Australasian Journal Of Psychoanalytic Psychotherapy
NO.1&2 - 2022
Australasian Journal OfPsychoanalytic Psychotherapy
NO.1&2 - 2022
THEORY AND PRACTICE
Projective Encounters of the Fatal Kind
Using the story of Wagner’s opera, Lohengrin, the author draws attention to phenomena which he calls Projective Encounters of the Fatal Kind, in which the subject is taken over by a doubt and loses faith in a previously valued object. The theoretical constructions which account for this phenomenon, not uncommon in clinical practice, are examined in relation to recent infant research. An attempt is made to unify clinical experience, data obtained from infant research and from research into post-traumatic stress disorder into an explanation which has, as its basis, the theoretical understanding of individual development as starting from a psycho-somatic relationship.
The inspiration for this paper came while I was watching a performance of Wagner’s Lohengrin – the title came into my mind rather than the paper but, having found the title, I found that I then needed to write the paper. In Lohengrin, Elsa, the heroine, ward of Telramund and his evil wife Ortrud, is accused of murdering her brother Godfrey. Elsa, called to defend herself, relates a dream in which a knight, clad in shining armour, appears to defend her. The knight does appear, but only when Elsa herself prays to him. He betrothes himself to Elsa on condition that she never ask his name or his origin. By defeating Telramund he establishes the innocence of Elsa. Telramund and Ortrud seek revenge. This Ortrud does by sowing doubt in Elsa’s mind about the credentials of her knight. Although Elsa initially professes complete belief in his goodness and will not listen to Ortrud’s calumny that he is an impostor, the doubt takes seed in her mind. On her wedding night anxiety and uncertainty overwhelm her, and she forces the knight to reveal that he is Lohengrin, son of Parsifal, and that he comes from Monsalvat, home of the Holy Grail, to which, his secret now revealed, he must return. Lohengrin leaves and Elsa, having lost her knight, falls lifeless to the ground.
In this opera I saw the clear effect of a projective encounter of the fatal kind. Ortrud’s malevolent attack on Lohengrin through Elsa leads Elsa to lose her protector, the knight in shining armour and, in turn, her life.
Denigration and Destruction
This phenomenon, the denigration and destruction of the loved object, particularly of an object which has previously been idealised, as the result of an attack from outside is well recognised clinically. The change in Othello’s love for Desdemona as the result of Iago’s insinuations is another example from literature. The mechanisms which we use to account for it are splitting and envy. From a Kleinian perspective the origin of such mechanisms is very early, perhaps even from before birth. Klein1 says, for example: “I consider that envy is an oral-sadistic and anal-sadistic expression of destructive impulses, operative from the beginning of life, and that it has a constitutional basis”. Winnicott2 disagreed as to when such envy starts. He said: “So much of what Klein wrote in the last two decades of her fruitful life may have been spoilt by her tendency to push the age at which mental mechanisms appear further and further back”. Of the “splitting of object into ‘good’ and ‘bad’’: he says, “Klein seemed to think that … infants start in this way, but this seems to ignore the fact that with good-enough mothering the two mechanisms may be relatively unimportant until the ego organisation has made the baby capable of using projection and introjection mechanisms in gaining control over objects”.
This has always been an important theoretical difference between the two approaches. More recently, the issue of when the phenomenon of splitting occurs developmentally has been taken up by Stern3 who criticises the theoretical position of Kernberg, and thus of Klein, with regard to the stage at which splitting occurs. In brief, his argument is that based on infant research, no evidence supports the notion that infants dichotomise their experiences into ‘good’ and ‘bad’ early on. Rather, there is initially a whole set of experiences which vary from pleasurable to unpleasurable and it is a later achievement to re-allocate these experiences into the two clusters. He says:
At a later date, after verbal relatedness is well established the child or adult can, with the aid of symbols, re-index RIGs (that is, representations of interactions which have become generalised) and various working models to form two superordinate categories that are imbued ,with the full meanings of ‘good’ or ‘bad’. In this way, an older child or adult can indeed ‘split’ their interpersonal experience, but it is in fact not a splitting but rather an integration into a higher order categorisation.
The issue here is one of timing – viz. at what stage does splitting occur. Before returning to this, I want to look at the phenomenon that I have described as a projective encounter of the fatal kind and at what might preserve the object from such destruction.
