In a psychoanalysis each patient appropriates the analyst and subjects him to an idiom of object usage. If I am with an obsessional analysand, I may feel a sense of seemingly unresolvable frustration and irritation as a result of being the object of such a person’s aseptic relating. With a manic patient I may feel frightened by the murderous quality of the patient’s grandiosity. The borderline analysand’s chaotic internal world may well preserve in me a prolonged sense of confusion and dis-orientation, while the narcissistic patient lulls me into the grip of the sleepmaker as I fight his obtuseness to remain alert.
It is an essential feature of clinical work for the analyst to reflect on his experi-ence as the patient’s object. Many psychoanalysts believe it is useful to employ the countertransference towards a reconstruction of the patient’s early infantile object world. I might discover, for example, that the obsessional’s sterile self narration is his transfer of a robotic maternal introject, a mental structure partly derived from lifeless parenting, and my position as the object of this transference may be similar to the patient’s experience of the mother. In the grip of an element of this analysand’s mother, my task is to inform the patient that I am where he was.
I may discover that my countertransference with the manic patient re-enacts that person’s registration of moments in his early life when he was cast off by a mother who could recuperate herself from depressions only by engaging in activities that enhanced her now depleted narcissism and led her to denigrate mothering and the mothered. My countertransference mood, in particular my fright and paralytic inability to believe I can communicate with a person so utterly transcendent and totally dismissive of me, may well re-present part of my patient’s original experi-ence with his disappearing and dismissive mother. My struggles both to survive this patient’s imprisonment of me in his history and to speak to his primary objects inevitably involve me in an alliance with the analysand’s true self. Clinical work with borderline patients has taught me that my countertransference (here confu-sion and an inability to find a stable object in my patient) often re-creates the ambience of the parenting environment.
As we know, few patients enjoy the possession of an analyst quite like the hys-teric. Freud experienced and registered the hysteric’s theatre, in which the analyst is confronted with many others, and he also noted that she communicated through a forceful language of imagery which did not lead her towards reflection. Masud
Khan (1975) has written that one aspect of hysterical enactment is the need to compel the Other into becoming a witness-accomplice, a form of triangulation in which the hysteric compels the analyst to observe her introjects by means of a kind of performance art.
Why does the hysterical analysand so frequently dissolve herself into an event?
What effect does this have upon the analyst? How can the analyst’s countertrans-ference both illuminate the nature of such a captivity in the comedic and convert the force of dramaturgy into analytic reflection?
A discourse of senses
Elegant, well-dressed, intelligent, and informed rather than educated, Jane lives alone in a rather dingy flat and is quite restlessly depressed. When she first told me about herself, she did so with considerable dramatic flair, and the sessions were characterized by her vivid descriptions of what she had been doing in her life. I always felt a little uneasy when she suggested in her stories that she was capable of suddenly violent scenes designed to coerce someone into capitulat-ing to her needs. I wondered when it would be my turn to be the object of such ferocity, and this led me to feel a private dread of her. She would often recount a day’s event – one which was quite distressing and moved her to tears – and when she was collected, she would look at me coyly, laugh, and bite her lip. She used analytic interpretation readily but with such energy that I could sense her need to grasp it before she flew into a rage over its meaning. After the first few months she became despondent and, although she used analytic insight intellectually, she gave me warning that she was not happy with the way things were turning out.
Neither was I. I became distressed by the self observation that although I was easily moved by her narratives, I was reluctant to take her seriously. I found it impossible not to laugh now and then at her comedian-like representations, for I found her narration of certain life episodes infectiously funny. Several times she nearly moved me to tears with acutely sad tales about unfortunate moments in her life history. I became aware that she was affecting me but not in any lasting way, since my laughter, or my near-tearfulness, was so immediately evoked by her that I never felt I was actually taking in what she was talking about.
I became increasingly aware that I found her attractive and, as she is a sensually appealing person, I knew I was looking forward to seeing her for that sake alone.
At times she could make me quite angry, particularly when she would scream at me and denounce me for not understanding her. I am sure that when she said this I was cross with myself because I knew in some way that she was absolutely cor-rect. I was not understanding her, even though now and then I assuaged my guilt by telling myself that I was functioning analytically and, in any event, I could not proceed any more advantageously than I had. Now, since I was in the grip of this patient’s transference, in what ways did she possess me?
Sensationally.
Jane communicated through the senses. She was attractive and knew it. Her body-gesture syntax led me to view her as a spectacle, luring me away from a
thoughtful consideration of her internal life. On occasion, I was less inclined to listen to the content of what she was saying than to be snared by the musicality of her vocal delivery.
