Martin Schmidt on Psychic Skin

"Psychoanalytic practice and theory is fundamentally concerned with boundaries and containment. This requires the establishment of semi-permeable, flexible membranes that can create space, hold and control the passage of that which goes in and out. The consulting room and its furniture, the building that it is in, the person of the analyst, the words we choose, the silence, the transference and the analytic hour itself, all provide a kind of metaphorical ‘skin’ for the analysis.

Freud states that ‘the ego is ultimately derived from bodily sensations, chiefly from those springing from the surface of the body’ (1927, p. 26). In her seminal paper, Esther Bick (1968) argues that in its most primitive form, the parts of the personality are held together by the skin functioning as a boundary. Just as the Psychic skin: psychotic defences, borderline process and delusions psychological functions of nourishment, reassurance and comfort are dependent upon the introjection of the warm and receptive breast, so too the mental function of containment is dependent upon the introjection of an external object capable of providing a ‘skin-container’ function. Without the incorporation of this containing function, the concept of a space within the self cannot arise and consequently introjection itself (i.e. the psychological construction of objects in an internal space) is impaired. Unrestrained projective identification ensues and all the confusions of identity associated with it.

Following in Bick’s footsteps, Joan Symington (1985) describes how the baby lives in constant fear of its psychic skin being breached and spilling out into ‘unintegrated states’. If the mother is able to contain the baby’s distress, the psychic skin is strengthened. If, however, the mother fails or is absent, then the infant has to resort to its own means of holding itself together. She has observed a number of ways in which the baby attempts to do this: by focusing its attention on a source of light, sound, touch or smell; by engaging in repetitive movement and by muscular tightening/clenching. Adult equivalents of these primitive omnipotent defences include pacing the floor, continuous talking, self-stroking, watching television, plugging into headphones and compulsive exercise. The perpetuation of these survival mechanisms may lead to the development of what Bick calls a ‘second muscular skin’, based on robustness and muscularity, rather than identification with a containing object. If unmodified, this can become a defensive-offensive armour which we see in schizophrenia.

Didier Anzieu (op.cit.) developed these ideas and formulated the concept of a ‘skin ego’, a bodily pre-ego, a mental image based on the infant’s experience of the skin which it uses to support the functions of the ego. He argues that as every psychical activity is anaclitically dependent upon biological/physical functions, the functions of the ego mirror the functions of the skin: a container/sac for retaining thoughts, affects and good experiences accumulated through feeding, touch and bathing in words, an interface which protects against penetration and a means of communication with the outside world.

This skin ego provides a kind of ‘narcissistic envelope’ to protect the psyche. Anzieu imagines that there is a primitive fantasy of a skin common to mother and baby which is followed by a flayed skin (with separation) and then the establishment of a skin of one’s own. At this point, I would like to clarify my own use of the term ‘psychic skin’. There is a tendency in psychoanalysis to use metaphor to describe psychological functions/capacities in terms of body parts; e.g., Symington says the ‘optimal containing object’ is the nipple in the mouth and Bick directly equates psychic skin to physical skin. However, as Warren Colman points out, there is a danger in exaggerating the physical source of the metaphor: ‘The process of reduction back to the physical body has the effect of imbuing the physical body with meaning that it did not necessarily have before’ (Colman 2005, p 653).

I am using the term ‘psychic skin’ as a metaphor for an abstract psychological capacity, namely, the containing and protective function of the psyche. This is informed by the infant’s actual experience of its own physical skin and the actions of its parents (e.g., their touch); also by the integration of their feeling/thinking containing function (which processes and makes bearable the infant’s anxieties) and other archetypal factors which I will aim to describe." (pp. 23-25)

Martin Schmidt (2012) Psychic skin: psychotic defences, borderline process and delusions. Journal of Analytical Psychology, 2012, Vol. 57, pp. 21–39

Winnicott - The Interaction of Past and Present in the Fear of Breakdown

"I can now state my main contention, and it turns out to be very simple. I contend that clinical fear of breakdown is the fear of a breakdown that has already been experienced. It is a fear of the original agony which caused the defence organization which the patient displays as an illness syndrome.