Preservation of the Object – Clinical Examples
Sally, aged two months, is crying apparently inconsolably. Her whimpering when she first awoke was not heard and by the time her mother did hear her, she was crying uncontrollably. Although offered the breast by her mother, she averts her head and continues crying. Her mother gets up, walks around with Sally on her shoulder, gently patting her back. The crying ceases eventually and she settles down to a feed. In a second vignette a patient in twice-weekly therapy brings a dream. The therapist, in working with her material, makes a reference to another dream about which he is reminded by the material in this dream, and then realises his association was to another patient. The patient comments on his mistake and the therapist acknowledges it. The patient says that she thinks the therapist was indicating his wish to replace her with the other patient. Although the therapist points out that in fact the therapy has been going well, and that it has seemed as if both he and the patient have been enjoying the work they have been doing together and that this was not the reason for his mistake, the issue rumbles on for some weeks. The patient talks about the difficulty in trusting the therapist. Although the wish for a safe regression is there, she says how difficult it is to allow this to happen. But the therapy continues. The patient does not leave and agrees to continue to sort out what the mistake meant. Both with Sally and the patient there is a potential for a projective encounter of the fatal kind. The problem is that the experience can go either way. Sally may not settle and her mother may be overwhelmed by her anger and reject her infant or attack her; the therapist may be overwhelmed by his guilt and become unrealistically angry with the patient, preventing any resolution. Both the situations may end badly, one possibility being compliance of Sally or the patient and the development, or use, of a false self personality structure4 to deal with the trauma.
Indeed, with severely disturbed patients we know that there are times when the need to preserve the fantasy of the perfect therapist is paramount. We know from clinical experience that in the course of the therapy of such severely disturbed patients, there does come a time when it is possible to make mistakes and for these mistakes to be allowed by the patient without total denigration of the therapist and disruption of the therapy; or for a break from therapy to be taken without a sense of the therapist having been lost irrevocably. Knowing where the patient is in relation to this point is crucial in the clinical management; the way in which interruptions to therapy are dealt with depends on a clear appreciation of the patient’s position developmentally. If the patient is able to hold on to a sense of the survival of the therapist’s caring despite the interruption, without recourse to idealisation or to denial, we then regard him as having reached the depressive position. If the patient has not been able to reach this state, the stage is set for a projective encounter of the sort I am describing.
We can describe how this can be prevented in a number of ways. We can talk of the containing behaviour of the mother, or of her ability to envelop the pain which allows the painful experience of the infant to be manageable. Brazelton5 talks about the mother’s ability to talk the infant down from a distressed state to a state in which the infant is alert and responsive to the mother. Winnicott6 describes a similar process in his use of the concept of holding. Both Brazelton and Winnicott use terms which are close to physiological or somatic terminology, not surprising if one recalls their relationship to paediatrics. Bion7 talks of containment and the mother’s alpha function, and at a different level of abstraction again, Klein8 talks of the infant’s “persecutory anxiety [being] to some extent counteracted by the infant’s relation to the good breast”.
Psychic Functions and Somatic Substrates
“Human nature;’ Winnicott suggests, “is not a matter of mind and body – it is a matter of inter-related psyche and soma, with the mind as a flourish on the edge of psycho-somatic functioning.”9 From this perspective, it is instructive to explore how recent infant research findings might illuminate the clinical area we have been discussing, Two contributions are useful, one of which can be described as observational and the other as psychobiological.
The description of infant states of consciousness has been crucial in the development of infant research. Wolff10 observed a number of infants over a period of about 16-18 hours each day for the first five days after delivery and from these observations described six different states of consciousness: regular sleep, irregular sleep, drowsiness, alert inactivity, alert activity and crying. He observed that “during periods of alert inactivity, and almost only in this state, the infants made auditory and visual pursuit movements to appropriate stimuli”. In a footnote in this paper, he points out that the generally accepted view (at that time) was that an infant only became capable of visual pursuit at around the sixth week, but that, as the longest period of alert inactivity which he observed in the newborn was seven minutes and the total of all alert inactive periods in any 24-hour period never exceeded 30 minutes, the opportunity to study the infant’s capacity for pursuit movements was rare in the neonatal period. This might account for the general belief that pursuit movements might be a much later developmental acquisition. The observation that infants less than three days old were able to visually fix on, and follow with their eyes and head, an object moved in front of them, alerted researchers to what were, until then unrecognised capabilities. A significant result of Wolff’s observations was the realisation that infants were available for experiments involving their capacity to learn and remember during these periods of alert inactivity, The direct result of Wolff’s work was the new timetable of cognitive development, which has such milestones as the child’s ability to distinguish between the smell of his mother’s milk from stranger’s milk when he is six days old11. The classification of states of consciousness in the infant is not without difficulties, since different observers may classify what they see somewhat differently, suggesting that the division into various levels of consciousness is somewhat arbitrary, Yet there does seem to be general agreement that there is a state of consciousness in which it is possible to ‘ask’ infants questions which explore their perception and memory. The significant body of data resulting from this approach has certainly increased awareness of a much earlier competence in the infant than was previously thought to exist. However, it must be noted that this work is dependent on the response of infants to ‘questions’ asked of them in the alert-inactive state and we have no way of knowing whether what is able to be recalled in this state can be recalled in other infant states, such as alert activity or crying. I have been unable to find any work done which clarifies this. Stern,12 in a lengthy discussion about whether affect state-dependent experiences (that is experiences which are heavily coloured by the affective state in which they occur) are remembered in different affective states, can cite evidence only with regard to adults. His conclusion that the infant can translate experiences occurring in one state of arousal, such as alert-inactivity, to other states, such as distress, is based more on convincing argument than experimental data.