She possessed a remarkable comic presence, and sometimes I could barely refrain from laughing at her stories. On occasion I was touched by her utter des-titution, and now and then I felt tearful. She could suddenly alter her moods and would often accompany such changes with a different body ambience in the ses-sion, the total effect of which was to shock or alarm me. It is important to stress how the hysteric communicates through the senses, particularly if we understand the specific intersubjective communication available in the clinical situation through the transference and countertransference. What are these senses?
We see her. Visually vivid, she punctuates her narrative with body gesture. At times her image competes with her narrative as if to split the Other: do I attend to what she is saying, or do I witness her as a self-contained event?
The body is aroused.
We hear her. Whether the hysteric begins with a whisper compelling us to move closer to listen very intently or whether she moves into operatic speeches, shriek-ing so that seemshriek-ingly half the world can hear her, it is very clear that one form of the impregnation of meaning will indeed be via the ear, as the hysteric enters us with a kind of acoustic acuity that is at times remarkable.
The body receives.
We laugh with her. Although such moments may be short-lived, the comedian-like element in this person brings the analyst to laughter – more often than not as a discharge in affect of the very sensation that is presented to the analyst through the hysteric’s transference. As she transfers excitement and confusion via her event-fulness, the analyst discharges it in the laugh.
The body shakes.
We are angry with her. Too much is too much. Often her misbehaviour is so irksome, or her sudden shifts of mood so irritating, that whether we express our anger or not, we are in fact quite angry.
The body trembles.
We are moved to tears. Almost, if not quite. But the hysteric can bring us into sudden, Hollywood-type tearfulness, as she narrates pathetic episodes from her life. Indeed, her true helplessness, and the fated way in which she loses people, jobs, and her own self regard is deeply moving.
The body aches.
But seeing is not knowing and hearing is not understanding. It is as if the sen-sational discourse undermines true communication, and indeed as if the language of the body is a substitute for mental representation and thinking.
The mother
I was aware of dreading Jane’s intense need, and this recognition led me to realize that I wished to be rid of her. Her grip, therefore, was essential, for I was uncon-sciously refusing her admission to my internal world. How had this happened?
As though she had some foreboding of my potential mood, she told me about her mother. It became clear that her mother was an enormously self-preoccupied woman, desperate to achieve an ever-elusive social recognition, wedded to a material view of reality and therefore inclined to be interested primarily in those aspects of her daughter that would appear respectable. Jane recalls that she felt connected to her mother only when she was in states of acute distress, sobbing or very angry, or when she decided to entertain and amuse her mother. Otherwise, her mother was never really interested in what she felt or had to say, and she can recall her mother frequently walking away from her just as she was about to describe how she was feeling.
In her transference to me, she was re-creating aspects of this relation. As a child, she procured mother’s attention by giving voice to her senses: she lured the mother to her by being spectacular, or she burrowed into her mother’s mind by acoustically forced entry. One aspect of my countertransference was my represen-tation of the transferred maternal introject, as I had become unwilling to be moved beyond the sensational to the cognitive and reflective. That is, I was in the grip of a person whose prevailing assumption – that I could only be related to through coercion – nearly realized itself, since I was forced into being the mother’s outline.
By transforming sense-communication into language, however, and by think-ing and reflectthink-ing within the texture of the transference relationship about what Jane was doing, I was introducing for potential use by my patient an ego func-tion that derived from my continuous transformafunc-tion of sense and affect into sen-tiently reflective thought. As I have said in chapter 1 , it is my view that one of the mother’s crucial functions is her role as the infant-child’s transformational object.
Each mother transforms the infant’s syntax of sense and gesture into language, for she continuously comments on her baby in the baby’s presence. As she com-ments on the baby’s gesture, she also frequently alters the baby’s environment in his favour, thus linking language with actual transformation of the environment. This provides the infant with a natural passage into speech, since speaking becomes associated with the transformation of the self and is partial compensation for the narcissistic losses implicit in the necessity to speak to the Other about the self. It is unlikely that Jane’s mother functioned as a good-enough transformational object.
I think she was left as an infant to employ only very crude effects on the Other, so that although she acquired language, words were used more for their effective coercion of the Other – almost as sensory hold – than for communication as we ordinarily think of it.
Hysterics, therefore, do not believe in using language for the reciprocal exchange of feeling and meaning because the mother did not give the hysteric a continuous experience of finding through language adequate transformation of unintegrated affective and instinctual states.
The aims of externalization
It is my view that one of the reasons why the hysteric becomes an event for our witnessing is the need to compensate for her mother’s inability to internalize her.
She must place her internal world outside herself through theatrical representa-tion of feelings and thoughts in order to be recognized by the mother. Hysterical patients believe that the only way they will ever be known by anyone is if they can compel the Other to witness them because of their unconscious conviction – based on cumulative experiences of the mother – that no one thinks about them. If we realize that the hysteric’s externalization of psychic states occurs because of her adaptation to the mother’s failure to internalize her child, then I think it becomes clearer to us why hysterical patients bring with them an urgent need to become an event in our presence so that it is exceedingly difficult to forget them. We are witnessing the infant’s desperate effort to implant an image of himself or herself inside the refusing mother. Such people seem almost wholly concerned to grip the analyst in order to create an unforgettable vision, and such an aim takes priority over thinking, reflecting, and understanding.