This idea may or may not prove immediately useful to the clinician. We cannot hurry up our patients. Nevertheless, we can hold up their progress because of genuinely not knowing; any little piece of our understanding may help us to keep up with a patient's needs.

There are moments, according to my experience, when a patient needs to be told that the breakdown, a fear of which destroys his or her life, has already been. It is a fact that is carried round hidden away in the unconscious. The unconscious here is not exactly the repressed unconscious of psychoneurosis, nor is it the unconscious of Freud's formulation of the part o the psyche that is very close to neurophysiological functioning. Nor is it the unconscious of Jung's which I would call: all those things that go on in underground caves, or (in other words) the world's mythology, in which there is collusion between the individual and the maternal inner psychic realities. In this special context the unconscious means that the ego integration is not able to encompass something. The ego is too immature to gather all the phenomena into the area of personal omnipotence. It must be asked here: why does the patient go on being worried by this that belongs to the past? The answer must be that the original experience of primitive agony cannot get into the past tense unless the ego can first gather it into its own present time experience and into omnipotent control now (assuming the auxiliary ego-supporting function of the mother (analyst)).

In other words, the patient must go on looking for the past detail which is not yet experienced. This search takes the form of a looking for this detail in the future.

Unless the therapist can work successfully on the basis that this detail is already a fact, the patient must go on fearing to find what is being compulsively looked for in the future.

On the other hand, if the patient is ready for some kind of acceptance of this queer kind of truth, that what is not yet experienced did nevertheless happen in the past, then the way is open for the agony to be experienced in the transference, in reaction to the analyst's failures and mistakes. These latter can be dealt with by the patient in doses that are not excessive, and the patient can account for each technical failure of the analyst as countertransference. In other words, gradually the patient gathers the original failure of the facilitating environment into the area of his or her omnipotence and the experience of omnipotence which belongs to the state of dependence (transference fact).

All this is very difficult, time-consuming and painful, but it at any rate is not futile. What is futile is the alternative, and it is this that must now be examined." (pp. 104-105)
　

　

Donald Winnicott (1974). Fear of Breakdown. International Review of Psycho-Analysis, Vol. 1, pp. 103-107.

Carl Jung on the Transcendent Function

Jung's concept of the transcendent function, originally developed in 1916, is at the center of his system of Analytical Psychology. There are striking parallels between Jung's notion of the transcendent function and the concept of alpha function proposed at a later time by Wilfrend Bion (1962, Learning from Experience):

"The tendencies of the conscious and the unconscious are the two factors that together make up the transcendent function. It is called 'transcendent' because it makes the transition from one attitude to another organically possible." [The Transcendent Function, CW 8, par. 145.]

"Once the unconscious content has been given form and the meaning of the formulation is understood, the question arises as to how the ego will relate to this position, and how the ego and the unconscious are to come to terms. This is the second and more important stage of the procedure, the bringing together of opposites for the production of a third: the transcendent function. At this stage it is no longer the unconscious that takes the lead, but the ego." [The Transcendent Function, CW 8, par. 181.]

"From the activity of the unconscious there now emerges a new content, constellated by thesis and antithesis in equal measure and standing in a compensatory relation to both. It thus forms the middle ground on which the opposites can be united. If, for instance, we conceive the opposition to be sensuality versus spirituality, then the mediatory content born out of the unconscious provides a welcome means of expression for the spiritual thesis, because of its rich spiritual associations, and also for the sensual antithesis, because of its sensuous imagery. The ego, however, torn between thesis and antithesis, finds in the middle ground its own counterpart, its sole and unique means of expression, and it eagerly seizes on this in order to be delivered from its division." [Psychological Types, CW 6, par. 825.]

"If the mediatory product remains intact, it forms the raw material for a process not of dissolution but of construction, in which thesis and antithesis both play their part. In this way it becomes a new content that governs the whole attitude, putting an end to the division and forcing the energy of the opposites into a common channel. The standstill is overcome and life can flow on with renewed power towards new goals." [Psychological Types, CW6, par. 827.]"

