the external world had been experienced
and taken in from the outside. Not feeling securely emotionally held
together, or at a high risk of disintegrating, when faced with relating
to the world and its inhabitants is what I mean by security. This is a
developmental problem, whether it has been derived through envi-
ronmental failure or otherwise.
In relation to his description of “two-dimensional” relationships
between one’s inner and outer worlds, Meltzer (1975b) describes
how the circumstances that threaten the inherent changelessness
of this state would tend to be experienced as a breakdown of the
surfaces. While Meltzer was largely taking the lead in his theoreti-
cal formulations of dimensionality from autistic patients, there are
similar accounts of phenomena of this kind within the clinical work
with ­children who are fostered and adopted, particularly with those
children whose experience of trauma and environmental failure took
place in their earliest years. It is striking to note how many papers and
books describing psychotherapeutic work with looked-after c­ hildren

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 dimensionality, identity, and security 83

note the experience of being lost and found, such as Waiting to Be

Found (Briggs, 2012) and Psychotherapy with Young Children in Care: Lost
and Found (Hunter, 2001).
Joseph left a strong impression of being a lost little boy at the
start of treatment. It was extremely hard to feel one had him in one
place and in one piece. His experiences of relationships were highly
unregulated and extreme. One minute, he seemed to be buoyant, in
control and ahead of the game; the next, he was in a state of collapse
and appeared terrified and emotionally broken. The experience of
being with Joseph was a challenge both physically as well as emo-
tionally and, of course, this was also true for Joseph himself. What
slowly seemed to develop, however, was a sense that the relation-
ship between us could hold him and give him a greater sense of
gravity and orientation which, in turn, seemed to facilitate a greater
capacity for related communication and the security and solidity
that followed.
Finding Joseph seemed to be a central task in bringing him into
a relationship where experience could be thought about. There were
times when he clearly did not want to be found, and he would let
me know that he did have a place, albeit not the one I had in mind
but one called the “corridor”. He once exclaimed, “I am going home
to the corridor!” The corridor seems similar to what Meltzer (1975b)
described as the “fifth compartment”—“the ‘nowhere’ of the delu-
sional system outside the gravitational pull of good objects” (p. 223).
For Joseph, the corridor had, in the absence of inner cohesion or an
external reliable structure, become home. But in this outside place,
development was stymied and contact was severed. In the assess-
ment at the family assessment service at age 18 months, Joseph was
observed to spend extended periods of time walking up and down
the corridor. During this highly obsessional activity, Joseph would
disregard any attempt by parents or staff to make contact. There is
no doubt that his status as a child in transition contributed to this
experience and challenged any belief that home could be somewhere
he could arrive at and feel safe, held, and rooted.
In Jeanette Winterson’s autobiographical account of her scar-
ring childhood adoption (2011), she considers its impact upon her
capacity to feel at “home” and all of its ramifications. She quotes
the Romanian philosopher, Mircea Eliade, who refers to “home”
both geographically and ontologically speaking, as “the heart of
the real”:

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 84 louise allnutt

Home, he tells us, is the intersection of two lines—the vertical and

horizontal. The vertical plane has heaven, or the upper world at one
end, and the world of the dead at the other end. The horizontal plane
is the traffic of this world, moving to and fro—our own traffic and
that of teeming others.
Home was a place of order. A place where the order of things
come together—the living and the dead—the spirits of the ancestors
and the present inhabitants, and the gathering up and stilling of all
the to and fro.
Leaving home can only happen because there is a home to
leave. And the leaving is never just a geographical or spatial separa-
tion; it is an emotional separation—wanted or unwanted. Steady or
ambivalent.
For the refugee, for the homeless, the lack of this crucial coor-
dinate in the placing of the self has severe consequences. At best, it
must be managed, made up for in some way. At worst, a displaced
person, literally, does not know which way is up, because there is
no true north. No compass point. Home is much more than shelter;
home is our centre of gravity. [2011, p. 58]

The gathering together that Eliade identifies at the meeting point

called “home” is close to what I believe to be involved in psycho-
analytic treatment. For me, his powerful claim that home forms the
centre of gravity, combined with Winnicott’s (1952) description of
the way that disturbing kinds of anxiety promote a move in which
“the centre of gravity of consciousness transfers from the kernel
to the shell”, create a helpful description of the territory Joseph
appeared to inhabit during the early phase of the clinical work. The
sense of disorientation was, at times, immense: Joseph lacked a true
sense of north—an absence of what Tustin would describe as “root-
edness” (1981)—and he experienced the pathways between different
spaces as filled with obstacles and terrifying pitfalls. Home was not
a place Joseph could trust. Coupled with his spatial confusion and
disorientation was his experience and expectation of those he met
in transit. How he related to his therapy and also his foster carer
seemed to reflect quite a complex and emotionally unsettling picture
of his early experience and the struggles to relate and orientate him-
self it had left him with.
Joseph was referred for psychotherapy due to serious concerns
about his development and emotional health during the family spe-
cialist assessment when he was 18 months old. As mentioned above,
he was observed to wander aimlessly up and down corridors, with

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 dimensionality, identity, and security 85

little sense of purpose. He made eye contact with neither parent nor
staff at the centre and had little language. He did not cry but was heard
to grunt and moan. He did not play and sought neither comfort nor
the company of either of his parents or any other adult. The initial
assessment concluded that parental neglect and emotional abuse were
having a profound impact on Joseph’s development.
Following this assessment and his foster placement, Joseph returned
to the assessment centre for some therapeutic sessions with his new
carer. My first contact with Joseph was during these six sessions with
a social work colleague, aimed at supporting him and his carer with
his transition into care in order to prepare him for adoption as well as
serving as an assessment for further therapeutic work.
Joseph did not speak during these sessions. Rather than play, he
tended to wander around the room aimlessly, locating objects in a
blank way. Initially these objects appeared to have little communica-
tive meaning. As in the assessment, Joseph was observed, during the
first couple of sessions with his foster carer, to take a small toy kitchen
pan and a wooden spoon and beat the two together repeatedly, the
spoon stabbing the inside of the pan with a thud. There was no modu-
lation in this activity, nor did Joseph seek the interest of the adults
present in what he was doing. This “mindless” and “one-dimensional”
activity (Meltzer, 1975b) continued throughout the first two sessions
despite our attempts to make contact with him.
As the sessions developed, so did Joseph’s curiosity, and during
the third session he turned his attention to the dressing-up box, where
there were a few small plastic clothes hangers. Joseph appeared quite
enlivened by these hangers, gathering up a few and handing one
to each person in the room. His foster carer and the clinicians were
surprised and equally enlivened by this process, and our discussion
in the room then centred upon how this was his first use of play as
communication. Despite Joseph’s high level of need and wide range
of difficulties, it was encouraging to see him engaged and beginning
to make contact with us.
Joseph’s foster carer was getting to know him, and this was also
having a positive influence upon his development. The hangers
became a regular feature in the sessions, accompanied by increased
enjoyment and contact with each person to whom he handed one. It
was almost as if he were deliberately giving us something from which
to hang him in our minds. It certainly had the desired effect, as Joseph
was a child whom you remembered and thought about between each

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 86 louise allnutt

session. The hangers were, perhaps, also a communication about his

increasing awareness that everyone had their place. From these ses-
sions we decided, with his foster carer’s support, to move Joseph into
intensive psychotherapy.
Despite his outward appearance, which could seem vacant and
unmoving, there was nevertheless a nugget or spark of life in Joseph
from the outset of treatment. When he was collected for his very first
session with me, he bounded down the corridor with giant steps and
excitedly leapt into the consulting room without apparent fear. I was
left wondering if this was confidence, faith, or just manic omnipotence.
Whatever it was that imbued him with such confidence at this first
moment of his therapy, it quickly collapsed as the encounter unfolded.
This state of collapse became a regular and distinctive feature of our
sessions, but despite this, his initial confidence became something
that he and I unconsciously relied upon to keep going with an often
extremely difficult treatment.

Transitions: falling and dropping

Soon into his first session, Joseph became preoccupied with falling
and dropping.

Joseph took a car to the sink and rolled the wheels along its edge.
He then let it fall from the edge into the sink. He said, “Fall over.”
Joseph looked down into the sink at the car.
Joseph removed it from the sink and took it to the table, where
he placed it on the edge. He rolled it back and forth along the
edge a couple of times. He then abandoned the car and returned
to the box. [Following this, Joseph struggled to focus; he located a
couple of objects—a rocker stack and then a teapot—which he ended
up throwing away; he then returned to the car.] The car on the table
caught Joseph’s eye. He wandered back to the table and with
his head down to one side he rolled the car back and forth. . . .
He returned with the car to the sink and again placed it on the
edge. He again let it drop and stated, “Fall over.” He repeated
this several times. At one point he then turned, leaving the car
in the sink and said, “One, two, three!” at the same time jump-
ing with both feet in the air. I remarked Joseph was counting and
he shouted, “Three, four, five!” He then turned and banged on
the door.

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 dimensionality, identity, and security 87

The anxiety of being dropped emerged in this session in connec-

tion with a sense that nothing could be sustained. Joseph seemed
to manage his fear of falling by trying to take hold of some order or
sequence, such as his jumping and counting, a defensive response
to the anxiety caused by deep feelings of insecurity. There were
brief moments of apparent interest and optimism, expressed through
Joseph’s interest in the toys, but these were quickly disconnected
and his focus either ran adrift or toys were discarded. There was
a flurry of activity in this first session that showed me the pain-
ful experience of an almost buoyant beginning that quickly disinte-
grated; the therapy quickly became a place where nothing worked
and nothing could be sustained.
Soon after this sequence, Joseph collapsed following a disturbing
encounter with the mirror he found in his box. Looking into it closely,
he encountered his own reflection, which was, possibly, unrecogniz-
able to him and which frightened him. Joseph threw the mirror and
then fell to the floor as if the loss of the reflection meant the loss of
his own physical form—an instance of Meltzer’s “breakdown of the
surfaces” discussed above. From the floor, Joseph stared into the
open cupboard beneath the sink, an empty space he had referred to,
earlier in the session, as the fridge. It is striking that, following his
collapse, Joseph left the relationship with his therapist and fixed his
eyes onto the empty cupboard. This space, which to Joseph appeared
empty and cold (he seemed, at this point in his development, to have
little expectation that spaces can have potential) represented his lack
of inner space in which, according to Meltzer (1975b), “experimental
thought can take place” (p. 225).
One might say that Joseph loses his more object-related inter-
nal capacity at the point when he seeks the stability of the empty
“fridge” cupboard, apparently in response to his misperception
and terror at his own reflection. Joseph fixes upon this empty shell
almost as if he fears he would lose his own fragile coherence with-
out it. Winnicott (1952) describes the response to anxiety caused by
insecurity unmitigated by a good-enough environment, as a “lack
of relationship of psyche to soma, becoming a sense of deperson-
alization” (p. 99). Developmentally, then, the implication of being
overwhelmed by this level of anxiety is that one loses, or never
perhaps even gains, a core sense of self and a reliable sense of one’s
own coherence in the face of a relationship to the external world and
its spaces.

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 88 louise allnutt

In the second and third sessions, Joseph again collapsed to the

floor on crossing the threshold of the room and proceeded to bang
his head. These early sessions appeared indicative of the way his
experience of being dropped had permeated his experience in the
here and now of his relationship to, and coordination in, space.
Moving from one place to another appeared impossible without
giant leaps, jumping, or being held, without which Joseph would
otherwise collapse. The thresholds that separated inside and out, self
and other, room and corridor, were junctions that caused Joseph dis-
tress and confusion.

Boundaries: holding and rhythm

In the fourth session, Joseph was carried to the room by his foster
carer, who then stayed for a couple of minutes to help to settle him.
On her departure, Joseph sat with his back to the door and rocked
with a blank and vacant expression. This was a development from
the first three sessions as he was clearly using the rocking to comfort
himself in the face of the separation that, for him, felt like a catastrophe
(Tustin, 1981).

During this moment at the door, I held Joseph’s head and spoke to
him echoing the rhythm of his rocking. As Joseph calmed down,
he looked around the room—for the first time—and I identified
that he was showing interest in the inside of the room. At this
point, he placed his fingers inside his mouth. Both physical hold-
ing during the transition and rhythmical attunement during the
emotional transition from distress to calm provided the conditions
for Joseph to look into the physical space of the room and imme-
diately equate this interior with the inside of his own mouth. He
was, at this moment, held together by the relationship between
inside and outside.

This material shows marked developments in Joseph’s capacity to

make the transition into the consulting room. Joseph sought the
support of his foster carer before even attempting to walk along
the corridor. He then collapsed when left by his foster carer at the
threshold of the consulting room, and following this he was held
and rhythmically spoken to about his experience and fear of being
dropped. The physical holding in addition to the rhythm of vocali-
zation brought about a moment of calm, and Joseph then looked

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 dimensionality, identity, and security 89

into the room for the first time. Looking into the room implies an
evolved capacity for noticing, as distinct from the first session in
which Joseph appeared to move from one activity to the next with-
out leaving much space for noticing. There is little reference to the
therapist in the first session, whereas the additional support sought
out for the transition from his foster carer and then experienced in
relation to his therapist appears to create a bit more space for Joseph
to take in the environment. This seems to be an example of what
Rey (1979) described as the experience of “marsupial space”. The
shift between collapsing to looking into the room seems to be facili-
tated by the experience of being held rhythmically. This is very dif-
ferent from Joseph’s experience of the “fridge” which followed the
perception of a frightening occupant in the mirror.
This experience in infancy is explored by Sorensen in “Observa-
tions of Transition Facilitating Behaviour” (2000). Through her obser-
vations of nursing care provided to premature infants on a Neonatal
Intensive Care Unit (NICU), Sorensen identified that the function of
such behaviour is to “create a bridge from one state to another or
one experience to another” (p. 49). In this sense, the discontinuity
expressed by Joseph’s collapse is subsequently bridged by the support
offered by me as I physically held him and talked to him. His need
for a concrete experience of holding was significant and reflected the
infantile level of his anxiety, what Winnicott (1960) describes as the
level of “absolute dependency” (p. 113). The rhythmical quality of
my vocalizations are in this respect more important than the content
and are reminiscent of Tustin’s “rhythm of safety” (1986a) and what
Canham (1999) identifies as often lacking in fostered and adopted
children. Canham noted:
Many of these children come from backgrounds where their lives
have not been characterised by rhythm, but rather by its oppo-
site. Many children who end up being taken into care have been
neglected for very long periods of time—left unfed, unwashed and
forgotten. [1999/2012, p. 62]

With the development of more language and our increasingly com-

municative relationship, Joseph began to communicate verbally and
to use the toys to show and express his experience. In his twentieth
session, he communicated his experience of not finding a place in the
world, and his consequent falling out, through play and words. The
sequence began when he was filling a cup with crayons but found that
one of them would not fit in the cup with the others:

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 90 louise allnutt

Joseph persevered and made several attempts at putting the last

crayon inside. He got down off his chair and brought the crayon to
me and said, “Do it.” I looked at the crayons in the cup and said,
“There’s not enough space for all those crayons in there.” Joseph
was frustrated and huffed and puffed. He asked again, “Do it,”
before taking them away and trying to fit them himself. I said,
“One of them doesn’t fit, oh dear.” Joseph then became extremely
animated and took the crayon in his hand and held the crayon
above his head before then bringing it down to the ground and
saying, “Fall down.” I said, “Joseph is worried that the crayon
that doesn’t fit will just fall down.” Joseph agreed and went to the
sink and put it inside the sink. I said, “Joseph needs to find some-
where else to keep the crayon safe.” I then said, “Joseph needs to
know that there is enough space for him here with Ms A so that he
doesn’t fall down.” Joseph walked back over to the table and then
crouched down towards the floor and looked up at the ceiling. He
had removed the crayon from the sink and had it in his hand and
now tapped it on the floor. I said, “It feels dropped when it doesn’t
have a place.” Joseph looked up at the ceiling and then down to the
floor and I said, “How does it all fit together? There’s up there and
down there and all this in the middle.” Joseph looked interested
and then looked over to the window and said, “Window.” Joseph
then stood and went to the window. I said, “And there’s inside the
window and outside the window.” Joseph climbed up on the chair
and I went to hold the back of the chair to stop it falling over, and
Joseph noticed and said, “Help me.” Joseph climbed up onto the
table next to the window.

Joseph’s awareness of spatial dimensions and the place objects have

within space was increasing, and he was exploring how objects fit
inside other objects and how stability can be negotiated. The dialogue
between Joseph and me was closely woven and reciprocal, allowing
the emotional experience to be somewhat contained and enabling him
to communicate the experience rather than act it out physically and
emotionally as he does in the earlier examples. The reference to the
window suggests something important about the kinds of boundaries
he is beginning to internalize. The “helping” therapist also seems to
offer a window through her benign observation and attention, offer-
ing him a way in, without feeling he needs to bang through, to find
a secure place.

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 dimensionality, identity, and security 91

As the therapy progressed, Joseph’s experience of boundaries

seemed to relate more to the environment created by our relationship
than the experience of boundaries as obstacles in the physical world.
In the twenty-fifth session, Joseph responded negatively to the time
boundary that I mentioned five minutes before the end of the session.
Having placed his shoes on my lap, he then threw them across the
room when I identified the time boundary. He proceeded to the door
and, rather than bang his head against the door, as he used to previ-
ously, Joseph called out “Open!” while pulling on the door handle.
There is clearly quite a shift here. Here, Joseph uses language in place
of action, expecting that our relationship is the environment through
which negotiation of the boundary can take place.

Separation
With these new realizations came an increased awareness and explora-
tion of the experience of separateness. In Session 26 Joseph explored
what he described as the “snap snap scissors”; he drew a line down
the centre of a piece of paper and proceeded to use the blades of the
scissors to mark along the line, saying, “snap snap scissors,” as he did
so. I felt Joseph was seeking to identify how the scissors could be used
effectively to define separateness.
Interestingly, in the next sequence Joseph used a black crayon to
draw two separate circles:

Joseph drew two circles side by side on a sheet of paper. I noted

there were two shapes. Joseph pointed at each circle and said,
“One–two.” I agreed, saying “Yes there are two: one, two.” Joseph
repeated this, pointing towards the shapes. I then suggested, point-
ing between us, “Ms A–Joseph, one–two.” Joseph agreed, “Yeah.”
He continued pointing, and I said, “Two hands: one–two”, point-
ing to Joseph’s hands. Joseph shouted, “Hands!” We repeated this
with eyes, ears, etc.

This was the first time Joseph had drawn two separate objects, in
contrast with a “cut” or “split” singular object. The developments
in the material emerged alongside my interest in Joseph’s preoccu-
pations and, as he identified “one–two” in response to my enquiry
about his drawing, we engaged in a game of identifying different
pairs.

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 92 louise allnutt

This developmental surge, however, becomes overwhelming for

Joseph:

After a short period, he looked a little lost and stared at me in a

way that made me feel quite overwhelmed. I was anxious about
what might happen between us. He leaned back in his chair and
looked up at the ceiling. He then paused silently and looked at me
out of the corner of his eye.

With the identification of two-ness and separate but together pairings,

Joseph seemed to be thrown back into a more cut-off, but suspicious,
state of mind. His challenging look towards me suggests an air of
disbelief. When taken all together, the sequences that emerge in this
session show a striking development in Joseph’s capacity both to use
the relationship with me to express and explore his preoccupations
and developmental dilemmas as well as to communicate his anxieties
about such dilemmas. In this session, Joseph is showing how complex
separation feels for him. He questions whether separation causes
harm, to himself and to others. He is trying to understand the nature
of cutting and separating and the experience of two-ness, which bring
him into contact with historic anxieties associated with not having
a place, falling out, and being left as well as the presence of a more
powerful party whom he fears and from whom he retreats. As Joseph
developed a greater sense of cohesion, and could therefore be more in
touch with his experience as an individual, his relationship to separa-
tion changed. Later sessions suggested that Joseph’s anxiety about
separation was more rooted in feelings of exclusion, and there was
greater working through of oedipal material.

Final remarks
With these brief vignettes of the first few weeks of Joseph’s treatment,
I hope I have illustrated how psychoanalytic work with very young
children can attend to difficulties in spatial organization and orienta-
tion and further contribute to stability and security in object relations
and identity. My sense is that, similar to what Meltzer described in
terms of the developmental process of spatial organization, the experi-
ence of “being at home” in both an internal sense as well as an external
one is developmentally driven.
Psychoanalytic psychotherapist June Campbell (2006) highlighted
these issues in relation to the adult homeless population in Edinburgh.

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 dimensionality, identity, and security 93

In an audit conducted by the psychotherapy department at the Royal

Edinburgh Hospital, 66.7% of homeless people were shown to have
personality disorders, the highest prevalence of which were in the
categories of borderline and impulsive:
Unsurprisingly, the sample also showed high levels of physical and
sexual abuse, significant loss or absence of fathers, recurring contact
with the police and extensive psychiatric histories, amongst other
significant data. [Campbell, 2006, p. 158]

Following this audit, a psychotherapy pilot was developed to offer

support to both the homeless people and the workers, who were
identified as having a high risk of burnout and high levels of staff
turnover. The main cause for concern was the inability of homeless
people to make good use of the provision of accommodation. Using
a psychoanalytically informed theoretical model, largely drawn from
Rey (1994) and Winnicott (1951), Campbell describes how the home-
less people were unable to maintain socially expected relationships
to their dwellings. Following the work that she undertook with the
population and their workers, she was able to highlight that it was
the internal relationship that the homeless people had to their sense
of place that fundamentally impacted on their capacity to make use
of a new home. I think this is a striking piece of research in relation to
the case that I have presented here, as Campbell’s formulation both
resonates with and adds substance to the kind of formulation one
might draw from Joseph’s response to therapeutic space. It substanti-
ates his need to have a place in someone’s mind as opposed to being
given a home.
Feeling one has been placed outside the family unit, or that one
has been somehow cast adrift, seems to lead to confusion about both
the nature and the function of the boundaries and thresholds between
inside and outside, as well as the question of how, and if, one is able
to make a relational and, therefore, secure transition between the two
(Houzel, 1996). It also calls into question the nature of the objects
whose presence and absence further disturb the development of secu-
rity and powerfully influence what then is imagined as necessary to
establish one’s rightful place. These are as much about the develop-
ment of internal reality as they are about the nature and importance
of external reality. In Joseph’s case, the use of primitive defences to
manage overwhelming anxiety in the face of his experience of space
demanded a developmental approach to psychotherapeutic work.
When he first attended his therapy, he depended upon a variety of

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 94 louise allnutt

“second-skin” functioning physical defences (Bick, 1968), including

jumping, banging, and covering his head to manage his anxiety. This
anxiety broke through at times, and it was clear then that the collapse
was both externally and internally experienced. Joseph was seen to
lose the connection to his own mind and its functioning at times. The
kinds of defences he needed to employ to keep such fragmentation
at bay were restrictive and inflexible. The use of rhythmical, physical
holding appeared to bring about a softening of these defences at the
beginning of psychotherapy, which equally demonstrated the infantile
level of Joseph’s developmental needs. As Sorensen (2000) stated, the
vulnerable infant needs the experience of “holding” that can bridge
the otherwise overwhelming nature of spatial and transitional experi-
ence.

Note
This chapter is based on a version previously published in the Journal of Child
Psychotherapy, Vol. 42 (No. 1, 2016), pp. 18–29. Copyright © Association of Child
Psychotherapists, reprinted by permission of Taylor & Francis Ltd, http://www
.tandfonline.com on behalf of the Association of Child Psychotherapists.

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 CHAPTER SIX

The isolated adolescent

Carlos Tabbia

A
t all ages, involuntary and persistent isolation is a matter for
concern. At the end of infancy, it may be worrying, but the
isolation that appears in adolescence is frequently a symptom
of emotional disturbance and can feel deeply alarming for the fam-
ily. This conflicting developmental period can be better understood
psychoanalytically but remains a common topic in the media, which
often focus particularly on the influence of electronic games in causing
adolescent isolation.
After infancy and latency, puberty emerges with a vigour that
can surprise the young person, the family, and his or her friends.
Particularly unsettling is the imbalance created by the unintegrated
movement of the personality, prone to splitting while sustained by
obsessional defences. Puberty also seems to destabilize the physical
“centre of gravity”. This is reminiscent of the physical experience that
takes place with ice skaters. The Olympic ice skater Yulia Lipnitskaia
won a gold medal when she was 15 years old, at the Olympic Games
in Sochi, Russia, in 2014. One year later, she had to modify her skating
technique because her bodily changes had shifted the centre of gravity
she had established over many years of training. While her coaches
refer to her physical loss of equilibrium, we might also imagine a
loss of emotional balance in the face of the changing states of internal
objects.

95

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 96 carlos tabbia

The centre of gravity of the personality starts and develops in

the highly complex relation between the baby and its mother; with
the nipple in its mouth, the baby gazes into its mother’s responsive
eyes (Meltzer, 1989, p. 133) while its hearing is alert to the mother’s
voice and words. The baby introjects this experience of the early
relationship, gradually internalizing a good object which becomes a
cornerstone of the budding personality. Hence the baby’s dependence
on such an internal object forms the core of its emotional stability.
Destabilizing factors, such as the increment of intrusive identification,
interfere with the potential to promote further introjective identifica-
tion with live whole objects.

Shift from latency to adolescence

The pathogenic consequences for a child who reaches the end of
infancy with an unstable centre in his or her personality, while going
through pathological splittings, are described by Meltzer (1999) in
“Clinical Dialogues with DM: Graciela”:
In general we think that puberty takes place as a result of physiologi-
cal and hormonal changes, but we have found evidence that in ano-
rexia the hormonal system is strongly linked to states of mind and is
capable of setting back the physiological developments of puberty:
children remain in latency for years and, among other things, do not
have menstrual periods and do not develop breasts and pubic hair.
It is also possible to encounter premature puberty when these
children were the target of sexual stimulation and abuse, which
prematurely awakened their sexuality and interfered with the onset
of latency. In this case we may come across early menstruation at
9 or 10 years of age, precocious development of the breasts, and
becoming young women at the age of 12. [p. 145]

The adolescent and the group:

the nature of isolation
Puberty and adolescence are states of mind. In addition to having a
physiological component, the pubertal state of mind is reached when
the obsessionality of latency is relinquished. As a result, there will be
a dispersal—a splitting of the self—that requires a group structure to
hold together the parts of the self to prevent its fragmentation. Pro-
gression towards normal adolescence in the face of this fragmentation

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 the isolated adolescent 97

will necessarily be conducted under the influence of the core of the

personality that was operative in earlier life. At this point, the child
may throw him/herself into the experience of puberty or take refuge
in, for instance, isolation.
The experience of puberty often involves multiple dissociations,
which are projected into a group. Each group member becomes a
provisional container for an aspect of the personality. Fluctuations
within the group are common, and it can often feel like an anguished
strategy to eliminate psychic pain. While some adolescents can toler-
ate oscillations, others become terrorized and prefer to withdraw from
the group, remaining on its periphery. The group needs constantly to
expel pain, and it does this by projection into the weaker members,
friends, and family.
It is important to recognize that the paranoid anxiety triggered by
disintegration in the genital period luckily finds some containment in
the paranoid group, leading Meltzer to believe that puberty was the
“maddest” period in human development. It would seem paradoxical
that the road to health should include the experience of a paranoid
group, but Meltzer thought it was essential for development to have
the experience of “belonging” to a group and that shortcuts were not
the best way to prepare for the adult world. Shortcuts are alterna-
tive defences, often stimulated by the social intolerance of juvenile
conflicts.
Some shortcuts can result in young people remaining as latency
members of the family group or—in identification with the parental
model—creating an idealized and infantile couple. Alternatively, they
might flee from adolescent turbulence by becoming hard-working
students, only to become brilliant but emotionally fragile executives
or, lastly, joining the worrisome community of those who choose
isolation.
In pubertal same-sex groups, individuality is a grave threat to
the group mentality and is not tolerated. The same hostility towards
powerful people can be found in institutional groups, where expres-
sion of individuality, leadership, or creativity is not tolerated. Anyone
entering the group with a weak “centre of gravity” will have to either
submit to the group tyranny or emotionally isolate him/herself and
remain on the periphery.
Within these groups there are roles and functions. Focusing on
the pubertal (Meltzer, 1967, p. 67) and adolescent group, Rios (1985)
has considered the significance of the leader, the best friend, and

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 98 carlos tabbia

the ­marginal member.1 A healthy adolescent can perform different

functions and roles at different times, whereas a disturbed adoles-
cent cannot. In order to gain access to the adolescent community, it
is extremely important to have a “best friend”. According to Man-
tykow de Sola (1991), the best friend’s function is to promote suf-
ficient tolerance to bear oedipal turbulence. It is a maturational link
that takes place, first with the same sex and then with the oppo-
site sex. The absence of a best friend may indicate a perpetuation
of latency and difficulty in moving freely into puberty and ado-
lescence. The best friend may function as a transitional object that
allows entry into and exit from adolescence. Having a best friend
indicates a capacity to give up isolation, and the adolescent without
a best friend suffers terribly.
Within the group, the isolated young person can become a pariah
or marginal. He or she will become a receptacle for the psychotic
part of the group and will, in this way, contribute painfully to the
creation of the gang. This is the price of belonging to a group into
which he or she can project the healthier and potent parts of him/
herself, in particular into the group leader.
When an individual becomes stuck on the margins, he or she can-
not swap roles freely with other group members; the individual loses
the benefit of the group experience and can no longer reduce his or her
dissociations, omnipotence, and paranoid anxieties, nor distance him/
herself from the lure of megalomania. We here have the ingredients
of a more disturbed psychopathology. Isolation becomes a dangerous
and painful refuge where the benefits to be gained from the adolescent
community become unreachable.
What prevents this young person from being part of a group and
from being able to socialize his conflicts, as Meltzer (1973a) framed it?
One adolescent, 16-year-old Esteban, said, “If I don’t hang out with
drug addicts and drop-outs, I would have no company and would be
all alone”. Terror of loneliness may prompt the adolescent to “create”
an unconditional friend, as in the case of Hector (discussed below),
who adopted a dog, whom he named Samson. Hector turned to Sam-
son for companionship and comfort when he became trapped in a
narcissistic gang with his parents. Hector was like a God and, in his
splendid isolation, turned to Samson for fidelity and comfort.
From what does the adolescent isolate him/herself? Isolation makes
the “socialization of conflicts” impossible. As isolation expresses itself
in many ways and responds to different states of mind, it may be use-

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 the isolated adolescent 99

ful to make some differentiations, without aiming to cover the whole

psychopathological range of isolated adolescents.
First, we must differentiate two types of isolation from the vertex
of loss and mourning; an adolescent may suffer from the collapse of
his or her same sex group, becoming unable to benefit from its group
dynamics; he or she may develop a depressive illness when his or her
best friend becomes part of a couple and may end up isolating him/
herself.
Then there are adolescents who, after the loss of infantile ide-
alizations, withdraw into a narcissistic organization that may lead to
megalomania. These adolescents are unable to recognize their depend-
ence upon parental objects and may believe that they have conceived
themselves and that they have a mission in life. The manic basis of
their personality may express itself in the conviction that they have
to educate their parents to become better parents and to change the
state and its institutions. Such arrogance does not disappear when
feeling lonely and nor does the sense of isolation (Meltzer, 1971),2 but
increases with their resentment. This becomes worse when delusional
jealousy leads to the kind of extreme vandalism involving the murder
of children or youngsters.
Beyond the paranoid-depressive and the megalomaniac iso-
lated adolescents, there are other manifestations that deserve scru-
tiny because of their frequency in psychoanalytic sessions. These are
friendless young people who do not belong to a group and who usu-
ally lock themselves in at home. They leave home only to go to school
but have no relationships with other students, making contact only in
the atmosphere of social media where there is no physical contact. I
believe that this could be due to the massive use of narcissistic iden-
tifications and the fear of having to forego their narcissistic defences
through the loss of their obsessional control. This loss of control at
the time when they are immersing themselves in an adolescent com-
munity creates the conviction that they will not be able to regroup and
reorganize themselves. The ambition to join the group can create the
secret urge to run it and become the leader. Alternatively, they might
join the group but remain slightly apart, like a fly on the wall, spying
and judging the other group members. None of these strategies help
such adolescents to participate in the group experience. Indeed, this
false link enables them to feel grandiose and even to occupy a prestig-
ious place, despite not feeling included, as the group recognizes their
partial contact and ends up distrusting them.

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 100 carlos tabbia

This dynamic can alter when the group becomes more depressive
and less paranoid-schizoid, and at that point the isolated adolescent
may be able to obtain more understanding and containment for his
or her suffering.

The ubiquity of projective identification

I would now like to focus on three omnipotent phantasies that impede
joining the adolescent community and experiencing its transforming
influence.
First, I want to refer to those who live in a retracted state, fol-
lowed by those who live in intrusive identification, and, finally,
those who become sucked into an object. According to Meltzer
(1992b):
At the beginning of psychoanalysis there was a lot of talk about
returning to the womb. But all this was discarded when the con-
cept of projective identification was formulated. I do think there
is a difference. There are the phantasies that exist before birth and
the intrusive phantasies related to states of projective identification.
They have a different meaning and also different consequences. In
effect we can identify the returning to the womb through which
patients retreat inside, isolate themselves and remain in a cocoon.
This is where we see states that appear frozen, some with narcolep-
sia in which the patient sleeps a lot, some in catatonic states and
they all have a connection with the phantasy of going back in time,
to that marvellous situation of being inside the mother before the
father turns up.
The conflict created by the appearance of the father as well as other
unavoidable frustrations may lead to the joke: “What do we come to
the world for? To suffer? In that case we go back!”
Even when the idealization of intrauterine life is debatable, we
have to take on board the belief that in the womb, in the face of
unpleasant experiences, “the foetus gets rid of [these experiences] as
soon as it can” (Bion, 1997, p. 50). This phantasy of paradise is always
possible when facing a conflict and finds expression in a dialogue
between Somite Thirty and Term, in the third volume of Bion’s A
Memoir of the Future:
somite thirty:
Get back into the Amniotic Fluid.
term:
Get out into the sun! Glory! The fields are bathed in light.
Moonlight! Don’t lie snoozing in bed.

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 the isolated adolescent 101

somite thirty: Keep warm in bed. Your King and Country want
you—you stay in bed. [1991, p. 443]
This staying in bed, locked in a world without stimulation, is the
consequence of relinquishing the external world, because it feels too
dangerous and frustrating. Meltzer suggests that possessive jealousy
is a motivation for projective identification, observing how it is seen
“in the autistic children and in children whose drive to maturity is
very low, so that they wish either to remain infantile or to die. This
means in their unconscious to return-to-sleep-inside-mother” (1967,
p. 15). This omnipotent phantasy is at the core of states of retraction
and somnolence.
We can differentiate between a wish to sleep inside the mother and
a state in which some “parts may be left behind in the womb, produc-
ing states of withdrawal quite different in phenomena from those of
projective identification” (1992a, p. 127). I think that when there is a
predominance of intrusiveness—as in the head/breast compartment
of the internal mother—we find states of Oblomovian lassitude, where
the subject has no desire to leave the object because he enjoys indo-
lence. In the case of isolation due to unborn parts of the personality,
however, the baby shows an absence of stimulation or incentive to
come out into the world and appears drowsy. According to Meltzer,
some parts have not been born due to a failure in the aesthetic con-
flict between baby and mother. He relates this to the possibility that
puerperal depression may be more common than is reported; if a baby
does not find a passionate containing object, it is likely that it will fail
to be born complete.
Whether it is returning to the womb or not wanting to abandon it,
there is a universal phantasy that there is no experience of need in the
womb because a constant provision makes the notion of lack or desire
impossible. Nevertheless it is possible:
to experience unpleasantness, sometimes violence linked to sudden
alterations of the biochemistry of the environment as it is also possi-
ble to feel comfortable in a stable environment protected from exter-
nal interference. These differences in intrauterine life will surely
have an influence on growth, strength and vitality, on the capacity
to take an interest in the objects that are present in the womb and
in the last instance on the way in which he can be prepared for the
delivery and life. [Caccia, 2007, p. 60]
The phantasy of lost paradise, together with the fear of conflicts in the
external world, can attract and sustain mental states characterized by

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 102 carlos tabbia

isolation and somnolence. This fear can be observed in adolescents

who spend most of their day locked in their room, only emerging in
an explosive way, as if in a panic, charging against everything that
stands in their way.

Gerard
Sixteen-year-old Gerard had been a “good boy”, adapting well to
school and belonging to a latency group. Once he reached puberty, he
isolated himself after getting into trouble with the police: he had been
caught stealing from supermarkets and touching-up girls while steal-
ing their mobile telephones. For Gerard, the external world was full of
dangers, and he experienced his sessions as approaching the horizon
and being about to fall into hell. His parents were confused profession-
als with a problematic relationship and were very annoyed with their
frustrating adolescent. It seemed that his entry into adolescence was
not supported by objects capable of containing him; his parents found
it unbearable to see him too isolated to sustain a therapeutic process,
and they decided to interrupt his therapy and give him medication.
The “case or sheath as an exo-skeleton” (Bion, 1991, p. 431) that Gerard
chose for himself was a caricature of a Wild West bandit: his thin arms
always looked ready to draw his pistols. He was so terrorized that he
could find refuge only within the four walls of his room.
Certain ways of locking oneself in a room can be as serious as
those found in the psychotic states linked to addictions and video
games (Rosenfeld, 2001). Some isolated adolescents with a borderline
psychotic psychopathology manage to go through life appearing to
be well-adjusted, enjoying successful academic or sporting lives but
enduring great difficulties in establishing intimate relationships. Their
painful isolation surprises those who know them. Gerard was an
educated, studious, and well-adjusted child, and we can assume that
he left latency in a pseudo-mature state; while his brothers played
football, he studied philosophy and discussed politics. This enabled
him to avoid juvenile emotional turbulence and allowed him to look at
the world with arrogance and judge his friends, relatives, and neigh-
bours. In some sense, this arrogance is characteristic of adolescents,
because it is the consequence of confusional states. In the same way,
however, just as all adolescents go through confusional states, this can
become chronic when one tries to escape the limitations of the self and
an attempt is made to “seize an object’s identity by intrusion into it”
(Meltzer, 1973a, p. 53).

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 the isolated adolescent 103

To live in intrusive identification, the part that lives in an inter-

nal compartment remains alienated from the external world. Meltzer
doubted if it was useful to speak “in terms of external world or inter-
nal world, because the patient who lives in projective identification
loses a sense of differentiation between inside or outside”, as he is
dealing with compartments rather than inside and outside (Meltzer,
2002, p. 18). These compartments form the barrier that prevents a true
emotional contact with the world.
Elitism and arrogance that stem from intrusive identification with
qualities of the object stimulate in these adolescents feelings of supe-
riority and self-sufficiency, but these do not anaesthetize completely
the state of isolation that overwhelms and persecutes them. Nor does
it mitigate feelings of fraudulence, and they feel persecuted by the fear
of being found out and denigrated. They do not arouse interest in their
colleagues, their telephone seldom rings, and their diary is only filled
if they take the initiative. They are efficient and appreciated as coop-
erative with adults, but their private life is confined to masturbation,
pornography, and despair. In relation to people of their own age or
younger, they can adopt a protective attitude that can be understood
as a desire to look after healthy aspects of themselves projected into
them, while at the same time they can jealously control the younger
ones to abuse and exploit them.

Alexander
Another young man, Alexander, has been living an isolated life for
many years. At first, he was the idealized object of his parents’ hopes,
but this changed when his brothers were born. Each new baby became
their idealized love object while, at the same time, they kept bundling
the older siblings together as if to confirm the infantile phantasy that,
“Adults are fascinated when they have babies, but later they drop
them, and it all boils down to the fact that what they really like is mak-
ing babies, simply the product” (Meltzer, 2002, p. 30). Jealousy and
resentment stimulated a wish in Alexander not to become excluded,
and he split his world in such a way that, in relation to his mother, he
developed a narcissistic identification and became her counsellor and
support. With his father, on the other hand, he became a dutiful son,
and, while he tolerated his father’s contempt by placating his brutality,
he managed to stay near him and become the manager of the family
business, without feeling that he had earned it because of his intellect
or his managerial skills. He was unable to have a relationship with his

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 104 carlos tabbia

sisters and had a sadomasochistic relation with his older brother. His
life took place in the greatest solitude.
During adolescence he tried to establish friendly relations, but
these, somehow, wore off. Internet pornography became his refuge
from isolation in which women would get undressed and praise his
penis. But, terrified by the prospect of a physical encounter, he never
went beyond the internet. Only intrusive identification allowed
him to overcome his isolation, but these invaded objects, far from
improving his feelings of safety, undermined his personality and
made him increasingly distrustful and fearful of meeting other peo-
ple. Through his therapy, he has been able, partially, to restore his
internal objects, in which he has come to trust. This has allowed
him to give up his masturbatory activity and his use of marijuana,
diminish his total isolation, and become increasingly dedicated to
other children. He has, laboriously, managed to create a group of
friends from whom he still feels the pain of being excluded, from
time to time. All this does not mean that he has become able to
tolerate emotional pain; when this increases, he flees, preferring to
placate his persecuting paternal object rather than rebelling: being
left alone is more persecuting than being hurt or going out into the
external world. As long as the pleasure from the different compart-
ments of the internal mother protect and gratify him, he will con-
tinue to avoid the external world in which his parental objects are
not very interested in discovering their son’s individuality.
In the same way that Alexander forced his way into his objects
through masturbatory intrusiveness and, in doing so, acquired a
pseudo-identity, there are situations in which adolescents become
vulnerable to the intrusiveness of other people. This is the equivalent
of being swallowed up by an “aspired projective identification”, as
occurs with the psychopathology of the folie à deux, where mixed
projective identifications make it difficult to create an emotional link
with one member of the collusive couple.3 For the adolescent girl, this
might entail an inseparable, twin-like alliance with her mother, almost
sharing an identity. This might revolve around their beauty, expressed
by their referring to themselves in terms of “we, we, we” (Meltzer &
Harris, 1998). These perverse4 alliances can have different objectives,
such as exploiting others with the bait of their beauty or intelligence
or delinquent plotting. In these cases, the family group has become the
adolescent gang, for whom transgression offers shared excitement. It
becomes very difficult for an adolescent immersed in this delinquent
culture to abandon the group and join the real adolescent community;

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 the isolated adolescent 105

the adolescent may feel that he or she is betraying his or her family by
rejecting the erotization of orgiastic family life.