The hysteric’s mother may often be a powerful woman whose effect upon the child is more sensational than it is thoughtful. Jane’s mother taught Jane the lan-guage of hysteria, in that she kept her children off guard by her unreliable yet vivid moods and actions. She would move from a dark depression to a burst of active involvement in life; she would linger thoughtfully for a moment with one of the children and then suddenly disappear without any idea of having aban-doned her child; she would scrutinize the children and with dramatic flair but little understanding – so far as the children could make out – deliver some pithy com-ment on their appearance or their personality. These children knew this woman in many ways, but not the least was the way in which the mother got inside the children through ‘stirring them up’.
Whether the hysteric’s mother was traumatizing by intruding sensationally upon the child or whether the child exploited senses to gain the parents’ attention, the adult hysteric’s innervation of her senses can be seen as an act of freedom. At least it is her way of refusing either to be stirred up or to stir herself up, and, as the sensational discourse has always been at her expense, her attack on the senses and the body becomes a means to force thoughtfulness. As if she must try to compel someone into a talking cure.
One of the unanswered questions for the hysteric in a session is: ‘Who is going to be stirred up here? You [analyst] or me [patient]?’ Will she move herself into an event, exploiting her feelings and intelligence, or will she scrutinize the analyst, pummel him with questions, shriek at him, and transfer her distress and confusion into him: often, as Khan has suggested, to watch the analyst struggle?
The analyst’s conversion hysteria
I have said that in the countertransference I was unconsciously endowed with ele-ments of this patient’s mother, an introject now in me as an ego-alien phenomenon transferred by my patient. The other side of the countertransference – that part of me compelled to become a bit of the patient’s infant self – emerged through a subtle but persistent fear of my patient. I never knew what Jane would do, and
yet, viewed rationally, I am sure that I had nothing to fear. My fear was an ele-ment of something being relived by my patient and me, some crucial feature of my patient’s infantile self-and-object world. I understood this fear to be my paralysis in the face of an object to whom I could not relate through understanding and who moved so quickly and bewilderingly in the session that I was suffering from a form of trauma.
When reflecting on how we become possessed by our patients, on how they grip us, it is well to recognize the fact that although we provide the setting for the patient, it is the analyst who becomes the patient’s object, not the other way round. Each patient handles us differently as the object of his or her transference.
I gradually understood that my experience with Jane must certainly have partly re-created elements of her relation to her mother. In these moments, I think the patient handles us in the way that she unconsciously recalls being handled by her own primary objects, so my fear and confusion re-created Jane’s fright with her unpredictable and dismissive mother.
Hysterical conversion still exists. The primary difference is that in the past the hysteric converted psychic content into a numbed object that was a part of her body, whereas now it is the analyst who suffers the effect of hysterical conversion.
It is as if my mind (my capacity to be empathically analytic) were numbed by my analysand, and as if I (the analyst who should be intently devoted to understanding his patient) were oddly indifferent to the presence of pain in the patient.
This conversion is achieved when the hysteric embodies a specific affect or thought in a representationally grotesque manner, compelling me in the counter-transference to become numb in that potential space where I ordinarily receive and reflect on the nature of a patient’s thoughts and feelings. For example, Jane began a session telling me of a sad event with her boyfriend. She had arranged to meet him at an ice-skating rink with two other couples. She had only met the couples recently but had taken quite a liking to them. Her boyfriend was traditionally wary of her friends as he came from a different social class than she did, and on this occasion she had taken great pains to assuage his anxieties. Telling me in great detail about how the events unfolded, she informs me that when the boyfriend turned up at the rink, he became suddenly offensive towards her for no appar-ent reason and stomped off into the distance, leaving her feeling humiliated and bewildered. At this moment in her story I felt very sorry for her, but she began to scrutinize me with increasingly irritated expectancy, ultimately demanding from me some kind of positive verdict on her performance: ‘Well, how do you feel about what I have just told you?’ Instead of feeling in touch with that anguish that is quite genuinely contained within the story, I feel attacked, and certain empathic areas of myself close off as I become more vigilant and gear up for the now famil-iar assault. I am also aware of a nagging feeling of increased irritation with her, a sustained sense that is punctuated now and then with quite intense hate. On reflec-tion, I think I hid from my own affect by hiding within the psychoanalytic silence.
As I understood it, Jane could not contemplate her genuine hate towards her boyfriend. She reports the trauma and begins to hate me. A conversion takes place