Perhaps the last word on this controversy should be given by Papousek and Papousek,13 two long-standing infant researchers who work from a biopsychological model. They say:
Obviously, even with the degree of competence and autonomy admitted to the newborn at present, the first post-natal interchanges with the environment lead to a successful integration of experience only under very favourable conditions, which may be rare unless they are adjusted to the newborn’s constraints in some supportive interventions.
The reason for emphasising this body of recent infant research in exploring the phenomenon of projective encounters, has been to highlight a common criticism of the theoretical constructions employed in explaining projection and projective identification: viz. that they describe the ‘infant-in-the-patient’ and that this clinical infant may not bear very much resemblance to the observed infant.
Peterfreund,14 for example, stresses the problems of adultomorphisation of the data of infant observation. He points out the danger of interpreting material from regressed adult patients in theoretical terms derived from such adultomorphic constructions, as if it were a fact of the infant’s experience. However, not only does the work of empirical infant researchers anchor our theory in actual research, but it can also enhance our understanding of what is observed in the ‘infant-in-the-patient’.
Alert-inactivity and Free Floating Attention
Brazelton15 describes the alert-inactive state as follows:
The infant will respond with periods of active fixation on an attractive visual stimulus … they will quiet, maintain a quiet inactive state in order to follow a ball through complete 180° arcs of movement, and turn their heads as well as their eyes. If, then, they are presented with a human face, infants will act ‘hungry’ as they follow the face laterally and vertically … it is impossible for an adult interactant not to become ‘hooked’ to the infant.
The availability of the infant and adult to an intense interaction at this time in the context of an absence of ‘sturm und drang’ recalls Bion’s16 comment: “the capacity to forget, the ability to eschew desire and understanding must be regarded as the essential discipline for the psychoanalyst”. Bion is suggesting that it is this state of mind that allows the analyst to be open to the communication of the patient. It seems to me to be close to what Freud17 describes as the free floating or evenly suspended attention which he saw as necessary on the part of the analyst. I am suggesting that a major part of the work of therapy may go on in a situation which is very close to, or the same as,. what goes on between mother and infant; when the infant is in the alert-inactive state. This is not to deny the importance of putting into words at some stage the experience of those times. Rather, it emphasises that it is through such experience that the therapist is able to know what is going on within his patient. I would emphasise that on one end of this spectrum is the therapist and/or patient asleep, and on the other the therapist and/or patient distressed with internal pain.
Alert-inactivity and Containment
To return to my main theme: what led to Elsa’s experience of a projective encounter of the fatal kind was her inability to put to one side the doubt that Ortrud had raised in her mind. The doubt overwhelmed her reason and led her to ask the forbidden question. I am suggesting that the doubt reactivated an earlier trauma, that of not knowing; this experience being, perhaps, one of what Winnicott calls the unthinkable anxieties.18 When this experience occurs in the therapy of a fragile patient, I suggest that the management of it can be conceptualised in terms of the need to return and to hold the patient in what corresponds to the alert-inactive state: that is, to provide a sense of containment for the patient. Further, I am suggesting that the therapist monitors, by his own state of alertness, the possible shift in the patient’s state which threatens a projective encounter of the fatal kind, recognising either sudden anxiety or sleepiness in himself, i.e. a shift from his own alert-inactive state, as a sign of something going wrong.