Hector
This is what Hector believed when he struggled to prevent his
bipolar mother walking around the house wearing only her ­knickers
and feeling free to touch his body, something that his father did noth-
ing to prevent. He was frequently sandwiched naked between his pro-
miscuous parents—three polymorphous “adolescents”—in a state of
shared excitement. This did not prevent Hector from feeling isolated;
with his excessive greed and jealousy, he struggled to make friends.
Hector’s imprisonment in his family gang only offered temporary
relief that could not protect him from urgently seeking any object that
would fill the vacuum. It seemed as if Hector would not have to worry
about his future because he would inherit the small business, as well
as the various family properties. The family pact was “us against the
world”, but this did not soothe his sense of isolation and helplessness.
His compulsive eating, drinking, promiscuity, and cocaine abuse was
not enough to fill his emptiness. For Hector, other children were not
so much rivals but objects for consumption. As the geographical con-
fusions and the symbiosis in the family were dissolved, his anxiety
increased, and he expressed a great desire to possess the analyst as a
transference object. He said in a session: “I get annoyed about having
to pay €2 for parking even when I have a nice car, I get annoyed about
paying €2.5 for a beer in a nice place. I hate mankind, it is desperate.
I would like to eat you up whole so that you become only mine and
nobody else’s.”
Once he recovered from his anaesthetized state, born out of the
confusion with his family gang, his needs increased as well as his
understanding of his mental states, and he could recognize his wish
that everything should be his for free. There was no hunger attached to
the erotized family sandwich, but the moment he separated and had to
pay for himself, he became furious. Not so long ago, Hector dreamed
that he was robbing a bank. When he reached the safe, he noticed it was open
and that other thieves were already present. At this point, he lost interest and
left because he wanted the loot just for himself, he wanted to monopolize the
object. After a lot of work, Hector is recognizing that he cannot relate
or love in that state of mind. “I feel as if I am in a big continent, in the
shape of a bowl or a cone, and that everything that falls into it is for
me, but I cannot feel love, I feel I have no love for others, or for you.”

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 106 carlos tabbia

Hector is slowly leaving behind the borderline/psychotic gang that

isolated him and made him feel that his only friend was his dog, Sam-
son. He is also leaving behind the sad feelings that made him chase
people, pay for meals, or offer them lifts, only to receive in exchange
their contemptuous and demolishing comments, like being told that
he is always running after people.

Conclusion
Adolescence is a time when maturational processes are synthesized
and when the gates open towards adult life. If the adolescent arrives
at this point with a faulty centre of gravity, the passage towards adult-
hood will require a restructuring that is likely to have an uncertain
outcome.
I believe that many of the disturbances suffered by isolated ado-
lescents fall into the category of borderline psychotic states that are
always linked to geographical confusions. In my opinion, overcoming
these states of isolation requires going through stages that have been
avoided out of fear of emotional turbulence. The itinerary that leads
to maturity was clearly described by Meltzer when he wrote:
the resolution of this configuration of object relations stands as the
border between mental illness (psychosis) and mental health, just as
the resolution of the obstacles to the dependent introjective relation
to the breast traverses the border between mental instability and
mental stability, and as the passing of the oedipus complex leads
from immaturity to maturity. [1967, p. 22]
In order for the isolated adolescent to resolve conflicts at every stage,
he or she must rely on the containing capacity of the analyst, because
“if an analyst can bear to persevere when geographical confusions are
in the forefront of the transference he will certainly be rewarded with
progress” (p. 22).

Notes
1.  “Introjections that are linked to the figure of an unconditional friend are of
great importance as the basis that is used for the choice of a loved object, and we
could almost say that it is the most important identificatory substratum” (Rios,
1985, p. 508).
2. “When a particular infantile part, or organization of them, seizes upon
consciousness and dominates a person’s behaviour, temporarily, say, the sense-
of-identity is bound to be oppressed by the loneliness, however defiant, of the
child-in-the-adult-world” (Meltzer, 1971, p. 202).

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 the isolated adolescent 107

3. Meltzer (1967) explains how difficult it is to establish the transference

situation when the mother involves the child in her anxieties: “I have had [the]
experience where it was not the mother who was ‘bringing’ but was the mother
who was involved in the ‘folie’ which prevented the ‘gathering’ from sufficiently
taking shape to set the process of analysis in motion” (p. 3).
4. These alliances can be intergenerational or intragenerational, as between
children and parents or between siblings: see Meltzer & Harris (1998b).

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 CHAPTER SEVEN

Supervision as a space for

the co-creation of
imaginative conjectures

Clara Nemas

“So these are my ideas on supervision. You can see [it] is not like
a master class in music. It is more of a participation—more like
playing in the orchestra; just contributing . . .”

Donald Meltzer, “On the Nature of Supervision”

(in Oelsner & Oelsner, 2005)

C
ontact with the work and the person of Donald Meltzer has
produced in all who met him not only a strong conviction
in the value of the psychoanalytic method and a most vivid
approach to our clinical work with children, adolescents, and adults,
but also changes to our view of the world, of life, and of the human
being. All this made of each contact with Meltzer an emotional learn-
ing experience: a K-link, to use Bion’s term. But it was in his super-
visions—“eye openers”, as Francis Tustin once called them—that one
could feel the passion, the capacity for observation, and the “real proof
of his experience” and creativity full at work. I must say that none of
this would have been possible without the generosity of Benito López,
our teacher for so many years, who first introduced us, in Buenos
Aires, to the work of Meltzer and, later, to his dear friend, the man
himself in person.

108

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 the co-creation of imaginative conjectures 109

Meltzer was preoccupied with the development and transmis-

sion of psychoanalysis. He proposed the need for more experienced
­analysts to “pause, and teach, and help the others to catch up” (Melt-
zer, 1986b, p. 203), in order to contribute to developing the next gen-
eration and to help them to realize their nascent creativity. He also
advised young colleagues to listen to each other, however, to develop
their own ideas and not depend only on the “knowledge” of the older
generation.
At other times, he stressed the need to develop tools in order to
discover the model of the mind the individual analyst is in fact using,
in the hope that through such discovery the analyst will be enabled
to extend and develop his or her own model further. The discovery
of new phenomena is completely dependent on the explicit and con-
scious use of a model; without that, the emergence of new phenom-
ena, not explicable by previous models, cannot be recognized. For
this reason he invited analysts to examine their personal definition
of psychoanalysis. Given an agreement over the method—the close
examination and the description of the transference by means of an
internal examination of the countertransference—each analyst should
scrutinize the type of psychoanalytic process he or she is working
with. But how experienced should we be in order to be able to follow
this proposal? At what stage of our development do we have a stable
enough conception of the process we engender?
In our becoming psychoanalysts, a terminable/interminable pro-
cess, we travel a complex territory, following what appear to be
diverging roads: the development of a “mind of one’s own” together
with the need to acknowledge our dependence on the internal objects
as parental figures that provide new ideas which the self, eventually,
will be able to receive.
At this point, we may recall Freud’s quotation from Goethe’s
Faust: “What thou hast inherited from thy fathers, acquire it to make
it thine” (1940a [1938], p. 207) How can we understand this message
more than 50 years on? I think that Freud urges us to develop his
teachings in the pursuit of what we are focusing on here: a mind of
one’s own. Certainly, however, this remains a paradox: the fact that
the best part of our mind evolves in its relation to its internal objects
until it ripens to inspired independence under the sway of admiration
for the qualities that we appreciate (and this is important) according to
our own potentialities.
To supervise and also to participate in supervisions with Melt-
zer was a powerful emotional experience. I remember a senior

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 110 clara nemas

child analyst, moved by Meltzer’s comments on the presentation

of a child who had been diagnosed as autistic, told him after the
supervision: “You are a poet analyst.” I think that this was a good
description of his communications. He thought that what we have
to do is make the most of the language that is available and to be as
poetic and precise as we can.
At this point, I would like to share with you something he said
back in 1989, which has remained quite present and alive in my mind
since then. I think it relates not only to the way Meltzer conceived the
analytic situation, but also to the way he transmitted his clinical expe-
rience. I recall it more or less as follows: “At this time in my work, I
am more concerned with nurturing and assisting the buds of the mind
that are capable of thinking than with clearing out the weeds; that is,
more interested in what the mind does well than in what it does badly
or, in other words, less inclined to place the accent on the function-
ing of the paranoid-schizoid position than on the depressive.” In my
work, I gradually began to apprehend the meaning of this thought,
although, as often happens with learning, this started in a way that
was somewhat painful for me.
During Meltzer’s second visit to the Asociación Psicoanalítica de
Buenos Aires, I presented the clinical material of a very disturbed
15-year-old girl who presented with a psychotic breakdown with an
erotomanic delusion. Meltzer suggested that she had felt—and prob-
ably had been—seduced into talking about her delusion. He felt that
the analytic work should focus upon helping her to modify the centre
of her preoccupations and to consider the contents of her delusion as
“flotsam from the shipwreck”, to be allowed to float. He even pro-
posed that I tell her to leave the delusion until later, when she would
be able to think and speak about it. My interpretations had been aimed
at the patient’s fears of feeling overwhelmed by ideas that could not
be contained in her mind (on one occasion, she had lost control of
her sphincter while waiting for me to open the door of the consulting
room). Meltzer proposed that I help her to develop a container for the
most disturbed aspects of herself and to discriminate the symbolic
thoughts from the flotsam from the shipwreck—in this case, the contents
of her erotomanic delusion.
“Nurturing and assisting the buds of the mind that are capable of
thinking.” This is the way Meltzer understood psychoanalysis, and I
think that this extends to the understanding of supervision as a facili-
tation of learning, acknowledging the contribution of both members
of the couple to the analytic work.

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 the co-creation of imaginative conjectures 111

This conception of analysis seems to consider the reverie func-

tion as a factor of what we call countertransference. Reverie function
refers, as an extension of the maternal reverie described by Bion, to
the capacity of the analyst to be open to all the projections of the
patient, whether they are felt to be good or bad, being aware of the
masochistic aspect that may be present in this receptivity. Each one
of us knows or at least tries to deal with our limits to this receptivity,
with our blind spots, and also what I once called our hallucinated
spots: our own projections, what we need to find in our patients. Our
profession has been described as solitary, which is true up to a point;
supervision responds to the need to be contained, to be followed in
our oscillations, and to feel our raw material transformed by our
contact with other colleagues. Reverie function has been extended to
include analytic work with patients. The analyst and supervisor per-
form alpha-function and what Meltzer has called counter-dreaming.
The aesthetic dimension of the mind, proposed by Bion and devel-
oped by Meltzer, is expressed in the attitudes, the styles, the lan-
guage, and also the music of the interpretation, which makes of the
session something so ineffable.
The supervisory situation deals with experiences that are inti-
mately provoking emotionally, as does analysis itself, and we need
to have this in mind. As supervisors, however, we do not carry the
weight of the anxieties that are communicated directly to the analyst.
As Meltzer has humorously described it: “You get a second integral or
derivative of the clinical situation” (in Oelsner & Oelsner, 2005, p. 455).
It has been argued that the core function of psychoanalytic supervi-
sion is to help contain the emotional turbulence and the unconscious
anxieties arising and evolving in the two interacting domains of the
analytic and the supervisory sessions. According to Meltzer, in his
re-creating of Bion’s concept, the model of container-contained places
a new value on receptiveness and the holding of the dynamic situa-
tion of transference-countertransference in the mind. The container is
formed by the fitting together of the analyst’s attention and attitudes
to the cooperation of the patient, lending it the degree of flexibility
and resilience required from moment to moment.
We need words as tools for thinking, yet we also need imagery:
the imagery of the senses that is formed before words as well as
afterwards. Symbols are the container of emotional meaning: musi-
cians also think, but not in words. The conjunction of these two areas
in the supervision—symbol formation and imagery—is what I would
like to explore here.1

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 112 clara nemas

Vignette 1
A young colleague brings to the supervision her difficulties with a
patient who has a history of abandoning analytic treatments in the
past. The patient received psychotherapy at the age of 4 years after her
mother’s death, but all she could recall was not liking the therapist.
At the age of 17 years, she was referred to a group for eating disor-
ders, but she stopped going because she found it too invasive and not
containing. More recently, she started another treatment which soon
ended when she felt insulted by the therapist; she did not feel under-
stood, attributing this to the fact that she came from a small provincial
town whereas the therapist came from the big city.
The supervisee is not Argentinian; she has recently come from
another country and has a distinctive Central American accent. When
the patient contacting the analyst by phone and heard her accent, she
expressed doubt whether the analyst, being from another country,
would be able to understand her. The analyst suggested they have an
initial meeting and see how she felt, which the patient accepted.
In the first interview, the patient was very hostile. She would not
allow the analyst to finish her phrases, interrupted her whenever she
tried to say something, and, on the occasions when she did listen to
her, denigrated her comments. Nevertheless—and not surprisingly—
she agreed to start therapy. When the analyst tried to describe the
hostile atmosphere present in the sessions, the patient would reply, “I
don’t know what are you talking about! This does not happen to me!
This is your problem!”
In supervision, the analyst commented: “In my countertransfer-
ence I felt uncomfortable with the way she was treating me; I tried
to get close to her, but each time I felt that my interpretations were
rebuffed and even attacked. I felt doomed to join the list of her failed
therapists, and I realized that this had become like a challenge I had
to overcome, which complicated my analytic attitude and neutral-
ity.” We were aware that, despite her good reputation, the analyst
had struggled to get referrals; unfairly, people may have wondered
whether she might one day have to interrupt treatment and return to
her own country. This had caused her pain, as she was a committed
and responsible analyst. As her supervisor, I felt that this situation
was weighing heavily in the countertransference, creating feelings of
annoyance and exhaustion while, at the same time, the analyst was
becoming preoccupied with keeping the patient in treatment. On the
patient’s side, we knew that her mother had died when she was little,

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 the co-creation of imaginative conjectures 113

and the fear of being dependent and abandoned weighed heavily in

the transference.
During supervision, an image of this patient emerged as a burnt
person, for whom any close contact was threatening, painful, and
feared. We started to play with this idea, and the therapist became
aware of her own sensitivity about feeling foreign and the need to
demonstrate herself to be an established professional: her own burnt
skin. “This image of the burnt skin”, says the analyst, “became a con-
tainer for her reactions, and also mine, when I tried to approach her. I
could receive her rejections without feeling attacked. My voice and the
words I used sounded different, and the rhythm of the session became
less hurried. We became less defensive on both sides.”
We may ask ourselves what changed. Meltzer tells us that the
relationship between analyst and patient is contained not just in the
words, but in the music as well. For some reason, even if the image of
burnt skin was not part of the patient’s material, it served as a short-
hand between supervisor and supervisee and worked as a leitmotiv in
the sessions, a recurring musical phrase associated with this particular
patient even if modified on subsequent appearances.

Vignette 2
Ana, an 11 year-old patient, has been in analysis for five years now.
The treatment started at the time the parents were in the middle of a
turbulent divorce. The school suggested the consultation. The patient
was a first-class student who also excelled in sport and art, but her
communication was impeded by her persistent thumb-sucking, which
had already provoked a degree of malformation in her palate and
teeth. From the beginning, her face showed no emotion and she wore
a fixed smile. In her sessions, she built elaborate constructions and
small-scale models that she kept tidily in her box, together with the
strips of paper she had used to make them.
Years passed before Ana showed any emotion in the sessions; she
could cry and express feelings of anger and frustration, but her thumb
remained in her mouth, despite continued efforts to understand this
fixed symptom. In the supervision, I proposed talking to the thumb-
in-the-mouth as if it were another character in the session. How did
the thumb feel inside the mouth, and how did it think it might feel if
it went outside the mouth? Was it scared to leave its sanctuary? Was
it curious about what went on outside? Would it be able to get back
inside if it felt too scared outside? All of a sudden all these questions

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 114 clara nemas

started coming up, until we could both empathize with the fear of the
thumb getting out of its refuge as a personification of the unborn baby
part of the personality, which did not dare to come out into the world.
The analyst started playing this game in the sessions, and it took
some time for the girl to engage in it. The therapist would personify
the finger, talking in the first person, and Ana would speak for the
other characters in the mouth: the teeth, tongue, and lips. Sometimes
they changed roles. They started making up stories in the session
about the thumb who had been adopted by this mouth family. Mostly,
the thumb felt safe but sometimes it felt threatened by foreign things
coming in, such as the moving tongue or the biting teeth.
The thumb-in-the-mouth became a subject of shared interest
between analyst and patient. It was also an invariant picture of a part
of the personality in the way that sometimes happens with dreams,
as Melanie Klein points out in her wonderful text “Personification in
the Play of Children” (1929), becoming a shorthand not only between
analyst and patient but also throughout the supervision.

Vignette 3
Mark, who had been in analysis for six years, was a very disturbed
young man who demanded a strong psychoanalytic conviction from
the analyst. The latter has been well contained by her supervisor in
all the years of this treatment, finding the courage to treat Mark with
firmness and commitment. She had one supervision with me when
she visited Buenos Aires, after presenting the same patient to me at a
clinical seminar some months earlier in New York. I shall focus on one
particular aspect of this encounter. This is what she brought:

In the Spring of 2014 Mark had begun to weigh up whether to

continue his undergraduate degree at a college far outside New
York or to remain in the city and continue to study from home.
One of the attractions of staying in the City was the thought that
he could continue his three-times-weekly analysis with me. Know-
ing I would be relocating to London in the summer of 2015, I felt
obliged to disclose the fact that treatment would have to terminate.
This impending breach brought about a multitude of shifts in the
treatment, most notably impacting on his previous tenacious hold
on his omnipotent and idealistic defences.
I have worked with him for six years, three-times a week. Some of
his issues have revolved around a “folie à deux” with his mother,

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 the co-creation of imaginative conjectures 115

the result of transgenerational trauma, unknown consciously to

him. His mother had tried, unconsciously, to keep him a non–
gender-differentiated baby because of the trauma of adolescent
sexual abuse to which she herself had been subjected. His character
structure revealed itself to be extremely narcissistic and omnipo-
tent, always trying to maintain a distance from his objects so as to
deny any need for separation. For many months, the nature of the
countertransference was the holding of an excruciatingly unbear-
able deadness. As he began to emerge slowly from the “claustrum”
of his own internal world through the ongoing exploration of the
space between us—the otherness—I began to be removed from my
pedestal and, finally, a negative transference emerged in which he
could safely express his considerable repressed aggression. The
content of his material became increasingly violent, and I felt, at
times, ill at ease. I was trying to work through my feelings of guilt
about abandoning him. As the Christmas break approached, he
asked me if he could take a risk. He said that he had wanted to tell
me something for some time but was scared that I might reject or
ridicule him. This is what he said: “I want you to know that I really
care about you. I care about you enormously; in fact I think I really
love you. Do you know that you will be in my mind forever? I will
never forget you. Do you know that? Every day for the rest of my
life you will be with me in mind. I will remember you forever.”

At this point in the supervision, I was impressed by the patient’s asser-

tion. Even though he was talking about love, his promise to remember
forever brought to my mind, to my surprise, the “remember me” of
Hamlet’s ghost, as though both an articulation of remembrance and a
call for revenge. I felt that the idea of “never forgetting” and “remem-
bering for ever” could be the expression of an unforgiving superego
which also demanded that the analyst remember him in this same
way. This distinction between recalling and remembering prompted
an interesting exchange of ideas that continued, via email, beyond the
hour of supervision.
When people having a conversation do not share the same mother
tongue, extra work is needed to make sure they understand each
other. What do we mean by the words we use? This also applies, of
course, to people who speak the same language, to some degree. The
difference between remembering and recalling did not strike the same
chords in supervisor and supervisee at the time. For the supervisor,
recalling was closer to an evocative memory related to the depressive

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 116 clara nemas

position and the presence of the good lost object as the nucleus of the
self. Remembering had an active quality that, in this patient, seemed
to be closer to a superego demand in response to the fear of losing
the object. The supervisee shared thoughts that our conversation
had evoked in her about the Christian faith (which were new to me),
and she brought in a new perspective from which to understand the
patient and his violent defences.

Vignette 4
This vignette describes a situation in which a disruption in the atmos-
phere of the supervision created a new way to understand clinical
material. The work between supervisor and this intuitive and experi-
enced supervisee was usually characterized by good communication
and receptivity on both sides.
The analyst brought a session of a patient who was having difficul-
ties becoming pregnant. She had consulted doctors at a fertility clinic,
who could find no organic cause, but the patient insisted on the idea of
being ill. The analyst was caught between a description of the medical
procedures involved in the consultation and the problems the patient
had relating to the doctors. The analyst felt that it had been difficult
to keep the analytic focus in the session, but she did not realize the
enactment that was taking place. Each time I tried to draw her atten-
tion to this fact, I felt that she, uncharacteristically, seemed to defend
herself and her approach to the material. I found myself feeling that I
was facing an aspect of the analyst I had not encountered before, won-
dering if I had neglected to realize that there had been some mutual
idealization going on.
I remained silent until it occurred to me that we were having a
fertility problem in our supervision. I told the analyst that it was as if
there was a condom that was preventing the sperm from penetrating
the ovum in the session with her patient and that, somehow, the same
situation was repeating itself in the supervision. The atmosphere in
the supervision changed, and the analyst became aware of the weight
this situation had in her countertransference.

Conclusion
In “Constructions in Analysis” (1937d), Freud introduces the notion
of constructions, as distinct from interpretation, wherein the analyst
may need, in certain situations, to reconstruct a part of the patient’s

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 the co-creation of imaginative conjectures 117

infantile history. It is important to consider the limits of this particular

intervention of the analyst—and of the supervisor—in order to avoid
proposing something far removed from the patient’s discourse. In
Freud’s words: “we do not pretend that an individual construction
is anything more than a conjecture which awaits examination, con-
firmation or rejection” (Freud, 1937d, p. 265). It would not, I think,
be far-fetched to relate the use of models to Freud’s constructions in
psychoanalysis in so far as the model construed in the session (and
in the supervision) promotes a sense of truth that has the effect of the
encounter with a selected fact. By this I refer to the emotional capac-
ity to link imaginatively what seem to be unrelated elements in one’s
free associations.
In his 1970 paper, “The Problems of Supervision in Psychoanalytic
Education”, León Grinberg mentions something I have come across
quite often and which I consider significant: the supervisee occasion-
ally starts with a trivial remark about the weather, some traffic trouble,
or something that has occurred during the seminar or has happened
to his or her children. In my experience, these incidental comments
are often a kind of free association indirectly connected with the main
theme of the material the supervisee brings. In this way, latent aspects
of the analytic situation which were still at an unconscious level are
brought into the supervision. Grinberg contends that “If the supervi-
sor discusses this situation every time it happens, he will help the
candidate to be more confident and to be bolder in handling more
directly the discovered content” (p. 376).
The use of models helps develop a more flexible container capa-
ble of containing not only the projections of a complex inner life but
also the inner life which is deployed in the relationship between two
people in a consulting room, both in the analytic relationship and in
the supervision. The imaginative conjecture was described by Melt-
zer in his developments on the aesthetic conflict. The imaginative
conjecture owes its provenance to the poignant presence of the object.
This object—the other—both inspires the imaginative conjecture and
becomes the object of the conjecture. This is what Meltzer called
“aesthetic reciprocity” (Meltzer & Harris Williams, 1988, p. 42), and
it forms the basis of every meaningful relationship. To grow in an
experience means to be able to learn from experience in a process of
transformation.
This is far from mutual idealization or mutual fear; we are con-
cerned to generate a space and an atmosphere that will allow for the
working through of the crisis that any development has in the search

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 118 clara nemas

for a mind of one’s own, an identity, and a style of life. Only by tak-
ing into account the anxieties elicited by a three-dimensional creative
growing—as opposed to socializing or fakeness of projective identifi-
cation or pseudo-maturity—we may develop the true capacity to bear
uncertainties and difficult questions.
The challenge we meet in supervision is to generate a space in the
thin line where imagination may develop at the same time that our
work takes anchor in the basic analytic technique and theory.
Bion, in Taming Wild Thoughts (1997), talks about this apparent
paradox:
Unless the analyst allows himself the exercise of his speculative
imagination he will not be able to produce conditions in which a
germ of scientific ideas can flourish. . . . So while I say that it is
extremely important to exercise your imagination, to let it go, to give
it a chance to flourish, at the same time keep it under some sort of
discipline. [pp. 46, 48]
Working in other contexts where psychoanalysis is still developing, we
are more overtly confronted with the problem of colonization: how to
help somebody to develop a mind of his or her own and, at the same
time, understand what is truly analytic beyond more cultural and
historical facts. It is important to be able to understand how much of
our identifications, how much of our more conscious elections, enter
into the process of developing a mind of one’s own. Perhaps it is the
work of a lifetime.

Note
1. I am very grateful to Nancy Moreno Dueñas, Adela Vinocur, and Alison
Bruce for allowing me to use material from their supervision for this presentation.

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 CHAPTER EIGHT

Keeping tension close to the limit:

from latency towards development

Monica Vorchheimer

“The dream that invents me has its eyes wide open

And I close my eyes to look at the world.”
Claude Roy, quoted by Pontalis (2011, p. 16)

A memory

I
t was during Donald Meltzer’s last visit to Buenos Aires that I had
the privilege of being supervised by him on a very complicated
clinical case that I was treating at that time. A young homosexual
woman had been coming for treatment and had developed a very
open and intense transference love: “A very complicated woman;
very sensual, very erotic, and very homosexual. What is going to
happen with her rude demand of and erotic and sensual gratification
towards her analyst? We will see. But she seems armed to the teeth
against parental care from her analyst.” In this way Meltzer opened
his comment and shared with us his usual very interesting ideas; but
there was one in particular that I kept in mind, echoing down time.
He said: “This could be thought of as resistance, but it is not. I guess
that she has opened the door to her pornographic concern and to her
masochism and she wants you to feel guilty for having profited from
the opened door which allowed you to investigate what has been
revealed. . . . Everything is opened here, there is no resistance.” And
119

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 120 monica vorchheimer

later he added, “All the material is now present for Monica to explore
as slowly or as fast as she would wish . . .”.
This was going to be a challenge, a real test of the courage to
analyse—the courage that one can find over and over again through-
out his work. I always considered that the image described in The
Psychoanalytical Process (1967) regarding the analytic attitude as a ten-
sion close to the limit would acquire new shades in the “Routine and
Inspired Interpretations” paper (1973c). I have tended to go back to
the latter more than once, whenever I feel the need to shake off the
drowsiness that sometimes hampers my interest or my creativity, in
order to recover an awakened state that allowed me to return to the
analytic listening “close to the limit”.
Exploring as slowly or as fast as I would wish—is it merely a mat-
ter of wishing? This question becomes especially crucial with certain
patients, such as the so-called protracted latents who get settled in
analysis with a phantasy of an endless process, in a kind of mother–
baby secret love affair “until death do us part”.

Protracted latency in the analytic situation

These patients make us face up to a paradoxical situation: how to
remain a patient while allowing development to progress at its own
tempo and, at the same time, keeping tension close to the limit.
Although we know that the transference situation will unavoidably
be the scenario for the actualization of this latent potential, since
development seems to have been slowed down or even stopped, we
need to avoid colluding in a de-vitalizing process so that the analytic
exploration neither comes to a halt nor lasts forever. We must continue
to search for passion, even when it seems to be absent, and to pursue
the integration of L, H, and K (Bion, 1963, p. 34).
The lack of passion—which, at best, appears dampened, intellec-
tualized, obsessive, or dissociated—is what characterizes latency-age
functioning, regardless of the patient’s age. In these cases, we usually
find that the adolescent crisis has been avoided in order for the child
to remain in the family. Such patients inhabit a kind of doll’s-house
marriage, and social inhibitions are concealed in the continuity of
childhood friendships. The calm and obsessiveness of latency can be
disrupted by external events that provoke some curiosity about sexual
life, quite different from the scant and lack-lustre genital encounters
of their marriages. The incapacity to feel excitement, awaken desire in
the sexual partner, or the fear of exploring the body or masturbating

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 keeping tension close to the limit 121

characterize a diffuse and mainly imitative identity, with orgasmic

anaesthesia.
This was the case with a young woman in her forties whom I had
been seeing for a long time and who brought me face-to-face with this
dilemma. She had married her only boyfriend, and her two daughters
were developing well. A sense of fragility coloured her way of being
in the world, however, as if she were still the small, sick girl she
had been since her brother was born and her psychosomatic symp-
toms appeared. Her memories from puberty were filled with shame
and shyness, mainly related to body changes. Even before these had
appeared, she invented a story for her classmates, claiming that her
breasts had grown but she had preferred to reduce their size because
she did not like to show off.
The lethargy and obsessiveness of latency were shaken after sev-
eral years when she learned that her best friend was having an extra-
marital love affair. She was shocked, mainly out of curiosity about
her friend’s interest in sexual life. This was almost completely absent
between herself and her husband or, when present, was dull and
passionless. What did this woman have that might awake desire in a
man? Why did she not get excited? Why was she so afraid of touching
herself or being touched? She had never masturbated, nor had she felt
the desire to do so. The turbulence of this period soon died down to
some extent, however, in order to avoid conflicts of jealousy, rivalry,
and envy. She embarked on new postgraduate studies and reinforced
her obsessionality.
A kind of intellectualized contact in the sessions, far from passion-
ate experiences, colours the analytic situation of patients who seem
to be comfortably settled on the analyst’s lap. These patients provide
material that can be symbolically rich, evocative for the analyst’s
activity, even passionate in its contents, tempting the analyst strongly
to go “fast”. However, the patients lacks the passion to make use of
what we offer; they may find it interesting, but it does not touch them.
Their abundance of dreams seems complacent, and they receive our
interpretations as if they are spoken by the Oracle. Transference can
be spoken about, but experiencing it is completely another matter. It is
not only about regulating temperature and distance, but, as Liberman
(1976) would say, a complementary style in communication has to be
sought. As for the obsessive, a counter-interpretative style is required,
close to action, where the risk lies in inducing action or introducing
personal values or being prescriptive and losing self-restraint. The
process feels static, suspended in a timeless dimension, and the end

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 122 monica vorchheimer

is nowhere to be seen; stillness and immobility seem to be a hallmark.

As Meltzer suggested, if the role of the analyst is to strike fire into the
mind of his patient, it is something that we would all find ourselves
fundamentally incapable of doing, if it were not due to the transfer-
ence. But what is it that happens when the transference itself unfolds
as a small, pale flame that is not enough to light the fire?
A good pupil/patient relationship, even when there is an interest
in dreams, can stimulate a tendency to routine interpretations and
psychoanalytic clichés. The negative transference is difficult to find.
The analyst wavers between intervening in an unsaturated manner,
in order to avoid becoming “the teacher teaching his pupil”, and
using a more narrative style. Countertransference fluctuates between
a feeling of being sharp or aggressive or explaining too much, dealing
with a sense that it is difficult to keep “tension close to the limit”, as
Meltzer (1967, p. 93) would have put it, and the analyst’s conscious
and unconscious desire to speed up the process can involve counter-
transferential acting-out.
The question of whether or not an impasse is taking place is always
at stake. At this point, it is interesting to remember Etchegoyen’s
remarks about the forces opposed to the analytic process, which he
organizes under three main rubrics (1991, p. 692):

1. acting out: the substitution of action for memory and insight;

2. the negative therapeutic reaction (NTR): the undermining or wip-
ing out of achieved insight;
3. the reversible perspective, as Bion (1962a) and Money-Kyrle (1968)
described the subversion of the analytic rules.

Etchegoyen suggests that all phenomena that fall under these head-
ings might coalesce into a psychoanalytic impasse, which must be
differentiated from the non-coercible resistance of the patient and the
technical mistakes of the analyst. The true impasse is described as
neither of these two but, rather, as a total halt of the analytic process
achieved by the converging forces of acting out, reversible perspective,
and NTR. As we know, destructive emotions are the basis of these
anti-process manoeuvres, which I view as quite distinct from the kind
of features I am trying to convey with the patients I am describing.
It is clinically important to distinguish the stasis of an impasse
from the motionlessness of protracted latency within the analytic
situation. The cause for the latter can be found in a detention in the
threshold of adolescence which is actualized in the transference situa-

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 keeping tension close to the limit 123

tion. ­Further developments in meta-psychological understanding are

needed to answer the question about whether there exists an isomor-
phism between the developmental infant latency and the psychopa-
thology of protracted latency in adult patients.

Dream-life as experimentation
After a long time, however, movement begins to find representation
in dream-life, in spite of what appears to be immobilized in daily life.
Dreams flourish during the night and can be expanded in the sessions
during the exploratory phase, opening the door to the roots of infantile
sexuality. At first, the analyst’s enthusiasm cannot be satisfactorily
transformed into clear interpretations; although conjectures might be
plausible, it is not yet clear to whom they can be communicated. A
sense of artificiality permeates the consulting room, while the thera-
pist can be suspected of nymphomania or promiscuity, insofar as his
or her curiosity is excited by these dreams. Paraphrasing Meltzer, it
could be said that “all the material is there”, but due to projective
identification—with powerful effects on the countertransference—it
is difficult to find a way of approaching the material without falling
into interpretative stereotypes or formulations inducing the patient
to action. There is a strong feeling of sterility despite the richness of
the oneiric production, as the material only confirms what has been
examined on numerous occasions.
With the patient mentioned above, in the transference, I was either
the mother who would teach her how to be a woman and please her
husband or the laboratory medical-father who would fecundate her
without sex. I remember fighting against my own lethargy, trying to
stay awake and alert, and always being grateful when she brought
dreams that could enliven the dull atmosphere in the consulting room.
Once, she dreamt that

she was in a little town in the countryside with her daughter who was
learning how to ride on horseback; they passed by a church; people were
going inside for Mass, and the girl wanted to go inside with the horse
but they passed by. There was a woman standing on the pavement, and
the patient shouted at her daughter that she should be careful.

A memory from her childhood reappeared in this context, when she

fell off a horse during a riding lesson. She was wounded and bled
profusely and still had a scar on her belly. She traced her fear of riding,
airplanes, and speed back to this incident.

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 124 monica vorchheimer

As we can see, from time to time, the problem of learning and expe-
riencing novelty and voluptuousness came up in her dreams, and the
transference scenario moved to the outside—the countryside—where
it is possible to achieve speed in development, although experimenta-
tion and exploration could still be dangerous and castration or a cut
could be discovered. The temptation to go back to religious–ascetic–
church life remained present.
In these patients, the question about how passions are aroused
seems to be a central enigma, mirroring the analyst’s search for a way
to reach the self while modulating temperature, distance, rhythm, and
speed. Fortunately, however, difficulties in analytic communication
can be also recollected in the oneiric scenario: the search for the penis
can be suspicious, introjection might be cheating, and something may
elude the analyst; corruption of the analytic method can be reported
in dream features like feeding the children rotten food, telephones that
don’t work, not being able to bring together the feminine, the mas-
culine, the feeding-creative function, keeping the objects apart, and
maintaining bisexuality split off. If infantile polymorphism cannot be
integrated, neither can bisexuality, and the mystery of how passions
are aroused cannot be accessed either.
In the transference and countertransference situation, this has been
created by the diminished creativity of interpretative activity, as a
result of the dissociation of the combined object in the analyst’s mind.
Instead, the analyst provided corrupted interpretations—out-of-date
food—desexualized and devitalized, in which the fertile and potent
penis (and testicles with good “milk”) was kept at a distance, unable to
communicate with the bitch-sensual-woman. In this way, the desexu-
alization of the parental figures of latency was reproduced, and no
passionate quality could emerge in the transference. But in dreams,
this problem finds expression.
As time passes, and dreams help to clarify the transference–coun-
tertransference field, there are indications that something new is being
mobilized in the oneiric scenario; new experiences (rejected while
awake) come to life while sleeping. Surprisingly, in dream-life, a new
capacity to experience excitement and attraction towards the other sex
becomes more vivid, in contrast to what seems to be a small, pale flame
during waking life or in the transference relationship. “It looks as if,
in dreams, I dare to live what I cannot while awake”, a patient vividly
commented, as if quoting the epigraph: “The dream that invents me
has its eyes wide open. / And I close my eyes to look at the world”
(Pontalis, 2011, p. 16). In the same session, he had realized that he had

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 keeping tension close to the limit 125

come through an operation quite well, although he was nervous; he

realized that it was foolish to reproach himself about his earlier fears.
Instead, he felt that he had been courageous, since he had undergone
surgery in spite of his nerves and had not postponed it as he would
have done in the past. The sessions became more colourful; new
childhood memories were recovered spontaneously and surprisingly.
At the same time, plasticity, language games, musicality, and poetry
can create a flow of associations between patient and analyst as if in
a harmonic dance. Almost by chance, the analyst is informed that
external life has become more intense, new characters appear in the
external scene, language becomes more sophisticated, curiosity about
trying new food or new experiences do not seem to be as rejected or
feared as they were before. Time begins to be registered, first tinted
with claustrophobic anxieties, while the idea of termination shows
its face for the first time as a desire and real possibility. The process
seems, suddenly, to have gained momentum, and the infantile objects
are characterized as courageous and strong.

Discussion
During a conference of the Asociación Psicoanalítica de Buenos Aires
in 1995, Meltzer suggested that emotions are first experienced as body
states and it is only gradually that those states find their way to expres-
sion through symbols that can be dreamed. However, sometimes
things seem to follow an inverse direction. Body states and sensations
appear initially in dreams, allowing the experimentation that had been
avoided in development to unfold, as found in clinical cases such as
the ones described above (Meltzer, 1997).
The oneiric space, the “real and vital” dream experience, is the
space where confusions can be sorted out and knowledge can be
accessed. Although for many years patients, like children, had drawn
upon rather conventional symbols in dreams, it is unclear whether
those symbols could transmit more than “the shade of emotions” or
uncoloured metaphors, as Meltzer suggested on that occasion. How-
ever, after years of repetition with weak and subtle transformations,
something starts to move. It is reminiscent of how children enjoy lis-
tening to the same stories thousands of times over; perhaps patients
provide dream material for the analyst to tell them their stories over
and over again, never quite sure whether the value is in the lyrics
or the music. As children begin to prefer writing their own stories,
there comes a time when patients appropriate their own dreams as a

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 126 monica vorchheimer

way of preparing themselves to move forward; they begin to invent

themselves—inspired by the combined objects/gods—although this
process is more intense when sleeping, allowing new sensations to
take shape in the body and enabling new symbol formation.
Returning to my initial question concerning the difficulty of talking
with passion when passion is absent in the patient, I have pointed out
the effect of the dissociation of the combined object in the patient’s
internal world which drags the countertransference towards routine
interpretations or into a style that might seem harsh or action-induc-
ing. Both a timeless analysis and spurious behavioural changes, out
of identification with the analyst’s desire, are a risk when passion is
weak or absent.
I will now go back to Meltzer through a beautiful paper by Clara
Nemas (2016) referring to courage and reverie as the basis for sincerity
and interpretation. Nemas alerts us to the question of keeping the fight
for our passions awake, as a source of authenticity and sincerity in the
contact with our patients. This becomes particularly crucial when the
patient is systematically devoted to fighting against the intensity of
passionate life, as happens with latency patients of all ages.
In her paper, Nemas suggests that courage is a function of the
maternal quality of the combined object; the opposite, as she says, is
not cowardice but giving up on the child’s upbringing. How much
courage is needed, when raising a child, to trust that the reverie
function is food for development yet to unfold! Together with this
maternal quality, the paternal function must offer the mother support
and reparative penetrability so that she can do her job courageously
without giving up. Talking through the analyst’s interpretation, the
Gods—the combined object, the integrated parental functions—pro-
vide passionate inspiration.
Courage is needed to support patience with hope over time, rely-
ing on development and trusting the analytic method, so that despair
can be contained without having to resort to inauthenticity by promot-
ing a pseudo-development in our analysands. The latter should not
be confused with the reparative penetrability of the father’s function.
Ultimately, we need maternal courage, supported by the father’s
reparative function, in order to keep our eyes open to look at the
worlds of our patients and ourselves, while, at the same time, need-
ing to close our eyes in order to invent our own analytic dreams and
stories and to help them to invent their own.