C.G. Jung (1916/1958) The Transcendent Function, Collected Works Vol. 8, Princeton, NJ: Princeton University Press

C.G. Jung (1921) Psychological Types, Collected Works Vol. 6, Princeton, NJ: Princeton University Press

Leuzinger-Bohleber and Pfeifer - Memory as Embodied Process

Abstract: "Memory has always been a central issue in psychoanalytic theory and practice. Recent developments in the cognitive and neural sciences suggest that traditional notions of memory based on stored structures which are also often underlying psychoanalytic thinking cannot account for a number of fundamental phenomena and thus need to be revised. We suggest that memory be conceived as a) a theoretical construct explaining current behaviour by reference to events that have happened in the past. b) Memory is not to be conceived as stored structures but as a function of the whole organism, as a complex, dynamic, recategorising and interactive process, which is always ‘embodied’. c) Memory always has a subjective and an objective side. The subjective side is given by the individual's history, the objective side by the neural patterns generated by the sensory motor interactions with the environment. This implies that both ‘narrative’ (subjective) and ‘historical’ (objective) truth have to be taken into account achieving stable psychic change..." (p. 3)

Marianne Leuzinger-Bohleber and Rolf Pfeifer (2002). Remembering a Depressive Primary Object. Int. J. Psycho-Anal., 83:3-33

Murray Jackson - Considerations in Symbolic Process with Schizoid Patients

"In recent years there has been an increasing interest among psychopathologists in the study and treatment of schizoid disorders, which are now known to be more accessible to analytical psychotherapy than was formerly realized. Clinical and theoretical studies, mostly made by psycho-analysts, have revealed types of mental mechanism specific to the schizoid level of mental organization, and thrown light on the process of the formation of symbols and their precursors. In the course of analysis of schizoid patients the process of symbol formation may sometimes be seen developing. At primitive levels symbolism is archaic and prelogical, the symbol having the same emotional value as the thing symbolized, and this stage has been called the symbolic equation. With further development this changes to symbolic representation, where the symbol represents rather than presents the thing symbolized, is a picture rather than a replica. When this change occurs in the treatment of schizoid patients, it is associated with a lessening of persecutory anxiety and an increased capacity for depression and for healthier object relations.

In the transference with such patients primitive contents are projected into the analyst and may confer a delusional quality on the process. Examples are given from clinical practice of the appearance of symbolic equations in such cases, and of their change to representations as treatment progresses.

In the context of clinical observations a condensed account of psycho-analytic theories of symbol formation is presented, and the relevance of all this to Jung's concept of the symbol is considered.

The main contention of this paper is that Jung's use of the term "symbol" corresponds to the experience of symbolic equations by a relatively mature ego, an ego with a specific attitude of receptiveness, the "symbolic attitude", towards such experience. With the immature ego at the schizoid level of mental organization, it is most unlikely that symbols can be appreciated in this way, and attempts to use symbolic experience in a conventional therapeutic way are likely to lead to defensive splitting in the ego.

The best safeguard against this happening is for the therapist to give the bodily aspects of mental life the importance they deserve, and to be aware of the need for genetically earlier levels of experience to be properly integrated before there can be much hope of potentially creative experience having a truly creative, rather than a defensive, outcome.

These ideas contain little that is new, and accord with Jung's views about the need, in certain cases, for regression to the archaic object relationship, which is represented by the biologically based symbol and which has the potential of resolving the state of splitting into opposites. However, the linking of current psycho-analytic concepts with these established ideas of analytical psychology seems, to the author, to be quite essential if progress is to be made in the treatment of, and discussion of, schizoid patients." (pp. 156-157)

　
　

Murray Jackson (1963). Symbol Formation and the Delusional Transference. Journal of Analytical Psychology, Vol. 8, pp. 145-159

Brief Overview of the Work of Hyman Spotnitz and the School of Modern Psychoanalysis

"The term modern psychoanalysis is used to describe a body of new developments in psychoanalytic theory and technique that emphasizes the role of emotional communication in the analytic situation, especially in the analyst's interventions. Clinically, the methods and techniques of modern psychoanalysis enable psychoanalysts to treat a much wider range of disturbances than was believed possible using classical methods. In fact experience has shown that modern psychoanalysis can be an effective treatment for all the psychodynamically reversible illnesses, including psychosomatic disorders, organic disorders with a psychological component, psychoses, neuroses, and character disorders.

