TRACE THEORY AND SYMBOLIZATION PROCESS IN THE CLINIC OF PSYCHOSISABSTRACT.
This article is a thematic review about the conceptual field and the symbolization process in the clinic of psychosis. In the first part, we do a route in the field of conceptual field of psychosis, specially in the relations with the pathos and the constitution of the self, in the perspective of the phenomenology and, mainly, of the psychoanalysis. In the second part, we develop symbolization aspects in the psychosis in continuous reference to the trace theory of Freud and Roussillon. In psychosis, there are flaws in the field of primary symbolization, that concern the sensoriality in imagetic representations organization. the premature experiences that make up the "personality psychotic part" demand transformation works and subjective appropriation. The "matter first" é syncretic and complex and, because the are pre-verbals, adequate mediation devices that avoid the transferencial dispersion are needed, favour parcial investments, and help the creativity and communication rescue.
Keywords:
Psychosis; symbolization; trace theory
RESUMO.
O presente artigo é uma revisão temática acerca do campo conceitual e dos processos de simbolização na clínica da psicose. Na primeira parte, fazemos um percurso no campo conceitual da psicose, especialmente nas relações com o pathos e a constituição do Eu, na perspectiva da fenomenologia e, sobretudo, da psicanálise. Na segunda parte, desenvolvemos aspectos da simbolização na psicose em referência contínua à teoria dos traços de Freud e de Roussillon. No contexto da clínica, a exploração de formas primárias de simbolização permite levar em conta os aspectos mais primitivos da experiência subjetiva. Na psicose, existem falhas no campo da simbolização primária, que dizem respeito à organização da sensorialidade em representações imagéticas. As experiências precoces que compõem a “parte psicótica da personalidade” demandam trabalhos de transformação e apropriação subjetiva. A “matéria primeira” é sincrética e complexa e, por serem pré-verbais, fazem-se necessários dispositivos de mediação adequados que evitem a dispersão transferencial, favoreçam investimentos parciais e auxiliem no resgate da criatividade e da comunicação.
Palavras-chave:
Psicose; simbolização; teoria dos traços
RESUMEN.
Este artículo es una revisión temática acerca del campo conceptual y de los procesos de simbolización en la clínica de la psicosis. En la primera parte, examinamos el campo conceptual de la psicosis, en especial lo que se refriere al pathos y a la constitución del Yo desde la perspectiva de la fenomenología y, sobre todo del psicoanálisis. En la segunda parte, desarrollamos aspectos de simbolización en la psicosis en continua referencia a la teoría de los rasgos de Freud y de Roussillon. En el contexto de la clínica, la exploración de formas primarias de simbolización permite tener en cuenta los aspectos más primitivos de la experiencia subjetiva. En la psicosis existen fallas en el campo de simbolización primaria, las cuales se refieren a la organización de la sensorialidad en representaciones de imágenes. Las experiencias precoces que componen la “parte psicótica de la personalidad” demandan trabajos de transformación y de apropiación subjetiva. La “primera materia” es sincrética y compleja y, por ser preverbal, es necesario contar con dispositivos de mediación adecuados que eviten la dispersión transferencial, que favorezcan las inversiones parciales y que auxilien el rescate de la creatividad y de la comunicación.
Palabras clave:
Psicosis; simbolización; teoría de los rasgos
Introduction
This article aims to discuss the processes of symbolization in the psychosis clinic, focusing on early experiences. Several authors (Aulagnier, 1975/1986; Balestrière, 2003; Roussillon, 2014a; Brun, 2014b) based on psychoanalytic theory address issues related to image representations in psychotic disorders, which denotes the importance of studies that deal with this topic and the respective possibilities of treatment.
Firstly, we take a look at the conceptual field of psychosis, especially in the relationships with pathos and the constitution of the Self. We investigate the flaws in the sensation of existing, which brings us to the study of the field of sensoriality in search of understanding the stasis in vital and primordial processes. These are directly linked to the fragmentation of the Self and the losses in the process of mediation with the environment, as well as fantasies that do not find adequate spaces in representative activity.