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 CHAPTER NINE

Donald Meltzer’s supervision

of psychotherapy with a psychotic child

Jeanne Magagna

T
he structure of time is inextricably linked with the concept of
hope. In the beginning of a baby’s life there is hope, hope for
a communion with the mother and father as loving, protective,
caring figures. Alongside this hope is a preconception that the breast
will meet the baby’s requirements to be nourished. As the baby grows
and matures, holding on to this hope is both difficult and dangerous;
hope can be filled with too much greed to possess all of a mother’s and
father’s life. Hope can involve a constitutional incapacity to tolerate
the frustration of waiting for mother’s reappearance, filled with rage
at mother for not being attuned to the baby’s rhythm of communicat-
ing needs. Hope is then submerged beneath rage and disappointment
with mother. Hope, which promised a future of contentment, then
becomes despair. Without hope, there is no sense of the future, just the
disappointing present or the yearning for a moment in the past that
was experienced as good.
In meeting a child for the first time with his or her parents, I am
acutely attuned to the sense of the child’s expectation in meeting me.
In that first look, I see hope, curiosity, and anticipation that, perhaps,
with this new person, some different experience may occur. Alterna-
tively, I see fear or even terror that something dreadful will certainly
happen in my presence. I, too, have a sense of suspenseful anticipation
as I get to know the child. In this first meeting I am the recipient of

127

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 128 jeanne magagna

the child’s unconscious phantasies, developed through internalized

past interactions with mother, father, and siblings and suffused with
the child’s own feelings. I am also myself, with my personality, my
inner world, flaws, and capacities in the present, all of which invites
a particular configuration of the child’s phantasies. What the future
holds is uncertain. As a therapist, I arrive with a hope that, together,
we might repair some of the damage that has occurred internally, pos-
sibly in conjunction with external conflictual events.
A child’s sense of time is apparent in the first session and changes
considerably during the course of therapy. In presenting my work with
a 6-year-old psychotic child in four-times-a-week psychotherapy for
three and a half years, I shall contrast the experience of time in a manic
state of mind to that in depression and in depressive states of mind.
The understanding and repair offered to this child was substantially
influenced by Donald Meltzer, whose weekly supervisory reflections
on her psychological development are brought alive here. Herein are
also contained clinical examples of his work described in his favourite
published work, The Psychoanalytical Process (1967).
Mia, a child with many psychotic features, made me acutely aware
of distortions of time and space from her first session. Aged 6 years,
Mia was brought to the clinic by her parents because her teacher was
worried that she was “living in a world of her own”. Everyone knew
when Mia had arrived in the clinic as she darted through the corridors,
shrieking. She was a lively, robust little girl with brown curly hair and
a hard, muscular body that gave an impression of toughness.
Complaining that there was a large frightening man in the cor-
ner of the interview room, Mia constantly moved from one place to
another. In the first family interview, when no one responded to her
complaints about the man invisible to them, she screamed at the hal-
lucinated figure, “Bugger”, “sod”, “bastard”! These remarks provoked
distaste and alarm in the psychiatric meeting with the family, as did
Mia’s teasing and hitting of her 12-year-old brother Rick, who seemed
to be the focus of both her and her mother’s attention. (Her mother
whispered to him as a close confidant.) Meanwhile, Mia’s father was
assertive and flamboyantly hypomanic, in contrast with his with-
drawn, subservient, and depressed wife.
According to the family, Mia was conceived so that her brother
“would not be left on his own with no one to care for him”. Breast-fed
until the fourth week, when mother’s milk dried up, Mia did not cry
much as a baby. For this reason, her mother said, she rarely felt the
need to pick her up and cuddle her. At 10 months, Mia was walking.

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 supervision of psychotherapy with a psychotic child 129

Her mother encouraged her to draw, as she showed little interest in

toys. Sometimes she waved around a hard, sexy fashion model doll,
but she never played with it.
The psychologist attempted on two occasions to give Mia intelli-
gence and achievement tests, but found it impossible to get anything
but nonsense from her. Certainly her teachers felt that she was not
functioning within the normal range of intelligence: she could not
concentrate and learned little in her year and a half at school. Teachers
said that Mia rarely responded to her own name and would, instead,
demand that the teachers call her by different names. Once, at a school
bazaar, Mia managed to leave the adults and put on some clothes that
were on sale, and her own clothes were inadvertently purchased.
Family life was chaotic, and her father had frequent affairs. There
was a history of violent rows between the older three family mem-
bers, which resulted in doors being broken and the mother needing
to have her face stitched while trying to protect the children from the
father’s frightening shouts. Mia’s parents clearly needed assistance in
handling their marital conflicts as well as parenting. Much of the time,
her mother was too depressed and lonely to be actively concerned
with Mia. At times, Mia’s father was absent from home, preoccupied
with his other sexual partners and work, which he used to relieve the
“deadness” he complained about experiencing at home.
Here is an excerpt from Mia’s first session:

As I approach Mia, I see sores around her mouth and under

her nose. Her face seems unattractive, particularly because of
her dulled expression and her avoidance of eye contact. Mia’s
movements are extremely swift. Catching sight of me, Mia rushes
towards me saying, “soft, good lady”. A complete stranger to her, I
am startled as she immediately strokes my grey, lambswool jumper
and eagerly demands, “Can I go with you now?” Hurriedly she
grabs my hand, repeats “soft, good lady” and leaves her mother
without even a parting glance to say goodbye.

Upon entering the therapy room, I give Mia a box of play materials
and explain that the materials are for her to use during her time
with me. Mia ignores the toys and hastily grabs the sellotape and
all the crayons. Immediately she begins a detailed drawing of the
room and all its contents (Figure 9.1). She draws the chairs, the
tables, the sellotape and then a detailed picture of me. I occupy
the same space as the desk and the chair.

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 130 jeanne magagna

Figure 9.1.  The therapy room.

With mounting excitement, Mia names the objects in the room:

blonde hair, grey eyes, knickers, table. Drawing and naming the
objects suggested Mia’s attempt to understand and control them as
well as her need to make the place with me less frightening. Mia
seriously observes, “You don’t have pink skin.” She then completes
her list: “Knickers, brown knickers filled with smellies and wees.”
Darting her eyes at me, Mia demands, “Pig, make grunting noises.
I’m a lady.”
Swiftly she removes every toy from the box while correctly nam-
ing the sheep, cow, lion, and other animals she is dropping on the
table. While doing so she proclaims, “I’m afraid of the man in the
pink shirt!” Subsequently, at lightning speed, she races out of the
room into a tent in the waiting room. Shocked, it takes me a sec-
ond to reach her. As I go near, Mia shouts at me, “Pig! Frightened
of you!”
Mia hastily grabs my hand and begs me to take her to the loo. We
go to the loo, and as she returns to the therapy room she remarks,
“Man in the pink shirt. He’s after me.” She points at me and repeat-
edly tries to dash out of the room. Now being more alert, I firmly
encourage her to remain inside the room until the end of the ses-
sion. As the session is ending, with a look of pleasure, Mia notices
Turner’s water landscape, Sunrise, hanging on the wall. Then she
exclaims, “It’s filled with smellies!” At this point the session ends,

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 supervision of psychotherapy with a psychotic child 131

and I return Mia to her mother. A few minutes later, the door bursts
open. Mia is there shouting “pig” once again. She subsequently
races to the exit where her mother is standing.

Contemplating Mia’s manic state, I ask myself, “What has happened

to make everything go so fast, creating Mia’s manic state? Why are
her emotions of love, fear, and hate reversible in seconds?” It feels
as though a hurricane has enveloped me in a swirl of confusing feel-
ings. Finding a time to think about my own emotional responses was
essential before beginning another session with Mia.
Henri Rey’s (1994) structure for thinking lends a depth to the
process of examining Mia’s manic relation to time and space. Like
Meltzer in The Psychoanalytic Process (1967), Rey in Universals of Psy-
choanalysis (1994) recognizes the essentially spatial structure of the
mind and its representation of objects. Rey’s developing conscious-
ness of the spatial structure of states of mind can be summed up in
his model of thinking:
What part of the subject
in what state
situated where in space and time,
does what
with what motivation
to what part of the object,
in what state,
situated where in space and time,
with what consequences for
the object and the subject?  [Rey, 1994, p. 7]
I used this model as a base for my review of the session with Mia, a
baby who “didn’t cry”. Her depressed mother’s milk dried up after
four weeks. Mia exists in a sensorimotor stage of thinking. Her mind
has easily permeable pores through which all sensual qualities of
external objects beckon her, like the tune of the Pied Piper. As she
touches my soft, wool jumper, she is dragged into a static sensuous-
ness that obliterates her emotions and thoughts. My hair, eyes, and
jumper seem virtually equivalent to the toys, table, and sellotape
which she also names.
Mia attempts to “hold on to” a person immediately. All those labo-
rious steps of taking time to get to know someone are skipped over as
she grabs my hand and hastily claims me as her “soft, good lady”. She
doesn’t know my inner qualities, but since I am “soft” she assumes
that I must be “good”. Present is an omniscient certainty about who

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 132 jeanne magagna

I am and she exerts a primitive omnipotent control through naming

objects and pinning them down in a drawing. What becomes impos-
sible is waiting for the future with ordinary curiosity and anxiety
regarding what might happen in the session.
The unheld, terrified “baby-Mia”, finding herself in a new space,
grabs the sensuous aspects of the “mother-therapist”. Through sensu-
ous looking and touching, she attempts to hold on for dear life. Being
overwhelmed with the sensuous qualities of the maternal object, she
quickly intrudes beyond the space that the baby shares with its mother
and enters into the primitive oedipal phantasies of the mother in an
exciting intercourse with the father. Only when I attempt to under-
stand Mia’s anxieties about being with a stranger in a new place is
she able to say, “You’re not pink.” However, this quality of “not-
pinkness,” meaning “not too exciting”, is quickly lost in her wish to
possess immediately all that the mother has, including the sensuous,
sexual relationship with the father: she cannot permit mother to have
time with father. Rapidly the hallucinated “pink man” returns to the
room and is located within me. In other words, the “soft, good lady” is
spoiled by the exciting, hated, and terrifying “pink man” and becomes
a “pig”.
There is no separation in time of the “nurturing, feeding mother”
from the phantasies, which quickly become sensual, sexual, and anal
in quality. In her unintegrated state, Mia flits rapidly between dif-
ferent states of mind. This form of splitting exists, but only for a
second: mother is good, father is bad. Then good and bad become
confused, leading to a monstrous “pig” containing Mia’s projections.
Mia’s greed is stimulated by her lack of inner containment; sensuous
erotization is Mia’s defence against the pain of dependence and the
loss of the nurturing, understanding object. The manic race involv-
ing non-stop touching of objects, and flitting through different activ-
ities, is a flight from the primitive persecutory anxieties and terrors
of the hallucinated monster, “the pink man”. Any potential emo-
tional rather than sensuous relationship with me is superficial and
quickly loses value. This is the world of two-dimensional time and
two-dimensional adherence to the surface of objects as described by
Meltzer (1975a), Tustin (1990), and Rhode (1997) in their essays on
autism.
In ordinary human experience, over time, there is a continuity of
emotional experience rather than the roller-coaster of excited and ter-
rifying states of mind in which Mia exists. The continuity of emotional
experience in time is provided through the containing presence of the

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 supervision of psychotherapy with a psychotic child 133

external mother and father. This becomes internalized to form the

child’s internal psychic structure. Manic racing through time is thus
replaced by an ordinary use of time once there is an internal psychic
structure holding Mia’s feelings sufficiently long to be perceived and
given consideration.

Blistering of the skin

By the third week of therapy, Mia experiences separation from me as
being dropped from a state of “at one-ness” into a state of being torn
off, bruised and blistered. My heart cries out as I see her futile attempts
to interrupt the passage of time leading to the end of the session. Ini-
tially, Mia starts wearing lipstick and carrying a small bag containing
her mother’s eye shadow, lipstick, rouge, mascara, perfume, and nail
varnish; she spends time, before leaving the session, making up her
“beautiful face”. At other times, she puts glue on her feet, tries to stick
them to the floor, and continually checks to see if they have stuck.
There is to be no “baby” experiencing the passage of time away from
the “mother-therapist”.
The following excerpts illustrate Mia’s search to get into and
adhere to the protective skin of the “mother-therapist”. In her search,
she also covered herself with plasticine, an activity that represented
a form of “adhesive identification”, described by Meltzer (1975a) and
Bick (1968), which involves “sticking” to an object rather than project-
ing into it. Without an internal space, there is a tendency to relate to
objects in a two-dimensional way as though they, too, have no depth.
In Mia’s play (described below), there is a feeling that one can “stick
to the skin of the mother”:

Third week of therapy

Mia pours water all over the room and throws and scatters her
toys. She then begins rocking back and forth. She seems very sad,
not knowing what to do. Mia then collects plasticine pieces from
among the debris and stands near me, saying, “I’m putting plasti-
cine all over myself.” She labels a piece of the plasticine “the desk
bit” and tries to stick it onto the bottom of her feet. When she is
unsuccessful, she tries using glue to make the “desk bit” adhere
to her feet. Shortly afterwards Mia collects more plasticine and
begins sticking it all over her body, saying, “I’m putting Jeanne all
over me.” Mia is serious, slow-moving, and quiet. I feel that she is

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 134 jeanne magagna

slightly desperate. She repeats this in subsequent sessions, adding

felt tip to cover her navel and arms.

The plasticine cover, the felt-tip colour, and the “make-up mummy
beautiful face” are part of Mia’s attempt to retreat from any experi-
ence of being a kind of stick figure without much inner substance,
flesh, or even human shape. These covers are attempts to “hold
herself together” in the face of some terrible sense of fragmentation
and potential sense of loss of the mother-therapist (Rhode, 1997).
Mia’s unconscious aim is to obliterate time, a sense of waiting and
the psychic terror and pain she feels when she experiences herself
as a separate person.

The experience of rage and hurt is emerging, however. The skin as

a concrete locus of Mia’s separation soreness is particularly evident
at the end of many sessions. Frequently she does not want to leave
the sessions. When I firmly insist that it is time to go, Mia tries to
scratch me, rip my tights, kick me, and pull my hair. In this way I
am to concretely experience the flayed-skin sensation, the blister-
ing skin, the hurt that Mia experiences when I say, after a warning
five minutes previously, “It’s time to go.”

Around the third and fourth week, it is clear that Mia is more vehe-
mently using me as a kind of “dump” into which she evacuates parts
of her blistered self (Tustin, 1990). For example:

Fourth week
At the beginning of one session she immediately rushes to the jug
of water. Pouring water on the couch, she declares, “Pouring water
on your bed.” She then takes off her shoes and socks. Racing to
the desk, she grabs her box and dumps all its contents on the floor
saying, “I’m messing up your room again.” She pours glue all over
and attempts to kick me. When I restrain her, she bites me.
But then she steps on a pieces of fence and cries, complaining, “It
pricked me.” When I describe her feeling that she has messed the
inside of the mummy and now she feels she is being pricked and
made to cry, Mia responds, “Yes, it hurts me.” This is a sobering
moment, for she has put her pain into words.
In the next session, Mia puts the fence pieces in a bucket and places
them under the couch along with other hard toys. She explains, “It

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 supervision of psychotherapy with a psychotic child 135

is so they won’t hurt.” Emerging for the first time is a concept of a

space where the bad bits can be stored. The session is also marked
by Mia’s uncharacteristic crying and verbal communication about
feeling hurt. Now there is a “mother as a dumping place” into
which Mia can expel some unbearable destructive and hurt feel-
ings. [After the painful and bad parts of experience can be stored
in the room, representing my mind, it becomes possible to see the
development of a space to protect “good parts” (Meltzer, 1975a).
A splitting of good and bad parts is beginning to emerge. Such
splitting is necessary so that not only can there be some “good
parts”, but also there is a beginning of possibility of establishing
and preserving a good object.]

Fifth week
During the fifth week, Mia spends some of the sessions curled up
under the blanket on the couch. I feel she is beginning to become
painfully aware as we part of her sense of loss, her feeling of bod-
ily damage. She feels helpless without a sturdy internal psychic
structure enabling her to consider that there will be another session
and another. This internal rhythm of safety could hold her flood of
despair and terror arising through fragmentation of the self in the
time apart. I talk about Mia wanting a “blanket-mummy” to hold
her together and make her feel safe. At the end, Mia cries, pleading
that she does not want to go. Later in the corridor, as she meets
her mother, she becomes very subdued and begins sobbing. Mia
complains that her mother has not brought her scarf. This is the
very first day I have seen Mia crying. As she cries in front of her
mother, I feel that “Now there is a crying baby, a baby crying for
‘a mummy’ to hold her pain and protect her.”

I remember mother saying in the first interview that Mia didn’t cry
much as a baby. Now Mia is having a different experience with her
mother, who is supported by a therapist and me. For a moment, the
obliteration of time through sensuousness ceases. There is an acute
experience of an emotional point that is held still. There is a tie and
some internal space in which Mia feels sadness and fear of being with-
out a protective cover. Emerging in Mia is a new concept of “mother”,
the concept of a mother who can experience and understand her sad-
ness and fear of loss of a protective mother.
Mia’s new concept of mother transforms her basic structure of
time. There is now the possibility of a sense of time followed by a

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 136 jeanne magagna

reunion, a sense of loss with a limit. Timelessness, the sense of infinite

loss, can be gradually replaced by waiting for a reunion with the “lost
good mother” (Meltzer, 1975a; O’Shaughnessy, 2015). A sense of hope
for the future gradually emerges as Mia starts to perceive a future
reunion as being the end to the present painful sense of loss.
At this stage, feelings and thoughts are still fragmentary and domi-
nated by an emphasis on sensory concretization of her experience.
This is apparent in the sixth week of therapy:

Sixth week
Mia arrives for the first time with a watch on. She requests that
I take care of her “ticker” in my drawer. Shortly afterwards she
asks me to keep her large red button earrings safe in my drawer
during the session. I feel that I am to be a kind of “special secure
place” for those saner parts of herself that she wishes to protect
from the chaos created by her confusion and continual messing of
the room. There is just a hint of Mia’s developing internalization
of a “talking mummy with a protective space inside her”. Mia
alternates between messing the entire room and lying completely
under the couch cover using my words as an additional blanket
to wrap round herself.
Mia has little capacity for symbolic thought; she makes concrete her
notion of time passing and a future time—when we will meet again—
by asking me to keep safe her watch and her earrings. She cannot keep
the notion of our time together safely inside her, and, at the beginning
of each session, she recapitulates the internal process that has occurred
during the separation from me. Rage at separation and subsequent
fragmentation of the introjected experience of feeling understood by
me creates internal chaos. Upon entering the room, Mia regularly feels
compelled to throw toys and water all over the room, thrusting her
furious chaos into me. I must say I feel very confused and disoriented
when her mind is in this state, but after I receive this chaos and lend
thought to it, Mia can begin to elaborate on other experiences:

Sixth week continued

The minute that there is a greater sense of my having good contain-
ing and protective functions, Mia becomes worried about the time.
She greets me, worrying, “What time is it? When will it be time to
go?” She curls up under the couch cover and then pops up, rushes

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 supervision of psychotherapy with a psychotic child 137

over to me, and explains that she wants to “push the button on my
head”. I describe how she wants to push the button on my head in
order to take control of my speaking and thinking with her. I say
she wishes she could turn me on and turn me off as she wished.
This is primitive omnipotent control, showing me that she cannot tol-
erate the terror of being dependent on a good figure. When she experi-
ences me as someone who is helpful, she feels compelled to hold on to
me in this way. This increased dependence on the mother-therapist is
heralded by more severe anxieties about feeling helpless outside the
sessions. Mia cries plaintively when she leaves this session.
At this time of intensifying dependence on me, Mia also begins
to experience sleeping difficulties. She says she likes sleeping in my
room and would like to sleep there every night, because my room does
not have cracks in it like her room. The external object (the therapist)
gives her the feeling of a soothing protective space, a space without
cracks. However, with her depressed mother outside the therapy, Mia
feels she is left with a faulty, cracked, internal psychic container that
does not protect her.

Sixth week continued

In the sixth week of therapy, Mia also inserts a big red dot, called
a button, inside a bus she has drawn (Figure 9.2). She indicates
that the woman in the bus could “press the button so the bus
would stop”. She adds that “the button is to make sure that
nobody falls out”. I describe her desire for the mummy as a kind of
“bus-mummy protector” who holds her in mind and does not

Figure 9.2.  The button to stop the bus and the

“bus conductor/daddy-figure”.

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 138 jeanne magagna

let her drop out of my mind. Also present, however, is a very

monstrous looking “bus driver”. She now has a sense of a daddy
infringing on her relation to the mother.

In subsequent sessions, the drawings indicate that the “daddy” threat-

ens to leave her feeling dropped out from the cocoon of the “bus-
mummy covering”. What is meant by the emergence of this figure
who can put a time limit on experience, either good or bad? In a very
primitive way, this limit on time with mother is felt to be the “role of
the father”. The structure of time, with the limiting role of the father,
is depicted through the button to press to get out of the bus and away
from the bus conductor.
Mia now ascribes different meanings to her notion of a “time
limit”. At the end of sessions, she experiences terror of being dropped
into an abyss. She also feels rage towards an already violent external
father who assists in the creation of “the internal monster father” who
enforces cruel limits and drops people out of mind, thoughtlessly. This
contrasts with Mia’s other concept, the button that the mother presses
in a more kindly role of enabling people to get out safely from “inside
the mummy” and making sure that they do not ride inside the “protec-
tive bus-mummy” forever. Of course, in the unconscious, there exist
many varieties of the protective or cruel father imposing time-limits
or limits between the baby and mother.
In psychotherapy, asymmetrical and symmetrical logic challenge
one another; the presence of an internal containing mother who per-
mits thinking to take place allows Mia to feel that I am not a monster-
father who cruelly pushes her out simply because our sessions have
a time limit. When feelings become too intense and violent, however,
the deeper symmetrical logic takes precedence: “There is a time limit.
People who put time limits are monsters. The therapist is a monster.”
Mia drew the pictures shown in Figures 9.3 and 9.4 when she expe-
rienced the monstrous time-limiting figure. Before she drew the witch
figure, she said she hated me because I said, “No”.
The question that follows is what happens to this experience of
the cruelty of time limits, once a sense of dependence on a protective
mother figure has emerged?
How does a substantial transformation of Mia’s personality struc-
ture take place so that the “hallucinated monster man” or the “fright-
ening witch-mother” of her drawings do not reappear each time her
wish to live non-stop “inside the protective mother cover” is thwarted?
As Mia develops, her singing becomes a bridge between concrete

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 supervision of psychotherapy with a psychotic child 139

Figure 9.3.  Mother-therapist hated for saying “No”.

sensation-dominated experiences and symbolic thought. At times her

singing blots me out, but at other times it indicates her acknowledge-
ment of absence and an attempt to make an internal mother come
more vividly alive inside her. Her made-up song about a needy beggar

Figure 9.4.  The witch-breast mother.

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 140 jeanne magagna

suggests a complexity of thought and feeling that “love makes her a

beggar”. After singing this song, she asks about the number of minutes
remaining and measures the time by singing the scale, “do, re, mi”.
Time has become quantifiable through music. Mia is also begin-
ning to quantify time with an awareness of rhythm and pace: going
fast, going slow, and having musical notes linked with the sounds of
my voice. Accompanying this quantification of time is the sense of
intervals, like the breaks in therapy. This is illustrated in a series of
drawings made over two weeks preceding the Christmas holidays.
The Christmas holiday calendar that I make is linked by her to the
musical scale (Figure 9.5).
Another drawing (Figure 9.6) suggests Mia’s awareness of the
“father-conductor” who directs the flow of the mother’s milk-voice
understanding and the tempo of the session. Still present at times
in the face of the termination of therapy is Mia’s wish to replace the
father as the conductor of the music of the mother’s voice: the different
rhythmic movements of the lines on a series of drawings seem to rep-
resent Mia’s recreation of the rhythm and flow of her therapy music,
the intervals and days of the sessions, and her wish for an endless flow
of sessions (Figure 9.7). Present, though, is an acknowledgement of
the father’s role as the creator, along with the mother, of the mother’s
internal music (Figure 9.8).
In reviewing the sessions, I begin to ask myself, “When does Mia’s

Figure 9.5.  Beginning of musical scale with father-head.

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 supervision of psychotherapy with a psychotic child 141

Figure 9.6.  The father-conductor of music.

copying of concrete sensory details move towards creative symbolic

representation?” My tentative thought is that when there is the threat
of “time apart” and Mia’s destructive self is in a rage against the “con-
ductor-father” who puts an end to the therapy music, several different
possibilities emerge. The first possibility is that, in a r­egressive step,
the “conductor-father” becomes hallucinated as the “terrible man”
in the room, in an attempt to prevent his introjection and s­poiling

Figure 9.7.  The wish for “endless flow of music“.

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 142 jeanne magagna

Figure 9.8.  Father creating the mother’s internal music.

the good but idealized mother in a good internal space. The second
possibility is that Mia slips into being projectively identified with a
mother looking after a baby whom she is wheeling in a pram rather
than a mother preoccupied with her appearance, as at the beginning
of therapy. The third possibility is that, following a destructive attack
on the disappearing “mother-therapist”, there is an upsurge of loving,
reparative wishes mitigating Mia’s hate. When this predominance of
Mia’s love for a good internalized mother-therapist mitigates her jeal-
ous attack, she produces these more symbolic drawings. The flow of
the lines suggests that her thoughts and feelings are becoming inte-
grated in a more spontaneous and creative manner (Jackson, 2015).
Thus it is possible to envisage separation from a loved mother-
therapist as a crucial moment for Mia to regress or to develop.

Transformations in time
Assessment of a child’s therapeutic progress involves examining the
changing nature of the time-limiting role of the father, which permits
the mother-therapist to have a creative space to join the father and
other babies. The role of the father also ensures a regular rhythm of
therapy sessions, at a particular time, for a particular period. Near the
end of treatment, there may be a resurgence of love and a capacity to
appreciate the notion of time; the child may begin to feel supported
by the father’s protective role in setting and maintaining limits. There
is also, often, a resurgence of hate and the potent, perilous feelings
aroused by the time limit proposed by the end of therapy.

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 supervision of psychotherapy with a psychotic child 143

For this reason, I shall now describe the end of our psychotherapy
to show the fluctuations in Mia’s concept of time.

Knowing therapy is ending in a few months’ time, Mia arrives

pushing a pram with a baby doll inside. (The previous week she
had brought a live kitten from home into the session.) Mia says to
me, “You are an old-fashioned cushion”, and, when questioned
about what she means, she says, “It is smelly and wrinkled.” I
reply, “You seem to feel a nice, fresh young mummy looking after
a new baby. I seem to be the old mummy, a kind of old grand-
mother.” Later I wonder, “Perhaps you are having difficulty letting
me remain a good lively mummy-therapist for fear that there will
be another child following your time in therapy with me.”
About halfway through the session, Mia looks at me with amaze-
ment, smiles with a lovely expression on her face, and says, “You
have the lovely green silk blouse on. I’d like to touch the collar and
sit on your lap.” She remains seated across from me, simply gazing
at me with a contemplative, serene expression on her face. After
a moment or two I respond, “You feel grateful for the experience
of being with me, being understood by me. You feel the beauty of
the good mummy.” She continues looking at me.

At this moment, Mia seems to have stopped attacking the goodness

of the mummy-therapist. When she arrived, she was projectively
identified with the internalized mother-therapist looking after the
baby, and then, after my attempts to understand her, she became filled
with awe at the presence of the object and love for the object and its
resilience (Meltzer & Harris Williams, 1988). Mia’s experience shows
a transformation from sensuous appreciation of the object—prompt-
ing adherence to silkiness and intrusion into the “mother’s skin”—to
experiencing the love and passion necessary for any creative endeav-
our to emerge.
Mia’s transition is heralded by her creative expression, taking her
beyond the immediately perceived present moment with me. She yells
at me, complaining, “You don’t really love me, you just love yourself!”
Then she enquires, “Why are you looking so worried? Your face is all
screwed up!” After anxiously looking at me, she says, “Your eyelashes
are like spiders, your teeth are like pointed spears, your eyes are like
footballs, your neck is like a tree trunk.” She proceeds to draw an
image of me (Figure 9.9). After she finishes this drawing, Mia con-
tradicts herself, saying, “No, you are not really like that.” Then she

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 144 jeanne magagna

Figure 9.9.  The therapist, containing spider eyelashes

and pointed spear teeth.

does another drawing, transforming “tree trunk neck” into a tree with
flowing branches (Figure 9.10).
In a subsequent session, Mia says, “You have a child already lined
up to be with you when I leave . . . and you will see this child forever
and take her go home with you.” A series of sessions then occur in
which Mia tries to break the window, and she hits me. Regression has
occurred in the face of the ending.
Mia seems to allow me to have my therapeutic capacities when
apart from her, but she wants to imprison me in my consulting room

Figure 9.10.  The therapist’s neck transformed into a tree trunk.

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 supervision of psychotherapy with a psychotic child 145

so that I will have no future except as a therapist. Here is an excerpt

from a session three months prior to ending therapy:

Mia asks me, “Do you remember yesterday when I put you in a
prison with me?” I acknowledge her wish to stay with me. She then
wants to imprison me in the corner of the room furthest from the
door, saying, “I am going to lock you in. I can get out.” I say, “You
can put into words now what you feel.” She adds, “I am going
to leave you all the mess and you can clean up and I am going
to have a fantastic feast and you are not invited!” Mia covers me
with the couch blanket, declaring, “Your eyes are to see beautiful
things with and you can use your mouth to talk, but the rest of
your body is old, mouldy, and rotting and your head is covered
with old grey hairs.”
I respond, describing how Mia sees the future: “Yesterday you
talked about the mother with lovely white mummy breasts who
took care of babies in a good, loving way. Today you are impris-
oning me so that I can have no future with the daddy, no babies,
no other patients. I am to be your therapist and only a therapist.
It seems this is the only way you can hold the mummy-therapist
forever good inside you.”
Mia subsequently recounts two dreams: “First, I had a dream of
your being a prisoner locked up with only bread and water. Only your
head was showing in the dream. Then I had a dream of your dying
and ending up with the devils who burn you up. Afterwards you are
only ashes.”
I describe how it is very hard to keep me good inside her, saying,
“The baby’s rage is spoiling me leaving nothing good inside.” I
suggest, “We can keep each other in mind forever, you know.”

Intimations of the future when ending therapy

During the last three months of therapy, Mia’s thinking is dominated
by the sense of our ending and our future lives. For a moment, she
contemplates the notion of being a girl who can develop:

Mia says, “I am growing up. I am going to wear dresses from now

on.” After exploring this statement a little I suggest, “Now there is
a feeling that you can grow up to be a woman like me. You can let
go of being the daddy with me.” Mia looks calm and very pleased

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 146 jeanne magagna

as she says, “Do you remember when I was seven? Do you remem-
ber when I was eight?” She implies by her calmness that she has
outgrown all her wild messing of me and the room. “Yes, now you
can think about and talk about your feelings. It feels very different
inside. It feels safer now when you hold onto the good-mummy-
therapist who thinks with you.”

The emphasis on growing up and being able to separate from the

mother-therapist immediately brings into play notions of the “new
baby”, the magician oedipal father who takes the little girl from her
mother and leaves a little girl left out in the cold, running for safety to
her mother. As Mia draws this picture, she says, “You are not allowed
to say ‘why’, ‘mummy’, ‘daddy’, ‘baby’ or ‘think’.” In other words, it is
difficult to contemplate these issues of separateness from the mother,
allowing the mother-therapist the possibility of more patient-babies
in the future. Yet Mia’s future feminine identity is based upon her
identification with the mother and her procreative capacities. A brief
glimpse of this is in the drawing made just before the end of therapy.
In this image (Figure 9.11), the “mummy” is allowed to be pregnant
and to have a baby.
As the ending looms, Mia struggles to consider the future, in much
the same way as the baby does when mother puts it to bed for the
night: how can the baby-Mia allow the mother-therapist her freedom
to have a life with the father and with other children? At this point,

Figure 9.11.  Pregnant mother figure.

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 supervision of psychotherapy with a psychotic child 147

she imprisons the mother and burns her mother with her rage; then
there is no sense of the future, only the death of the object. Hate and
possessiveness are feelings easier to experience than the vulnerability
and pain of losing the therapist.
In retrospect, I would say that a much longer time in therapy is
needed for such a very ill child in such an uncontaining family setting
to consolidate any internal developments made in the course of ther-
apy. The question of how the patient will live in the future is always
uncertain, although I do know that, by the end of her psychotherapy,
Mia had gained an appreciation of her responsibility for trying to
protect her good internal parents from her possessiveness and rage.
Mia wrote a note suggesting that I had given three and a half years
of my life to help her to grow up. She also acknowledged that in some
ways she had grown to be nice and in some ways she was still nasty.
The future is determined by how Mia will be nurtured and understood
and how she will allow me to have my freedom away from her. Most
important is the question of how she can forgive me for what we were
not able to do together to foster her psychological development.
Hope for the future is really based upon recognizing and protecting
the goodness of the internal mother. This comes through having suf-
ficient love to forgive the internal mother and father and allow them
the possibility of being a procreative couple.
Time for the ending of therapy should arise in the therapist’s mind
when he or she senses that the possibility of preserving the good
internal parents has arisen within the child’s mind. As in the ending
of Mia’s therapy, however, when such total internal destruction of
the good object occurs and there is no possibility of going through
the mourning process, the therapist needs to reconsider the notion of
“time for the ending of therapy”. Whatever external crises arise, hope
for the future can exist only through the taming of destructive feelings
so that the internal parents can be restored to goodness and remain
understanding and protective throughout life.

Final hypothesis
Until there is a perception of a good object, separate from the external
good object, life is emotionally hazardous with unpredictable out-of-
control feelings. The introjection of the good object, and the maintain-
ing of its goodness while allowing the primary object to be absent,
produces three profoundly important transformations in the child’s
experience of time (Colarusso, 1979).

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 148 jeanne magagna

First, the child’s sense of time becomes more self-contained and

internalized, becoming less dependent upon the presence or absence
of the mother. Although the child’s sense of time appears more autono-
mous, it is still largely related to the goodness or badness of the inter-
nalized mother. If, for example, the child’s rage against the absent
object is too intense, the absent good object becomes a damaged and
dying internal object. The damaged internal object may then take the
form of concerns about the reality of the external object. For example,
there may be accompanying fears that the mother has died in a crash
or drowned when she is away from the child. In this situation, the
child experiences the waiting period as infinitely long until mother
returns intact.
When the inner object is destroyed, there can be no personal devel-
opment, only depression. In depression, the inner feeling of time stops
and there is no sense of the future. This sense of no future is often
linked with the child’s sadistic desire to perpetuate the suffering of
others. Of course, the child’s sadism may, in part, be connected with
a destructive and extremely disappointing external environment, but
the sense of time is always connected with one’s inner emotional life.
If the child does not attack the external mother for being absent
and allows her the possibility of being with the father, other children,
and her work, the child is able to hold onto a good internal object.
Time away from mother does not seem so long, for the “good mother
inside” can be depended upon in the mother’s absence.
Second, with the endurance of the good internal object, past, pre-
sent, and future begin to have some continuity as a psychic experience.
The presence of the good internal object allows the child to use the
experience of the past to think about the present situation and contem-
plate the future. In this way, past, present, and future are all of interest
and present in the child’s conversation and thinking.
Third, the child’s identification with the internalized good object
allows it an independent existence in the common time–space contin-
uum. In this way, the frustrations associated with time can be endured
and mastered. Also, it is the presence of the internalized good object
that maintains the child’s hope for the future.
The sense of time is reflected in the language of a young child
(Ames, 1946). “Soon”, suggesting a sense of future by connoting wait-
ing or delay, is usually first spoken by a child at around 18 months of
age. “Soon” is used knowingly when the child is around 24 months.
“Tomorrow” is not verbalized spontaneously until the child is around
30 months, and then it is expressed only after “today” has been

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 supervision of psychotherapy with a psychotic child 149

Figure 9.12.  Images of persecution.

expressed. “Yesterday” appears when a child is around 36 months.

“Now” and “when” also appear when a child is between 18 and 36
months.
In her therapy, Mia seems to follow a similar sequence of relating
to time, but first she goes through a severe depression in which she
feels that the torture to which she is exposed will last an eternity. Her
sense of destruction and consequent despair is implied by the initial
non-stop messing of my room, her persecutory experiences (Figure
9. 12), and her images of death (Figure 9.13).
If hope is directed solely towards an external event changing,
rather than the development of the capacities of the good internal

Figure 9.13.  Images of death.

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 150 jeanne magagna

object, the adult is left in danger of facing devastating despair. A young

child, however, is emotionally dependent upon external figures to
develop internally and, hence, is at greater risk of hatred and despair
when these are not sufficiently containing, protective, and loving. As
a therapist, I try to alleviate the child’s despair and provide hope for
his or her future by providing parental work as an essential accom-
paniment to individual psychotherapy. Hope for the child’s future is
based upon the security provided by the capacities of the good internal
object to look after the self. When good internal objects are present,
appreciation of the present moment, as well as hope for the future,
are noticeable.

Meltzer’s supervision accompanying this therapy

Mia was one of my first three psychotherapy patients when I was
training as a psychotherapist. Naturally, I was filled with ignorance,
lacking both clinical experience and conceptual knowledge. Meltzer
focused neither on Mia’s history nor on my inexact interpretations.
Rather, he aimed to illustrate, as precisely as possible, Mia’s intense
transference in the current moment-to-moment interaction between
us. He delineated the nature of her internal mother, father, and sib-
lings. We also looked at what supported, inhibited, and obstructed
her capacity to think about her emotional experiences. We also took
careful note of her response to my interpretations, considering how
she evaded, evacuated, or contained some of the emotional sense of
what I was saying and how I was being with her.
My supervisory experience with Meltzer was not very different
from an analytic encounter and is well captured in Clara Nemas’s
description of psychoanalysis:
. . . shared responsibility for the analytic task transforms the relation-
ship . . . into a work group of two, operating in a non-authoritarian
atmosphere in which each does his or her job according to his or her
capabilities. The function of understanding, divested of the expec-
tation of knowing, allows for greater freedom to speculate and to
make imaginative conjectures. [2000, p. 41]
Meltzer created an atmosphere of exploring, getting to know, and
counter-dreaming. The supervision, like analysis, involved the forma-
tion of a symbolizing couple with the willingness to discover together
the nature of the linking between Mia and myself (Eaton, personal
communication, 2015). I sometimes described in detail my intensely
disturbed feelings in the countertransference. Meltzer responded that

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 supervision of psychotherapy with a psychotic child 151

unless I deeply felt Mia’s emotional turbulence, it would be difficult

for her to develop emotionally. I needed to receive the projections of
her very confused and confusing inner-object relationships and lend
meaning to them for her to introject an emotionally receptive and
thoughtful therapist.
More precisely, as Mia’s drawings illustrate, the state of her inner
objects determined how she saw me, how she approached me, and
how she felt about me. I moved from being “a sensuous object” with
whom she merged, to an object into whom she could project “bad
stuff”, and, finally, into an object who created a sense of safety for both
her loving and her hating feelings. She moved from hallucinating to
dreaming and drawing, from “being in my shoes” to identifying with
a “mother with a baby who needed care”.
Meltzer was particularly interested in the way in which free-flow-
ing creativity occurred in the spontaneous rhythmic lines and musical
sequences (Figure 9.14).
In looking at the aesthetic experience of being deeply understood
in the analysis, he often alluded to art and sometimes to music. Melt-
zer at times quoted Keats’s poem “La Belle Dame sans Merci” (1884)
to describe the “analytic baby’s” suffering the pain of love and hate in
the separations and disappointments of the psychoanalytic encounter.
My supervisory encounter with Meltzer provided psychoanalytic
understanding of Mia in a non-judgemental, non-persecutory manner.
This suffused my style of talking with Mia in an emotional reflective
manner that was felt as a greeting of her internal state and physical

Figure 9.14.  Free flowing rhythm of feelings.

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 152 jeanne magagna

gestures through a very wide range of varying tones of voice, words,

and attitudes. I was not told what to say, nor was I expected to think
what Meltzer thought. What predominated was an experience of being
on a shared journey towards getting to know the truth of Mia’s inner
experiences at that moment in her relation to me representing her
internal objects. I have internalized Meltzer as a mentor, enabling me
to sustain feelings without searching for a thought, but, rather, wait-
ing for a thought to emerge. For this I am eternally grateful to him.

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 CHAPTER TEN

The second life of dreaming

Jeffrey L. Eaton

“[W]hat of the fruitful harvest of those dreams which succeed

in grasping the nettle of mental pain, resolving a conflict,
relinquishing an untenable position? We will surely wish our
hypothesis about dream-life to shed some light on this question of
growth.”
Donald Meltzer, Dream-Life (1983)

F
or Donald Meltzer, dreaming is at the centre of the psycho-
analytic experience. He links the exploration of dreams with the
efficacy of the psychoanalytic process. Exploring dream-life helps
to glimpse the way dreaming contributes to what Meltzer calls “the
question of growth”. Here, I offer some personal reflections, inspired
by Meltzer, on the fruitful harvest of dreams and dreaming.