Scientifically, the findings of modern psychoanalysis have contributed new insights into both the dynamics of emotional illnesses (especially the more severe disturbances such as schizophrenia) and our understanding of the mechanisms through which the analytic process cures these conditions. As in classical analysis, the modern analyst's strategy is to create a transference situation by having the patient communicate verbally from the couch. Cure is then effected through analysis and resolution of the transference resistances.

Historically, modern analysis dates from the work of Spotnitz, who during the 1940s used psychoanalysis to treat severely regressed, hospitalized patients. Spotnitz, and other modern analysts since then, have found that for psychoanalysis to be effective with such disturbances, it is necessary to establish a narcissistic transference with the patient. This condition differs from object transference because it involves a re-creation of the relationship that existed with the mothering figure before the ego boundaries became defined.

Classical analysis, beginning with Freud, have held that the narcissistic disorders do not respond to psychoanalytic treatment. However, modern analysts have found that the development of a narcissistic transference makes possible the treatment of such patients.

Early work by modern analysts disclosed that the narcissistic patient's major resistances involved defenses against powerful aggressive feelings. This finding suggests another important difference between modern analysis and classical analysis: the primary focus of classical analysts is the resolution of transference resistance to the expression of libidinal feelings; modern analysts, when working with the narcissistic disorders, focus first on the aggressive drive in order to liberate the libidinal drive.

Theoretically, it is fruitful to view the symptoms of narcissistic disorders (depression, withdrawal, ego fragmentation, psychosomatic complaints, and so on) as primitive defenses against acting out murderous impulses toward an object. To prevent action the impulses are turned inward against the patient's own ego or soma." (pp. 3-4)
　

Editorial Board (1976). The Origins of Modern Psychoanalysis. Modern Psychoanalysis, Vol. 1, pp. 3-16

Hester Solomon - Dialectical Process and the Creation of the Individual

"Throughout our lives, there is a constant dialectical process that enables our essential personal coniunctio-our internal and external families-to elaborate and grow. This paper has tried to achieve a particular synthesis between apparently opposing theoretical elements, illustrating with clinical material how this explanatory model may be of use in the elaboration of the intricate and subtle build up of the personality over time in its relation to important others.

The infant's personality is built up through a constant, dynamic three-way interaction between:

(1) the unique real individual baby (primal self);

(2) the common innate predisposition to perceive the world through certain fixed categories, i.e., through the archetypal patterns, or the images of the instincts, with which each of us is invested by virtue of being human;

(3) the real parents, both as individuals and as a couple and how their care for the baby with its variations and vicissitudes moderates the experience of I-ness of the infant and the shape of the archetypal structures.

This third category, the quality of the parental environment as it is transmitted in subtle ways to the infant, is itself a result of an interaction between (1) and (2) and (3) in the previous generation, the real mother, the real father, and the other carers, themselves carrying an ongoing dynamic process between the elements (1), (2), and (3) from their own history.

The infant responds to this complex mixture, and the real parents respond in turn to the developing infant, through a constant to-andfro communication. How all this happens, back and forth, over time, building up a complex feedback set of stimulus and response patterns that become the foundation of each individual's personality - all this is the stuff of our analytic work. This represents a vision of the history of the mental functioning over the life of an individual which is common to both archetypal analytical psychology and to object relations theory.

So image creates image, and in the work of analytic reconstruction, a history of the internal image building is recreated. This may be similar to, different from, or overlap with the real or objective history. It has fundamental implications for concerns about epistemology in analytic theory building-how do we know what we know and what is it exactly that we do know.