In the second step, we develop aspects of symbolization in psychosis in continuous reference to the trace theory of Freud (1896/2006) and Roussillon (2014a, 2014b). The trace theory starts from a need to think about traces of memory not organized into images, constantly referred to as sensoriality (Balestrière, 2003). In psychosis, there are flaws in the field of primary symbolization, which concerns the organization of sensoriality in image representations. The first experiences demand mediation devices that facilitate the emergence of representative activity in search of adaptation to the symbolization capabilities of patients.
Pathos and rhythms in psychosis
Suffering is inherent to human beings but the anxieties that affect them are not necessarily pathological to the point of causing self-disorganization; on the contrary, this dynamism of life underlies human existence. Anxiety, in its intense manifestations, places the being in front of something essential of a pathic nature, which constitutes the being's very existence. The domain of psychopathology often deals with anguish, which is an affective state found in all fields of human existence. In human suffering, the pathic aspect of existence becomes evident (Minkowski, 1968/2000), being a field that is seriously altered in the psychotic (Oury, 2000).
According to Schotte (1984-1985), the living being is constituted in presence, in a constant becoming that is formed through contact. The pathic field is related to this sensitive experience that underpins representative activity, as it is in this primarily bodily encounter that the object presents itself and is constituted in psychism. Presence is what guarantees the apprehension of the world and its transformation into objects, and thus comes the introduction of the subject, through engagement and decision-making, as something that breaks out in the critical tension between wanting, power, and duty.
Living with and experiencing anguish exemplifies how the impairment of pathos appears in schizophrenics, as they commonly place it in the field of narration, with an important distance. “The schizophrenic often speak of themselves as if they were acting through the intervention of a third person” (Minkowski, 1968/2000, p. 8).
Minkowski (1927/1997) further elucidates the impairment in the pathic field when discussing the “loss of vital contact” with reality. For the author, the problem within the scope of “primordial sensation” in schizophrenia concerns the “irrational factors of life” (excitation, sensation, reflex, and motor reaction). However, this loss “is not the possibility of a simple sensorial contact with the environment but the dynamics of these contacts, that is, everything that makes the subject’s relationship with the other alive” (Minkowski, 1927/1997, p .8). The profound imbalance in this dynamism affects the envelope and constitution of the environment for the subject, and the main symptoms are impairments in relation to feeling and existing, especially concerning the body and the place it occupies. In this way, there is a failure in the affirmation of the Self and the spatio-temporal orientation (Minkowski, 1927/1997). Psychosis is the basal situation from which the patient tries to exist (Maldiney, 2003).
Disharmony in the field of feeling and existing appears essentially in the way of relating. According to Maldiney (2003), the inability to “encounter” is at the foundation of psychosis, as the psychotic can't be present, due to a disarticulation in their temporality and spatiality. The authentic encounter essentially implies “mystery”, that is, an engagement that is impossible to enunciate. In melancholic, for example, their existence is characterized by constant complaints fueled by the impossibility of “authentic encounters”.
Jean Oury (2000) locates, in a more specific way, the impairment of the psychotic, which would be a rhythm disorder, a domain of the pre-pathic. According to Maldiney (1973), rhythm is the guarantor of the notion of reality in the world through the communication that feeling establishes. Psychosis is found in what is primitive, in what concerns rhythms that are inappropriate for the subject and that do not constitute them in the symbolic field. Rhythm is the first communication with the world. Through it, the shift from chaos to order takes place and in it, feeling is articulated with movement, as it covers the entire field of sensitive receptivity. The Greek notion of Ruthmos concerns the form (scheme) that is improvised and modifiable (Maldiney, 1973).
One of the fundamental aspects that occur as a consequence of failures in the field of feeling concerns the “feeling of harmony with life”. It is a regulatory feeling that cannot be intellectualized. There is a desire to feel at one with life and with oneself. When disharmony reigns, only oppositions occur that cannot be integrated, for example, when feeling opposes thinking (Minkowski, 1927/1997).
