Primitive Experiences of Loss

Working with the Paranoid-Schizoid Patient

Robert Waska

• Publisher: Routledge
• Year: 2018
• ISBN:
  9780429917530
• Edition: 1
• Topic: Psychology
• Subtopic: History & Theory in Psychology
• Index: Psychology

Taking as his starting point Melanie Klein's concept of the paranoid-schizoid position, and succinctly reviewing subsequent developments within the Kleinian perspective, the author formulates a distinctive and subtle argument concentrated on the topic of primitive loss. It isthe author'sconviction that the experience of loss has a primacy within the paranoid-schizoid position but that this has received insufficient and inadequate recognition, with significant implications for analytic technique. With this standpoint as his orienting focus, the authorprovides a finely-textured and penetrating discussion of such issues as projective identification, symbolization, transference and counter transference. A thoughtful and perceptive examination of theoretical issues is buttressed with substantial illustrative case material throughout. Calling for further work to be done in refining and clarifying the understanding of loss, and its intrapsychic, interpersonal and technical ramifications, the present volume represents a significant contribution and stimulus to that task

PART I

THE CONTRIBUTIONS OF PROJECTIVE IDENTIFICATION AND SYMBOLIZATION

CHAPTER ONE

Theoretical issues

“Even in the adult, the judgement of reality is never quite free from the influence of [the] internal world.”

Klein, 1959, p. 250

Under certain circumstances, phantasies of past, current, and impending loss can shade the intrapsychic world. These fears and the repetitive defences that build up to cope with these catastrophic anxieties shape internal and external relationships. The ego forms internal bargains between itself and the object in a desperate attempt to ward off the sense of self and object loss.

As noted, the study of loss and separation within the paranoid–schizoid experience has been rudimentary. Some Kleinians have made mention of it, but they have made no extensive exploration. Jean-Michel Quinodoz (1993) is an exception. His book does a remarkable job of summarizing and exploring Kleinian views of separation anxiety, and he does bring in the element of PI. I add to his investigation by examining the specific unconscious dynamics of loss within the paranoid–schizoid position.

While much has been written on the experience of loss within the depressive position, my emphasis here is on loss within the paranoid–schizoid position as well as the role of symbolic function and PI.

Anxieties concerning loss threaten the integrity of the ego and create a reliance on PI for protection. At the same time, excessive reliance on PI and splitting can foster even greater phantasies of loss and engender ego fragmentation. With many patients struggling with loss, the use of PI represents a significant portion of the moment-to-moment clinical work.

Klein described the ego as the mental agency accountable for not only instincts and the external world, but the countless anxieties created by the struggles with internal and external forces. To defend itself, the ego uses introjection and projection, mental mechanisms that operate in a reciprocal manner (Klein, 1959). Klein described the ego as constantly taking in of the outer world, its impact, its situations, and its objects. These introjections continually shape the ego. Through projection, the ego begins to reshape the external world. The constant interplay of introjection and projection produce what we call personality and perception.

Hinshelwood (1991) writes:

For Klein, introjected objects that are not identified with become internal objects, and she conceived of a varied and continuous process which populates the internal world with very many internal objects. This internal society becomes, on one hand, a resource of objects for identification and, on the other, a set of experiences about what the ego consists of and contains (good and bad). [p. 332]

Projective identification was a notion introduced by Klein in 1946 and involves the ongoing taking in and expelling of the infant’s intrapsychic relationship with the world. It is an inner experience that simultaneously holds the expression of the internal world and the impression of the external world. The ego deposits certain feelings and aspects of the self into the object and remains in contact with that object. This connection is dynamic and involves a wide range of positive and negative feelings.

The patient’s anxieties concerning love and hate for the object and the quest for knowledge about the object are all shaped by either paranoid–schizoid or depressive phantasies. These phantasies organize internal experience, which is contained, managed, and expressed through introjection and projective identification. The analysis of projective identification and its associated mechanisms is often the essence of a successful treatment. Rosenfeld (1983) writes: “in analytic work today the analysis of projective identification into the analyst and also into others in the patient’s environment plays such a prominent part that we can no longer imagine how an analyst could work before 1946” (p. 262).

PI in the clinical setting

Issues of separation, loss, and PI are under-represented in verbatim clinical reports of Kleinian interpretations. However, Segal, Grotstein, and Spillius provide some examples of how PI looks in the clinical moment and how the analyst might react interpretatively.

Segal (1997c) reminds us that some PI situations are only understandable after the fact. Segal’s patient had, as a child, lost her mother through a car accident. The patient’s father had been the driver. When she began analysis, she could not drive. Once able to drive, she was propelled into a manic state. Segal writes:

one day she gave me a rather frightening account of how recklessly she drove her motor bike. The next day, she missed the session without letting me know—which had never happened before. I was exceedingly anxious, and also guilty, wondering what I could have done to induce her to have an accident. The next day, she turned up, cool as a cucumber, and I was furious. I recognized, however, that she had inflicted on me an experience of her own, of waiting for her parents to return home, and being told of the accident. But that recognition came to me only after her return. In between, I had been dominated by her projections. [p. 112]

Here, Segal points to the countertransference aspects that so often figure in PI and the difficulty with interpreting PI as it occurs. Often it is only later that the analyst can translate to themselves what has occurred. Clearly, Segal experienced the patient’s sense of loss through PI and her own countertransference. Only later could she bring it back to the patient in the form of an interpretation.