The second life of dreaming

What is the fate of the dream, the thing-in-itself, upon waking? The
situation is simple: the dream has vanished. In fact, we never remember
our dreams. Upon waking, we can collect only bits of evidence that
the dream was recently alive and wandering inside us. The fragments
and details, the emotions, and the unpredictable residue that lingers
from the inventiveness of our dream-life are like the skeletal traces of

153

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 154 jeffrey l. eaton

a fabulous lost beast. The dream itself can never be recovered, relived,
or represented in any complete way.
Dreaming creates what can be poetically called “a country of the
mind”, a place where we can go, usually while asleep, to yield full
attention to psychic reality. In this new country, we can live a second
life while dreaming. This second life may become a laboratory where
unconscious experiments in living and feeling are carried out each
night. While dreaming, problems are pictured, solutions are sought,
alternatives are realized, and emotions and memories are tested in
ways that may not be available during waking life.
Dreaming may be seen as a form of unconscious play; watching
children play is, perhaps, as close as we can come to observing a
dream being made. The child playing makes a scene populated with
characters, actions, backgrounds, intentions, conflicts, and rapid trans-
formations of anxieties, ideas, fantasies, and emotions. Something
similar takes place in dreaming. The concreteness of the experience of
entering a dream scene lends the experience emotional power, while
the transience of dreaming makes possible the realization of myriad
circumstances.
Even violent impulses can be safely expressed in play and dream-
ing because there is a mysterious process of symbolization develop-
ing—an atmosphere that children call “just pretend” and that adults
call “just a dream”.
Dreaming, then, like playing, opens up a space of psychic freedom.
Somehow, something troubling, or something new, or even something
reaching towards us from the future makes its way into the dream
scene and, from there, sometimes proceeds on into waking conscious-
ness.
Through dreaming and the production of dream thoughts and
events, there is contact with a continuous unfolding unconscious con-
versation between the self and its own experiences. As one continues
to dream, night after night and year after year, autonomous symbols
naturally emerge, and the result is what the poet Shelley (1891) calls
an “expression of the imagination”.
Meltzer emphasizes that we import meaning from one world (the
dream laboratory) into another (the world of our waking lives): dream-
ing leaves the gate to the psyche open every night, and the emotions
generated by dreaming wander back through and linger into the day,
shaping our perceptions.
The many experiences accumulated in the second life of dreaming
influence our choices in waking life. Successful dreaming means that

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 the second life of dreaming 155

less pain must be hidden in the body, projected into the group, or
split off, denied, and located in other objects or dimensions. Through
the intimate exploration of the patient’s dreams, shared in the ana-
lytic encounter, waking and dreaming processes begin to cooperate.
Contact with dream-life, paradoxically, helps one to develop a greater
tolerance and deeper respect for the facts of external reality.

Grasping the nettle

According to Meltzer, there is always one important question at the
beginning of every treatment: Who shall have the pain? In the analytic
setting we can observe that some people turn towards the analyst,
hoping to find someone capable of tolerating the expression of painful
emotions. Other people turn away, overtly rejecting the possibility of
glimpsing, feeling, facing, and sharing their emotional pain.
There are, of course, many obstacles to sharing emotional pain.
Some patients report that they cannot dream, or that they cannot recall
their dreams. Some claim that their dreams mean nothing. Still others
hate their dreams—or are terrified to go to sleep, hoping at all costs to
avoid having a dream. Some patients seem convinced that, at a deep
level, revealing the truth of their suffering can only lead to punish-
ment. And, finally, in some situations, people expect awareness of the
pain, so vividly made present by certain kinds of dreams, to excite and
stimulate cruelty in the minds and actions of others.
The self absorbs the impacts of dreams, for better or worse. Dreams
devolve into nightmares and into night terrors. These shocks and
insults accumulate over dozens of nights, with no sense of relief or
rescue. What happens if, for some, dreaming is more difficult to bear
than waking life? People can be haunted by their dreams. Dreams
can be traumatic objects; you can feel injured not just in your dreams
but by your dreams. No wonder some people hate the experience of
dreaming and, even, of having a mind that dreams.
Yet painful dreams can also be important beginnings. When a per-
son is unable to ask or formulate the question “Who shall have the
pain?”, his or her dream may be capable of giving form to the question
instead. Dreams bring psychic reality directly into the foreground and
allow this question to emerge and to seek an adequate reply.
Now I want to share an example of such a dream. I am neither
presenting a case study nor offering an analysis of the patient’s dream.
I present the dream simply as a specimen of the emergence of the
intensity of mental pain in the early months of an analysis.

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 156 jeffrey l. eaton

I am in a crowded street somewhere and there is an evil force coming

towards me. I can’t see it or hear it but I know it is there, and getting
closer. Horrible things are happening all around me. Women and kids are
dying in horrible ways. I have a mirror or something and somehow I’m
supposed to use it to fend off this “thing”. It is getting closer and closer
and I know something terrible is going to happen.

The figures and events, the objects and emotions that emerge in dreams
like this one are painful to register and intimidating to behold. The
intensity of the dream strains both the analyst and the patient. Yet at
the same time such dreams are really gifts if one can find the psychic
space necessary to welcome their intensity; if it can become possible to
turn towards the dream, it can become a shared object that takes on its
own life between the patient and the analyst. The shared dream (and
the pain) can then be explored against a new background of gradually
expanding spacious awareness generated by a dreaming couple.
To me, this is the heart of the therapeutic action of psychoanalysis:
the discovery of a symbolizing couple and its growth in the inter-
action between analyst and analysand through a process that can
become repeatedly internalized and elaborated within the patient’s
own dream-life.

The background of dreams

I value dream-life. I encourage my patients to pay attention to their
dreams, to report on them, and to explore them with me in our sessions.
Over many years I have heard many hundreds of dreams narrated
by my patients, and often, in an analysis lasting several years, I have
the privilege to hear dozens if not hundreds of dreams from a single
dreamer. From this richness of this raw material I have abstracted
three domains that can, I think, offer meaningful shape to the analyst’s
listening strategy when approaching the significance of any patient’s
dream-life.
I have come to believe that we must pay more attention to the
background of people’s lives and experiences. The context and setting
of every experience is important, including—perhaps especially—the
background of dreams. The background of the dream offers a differ-
ent kind of information than the objects of the dream or the actions
of the characters in the foreground do. Deliberately slowing down
and focusing on the background of the dream can highlight other
dimensions of psychic reality for both the patient and the analyst. The

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 the second life of dreaming 157

background may be an indicator of profound psychic stress, conflict,

or the emergence of new psychic functions and has, as I suggested,
three general domains or patterns within the larger, more elusive and
mysterious process of unconscious symbol-formation. This can be
observed through the development of a deepening analytic process.
I want to contextualize this conjecture in relation to Meltzer’s
description of life in the claustrum. It is possible that the background
of dreams may show evidence of life in the claustrum and the corre-
sponding attitudes associated with the compartments of the internal
mother. The domains that I am proposing, however, refer more gen-
erally to all dreams, not just to dreams in which the subject is living
inside an internal object through intrusive identification.
Three more dreams from the same patient will, I hope, illustrate
this, although I recognize that these ideas require further elaboration.
Nonetheless, I want to open these new avenues for thought, even if
they are, thus far, only partially travelled.

Survival
I was driving a truck, a real beater, and even though I was not going over
the speed limit, everything felt really shaky. Then, all of the sudden, the
road collapsed and I and all the others cars plunged into a gigantic hole.
I just kept falling, there was no bottom. I woke up and I couldn’t go back
to sleep.

Survival is an existential life problem of the organism or individual.

The dreams in this domain convey profound psychic distress. They
have to do, I think, with the unconscious memory of the problem of
the viability of the organism in relationship to the environment.
These are areas described by Winnicott (1974) as “primitive ago-
nies” and by Bion (1962b) as “nameless dreads”. I am also impressed
by Tustin’s (1984) descriptions of the earliest impacts of the premature
awareness of separation. I describe all these kinds of agonies as linked
by an experience of primal exposure. This is a state of unthinkable
vulnerability characterized by the awareness, however rudimentary
or intuitive, of the absence of protection from annihilation. In other
words, the preconception of not existing has been stimulated much
too early for the individual to be able to use it as an inauguration into
thinking through and elaborating this particular reality.
One solution to the presence of such primal exposure may be
intrusion, through projective identification into an internal object, as

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 158 jeffrey l. eaton

Meltzer has compellingly described. But that is only one possible fate.
I believe dreams in this domain convey the beginnings of a process
that attempts to make thinkable the unthinkable through picturing
experiences of catastrophic background events.
As an individual’s dream-life evolves in the analytic process,
we may discern plausible patterns that suggest how the person has
unconsciously coped with his or her own personal primal catastrophe.
Dreams such as this one suggest that the patient feels he or she is miss-
ing what I call “a reliable floor” for experience. Without such a floor,
the very possibility of survival is called into question.
I believe that identifying this dimension of the dream background
can be crucial in giving the patient not only a feeling of being under-
stood, but also belief that it is possible and worthwhile for the analytic
couple to face such intimidating pains and go forward together. It
is through sharing these disturbing images and the sensations and
affects that they carry that a gradual trust in the reality of an emotional
floor for experience can be discovered and built.

Adaptation
I’m standing on a stage with a group of men with a giant Nazi flag behind
us. I’m wearing a Nazi uniform. I’m giving the Heil Hitler salute with
everyone else. I’m terrified people will see that my heart’s not really in it.

The theme of adaptation has, of course, a long and complex history. The
concept is central in biological and evolutionary sciences as well as in
some streams of psychoanalysis, especially in ego psychology. As I am
using the term, the dreams in this domain have to do with the struggle
to create personal meaning versus complying with (or being domi-
nated by) the family and the group. Obviously, such a theme involves
a kaleidoscope of issues: obstacles to intimacy and sincere expression
are often pictured, or patients may describe feelings of helplessness
and frustration that coexist with thwarted initiative. There is often the
feeling that the patient may be selling out, settling for less, cutting his
or her losses, being a coward, playing the fool, and running out of time.
Once the issue of survival has been adequately addressed in the
analytic process by successfully creating an emotional floor for expe-
rience, the next domain often involves entering the profound realm
of adaptation to the family, the group, the community, and even to a
particular moment in history. The environment can then be explored
as a multitude of variables that both constrain and facilitate the devel-

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 the second life of dreaming 159

opment of the self. Within it, emotions are patterned and processed
through the challenges of adaptation and through increasingly per-
sonal interaction with the environment, which sponsors learning and
maturation across the life span. Dreams help show the history of this
process as well as its progress.
An important aim of the analytic work is to help the patient dif-
ferentiate between contractual interactions (dominant in the adaptive
domain) from opportunities for real intimacy and the development of
sincerity in relationships.

Thriving
I’m in a beautiful place in the mountains with a woman I am in love with.
I have some kind of arithmetic problem I’m trying to solve. I’m trying to
write it out on a large piece of paper on the ground. The woman offers
to help me and I let her. I wake up with a feeling of incredible happiness.

The dreams in this domain have to do with learning to trust one’s

own internal objects, letting them be free, and establishing a space for
creativity where one can harvest the fruits of intuition and welcome
thoughts in search of a thinker.
To outline a model of the factors that promote thriving is beyond
the scope of this chapter. However, I think we can say that the develop-
ment of an apparatus for thinking, feeling, and experiencing is crucial,
beyond the immediate demands for survival and social and emotional
adaptation. Bion emphasized what he called the K-link, a robust curi-
osity to know about others. This desire to know can widen into an
impulse to investigate the vast scope of the mystery of creation, life,
and the universe, the domain Bion noted as O. James Grotstein (2004)
has taken this yearning to learn about life in the fullest ways possible
and emphasized the motive force of a “truth drive” that, I think, is
linked to the subjective orientation I am calling “thriving”.
What I am offering is an outgrowth of reflections on Bion’s Elements
of Psycho-Analysis (1963) and Meltzer’s description of the psychoana-
lytic process. Dreams give us glimpses and preconceptions of thriving,
as well as, over the course of our work—and with careful attention—
clues to the structure of the personality that can help it to thrive and
learn from experience. I believe that, to some degree, thriving implies
going beyond self and emotion and beginning to consider one’s rela-
tionship to what Bion called O, an unknowable, absolute reality that
is the ultimate background for all our dreams and experiences.

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 160 jeffrey l. eaton

The analyst’s own dreams as a guide

I want to briefly describe how a dream helped me to symbolize the
emotional impact on me of my relationship to a young schizophrenic
patient whom I shall call Andy. I shall also describe how this dream
guided me in making deeper communicative contact with him.
When I first met Andy, he was thin, dishevelled, and haunted-
looking. Andy told me he spent most of his days in bed, “under
cover”. He said he enjoyed daydreaming. This intense activity seemed
to insulate him from powerful feelings of persecution. I vividly recall
a session in which Andy felt so persecuted that he threatened to break
the window to escape.
His communications sometimes flowered into religious delusions
of intense grandiosity. He believed, for example, that he had been
secretly placed at the centre of a giant cosmic net and had been chosen
to absorb the pain of the entire world. His job was to filter the pain of
millions of lives through his own body and mind.
In the early months of our work, Andy often withdrew into word-
lessness. He would sit in the corner of the couch, slumped and silent.
He would not look at me. In the silence I often noted feelings of help-
lessness, frustration, and sometimes extreme anxiety in my body. I also
had the feeling that I might suddenly fall asleep.
I understood all these experiences as elements of intense projective
identifications. I struggled to find words for this experience and to
share my understanding with Andy.
One night I dreamed:
I am standing outside a tall, round brick tower that looks as if it is part
of a castle. I go inside and climb a steep, circular stone staircase. At the
top of the stairs is a small, round room with windows. In the middle of
the room is a table and on the table is a hunk of clay on a pedestal. Next
to it is a computer screen. As I watch, the clay begins to form itself into
a human head, with the face of a man. I feel, suddenly, incredible fear.
The clay is making itself into something. Then I notice that the process
is being represented on the computer screen, which also shows the pic-
ture of the clay face. This makes me curious and I’m aware of both fear
and curiosity powerfully combined. When the clay is fully formed, I
become even more frightened. Now I feel an enormous force coming
from inside the empty eyes of the clay face. I feel I am being physically
sucked into the clay head and that I will be trapped inside. I wake in
terror.

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 the second life of dreaming 161

I was relieved to wake up. But I had a strongly uncanny feeling, a

bizarre and disorienting feeling in my body. The atmosphere of the
dream lingered for a long time, and I thought, “This is Andy’s dream!”
Upon reflection, it seemed that this dream might be about my
experience of the conscious and unconscious impact I was ambiva-
lently trying to welcome as I got to know Andy. The dream, I felt, was
showing me what it was like unconsciously for me to be with Andy.
Another way of looking at the dream is to say that my contact
with Andy introduced me to a split-off psychotic element of my own
personality. Spending time with Andy invited this new “character”
to enter my dream theatre and to inaugurate an improbably intimate
conversation with psychosis. Unconsciously, I was trying very hard to
make sense of the emotional experience of schizophrenia.
There came a moment, in a subsequent session, when Andy with-
drew again into silence. I waited for several minutes and, during that
time, the atmosphere of my dream returned spontaneously. I had not
planned to make an interpretation based upon my dream, but, draw-
ing on that experience, I said something like, “I wonder if you’re afraid
to look at me because you fear that, if you do, something terrible will
happen. Looking at my face might feel overwhelming. You’re afraid
something powerful will take you over and trap you. Maybe there just
are no words for such awful things.”
Andy now looked directly at me. Suddenly, he found his voice. He
told me, in a very lucid way, about a night at the psychiatric hospital.
He said he had been given an injection and had terrible cramps that
had paralysed him. He remembered feeling that he just wanted to die.
He described being taken to a locked ward where he later witnessed
a patient assaulted by another patient. He said he did not speak for
days after that.
A mother cannot dream her infant’s dream. But she can dream her
own dream about what it might be like to be her infant. This does not
give her access to her infant’s subjectivity in the sense of knowing it
directly, completely, or transparently, but she can imagine it in a mean-
ingful and embodied way. When she shares that meaning, made from
the inside out, the song and dance of her voice and her actions carry
intuitions that awaken her infant’s preconceptions about what contact
with the mind of another might ultimately make possible. In its own
way, this is the genuine and fruitful harvest that the psychoanalytic
setting seeks to make possible: an intimate contact with psychic reality
that can be shared with another, like the experience of a dream.

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 162 jeffrey l. eaton

Opening a window into psychic reality

Dreaming, according to Meltzer, is a process that creates the possibil-
ity of transforming emotional experiences into meaning. One of the
most important problems, which every analysis will face, involves the
patient’s capacity to recognize and develop the organ of conscious-
ness—the capacity to tolerate and explore psychic quality. For this
to take place, a dream space (which, I have emphasized, has various
evolving background qualities) must gradually be helped to develop.
Meltzer (1983) calls this space “the theatre of meaning” and, by col-
lecting, exploring, and discussing the patient’s dreams, the analyst can
observe, over time, the transformations of many different psychic func-
tions through the evolution of this theatre of meaning which is made
visible by looking into the window of dream-life.
Meltzer paid close attention to several different aspects within the
theatre of meaning. One important question was whether or not the
patient could turn towards his dream-life or whether he repeatedly
turned away from it. Turning towards dream life involves growing
the capacity for tolerating contact with psychic reality, and this, in
turn, is related to the “organ of consciousness”, which, according to
Freud (1911b), is defined as a “sense organ for psychical qualities”.
Meltzer wonders which characters in any particular dream represent
this function and its fate, and, additionally, he asks what happens to
this function upon waking.
In chapter 6 of Dream-Life, Meltzer writes:
If we remember that we are not dismissing the distinction between
consciousness as an “organ for the perception of psychic qualities”,
we can ask the question, “Which character in our theatre is, at the
moment of dreaming, in possession of this organ?” But also, “Is it the
same as the recaller and narrator of the dream during the analytical
session?” We must allow for the possibility that they may not be—in
fact probably usually are not—the same. [1983, p. 93]
Meltzer seems to have paid particular attention to the development of
this capacity to perceive psychic qualities and, additionally, to inves-
tigate which part of the personality either sponsors or captures (or
even exploits) this function. Indeed, if one of the goals of analysis is to
successfully establish the possibility of self-analysis, then attention to
the growth of the organ of consciousness must take a central place in
the analyst’s ongoing observation of the process. In thinking about the
complexity and importance of internal object relations, the question of
which (or what kind of) internal object controls the organ of conscious-

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 the second life of dreaming 163

ness opens a new window through which one can observe the evolu-
tion of the self and its circumstances within a psychoanalytic process.
In Meltzer’s view, a dream is a construction that reveals an evolv-
ing continuity, not necessarily within one dream, but over the course
of many dreams strung together in time. This crucial time dimension
can be measured over a span of nights, weeks, months, years, or even
decades. In particular, Meltzer speaks of dreams being able to depict
a problem that the patient is unconsciously trying to work out. If this
can be noticed, he suggests, then a problem can be investigated more
clearly, and with greater depth and nuance. If this psychic complexity
can be tolerated, rather than evaded, then it can be thought about and
reflected upon. This opens another dimension of experience, which
brings with it not only different forms of anxiety, but also, over time,
evidence of transformation and even, in the best instances, novel solu-
tions proposed through the unconscious creativity of the dreamer’s
inner work.
What I think should be highlighted is the way that the background
of the dream evolves into an inner workspace for the organ of con-
sciousness. Dream exploration starts with the analyst getting to know
the patient’s dream-life but may soon become a shared task. The
psychoanalytic setting is a workspace for exploring dream-life, and,
if it is successfully elaborated, a kind of apprenticeship in exploring
psychic reality can unfold. Gradually, dream-life reveals the construc-
tion of an inner workspace, a space capable of welcoming, tolerat-
ing, investigating, and learning from dream events. The patient’s
capacity to recognize this transforming inner workspace is one factor
that makes the creativity of analysis an aesthetic experience for both
participants.
One obstacle to this kind of process would seem to be the discom-
fort that patients, as well as many analysts, feel in handling dream
material. There is a mistaken conviction that one must be able to
decode the dream, rather than simply getting to know it and explor-
ing its details. If an analyst can assume a humble role of curiosity
about the dream and all its particulars, a spontaneous force field of
emergent meaning may be detected. Over time, patterns with linking
power become clearer. Meltzer felt he had a gift for opening dreams
as a generative process, not as a source of fixed meaning.
The process of exploring dreams promotes a deep sense of intimate
cooperation and can inspire an evolving appreciation for the process
of expanding self-awareness. Gradually the patient begins to take
an interest in and develops a desire to actively explore, learn from,

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 164 jeffrey l. eaton

sustain, and protect the analytic project because she realizes that the
analyst is not trying to do something to her, but, instead, is present to
help her discover herself as a complex subject in process.
I met Meltzer only briefly towards the end of his life. He seemed
both vibrantly intelligent as well as irascible. His physical presence
and communicative intensity made a strong impression that still lin-
gers many years later. Meltzer, not unlike some Buddhist teachers,
transmitted something simply through his way of being. I remember
him rather like an old Alaskan miner somewhat hardened by life in the
deep backwoods. I like to picture him in the Alaskan wild, standing
hip deep in the stream of the unconscious, panning for gold. As an
experienced dream explorer, Meltzer would patiently sift the contents
of each dream, taking in all the details before deciding which specific
elements to examine more deeply. He did not seem to be looking for
a single golden nugget (of meaning) but, rather, allowed himself to
become fascinated by all that the dream stream produced and left in
his tin pan (the clinical hour).
In his gruff but often humorous way, Meltzer showed a remark-
able freedom to lend his agile attention to patterns that spontaneously
emerged to him. Once he had described them, the patterns seemed
somehow obvious. He was patient, relaxed and receptive as he repeat-
edly dipped his attention and sifted the material he gathered from the
river of the unconscious (including the natural history of the transfer-
ence). He gave me conviction that it was necessary (not grandiose) to
seek to contact the heart of the matter in any given moment.
For Meltzer, the dream is neither debris nor pure gold but is the
raw material for important inner work. One sensed that Meltzer rel-
ished getting dirty, bending close to the muddy river, and that he was
inspired by its changing conditions across the seasons of life. His inti-
macy with the energy and the landscape of the unconscious showed
him the continuity of the dream process, the unity of the dream itself,
and revealed what he called “the grammar of the dream”. I admired
his profoundly disciplined imagination, and he offered a model of
clinical intuition that remains inspiring.
Psychoanalysis sponsors an improbable conversation, not just
between the analyst and the analysand, but also between the patient’s
discovery of psychic reality and the many complex links to daily life
and the external world. Of immediate interest is the dream’s linking
function in the interaction between the external world and the internal
world, between the body and symbolization, between relationships
with others and how our fantasies unfold, between thinking and feel-

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 the second life of dreaming 165

ing, and between getting to know and the illusion of always already
knowing.
There is no such thing as a dream, only a dreaming process. Dream-
ing is a kind of river. You cannot show someone only a part of the river,
except as an abstraction. You can only really speak about moments in
the flow of the river, just as you can only really speak about moments
in the process of dreaming. This is why the focus on process is so
important in understanding the sensibility that Meltzer brought to
understanding dream-life. The habits of language create a distortion of
this larger truth. The better we can describe the actuality of dreaming,
the more we may be open to question the mystery of the experience of
becoming a self. Is there a self that creates a dream and then narrates
it? Or, is dreaming a process that creates a feeling of self which, later,
becomes aware of living moments in the river of dreaming?
In a deepening analytic process the patient will also learn how to
wade out into the river of dreaming. The patient will not idealize the
analyst and wait for him to deliver his knowledge, but will join along-
side him, increasingly able to share the task of gathering and sifting
the dream material for fragments of emotional gold. Meltzer left me
with a visceral sense of the task shared between patient and analyst,
both at work together, waist deep in the river of dreaming, opening
to whatever arrives, surrounded by the wilderness of O.

Notes
This chapter is dedicated to Franco Scabbiolo with gratitude for the many conver-
sations we have shared regarding dreaming and dream-life.
Much of the text in this essay appeared as a chapter in my book A Fruitful
Harvest: Essays after Bion published by The Alliance Press, Seattle, WA, in 2011 and
used by permission.

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 CHAPTER ELEVEN

On having ideas:
the aesthetic object and O

Meg Harris Williams

“The new idea presents itself as an emotional experience of the

world and the beauty of its wondrous organisation.”
Donald Meltzer (in Meltzer & Harris Williams, 1988, p. 20)

I
should like to talk about what we mean by “having ideas”, using,
as reference points, Donald Meltzer and three of the Kleinian
thinkers who had an influential bearing on his own ideas—Wilfred
Bion, Adrian Stokes, and Roger Money-Kyrle—to sketch a composite
picture of their idea of how we have ideas. This is equivalent to ask-
ing how we learn from our internal objects without being overawed
or inhibited by them. These objects are those advanced aspects of the
mind that are formed progressively from a complex mixture of exter-
nal influences, intimate relationships, and innate internal qualities.
Psychoanalysis, Meltzer said, works through holding “conversa-
tions between internal objects” (see Williams, 2003, p. 219)—those of
analyst and analysand working together to form a symbol for the idea
of the current emotional experience. As the definition of mental health
shifted to one of self-knowledge, the goal of psychoanalysis changed
from one of cure to one of facilitating the formation of ideas, through
the creation of symbols. This endeavour is not unique to psychoa-
nalysis: it runs through all artistic disciplines, as it does through life.

166

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 on having ideas: the aesthetic object and o 167

Meltzer, especially in his later talks and writing, tried to convey the
“simplicity” of this process, by which he meant its complexity. But the
message itself is a simple one. To quote Martha Harris:
Introjection remains a mysterious process: how do involvement and
reliance upon objects in the external world which are apprehended
by the senses (and, as Wilfred Bion has pointed out, described in
language which has been evolved to deal with external reality)
become assimilated and transformed in the mind into what he calls
“psychoanalytic objects” which can contribute to the growth of the
personality? This is a process about which we have almost every-
thing to learn. [Harris, 1978b, p. 176]
The great psychoanalytic thinkers are well aware that psychoanalysis
has, to date, added only a little to our knowledge about the mind.
This is not surprising when we consider the awesome global cultural
heritage. Meltzer saw the cultural significance of psychoanalysis as
contributing a new aesthetic object—the psychoanalytic method—a
way of using the transference that is a fundamental feature of human
nature and that already exists and operates in other human relation-
ships. Meltzer, Bion, Money-Kyrle, all repeat that the “new idea” we
are considering is really an old idea in a new context. It is the new link,
the new context, that brings it to life, so that it begins to mean some-
thing, either to a particular person or to a whole school of thinking or
an artistic–scientific methodology such as psychoanalysis. “Meaning
something” means it becomes “known”, not just “known about”.
At the end of his final paper, “Making the Best of a Bad Job”
(1979), Bion cites Plato’s Theaetetus on the difficulty of ensuring that a
young man’s education fill his head, not with “phantoms”, but with
“live thoughts”. Bion made it clear that we don’t invent our ideas:
we discover them, after they have somehow made their way into our
mind—what the poets call inspiration, or psychoanalysts introjective
identification. In response to Roland’s question in A Memoir of the
Future—“Why can’t you make up your mind?”—Bion’s heroine Rose-
mary replies that she doesn’t make up her mind: “I let my mind make
me up” (Bion, 1991, p. 407), or, as Meltzer has said, “I haven’t done
psychoanalysis my way—I’ve been done its way” (quoted in Cassese,
2002, p. 104). Ideas “make up” the mind. Having ideas is a “passive”
if strenuous process (with its connotations of turbulence and suffer-
ing), accompanied by a sense of dependency—not on external objects
or persons but on internal objects.
The Platonic quasi-theological system, adopted by all these think-
ers, is the philosophical bedrock for object-relations psychoanalysis,

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 168 meg harris williams

as it has always been for poetry. It supports the view of mediated

levels of knowledge, through which truth or reality filters down to the
self, via internal objects, finding a symbolic form that is an aspect of
truth—even though never the whole truth, but clothed or fictionalized
in a digestible way. All cognition is essentially re-cognition. Culturally,
psychoanalysis is seen as a pre-existing thing-in-itself, waiting (as
Meltzer describes it in The Kleinian Development, 1978) to be discovered,
digested, and become part of modern society. Bion often speculates on
the “non-Mendelian inheritance” of ideas and the mysterious way in
which they pass from the global treasury (as it were) into individuals,
so it is worth thinking of ideas in the context of their origins or track-
ing system—for which Bion uses the classical metaphor of the River
Alpheus (1979, p. 256). It is a pity that our current academic culture
pushes us towards a false presentation of this tracking system: in
citing only the first source of a reference, we lose the individualistic
colouring of how a particular thought has entered a particular mind
and mated with the existing contents.
Perhaps it might be helpful to consider ideas as awaiting us, as
individuals, to notice them and integrate them in our mind. The act of
noticing entails developing a certain type of perception, a link between
internal objects and subject. The part played by the self in “having
ideas” is to make these links—or, rather, to notice different vertices so
that links can form between them. The essential pre-requisite for this
is a capacity for self-scrutiny, for looking inwards, as in Bion’s binocu-
lar vision or observer–observed. The only ideas that come within our
observational orbit will be those that our existing mental structure is
ready to incorporate: they are new to us. We “notice” them when they
impinge via an emotional turbulence—not necessarily a crisis, just a
feel-ing. Given the universality of human nature and the logical func-
tioning of the brain, some will have had the same idea hundreds of
years before us, while others may never have it (for whatever reason).
The alternative to incorporating an idea authentically is to appropriate
it (colonization), to ignore it, or to fossilize it.
Ideas are absorbed through internal communication—“symbiotic
links” between vertices, as Bion terms them. The original commu-
nicative link or “base” for having ideas is the baby’s first feeding
experience, as Money-Kyrle explains in his 1968 paper, “Cognitive
Development”. He lists three essential innate preconceptions upon
which all subsequent conceptions are based: the good breast (and,
we note, this must logically precede the idea of an absent breast, as
in the idea of aesthetic conflict); good parental intercourse (based on

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 on having ideas: the aesthetic object and o 169

nipple-in-mouth experience, which must be achieved by the age of

six months); and fear of death, which creates awareness of time and
the realization that no good thing can last for ever—hence the need to
mourn loss and thus to establish the capacity for introjection, which is
key to thinking and mental evolution. Without the innate awareness
of death and loss, symbols can have no structure, no three-dimension-
ality, and the new idea can have no container.
When Meltzer came to formulate the “aesthetic conflict” for psy-
choanalysis (Meltzer & Harris Williams, 1988), it became clear that all
three of Money-Kyrle’s preconceptions needed to be engaged for the
“baby” in the human personality to experience the aesthetic conflict
of a new idea entering the mind: the baby link, the combined-object
link, and the end of all links.
So, in having ideas, we put two vertices together and allow them
to communicate—that is, to find where they adjoin or complement
each other in a way that accrues meaning rather than depletes it.
Keats, in his famous formulation of Negative Capability, calls this
“dovetailing”:

Several things dovetailed in my mind, and at once it struck me what

quality went to form a Man of Achievement especially in Literature
and which Shakespeare possessed so enormously—I mean Negative
Capability, that is when man is capable of being in uncertainties,
Mysteries, doubts, without any irritable reaching after fact & reason
[in Gittings, 1970, p. 43]

He doesn’t specify what the “several things” are, although we can

guess from the context that they may be linked to his preoccupation
with learning poetry—both technical skills and poetic inspiration—
from the “great poets” such as Shakespeare and Milton. We note that
dovetailing is an involuntary act: it is something that happens and
strikes the personality, the self, rather than being deliberately pieced
together. A congruence suddenly manifests itself, and this results in
a new idea.
When Bion adopted Keats’ formulation, he was paying homage not
just to the idea but to Keats’ capacity to think for himself, his demon-
stration of how to think—by means of thinking about poets who had
preceded him. He was incorporating Keats’ way of thinking, in order
to become introduced to himself—a marriage that will last “for as long
as he lives”, as he defined the aim of psychoanalysis (Bion, 1980, p. 40).
Minds can encounter one another in a teaching–learning experience
outside their bodies or earthly lifespans. This encounter generates an

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 170 meg harris williams

“emotional storm” and the chance to form (or deny) a symbol of the
emotional experience: either to dovetail in conversation, or to split or
cover over with dogma or denial.
Bion called the dovetailing “intersecting with O” (1970, p. 32) the
ultimate source of knowledge; it is something that happens through-
out life, not only in psychoanalysis, and not only between mother–
baby or analyst–analysand, but between any two minds that spark a
contact, or any two parts of a mind (such as prenatal and postnatal),
any two art forms, or any two fields of knowledge of any sort (amongst
these Bion emphasizes the three basic vertices of art, science, religion).
Following Socrates, we can know nothing without the knowledge of
our ignorance. The formulation “O” (as Bion uses it) has two levels of
reference: the unknowable world of absolute reality, and the unknown,
underlying idea or meaning of an emotional encounter. The greater
O is like the godhead, whose function is to emphasize dimensions
beyond time and space that we can never penetrate, hence giving us
the concept of infinite possibility, beyond our comprehension. The
smaller or lesser O refers to the underlying but abstract idea of a
specific conflict or situation at a specific time; we become aware of
its existence through an emotional experience; this is Money-Kyrle’s
(1968) conceptual “base” of the mouth-and-nipple (p. 218).
Hence Bion concludes Attention and Interpretation with the dec-
laration that we need both the “restoration of god (the mother)”
and “the evolution of god (. . . the ineffable)” (Bion, 1970, p. 129).
God the mother is the first object, the conceptual base; god the inef-
fable is the larger O, the guarantee of the evolutionary quality that
will extend that first oneness (“at-one-ment”) to othernesses in the
future: unbounded, unknowable, infinite in potential. (We note that,
to Money-Kyrle’s three preconceptions, Bion seems to add another: the
infinite, although this may actually be a sub-category of the idea of
death.) The object’s own capacity to develop depends upon this belief
in the infinite source of all qualities, a source that cannot be tapped
directly but only mediated. Its existence, though unknowable, is an
essential feature of our innate worldview.
The two levels of O are both necessary to picture learning from
experience. As Bion says, “the Absolute . . . is not so biting as a tooth-
ache” (1991, p. 574); O does not impinge upon human experience or
sensation in any direct way. What “bites” is the emotional experience,
which becomes fictionalized in the form of a symbol, something that
is an incomplete or slanted version of the abstract or absolute truth
but is nonetheless truthful and therefore mind-building. According to

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 on having ideas: the aesthetic object and o 171

tradition, Truth enters the world not as a whole or perfect shape but in
pieces, as in Milton’s description in Areopagitica (1644): “The Absolute
enters the human world in many pieces, these pieces are perceived
by our senses . . .” (p. 143). A symbol is produced by the intersection
of O with the life of sense. The mother is knowable on the sensuous
level, yet contains the abstract or unknowable god-principle that is
infinite and ineffable, hence is the source and guide of vital curiosity
(the K-link). In Meltzer’s version of the myth, this idea takes the form
of the aesthetic conflict and the tension between the mother’s beauti-
ful exterior and enigmatic interior. Where the traditional neo-Platonic
system envisaged a ladder ascending from sensuous to divine beauty,
stepping towards the heart of meaning, the aesthetic conflict describes
the interaction of outside and inside, in which the search for the inside
is stimulated by the contrast between the sensuously known and the
unknown meaning or truth.
Every symbol demonstrates the intersection of the abstract noume-
non with a sensuous phenomenon—as described by Coleridge (1816)
when he says that a symbol, as distinct from an allegory, always “par-
takes of the reality which it renders” (p. 30). The abstract or noumenal
level allows for the evolution of the internal object as it searches in
the world of Platonic forms for the next little piece of truth required
by the infant-self in its current phase. This mediated communication
with the object via different levels of intersection (towards godhead)
thus allows the self to introject not only the object’s understanding
of its present emotional experience (via the symbol), but the object’s
capacity to think, which entails its dependence on a greater object
or O. For although the object knows more than the self, it must be
simultaneously learning from a further O, a fount of truth that has no
logical endpoint, since mental development is not circumscribed by
bodily growth or decay.
For this reason it does not make sense to talk about “becoming O”,
any more than “being O”. Bion likes to speak of “becoming” but in
the context of becoming oneself, not becoming one’s object or object-
source. Instead, to designate what happens when we have ideas, he
suggest alignment with O, or “at-one-ment”—“transformations in O”
not transformations into O. (Milton pictures this as the earth hang-
ing from heaven by a golden chain.) It is more like iron filings in a
magnetic field, or “consensuality” as all the senses come together and
point in the same direction in an act of recognition. Alignment is not
the same as fusion or unity in the primitive oceanic sense but, rather,
indicates a sense of direction and proportion. Alignment with truth

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 172 meg harris williams

results in our ingestion of a particular truth about ourselves, a piece

of self-knowledge; and every piece of knowledge has an aspect of
self-knowledge about it: it is never purely objective (neither in art nor
in science). The idea of alignment stresses the aesthetic quality that
accompanies having ideas. It fits. It is known not to be the absolute
Truth: this nonetheless governs it, since it gives the sense of evolution
of the object or, rather, its infinite potential for evolution. Alignment
means aligning oneself with this evolutionary potential, the O that
lies beyond the concept containing the present small experience. O is
infinite: there is more to come, if we align ourselves with an evolving
internal object.
Aligning with O requires a paradoxical sense of feeling contained
and feeling left out, that Adrian Stokes analysed in terms of two
modes of aesthetic experience required to either create or to creatively
appreciate any work of art (Williams, 2015, p. xiii). One type allows for
partiality, closeness, and evolutionary process; the other type allows
for inviolability, inscrutability, unknowability, and inviolable other-
ness of the object. Even though the object (O) can never be known,
changed into, or possessed, these very qualities initiate our quest for
self-knowledge. In aesthetic conflict, the desire to imaginatively know
the object establishes the container–contained, reciprocal, symbol-
forming dialogue.
Stokes notes the dialectical structure of all philosophical quests
(Williams, 2015, p. xiii). Two basic principles or positions are required,
which need first to be distinguished, and then integrated. This cer-
tainly applied to his own lifelong preoccupation with the way the two
fundamental modes of object-relationship operated in aesthetic experi-
ence: otherness and fusion, separateness and possession, the whole-
object and the part-object viewpoints—for which he adopted the idea
of an interplay between “carving” and “modelling” approaches to
the object. He came to see that the two modes are both essential to
object relations and are, in fact, complementary, each with a necessary
function: one ensuring the aesthetic harmony of a particular achieve-
ment, the other ensuring a continuing process of development: being
and becoming. Both play their part in having ideas and are founded
upon the vision of an aesthetic object with an inside and an outside,
which invite different modes of contact. This is indeed the basis of
the deep grammar in poetry. The function of any form of art is to
model this educational process of flux and stability so that the viewer
can “appreciate”—that is, imitate and introject—it. Through art and
psychoanalysis we become more aware of the internal dialogue that is

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 on having ideas: the aesthetic object and o 173

awoken by the aesthetic object’s O, with its intimations of infinity, of

eternal development. The psychoanalytic reverie has its antecedents
in the artistic or poetic reverie.
There is aesthetic conflict in the coming together of art forms or
other disciplines as well as of minds, with the attendant temptation
to divide or split these internal objects or their mediators. Yet all
thinking relationships have the capacity to be generative—that is, to
inspire others who introject the dovetailing in their own way, evolv-
ing autonomous symbols. The postnatal group at the end of Bion’s
Memoir conclude: “Fancy? Or fact? Just fancy, if there was something
about ideas which might make them ‘generative’!” (1991, p. 572). It
is not the term “aesthetic conflict” that is the new idea but, rather, its
new life in the context of clinical psychoanalysis. And perhaps ideas
can only become generative if they are conveyed in their true colours,
with their mediators and tracking systems, their progenitors, as felt
on the pulses.
The concept of the restoration of the good mother is the foundation
for Stokes’ declaration that successful art is a representation of “sanity”
and that, likewise, sanity is “an aesthetic achievement” (in Williams,
2015, p. xv). Meltzer founded his view of the psychoanalytic process
as an aesthetic object (promoting sanity) on this central humanistic
vision, writing about its “compositional” and “iconographic” aspects
(in his 1981 paper on Money-Kyrle’s concept of cognitive develop-
ment). Then, in Studies in Extended Metapsychology (1986b), as a result
of reflecting upon his work with autistic children, he describes how
the “new idea” of psychoanalysis gradually became clear to him: “In
the beginning was the breast and the breast was the world. . . .” (p.
204). Psychoanalysis itself is the O, the idea-generator; individual
psychoanalysts and analysands can be mediators in relation to this
object, if they have an artistic capacity for self-scrutiny, which is what
enables the reception of emanations from the object. Meltzer states
that the analytic couple comprise the “container” for the meaning
between them (the symbol), by means of the conversation between
internal objects. He goes on to relate how the key of alpha-function
and the lock of symbol-formation dovetailed in his mind to form his
own new picture of the self’s three-dimensional relation to the object
and how meaning can be flattened out of it, preventing the forma-
tion of symbols. In normal development, the container for an emo-
tional experience takes on a certain shape (the symbol) reflecting the
world–mother—the partly or fictionally knowable O—which is itself
an elaboration of Money-Kyrle’s mouth-and-nipple “base” (1968). If

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 174 meg harris williams

the analysis as aesthetic object has its compositional aspects, so do

all relationships, seeking to achieve fit or congruence, and to avoid
the “paramnesias” that arise through “envy of the growth-promoting
objects” (Bion, 1970, p. 128).
The process of symbol-formation is therefore the same thing as
having ideas, and it depends upon inspiration or introjection-and-
projection. Bion doesn’t really delve very much into the nature of sym-
bols; until he starts specifically to evoke aesthetic experience in his late
writings, he tends to equate symbol with verbal symbol. Money-Kyrle,
too, says that a concept is grasped once it can be named—which is a
signing action, not a symbolic one. But Meltzer, steeped in the “origins
of language” tradition that flowered in the philosophy of Wittgenstein,
Ernst Cassirer, and Susanne Langer, emphasizes the dreamlike quality
of the symbol that contains the new idea. This is not a new thought:
it was brought into focus by the eighteenth-century philosophers of
language and was given its essential modern shape by Coleridge,
who said that an idea cannot be had except through a symbol. But
it didn’t really dovetail with psychoanalytic thinking until Stokes
made vivid the connection of the Kleinian drama of part-objects with
exploring the inside and outside of the art-object. This could then be
connected with the philosophy of poetry, deep grammar, organic form,
musical diction, and so forth, as distinct from didactic statements and
the manipulation of words in a conventional or superficial manner.
Knowing versus knowing about; or in literary criticism, “thinking
with” rather than “thinking about” a book. New symbols, transforma-
tions in O, can only be formed by thinking with the aesthetic object, of
whatever type—an attitude of dependency, but oriented inwards, not
outwards to external or social figures. “Trust in your good objects”, as
Meltzer said in his “Good luck” speech in Barcelona: “Good luck for
the survival that you never could have planned, and which happened
in spite of all your cleverness and ingenuity” (Meltzer et al., 2003,
p. 318). Inspiration, he believed, must be happening all the time, but
“if it weren’t for the transference [from internal objects] we would be
absolutely helpless to assist our patients . . . [it] enables us to seem to
perform functions for the patient that are essential to the development
of their thinking” (in Williams, 2010, p. 135).
But the problem of types of knowing starts a conflict of identifica-
tions. The mental and the “protomental” now “compete for the soul
of the child” (Meltzer, 1986, p. 12). In professional terms it is hard not
to let cleverness and ingenuity get the upper hand, to defend against
doubts about the enigmatic interior of the psychoanalytic object, to

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 on having ideas: the aesthetic object and o 175

believe that we are “developing” ideas rather than scavenging, as

Meltzer called it (Meltzer & Harris Williams, 1988); relabelling or para-
sitizing, in Bion’s (1970) words; or “misconceiving” as Money-Kyrle
(1968) kindly yet very precisely put it. (He said he had encountered
in patients almost every phantasy of the internal parental intercourse
“except the right one”.) It is worth remembering that the meaning of
an idea is inseparable from a sense of its having arrived in our mind
from somewhere else, undoubtedly from someone else, via some
type of internal intercourse or combining of objects. It is genera-
tive outwards because it has generated inwards. The fact that it will
undoubtedly have been had before doesn’t matter, because that is not
where originality resides: ideas are alive and useful when they are
authentic—that is, when we can incorporate them into our existing
web of life without needing to claim we have invented them.
Keats said his friend Charles Dilke could never “come at a truth”
because he was always “trying at it” (in Gittings, 1970, p. 326). If
we can remove the clouds of misconceptions and obfuscations that
are created by our own cleverness and ingenuity, we will find that
ideas can dovetail or propagate themselves; all we need to do—or
can do—is develop our skills of self-observation, which means our
awareness of being observed by internal objects, not external ones.
When the idea gets through the smog, a sign of its arrival is our
astonished sense that—as my mother said of Bion—it is “blindingly,
obviously true” (Harris, 1980, p. 50). We have been put in touch
with its ancestors, in the Platonic realms of being and becoming. In
conclusion: we do not develop ideas, but if we could stop trying,
then ideas would develop us.