Biological Substrates of Separation
The other line of infant research I would like to highlight can be described as psychobiological or psychophysiological. At first glance this has little relevance to projective encounters. Hofer,9,19 in a paper summarising recent research on the biological response of infant rats to separation, calls attention to the similarities between the observed response of infant rats and primates, including human infants, to separation. He suggests that there may be similarities in the biochemical changes which can be demonstrated in rats to those which occur in human infants. He points out that in infant rats there are two stages of response to separation from their mothers when they are 10-12 days old; an acute stage, corresponding to what Bowlby called the protest stage, and a chronic response, corresponding to the stage of despair. Although it was possible, using mother surrogates, to prevent the development of an acute response, the changes of the chronic response continued to occur, suggesting an independence of the mechanisms underlying these.
Looking first at the changes in the infant rat following separation, Hofer shows that there are a range of acute changes such as agitation, vocalisation and searching which go along with biological changes of increased heart rate, increased cortisol and increased catecholamines; and a range of chronic changes which develop slowly, such as decreased social interaction and play, rocking and facial expressions of sadness which are o companied by physiological changes such as lowered core temperature, sleep disturbance and decreased T-cell activity*.
However, he was also able to demonstrate that a single aspect of the mother-infant relationship would entirely prevent one of the physiological responses without affecting the others. Thus hyperactivity, a usual response to separation, was prevented by alternative forms of tactile simulation. What was happening here was that a specific behaviour in the mother rat was affecting a particular aspect of her infant’s behaviour. Speculating on what this might mean for humans, he suggests that the “response to bereavement may be caused by the withdrawal of the multiple regulators woven into the fabric of the relationship, at the biological as well as at the psychological level, during the time prior to the loss”, recalling Freud’s comments in ‘Mourning and Melancholia’.20
Another set of experiments was able to demonstrate the synchronicity of behaviour between mother and infant rat. Infant rats feed when they are asleep and their inactivity at this time allows the mother rat to sleep also and enter a period of slow brain wave activity, which is necessary for milk let-down to occur. In these experiments, a physiological change in the infant led to a physiological change in the mother. The delicate interplay between mother and baby, which we have seen so clearly in split screen films of mother-infant interaction, is shown to exist at a physiological level.
Biological Substrates of Post Traumatic Stress Disorder
This work calls attention to the biological mechanisms which underlie what we observe as psychotherapists. Post Traumatic Stress Disorder (PTSD) is one condition where such biological mechanisms have been explored and this work has been reviewed recently by Burges Watson.21 The clinical features of PTSD include re-experiencing the traumatic event through recurrent and intrusive recollections, dreams or nightmares; suddenly acting or feeling as if the event were recurring again following a triggering stimulus; and cognitive or autonomic symptoms such as hyperalertness, insomnia and memory impairment. Palombo22 calls attention to a group of children, previously diagnosed as borderline, who may be suffering from PTSD. Similarly, relationships between some adult patients apparently suffering from Borderline Personality Disorder may in fact be showing the symptoms of PTSD.
The locus caeruleus, an area in the floor of the fourth ventricle of the brain stem, seems to have a key role in the mediation of stress. It is a primary source of adrenergic innervation of the limbic system and it has been suggested that it exerts hierarchical control over the autonomic system, thus being intimately involved in stress responses.23 Its activity is inhibited by opioids. Increased activity of the locus caeruleus may be responsible for the intrusive nightmares or recollections experienced in PTSD.
Burges Watson suggests that “PTSD involves an imbalance between noradrenalin and opioid release in the area of the locus caeruleus. Opioid exhaustion may remove an effective opioid inhibition of the locus caeruleus neurones”.
Delayed PTSD may be a response to a sensitivity to a stress already experienced. It has been suggested that “reintroduction of the stressor may come to elicit an exaggerated and rapid neurochemical change” which hinders adaptation to the stress,24 so that an individual, many years after satisfactorily coping with extreme stress, may suddenly break down.
Projective Encounters, Black Holes and Psychotherapy
A synthesis of the recent work on infant development and the biological response to separation in infants, leads to a possibility that what we see in a projective encounter of the fatal kind is the end point of a trauma of early infancy. This trauma causes an imbalance between noradrenaline and opioid release in the region of the locus caeruleus and leaves behind an increased sensitivity to the trauma, a biochemical trigger, or a black hole’. The trauma may be subtle and may be something like an absence of one of the maternal regulators which Hofer talks about and which have been shown to have long-standing effects; or a repetitive counter attunement using the model derived from Stem’s work. Alternatively, the trauma may be gross, such as severe early privation. A repetition of the trauma in later life causes reactivation of the biochemical trigger with opioid exhaustion and increased locus caeruleus activity. This can result in a clinical picture similar to that of PTSD; or, using another framework, in what I have described as a projective encounter, with the patient experiencing the loss of the object in the past as if it were destroyed in the present.