This article proposes a way of understanding the intricate and subtle processes of change and development that are described in the traditions of both analytical psychology and object relations theory through the mediation of the dialectical model. In order to accomplish this, theories concerning deep structures are invoked, of which the dialectical model is one." (pp. 327-328)

　

Hester Solomon (1991). Archetypal Psychology and Object Relations Theory. Journal of Analytical Psychology, Vol. 36, pp. 307-329

Andre Green - The Work of the Negative

This passage is offered in memory of Andre Green who died on January 22, 2012.  The excerpt addresses his concept of "The Negative" which is one of his most enduring contributions to the field of psychoanalysis:

"Bion's work has been one of the sources of inspiration of my book published in 1993: Le travail du négatif.1 The work of the negative is an expression borrowed from Hegel but the way I use it for psychoanalytic theory is analogous to the way Bion uses Kant's philosophy for his own thinking. We both give these philosophical concepts a new meaning according to their applications to clinical psychoanalysis. It is impossible to evaluate Bion's own discoveries with precision without starting with Freud and comparing the point of departure to the point of arrival. During a meeting in Lyon where Bion gave one of his thinking improvisations, I went to him when he ended and had a short private exchange with him before the discussion started. I told him: ‘The more I listen to you, the more I see that you quote less Melanie Klein and more Freud’. He replied: ‘Melanie Klein was a contribution, an important contribution but just a contribution’.

I do not wish to evaluate here the respective influence of Freud's and Melanie Klein's work on Bion. What I wish to emphasise is the presence in Freud's work of an unnoticed framework about the concept of negative that has since been developed in many directions, each depending on a different context. For instance, with Lacan (‘The mirror stage’, 1949), Winnicott (Playing and Reality, 1971) and Bion, we have different views of it. It is not so important to raise questions of priority here as these different theoretical contexts did not communicate with each other and did not derive one from the other. It has been my attempt to show that a set of correspondences could be deduced from the confrontation of the different theoretical corpuses. All of them, in fact, derive from Freud, whether they are ready to recognise it or not.

It is important to be aware that the negative is very present in the ‘basic assumptions’ of Freud. Let us think only of the two major central concepts: the unconscious and the id. About the first one, the remark is obvious as the word is forged with the prefix un- that speaks for itself. Concerning the second, Freud says that almost everything we know about the id is of a ‘negative character’ compared to the ego (1933, ). Moreover, if one thinks of the subtractions due to repression, consciousness is, in Freud's view, in the opposite place it has in classical philosophy. It is a very restricted portion of psychical activity. There is no need to recall here the constant struggle of Freud against the equation psychical = conscious. Moreover, the fact that for Freud drives are at the root of psychical activity implies that something is basically in excess, an overload charge on the mind, linked with the bodily exigencies of the drives whose derivatives have to be sent back to the unconscious because their free expression forbids psychic organisation. This is what happens in the building of the ego, more precisely in its conscious part. So, the negative that is at the base of psychic activity is not only normal, it is also a prerequisite for any kind of psychic development. Moreover, it is because of the lack of the object under the pressure of the drives seeking satisfaction that the mind is activated and gives birth to the wish hallucinatory fulfilment that constitutes the most elementary form of psychic activity, at least according to Freud.

Later on, in 1943, Susan Isaacs, during the Freud - Klein Controversies, defended the idea that ‘phantasy’ is the psychic expression of the drives, a well known Kleinian idea that deserves a lot of attention and can raise a reasonable number of criticisms despite its apparent simplicity (Isaacs, 1948). Freud was to discover that his description of repression found in neurosis as well as in normal development was incomplete. This step was taken in his comment on the Schreber case. After having written that repression was at work in the patient's symptomatology, he corrects himself: ‘It was incorrect to say that the perception which was suppressed internally is projected outwards; the truth is rather, as we now see, that what was abolished internally returns from without’ (1911, ).