The Self in Psychosis
Psychoanalytic perspectives on the phenomena of psychosis especially take into account the fragility in the constitution of the Self and, therefore, of conscious perception and negotiation with external reality. There is a return of investment in the world for the Self, bringing several consequences for the subject, such as the excess of the subjective world and the non-appropriation of one’s own body. The constitution of the Self is seriously impaired in psychotics. However, the idea of the human Self is a metaphor (Martins, 2010), which concerns the psychic instance that provides organization, reference, and meaning to what we do, but also gives us a feeling of unity and mediates negotiations between impulses and the possibilities of external reality.
In addition to the issue of impairment in the field of Pathos and Ruthmos, as pointed out by the authors of phenomenology, the problem of psychosis lies in the disturbances in the ties between the Self and the outside world, in which delirium serves the function of a patch which aims to cover up this crack in the relationship. Thus, the manifestations of the pathogenic process are constantly covered up in attempts at reconstruction and healing in the face of the radical shattering of the Self (Freud, 1924a/2010).
Just as in neuroses, the emergence of psychosis comes from frustrations (Versagung1) from the external world, but also from the internal (Superego), due to the non-fulfillment of childhood desires, which also denotes failures in the function of the Self, which does not fully comply with mediation. Freud (1924b/2010) also believes that the loss of reality is already present in psychosis from the beginning and emphasizes two stages in its development: disinvestment of the Self in reality (denial) and reality correction through substitution.
The abandonment of interest in the external world (people and things) also occurs in neuroses, but in these, there is no suspension of the erotic relationship with objects. According to Freud (1914/2010), the libido withdrawn from objects in schizophrenia is directed at the Self (secondary narcissism), causing an overestimation of the power of one’s desires and psychic acts (omnipotence of thoughts), belief in the magical force of words and magic as a way of dealing with the external world. Secondary narcissism is built on primary narcissism, that is, it is “the amplification and explanation of a state that had already existed before”, (Freud, 1914/2010, p. 16), in which the child invests all its libido in itself (Laplanche & Pontalis, 1987/2001). Thus, secondary narcissism is characterized as a regressive movement.
Narcissism and the relationship with the environment in psychosis
In the article “The Unconscious”, Freud (1915b/2010) places psychosis within the concept of “narcissistic psychoneuroses”. This position concerns the overinvestment of the Self and the disinvestment in objects, which would bring psychotic phenomena closer to the idea of the unconscious in psychoanalysis. It is a process that especially affects language, causing considerable transformations that lead to a state of subjective disorganization. For Martins (1995), the conception of psychosis as a narcissistic psychoneurosis necessarily brings a theory of the Self, of its origin, genesis, and constitution.
Primary narcissism is the process that establishes a “synthesis” of the body with psychism and in which the maximum point of differentiation between the Self and the non-Self occurs to emerge the ideal Self. The development of the Self occurs through the movement of distancing oneself from this primary narcissism (Freud, 1914/2010). The “initial reality-ego” gives way to a “pleasure-ego”, which distinguishes the external world based on the incorporation of what gives it pleasure or not, which provides, in turn, the experience of hatred, which is the basis of object relations (Freud, 1915a/2010).
In psychotic, there is difficulty in moving from the pleasure principle to the reality principle. This characteristic leads to sensitive qualities (in addition to pleasure and pain) being understood in an unsatisfactory way, resulting in a destructive movement directed against the newly invested sensory organs and the consciousness linked to them (Bion, 1994). When there are flaws in the “stimulus-body” symbolization, symbolization difficulties arise (primitive states of organization). In psychosis, the narcissistic bond does not occur and words are subjected to primary processes (Freud, 1914/2010). The weakness of synthesis is responsible for the maintenance or conservation of primary processes (Freud, 1941ϟ1938]/2006).