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 CHAPTER TWELVE

Degrees of entrapment:
living and dying in the claustrum

Pamela B. Sorensen

I
n his evocative and difficult book, The Claustrum (1992a), Donald
Meltzer offers an investigation and description of claustrophobic
phenomena. I suggest that these phenomena might be viewed on
a continuum from relatively ordinary, with potential to yield to the
developmental momentum of object relations both internal and exter-
nal, to so severely disturbed that the life of the mind hardens into a
death of the soul. To illustrate this continuum, I use two films: Coraline,
directed by Henry Selick (2009) and based on the 2002 novella by Neil
Gaiman, and The Talented Mr. Ripley, directed by Anthony Minghella
(1999) and based on the 1955 novel by Patricia Highsmith. These films
characterize the predicament at either end of the continuum; they
show how escape from the non-life of the claustrum is made possible
at the more benign end and how the possibility of exit is foreclosed
in the most extreme form of pathology. Studying the films through a
psychoanalytic lens brings into focus the critical factor in determining
the degree of entrapment suffered by the self caught in a claustropho-
bic world, devoid of emotional intimacy and filled with dread.
The concept of the claustrum is an unconscious phantasy of a space
inside the body of the internal mother that has been forcibly entered
and occupied. With this concept, Meltzer has elaborated Melanie
Klein’s (1957) idea of projective identification in three ways. First, he
emphasizes that this phantasy space is inside the internal maternal

176

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 degrees of entrapment 177

object and therefore suffuses all aspects of mental experience. Second,

he describes this space as characterized by particular qualities specific
to the imagined compartments of the space, which he divides into
three: head/breast, genital, and rectum. Third, he changes the term
used to designate the mode of entry into the object from excessive
projective identification to intrusive projective identification, since he
wishes to emphasize not so much the idea of frequency or quantity
as that of the force and quality of intrusion—whether by violence,
stealth, lies, or trickery.
The function of the claustral phantasy is defensive. Where the
containing process has been unable, for whatever reason, to mitigate
infantile anxiety the frantic infantile part of the personality pushes in
phantasy into the impervious internal maternal object and takes up
residence, finding short-term relief from the fear of death and aban-
donment, but long-term enslavement to lies, cruelty, and fraudulence.
Such enslavement or addiction serves the function of temporarily
obliterating awareness of helplessness and vulnerability. Lies provide
a more desirable version of events and motivation; cruelty displaces
fear into the other; and fraudulence provides an entirely alternative
version of the self. Thus, the possibility of escape from this claustro-
phobic world through the growth of genuine intimate connections
becomes a most terrible trial, because it rests on the capacity for bear-
ing depressive pain and allowing the beauty and goodness of a crea-
tive couple to take shape in the inner world.
What distinguishes Meltzer’s description of a claustrophobic
retreat from other psychoanalytic writers is that he conceptualizes
this as a life space—an internal landscape or world with a particular
geography and its own specific qualities and values associated with
that geography. Each compartment is suffused by characteristic atmos-
phere and attitudes, lived through the intruder’s unconscious mind.
Meltzer’s descriptions of these phantasied dwelling places and the
feelings they generate are immediately recognizable. This is because
Meltzer shows how the qualities found in the external world are
internalized and their subjective meaning externalized, so that there is
continuous “commerce” (Meltzer’s word) between the inner and outer
world, resulting in the subjective experience we can all recognize. In
this sense, the possibility of claustral life is ubiquitous, albeit relieved
much of the time by the vitality of real connections, so that we feel
grateful to be alive, notwithstanding the agonies of inevitable loss. But
when despair extinguishes the possibility of intimacy and sincerity,
the non-life inside the compartments of the claustrum takes hold. The

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 178 pamela b. sorensen

visual metaphors of the films illustrate this, but a brief review of the
characteristics of the claustral compartments may be useful.

The head/breast compartment

The primary quality of the head/breast is richness. Viewed from the
outside by the infantile part of the personality able to tolerate sepa-
rateness, the qualities of the breast and mind of the maternal object
inspire love and gratitude, as well as hate and envy. But viewed by the
intruder from the inside of the object, those qualities observed from
outside the object, such as beauty, knowledge, wisdom, and compas-
sion, are distorted so as to evade painful emotions. They become
vulgarized as ostentation, arrogance, self-serving indulgence, lavish
display of pseudo-generosity, and a know-it-all interest in status and
possession. Through the mechanism of intrusive projective identi-
fication the attitudes of cynicism and contempt prevail, and elitism
disguises the loneliness of superior separation. A sense of fraudulence
infects life in the claustrum of the head/breast, where no meaning can
grow through authentic struggle. The personality skates on the thin
ice of pseudo-maturity, threatened at every turn with the icy plunge
into the waters of infantile anxiety.

The genital compartment

The phantasied space of the genital compartment, viewed by the
intruder from the inside, is a wild and continuous orgy, where femi-
nine beauty is meant to incite the irresistible erect penis to masturba-
tory display. There is an obliteration of the generational divide, and
sex is entertainment verging on perversity. There is constant fear of
treachery and abuse, and a total absence of mystery and creativity.
There is no trust or loyalty; rather, frantic erotic transience heightened
by the conviction of irresistibility.

The rectal compartment

The rectal compartment is the phantasied space where tyranny reigns.
There is only one value—survival—for there is the ever-present dread
of being found out to be an impostor and interloper, to be cast out into
a bizarre world of absolute loneliness. The rectal claustrum is a world
of total degradation, not only of behaviour but of mental function.
There is no justice, only rank. There is no truth, only manipulation.

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 degrees of entrapment 179

There is no trust, only obedience. Meltzer says that this is the world
of the concentration camp, where survival is all. Deviousness and
self-idealization serve to postpone the dreaded reckoning with the
phantasied sadistic paternal object that rules this world. There is no
escaping him, only becoming him.
These descriptions of compartments represent the emotional geog-
raphy of the claustrum. Inhabiting this world means living not in
relationships, but in transactions. These phantasied spaces are like
commercials where cliché substitutes for thought, and where there
can be no mysterious ambiguity of another because the other is
never beheld within the context of separateness— the other has been
invaded so as to obliterate separateness and thus obliterate what can
never be known, only contemplated. Such states of mind afflict us all
from time to time with loneliness and fear. We need the help of other
people to overcome them, and sometimes we cannot.

The films
These two films make an unlikely pair. The first, Coraline, is an ani-
mated film that is as whimsical and funny as it is thought-provoking.
The main character is a strong-willed little girl who is quite endearing.
The second, The Talented Mr. Ripley, is a tale of murder and intrigue
with a sumptuous Italian setting. The main character is capable of
chilling manipulation, exploitation, and murder. Yet both protagonists
suffer forms of entrapment in their respective claustra, skilfully con-
veyed through plot and visual detail. Coraline escapes her entrapment
to find the opportunity for repair and restoration of her good objects,
while Ripley sinks deeper into hopelessness and despair. The critical
factor that allows for development in the one and death in the other
is discussed below.

Coraline
Coraline is the story of a girl aged about 9 or 10 years, who is very
angry with her parents. They have moved from a neighbourhood
with many friends to a new home that we see through Coraline’s
eyes as a drab and desolate house, ironically and provocatively called
the Pink Palace. This house has other tenants at the top and bottom
of the building who will become significant in filling out the picture
of Coraline’s inner world. Coraline is contemptuous of her mother’s
lack of home-making skills and resentful of her preoccupation with

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 180 pamela b. sorensen

the work she does with her husband from home, which is creating a
seed catalogue business. Although her father takes a bit more notice of
her and shows an amused affection, he too, from her point of view, is
unwilling to take proper care of her—for instance, offering disgusting,
slimy vegetables as the only food. The refrigerator never has anything
good in it.
Defiant, Coraline marches out of the house to explore the barren,
empty landscape beyond her home. The tilted void of the animated
drawing conveys the feeling of being nowhere, just as Meltzer describes
the fundamental fear of the claustral dweller. Coraline unknowingly
plucks a dousing stick from a poison oak to assist her furious foray
into the unknown in search of water, when she is surprised by the
noisy arrival of a helmeted boy on a motorcycle named YB (short for
Why Born). This name, Why Born, suggests that he too has known the
feeling of falling into nothingness—perhaps finding no welcome in the
eyes of his mother at birth.
Fellow sufferer or not, Coraline is contemptuous of anything YB
might have to say and rejects his overtures of friendship, only to
retreat into her lonely house. She has noticed a small door in the down-
stairs hall, but her mother has shown her that there is only a brick wall
behind it and places the key where Coraline cannot find it. Of course,
late at night, when dreams conspire to reveal emotional truth, Coraline
follows the helpful scuttling of a guiding mouse to discover that the
door does, indeed, open into another world—the claustral world of the
other mother, where Coraline is treated as the special child she longs to
be and where she is offered all the wonderful food she could possibly
eat, in abundance and without waiting, and all the adoration and com-
fort she could possibly want. There is only one hitch. In exchange for
being the idealized and spoiled daughter of the other mother and father
she must agree to allow them to replace her eyes with buttons. Why?
Button eyes do not see. Thus, there can be no authentic connection
between two people, which necessarily includes ambivalence, both
love and hate, only the flat acquiescence to the lie of idealization. No
let downs, no waiting, no uncertainties. Initially, Coraline declines the
invitation and returns to the exigencies of her disappointing daily life
with her disappointing, though hard-working, parents.
Meltzer suggests that intrusive projective identification may be
accompanied by secret masturbatory phantasies that propel entry into
the object in a damaging way. The depiction of the little door as a hid-
den opening into a spiralling chute leading to the delusional world
of the other mother shows how such phantasies may rev up the manic

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 degrees of entrapment 181

conviction of being in possession and in command of every treasure

inside the pink palace of the mother’s body. There are many images
of hands throughout the film, some disembodied, some performing
frightening tricks, another sore from a poisonous plant. Even gloves
enter the imagery as Coraline’s rage with her parents begins to shift,
perhaps suggesting that she is trying to restrain her damaging mas-
turbatory phantasies.
But before this turning point, the seductive power of being the
special one inside the claustral world increases as Coraline’s loneliness
and frustration with her quotidian life persists. She crawls through the
little door by day, tempted by promises of pampering, and is encour-
aged by the other mother to visit the exotic and exhibitionist neighbours
who live at the top and bottom of the Pink Palace. This false maternal
object urges her into a greater and greater whirlwind of voyeuristic
excitement, enflaming her further with the cruel suggestion that her
real parents have become bored with her and left to go to France (the
destination of choice for romance).
Coraline finds that her eccentric neighbours have put on shows
just for her. Upstairs, Mr Bobinsky, looking like an acrobatic phallus,
preening and whirling in his magic show of jumping mice, excites
and amuses her. She is dazzled, losing the capacity for moderation or
discretion; she eats chicken-poop popcorn and exploding candy-floss.
Downstairs, Miss Spink and Miss Forcible compete to display bottom
and bosom in a wild circus of erotic acrobatic feats, culminating in
Coraline flying through the air to land on top of them. But this excite-
ment is mixed with menace, both upstairs and downstairs, as the
jumping mice turn to rats and the circus audience of Scottish terriers,
who previously had been a legion of interchangeable turd-like pets,
turn into frightening bats.
It is becoming clear that things are not what they seem in the
home of the other mother. She treats her husband with such scathing
contempt that he deteriorates into a flaccid puppet. Her body gradu-
ally transforms into the shape of a spider and her coaxing lilt into a
piercing staccato. Terror mounts. In a state of bewildered excitement,
Coraline backs away from the promise of being special forever and
begins to look again for her real, though imperfect parents.
Coraline realizes that she is trapped. Her own projections have
become so powerful that they threaten to wipe out her memory of
being loved as she is. She misses her parents and needs them. The
plot turns and Coraline fights, using her parents’ gardening tools as
weapons to aid her escape from the web of narcissism in which she

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 182 pamela b. sorensen

has become entangled. Here is the first image that carries the meta-
phor of the good combined object needed to provide the grounding
for emotional growth and development. The process of reclamation
and restoration of her good objects now begins with all the pluck and
energy with which Coraline marched away from them in her yellow
boots in the first place. Coraline’s greed for adulation has yielded to an
appreciation of the love she has been given, and her struggle has led
to a greater capacity to endure depressive pain, allowing it to enrich
her mind so that she can tell truth from falsehood in both herself and
others.
What is it that allows Coraline to resist the temptations of the
claustral world and struggle to find her real parents and her real self?
It is a combination of internal and external factors. Coraline has the
good fortune to have loyal friends who tell her the truth about herself
and, in so doing, strengthen her hold on her good objects. One of these
friends is an analyst in the form of a cat who is reliably available at
critical moments, disappearing at the end, as analysts do, to leave
Coraline to live her life with greater confidence in her own capacity
for love. He has assisted her by pointing out her arrogance, helping
her recognize what is false, bearing with her in facing the cruelty of
her own projections in the form of the other mother, and offering the
tenderness of friendship—a guide, philosopher, and friend, as Roger
Money-Kyrle defined the role of the analyst (personal communica-
tion).
Coraline’s first friend, YB from the earlier scene, has persisted
despite her contempt. He is loyal, protective, and funny, offering Cora-
line the possibility of being part of a creative couple at the end of the
film, when, together, having vanquished the other mother, murderous
in her jealous rage, they make a garden of their own, using the seeds
and tools Coraline’s parents have given them. But most important,
Coraline has parents who can withstand her jealous rage and hold on
to family life. Amidst the destruction wrought by the other mother’s
violent attempt to capture Coraline and prevent her from finding her
real parents, Coraline notices an object over the hearth in her home.
It is a broken snow globe from a family trip, dripping water like tears
onto the floor. Inside it, the distressed faces of her parents peer out.
Coraline now knows that she has hurt them through her dismissive
contempt and realizes that they love her, nevertheless, and can forgive
her. The reliance on an internal couple who can withstand attacks
through lies and distortion, yet persist in the task of building some-

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 degrees of entrapment 183

thing worthwhile, like a garden or a family, allows Coraline to retrieve

and restore the good objects in her internal world.
Twice during the film there has been an aerial view of the garden
belonging to the Pink Palace, once in its beautiful form and once in its
nightmare from. The garden is the shape of a girl’s head. This visual
metaphor clearly conveys that Coraline’s story is the story in her mind,
in the world of unconscious phantasy, where objects can be lost and
found, destroyed and reclaimed, in all their aesthetic and emotional
complexity.

The Talented Mr. Ripley

The situation for Tom Ripley is at the other end of the claustral con-
tinuum where the degree of entrapment increases until there is no
escape. Tom, a baby-faced young man, slides into a life of fraudulence
within the first few minutes of the film. He borrows the jacket of an
acquaintance in order to perform the piano accompaniment to a beau-
tiful, classical singer. The jacket bears a Princeton insignia, and in a
split second Tom goes along with the misperception of the wealthy
Mr Greenleaf that he went to Princeton with Greenleaf’s wayward,
dissolute son, Dickie. Tom agrees to accept payment for a trip to Italy
with the stated purpose of persuading Dickie to return to his family.
The psychological ground of the film is laid in the imagery of the
opening scenes. Tom is without the necessary clothing. One might
see this as a suggestion that he is without an adequately functioning
skin, in the sense that Esther Bick (1968) means when she describes the
mental skin, provided by mother’s attention, that the infant needs to
hold himself together. Tom Ripley’s second skin, which is, according
to Bick, the defensive means of holding the self together, represented
initially by the Princeton jacket, becomes the pretence that he has a
status not his own. His actual job is that of a lavatory attendant, where
he hands out towels and brushes off the coats of wealthy men.
Having accepted Mr Greenleaf’s offer, as Tom is packing his mea-
gre belongings in his dark basement flat, he is disturbed by the angry
yelling in the flat above him. It is clear from the expression on his face
that he has been witness to the violent quarrelling of the couple living
just above his head many times before. This couple’s angry yelling
appears again in a dream towards the end of the film as Tom is try-
ing to hide the second murder he has committed. Tom emerges from
his living quarters in a meat-packing district, where skinless animal

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 184 pamela b. sorensen

c­ arcasses are pushed through the streets, a visual metaphor, perhaps,

for Tom’s extreme vulnerability to those around him and for how eas-
ily he can be swept along by forces outside his awareness. Tom gets
into a limousine paid for by Mr Greenleaf, and so begins the long,
lethal journey of Tom’s fraudulent intrusion into the lavish and excit-
ing idyll of Dickie Greenleaf’s Italy.
Part of the tension in this journey of lies, trickery, and fraudulence
propelling the complicated plot of the film comes from the persis-
tent glimpses of another side of Tom Ripley conveyed through his
responses to music. The film opens with Tom at the piano and later
practising alone in a theatre. At different moments throughout the
film, when Tom listens to classical music his face loses the shallow
cheeriness of his false smile and expresses an authentic vulnerability
to beauty. His only genuine love is for another musician whose musi-
cal sensibilities Tom shares. But this aspect of Tom’s personality is not
sufficiently robust to withstand the corrosive effect of the lies, trick-
ery, and fraudulence with which he insinuates himself into the life of
Dickie Greenleaf. He is driven to steal all the privileges, qualities, sta-
tus, and power, real and imagined, that belong to Dickie. Ultimately,
he steals his life.
This first murder takes place when Tom and Dickie go boating. For
Tom, this outing is a prelude to a longer and more intimate trip. Tom is
in love with Dickie and believes that his feelings are returned. But for
Dickie, the outing is nothing more than a distraction, just another one
among the hundreds of fleeting pleasures with which he crams his life.
Dickie is suddenly bored with Tom and tells him so, calling him a leach
and saying that it’s time he moved on without him. Without warning,
the surge of humiliation and rage overwhelms Tom. He had imagined
they were like twins, sharing sophisticated tastes and knowing ways.
(When they travelled together on trains, Tom would slyly merge their
reflections in the window.) Tom smashes Dickie’s skull with an oar,
and as he lies dead in the bottom of the boat, Tom rests his head on
Dickie’s chest in a delusional lover’s embrace.
Tom tries to cover up the murder by sinking the boat and assum-
ing Dickie’s identity. This leads to complicated deceptions with other
characters, mainly Dickie’s fiancée, Marge. Tom plays himself with
those who recognize him as Tom, and plays Dickie with those who do
not. Eventually, one of Dickie’s dissolute chums suspects foul play and
confronts him. Tom commits the second murder to protect his secret
and stages a car crash to make it look like an accident.
Once Mr Greenleaf comes to Italy to find out what has happened

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 degrees of entrapment 185

to his son, Tom thinks the game is up. But to his astonishment and
despite the protestations of Marge, who knows Tom is guilty, his guile
succeeds in convincing Mr Greenleaf and the authorities that he is
innocent. Only at the very last minute, as Tom is leaving Italy with his
musician lover, Peter, who knows him as Tom Ripley, is he spotted by
another passenger on the ship, a girl he has feigned interest in, who
knows him as Dickie. He fobs her off with a kiss. When Tom returns
to his cabin, Peter is hurt because he has seen the kiss. Tom, know-
ing now that his ruse will be exposed, pretends to embrace Peter and
strangles him with a necktie.
The life that Tom Ripley steals from Dickie displays all the claus-
tral characteristics Meltzer describes: the elitist and entitled display
of material riches in the head/breast compartment, as seen in the
luxurious lifestyle of Dickie and his friends; the sexual frenzy of the
genital compartment, seen in the heady scene in the jazz club, where
Tom jumps in to mimic the louche singing of Dickie’s friends; and the
ultimate tyranny of the rectal compartment, seen in the three murders
Tom commits. Although there are brief moments when Tom views the
beauty of the maternal object from the outside, as when he wants to
go sightseeing in Rome and when he listens to music, his utter despair
and fear of abandonment drive him to force his way into the maternal
space, represented by the gorgeous landscape of Italy, and steal the
identity of Dickie Greenleaf through violence, trickery, and lies. The
fear of being found out as an impostor fills the atmosphere with dread.
Tom’s homosexual ardour for Dickie—his longing to merge with
him in every way, through dressing in his clothes, singing his songs,
joining their reflections in the window glass of trains, sharing his
bath—is an expression of his utter loneliness and fear of being nothing
and no one, as he tells Peter at the end of the film, “I’m going to be
stuck in the basement, alone in the dark. No one will ever find me”.

Degrees of entrapment
Both Coraline and Tom Ripley are trapped in inner worlds where
greed and self-delusion dominate: Coraline for a while, and Tom for-
ever. In this world, sorrow cannot yield the fruit of remorse. Gratitude
cannot soften the pain of separation. Hope cannot allow the unknown
to unfold. Coraline develops in her capacity to bear psychic pain and
in her capacity to face the truth about herself through struggle with
her demons and with the help of a good internal couple and a cat. Tom
cannot escape his claustral world, but is driven deeper in with every

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 186 pamela b. sorensen

violation. The fleeting impressions of the internal couple he carries

(the angry voices above his head in the early scene and then again in
a dream) are damaged and damaging. Even music is murdered when
he kills Peter, the one person with whom he might have shared his
true nature.
How does a good internal couple protect against the ravages of
intrusive projective identification? The respective functions of mater-
nal and paternal objects play their parts, as does the collaboration
between them. The good internal maternal object can accept distress
without falling apart or retaliating; she can make room and even more
room for all the children, so that no one is cast out; she can mitigate
the toxic mix of envy, jealousy and fear through her struggle to com-
prehend their meaning. The good paternal object not only protects
the maternal space from infant excess, but also offers a bridge to the
baby to find new worlds outside the maternal space. By doing this,
he engenders the possibility of a future. Together, the good internal
couple can mitigate the sorrow of inevitable loss through their creative
interdependence, generating hope in the infant that one day he, too,
may become part of a creative couple.
Both films reveal the importance of the role of an internal couple
in psychic development through the appearance of phantasies about
inside babies. Coraline discovers the ghosts of children that the other
mother holds hostage. They float in some mysterious, dark, and hidden
world that we can understand as the world of unconscious phantasy.
They cannot come to life because their eyes have been stolen and hid-
den. Without them, they are mere dolls, not real babies. In her work
of repair, Coraline finds these eyes and returns them to the children,
thus restoring their individuality and their ability to seek and find the
reciprocal gaze of their own mothers. Here, Coraline shows the capac-
ity to acknowledge that other children, too, need authentic contact
with their mothers. She is not the only one.
Emerging from the unconscious in quite a different way, the phan-
tasy of dead inside babies rises from the ocean in The Talented Mr.
Ripley. While watching a village religious ritual in which a statue
of the Madonna is carried through the waves, Tom, Dickie, and his
­fiancée, Marge, see the drowned body of Dickie’s secret paramour
rise to the surface. She is pregnant, and even the callous Dickie is
overcome by the thought of the dead baby inside her. Tom instantly
offers to publicly accept the blame for this doomed conception, and,
although Dickie waves him away, this strange idea fits Tom’s inner
world, where no independent life can thrive.

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 degrees of entrapment 187

The “mystery of the nuptial chamber”, as Meltzer calls it in his

penultimate book, The Apprehension of Beauty (Meltzer & Harris Wil-
liams, 1988), evokes awe and envy, placing upon the infantile part
of the personality the strain and burden of being on the outside, not
knowing and not being able to know what happens there. The uncon-
scious phantasy of entering the maternal space through lies, trickery,
and violence puts a stop to this, silencing mystery and killing the new
life that it may engender.
Coraline and Tom Ripley are not our patients; they are fictional
characters. But the defensive unconscious phantasy of a claustrum is
not a fiction. Meltzer’s description of such a frightening world, one of
falsehood without reprieve, conveys a terror we all can recognize, and
some cannot escape. His imaginative elaboration of Kleinian theory is
compelling in the way it explores the experiences of the infantile part
of the personality by delineating the emotional meaning of uncon-
scious phantasies about the inside of the internal maternal object.
This infantile part of the personality, as we have imagined it
through Coraline and The Talented Mr. Ripley, suffers in a particular
way as a consequence of intrusive projective identification. As an
occupant of the claustrum it is both a refugee and an invader, seek-
ing to get under the skin of the internal maternal object to escape the
terror of utter loneliness. But once inside, the world beneath this skin
becomes a false container, growing tighter and more constricting as
mental pain increases. Seeming to offer relief from suffering through
glamour, importance, excitement, or power, the claustral space is like
an exclusive hotel, one you are dying to get into, only to find that you
are nowhere, after all.

Note
This chapter is based on a version previously published in the Journal of Child
Psychotherapy, Vol. 42 (No. 1, 2016), pp. 45–53. Copyright © Association of Child
Psychotherapists, reprinted by permission of Taylor & Francis Ltd, http://www.
tandfonline.com on behalf of the Association of Child Psychotherapists.

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 CHAPTER THIRTEEN

Trapped in a claustrum world:

the proleptic imagination
and James Joyce’s Ulysses

Mary Fisher-Adams

“Oh Jamesy let me up out of this pooh.”

“Molly”: James Joyce, Ulysses (1922b)

I
n this chapter I look at Ulysses as a description of a claustrum world
and how fear and dread can produce, in the so-called “replacement
child”, a proleptic imagination that keeps the claustrum dweller
imprisoned and paralysed. A link is made with Shakespeare, who is
a presence throughout Ulysses and was himself a replacement child.
I had been struck by similarities between two of my patients and
James Joyce. They had all lost siblings in early childhood and seem
to have felt emotionally cut adrift by the mother’s grief at her loss—
a feeling marginalized that had extended into adulthood. They all
showed particular sensitivity as children and were possessed of a
highly active imagination and exceptional literary creativity. Above
all, they seemed tormented by fear in the extreme. My two patients
came into analysis in their forties still plagued by nightmares of
lions, monsters, and dead babies. Most strikingly, both expressed
the fear that they had murdered someone and that they remain
lethal and shouldn’t be allowed out into the world. James Joyce also
suffered great fears and nightmares. He spoke of “that skull” that
came to torment him at night (Ellmann, 1982, p. 178). He was highly

188

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 trapped in a claustrum world 189

superstitious, had crippling phobias causing fainting fits—afraid of

dogs, rats, and water, for example—and lived in fear of thunder and
lightning.1
In Ulysses, Joyce seems to portray a stuck and confusing world:
what he calls a “paralysis of the insane”. It is a world packed full of
allusion, information, and philosophizing. As Wyndham Lewis put
it, “Ulysses confines the reader in a circumscribed psychological space
into which several encyclopedias have been emptied” (Lewis, 1927, p.
91). Ulysses is also a tour de force of the imagination.
For my patients and for Joyce, their heightened imagination and
creativity seems to have been a mixed blessing. On the one hand,
it brought them some glory and allowed a form and expression for
their fears, but at the same time their childhood experience produced
what James Fisher (2009) termed a proleptic imagination that actually
perpetuated those fears. It seems that, as children, murderous wishes
they felt towards their mothers’ new babies coincided with the actual
deaths of their siblings, triggering the belief that they had caused the
deaths. This kind of congruence between fantasy and reality feeds into
the magical thinking of the proleptic imagination and can paralyse a
child emotionally. The child is left with the fear that one’s wishes and
one’s imagination can cause disaster.
Silvio Fano Cassese states that in “Terror, Persecution, and Dread”,
Meltzer describes an extreme form of paranoid anxiety, terror:
“. . . The object of terror (being in unconscious phantasy dead objects)
cannot even be fled from with success” (Meltzer, 1973d, p. 105). The
mother’s internal babies are not only damaged . . . but killed by the
destructive-possessive jealousy of oedipal rivalry and intolerance to
separation, and “what is feared is the retaliatory re-projection of the
murderous attacks on the mother’s internal babies” (Alberto Hahn,
personal communication). [Cassese, 2002, p. 43]

The proleptic imagination

Proleptic means a leaping ahead, and in the proleptic imagination a
world of certainty is created in which the patient “knows” what will
happen. It is an unconscious attempt to control the imagination, but
one that traps one in the deluded state. Fisher describes it as “what-
ever is pictured—in the moment as well as in the future—is taken
concretely as reality” (2009, p. 35).
It differs from Klein’s concept of “symbolic equation” (1930, p. 220)
in that it focuses on the role of the imagination and describes an

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 190 mary fisher-adams

overall state of mind. Symbolic equation refers to a difficulty think-

ing symbolically. I am looking at patients who can think symbolically
but who try, unconsciously, to control their thinking out of fear. There
is, perhaps, too active an imagination—“a dangerous prevalence of
imagination” (Bloom, 1999, p. 535)—that makes it hard to know the
reality. As a result, rather than being free, as children, to imagine, play,
and fantasize, in their terror at not knowing what else might go ter-
ribly wrong they have sought certainty. Rather than allowing things
to take their course and finding out, they tell themselves they know
what will happen. It is the antithesis of Bion’s image of reverie and
receptiveness and of being without memory or desire.
Although based on fantasy, this state of mind works, in fact, to
block the free use of the imagination. As described by Ogden (2005),
this has particular consequences for work in analysis:
The imaginative capacity in the analytic setting is nothing less than
sacred. Imagination holds open multiple possibilities experiment-
ing with them all in the form of thinking, playing, dreaming and in
every other sort of creative activity. Imagination stands in contrast
to fantasy which has a fixed form that is repeated again and again
and goes nowhere. . . . To imagine is not to figure out a solution to
an emotional problem; it is to change the very terms of the dilemma.
[p. 26]

In The Claustrum, Meltzer differentiates between “a conception of the

inside of the internal mother derived from imagination and one that is
the product of the omnipotent intrusion, and thereby of omniscience”
(1992a, p. 62).
One patient refers to this omnipotent state of mind, which perhaps
we should call proleptic fantasy, as her tendency to “catastrophize”,
the way she anticipates and “knows” that there will be a disaster of
her own causing. So firm was the belief in her murderousness that
she quoted a murderer released from prison who asked: “‘How can I
make a life for myself when I have killed someone?’ I know what he
means”, she said. This is a fearsome state to live in and, tragically, as
frightening as living in a state of not knowing. Writing on the claus-
trum, Meltzer says:
. . . in response to this hovering sense of immanent catastrophe, the
picture of the world becomes compartmentalized and stratified. The
compartments . . . resemble . . . the divisions Hell, Purgatory and
Heaven: in the rectum, the genital or inside the breast or head of the
primal mother. [1992a, p. 119]

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 trapped in a claustrum world 191

“The dead third”

To lose a sibling and the mother’s attention at this early stage of devel-
opment, when there is a delicate back and forth between the use of
fantasy and a gradual accommodating of reality, would be traumatic,
and it brings us into the sphere of the “dead mother” syndrome
(Green, 1986). Samuel Gerson eloquently expands the concept of the
“dead mother”. He describes the child in this situation as having lost
the “containing third” (Britton, 1989) and finding himself in the pres-
ence of a “dead third”:
Rather than the potential for growth and security found in the notion
of triangular space, the absence of an involved and caring other
leaves only a dense and collapsed heap of destroyed internal and
external objects for whom no one mourns. Imagine life, when the
third is dead, when the container cracks and there is no presence . . .
to represent continuity. It is a world constituted by absence, where
meaning is ephemeral and cynicism passes for wisdom. [Gerson,
2009, p. 1343]
For both of my patients, in their eyes the mother seemed to become
wooden following the sibling’s death. One patient’s mother told her,
“my face cracked when the baby died”, and her family took to their
beds. The other patient learned the cello, practising for hours trying
to bring life and music out of this wooden mother.
Important in Gerson’s description is the lack of mourning. Helene
Deutsch, in a discussion of mothers mourning their deceased chil-
dren, observes that the replacement child “has very poor chances
of conquering the mother’s heart”, and that “during the period of
mourning even the woman’s own children are deprived of love and
exposed to the painful silent reproach, ‘Why did you not die instead
of the other?’” (quoted in Silver, 1983, p. 520). The picture my patients
conveyed was of a mother turned away.

Fury at the mother

Along with the fear of impending disaster, there is a profound fury at
the mother for abandoning them in her state of grief. James Joyce had
good reason to feel aggrieved. Before he was 2 years old, his mother
lost a baby son. She then went on to have nine more children and at
least three miscarriages.
Furthermore, he was sent away to boarding school age 6, and then
his mother died of cancer age 44 when he was only 21. He bitterly

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 192 mary fisher-adams

attributed her death to the constant pregnancies, and he blamed the

Church and his alcoholic father—and also himself. In a letter to his
wife, Nora, he said, “My mother was slowly killed, I think, by my
father’s ill treatment, by years of trouble, and by my cynical frankness
of conduct” (Liegner & Motycka, 2003, p. 151).
His novel, Ulysses, is filled with betrayal, grief, guilt, and fury at
the mother. It begins in the Martello tower—a small, almost window-
less fortress on three floors, with narrow stairwell. Stephen Deda-
lus, lodging there with Buck Mulligan, is feeling usurped by a new
arrival (another new baby): the “privileged” Englishman, Haines. As
he decides to leave, he is haunted by a dream of his dead mother
returning to reproach him. He cries out, “Ghoul! Chewer of corpses!”
and then pleads with her, “No, mother. Let me be and let me live.”
Joyce speaks of the mother’s “hardness of heart”, “black basilisk
eyes with the power to poison”, a “withering mind”, her “cold blighted
love for him”. In Ulysses, Stephen says: “But thou has suckled me with
a bitter milk; my moon and my sun thou has quenched forever. And
thou has left me alone forever in the dark ways of my bitterness; and
with a kiss of ashes hast thou kissed my mouth” (1922b, p. 387).
The first woman to appear in Ulysses is the old milk woman—“a
scary wandering crone, with shrunken paps” (p. 15). And elsewhere
Joyce compares the lights and shadows of the mother’s falsely smiling
face to the hues of rancid food—her body emerges as an odourless
flower, her mind a quagmire, the green hue of her dress metamorpho-
ses into lush grass, “the hair of graves” (Joyce, 1984, p. 12).
Ulysses is suffused with Stephen’s guilt regarding his mother’s
death. He refused her dying wish, and Mulligan condemns him for it:
You could have knelt down, damn it Kinch, when your dying
mother asked you. . . . To think of your mother begging you with
her last breath to kneel down and pray for her. And you refused.
There is something sinister in you. . . .
Ah poor dogsbody, he said in a kind voice. I must vie you a shirt
and a few noserags.
I’m the only one that knows what you are. Why don’t you trust
me more? What have you up your nose against me?
Don’t mope over it all day . . . I’m inconsequent. Give up the
moody brooding.
Mulligan could be seen as the most real-life person in the book and
the only one to challenge Stephen as a father might. There is a sense
of homosexual longing between them, with references to Oscar Wilde
and “the love that dare not speak its name” (p. 259). But Stephen, full

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 trapped in a claustrum world 193

of guilt and ill equipped to engage with him, makes Mulligan the cruel
one and walks away. There is talk of fathers throughout Ulysses, as
though seeking someone to lift Stephen out of himself and his resent-
ments, but, in his wish to deny generational reality, Stephen proclaims
himself his own father, “made not begotten” (p. lxix).2 Joyce’s biogra-
pher, Richard Ellmann, comments that “paternity is a more powerful
motif in the book than sexual love” (1982, p. 371).
Guilt was also a major feature for my two patients. But this was not
depressive-position guilt seeking forgiveness. They did not expect or
even seek compassion in life, only condemnation. The “guilt” seems
more an expression of fear and anger. It is a persecutory anxiety
based on a fantasy rather than an actual crime or hurt the person has
caused. “I know it is all my fault”, we hear patients say, even though
intellectually they know that is not the case. It is one of those “end of
story!” statements—a state of mind fearful of exploring what might
be their fault and what isn’t. The “I know” becomes the certainty with
which they try to hold themselves together, but it conveys, “I don’t
really want to know.” It is as though the act of imagining has become
a dangerous act that might lead to new awareness and pain.
Feelings my patients had were intense and hard to control and
often produced behaviour that one might well condemn. It was almost
as though they wanted to prove their badness, but any attempt by me
to address this seemed to touch on real fragility and fear. One patient
described her life as being tirelessly available for all and sundry, but
at the same time she was telling me about behaviour that was clearly
unethical and hurtful to others.
Ulysses is full of Joyce getting revenge on the many people he felt
had wronged him. Leon Edel (1980) called Joyce an “Injustice Collec-
tor”, and Hugh Kenner points out that Joyce imprisoned himself and
had to remain in exile because of all the lawsuits he would have had
against him had he returned to Ireland: “Joyce’s revenge on Oliver
Gogarty [Buck Mulligan in the book] was to shut him into a book for
all to see” (Kenner, 1962, p. 49).3
In real life, Joyce’s sense of entitlement—born of fear and guilt—
particularly with his wife and brother, made him notoriously ruthless.
It is a curious dynamic: the way some who lost siblings latch onto
another sibling in a most intense and controlling way. Van Gogh and
Thomas Mann are two examples. It becomes a sadomasochistic folie à
deux. Julian Barnes refers to Van Gogh as the “flat-sharer from hell, an
insistent, overbearing presence, needy, demanding, free with advice
and always knowing better” (Barnes, 2015, p. 8). One of my patients

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 194 mary fisher-adams

tried to control a younger sister to such an extent that she ended up

feeling she had ruined the sister’s life, and I think she had a point.
A letter from Joyce’s brother Stanislaus, on his return to Trieste
after having been interned for four years in an Austrian camp, conveys
how fed up he was with Joyce’s treatment of him.
I have just emerged from four years of hunger and squalor, and am
trying to get on my feet again. Do you think you can give me a rest?
[McCourt, 2000, p. 249]
But Joyce couldn’t and didn’t.
It is as though the fear and anger associated with the survivor
guilt of the “replacement child” becomes so unbearable in the cir-
cular prison of the proleptic imagination that the only escape is
to actually be bad—“break all the windows” and enter the world
finally in their rightful place, as a criminal, achieving a perverse
kind of authenticity. At the same time Joyce, like my patients, could
be very good company, and with his brilliant mind and wit he was
funny and seductive—especially when drinking. According to his
biographer, “no one could laugh more wholeheartedly or more
infectiously”. With his head back and mouth wide, he resounded
throughout the room, and he was always bursting into song.
Another image is of him doing his spider dance down the street—
his long legs flailing around (Ellmann, 1982, p. 95). And his many
admirers went out of their way for him. Meltzer refers to this myste-
rious charisma that paralyses the opposition—especially loved ones.
Joyce’s wife, tested to the limit with his late-night drinking and
problems with money, while strangely unwilling to read his master-
pieces, still stood by him devotedly, tuned in, like a mother, to the
tragedy of this genius mind at the mercy of inner fear.4

Thirst for knowledge

Joyce dazzled with his encyclopaedic knowledge and verbal pyro-
technics and is described as a latter-day “worldwide web”, with a
“spider’s eye” constantly absorbing information. From early in life
he made copious and exhaustive lists and elaborate designs, elicit-
ing from his father the wisecrack: “if that fellow was dropped in the
­middle of the Sahara, he’d sit, be God, and make a map of it” (Kiberd,
1992, p. xxii).
In Ulysses and Finnegans Wake, he includes the names of Shake-
speare plays, all the books of the Bible, the chapters of the Koran,

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 trapped in a claustrum world 195

the rivers of the world, figures of rhetoric. Joyce seemed to rely on

the power his brilliance gave him. “I’ve put in so many enigmas and
puzzles”, he said, “that it will keep the professors busy for centuries
arguing over what I meant and that’s the only way of insuring one’s
immortality” (Ellmann, 1982, p. 521).
Similarly, one of my patients avidly devoured extraordinary
amounts of knowledge and information. Within the first few months
of her analysis, she had not only noted the books on my shelves but
ordered and read the complete works of Melanie Klein, quoting to me
from the couch. She was so all-knowing and had such verbal facil-
ity and humour that in the analysis I had to withstand feeling both
seduced and intimidated by her.
Meltzer talks of a specific aspect of projective identification being
bound up closely with the epistemophilic instinct. He describes this
thirst for knowledge and the omniscience it seeks as being too impa-
tient to learn from experience.
Where the thirst for knowledge is still strongly dominated by motives
related to envy and jealousy, the thirst for knowledge is [too] impa-
tient to learn from experience, example or demonstration. It seeks
[instead] the immediate emotional satisfaction of omniscience and
this it accomplishes by intruding inside the sensory apparatus and
mental equipment of its internal object. [1976a, p. 142]

But for my patients, and for Joyce, the intensity of feelings from their
early experience felt, I believe, barely survivable. They did not have
the space and security to let things take their course. They were poised
ready for disaster, wishing to “jump the life to come” (Macbeth).