If this is so, management of the patient can be conceptualised in terms of the need to hold the patient, in the sense that Winnicott25 uses this term, in what corresponds to the alert-inactive state; or to provide what Brazelton26 describes as the mother’s ability to talk the infant down from a distressed state to a state in which the infant is alert and responsive to the mother. It may be that what the therapist is able to do for the patient in these situations is to reinstitute what Hofer calls the maternal regulators; avoiding what Tustin27 describes as getting sucked into the black hole’. Conversely, in those patients who do badly with psychotherapy, it may well be
- M. Klein, ‘Envy and gratitude’ in Masud Khan (ed.), Envy and Gratitude and Other Works, Hogarth Press, London, 1975.
- D.W. Winnicott, ‘On the Kleinian contribution’ in The Maturational Process and the Facilitating Environment, IUP, New York, 1965.
- D.M. Stern, The Interpersonal World of the Infant, Basic Books, New York, 1985.
- D.W. Winnicott, ‘Ego distortion in terms of true and false self’ in The Maturational Process and the Facilitating Environment, IUP, New York, 1965.
- T. Berry Brazelton, ‘Precursors for the development of emotions in early infancy’ in R. Plutchik and H. Kellerman (eds), Emotions in early development, vol. 2 of Emotion: Theory, research and experience, Academic, New York, 1983.
- D.W. Winnicott, ‘The theory of the parent-infant relationship’ in The Maturational Process and the Facilitating Environment, IUP, New York, 1965.
- W.R.’ Bion, Elements of Psycho-analysis, Heinemann, London.
- M. Klein, ‘Some theoretical conclusions regarding the emotional life of the infant’ in J. Riviere (ed.), Developments in Psycho-analysis, Hogarth, London, 1970.
- D.W. Winnicott, Human Nature, Free Association Books, London, 1988, p, 26.
- P. Wolff, ‘Observations on newborn infants’, Psychosomatic Medicine, 21, 1959,p p. 110-18.
- J, Macfarlane, ‘Olfaction in the development of social preferences in the human neonate’ in M. Hofer (ed.), Parent-Infant Interaction, Elsevier, Amsterdam, 1975.
- D. Stern, op. cit.
- H, Papousek and M. Papousek, ‘Biological basis of social interactions: implications of research for an understanding of behavioural deviance’, J. Child Psychol. Psychiat., 24, 1, 1983, pp. 117-29.
- E. Peterfreund, ‘Some critical comments on psycho-analytic conceptualisations of infancy’, Int. J. Psychoanal., 59, 1978, pp. 427-31.
- T. Berry Brazelton, op. cit.
- W.R. Bion, Attention and Interpretation, Tavistock, London, 1970.
- S. Freud, ‘Recommendations to physicians practising psycho-analysis in S.E., XII, pp. 111-20.
- D.W. Winnicott, ‘Ego integration in child development’ in The Maturational Process and the Facilitating Environment, IUP, New York, 1965.
- M.A. Hofer, ‘Early social relationships: a psychobiologist’s view’, Child Development, 58, 1987, pp. 633-47.
- S. Freud, ‘Mourning and melancholia’ in S.E. XIV.
- I.P. Burges Watson and others, ‘The neuro-psychiatry of post-traumatic stress disorder’, Brit. J. Psychiat., 152, 1988, pp. 164-73.
- J. Palombo, in Grotstein, Solomon and Lang (eds) The Borderline Patient, Vol. 1, Analytic Press, Hillsdale, 1987.
- Van der Kolk and others, ‘Inescapable shock, neurotransmitters, and addiction to trauma: toward a psychobiology of post traumatic stress’, Biol. Psychiatry, 20, 1985, pp. 314-25.
- H. Anisman, ‘Neurochemical changes elicited by stress: behavioural correlates’ in H. Anisman, G. Bignami (eds), Psychopharmacology of Aversively Motived Behaviour, Plenum Press, New York, 1978.
- D.W. Winnicott, ‘Ego integration in child development’ op. cit.
- op. cit.
- F. Tustin, Autistic States in Children, Routledge & Kegan Paul, London, 1981.