The movement of synthesis, which precedes the development of the Self, is a concept that primarily refers to autoeroticism and bodily synthesis. Thus, “For each such change in the erogenity of the organs, there could be a parallel change in the libidinal investment of the Self” (Freud, 1914/2010, p. 28), as the libidinal investment of the body is concomitant with the development of the Self. In this way, the Self is, above all, bodily and is constituted by bodily sensations originating mainly from the surface of the body, as well as representing the surfaces of the psychism, the basic understanding of the notion and theory of the skin-ego by Anzieu (1985). Narcissistic synthesis also essentially calls for the synthesis of polymorphous infantile sexuality towards genital organization. In psychosis, there is a stasis of the ego libido (Freud, 1914/2010).
Failure in narcissistic synthesis can occur due to “excessive object presence”. According to Winnicott (1952/2000), the loss of the sensation of being caused by early environmental intrusions (failed environment) leads to defensive organizations and isolation as an attempt at reconstitution. Psychosis, according to Winnicott (1963/1994), would be a form of defense against what the author calls “primitive agonies”: return to a non-integrated state, loss of psychosomatic collusion, loss of the sense of reality, loss of capacity of relating to objects, that is, a reaction to the fear of collapse, of what is unthinkable.
Some people’s dissatisfaction with their lives is related to the loss of contact, as they feel dissociated, without unity, and scattered. Psychotics have difficulty getting in touch with the facts of life. In severe cases, individuals do not care about living or dying - as they are completely oblivious to what is real, personal, original, and creative - without themselves identifying what they lack (Winnicott, 1971/1975).
The constitution of a fragmented Self, as in schizophrenia, resonates with the fragmentation of one’s own body as a representation of oneself. Freud (1915b/2010) speaks of the “language of the organ” to emphasize how some psychotics place, in the foreground, the relationship with some organ (or innervations) to represent an entire content, which concerns primary psychic processes.
The different theories regarding psychotic phenomena essentially encompass losses in the constitution of the Self resulting from disruptive experiences at early stages of development, which result in losses in sensitive experience and vital contact. Impairments in the feeling of being and existing accompany disorganizing affects, disturbances in corporeality, as well as important losses in representative activity.
Early symbolic registration and primary symbolization in the clinic of psychosis
Theory of traces and psychosis
At the beginning of the psychoanalytic movement, in a letter to a friend, Freud (1896/2006) hypothesized that the psychic mechanism is formed by a process of stratification, in which memory would break down at various times and would be recorded in different types of indications. The passage from one record to another would occur through “translation of the psychic material”. Freud (1896/2006) describes that there are three ways of inscribing psychic experience. The first would be the perceptive mnemic trace (indication of perception). The second, which is unconscious, are conceptual memories, inscribed in the form of thing-representations. Later, and in a more elaborate way, we have the pre-conscious inscription, which is linked to verbal representations and corresponds to the ego (I).
Mnemic traces (Freud, 1937/2006) have a special vivacity and almost indestructibility (like archaeological sites) of the essential elements of early experiences present in fragments of memories, associations, and behaviors. Freud (1939/2006) describes that such impressions are in the visual and auditory area and that, through integration with the function of speech, they can become conscious.
The theory of traces is related to dream work at some points in Freud’s work. He describes that, in regression work, “the structure of dream thoughts breaks up into its raw material” (Freud, 1900/2006, p. 574). Thus, dreams and representation come about to reanimate an incomprehensible unconscious impression or trace, that is, the elaboration of images from chaotic material (Freud, 1918ϟ1914]/2010).
In a similar way to the formations of dreams, the mechanism of delusions (individual and collective) is subjected to the power of the “element of historical truth which they have brought to the surface through the repression of the forgotten and primeval past” (Freud, 1937/2006, p. 287). These are inaccessible to logic, contradict external reality, are influenced by the fulfillment of desire over the content, and suffer deformations and displacements (Freud, 1937/2006).
Freud (1900/2006) highlights that the character of a subject is based on the mnemic traces of their impressions, especially from early childhood (which never become conscious), which retain, until old age, the character of sensory vividness (Freud, 1900/2006). Therefore, the transference relationship is fundamental to favor the return of emotional connections, which are the raw material for the analysis work and are presented in the repetitions and updates of early childhood reactions (Freud, 1913/2006).