The claustrum
One way to control the object is to get inside, and Ulysses seems a strik-
ing example of an author entering right into his characters in a way
that goes beyond mere imaginative identification and becomes the
intrusive identification characteristic of the claustrum dweller. Molly’s
monologue in the final scene could be seen as a particular example
of this—a kind of intrusion by Joyce himself. At one point Joyce has
Molly say, “Oh Jamesy let me up out of this pooh”, as though Joyce
is controlling things (18: 1128). There seems to be a subtle difference
between conveying what the character is like and thinks and Joyce
bringing to it his own fantasies, denying the woman, in this case, her
separateness and essential unknowability. Writers talk about their

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 196 mary fisher-adams

characters as independent selves with minds of their own, but here

Joyce seems caught in an unconscious masturbatory fantasy of his own
having intruded into the mind of his character.
Lionel Trilling talks about Joyce’s attempts to distance himself
from the “filth and depravity” of his fantasies, as expressed in his
letters to his wife, Nora, by locating them in all his characters except
those—such as Stephen Dedalus—more identified with himself (Trill-
ing, 1967, p. 475). Stephen, as artist, is idealized as detaching himself
from emotion, being “above desire and loathing”.
Lewis (1927) describes Ulysses as “telling from the inside”, and
Joyce himself, in Finnegans Wake, describes his character, Shem, as “self
exiled in upon his own ego” (1939, p. 184). Ulysses has 18 sections, each
one linked to a body part, and the three main characters seem located
in the compartments of the mother’s body: Stephen Dedalus, the poet-
artist, is located in the head-breast (Meltzer’s “Lotus Eaters” lassitude;
1992a, p. 119); Molly Bloom, fantasizing in bed with “compulsive
greed for sexual stimulation”, is located in the genital compartment;
and Leopold Bloom is in the anal world of the rectum.
I quote from Meltzer’s (a) description of life in the maternal rectum:
. . . [S]een from the inside, intruded into by stealth or violence in
anal masturbation or anal assault, it is a region of satanic religion,
ruled by the great fecal penis, the world of Orwell’s “Big Brother”.
. . . Truth is transformed into anything that cannot be disproved; jus-
tice becomes talion plus an increment; all the acts of intimacy change
their meaning into techniques of manipulation or dissimulation;
loyalty replaces devotion; obedience substitutes for trust; emotion
is simulated by excitement; guilt and the yearning for punishment
takes the place of regret. [pp. 91–92]
. . . [U]nlike the other two compartments where comfort and erotic
pleasure dominate the value system, in the rectal compartment there
is only one value: survival. Although the sadism may vary in inten-
sity as one moves along the spectrum from boarding school to con-
centration camp, the atmosphere of incipient terror is probably little
changed, for one meets evidence that the nameless dread consists
in being “thrown away”. . . . [T]his nameless dread is exponentially
worse even than exile and Cain’s lament: it is absolute loneliness in
a world of bizarre objects. [p. 91]

At the age of 40, Joyce had a dream that has elements of inevitability
of a proleptic and persecuted state of mind in a compartmentalized
claustrum world where there is no escape. It is set in a luscious Persian
pavilion:

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 trapped in a claustrum world 197

There were sixteen rooms, four on each floor. Someone had commit-
ted a crime, and he entered the lowest floor. The door opened on
a flower garden. He hoped to get through but when he arrived at
the threshold a drop of blood fell on it. I could know how desperate
he felt, for he went from the first floor all the way up to the fourth,
his hope being that at each threshold his wound was not capable
of letting fall another drop. But always it came, an official discovered
it, and punctually at the sixteen rooms the drop fell. There were
two officials in brocaded silk robes, and a man with a scimitar who
watched him. [Ellmann, 1982, p. 547]
Joyce, disparaging of psychoanalysis and opting for self-analysis,
interpreted the rooms as the twelve signs of the zodiac; the three doors
are the Trinity, the man who committed the crime was himself, and the
man with the scimitar was his “wife next morning”. The pavilion with
light-blue lattices was “like a box”, he said (Ellmann, 1982, p. 547). We
do not know the context for this dream, except that he had seen the
Russian ballet the night before and was writing Finnegans Wake, but
as well as a “criminal” entering the lowest floor trying to evade being
discovered, there is a distinct sense of nameless dread and “ineluc-
tability”—Joyce’s favourite word—meaning inevitable and inescap-
able, which has the ring of proleptic certainty: “I could always know”
and “always it came”. Most poignantly, the man in the dream was
wounded and felt desperate with no way of escape.
Perhaps the desperate wish to “escape” from some obscure guilt
and getting stuck, instead, in a luscious palace with erotic overtones
gives a glimpse of the state of mind in which Joyce wrote Ulysses. The
dream pales in comparison with the wild nightmarish pantomime
“Circe” section in Ulysses, in which lonely Bloom is hauled before a
court of judges and accused of everything under the sun in front of a
baying mob. While full of Joycean hilarity, it is also the extended heart-
felt outcry of someone caught in the bogus persecutory world of the
claustrum. It is a world replete with all kinds of “sluts and ragamuf-
fins”, bishops and ghosts, and a seductive Molly Bloom “in Turkish
costume, her opulent curves filling out the scarlet trousers and jacket
slashed with gold” (p. 570). Stephen’s dead mother also appears, as
do Macbeth and the three witches (p. 682).
James Fisher sees Macbeth as a moving portrayal of the proleptic
imagination in action. He emphasizes the depth of emotion expressed
in the play while describing Macbeth’s proleptic state of mind as an
attempt to control the emotions. He points out that there is no fool
or “truthsayer” in Macbeth—no Paulina, for example, who, in the

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 198 mary fisher-adams

­ inter’s Tale, could speak the truth to Leontes. Instead, there are a few
W
moments when Macbeth himself briefly reflects on what was happen-
ing—moments, Fisher says, that Shakespeare marks “with some of
the most unforgettable poetry of the play, indeed of any of his plays”:
Macbeth senses that his conscious action can never match this
strange experience where wanting and having appear to be one. Per-
haps as a warrior hardened in battle he distrusted the omnipotence
of action, although he had never given up his infantile omnipotence
of thought, at least not when it seems thrust upon him. It is remarka-
ble that Shakespeare chooses to have Macbeth give eloquent expres-
sion to an emotion we can only suppose threatens to overwhelm as
he thinks feelingly about the murder of Duncan. Pity, seemingly an
emotion as fragile as a “naked new-born babe”, is pictured “strid-
ing the blast”, blowing “the horrid deed in every eye”. It is as if
Macbeth, for the moment at least, sees a link between pity and an
infant, not as helpless but “striding the blast” of the heavens. It is a
picture of the power of the emotions, the kind of thing a Fool might
say to Macbeth, reminding him of reality, the reality of emotional
experience—tears that “drown the wind”. [2009, p. 15]
Rather than reflecting on reality, Ulysses seems more reality-evading,
or reality-trashing. Virginia Woolf described it as the work of a man
who “in order to breathe had to break all the windows” (Kiberd, 1992,
p. xviii). The “Circe” section in Ulysses has the same manic, unintel-
ligible, unstoppable quality as Lucky’s outpouring in Beckett’s Waiting
for Godot (2006b) and the character Mouth in his play Not I (2006a).
Leopold Bloom as a character seems quite extraordinarily strange.
Joyce tries to lift him into a realm of great humanity, saintliness even,
as though this “womanly man” might be the ideal. But at the same
time he is portraying a grieving, cuckolded, marginalized Jew who
distracts himself with endless bits of information, inhabits a world of
masturbation, and seems unable to cry out his pain. Joyce, perhaps
feeling the absence of a mature combined couple, may want to save
this bereaved couple, Molly and Bloom, who lost a child, and bring
them to life again. But it doesn’t happen. At the end, they remain lying
topsy-turvy, with Bloom kissing Molly’s buttocks, unable to overcome
their grief.

Intrusive identification
Sabbadini describes the replacement child who lost a sibling as “treated
more as the embodiment of a memory than as a person in its own
right”. Being allowed a life of their own was problematic, given their

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 trapped in a claustrum world 199

sense that they should not have survived when their siblings had died
(1988, p. 530). Desperate to prove their worth, and feeling angry at
their situation, can make them very competitive. (See Meltzer, 1992a,
p. 66, for a discussion of the Odyssey and the “Telemachus part of the
infantile personality vis-à-vis the bad and naughty brothers and sisters,
fraught . . . with savage infantile competitiveness”.) However, success
immediately brings new fears. Whatever survivors do, they feel that
being competitive risks causing the demise of the other. The proleptic
imagination pictures only one possible outcome, a devastating one,
whatever is wished for.
One of my patients is an accomplished writer, but, afraid of pub-
lishing in her own name, she works as a ghost writer instead, disguis-
ing her own identity. Anisfeld and Richards give a description of this
dynamic in their paper on the “replacement child”:
He could never be certain that he was loved for who he was or for
the genuineness of his achievements. When he performed an action
from which he reaped a reward at someone else’s expense, he was
convinced that he had initiated it; if his deeds were in any way altru-
istic, he doubted their sincerity. He believed that he should have been
able to do the impossible and save the lives of his half-sisters even though
he had not yet been born. This grandiose fantasy paradoxically made
him scorn his actual accomplishments as worthless and even led him
to be taken advantage of by others for their own glorification. [2000,
p. 314; emphasis added)

Here we get a vivid picture of the patient’s proleptic belief system—he

believed it even though he had not yet been born—and a sense of how
imprisoning it can be.
Joyce, whose competitiveness was extreme (Trilling, 1967, p. 463)
faces the competition head-on, outsmarts everyone, destroys the way
things have been done before, and is credited with the birth of the
modernist novel! As T. S. Eliot put it, “His book destroyed the whole
of the nineteenth century” (in Trilling, 1967, p. 452).
The lively and seductive qualities in both of my patients seemed
partly to be ways of trying to lodge inside and be as one with me rather
than engaging as separate people and developing the kind of inter-
course in which play and trust could develop. Often they seemed to
take over sessions and fill the space, almost as though they were “kill-
ing me off”, the way they felt killed off, and which perhaps reinforces
their belief that they are lethal. Joyce’s (half-joking) comment that the
demand he makes of his reader is that he should “devote his whole life
to reading my works”, has a similar feel to it (Ellmann, 1982, p. 703).

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 200 mary fisher-adams

The depressive-position capacity to put one’s self in the other’s

shoes, accepting the separateness of the other, is a very different state
from intrusive identification, in which the patient gets inside in order
to take over the other. In an early dream, one patient was being invited
to play a musical instrument:

It was a combined instrument, half harpsichord, half viol, at different

angles facing away from each other and a deep red colour. One side was
alive and like a dragon, and the other inanimate. To play it you had to
get right inside it. It seemed impossible to play.

Her difficulties getting inside me and “playing” me frustrated her.

She tried from all different angles, and she expressed fury at these
mothers who won’t let her in. The two sides of the instrument
seemed a picture of her only alternatives as either being wild like a
dragon or silenced and lying low. Again, one is reminded of Beck-
ett’s character, Lucky.
She brought poems to me and about me, seductive in their skill. I
became a wiry witch in a difficult-to-enter or -manipulate box. There
are images of “portals of entry”, getting through the double doors,
into my shoes and my eyes. Then she has me “thrusting” her out.
At the same time there was the wish to make us the same, both
­mothers, for example, and knowing the same to avoid our separate-
ness and having to imagine herself in my shoes—or even put herself
in her own shoes, so to speak, and feel compassion for herself rather
than guilt and fury.
Ghosts and witches abound in her poems, reminiscent of Macbeth.
And the poems have the “knowing” quality of the proleptic state of
mind. She is waiting outside my door, waiting to get in rather than
waiting for insight into herself or to imagine things differently. I
become as unreal, slippery, and controlled as she is.
Her imagination is given a kind of free rein, but with a purpose to
control and express her love and fury. What seems less free about her
imagination is the willingness to imagine alternatives and risk having
her anger collapse into grief. The poet–critic D. J. Enright said: “Poetry
itself is a way of preventing something or other you can’t defeat from
getting the better of you” (quoted in Wilkinson, 2012). And T. S. Eliot
said: “Poetry is not a turning loose of emotion, but an escape from
emotion; it is not the expression of personality, but an escape from
personality” (quoted in Ricks, 1993, p. 1).
Dreams are themselves the proleptic imagination at work in that
we experience images as reality during the dream. Fisher differentiates

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 trapped in a claustrum world 201

between a positive proleptic imagination, which allows us to picture

our emotional experience through images and stories, and a nega-
tive proleptic imagination, which becomes a defensive attack on the
capacity to become aware of our emotional experience (Fisher, 2011,
p. 6). It is only when we wake from the dream that we can reflect
on the images as an expression of our emotional states. My patients,
however, found it difficult to create a distance from their dreams—
they felt their dreams were more factual evidence of how dangerous
or guilty they were. One patient worried about having unconscious
murderous wishes: “Does this mean I am guilty having such feelings
or not?” she asked. We can see in this question her confusion and a
switch to the concrete.
After several years in analysis, she said to me, “You talk about my
picturing being lethal everywhere I go, whereas I know I am lethal.”
Although this conveyed a growing awareness of a difference between
picturing and knowing, between reality and fear, I still had the sense
that part of her really believed she is dangerous. Her interest was in
finding out what it is about her that is dangerous to others. What was
more difficult was to entertain the idea that she is not dangerous. Or
to make space to think and imagine differently. She even quoted Lady
Macbeth:
These deeds must not be thought,
After these ways: so, it will make us mad.

Shakespeare and the “Dark Lady”

Like Joyce, my patients found a resonance in Shakespeare. Shake-
speare himself lost siblings as a child, and there was a similarity of
tone in one patient’s poems to the Shakespeare Sonnets addressed to
the “Dark Lady”.
Donald Silver (1983) sees the “Dark Lady” Sonnets as Shake-
speare’s plea to his mother, who, having lost three daughters, turned
away from him in her grief. Silver says that in Sonnet 143, “it is not
difficult to imagine the boy Shakespeare speaking poignantly from
within himself to the mother of his past who mourned to the point of
neglecting her eldest son . . . the sonnet could be entitled, ‘Ode to a
Replacement Child’, because it so tellingly depicts the fate of such a
child” (Silver, 1983, p. 52):
. . . So runn’st thou after that which flies from thee,
Whilst I thy babe chase thee afar behind;
But if thou catch thy hope, turn back to me,

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 202 mary fisher-adams

And play the mother’s part, kiss me, be kind;

  So will I pray that thou mayst have thy Will,
  If thou turn back, and my loud crying still.
A poem of Joyce’s, Ecce Puer, has a similar quality and includes the
lines:
Of the dark past
A child is born,
With joy and grief
My heart is torn.
Joyce sees something of himself in Shakespeare but cannot pin it
down. He is not sure whether his identification is with Shakespeare
or with Hamlet. He tries to sort out who betrayed Shakespeare and
pictures it as the wife, Anne Hathaway:
He chose badly? He was chosen, it seems to me. If others have
their will Ann hath a way. By cock, she was to blame. She put the
comether on him, sweet and twentysix. The greyeyed goddess who
bends over the boy Adonis, stooping to conquer, as prologue to the
swelling act, is a boldfaced Stratford wench who tumbles in a corn-
field a lover younger than herself. [1922b, p. 244]
He has Stephen reinterpret the entire works of Shakespeare as a devel-
oping narrative of exile and loss and adds that:
. . . the theme of the false or the usurping or the adulterous brother
. . . is in Shakespeare always with him. The note of banishment,
banishment from the heart, banishment from the home, sounds
­
­uninterruptedly from The Two Gentlemen of Verona onward till
­Prospero breaks his staff, buries it certain fathoms in the earth and
drowns his book. [Kiberd, 1992, p. lxxii]
However, Shakespeare does not seem trapped in a claustrum world.
Located outside his plays, he portrays a complex range of emotions
in his characters who move towards maturity and relinquish their
resentments, their paranoia, and their certainty. Hamlet, as well as
accusing, is also questioning and moves finally to a “let be”. Prospero
can let go of the omnipotence and magical thinking—something that
Joyce seems ultimately to recognize.
Unlike the harsh mockery in Ulysses, Shakespeare gave Hamlet
all kinds of humour. Similarly, Samuel Beckett’s humour conveys not
only the humanity of his characters but also “the pity and understand-
ing of the characters for each other” (Rustin & Rustin, 2000, p. 171).
About Ulysses, Kiberd (1992) says:

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 trapped in a claustrum world 203

The virtuoso set pieces are less acts of creation than of parody; and
parody is the act of a trapped mind which, realizing that it cannot
create anew, takes its revenge by defacing the masterpieces of the
past. [p. xlviii]

Samuel Beckett, in comparing himself with Joyce, said: “The kind of

work I do is one in which I’m not master of my material. The more
Joyce knew, the more he could. He’s tending toward omniscience
and omnipotence as an artist. I’m working with impotence, igno-
rance” (Beckett, 1987, p. 78). This is a useful distinction, but Beckett,
though not himself a replacement child, knew very well the tend­
ency to omniscience that he saw in Joyce.5 Beckett’s own traumas,
and all he experienced during the war as a member of the French
Resistance, changed him profoundly and “brought him out of him-
self, distancing him from the arrogant, closed-in young man of the
1930s” (Knowlson, 1996, p. 350).6 (See O’Toole, 2015, on Beckett’s
similarities with Joyce.)
Joyce, in a moment of self-deprecation in later life, and with per-
haps a painful recognition of the truth, said: “I’ve not developed. If I
had matured I wouldn’t be so committed to this folie of writing Finne-
gans Wake” (Ellmann, 1982, p. 703).

Conclusion
It has been pointed out by Stephen Greenblatt (2004) that Shakespeare
found it difficult to portray or even imagine fully achieved marital
intimacy in his plays. Joyce’s own experience of a parental couple
was marred by the breakdown of his parents’ relationship. Perhaps it
is no surprise that in Ulysses Stephen proclaims that only the imagi-
nation can be the source of rebirth and regeneration (Schwarz, 1987,
p. 113). James Fisher has shown that if the imagination is a paralysing
proleptic one, defending against emotion, there can be no creative
intercourse. In discussing the K-state-of-mind that makes possible the
experience of the full range of human emotions, he states:
As Bion emphasized numerous times, it is the hatred of emotion
that lies at the heart of psychotic phenomena (Bion, 1959, p. 311).
Paradoxically certain emotions, such as anxiety, envy and hatred,
attack and make impossible the experiencing of other emotions.
Actually, rather than envy, perhaps we should put fear at the head
of the list of the –K factors, the fear that emotional experience is not
survivable. [Fisher, 2006, p. 1233]

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 204 mary fisher-adams

I conclude with Joyce’s original ending of Finnegans Wake, written two

years before his death. The style in this passage is strangely different
from the rest of the book, and he abandoned it. It is a dream image
that seems like a mother with her little boy and is reminiscent of the
Shakespeare sonnet. Perhaps the dream, in this “resurrection” chapter,
is of waking the “dead mother”.7
He said he felt completely exhausted after it and sat for a long
while on a street bench, unable to move. One wonders why he aban-
doned it—whether the emotion, linked with his early experience,
seemed not survivable.
Come. Give me your great big hand for miny tiny. We will take our
walk before they ring the bells. Not such big steps. It is hardly seven
mile. It is very good for health in the morning. It seems so long since.
As if you had been long far away. You will tell me some time if I can
believe its all. You know where I am bringing you? You remember?
Not a soul but ourselves. We might call on the Old Lord, what do
you say? He is a fine sport. Remember to take off your white hat,
eh? . . . I will tell you all sorts of stories, strange one. About every
place we pass. It is all so often and still the same to me. Look! Your
blackbirds! That’s for your good luck. How glad you’ll be I waked
you. My! How well you’ll feel. For ever after. First we turn a little
here and then it’s easy. I only hope the heavens sees us. A bit beside
the bush and then a walk along the  [Ellmann, 1982, p. 713]

Notes
1.  For Joyce, life was all coincidences and superstition. He referred to Finne-
gans Wake as having a “prophetic and magical nature”; he knew the superstitions
of most of Europe “and adopted them all” (Ellmann, 1982, pp. 517, 525). For Joyce,
reality was “a paradigm . . . the perception of coincidence . . . reality, no matter
how much we try to manipulate it, it can only assume certain forms; the roulette
wheel brings up the same numbers again and again” (p. 551).
2.  “James Joyce once remarked that Ulysses was for him essentially a way of
capturing the speech of his father and his father’s friends: “. . . so much literature
stems from a wish to assuage homesickness . . . [T]he modernist is one who is
likely to use his intimate life as material for his art, shaping the ordinary into the
extraordinary” (Oates, 2015, p. 84).
3.  For all his seeming dismissal of Oliver Gogarty, the two books left on his
desk when he died were a Greek Lexicon and Gogarty’s I Follow Saint Patrick
(Ellmann, 1982, p. 742).
4.  One night in the pub he had drunk one glass of wine when someone pointed
out a rat running down the stairs. Joyce said “Where? Where? That’s bad luck”
and a minute later lost consciousness. They took him home, and “Nora was about

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 trapped in a claustrum world 205

to scold him but became tender when she saw he was suffering from fright rather
than alcohol” (Ellmann, 1982, p. 517).
5. In Molloy (1955), Beckett recalls his own unwanted birth: “My mother, I
don’t think too harshly of her. I know she did all she could not to have me, except
of course the one thing, and if she never succeeded in getting me unstuck, it was
that fate had earmarked me for less compassionate sewers” (p. 15).
6.  “The shift to writing in French may have been an important way of escaping
the influence of Joyce—greater simplicity and objectivity—could concentrate more
on the music of the language, its sounds and its rhythms” (Knowlson, 1996, p. 357).
7.  Joyce asked Beckett to read this original ending to Finnegans Wake, and Beck-
ett was very moved by it. Interestingly, in one of his own last works, Company, some
forty years later, Beckett describes walking with his own mother, thinking back to
the skies of his childhood: “You make ground in silence hand in hand through the
warm still summer air. It is late afternoon and after some hundred paces the sun
appears above the crest of the rise. Looking up at the blue sky and then at your
mother’s face you break the silence asking her if it is not in reality much more
distant than it appears. The sky that is. The blue sky” (in Johns, 2010, p. 27).

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 Gaudete:
a response to Mary Fisher-Adams

David Mayers

L
et me begin by stressing that I totally agree with Mary Fisher-
Adams about the importance of both Meltzer’s claustrum and
Fisher’s proleptic imagination. My difficulties lie with the way she
brings these concepts to her reading of Joyce.
The relation between a writer’s work and his life and states of mind
is a vast and vexed topic—one that I shall not address here. I want to
confine myself to the interpretation of Ulysses. I think that one differ-
ence between Adams’ and my vision relates to the personal attitudes
that we bring to understanding Joyce: I have the impression, based
on her descriptions of his undoubted and manifold personal faults,
that she rather dislikes him; whereas I find his life and work so heroic
that I will largely forgive him everything. I recognize that his demand
of the reader that he will devote his whole life to studying the work
can seem omnipotently self-important; but I, and countless others, are
grateful for having been given the chance to do so.
Adams’ claim that Stephen, Bloom, and Molly are claustrum-
dwellers implies that their lives are tunnel-visioned and lacking in
development. I cannot avoid remembering that the Dublin of Blooms-
day was in many respects a narrow-minded philistine place in which
artists’ wings were relentlessly clipped. The atmosphere is poignantly
captured in the stories “A Mother” and “The Dead” from Dubliners
(Joyce, 1914): also in Yeats’s poem “September 1913” (in Yeats, 1989).
Joyce and Stephen had to escape to be free to think. Similarly, Molly
had to fight for her capacity to be a woman who enjoyed orgasmic
sex. Adams sees her “Ah Jamesy get me out of this pooh” as Joyce

206

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 trapped in a claustrum world  |  gaudete 207

intrusively identifying with his character (“pooh” was not at that time
a euphemism for excrement but, rather, a generalized term of disdain
or disgust). She does not mention that Molly had just realized she was
beginning to menstruate; nor that in demotic Dublin “Ah Jamesy” was
a mock-polite version of the ubiquitous “Ah Jaysus!”.
To be sure, a psychological reading is, in principle, quite compat-
ible with the one I offer. So let me give examples of why I find the
claustrum interpretation a bed of Procrustes that lops off vital parts,
whereas I see Joyce mobilizing a variety of points of view reminiscent
of Bion.
One feature of Ulysses that I cannot square with the claustrum
interpretation is that it is constantly side-splittingly funny. Now there
can be humour in the claustrum: in Beckett’s Endgame (1958), as vivid
an evocation of the anal claustrum as I could hope to find, Clov says
“If I don’t kill that rat it’ll die.” But this is gallows humour. In Ulysses
(1922a) and Finnegans Wake (1939), Joyce offers a spectrum of laughter
much more generous and life-enhancing, running from metaphysical
wit to slapstick.
Consider the Cyclops scene: a working-class pub; a place of hos-
pitality, bonhomie, meanness, pretentiousness, spite, gossip; a place
where life is down-to-earth or heroic, celebrated, ridiculed, reviled,
mourned; where food and drink offer the chance to feast with the gods
or make a pig of oneself; where singing can be uplifting and beautiful
or a social embarrassment; and so on.
Against this background, Bloom is attacked for his Jewishness by
the Citizen and counters triumphantly by pointing out that Jesus was
a Jew. He then flees the pub, pursued by the Citizen/Cyclops and his
barking dog, hurling an empty biscuit tin after him (think of the din
on the cobbles). Heroic, mock-heroic, triumphant, a rout, magnificent,
ridiculous? The lot.
Or think of the scene where Gertie MacDowell, crippled and iso-
lated, drowns herself in sentimentalized romantic fancy and shows
her knickers to a masturbating Bloom while the Host is elevated at
Benediction in a neighbouring chapel. Grubby, pornographic, blas-
phemous, of course: but also heart-warmingly accepting and sympa-
thetic—what else has the poor girl got? The claustrum interpretation
doesn’t leave any room for Joyce’s essential warmth and breadth of
vision.
When it comes to Finnegans Wake and its altered ending, I’m not
sure I understand what Adams thinks Joyce essentially discarded. I
think of two passages: the first from Anna Livia Plurabelle: where

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 208 david mayers

Shem (Irish for James) has been renamed Mercius (the grateful, the
merciful, the forgiven, the messenger and how many more?).
With a beck, with a spring, all her ringringlets shaking, rocks drops
in her tachie, tramtokens in her hair, all waived to a point and
then all inuendation, little old-fashioned mummy, little wonderful
mummy, ducking under bridges, bellhopping the weirs, dodging
by a bit of bog, rapid-shooting round the bends, by Tallaght’s green
hills and the pools of the phooka and a place they call it Blessing-
ton and slipping sly by Sallynoggin, as happy as the day is wet,
babbling, bubbling, chattering to herself, deloothering the fields on
their elbows leaning with the sloothering slide of her, giddy-gaddy,
grannyma, gossipaceous Anna Livia.
He lifts the lifewand and the dumb speak.
 Quoiquoiquoiquoiquoiquoiquoiq! [p. 194]
Hardly claustral: rather, mummy’s little duck, full of questions, luxu-
riating in the beauties of mummy’s body. And, some 200 pages later:
Three quarks for Muster Mark!
Sure he hasn’t got much of a bark
And sure any he has it’s all beside the mark.  [p. 383]
King Mark, cuckolded like Bloom; Mr. Mac, the eponymous Irishman,
Everyman, to be given three cheers. Because we’re all sons of Anna
and all loved, despite our manifest failures and shortcomings. This last
is a reminder of the judgement passed on Bloom in the Circe scene
that Adams mentions:
You’ve made your second-best bed, and others must lie in it.
Bloom is a cuckold. He is not a hero with magic weapons, so rather
than coming home to kill the suitors, he lives with them. Yet he gets
three quarks and a Shakespearean mention. And how many ways do
we interpret “lie”?
I once had a patient in work with whom I was much helped by
Donald Meltzer’s thought. In the beginning he brought a dream where
he was in an underground kitchen with a tribe of cannibal brothers who were
cutting their wrists, dropping blood into a cauldron of mother’s shit and eat-
ing it. He was expected to join in, but was too scared.
He spent many years dreaming of trying to escape this anal claus-
trum, but was so afraid of the outside that he went back in. Gradually,
he was able to dream of living outside and learning to survive there.
In his last session with me he brought this dream: he was coming to have
lunch with me in a college that was mine but not his; when he arrived, the

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 trapped in a claustrum world  |  gaudete 209

college had many qualities of a mausoleum; we had a pleasant lunch, but he

was acutely conscious that we should not meet again; he left and walked sadly
to the station; suddenly he saw a little house for sale; his mood lifted as he
realized that he could buy it, furnish it himself, and live there with his father.
I think both Joyce and Beckett would have appreciated that.

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 CHAPTER FOURTEEN

A mind of one’s own:

therapy with a patient contending
with excessive intrusive identification
and claustrum phenomena

Tara Harrison

T
his chapter chronicles the first years of therapy with a patient
contending with both external and internal intrusive forces,
leaving her struggling to form an authentic, thinking mind. I
show how Meltzer’s concepts of intrusive identification and claustrum
phenomena have provided a crucial framework to help understand
this patient’s internal system.
Donald Meltzer initially used the term “massive projective identifi-
cation” (1966, p. 17) to describe the excessive use of projective identifi-
cation as conceptualized by Melanie Klein. He shifted to a qualitative
view with the term “intrusive identification”—that is, an omnipotent
phantasy of forceful intrusion into an external or, crucially, an internal
object in order to control it, and eliminate its “otherness” (Meltzer,
1986b, p. 69, quoted in Fisher, 1999, p. 233). The aggressive quality
of the projections has a significant impact on the internal containing
function:
. . . the violent nature of intrusive identification destroys the con-
tainer, the place for maternal alpha function. The container is now
transformed into a claustrum, a rigid prison brought about by the
intrusive process either of active penetration or of being sucked in.
[Gosso, 2004, p. 21]
The work with the patient described here demonstrates the severe
impact of intrusive identification on internal object relations. It depicts
210

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 a mind of one’s own 211

the difficulties in trying to reach a patient whose inner world is rigidly

encapsulated, so unlike maternal containment, “which wraps round
and protects the baby, adjusting itself to its spatial and mental needs,
and favouring creativity” (p. 21).
The patient, Olivia, was 35 years old at the start of our work, and
lived in London. She described herself as having a chaotic life his-
tory, particularly during her university years when she developed
an eating disorder, and was “acting out” (her term) in various ways.
She linked the timing of her bulimia with moving away from home,
and she spoke at great length about her intense relationship with her
domineering mother.
According to Olivia, all the disturbing chaos was in the past. She
had a grip on her eating disorder, and she was now in a better situa-
tion. Olivia was living with her long-term boyfriend, a GP. Their social
circle was made up of doctors, psychologists, and psychotherapists,
and she had learned a therapeutic language, albeit a rather clichéd
version. She informed me that she had been “avoidant” or “regressed”
or was “acting out”, and she referred frequently to her boyfriend’s
diagnoses of her symptoms. During our initial meeting, Olivia told
me that she was keen to use the couch right away. She had a friend,
she said, who took years to get on the couch. Olivia described dinner
parties where her friends would discuss their therapies and therapists.
I wondered if Olivia felt that she too should have a therapy to bring to
the table. Perhaps she felt she could appear accomplished at “being in
therapy”, having already established a sophisticated-enough defence
to avoid real contact. Perhaps she brought into the consulting room,
from the first session, her tendency to be what she would call “adap-
tive”—that is, her expectation that she would have to shape herself to
the requirements of the therapy.

Intrusive identification
in relation to the patient’s external objects
Olivia’s intrusive relationships were most clearly demonstrated in her
presentation of two important people in her life: her mother and her
fiancé.
Authoritative and charismatic, her mother, as described by Olivia,
invaded Olivia with expectations and assumptions about who Olivia
was. Olivia felt she had grown to fit the space imagined for her by
her mother; if she revealed aspects of herself outside that shape, she
felt the response from her mother was terrifying. Olivia came from

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 212 tara harrison

a ­privileged background, and she had benefited from the family

resources, having extra French lessons, going to a pony club, and so
on. But every memory was associated with some sort of assault—her
mother hitting her on the head with a riding boot on the way to pony
club, for example. Her mother may have assaulted Olivia’s head
(invaded her mind), but she reportedly put Olivia “at the end of the
corridor” as a baby, so that she didn’t have to hear her constant crying.
Because Olivia spoke in psychological jargon, it was difficult to
connect to her words, but I did think these descriptions described
her paradoxical experience of feeling both invaded and neglected by
her maternal object. She spoke of childhood illnesses and accidents,
glandular fever, tonsillitis, a broken bone at only 18 months old. She
had asthma as well as many allergies and intolerances to foods, which
made life difficult for her. They were, perhaps, ways to get attention
that she very much needed, but at great cost to herself. Strikingly, her
mother had never been to Olivia’s home: the assumption was that
Olivia would travel to the village where her mother lived. “Mother’s
village” would become an important symbol for us throughout the
therapy. Olivia’s dreams were frequently located in her mother’s vil-
lage. In one dream, Olivia is driving around her mother’s village and she
crashes the car, smashing her face against the steering wheel. In another
dream, she drives around her mother’s village and runs down two dogs
that are killed and left at the side of the road. It seems that she feels her
mother’s “management” of them has injured both her and her brother.
Olivia’s association to the dreams is that, if she is at the steering wheel,
the results can be catastrophic. She is better as a passenger in a vehi-
cle. I wondered if there was a road out of mother’s village that could
become available to her in her dream-life.
Olivia’s fiancé was, as she portrayed him, another dominating
force. A specialist in psychosomatic symptoms, he would provide
absolute diagnoses of her symptoms and anxieties: “You are acting
out”, “You are suicidal”, or “You’re psychotic. I’m going to have you
sectioned!” Olivia seemed to cling to his absolute diagnoses, however
aggressively and impatiently they were put. She once fainted while he
was away on a sporting trip. He diagnosed a “pseudo-faint because
I was away”. He may well have been along the right lines, since she
certainly felt lost without the dominant figures in her life, but diag-
nosing Olivia substituted for understanding or containing her. Some-
how it appeared to give Olivia a sense of being held, albeit rigidly.
It seemed that Olivia had recruited a partner who maintained her
mother’s model of rather forceful communications and, like mother,

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 a mind of one’s own 213

seemed certain about who she is and what goes on inside her. Olivia,
it appeared, perceived herself as a passive receptacle, condemned to
accept the tyrannical management of an intrusive object.
From Olivia’s point of view, these characters, so intrusive with their
communications and projections, were impervious to any attempt from
her to reach them. She reported that she would become increasingly
more desperate, employing tears and tantrums to try and impact them,
until she gave up and locked herself in her room with headaches and
in despair. James Fisher describes the “not-good-enough mother who
can neither recognize nor respond to the gesture of the infant”, and he
suggests that “the substitution of her own gestures for those of the infant’s
is a tyrannical move” (1999, p. 46; emphasis added). He goes on to
describe the potential impact of this tyranny on the subject when he
observes how “every false-self personality structure hides in it the
tyrant, and one only has to observe such compliant persons when the
tables can be turned” (p. 46). Olivia’s reported tantrums and demands
seemed to reflect Fisher’s observation. I imagined Olivia’s migraines
as the pain of her banging her head against a brick wall—and I often
had that feeling myself throughout the work!
Despite these colourful stories, the experience of actually being
with Olivia in the consulting room was strangely hollow and empty. I
often felt blank and dazed, followed by a feeling of panic that I would
never be able to understand or help her.
Significantly, the assessor who first met with Olivia noted a similar
experience, ending her report with this insightful note: “In case all this
sounds a bit sunny and easy, I would like to put down a few thoughts
about the countertransferential feelings I had with this patient. I nor-
mally see patients for assessment for an hour and ten minutes. With
this young woman, I quite soon found my eyes straying to the clock
and had an increasingly uneasy feeling that we were going to get
through it all too quickly, that we would grind to a halt well before
the ‘end’, and I wouldn’t be able to think of anything more to say to
her.” Like the assessor, I would find myself looking at the clock wor-
ried that time was moving so slowly and wondering how would the
session be filled.
Fisher, now reflecting on a paper by Michael Feldman (1989), con-
tinues thus:
The infant confronted with an impenetrable mother or parental
couple becomes increasingly desperate and this gives rise to two
alternative patterns. Either the patient makes increasingly violent
attempts to get through to this impenetrable object, or it withdraws

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 214 tara harrison

to the blankness of a hopeless situation that it cannot face. Probably

with most infants in such a situation, the former gives way to the
latter. [Fisher, 1999, p. 46]

Over time I came to understand both the assessor’s experience and

mine as a countertransference experience of Olivia’s blankness of
mind. In contrast to the earlier “cry for help” tantrums, she had given
up on having her projections and communications taken in, under-
stood, and transformed by a penetrable, receptive object.
As we approached the first break, which fell quite early in the
work, Olivia described her morning before she came to the session.

Olivia:  So this morning I was in a really bad mood. I really didn’t

want to come today. I had a tantrum in the bathroom. I was
feeling ill and wanted to cancel the session. I was banging
things in the bathroom and shouting. Nick knocked on the
door and shouted, “It’s all about the break, Livvy!” (laughs) . . .
So I can see that I’m acting out about our break.
TH (gently):  It feels like I’ve been made redundant.
Olivia:  What do you mean?
TH:  Well, it’s as though a therapy has already taken place—you
are upset and you express this. It is recognized and interpreted
as seemingly connected to our break—and all this before you
get here!
Olivia (pauses for a moment):  Mmm . . . I think I can be quite avoid-
ant of real contact. Nick says I have schizoid behaviours.