So, in 1911, Freud added to the mechanism of repression (Verdrängung) the mechanism named foreclosure (Verwerfung) by Lacan, who took notice of this distinction.2 Freud's observation supposes a radical difference between to repress and to abolish. In this last instance, what is ‘abolished’ inside returns from the external world, for instance, as a hallucination or a delusional idea. This sounds like projective identification except that it was stated much earlier by Freud and was left unnoticed. For Lacan, the difference between the two terms could be interpreted as if in repression processes of symbolisation are at work in the unconscious whereas what is going on in the so-called abolition is a failure of symbolisation. One could also think here of Hanna Segal's symbolic equation (1957).

A third move was made by Freud in 1925 with his paper on ‘Negation’ (Verneinung) in which he defends the idea that this linguistic form is an intellectual substitute for repression (1925, ). To end with, in 1927, Freud describes the splitting of the ego (Ich Spaltung) in his paper on ‘Fetishism’ (pp. 152-7). His own conception of splitting is different from Klein's. He describes it as a disavowal of perception giving birth to a duality of mental mechanisms, one admitting the result of perception (the sight of the absence of penis on the mother's body) and the other denying it. It is as if the patient would say: ‘I know it (that women have no penises), but I can't believe it’. Therefore, the fetish will be the displacement, of the missing penis on to a piece of the mother's garments, for example, to struggle against castration anxiety. Freud has always insisted that splitting is not only a mode of denial but also always includes an acknowledgment, though it is contradicted because of its traumatic consequence.

I have proposed gathering together all these related mechanisms: repression, splitting or disavowal, foreclosure or rejection and negation, in the concept of ‘the work of the negative’. This gathering is justified by the fact that all these mechanisms are elaborations of the prototype of repression. All of them imply a judgment of acceptance or refusal: a question whose answer has to be given in terms of yes and no. This question is posed, as we have seen, in many ways, grounded in different contexts, dealing with various materials (instinctual impulses, affects, representations, perceptions, words, etc.) in Freud's conception. Among the various defence mechanisms described by Freud, Anna Freud and Klein (whose contribution includes denial) etc., this group is different from the others because its constituents directly imply this basic choice of acceptance or refusal in consciousness of derivatives that are rooted in the unconscious or the id.

So it is easy to show that Bion's ideas opposing the ‘no thing’ to the ‘nothing’ are deeply justified and can be related to Freud's elaborations even if one may stress the influence of Melanie Klein between them. Anyhow, strictly speaking, Melanie Klein's conception does not care so much about their structural differences. She invokes the ‘psychosis’ that can be found at the beginning of every development. Interpretations will in all cases have to go that far to bring any significant change. At least, this is my reading of her.

In this discussion of Bion's ideas, what is important is to make the distinction between the absence of the breast and the annihilation of the breast. In the first instance—the absence—which is found in normal and neurotic conditions, this situation leads to representations or, in other words, to fantasies. Freud's framework is applicable here. The other case—annihilation—would be more linked to the psychotic part of the personality and deals with a situation predominantly marked with destruction, a more precise form than abolition. This destruction, which can be understood either along Freud's line of foreclosure and rejection or according to Melanie Klein's annihilating anxieties, results not so much in archaic fantasies of destruction but even more, as Winnicott and I have shown, in a destruction of the psychic activity of representation which creates ‘holes’ in the mind, or feelings of void, emptiness etc. When Freud describes Schreber's delusions, he interprets them as processes of restitution after the withdrawal from reality. In other words, patchworks hiding scars or spaces that show some kind of loss of substance. Bion describes similar occurrences but for him the destruction takes the form of the consequence of excessive projective identification that evacuates the unassimilable contents of the mind: the ß-elements.

Of course, there are differences between Freud's early intuitions and Bion's conceptualisation half a century later although the necessity for differentiating between different modes of defences, which are also modes of thinking, is similar in both works. Contemporary psychoanalysis is in great need of structural differentiations in order not to mix up the material coming from different types of patients in a one and only matrix." (pp. 659-661)

Andre Green (1998). The Primordial Mind and the Work of the Negative. International Journal of Psycho-Analysis, Vol. 79, pp. 649-665