The theory of traces starts from a need to think about traces of memory not organized into images, constantly referred to as sensoriality. In the dream, the representation returns to the sensorial image from which it once emerged; however, for the primary matter to originate the representation, some operations are necessary. The primary matter has the structure that forms unconscious thoughts and these are capable of being represented by images. The image, through its plasticity, introduces the movement, mobility, and play necessary for representative activity (Balestrière, 2003). In this sense, several contemporary authors of Freud organized theoretical systems that contemplate non-symbolized primitive experiences.
Bleger (1967/1981) introduces the concept of an “agglutinated nucleus”, formed by primitive identifications, in which a discrimination between the Self and the non-Self has not yet been established. The author suggests that the agglutinated object is a residue of the most primitive experiences that constitute the psychotic part of the personality. It is a conglomerate or a condensation of very primitive experiences of the Self, concerning inner objects and parts of outer reality. It is formed from the earliest identifications, with a fusion between interior and exterior, and a lack of differentiation between exterior objects and the parts of the Self that are linked to them.
The “psychotic part of the personality” is a stratum or organization of the personality that has remained in or returned to a syncretic organization and remains cleaved from the more integrated part of the personality. In healthy development conditions, this part will be the precursor to the paranoid-schizoid position, a fundamental transition, and, when it does not occur, the “agglutinated nuclei” are formed (both the syncretic part and the agglutinated nucleus are called the psychotic part of the personality). Following this reasoning, all syncretism is not a clinical psychosis, but all psychosis is a syncretism. All psychotic restitutions (healing attempts) have a syncretic structure, that is, in their internal structure, there is no discrimination (Bleger, 1967/1981).
Aulagnier (1975/1986) introduces the concept of pictogram, which is characterized by an inseparability between bodily space, psychic space, and exterior space. The prototype of the pictogram is the original “breast-mouth” relationship, as a single and inseparable entity. This sensorial experience inaugurates two forms: holding pleasure within oneself and rejecting displeasure from oneself. The first form of union accompanied by pleasure is designated as a pictogram of linking. The second form will be called the pictogram of rejection, accompanied by simultaneous destruction of the breast and mouth.
The pictogram is presented as a hallucinated sensation, in which “the subject is nothing more than this function (auditory, olfactory, proprioceptive) inseparably linked to the perceived: the subject is this noise, this odor, this sensation and he it together this fragment and this single fragment of the sensorial body mobilized, stimulated by perception” (Aulagnier, 1975/1986, p. 398). Psychic activity thus passes from an introduction in form (of the non-figurable origin) to the introduction on stage (registration of the primary) and the introduction of meaning (registration of the secondary).
In turn, Anzieu (1985) defines the “formal signifier” as the first stage of symbolizing pictograms and describes a configuration of the body in possession of a transformation that imposes itself as hallucinatory knowledge. Formal signifiers are made up of proprioceptive, tactile, kinesthetic, and postural images and do not refer to distant sense organs.
Botella and Botella (2002) propose that the absence of representable content does not mean the absence of an event. The unrepresentable is signified only in negativity, a “non-representation”, which is radically different from representation. It is something that does not originate from repression, refusal, or the effects of the castration complex, and its existence can only be captured at the level of the very psychic movement. Non-representation is a negativity that, in the form of a change in the process, appears as a failure of thought. This thought is close to the concept of negative in Green (1988).
In the context of the clinic, the exploration of primary forms of symbolization allows us to take into account the most primitive aspects of subjective experience. These refer to the construction of the connection with the object and the processes of differentiation with that object as well. Nevertheless, archaic experiences remain present throughout the subject’s life. The archaic is related to the earliest forms of symbolization, and different metabolization processes allow us to move from one level of symbolization to another (Brun, 2014b).