This snippet shows how hard it was to make contact with Olivia. She
has an alternative system already established, with jargon in place of
language and certainty instead of exploration. Olivia “knows” she
should be disrupted by the break and that this should be “diagnosed”
by an assured and certain therapist. Meltzer (1976a) called this kind
of false-self version of therapy the “delusion of clarity of insight”,
and he linked it to intrusion into the head/breast compartment of
the internal maternal object. Meltzer describes the internal mother’s
head/breast compartment as the source of richness, generosity, and
insight. If in phantasy the internal object has been invaded and con-
quered, there is a shift in perspective—the resources, as Meltzer put
it, get “vulgarized”. Genuine search for knowledge becomes a rather
grandiose possession of information. Through the intrusive processes,
the patient is fused with the internal object. She has done away with

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 a mind of one’s own 215

any difference between them, including the difference of generations

and of experience. This “pseudo-maturity” lacks genuine wisdom and
relies on the delusion of mastery.
It was difficult to imagine a spontaneous exchange. Instead, we
would have a hollow, empty version of a therapy that would at best
maintain the status quo. Olivia portrayed her father as gentle and pas-
sive, but rather weak and disappointing. He features in the therapy
more as an absent object or one with limited capacity to influence the
external and internal dynamics. I think at some level she associated
me with the gentle but impotent paternal object, and she relied on her
fiancé’s brutal but “exciting” form of therapy, finding me rather dull
in comparison.

Internal situation
These relationships seemed to reflect Olivia’s internal object relations,
which also seemed to be characterized by tyranny and compliance.
We started to understand more about this through Olivia’s posi-
tioning of her handbag in the consulting room. At the start of every
session, she would place her handbag right next to my bag, even
though it was quite awkward for her to get to and it meant we had
to cross each other en route to the couch or chair: “It’s as if you expe-
rience where I place my bag as an instruction for you. This is how
you find a place for your bag.” Olivia was initially puzzled by my
observation. She could see that we crossed each other in an awkward
way because of the bag, but she could not see that there could be
somewhere more convenient for her to put her bag, a place that might
suit her better. Already in the consulting room she felt like the passive
receptacle for my instructive gesture. I wondered whether her bag
stuck to mine indicated an attempt to attach adhesively. When projec-
tive identification fails, Meltzer hypothesizes that intrusive identifica-
tion or adhesive identification can take its place. I wondered if there
were times when Olivia unconsciously presumed that her objects, so
unreceptive to her communications, had no space inside them, and so
she would try to attach adhesively to the outside layer. It is possible
that she would oscillate between attempts to get inside and attempts
to attach to the outside of her object.
I think it was highly significant that, around this time, Olivia had
started talking about two of her friends who had become pregnant. She
had been quite scathing about their decision to have a baby and was
quite sure that pregnancy was not for her. Yet just a few weeks later,

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 216 tara harrison

Olivia told me that she, herself, was newly pregnant. She described the
conception as accidental and quite a shock. I found myself wondering
if she had, quite unconsciously, experienced her friends’ pregnancies
as an instruction to become pregnant herself. And yet this would
indicate a seriously confused internal system.
A little later in the therapy as Olivia’s pregnancy developed, there
seemed to be more evidence to support this theory. One of her friends
suffered a miscarriage, and she told Olivia about this over a weekend.
On the Monday morning, Olivia felt unwell: she felt “tightness” in
her abdomen and strong sensations in her pelvic area. She became
alarmed, got off the bus, and went to hospital, cancelling our session.
During the course of the day at the hospital, perhaps as a response
to her anxiety, Olivia underwent three internal examinations. At this
point, she started to bleed, and by the end of the day it was Olivia who
was dealing with a possible miscarriage. Eventually the light bleeding
stopped and everything settled back down, but the pregnancy seemed
to have been potentially endangered by the day’s events. I was starting
to understand this as a process whereby Olivia herself perceives an
intrusive and instructive quality in her object’s communications. She
could not yet find her way to a kind of therapy in which we might
be able to think together and make a distinction between her friend’s
pregnancy and her own. It is quite literally a con-fusion: a fusion with
the identity and experience of the object, and there seems to be no
choice about it. Any attempt to understand her is misconstrued as an
instruction, and she is condemned to adjust to and even “suck in” the
hostile communications. It is a very distorted version of introjection.
It was a core issue in Olivia’s psychopathology and put her, I think,
in considerable physical and psychic danger.

Evidence of internal claustrum phenomena

Over the early months of her pregnancy, Olivia suffered from quite
severe morning sickness. An acquaintance had informed her that
morning sickness was an indication of ambivalence about the preg-
nancy. Olivia was deeply ashamed that she was “acting out” in this
way. She thought she had to get a grip on the sickness—that is, on her
ambivalence—and make sure it could not be seen.
Despite efforts to think with her about the credibility of such an
absolute theory, Olivia clung to the premise that her ambivalence was
a sign of being defective. She resisted the notion that mixed feelings

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 a mind of one’s own 217

about her pregnancy might be acceptable and we could think about

them together. The need for certainty left her shifting from one stance
(“I want this baby and I omnipotently became pregnant without even
trying”) to another (“I don’t want a baby and everyone knows I don’t
because I am demonstrating it through my morning sickness”). She
seemed to experience thinking as an internal act of violence, leaving
her despairing. During a morning session, just before she was due for
a scan at the hospital, Olivia spoke of her hatred of the scans: “They
show what’s inside you. I keep saying to the nurse, ‘Only show the
baby! Don’t move it around . . . I don’t want to see anything in there’.”
I asked her what the scan might show, and she answered with a shud-
der, “Oh one of my organs . . .”.
I suggested that she was afraid that our therapy might reveal
something that she feared was bad or unacceptable inside her. There
was a pause before she went on to tell me about a dinner party that
she had attended, where she had heard a story about an acquaintance
who had discovered a “dead twin” inside her. It was a teratoma she
was describing, I think: a tumour containing tissue or organ compo-
nents such as hair, teeth, and bone. She has never been able to forget
this image, Olivia said, because it resonated with her so powerfully.
Olivia started to describe a “creature” inside her. “It is a baby”, she
said, “but its face is old. Yes, it’s old but it never matures or develops.
It looks like Gollum from The Lord of the Rings. Gollum in the swamp
. . . that’s what’s inside me.” This was a very striking dream image
indeed. Olivia was allowing us even deeper into her internal world.
Meltzer describes an internal maternal object, built in phantasy, whose
internal structural design borrows its form from the external counter-
part, with an outside and inside with different chambers or compart-
ments. Meltzer posits that a patient can “helter-skelter” through the
compartments of the internal mother. And it seemed to me that Olivia
was moving from the pseudo-maturity and superiority of certainty, so
characteristic of the head/breast compartment, down into the darker,
bereft world of the rectal compartment. Her primitive sensations
are projected into the rigid, toxic rectal compartment of the internal
mother. Here, no containment is available, only encapsulation. With
no hope of the sensation being given language and symbolic mean-
ing, it is a nightmare version of containment. I think back to Olivia’s
dream situated in her mother’s village where she drives around in her
car and smashes her face on the steering wheel. I can understand this
now as a picture of Olivia feeling trapped inside a “compartment” (the

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 218 tara harrison

car) of the maternal object (mother’s village) where it is not possible to

develop her own thinking, and thus her identity is severely deformed
(her smashed, disfigured face). Now she provided us with the dream
image of Gollum living in the swamp: a dream image, to my mind, of
a primitive, infantile part projected into the rectal compartment of the
internal mother. Meltzer imaginatively describes the shifts of percep-
tion that occur in this claustrophobic environment. It is “a world of
assumption rather than thought, where right means either the law or
precedent, where to be genuinely different means to be detected as an
intruder . . .” (1992a, p. 92). It is a totalitarian and persecutory regime
where spontaneity and uniqueness is prohibited. This describes the
impression that I have gathered of Olivia’s inner world. She is often in
despair and exhausted—she seemed to be undergoing an almost con-
stant internal assault from a persecutory regime. As far as one might
be able to imagine the deeply unconscious world of internal object
relations, it seemed that Olivia’s internalized experiences and objects
are fixed and rigidly managed. Olivia resists an authentic therapy,
because she simply cannot imagine a creative, thoughtful container–
contained dynamic that could liberate the internal objects to mature,
develop, or combine. Reflecting on her dream image of the teratoma,
I imagine fragments of infantile experience—part-objects and bizarre
objects (beta-elements, in Bion’s terms)—projected and paralysed in
the claustrum, with little hope of transformation so that Olivia could
have access to a richer and freer internal life.

Technical issues
During her pregnancy, Olivia became very frightened that she was
going to lose her mind. Her anxieties seem to be connected to her
partner Nick’s history. His mother had become extremely disturbed
during her pregnancy with him, and Nick was born in a psychiatric
setting. During Olivia’s pregnancy, he frequently described her as
psychotic and requiring sectioning. Olivia experienced this as a sure
prediction, and it caused her a huge amount of panic. Nick’s exces-
sive projections and Olivia’s claustrum psychopathology are knotted
together. I would present the possibility that an object, as James Fisher
puts it, can “protect itself against intrusion, closing its orifices against
an intrusive attempt to penetrate” (Fisher, 1999, p. 228), but Olivia
found this concept difficult to really engage with.
Just as difficult for Olivia to acknowledge was the notion that her
own lively, creative, and aggressive aspects—indeed, some of the

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 a mind of one’s own 219

much needed aspects that might propel her forwards—get split off
and projected into her fiancé. She and Nick seemed to be caught in
a “projective gridlock” (Morgan, 1995) that felt to Olivia like a ver-
sion of togetherness and intimacy but is closer to collusion. It seemed
immensely exciting at some level for Olivia to be at the mercy of such
dominating objects, but the fixedness of their gridlock hampered pro-
gression in the therapy. The teratoma that Olivia imagines inside her
seems to be a mass of fragments of identity. What belongs to whom?
I suspect it is still too early to attempt unravelling, as that which is
truly Olivia is still embryonic.
There were other challenges to the therapy. Olivia missed many
sessions, and in this way the fragile link between us was broken. Any
corresponding internal linking was impaired too, I think. Language
would become jargon, and I would find my comments repeated back
to me, with meaning drained. The insight was hijacked in the system
of the claustrum, and in this way Olivia maintained control of the
culture within the consulting room. Like Olivia, I felt unable to expand
and develop outside preconceived expectations. I tried to find ordi-
nary ways of putting things, but my non-psychological vocabulary
caused suspicion that I must be underqualified and ineffective, rather
than actually having a capacity to not know and to discover. Olivia
was able to confess, at least, that Nick thought I was rather ineffectual.
I featured in a significant dream: I am a small, dreamy “London-
type” and Olivia discovers that I am a lesbian. I have a large, bossy wife
from the countryside who dominates me. I put it to her that she ima-
gines I have an internal world like hers, dominated by a larger,
managing aspect who comes from the countryside—a reference to
“mother’s village” and the intrusive maternal object, I think. As
Meltzer observed, the patient assumes that “this interior world is
all there is and the analyst is as much caught up in its net as is the
patient” (1992a, p. 102). This would indicate that, stuck in the same
swamp, I would be able to be of very little help to Olivia. She strug-
gles to perceive me as an object that could help her, and I feel like I
am banging my head against a brick wall to try to reach her. It is an
important countertransferential situation, however difficult it is to
bear. Perhaps the most hopeful aspect of the dream is that there is a
“small me” who has a capacity for dreaming. I might be able to be
uncertain, to explore, and to symbolize. Olivia may need to feel that
I can enter her claustral world with her and for her, but that I can
also exit and be able to think creatively. It might help her with the
idea that she, too, could leave the claustrum.

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 220 tara harrison

Returning to her mother’s village—

the allure of the claustrum
After two years of working together, Olivia told me that she was mov-
ing many miles away, back to her mother’s village. Indeed, her mother
had given her a huge amount of money to help her buy a cottage in
the village. Olivia felt she had no other option, since she found caring
for her baby very difficult and she needed support. This was extremely
discouraging, and I went through a period of despondency that things
could never change for Olivia—a reflection of her doubt that there
was any way out of her prison. Over the weeks that followed, I
started to present, more actively, a symbolic “mother’s village”, not
the actual, geographical one but the internal rigid trap of her earlier
dreams. I started to wonder with her whether she could move back
to her mother’s actual village but resist the urge to settle back into
the encapsulating system. Olivia would have to travel a significant
distance to come to therapy.
To my surprise, Olivia maintained a tentative link with me and
managed a once-weekly therapy. She decided to stop using the couch
and sat on a chair. I felt encouraged by her rejection of the couch. It
seemed that she was able to be more authentic about what she could
truly manage, despite how that might appear. I think Olivia was start-
ing to acknowledge and tolerate separateness between Nick and her.
Nick’s mother died during this period of the therapy. During a heated
row, Nick cried out to Olivia, “You are dead inside.” Olivia brought
this to therapy as an example of something belonging to Nick that he
needed to get rid of into her—and she was able to resist taking it in.
This is hopeful since, as Meltzer put it, “the potentiality of a space,
and thus the potentiality of a container, can only be realized once a
sphincter-function has become effective” (Meltzer et al., 1975, p. 226).
Olivia now has the challenge of differentiating herself from her baby.
Her baby resembles her in appearance and shares her food allergies
and other physical conditions, so there are considerable grounds for
confusion of identities. Olivia’s wish to be a receptive and responsive
mother, and an advocate for her child in the external world, has urged
her on in the work of separation and self-realization.
Her mother had left Olivia at the end of the corridor where her
cries would not disturb her. Olivia has created a long corridor between
us through her move back to her mother’s village. But she travels
the long distance, albeit sporadically, towards someone who wishes
to listen and respond to her cries. As Olivia starts to create and pro-

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 a mind of one’s own 221

tect a private internal space, she may be able to relate to her internal
objects in a less intrusive, controlling way too. This work, done deep
in the unconscious, relies upon a respectful, reciprocal, imaginative
intimacy. Crucially, it must be intimacy established from the outside
of her internal objects. If she can ease the rigid, intrusive culture in
her unconscious life, her internal objects may be “free to come and
go”, to develop and combine—so that she would have access to more
mature and creative internal resources (Cassese, 2002, p. 11). Olivia
may discover she could bear to be uncertain, to have mixed feelings
and to develop a mind of her own.

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 CHAPTER FIFTEEN

Battered women lose their minds

Cecilia Muñoz Vila & Nubia Torres Calderón

T
he material presented here comes from a three-year research
project conducted by the Psychology Faculty of Javeriana Uni-
versity, Colombia, which took place in a shelter for battered
women and their children, in Bogota. The authors of this chapter were
supervisors of the project and thesis directors and were responsible
for a research group of five students. The dissertations included the
presentation of three individual psychotherapeutic process record-
ings, which were supervised and analysed using the meditative review
method described by Bion (1963, pp. 99–100).
In total, we observed 40 women whose abusive relationships since
childhood and currently with their spouses were described in detail in
these protocols. As the stories of these battered women were reviewed,
the research team had the impression that they were entering a terri-
tory of human misery and dehumanization that was common ground
for these women, their aggressors, and their families, as well as for
the neighbourhood they lived in. An atmosphere of despair and rage
could be sensed by the research group, as if the psychic weave of the
chronicles permeated the way they listened to the distressing stories
born out of the presentations. The same thing happened when we
reviewed the material for a second time, long after the original dis-
cussion.

222

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 battered women lose their minds 223

The therapists working with these women were confused by the

intensity of the drama in the accounts, and this made it difficult for
them to understand the phenomena they were observing. The way
these women had experienced their relationships persisted in their
relationships with the staff and therapists in the shelter. The therapists
either felt an urgency to do something immediately or were paralysed
by a helplessness born of the terror and submission in the experiences
of maltreatment and abuse. Rather than transference and counter-
transference, these stories seemed to generate actions and reactions
in their listeners.
In cases where there had been early sexual abuse, there was denial
and refutation, which prevented them grasping what was evident.
Meanwhile, the students who worked in the shelter as psychologists
or social workers were deeply affected by the suffering of these bat-
tered women, even when they had no direct contact with them; many
broke their contracts and fled to protect themselves. This showed the
impact on the therapists, who were in contact with experiences in
which the annihilation of the self and the destructive urgencies of the
id prevail and the tyranny and seduction of the object are simultane-
ous and become intolerable. Above and beyond this, as therapists,
we are unlikely to be adequately prepared for such overwhelming
situations.
Once the research team found a conceptual framework within
which to understand the material, new questions and understandings
arose: what makes a battered woman stay with her batterer and allow
this vicious circle to be repeated for years? How can we understand
these states of the mind? What conceptual frameworks can shed light
on this phenomenon to generate therapeutic models specific to this
population? How can we assist these women in their allotted two
months in the shelter when we know that this time is too short to effect
change in their social and psychic realities?
Throughout these three years, we found certain conceptual
frameworks that accounted for the compulsion to repeat and to
invite punishment. These battered women permanently function in
a rotation of basic assumptions, as described by Bion (1961): going
from dependence through a long process of fight and flight and
ending up in pairing, which brings about the illusion of hope for
a better future and the renewal of dependence. Dehumanization is
also predominant as a form of existence, with the disappearance of
social rules that enable the preservation of groups and c­ ommunities.

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 224 cecilia muñoz vila & nubia torres calderón

­ ltimately, this leads to individuals pursuing survival without

U
regard to the needs of others.
Likewise, we found an imbalance in the influence of the psychic
structures described by Freud as essential components of the psy-
chic apparatus that lead to both an invasive pressure of the id and a
destructive social reality. Thus the ego is left under the influence of
objects in external reality and lives in fear of harming these objects
or being punished by them if they are challenged. In this situation,
the ego becomes defenceless against ill-treatment, and its functions
deteriorate or become unable to develop.
Meltzer’s concept of the dimensionality of psychic space (Meltzer
et al., 1975) provided a helpful framework to think about the dynamic
of battered and battering women and men, most of whom presented
the one- and two-dimensional spaces that impaired the emergence
of the internal world, the psychic space for meaning and symboliza-
tion. For the most part, they functioned in one dimension, in constant
action–reaction and circumstantial attraction–repulsion. In the senso-
rial field they were two-dimensional: able to contact the outside world
and experience physical sensations, but only capable of relating to
others by imitating their sensorial qualities. Their existence is guaran-
teed by the presence of the other on the outside, which allows them
some awareness of sensorial contact. Glances, words, sounds, skin
contact, smells, and flavours experienced by the perceptive apparatus
catch their attention and make them realize what nature and the social
world have to offer. Often, the need for closeness takes precedence,
impeding their capacity to consider the kindness or wickedness of the
object. Similarly, the concepts of sensorial and structural dismantling
described by Meltzer seemed to be present in many of these battered
women. Another important finding was that the functioning of these
women’s families was gang-like or inverted.
Green (1986), focusing on Freud’s psychic apparatus, reconsiders
the supremacy of the id with the ego at its service, which inhibits
the development of the Oedipus complex or its dissolution for the
configuration of the superego; prohibition of incest is disregarded,
and so life revolves around the fear and the threat of castration,
resulting in random acts aimed at claiming possession over the
other to ensure the existence of the powerful, unharmed penis. This
dynamic is similar to the one described by Meltzer in his book The
Claustrum (1992a).
The work that we present here stems from a wish to find human-
ity amidst the miserable life of many human beings living in a world

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 battered women lose their minds 225

dominated by destruction and death. It is based upon the work of

therapists who tried to reach people who were both destroyed and
destructive, by understanding their mental state. They remained side
by side with them, as alive and available as they could be, in spite of
their feelings of impotence, which they were only able to overcome
in the discussion of their final reports. In this process, they came face
to face with little girls who had been battered and abused and who
went on to find groups or individuals who continued to maltreat
them; these girls, filled with hatred, hopelessness, and rage, would
take revenge and lead others to suffer the same ill-treatment and abuse
that they had suffered.
The dehumanization of these battered women was evident. The
environment in which they had survived evoked Turnbull’s painful
experience with the dehumanized tribe of the Ik, described in his book
The Mountain People (1972). A life of scarcity and hunger had starved
the tribe of all traces of sympathy, making them distrustful and cruel;
they made fun of the difficulties of others and competed endlessly,
even with their closest ones, for the morsel that would keep them alive
in a hostile environment. This situation caused isolation in the fami-
lies of the tribe and rupture in the relationships between husbands,
wives, children—each one concerned only with their own survival.
On the cover of the book, Margaret Mead wrote, “As Turnbull’s writ-
ing weaves in and out between outrageous acts and his own outrage,
he emphasizes again and again how fragile the structure of a society
is.” Turnbull suggested that the breakdown of social organizations
and the deterioration of value systems permeates and disrupts the
psychic functioning of human beings who grow and develop in these
dehumanized social and cultural settings.
This would suggest that in order to survive, people will abandon
their emotional, social, economic, and political ties; they will give up
values, beliefs, and feelings related to love, hope, sympathy, esteem,
help, cooperation, care, and protection, because they consider them
an impediment to their survival. Society and communal life become
dangerous and are replaced by a survival system devoid of human
emotion and warm social interaction. It is undeniable that throughout
history, some groups of people have assumed extreme positions of
inhumanity towards other groups and built life styles that have per-
petuated dehumanization. Violence in Colombia, for instance, testifies
to the cruelty that dominant groups exert on populations that they
attack, decimate, slaughter, and destroy in order to take over their land
and increase their power.

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 226 cecilia muñoz vila & nubia torres calderón

Magdalena
Magdalena’s breakdown
“Magdalena” was a 29 year-old prostitute who had taken refuge in
a shelter for battered women and their children in Bogota. It was the
second time she had sought therapeutic help. From her first session,
she confronted us with the cruelty she had suffered and exerted since
she was little. She told us how she had been abused by her brother-
in-law, the father of her older sister, and a carpenter who used to give
her money. She told the story of her relationship with a paramilitary
man that made her the most wanted and expensive woman in the
brothel. Things went sour when he demanded that she abort the
child they had conceived “by mistake”, arguing that he did not like
to “leave a trace of his actions”. When she refused, he sent hit-men to
beat her up. They hurt her badly, but—as always—she felt nothing,
alone with her “clouded mind”. She was simply the woman who was
abused by everyone, who felt nothing, because “it is not as terrible as
people may think”.
She described her current situation as the result of multiple expe-
riences of work exploitation, poverty, starvation, and sexual abuse.
When she reported her brother for raping her daughters and niece,
she described him to the police as an “ill man, criminal, thief, and
rapist”. Her mother cursed her for this. The material of her stories was
composed of dramatic adventures lived with indifference; her own
experiences were felt to be someone else’s. Her accounts were made up
of scattered stories. Nevertheless, amid this violence, abuse, maltreat-
ment, and attempted murder, two good figures appeared: her father,
who had always taken care of her and loved her, and Miguel, her cur-
rent boyfriend, who bewildered her with his unconditional kindness
because she thought that, “in the end, all men are women abusers”.
She would go from being the bad woman, condemned to poverty
and filth, to being the great queen of the brothel, the one with the best
income and largest number of clients. She claimed that she “never
drank or sniffed anything” but told how she would “come home com-
pletely destroyed” or stopped by at her friend Miguel’s place, so that
other people would not see her like that: showing her worst face to
the loved man and her best face to her abusers was a constant pattern.
As she shifted from being good, rich, and powerful to being bad,
ugly, and poor, so her objects changed from good to bad at a glance:
from great helpers to great abusers, from caring figures to battering
figures. Her bad sister could suddenly become her good sister. The

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 battered women lose their minds 227

only constant was the endless sexual abuse: fathers and daughters,
brothers-in-law and sisters-in-law, adults and children. The shelter
and protection that she acknowledged they could give her could
become the nastiest prison, with the worst conditions of abuse and
maltreatment. She even thought of going back to the brothel, despite
the death threats of her former client, because there she could at least
make a living for herself and her daughters.
For Magdalena, neither sensations nor emotions helped her to dif-
ferentiate between her experiences. Her stories lacked symbolization
and meaning and were not organized in time and space; her only
tense was present continuous and she alternated between idealized
and denigrated persecutory places. In repeating herself, she conveyed
the absence of an object capable of making sense of these contrasting
experiences, with no one to mediate them.
Her disorganized sensory system seemed to have been damaged by
violent intrusions, which may have ruptured her perceptive sensory
matrix, making it difficult for her to discriminate, differentiate, relate,
or transform her experiences. In such cases, the end result is a broken
sensuality that makes women unable to feel, integrate, and make sense
of their experiences and to generate meanings. Magdalena’s internal
reality, suffused with trauma, threats, and concrete images of finding
a way out to a better future, oscillated, for no obvious reason, between
being persecuted to persecuting, from abused to abusing. It was as
though her body disappeared along with the possibility of perceiving
and remembering her experiences or making any sense of them; she
lost all sense of pleasure (Michel de M’Uzan, quoted by Green, 2002).
Her sexuality became her profession, disassociated from her body,
where the trauma was re-experienced time after time, masked by her
attempts to listen to the men who visited her.
This sensory breakdown became more evident through the
six sessions. The general feeling was that her discourse was fall-
ing to pieces and the association between events and words was
unclear; no time, space, sensation, emotion, image, or bonds with
objects remained long enough to become an organizing element. In
her mind, everything appeared and disappeared: nothing was sta-
ble and nothing remained. For this reason, she would turn to her
enemies for help, as if they could be her friends. Not even the scars
of physical violence remained in her mind: she would see them and
then forget them the next minute. One minute, she was a beauty
queen; the next, she was bruised and bloody. With these alternating
images, the essence of her existence was lost.

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 228 cecilia muñoz vila & nubia torres calderón

Magdalena told stories about repeated abuse by “ugly men”, who

gave her money that she would give to whoever needed it. Without
body sensations, feelings, or clear memories that could link together
and stay organized, she became simply a thing through which others
would pass. Her stories suggested that the only way she could survive
was by “clouding” her sensory apparatus. The ego was caught up in
an expulsive movement from the inside of her body, where there were
no differentiations, only abolitions. Since she could not build represen-
tations, everything was cloudy or void: she had nothing but percep-
tions, which moved back and forth between positive and negative,
leaving her feeling disorientated and in need of someone to give her
instructions. She was an ear that listened and an eye that saw, but she
did not have “common sense” (Bion, 1963) at the core of her attention.
She was a clear example of sensory dismantling and de-mentalization
(Meltzer et al., 1975).

Magdalena’s broken mind matrix

In Magdalena’s case, it seemed that nothing remained of the two-way
movement between container and contained that enables the devel-
opment of thought, meaning, and mind itself. All she had were frag-
ments, alternating in a disorganized manner, as pieces that appear and
leave the sensory scene. These movements are erratic because of the
lack of an organizing principle coming from the object or from the ego.
In addition, it is as if the two-way movements that facilitate inte-
gration by the discovery of a selected fact, which creates new constel-
lations of elements, did not exist, and the only remnants in the mind
were broken and disintegrated pieces of timeless experiences (Muñoz
Vila, 2011). It is like a sensory collage, randomly built by bringing
time, space, and objects together and apart. Good and bad characters
alternate and change their status. Times alternate, and it becomes
impossible to identify when a specific event takes place.
Magdalena seemed to pull her stories from up her sleeve until she
ran out of energy and words. These were not coherent narratives but
dispersed elements that came together by verbal contiguity or just
by accident so that the qualities attributed to her objects as well as
to her experiences was random. Bound up in discontinuous events,
Magdalena seemed to use her stories as a second skin (Bick, 1968). In
the absence of an internal space, the mechanisms of introjection and
projection could not work, making it impossible for her to reduce her
pain or develop her perceptual apparatus and her mental structure.

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 battered women lose their minds 229

Final considerations
From what we can see, the non-mental functioning of battered women
is the result of early experiences that damage the body and hinder the
construction of an adequate psychic apparatus. These women were
bombarded, from very young, with sensory experiences that exceeded
their physical and mental capacities, and they had nobody to prevent
this from happening. They had no object that could discriminate, dif-
ferentiate, and set boundaries for this sensory and bodily experience,
resulting in sensory dismantling and de-mentalization. All of them
lacked an object that might act as a protective screen from the intrusive
stimulation to which they were exposed: an object with the function
of a boundary for the overflowing impulses, so they were not forced
to eliminate their sensorial and mental apparatus.
The functions of Klein’s “good object” and those of Winnicott’s
“good-enough mother” became clearer with Bion and Meltzer’s work
on the maternal function and its relation to the psychic apparatus,
and the findings on infant observation published by Bick and Harris.
The mother—or her replacement—receives the anxiety of the baby,
contains it, thinks it, and returns it to the baby digested, creating the
possibility of developing a thinking apparatus. This makes it possible
for the sensory impressions of emotional experiences to be trans-
formed into alpha elements, thoughts, connectors, and organizers
of the experience of the world and its events as well as loving and
destructive impulses.
It became clear that we were facing serious thinking disorders
in the repetition of unrelated events in these women’s stories. In
Explorations in Autism, Meltzer differentiates between the secondary
obsessional mechanisms related to motivational or defensive splitting,
which aim for omnipotent control of objects to reduce anxiety, and the
primary obsessional mechanisms that are more related to a “breach in
the logic of cause and effect that leaps from the wish to its fulfillment
without pause, to achieve the means of the transformation” (p. 186).
He also focuses on the relation between the use of autistic and obses-
sional mechanisms and the impossibility of using introjection as “a
means to establish identity” and for “coping with the separation from
external objects”. Existing merely in the sensory realm, dismantled
and with a motor action–reaction ruled by attraction and repulsion,
the self finds it impossible to develop or to differentiate between itself
and the object. This highlights the absence of an internal world and
the fragility of existence in the external world.

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 230 cecilia muñoz vila & nubia torres calderón

Meltzer also states that “judgment” may be defined as a mental act

that, when verbally expressed, implies the presence of meaning and
the possibility of communication in a symbolic form (Cassirer, 1955)
through transformation (Bion, 1965). Thus, autistic and obsessional
mechanisms attack the ability to perform mental acts, since they do
not enable common sense or the attribution of meanings and symbols,
also impeded by the absence of emotion. For Meltzer, the aim of the
use of autistic and obsessional mechanisms in general is:
rendering an incipient experience meaningless by dismantling it to
a state of simplicity below the level of “common sense” so that it
cannot function as a “symbolic form” to “contain” (Bion) emotional
significance but can only, in its various parts, find articulations in a
random and mechanical sort. [Meltzer et al., 1975, p. 217]
He adds that emotional experience empty of meaning cannot be
used as a memory. In an emptiness of time and space, the remains
are events “dotted with disarticulated fragments of recollection and
image” (p. 217) shaped as thoughtless verbal pieces. According to
Meltzer, these disarticulated segments suspend vital movement and
impair emotional life and the integration of emotional and intellectual
development.
At the end of his next chapter, “Dimensionality as a Parameter
of Mental Functioning: Its Relation with Narcissistic Organization”
(1975b), Meltzer explores two-dimensionality and the rejection of psy-
chic reality, clarifying the confusion between the description of the
deterioration of mental functions and the deterioration of the aware-
ness of mental facts. He considers two-dimensionality to be not a state
of consciousness, interest, or attention, but an organization of the self’s
perceptual processing of the objects and the “world”; nor is it a state
of “thinness” of emotional life: rather, it describes how the self lives
in a two-dimensional space where the only possible contact with one’s
objects is from surface to surface. It is a life with no inside world,
where neither introjection nor mental acts are possible. This gave us
a framework to conceptualize the impoverishment of the ego in bat-
tered women as the absence of an object that performs the containing
function proposed by Bion, and Bick’s “second skin” function (1968),
essential for the constitution of the inside world and for the develop-
ment of ego strength.
In the case of these battered women, their mothers were absent
or unable to provide the maternal functions of perception, contain-
ment, and soothing of their children’s anxiety due to their own dif-
ficult circumstances or, perhaps, because of their own personality

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 battered women lose their minds 231

­ isturbance. These mothers are like the mothers in the Ik tribe, who
d
push their children into the world before they have been able to build
the psychic apparatus to perform the functions of perception, atten-
tion, consciousness, judgement, and reflection in relation to the world
and to themselves. These mothers do not assist in the introjection of a
protective object, one that can comfort and alert them, enabling them
to differentiate child from adult, good from bad, and self from object.
They may tolerate, even encourage, aggression and incestuous sexual
abuse. They also fail to provide the kind of integration that performs
differentiating and protective functions of awareness and alertness.
The absence of these objects and their functions leaves these battered
women as sighted but deaf, in some cases, and able to listen but blind
in others. They do not manage to articulate their experiences, a failure
that further impedes a helpful building of their own mind. As a result,
they remain trapped in an abusive situation, especially in a society in
which maltreatment and destructiveness are part of daily life.

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C&H_book.indb 232 23-Feb-17 12:30:10 PM
 Concluding thoughts
on the nature of psychoanalytic activity

Alberto Hahn

T
he content of our conference, as reflected in this book, bore
witness to Donald Meltzer’s enduring relevance, his inspiring
ideas, and his attitude of profound respect for patients’ relation
to their internal and external world—in particular to the infantile
parts of the self. During the conference, we heard repeated mention
of ­Meltzer’s legacy as a teacher and a thinker. The breadth of papers
showed how important this influence remains, both in our clinical
work and in our motivation to explore further the potential and the
boundaries of his psychoanalytic insights.
It is in this spirit that I want to address myself briefly to some
issues that have found their way into my own clinical work, the super­
vision of colleagues, and the process of teaching Meltzer’s life’s work,
for over four decades. Meltzer wrote widely about the nature of the
psychoanalytic processes he was observing, their theoretical connota-
tions, and their clinical and technical implications, and I think that the
foundations laid down in The Psychoanalytical Process (1967) 50 years
ago remain a beacon that throws a shaft of light on the worlds of the
two parties involved in every analytic process we engage in. This
view, which argues that our internal world determines our outlook
and ­creates the possibility of deploying our observational and analytic
function on the process, seems to remain a permanent fundamental

233

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 234 alberto hahn

source of interest and scrutiny. Consequently, I could not conceive

of the feasibility of developing an analytic relationship without an
in-depth knowledge of the unconscious variables that shape our char-
acter and, in particular, our countertransference. This knowledge,
which is part of what Meltzer liked to call our “equipment”, seems
to highlight questions about the nature of observation and the pro-
cedure that takes us ultimately to an understanding of unconscious
communications.
In reading the many accounts of his clinical cases, one is struck
by the sometimes mysterious ways in which Meltzer formulated his
understanding in terms of part- or whole objects, of qualities of
transference and internal object relations, and by his most vivid and
idiosyncratic way of apprehending and transforming mental pain
through the interpretation of states of mind that are always described
in a sensitive and coherent way. This way of making sense of the inter-
nal experience carries the essence of the containing capacity (of which
we so frequently talk) and is a stepping-stone for the integration of
split-off parts of the self.
I also believe that the opportunity to develop intuitive work points
to something more specific: it allows us to conceptualize our work
as deeply personal for each one of us, and it gives our patients the
opportunity to experience an intimacy with an object that is capable,
through his own relations to his internal objects, of gaining access to
deeper strata of his mind in order to have a view of the constellations
of his own and the patient’s unconscious phantasies.
In teaching Meltzer’s work, I have noticed the slow and always
puzzling and difficult process of learning that ensues for those who
come to it with a different mind-set and a different theoretical frame-
work. I am always struck first by the impact and then the inspiring
conviction that arises from his theoretical papers, but I find that the
area that creates a greater problem is the attunement to the clinical nar-
ratives that pepper his writings. This requires a decoding system that
is extremely personal in that it is fed by our own analytic experience,
our devotion to the method, and our capacity to not understand—as
well as to understand—another human being. The O of the patient,
as Bion formulates it, allows us to get close enough to the patient to
foster the intimacy required for the development of the transference
while at the same time understanding that the patient remains basi-
cally unknowable. This unknowability requires a state of “intuitive
receptivity” in our free-floating attention, which allows us to deal with

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 concluding thoughts 235

a multiplicity of uncertainties in the heat elicited by the transference–

countertransference interaction. This receptivity draws our attention
to our engagement or disengagement in this process, and it is my
experience that an approximation of these states of mind with our
“Negative Capability” is sometimes enough to bring about a mutative
shift in our patient’s emotionality. This provides the context in which
it becomes possible to change, through introjective identification with
the analytic qualities of an analyst who acquires the significance of an
object in psychic reality with ego functions and other parental capabili-
ties that promote and underpin the passage into a “depressive” view
of the world.
It should be understood that by “shift” I am referring to ­internal
changes brought about by understanding through empathy, as
opposed to counterproductive attempts to pursue behavioural or
symptomatic changes. In the last twenty years we have seen big
changes in the practice of psychoanalysis. Those of us who follow
the Kleinian tradition have witnessed a gradual distancing from
some of the core values that we learned from our analysts and
teachers. For example, unconscious phantasy and the understanding
of part-objects have given place to new para-analytic theories; work
with the infantile transference has been replaced by a discussion of
the intersubjective relation between the patient and the person of
the analyst in the here and now, with no reference to meaning or
symbolizations; and the interpretation of dreams has fallen away
as the “royal road to the unconscious”, to be replaced by a more
pragmatic understanding of the dream content with less reference
to internal emotional links. Witnessing the tendency to trivialization
or scotomization that affects the analyst’s observational capacities
is always a painful and dangerous experience, especially when it is
compounded with a state of denial of the psychic reality of the suf-
fering infant in the patient.
All clinicians have their own view about deviations from good
analytic practice and, indeed, about what “good” means in this con-
text. But it seems to me that we can compare that which we received
in our training and the many years spent in clinical practice with that
which is currently thought and practised by our young colleagues,
and we should feel free to question whether the ideas, theories, and
principles that underpin our view and theirs of current psychoanalytic
practice are enriching our discipline or impoverishing the possibility
of acquiring the knowledge that is due to our patients.

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 236 alberto hahn

This book clearly addresses these questions, and at the conference

it was heartening to hear Margaret Rustin, Maria Rhode, and Suzanne
Maiello do so with exceptional clarity and wisdom.
As a member of the organizing committee, together with Catrin
Bradley, Jonathan Bradley, and Margaret Cohen, I am very grateful to
them and all the other contributors to the conference and to the book,
as they confirm for us that we are following a tradition that keeps us
on the right track in our individual, personal, and professional devel-
opment. This is perhaps the best tribute we could have offered to the
memory of Donald Meltzer on the 10th anniversary of his death.

C&H_book.indb 236 23-Feb-17 12:30:11 PM

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In: Through Paediatrics to Psycho-Analysis. London: Tavistock Publica-
tions, 1958; reprinted London: Karnac, 1984.
Winnicott, D. W. (1952). Anxiety associated with Insecurity. In: Through
Paediatrics to Psycho-Analysis. London: Tavistock Publications, 1958;
reprinted London: Karnac, 1984.
Winnicott, D. W. (1960). The theory of the parent–infant relationship. In:
The Maturational Processes and the Facilitating Environment. London:
Hogarth Press, 1965; reprinted London: Karnac, 1990.
Winnicott, D. W. (1963). The mentally ill in your caseload. In: The Matura-
tional Processes and the Facilitating Environment. London: Hogarth Press,
1965; reprinted London: Karnac, 1990.
Winnicott, D. W. (1974). Fear of breakdown. In: Psycho-Analytic Explora-
tions, ed. C. Winnicott, R. Shepherd, & M. Davis. London: Karnac, 1989.
Winterson, J. (2011). Why Be Happy When You Could Be Normal? London:
Vintage.
Woolf, V. (1929). A Room of One’s Own. New York: Harcourt Brace, 1989.
Yeats, W. B. (1989). Poems. London: Macmillan.