Grotstein (1986) feels that PI takes on many different forms, including an exchange of internal objects within the patient’s phantasies. One patient began the hour by telling him how she didn’t like a plant in his office. She added that she used to think of herself as a dismal gardener, but now she felt like she had a green thumb. Then she added that while she was making progress in her life, her analysis seemed to be totally stuck. Grotstein writes:

I made the following interpretations: the weekend break caused you to feel that I had taken the good green breast with me for the weekend, leaving you with a barren and desolate backyard to cultivate. You then had a phantasy about entering into me, stealing my venture, possessing it for yourself, and identifying with it as the possessor of a “green thumb” which had no connection to me, and therefore you owed me no gratitude. At the same time, I am now believed to be the container of your undesired barren self which cannot make things grow. We have exchanged roles. [p. 182]

The patient told the analyst that she agreed, and she made associations in that direction, at first directly and then by displacement. Grotstein makes an immediate interpretation of PI and also is comfortable with analysing the deeper phantasy material. In addition, he makes use of body-part language. Here, he used all these elements to address the sense of loss, separation, and loneliness that the patient expressed through PI.

Spillius (1992) presents the case of “Mrs B” to illustrate PI in the clinical setting and states:

this session was dramatic and painful—no question of maintaining my usual analytic stance on this day. In phantasy the patient was projecting a painful internal situation into me and acting in such a way as to get me to experience it while she got rid of it. [p. 66]

The patient had very high expectations of herself and was critical of herself when she fell short of them. She avoided these pressures by not aspiring too much and by blaming things on “fate”. Separations were difficult for her and she acted-out during breaks in the treatment. This session took place immediately before an unusually long break in the analysis. The patient was late for this particular session, and, after a long silence, Spillius commented that the patient seemed angry. After more silence, the patient began to complain about many things and said they were all petty complaints. Spillius tried to comment again, but the patient escalated into screaming and paranoid accusations. She felt that the analyst was deliberately not listening to her and was purposely distorting what she said. Spillius began to feel like a bad therapist.

She writes:

but I managed one small thought, which was that she must be feeling inadequate too, and that my leaving had a lot to do with it. Then came a second thought, that she hates herself for being cruel even though she gets excited by it. It felt to me as if I was like a damaged animal making her feel guilty, and she wanted to stamp me out. I said she couldn’t bear for me to know how painfully attacking she is, how much she wants to hurt me, how cruel she feels; but she also can’t stand it if I don’t know, don’t react. It means she is unimportant. [p. 67]

The patient screamed at her in response, telling her she was totally uninterested in what the analyst had said. After a long, tense silence, Spillius writes:

what I said … was that I thought she felt I treated her cruelly, with complete scorn and indifference, as if she was boring and utterly uninteresting, and that was why I was leaving her. She felt that the only way she could really get this through to me was by making me suffer in the same way … I said she thought I was cruel for leaving her on her own so arbitrarily and that she therefore had a right to attack me in kind. But she also felt I was leaving her because she was so attacking. [p. 68]

Spillius explains the PI dynamics that held sway in thesession:

My self doubt was, I believe, very similar to her feelings of unlovableness when her parent had left her. It was also very similar to the picture she painted of her parents, who had cruelly left her but felt very guilty and self-critical about it. Failure, damage, and imperfection were rampant in both of us. Her answer was to get the worst of it into me and then attack and abandon me. She became the cruel me who was leaving her and the cruel parents who had left her, and I became the stupid, miserable child fit only for abandonment. [p. 69]

In 1994, Elizabeth Bott Spillius made a general statement about Kleinian technique that is important to consider as she is also noting the typical Kleinian approach to interpreting PI: “the basic features of Kleinian technique are … interpretation of anxiety and defence together rather than either on its own” (p. 348). We can see how this technical and theoretical tenet was used in the moment-to-moment analytic work of her previous 1992 case example. She addressed both the anxiety concerning loss and abandonment, as well as the patient’s defences against it.

Annihilation

Klein (1955) felt that the infant’s deepest fear is annihilation, as the result of the ego turning on itself. My view is that phantasies of losing the object produce a condition of dread and an implosive state of anxiety. The good object turns into a persecutory one that abandons the ego. The ego, overwhelmed by internal collapse, experiences annihilation. Segal (1981) writes: “Whenever the state of union with the ideal object is not fulfilled, what is experienced is not absence; the ego feels assailed by the counterpart of the good object—the bad object, or objects” [p. 51]. Therefore, for some patients, loss is the principle anxiety, followed by dread and persecution. They either fear losing their objects altogether, or fear losing the object’s affective interest. This includes the loss of love, hate, and any other emotional notice. Anxieties regarding the maintenance of attachment fuel the patient’s painful phantasies.

External trauma has often touched these patients at early stages of development. Klein (1957) writes: “another factor that influences development from the beginning is the variety of external experiences which the infant goes through” (p. 229). In 1959, she writes: “the importance of actual favourable and unfavourable experiences to which the infant is from the beginning subjected, first of all by his parents, and later on by other people [is of great significance]. External experiences are of paramount importance throughout life” (p. 256).

Unable to bear the destructive forces of the death instinct through a balance of good introjected objects, the early ego experiences a frustrating cycle of desperation and envy. Overwhelming internal chaos and violent confusion follow, which the ego projects into the object. The paranoid–schizoid experience is then of the object shifting from a good part-breast to an angry, abandoning part-breast ...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Table of Contents
• Preface
• Introduction
• Part I The contributions of projective identification and symbolization
• Part II Primitive loss and the masochistic defence
• Summary and conclusions
• References
• Index