The field of early experiences occurs before the emergence of verbal language and therefore they are inscribed in the language of the body, affect, and the sensory-motricity game, which is highly demanded in the clinic of psychoses. The origins of symbolization processes occur in the articulation between the baby’s sensoriality and the potential virtuality of the environment’s responses (Brun, 2014b). The domain of sensory-motricity in the psychoanalytic clinic was initially developed by Winnicott (1960/1983), who relates it to the spontaneous impulse, the true self, which comes, in turn, from the Freudian theorization about the function of the part of the Self that is back to sexual drives.
The work of symbolization is organized by Roussillon (2014a, 2014b) in a mode of understanding that encompasses Freud’s theory of traces, but also emphasizes the transformation of primary experiences (primary inscription) as a first way of symbolizing. Thus, the author defines the work of subjective transformation and appropriation based on a primary symbolization that makes secondary symbolization viable.
Subjective appropriation and symbolization processes in the clinic of psychosis
Freud (1933/2010) describes that the efforts of psychoanalysis are about strengthening the Self, in a sense of greater independence of the Super-Ego and expansion of its perception and organization, so that “it can appropriate new portions of the Id. Where Id was, there shall ego be” (p. 151). This understanding of psychism in Freud denotes a tension (and emergence) of appropriation of the “obscure and inaccessible part of our personality” (p. 154) by the instance of reason.
In this way, the appropriation of psychic experience is not immediate, as it demands transformation work. The primary experiences are subject to the work of compulsion to integration, or compulsion to synthesis (Laplanche & Pontalis, 1987/2001), which is carried out by metabolizing its form into a symbolic form, which makes the process of subjectivation and reflexivity possible (Roussillon, 2012a, 2012b).
The sense of reflexivity that the author proposes is similar to the self-observation of the Super-Ego described by Freud (1933/2010). The primary transformation (primary symbolization) concerns the processes by which the “primary memory trace” is transformed into a thing-representation. The second transformation (secondary symbolization) is related to the processes by which thing-representations are transformed into word-representations, or translated into the verbal language apparatus. Thus, symbolization is always a symbolization of absence, as it is in this that the representation of the object (hallucination) occurs (Roussillon, 2012b).
Psychic suffering comes from not appropriating history and subjective experience. The latter leaves interior traces that are symbolized or not. Primary matter is unconscious, enigmatic, and cannot be immediately integrated. It is multi-sensory-motor, multi-perceptive, and multi-drive, it mixes the inside and the outside, the self and the object, and it mixes subjective and objective factors. It is always threatened with confusion, in addition to being produced in the self-other encounter. The treatment of primary matter requires externalization work, as well as transfer into the perceptual matter, in addition to decondensing its complexity to divide it between different articulable objects (Roussillon, 2014a, 2014b).
Reflection on care devices must take into account some functions essential to the work of subjective appropriation. In general terms, this metabolization process occurs in three functions: the phoric function (contain and carry), the semaphoric function (put into a significant form), and the metaphorical function (make symbolizable and integrable) (Roussillon, 2014a, 2014b). In this way, the integration of instinctual life involves functions related to feeling, seeing, and hearing. To feel yourself is to accept being affected by the affective representative of the drive. Being able to see and see yourself is to integrate the representation of a thing, as in a dream activity. Finally, being able to hear and hear yourself is to integrate word representation. Therefore, a subject capable of feeling, seeing, and hearing themselves have a triple mode of relationship with themselves and are also capable of feeling, seeing, and hearing others, in addition to articulating these three systems of reflexivity (Roussillon, 2012a). This author’s understanding of subjective appropriation provides a new dimension of complexity in the psychoanalytic process.
The work of subjective appropriation involves the integration of what the subject confronted in his/her instinctual life and the encounter with objects. Suffering comes from non-integration, that is, the objective of psychoanalysis is more a matter of appropriation and not just consciousness (Roussillon, 2012a, 2012b). Appropriation occurs especially in the creative experience (Milner, 1952/1991; Winnicott, 1971/1975; Brun, 2014b), as it provides the work of figuration of a primary trauma that could not be symbolized.