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 INDEX

Abbott, E. A. (Flatland), 35–38, 68 Allnutt, L., xiii, 2, 81–94

Abraham, K., 8 alpha-elements, 229
absolute dependency, level of, 89 alpha-function, 111, 173
abused women: see battered women maternal, 210
abusive relationships, effect of, ambivalence, 180, 216
222–231 Ames, L. S., 148
acting-out, 211, 212, 214, 216 anaesthesia, orgasmic, 121
countertransferential, 122 anal compartment of claustrum, 196
adhesive identification, 19, 21, 133, anal masturbation, 196
215 analysis situs, 74
adhesiveness, imitative, two- analyst:
dimensional, 55 countertransference impact on, 7
a-dimensional Pointland, 35–37 personality of, split-off psychotic
adolescence, isolation in, 2, 95–107 element of, 161
adolescent isolation (clinical example: role of, to strike fire into patient’s
Esteban), 98 mind, 122
adolescents: analytic attitude, 112, 120
megalomaniac, 99 analytic communication, 124
paranoid-depressive, 99 analytic listening, 120
adoption, 81, 83, 85 analytic neutrality, 112
aesthetic conflict, 101, 117, 168, 169, analytic practice, deviations from, 235
171–173 analytic process, forces opposed to,
Meltzer’s concept of, 19 categories of, 122
aesthetic object and O, 166–175 Anisfeld, L., 199
aesthetic reciprocity, 117 annihilation, absence of protection
allegory, vs. symbol, 171 from, 157

249

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 250 index

annihilation anxiety, 37, 46, 64 (clinical example: Emilio),

anorexia, 96 38–54
anxiety(ies): work with:
annihilation, 37, 46, 64 dimensionality in, 19, 38
bodily, intense, primitive, 24 Meltzer’s, 9, 57, 173
claustrophobic, 19, 125 Tustin’s, 21
concept of, 10 autistic encapsulation, 71
confusional, 78 autistic enclave, 74
death, 50 autistic experience, complexity of, 75
depressive, 19 autistic functioning, two-
existential, 19 dimensional, 57, 58
infantile, 8, 177, 178 clinical example:
paranoid, 97, 98, 189 João, 61–64
persecutory, 11, 193 Rosetta, 59–60
primitive, 132 Tommaso, 58–59
precipitation, 77 autistic mechanisms, 229, 230
separation, 46 autistic patient(s), 82
unconscious, 111 clinical work with, concept of
aphonia, 33, 34 dimensionality in, 56–76
articulate speech, capacity to autistic phenomena, 19
produce, 23 autistic spectrum, 25, 38
articulation problems and nipple- autistic states, 9, 58, 77
penis (clinical example: one- and two-dimensional mental
Andrew), 29–33 functioning in, 35–55
Asociación Psicoanalítica de Buenos
Aires [APdeBA], 110 Barnes, J., 193
atelier training, 17 basic assumption(s), 10, 223
at-home-ness, through basic assumption functioning and
psychoanalysis, 81–94 work-group functioning,
at-one-ment, 170, 171 Bion’s distinction between, 10
autistic child(ren), 36, 57 battered women, 3
bi-dimensional functioning of breakdown of (clinical example:
(clinical example), 68 Magdalena), 226–228
clinical examples: dehumanization of, 225
Anthony, 26 dynamic of, 224
Cyril, 70–74 work at shelter for, 222–228
João, 61–64 Beckett, S., 198, 200, 202, 203, 205, 207,
Rosetta, 59–60 209
Tommaso, 58–59 Beethoven, L. van, 60
complexity of construction of best friend, 97–99
experience of, 76 function of, 98
jealousy as motivation for beta-elements, 218
projective identification in, Bevilacqua, F., 55
101 Bick, E., 8
mother’s internal father, effect of, collaboration with Melzer, 19
33 infant observation, 9
presence of “portals” in, 78 nipple in the mouth as optimal
struggle to emerge from a two- object, 58, 80
and one-dimensional world second skin, 94, 183, 228, 230

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 index 251

bicontinuous transformations, 69 Canham, H., 89

bi-dimensional space, 68 Cartesian dualism, 66
autistic, 69 Cassese, S. F., 167, 189, 221
bijective transformations, 69 Cassirer, E., 174, 230
binocular vision, 37, 168 castration, 124
Bion, W. R. (passim): fear and threat of, 224
alpha-function, 173 catatonic states, 100
basic assumptions, 223 cause and effect, experiences of, 76
beta-elements, 218 Cecchi, V., 25, 28
binocular vision, 37, 168 child(ren), on autistic spectrum, 25
distinction between basic child analysis:
assumption and work-group and adult analysis:
functioning, 10 continuity and coherence of, 8
emotional space, 67 unity of, 5
K-link, 108, 159, 171 central relevance of, 5
L, H, and K, integration of, 120 child psychotherapy, 15, 18–20
learning from experience, 10, 170 training, 6, 9
meditative review method, 222 circular time, 10
nameless dread, 50, 157, 196, 197 claustral phantasy, 177
O of patient, 234 claustrophobic anxiety, 19, 125
space for thinking, 67 claustrophobic phenomena:
Birksted-Breen, D., 34 Coraline (literary example), 176,
bisexuality, 124 179–187
blind spots, 111 Tom Ripley (literary example), 176,
Bloom, H., 190 179, 183–187
borderline/psychotic gang, 106 claustrophobic retreat, geography of,
borderline psychotic 177
psychopathology, 102 claustrum (passim):
borderline psychotic states, 106 allure of, 220–221
boundaries, 15, 17, 59, 61, 93, 229, 233 anal, 207, 208
holding and rhythm (clinical emotional geography of, 157,
example: Joseph), 88–91 177–179, 190
Bradley, C., 236 characteristics of, 178–179
Bradley, J., 236 genital compartment, 178, 185,
breast, good, 168 196
breast-with-a-hole, 22, 23, 27 head/breast compartment, 101,
Bremner, J., 9 178, 185, 214, 217
Brentano, F., 67 rectal compartment, 178–179,
Briggs, A., 83 185, 196, 217, 218
British Psychoanalytical Society, 1 entrapment in, 176–187
Britton, R., 25, 191 degrees of, 2
broken mind matrix (clinical Joyce’s Ulysses (literary
example: Magdalena), 228 example), 188–205
Bruce, A., 118 claustrum patient(s), 3
bulimia, 211 claustrum phenomena and excessive
intrusive identification
Caccia, O., 101 (clinical example: Olivia),
Calderón, N. T., xiii, 3, 222–231 210–221
Campbell, J., 92, 93 claustrum psychopathology, 218

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 252 index

claustrum world, 3 and three-dimensional space

compartmentalized, 196 (clinical example: Emilio),
proleptic imagination, Joyce’s 44–47
Ulysses (literary example), continuing professional development
188–205 [CPD], 7
clinical group, value of working in, 5 counter-dreaming, 111, 150
clinical session, valency of, 11 counter-interpretative
clinical supervision, nature of, 2 communication, 121
clinical work, significance of holiday countertransference (passim):
breaks in, 18 excruciatingly unbearable
cocaine, 105 deadness in, clinical example:
cognitive development, 173 Mark, 115
Cohen, M., xiii, xiv, 1–3, 236 experience of child’s blankness
Colarusso, C., 147 of mind, clinical example:
Coleridge, S. T., 171, 174 Olivia, 214
combined object: impact on analyst, 7
concept of, 10 intensely disturbed feelings in,
dissociation of, 126 clinical example: Mia, 150
in analyst’s mind, 124 internal examination of, 109
good, 182 need for scrutiny of, 109
maternal quality of, courage as observation of, relevant to valency
function of, 126 of clinical session, 11
penis and breast as, 22 part of analyst’s “equipment”, 234
commensal links, 10, 14 patient with history of abandoning
communication(s): analytic treatments (clinical
analytic, 124 example), 112
complementary style in, need for, powerful effects of projective
121 identification on, 123
projected, 25 private to supervisee, 7
symbolic, 230 reverie function as factor of, 111
unconscious, 234 countertransferential acting-out, 122
compartments of emotional countertransferential situation, 219
geography of claustrum, couple families, 12
characteristics of, 178–179 couple psychotherapy, 11
confusional anxiety, 78 courage, maternal, 126
confusional states, 102 CPD: see continuing professional
container: development
maternal, 73 creativity, free-flowing, 151
potentiality of, 220
container/contained: dead father, 29, 33
concept of, 38, 56 dead mother, 33, 192, 197, 204
dynamic, 218 syndrome, 191
model, 111 dead third, 191
containing object, baby’s need for, death, fear of, 169, 177
73, 101 death anxiety(ies), 50
containment: defence(s):
inner, lack of, 132 mechanisms of, concept of, 10
maternal, 211 narcissistic, 99

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 index 253

obsessional, 95 one-dimensional Lineland, 36

omnipotent and idealistic, 114 primary experience of, baby’s, 44
physical, second-skin, 94 psychic, 75, 76
primitive, 93 of psychic space, 224
second-skin, 9 theoretical formulations of, 82
dehumanization, 222, 223 three-dimensional Spaceland, 35
of abused/battered women, 225 two-dimensional Flatland, 35–37,
delusion: 45, 55, 68
of clarity of insight, 214 two-dimensionality, 57, 230
erotomanic, psychotic breakdown in working with autistic children,
with, 110 19
de-mentalization, 228, 229 dismantling, sensorial and structural,
dependence, basic assumption of, 224
223 dissociations, 97, 98
depersonalization, 87 Donald Meltzer Development Fund,
depression, maternal, 31 1
depressive anxiety, too-early, 19 dream(s)/dreaming:
depressive pain, 11, 177, 182 adaptation, 158–159
depressive position, 115 analyst’s own, guide to
functioning in, 110 schizophrenic patient (clinical
“depressive” view of world, 235 example: Andy), 160–162
Descartes, R., Cartesian dualism, 66 background of, 156–159
de Sola, B. M., 98 capacity for, 219
Deutsch, H., 191 as dreaming process, 165
developmental infant latency, 123 evolving continuity of, 163
Dilke, C., 175 as generative process, 163
dimensional breakdown (clinical grammar of, 164
example: Emilio), 38–54 interpretation of, as “royal road to
dimensionality: unconscious”, 235
and at-home-ness, 81–94 linking function of, 164
autistic child’s struggle to second life of, 153–165
emerge from two- and one- survival, 157–158
dimensional world (clinical thriving, 159
example: Emilio), 38–54 transience of, 154
and autistic states, 35–55 as window into psychic reality,
in clinical work with autistic 162–165
patients, 56–76 dream-life, 153–158, 162–165, 212
concept of, 56, 58, 73, 76 as experimentation, 123–125
and identity and security, 81–94 dream space, 162
issues of, in primitive states of Dueñas, N. M., 118
mind, 2
mental, 65 early mental development and
breakdown of, 36 serious mental illness, link
meta-psychological concept of, between, 6
geometrical vs. topological eating disorders, 112, 211
model, 66–74 Eaton, J. L., xiv, 2, 75–80, 150, 153–165
of mind, 38, 57, 58, 64, 76 echolalia, 39, 50, 59
model of, 67–69 Edel, L., 193

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 254 index

ego: family therapy, 10, 11

defenceless against ill-treatment, father:
224 dead, 29, 33
impoverishment of, 230 internal, 26, 33, 147
ego psychology, 158 Feldman, M., 213
ego strength, 230 fifth compartment, 83
Einstein, A., 35 fight and flight, basic assumption of,
Eliade, M., 83, 84 223
Eliot, T. S., 199, 200 Fisher, J. V., 11, 189, 197, 198, 200, 201,
Ellmann, R., 188, 193–195, 197, 199, 203, 206, 210, 213, 214, 218
203–205 Fisher-Adams, M., xiv, 2, 3, 188–209
Emanuel, R., 9 Flatland, two-dimensional country of,
emotion, hatred of, underlying 35–37, 45, 55, 68
psychotic phenomena, 203 folie à deux:
emotional pain, 104 psychopathology of, 104
sharing, 155–156 sadomasochistic, 193
emotional space, 67 fragmentation:
empathy, understanding through, of self, 135
235 sense of, 134
encapsulation, 217 free association(s), emotional capacity
autistic, 71 to link unrelated elements in,
Enright, D. J., 200 117
entitlement, sense of, 193 free-floating attention, state of
entrapment: “intuitive receptivity” in, 234
in claustrum, 176–187 French Resistance, 203
Joyce’s Ulysses (literary Freud, S., 7, 33, 36, 109
example), 188–205 analysis of Richard, 18
degrees of, 2, 185–187 clinical papers of, 8, 18
epistemophilic instinct, 8, 195 constructions in psychoanalysis,
Ercolani, P., 65 117
erotomanic delusion, psychotic notion of, as distinct from
breakdown with, 110 interpretation, 116
Etchegoyen, H., 122 “organ of consciousness”, as “sense
Euclidian space, 69 organ for psychical qualities”,
excessive projective identification, 162, 163
177 psyche as tripartite space, 67
existential anxiety, 19 psychic structures, as essential
exo-skeleton, case or sheath as, 102 components of psychic
experience, construction of, 76 apparatus, 224
exterior and interior, lack of topographies of, and concept of
differentiation between, 74 psychic space, 67
external space, 15, 59
eye contact, avoidance of, 129 Gaiman, N., Coraline, 176, 179–183
gang:
false-self personality structure, 213 borderline/psychotic, 106
family culture(s), typologies of, 10–11 family, 105
family gang, 105 gang families, 12
family organization, contribution to gang-like functioning of battered
life-space model, 10–11 women, 224

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 index 255

genital compartment of claustrum, identification(s):

178, 185, 196 adhesive: see adhesive
geographical confusions, 56, 105, 106 identification
geography, 179 confused, 26
of claustrophobic retreat, 177 with dead father, 29
of mind, 15, 56 forms of, 19
of phantasy, 68 introjective: see introjective
Gernsbacher, M., 24 identification
Gerson, S., 191 intrusive: see intrusive
Gittings, R., 169, 175 identification
Goethe, J. W. von, 109 narcissistic, 99, 103
Gogarty, O., 193, 204 negative, 12
good breast, 168 with paternal figure, 73
good-enough environment, 87 projective: see projective
Gosso, S., 210 identification(s)
Green, A., 191, 224, 227 identity:
Greenblatt, S., 203 and at-home-ness, 81–94
Grinberg, L., 117 confusion of, 19
Grotstein, J. S., 159 Ik, dehumanized tribe of, 225
illusory trauma of losing part of
Haag, G., 34 mouth, 25
Hahn, A., xiv, 1–3, 189, 233–236 imagery, and symbol formation,
hallucinated spots, 111 conjunction of, in supervision,
Harris, M., 8–13, 18, 22, 104, 107, 117, 111
143, 167, 175, 229 need for strong psychoanalytic
family, forms of, 12 conviction from analyst
Harrison, T., xiv, 3, 210–221 (clinical example: Mark),
Hathaway, A., 202 114–116
head/breast compartment of patient who was having difficulties
claustrum, 101, 178, 185, 196, becoming pregnant (clinical
214, 217 example), 116
Herbart, J. F., 66 patient with history of abandoning
Highsmith, P., The Talented Mr. Ripley, analytic treatments (clinical
176, 179, 183–185 example), 112–113
homelessness, 82 thumb-sucking (clinical example,
homeomorphisms, 69 Ana), 113–114
Houzel, D., xiv, 2, 33, 34, 66–78, 93 imagination:
Hoxter, S., 9, 40 expression of, 154
Hughes, A., 6 proleptic, 3, 188–190, 194, 197, 199,
Hunter, M., 83 200, 206
as source of rebirth and
id: regeneration, 203
destructive urgencies of, 223 imaginative conjectures, co-creation
invasive pressure of, 224 of, supervision as space for,
idealizations: 108–118
infantile, 99 Imago group, 14, 17
mutual, 116, 117 imitative adhesiveness, two-
ideas, generation of, aesthetic object dimensional, 55
and O, 166–175 impasse, psychoanalytic, 122

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 256 index

incest, 224 relations, 162

incestuous sexual abuse, 231 verbal coition of, 23, 33
independence of mind, inspired, internal object relations, 162, 210, 215,
analyst’s, 109 218, 234
ineluctability, 197 internal reality, 25, 227
infantile anxiety, 177, 178 development of, 93
interpretation of, 8 internal space, 15, 37, 48, 53, 57, 71, 80,
infantile idealizations, 99 133, 135, 142, 221
infantile parts of self, 233 absence of, 228
infantile polymorphism, 124 internal world, spatial representation
infantile sexuality, 123 of, 38
infantile transference, 7, 235 internet pornography, 104
infant observation, 6, 9, 10, 19, 20, 229 interpretation:
inner space, 59, 64, 67, 71, 76 courage and reverie as basis for,
discovery of, 80 126
for experimental thought, 87 of dreams, as “royal road to
inside and outside, relationship unconscious”, 235
between, 88 intrauterine life, 101
clinical example: Joseph, 82 idealization of, 100
institutional conflicts, 5 introjection, 23, 73, 124, 141, 216, 229,
intentionality, of psychic phenomena, 230
67 of art, 171–174
interior and exterior, lack of capacity for, 169
differentiation between, 74 of emotionally receptive and
internal claustrum phenomena thoughtful therapist, 151
(clinical example: Olivia), of good object, 96, 147, 171
216–218 incorporation as physical precursor
internal couple, 182 of, 58, 80
good, 185, 186 and inner space, 80, 228
role of, in psychic development, as mysterious process, 167
186 of protective object, 231
internal and external reality, repetition replacing, 64
distinctions between, 8 introjective identification, 8, 19, 55, 96,
internal father(s), role of, 26 167, 235
internal linking, impairment of, 219 intrusive identification, 19, 96, 100,
internal mother, 101, 139, 147, 150, 195, 198–201
176, 190, 214 excessive, and claustrum
compartments of, 68, 104, 157, 217 phenomena (clinical example:
head/breast compartment of, 217 Olivia), 210–221
rectal compartment of, 217, 218 impact of, on internal object
internal object(s) (passim): relations, 210
changing states of, 95 living in, 103, 104, 157
compartments of, 56 and patient’s external objects,
contribution to life-space model, 211–215
10 intrusiveness, 101
damaged and dying, 148 masturbatory, 104
good, 148–150 intrusive phantasies, 15, 100
no inner space for, 64 intrusive projective identification,
of phantasy, 18 177, 178, 180, 186, 187

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 index 257

intuitive receptivity, state of, in free- language development, 21, 24

floating attention, 234 language production, capacity for:
isolation: and nipple-penis confusion, 21–34
adolescent, 2, 95–107 relevance of, concept of nipple-
clinical example: Esteban, 98 penis confusion to, 21–34
danger of, 95 vocalization necessary for, 23
latency:
Jackson, M., 142 developmental infant, 123
jealousy, 23, 99, 105, 186, 195 development from, 119–126
as motivation for projective obsessionality of, 96
identification in autistic protracted, in analytic situation,
children, 101 120–123
of oedipal rivalry, 189 shift to adolescence, 96
Johns, G., 205 learning from experience, 170
Joseph, B., 8 Bion’s definition of, 10
Joyce, J., 3, 188–205, 209 Leibniz, G. W., 66, 74
Dubliners, 206 Lewis, W., 189, 196
Finnegans Wake, 194–197, 203–205, Liberman, D., 121
207 Liegner, E., 192
Ulysses, 3, 188–209 life-space model:
Joyce, N., 192, 194, 196, 204 contribution of adult and infantile
Joyce, S., 194 elements in personality, 10
contribution of family
Kant, E., 66 organization, 10
Kaufmann, W. J., 36 contribution of internal objects, 10
Keats, J., 151, 169, 175 contribution of temperament, 10
Kenner, H., 193 linear movement, discovery of
Kiberd, D., 194, 198, 202 (clinical example: Tommaso),
Klein, M., 8, 38, 57, 114, 176, 189, 195 58–59
infant’s unconscious phantasies, 67 linear time, 10
inner space, concept of, 67 Lineland, one-dimensional country
internalization of good object, 22 of, 35–37, 45
internal world, inhabited by Lipnitskaia, Y., 95
internal objects, 56 looked-after children, 82
Meltzer’s analysis with, 6 López, B., 108
on premature erotization, 34 Lubbe, T., 34
projective identification, 210
Klein, S., 8 Magagna, J., xiv–xv, 2, 24, 127–152
Klein bottle, 70 magical thinking, 202
Kleinian tradition, 235 of proleptic imagination, 189
K-link, 108, 159, 171 Maiello, S., xv, 2, 35–65, 75, 76, 80, 236
Knowlson, J., 203, 205 manic omnipotence, 86
Kolvin, I., 24 manifolds, tri-dimensional, 68, 77
K-state-of-mind, 203 Mann, T., 193
marijuana, 104
Langer, S., 174 marsupial space, 89
language: masochism, 119
failure to develop, 70 masturbation, 103, 120, 198, 207
of unconscious, 17 anal, 196

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 258 index

masturbatory intrusiveness, 104 dream(s):

masturbatory phantasies, 180, 181 evolving continuity of, 163
maternal containment, 73, 211, 230 as generative process, 163
maternal courage, 126 grammar of, 164
maternal depression, 31 as theatre of meaning, 162
maternal function(s), 230 as dream explorer, 164
relation to psychic apparatus, 229 family:
maternal object, 27, 28, 54, 132, 178, crucial functions of, 11
181, 185, 212, 218 forms of, 12
internal, 176, 177, 186, 187, 214, 217 patriarchal, 13
good, 186 fifth compartment, 83
intrusive, 219 identification, forms of, 19
uncompromising possessiveness infantile parts of self, 233
of, 75 inner space, for experimental
maternal reverie, 111 thought, 87
maternal space, 26, 185–187 internal and external space, 15
matriarchal families, 12 learning from experience, crucial
maturational processes, 106 value of, 10
Mayers, D., xv, 3, 206–209 legacy of, as teacher and a thinker,
McCourt, J., 194 233
Mead, M., 225 life in claustrum, 157, 178
meaning and symbolization, psychic maternal function, relation to
space for, 224 psychic apparatus, 229
mechanisms, autistic, 229, 230 maternal object, uncompromising
meditative review method, 222 possessiveness of, 75
megalomania, 98, 99 “A Mind of One’s Own”
megalomaniac adolescents, 99 conference, 1–3, 233–236
Meltzer, D. (passim): nipple-penis confusion, concept
aesthetic conflict, concept of, 19 of, relevance of, to selective
aesthetic reciprocity, 117 mutism and the capacity to
analyst, role of, to strike fire into produce language, 21–34
patient’s mind, 122 nuptial chamber, mystery of, 187
on analytic attitude, 120 psychic life, continuities of, 6
atelier training, model of, 17 psychic qualities, capacity to
autistic children, work with, 9 perceive, 162
autistic states, one- and two- psychoanalysis:
dimensional mental conception of, 7
functioning in, 35–55 as conversations between
breakdown of surfaces, 82, 87 internal objects, 166
claustrum, 190 cultural significance of, 167
life and death in, 176–187 psychoanalyst’s “equipment”, 234
contributions of, 5–20 psychoanalytic process, view of,
dimensionality: 173
concept of, in clinical work with psychoanalytic therapy, aim
autistic patients, 56–66 of, growth of introjective
model of, 67–69 identification as, 8
psychic, concept of, 76 sensorial and structural
of psychic space, 224 dismantling, 224
theoretical formulations of, 82 sensory dismantling, 228, 229

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 index 259

spatial reference, 73 Moebius strip, 70

supervision by: Money-Kyrle, R., 8, 122, 166–170,
as “eye openers”, 108 173–175, 182
psychotherapy with psychotic Monteiro, M. H., 65
child (clinical example: Mia), Morgan, M., 219
127–152 mother:
transference, gathering of, 19 dead, 33, 191, 192, 197, 204
two-dimensional adherence to fury at, of replacement child,
surface of objects, 132 191–194
see also claustrum good, 136, 148
mental apparatus, topological model restoration of, 173
of, 74 good-enough, 213, 229
mental development, three- internal: see internal mother
dimensional, 40 not-good-enough, 213
mental functioning: mother-therapist, 132, 137, 143, 145
dimensionality of, 56, 68 good internalized, 142
one-dimensional: loss of, 134, 142
autistic child’s struggle to protective skin of, 133
emerge from (clinical separation from, 146
example: Emilio), 38–54 motivational splitting, secondary
in autistic states, 35–55 obsessional mechanisms
three-dimensional, 37–41, 57, 59, related to, 229
60, 63 Motycka, R., 192
two-dimensional, 35–38, 40–44, 57, mourning, 99, 147
61, 64 lack of, 191
mental illness, serious, and early mouth, losing part of, 25
mental development, link mouth-and-nipple, 173
between, 6 conceptual “base” of, 170
mental pain, 8, 153, 187, 234 Mukhopadhyay, T. R., 24
concept of, 10 Muñoz Vila, C., xv, 3, 222–231
emergence of, in analysis, 155 mutism, selective: see selective
mental skin, 183 mutism
mental space, 17, 34, 68, 71 mutual idealization, 116, 117
forms of, 15 M’Uzan, M. de, 227
Menzies, I., 6
Micotti, S., 34 nameless dread, 50, 157, 196, 197
Milton, J., 169, 171 narcissism, 17, 181
mind: narcissistic defences, 99
dimensionality of, 38, 57, 58, 64, 76 narcissistic identification(s), 99, 103
geography of, 15, 56 narcissistic organization, 99
internal space within, 37, 48, 57 narcissistic phallus, 34
model of, used by analyst, 109 narcolepsia, 100
of one’s own, development of, 109 Negative Capability (Keats), 169, 235
spatial structure of, 131 negative identifications, 12
Minghella, A., The Talented Mr. Ripley, negative therapeutic reaction [NTR],
176, 179, 183–185 32, 122
–K factors, 203 Nemas, C., xvi, 2, 108–118, 126, 150
Mitchell, J., 33 Neonatal Intensive Care Unit [NICU],
models, use of, 117 89

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 260 index

nest of babies, 71, 72 child’s, 23

neurotic character structure, 24 internal, impact of intrusive
NHS, post-war development of, 6 identification on, 210
NICU: see Neonatal Intensive Care object-relations psychoanalysis, 167
Unit Oblomovian lassitude, 101
nightmares, 155, 188 obsessional defences, 95
night terrors, 155 obsessionality, 96, 121
nipple: obsessional mechanisms, 230
loss of, as existential catastrophe, primary, 229
33 secondary, related to motivational
masculine, 34 or defensive splitting, 229
nipple-penis: OECD: see Organisation for
and articulation problems (clinical Economic Co-operation and
example: Andrew), 29–33 Development
confusion, 21–24, 32–33 oedipal jealousy, pre-genital, 23
concept of, relevance of, to oedipal rivalry(ies), 31, 32
selective mutism and the jealousy of, 189
capacity to produce language, oedipal turbulence, 98
21–34 Oedipus complex, 106, 224
rivalrous appropriation of, 33 resolution of, catastrophic
nipple=penis=faeces sequence, 29 intrusion into, 28
non-mental functioning, 229 Oelsner, M., 108, 111
non-orientability, 74, 78 Oelsner, R., 108, 111
topological model of, 69–73 omnipotence, 13, 86, 98
not-good-enough mother, 213 of thought, infantile, 198
NTR: see negative therapeutic omnipotent control, 59, 229
reaction primitive, 132, 137
nymphomania, 123 omnipotent phantasy, 101, 210
concept of, 10
O, 2, 159 omniscience, 190, 195, 203
and aesthetic object, 166–175 one-dimensional Lineland, 36
alignment with, 171 one-dimensional mental functioning,
intersecting with, 171 38, 40–44
as ultimate source of knowledge, one-dimensional states, 57
170 one-dimensional world, autistic
patient’s, 234 child’s struggle to emerge
transformations in, 171, 174 from (clinical example:
wilderness of, 165 Emilio), 38–54
Oates, J. C., 204 oneiric space, 125
object(s): oral aggression (clinical example:
internal, see internal object(s) Emilio), 47–48
maternal, 27, 28, 54, 75, 132, 176– oral dyspraxia, 24
178, 185, 187, 212, 214, 217, 218 Organisation for Economic
parental, 14, 99, 104 Co-operation and
perception of and nature of space Development [OECD], 9, 14
(clinical example: Steven), “organ of consciousness”, as “sense
78–80 organ for psychical qualities”,
object relations, 92, 106, 172, 215, 218, 162, 163
234 orgasmic anaesthesia, 121

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 index 261

orientability, 78 perspective, reversible, 122

of psychic space, and autism phallus, narcissistic, 34
(clinical example: Cyril), phantasy(ies):
70–73 geography of, 68
topological model, 69–73 internal objects of, 18
Orwell, G., 196 omnipotent, 10, 101, 210
oscillating time, 10 unconscious, 10, 67, 128, 176, 183,
O’Shaughnessy, E., 136 186, 187, 189, 234, 235
O’Toole, F., 203 phobias, 189
outside and inside, relationship physical phenomena, causality of,
between, 82, 88 67
Pinter, H., 13, 14
pairing, basic assumption of, 223 Plato, Theaetetus, 167
paralysis of insane, 189 Platonic forms, 171
paramnesias, 174 play, unconscious, dreaming as, 154
paranoid anxiety, 97, 98, 189 Pointland, a-dimensional country of,
paranoid-depressive adolescents, 99 35–37
paranoid orientation, 10 point–line–surface–space, 35–55
paranoid-schizoid position, polymorphism, infantile, 124
functioning in, 110 Pontalis, J.-B., 119, 124
parasitic links, 10 pornography, 103, 104
parental functions, integrated, 126 “portals”, presence of in autistic
parental intercourse, 168 children, 78
internal, 175 Pozzi Monzo, M., 34
parental objects, 14, 99, 104 precipitation anxiety, 64, 77
part-object(s), 41, 42, 50, 54, 63, 80, pre–paranoid-schizoid phase, 19
218, 235 primitive agonies, 73, 157
concept of, 10 primitive defences, 93
Kleinian drama of, 174 primitive states of mind, issues of
paternal, 21, 22 dimensionality in, 2
paternal figure, identification with, 73 projected communications, child’s,
paternal function, 25, 33 25
reparative penetrability of, 126 projection(s), 23, 73, 97, 117, 132, 181,
paternal object, 104, 179, 215 182, 213, 218, 228
function of, 186 aggressive quality of, 210
good, 73, 186 child’s, analyst receiving, 151, 214
pathological splittings, 96 of patient, analyst open to, 111
patriarchal family(ies), 12, 13 of three-dimensional visions
penis, as link, 34 (clinical example, Emilio),
perception, maternal function of, 230 49–54
persecutory anxiety(ies), 11, 193 projective gridlock, 219
primitive, 132 projective identification(s), 19, 46, 55,
personality: 118, 157, 160, 176, 195, 215
adult and infantile elements in, in adolescence (clinical examples):
contribution to life-space Alexander, 103–105
model, 10 Gerard, 102–103
analyst’s, split-off psychotic Hector, 105–106
element of, 161 excessive, 177
infantile part of, 177, 178, 187 intrusive, 177, 178, 180, 186, 187

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 262 index

projective identification(s) (continued): psychic structure(s):

massive, 210 as essential components of psychic
obstacle to accessing material of apparatus, 224
dream life, 123 internal, lack of, 135
ubiquity of, 100–106 psychoanalysis:
projective plane, 70 analysts’ personal definition of, 109
proleptic belief system, 199 as conversations between internal
proleptic fantasy, 190 objects, 166
proleptic imagination, 3, 206 cultural significance of, 167
Joyce’s Ulysses (literary example), development and transmission of,
188–205 109
magical thinking of, 189 object-relations, 167
negative, 201 process in, Freud’s conception of, 7
positive, 201 psychoanalytic impasse, 122
proleptic state of mind, 197, 200 psychoanalytic objects, 167
promiscuity, 105, 123 psychoanalytic setting, 7, 161, 163
protective object, introjection of, 231 psychoanalytic theory, 5, 57
pseudo-maturity, 118, 178, 215, 217 psychoanalytic thought,
psyche: internationalism of, 20
and soma, relationship of, 87 psychosis(es), 34, 77, 98, 102, 106, 110,
as tripartite space, 67 127, 128, 161, 203, 212, 218
psychic dimensionality, 75, 76 psychotic breakdown with
psychic life, continuities of, 6 erotomanic delusion, 110
psychic movement: psychotic child, psychotherapy
exploration of effects of, 57, 76 with (clinical example: Mia),
qualities in one, two, and three 127–152
dimensions, 77 psychotic phenomena, hatred of
in time and space, 76 emotion underlying, 203
psychic pain, 97, 185 psychotic states, 102
psychic phenomena, intentionality borderline, 106
of, 67 puberty, 95–98, 102, 121
psychic qualities, capacity to premature, 96
perceive, 162 puerperal depression, 101
psychic reality, 78, 154–156, 161, 230,
235 Rashid, S., 34
dreaming as window into, 162– rectal compartment of claustrum,
165 178–179, 185, 196, 217, 218
psychic skin, 9 relational trauma, 25
psychic space, 68, 74, 76, 156 relativity, theory of, 35
concept of, 67 repetition compulsion, 223
and Freudian topographies, 67 replacement child, 188, 191, 194, 198,
dimensionality of, 224 199, 203
internal, 67 resilience, 8, 111, 143
for meaning and symbolization, resistance, 119
224 retraction, state of, 100, 101
orientability of, and autism reverie, 80, 111, 126, 190
(clinical example: Cyril), artistic or poetic, 173
70–73 psychoanalytic, 173

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 index 263

reverie function: self:

in analytic work, 111, 126 annihilation of, 223
as factor of countertransference, concept of, 10
111 infantile parts of, 233
reversed families, 12 split-off parts of, 234
reversible perspective, 122 self-analysis, 7, 162
Rey, H., 89, 93, 131 Selick, H., Coraline, 176, 179–183
Rhode, M., xvi, 2, 9, 21–34, 81, 132, sense organ, “for psychical qualities”,
134, 236 162
rhythm of safety, 89, 135 senses, dismantling of, 57, 228, 229
Richards, A. D., 199 sensory system, disorganized, 227
Ricks, C., 200 separateness, awareness and
Rios, C., 97, 106 exploration of (clinical
River Alpheus, metaphor of, 168 example: Joseph), 91–92
rootedness, 84 separation anxieties, 46, 92
Rosenfeld, D., 6, 8, 102 setting, psychoanalytic, 7, 161, 163
Roy, C., 119 sexual abuse, 93, 115, 226, 227
royal road to unconscious, early, 223
interpretation of dreams as, incestuous, 231
235 sexuality, infantile, 123
Rustin, Margaret, xvi, 2, 5–20, 202, 236 Shakespeare, W., 169, 188, 194, 204
Rustin, Michael, 14 and “Dark Lady”, 201–203
Hamlet, 115, 202
Sabbadini, A., 198 Macbeth, 195, 197, 198, 200, 201
sadism, 196 The Two Gentlemen of Verona, 202
child’s, 148 Winter’s Tale, 198
sadistic paternal object, phantasied, shapes, differentiation of (clinical
179 example: Emilio), 40–44
sanity, as aesthetic achievement, 173 Shelley, P. B., 154
Scabbiolo, F., 165 shell-shock, 24
schizophrenia, 6, 24, 160, 161 siblings, death of, 189
schizophrenic patient and analyst’s Silver, D., 191, 201
own dream (clinical example: sincerity, courage and reverie as basis
Andy), 160–162 for, 126
Schwarz, D. R., 203 skin, blistering of (clinical example:
second skin, 9, 94, 183, 228, 230 Mia), 133–142
second-skin defences, 9 social organizations, breakdown of,
security and at-home-ness, 81–94 225
Segal, H., 6, 8 social phobia, selective mutism as, 24
selective mutism, 21, 24, 25, 27, 33, 34 soma and psyche, relationship of, 87
clinical example: somnolence, states of, 101
Harry, 28–29 Sorensen, P. B., xvi, 2, 89, 94, 176–187
Ricardo, 27–28 space:
nipple-penis confusion, relevance emotional, 67
of, concept of, 21–34 experiences of, 76
clinical example: Ricardo, 27–28 internal, 37, 48, 53, 57, 71, 80, 133,
as social phobia, 24 135, 142, 221, 228
and traumatic experiences, 21 marsupial, 89

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 264 index

space (continued): thumb-sucking (clinical

meaning of, 15 example, Ana), 113–114
mental: 17, 34, 68, 71 core function of, 111
forms of, 15 disruption in atmosphere of, as
one- and two-dimensional, 224 new way to understand
perception of, and nature of object clinical material (clinical
(clinical example: Steven), example), 116
78–80 and need for containment, 111
potentiality of, 220 surfaces, breakdown of, 82, 87
therapeutic, 93 symbiotic links, 10, 168
for thinking, 67 symbol(s):
three-dimensional, 40, 46, 49, 58, 59 vs. allegory, 171
time, concept of, as fourth as container of emotional meaning,
dimension of, 35 111
use of and orientation in, 49 symbol-formation, 126, 173, 174
Spaceland, 35 and imagery, conjunction of, in
spatial organization, difficulties in, supervision, 111
92 need for strong psychoanalytic
spatial reference, 73 conviction from analyst
spatio-temporal orientation, 64 (clinical example: Mark),
speech, production of, 21, 27 114–116
sphincter function, 58, 80 patient who was having
split-off parts of self, 234 difficulties becoming
splitting, 13, 34, 95, 132, 135 pregnant (clinical example),
defensive, secondary obsessional 116
mechanisms related to, 229 patient with history of
pathological, 96 abandoning analytic
Staehle, A., 24 treatments (clinical example),
Stokes, A., 166, 172–174 112–113
suicidality, 212 thumb-sucking (clinical
superego, 115, 116, 224 example, Ana), 113–114
cruel and superior, 17 unconscious, 157
supervision (passim): symbolic capacity, 22
and co-creation of imaginative symbolic equation, 189, 190
conjectures, 108–118 symbolic play, 71
conjunction of symbol formation symbolic thinking, development of,
and imagery in, 111 38
need for strong psychoanalytic symbolic thought, 110, 139
conviction from analyst capacity for, lack of, 136
(clinical example: Mark), symbolization, 154, 164
114–116 lack of, 227
patient who was having and meaning, psychic space for,
difficulties becoming 224
pregnant (clinical example),
116 Tabbia, C., xvi, 2, 95–107
patient with history of Tamm, C., 34
abandoning analytic Tavistock child psychotherapy
treatments (clinical example), training, 6, 18
112–113 Tavistock Clinic, 1

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 index 265

teratoma, 217–219 linear, 10

termination, 125, 140 obliteration of, through
and intimations of future (clinical sensuousness, 135
example: Mia), 145–147 oscillating, 10
theatre of meaning, dreams as, 162 sense of, 128, 135, 148
Theatre of the Mouth, 21, 30, 58, 80 structure of, 135, 138
inner space of, 59, 76 and concept of hope, 127
therapeutic space, 93 transformations in (clinical
therapy: example: Mia), 142–147
false-self version of, 214 two-dimensional, 132
impediments to (clinical example: timelessness, 10, 136
Olivia), 218–219 topographic confusion, 42
thinking: topography(ies):
sensorimotor stage of, 131 first, 67
structure for, 131 mental, 61
thinking disorders, 229 second, 67
Thoreau, H. D., 76 topological model, 66
three-dimensionality, 23, 46, 47, 55, of mental apparatus, 74
169 of non-orientability, 69–73
breakdown of, 54 of orientability, 69–73
three-dimensional mental torus, 69
functioning, 51, 57, 58, 80 three-dimensional, 78
three-dimensional space: transference (passim):
and containment (clinical example: gathering of, 19
Emilio), 44–47 infantile, 7, 235
discovery of (clinical example: natural history of, 164
Tommaso), 58–59 negative, 115, 122
three-dimensional Spaceland, 35 observation of, relevant to valency
three-dimensional torus, 78 of clinical session, 11
three-dimensional visions, projection transference–countertransference, 235
of, 49–54 dynamic situation of, 111
three-torus, 69 interaction, diminished creativity
thumb-sucking (clinical example: of interpretative activity in,
Ana), 113–114 124
Thurston, W. P., 68, 69, 77, 78 transference love, 119
time, 143 transgenerational trauma, 115
circular, 10 transitional object, 98
as fourth dimension of three- transitions, falling and dropping
dimensional space, 35 (clinical example: Joseph),
continuity of emotional experience 86–88
in, 132 trauma:
dimension of (clinical example: illusory, of losing part of mouth, 25
Rosetta), 59–60 primitive levels of, 21
effort to obliterate, 134 relational, 25
experience of, 76 traumatic separation, 24
in depressive state of mind, 128 triangular space, 191
distortions in (clinical example: tri-dimensional manifolds, 68, 77
Mia), 128–152 Trilling, L., 196, 199
in manic state of mind, 128 Trowell, J., 24

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 266 index

Truckle, B., 24 of space inside, claustrum as, 176

truth drive, 159 world of, 183, 186
Turnbull, C., 225 unconscious play, dreaming as, 154
Turner, J. M. W., 130
Tustin, F., 9, 108, 132, 134 value systems, deterioration of, 225
appearance of cross-shape in Van Gogh, V., 193
autistic child’s material, 44 Vinocur, A., 118
autistic withdrawal/encapsulation, vocalization, 23, 32, 88
47, 71 Vorchheimer, M., xvii, 2, 119–126
mother’s nipple equated with own
mouth, 23, 25, 33, 37, 39, 41 weaning, 22, 32, 33, 39, 48, 50, 51, 70
nest of babies, 71, 72 catastrophic experience of (clinical
rhythm of safety, 89, 135 example: Emilio), 54
rootedness, 84 Weddell, D., 6, 9
separation: Wedeles, E., 6
as catastrophe, 33, 88 Weeks, J., 46, 68, 69, 77, 78
premature awareness of, 157 Weininger, O., 24
work on autistic children, 21 Wilde, O., 192
two-dimensional adherence to Wilkinson, B., 200
surface of objects, 132 Williams, G., 9
two-dimensional Flatland, 35–37, 45, Williams, M. H., xvii, 2, 9, 19, 22, 55,
55, 68 57, 117, 143, 166–175, 187
two-dimensional imitative family:
adhesiveness, 55 crucial functions of, 11
two-dimensionality, 57, 230 patriarchal, 13
two-dimensional mental functioning, learning from experience, crucial
61, 64 value of, 10
in autistic states, 35–55, 57, 58 Winnicott, D. W., 23, 84, 87, 89, 93
two-dimensional space, 78, 224, 230 good-enough mother, 229
two-dimensional states, 57 primitive agonies, 73, 157
two-dimensional time, 132 Winterson, J., 81, 83
two-dimensional world, 35 Wittenberg, I., 9
autistic child’s struggle to emerge Wittgenstein, L., 174
from (clinical example: women, abused/battered:
Emilio), 38–54 see battered women
two-ness, 52, 54 Woolf, V., 45, 198
identification of, 92 words, articulation of and nipple-
penis confusion, 21–34
unconscious: work-group functioning and basic
language of, 17 assumption functioning,
royal road to, interpretation of Bion’s distinction between,
dreams as, 235 10
unconscious anxiety, 111 working through, 7, 8, 92, 117
unconscious communications, 234
unconscious phantasy(ies), 10, 189, Yeats, W. B., 206
234, 235
defensive, 187 zonal confusions, 56
infant’s/child’s, 67, 128 nipple–penis–tongue, 22

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