Thus, creation consists of bringing into being what has not yet come, inscribing into the work original experiences that were previously unrepresentable, which constantly reveal a process of putting into form (Brun, 2014b). However, creativity is preceded by the ability to play: “It is in playing, and only in playing, that the individual, child or adult, can be creative and use their full personality: and it is only by being creative that the individual discovers the self” (Winnicott, 1971/1975, p. 80).
Work with mediation devices seeks to adapt to patients’ symbolization capabilities, which enables subjectivation, given the different forms of suffering (Roussillon, 2014a; Brun, 2014b). The devices favor the emergence of primary forms of symbolization, as they offer the possibility of putting into form, in a matter (matter to symbolization) (Brun, 2014b). In other words: “ϟ…] instead of talking only about the association of ideas, we could also consider, in the analytical process, an association of sensations. It is, in fact, about highlighting a reupdate of sensoriality through transference” (Fontes, 1999, p. 3).
An example is the work carried out with psychotic children, which is carried out through the sensory-motricity of the child, the object, and the therapist. Putting the sensorimotor association into play conditions the emergence of primary forms of symbolization, characterized as forms of non-verbal associativity, linked to gesture, the chaining of shapes, and deformations. In this context, the therapist must pay attention to the patient’s gestures, their mimicry, their body postures, that is, the entire mime-gesture-postural dynamic, as well as the choice of instruments to work with.
This work with the environment will allow the ascension to transference dynamics. In this way, there is a formal associative chain (individual or group), in which the work of the environment will elicit bodily messages that therapists take as messages (pictograms or formal signifiers, not appropriate) that can be transformed into messages through which the patients will be able to communicate (Brun, 2014b). Therefore, the work of subjective appropriation in psychotics demands special attention to sensoriality and its various forms of associations. What has not yet been figured has not acquired the plasticity of representations and feeds stasis and difficulties in communication and transitions between “discourses”.
“Spaces of saying” and transference in the clinic of psychosis
The experience of institutional psychotherapy at Clinique de La Borde provides us with important ways to think about the adequacy of effective devices in the treatment of severe psychotics and neurotics. According to Oury (1983), in psychosis, there is a dispersion of investments (consequences of the split process), which results in errant demands and the development of stasis that hinders circulation between the different possibilities of discourses (languages2). In this sense, treatment effectiveness lies in the dimension of facilitating the passage between systems, between different places and people. These are attempts to build possible places to receive psychotic people (named by the author as “spaces of saying”), where they can go, stay, and pass, but where something emerges, manifests itself, and changes. “Freedom of circulation” becomes fundamental to favor such “encounters” and this demands transformations in institutional relationships, their hierarchies, and functions.
The emergence of “spaces of saying” is crucial in transforming psychological suffering and rescuing creativity. Winnicott (1971/1975) considers that “creative living” is closely related to a general notion of “living” and the way of approaching external reality, in this context, creativity is present mainly in the subject who is active and takes part of community life, experiencing intermediate and transitional areas, through play and culture.
Furthermore, creative phenomena relate to the true self and the organization of integrated units in time and space. When the environment suffocates creative processes, there is considerable damage to contact with external reality. In cases where external reality remains a subjective phenomenon (schizoids, schizophrenics) or where there is an extreme anchoring in reality, creative living is impaired: on the one hand, there is a loss of contact with reality and, on the other, there is loss of contact with the subjective world (Winnicott, 1971/1975, 1968/1994).
Work on transfer with psychotic patients requires differentiated care and specific technical management. At the institutional level, Oury (1983) proposes the definition of practices that facilitate the emergence of places, spaces, and scenes, to establish transference multi-referentiality, which would be like “transference marks”. In this aspect, the “spaces of saying” - which are transitional spaces (Winnicott, 1971/1975) or “platforms” that take advantage of the space of the most singular subjectivity - act to provide places in fantasy, thus preventing the transfer become diffuse and dispersed.
Thus, Oury (1986) encourages the establishment of indirect relationships with a collective structure and mediation systems that correlate with transfer. Partial investments in activities are effective in a constituted exchange system, in which even those with the most losses in contact can find ways of investing in the system, serving as transference supports and fulfilling a diacritical function, compared to the syncretic in psychosis.
The collective care system provides possible therapeutic relationships, in which transferential intensities (Bleger, 1967/1981) and excesses find different forms of mediation and symbolization. In the analytical situation, these countertransference intensities described by Winnicott (1947/2000) appear in apparently meaningless affects of hatred and irritation, which requires the analyst’s attention and consciousness of these phenomena, so that they can communicate them to the patient in a gradual and objective (and non-reactive) way. It is a work of reception and reflection in which the analyst provides a space of integration and continuity, a space that failed at an early moment in the patient’s life, who could not hate their mother, as they did not find an object that would survive their primitive hatred so that the primary object succumbs to or retaliates against the hateful attacks carried out by the individual.
The experience of hate precedes the capacity to love (Freud, 1915a/2010, Winnicott, 1947/2000) and only those who are integrated can relate more adequately to objects. The psychotic, on the contrary, has within them the coincidence of love and hate, in an excessive and confusing way, and seeks, in an “authentic encounter” with the analyst, permission to express hate.
Other issues that arise from therapeutic work with psychotics concern the emergence of anxieties related to the loss of identity, fusion, and confusion, which are the biggest obstacles to therapy. It is necessary for the therapist to support autistic distancing and the depersonalization of proximity, but, above all, they must have the ability to contain the violent affects, tensions, and anxieties raised by chaos and “senselessness” (Balestrière, 2003).
Constantly, transference aspects in this clinic are updated in the sensoriality, in the marks, and in the bodily impressions, which the speech does not reach, as highlighted by Pontalis (1990, p. 73) when addressing the limits of the verbal field in the analysis: “ϟ …] transference escapes the order and violence of discourse”. Fontes (2002), in turn, describes that there is a bodily memory (pre-verbal) that is made up of fragments of sensory impressions (mnemic traces) from early childhood, awakened in analysis through the “hallucinatory regression” of transference. Because they are “pre-verbal”, such experiences are remembered by the body, and the return of traumatic sensitive impressions comes through the body memory, in the transference relationship: “The enigmatic in the transfer awakens the bodily memory and the body uses this discharge as a particular thought” (Fontes, 2002, p. 15). Balestrière (2003) highlights that the theory of traces comes to think about psychotic transference, because, unlike neurosis, there is an update in the form of a “raw material” whose effects seem incomprehensible to us.
Based on the theory of traces, several authors theorize about the importance of mediation work in psychosis clinics. Artistic production in mediation aims to provide forms (creation) that help in the patient’s psychic configuration; however, the mediating object requires the establishment of an appropriate framework, to achieve its therapeutic potential (Brun, 2014a, 2014b; Vacheret, 2014). Roussillon (2014a) emphasizes that mediation processes bypass the intensities of projections and transferences in the relationship between users and professionals, as they facilitate the maintenance of empathy and the work that involves using the therapist as a subject to symbolize.
Final considerations
The clinic of psychosis is quite complex and requires careful listening to the diffuse and peculiar transference manifestations. The impairments and disarticulations in the field of feeling and existing, caused by early disruptive experiences, bring a reflection on psychotic therapy to understand the processes of primary symbolization. In this sense, work with the pre-verbal field demands appropriate therapeutic mediations, which enable the creation of spaces and meetings in which something is manifested and transformed, which act as support for the externalization of the primary matter. Recovering creativity provides less divided contact with reality.
The collective system and the respective mediations give rise to transference marks that subsidize the representations. It is important, therefore, that there are several offers, that the patient can circulate and make partial investments in, that freedom is present in an appropriate
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1
Versagung is generally translated as “frustration”, a word that does not correspond to the German term. The term used by Freud commonly refers to an impediment (imposed blockage) and not to a feeling (Hanns, 1996).
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2
The use of languages by Oury is in the sense of different semiotic codes.
