The Basic Fault

Therapeutic Aspects of Regression

Michael Balint

• Publisher: Routledge
• Year: 2013
• ISBN:
  9781134963768
• Edition: 2
• Topic: Psychology
• Subtopic: Mental Health in Psychology
• Index: Psychology

In this volume, Michael Balint, who over the years made a sustained and brilliant contribution to the theory and technique of psychoanalysis, develops the concept of the 'basic fault' in the bio-psychology structure of every individual, involving in varying degree both mind and body. Balint traces the origins of the basic fault to the early formative period, during which serious discrepancies arise between the needs of the individual and the care and nurture available. These Discrepancies create a kind of deficiency state.On the basis of this concept, Balint assumes the existence of a specific area of the mind in shich all the processes have an exclusively two-person structure consisting of the individual and the individual's primary object. Its dynamic force, originating from the basic fault has the overwhelming aim of 'putting things right'. This area is contrasted with two others: the area of the Oedipus complex, which has essentially a triangular structure comprising the individual and two of his objects, and whose characteristic dynamism has the form of a conflict; and the area of creation, in which there are no objects in the proper sense, and whose characteristic force is the urge to create, to produce

Part I

The Three Areas of the Mind

Chapter 1

The Therapeutic Processes and their Localization

Part I of this book consists almost wholly of self-contained chapters, and this will not make the main argument easy to follow. I had to adopt this structure because on several occasions I had to clear away some established ways of looking at, and thinking about, well-authenticated clinical observations before I could start on the next stage of my train of thought.

Before beginning our journey, let us agree that all of us, the readers as well as the writer, are fairly reliable analysts who do not make elementary mistakes; that is, all of us give fairly correct interpretations at fairly sensible times and work through the material produced by our patients, as far as possible, on several, both genital and pre-genital, levels, both in the transference and in reality.

Having agreed on this, perhaps we may also admit that all of us occasionally have difficult patients vis-à-vis whom we feel puzzled and uncertain and that – according to rumours circulating in every Branch Society of our International Association – even the most experienced and most skilled analysts among us have occasional failures.

How can this be so; and what is the explanation of this unpleasant fact? On the whole the reasons for our difficulties and failures may be grouped under three headings. They may be due (a) to our inadequate technique, (b) to the difficulties inherent either in the patient’s personality or in his illness, and (c) to a bad ‘fit’ between our otherwise adequate technical skill and the otherwise curable intrinsic qualities of the case.

The first question we have to deal with is why some patients are more difficult to treat than others, or why some analyses are less rewarding to the analyst – and to his patients – than others. Let us formulate the same question in a different way which might enable us to tackle it better. What are the therapeutic processes; in which part of the mind do they take place; and what in them is responsible for the various difficulties experienced by us analysts?

After more than sixty years of research the problem is still largely unresolved as to which parts of the mental apparatus are accessible to psychoanalysis, and to what extent; or, to use our formulation, which parts of the mind are those in which the therapeutic processes take place. Though these two formulations do not describe exactly the same problem, they overlap considerably.

It is generally agreed that influencing the super-ego should be, and in fact is, one of the desirable aims of therapy. We even have ideas about what happens in that part of the mind, ideas, that is, about the therapeutic processes involved and the changes that take place.

We know, for instance, that the super-ego has been built up chiefly of introjections, the most important sources being the stimulating but never fully satisfying sexual objects of early infancy, childhood, and puberty; in a way one may say that the super-ego is the sum total of the mental scars left by these objects. On the other hand, the super-ego can be changed by new introjections as late as in mature life; a convincing instance of such change is analytic treatment during which the analyst becomes partly or even wholly introjected. I would like to differentiate between introjection and another process – most important in building up the super-ego – identification, which can be thought of as a secondary step after introjection: the individual not only takes in the stimulating but frustrating sexual object, but henceforth feels it an integral part of himself. Often identification is preceded by, or intimately associated with, idealization; on the other hand a high degree of idealization may be a serious obstacle against identification with the introjected object. All this is fairly well known, but we have hardly any knowledge about the processes that are needed to undo introjection, idealization, or identification. To sum up, we have some idea of the processes that lead to new introjections and identifications, but hardly anything is known about the ways that undo an established introjection or identification. This is regrettable because it would be highly important for our technical efficiency to know how to help the patient to get rid of parts of his super-ego.

There is also fair agreement that analytic therapy as a rule ought to aim at making the ego stronger, although our ideas of the exact nature of the strengthening and the techniques for achieving it are as yet rather vague. What we do know about this aspect of our therapy might be summed up as follows: the ego in closest contact with the id should be strengthened; I refer to that part of the ego that can enjoy instinctual gratifications, can endure a considerable increase of tensions, is capable of concern and consideration, can contain and tolerate unsatisfied desires, as well as hatred, and tries to accept, and can test, both internal and external realities. Whereas that part of the ego that cannot, and dare not, enjoy intense instinctual gratification, that must defend itself against any increase of emotional tension by denial, inhibition, and turning into the opposite, or by reaction formations – i.e. that part which is adapted to external reality and to super-ego demands at the expense of internal reality-should not be strengthened; on the contrary, its role should be made less dominant.

The question whether this strengthening of the ego and the previously discussed modifications of the super-ego mean only two aspects of the same process or are two processes, more or less independent, has not been explicitly stated, nor properly discussed. The formula used most frequently states that the ego has to mediate at the behest of the super-ego between the demands of the external reality and the id. It is still an open question as to whether the mediator has, or has not, any power of its own to influence the compromise and, further, as to what are the therapeutic processes that have any effect on this power.

There is still greater uncertainty about the possibility and the means of influencing the id. We have hardly any idea whether this can be done at all and, if it can, how it should be done. Those who accept the existence of primary death instinct and with it primary sadism, primary narcissism, and destructiveness, are forced to the conclusion that by our therapy the id must be changed too. One aspect of this possible change has been described already by Freud, in ‘Analysis Terminable and Interminable’ (1937), as ‘taming of the instincts’. In the special case of primary sadism this means that the vehemence of the destructive urges – sometimes called destrudo – must be mitigated during and through analytic treatment – or upbringing –either by changing them at their source, i.e. in the id, or at any rate by ‘fusing’ them with more libido. As the two theoretical concepts of ‘fusion’ and ‘defusion’ are very vague, it is almost impossible to place them with confidence either in the id or in the ego; moreover, apart from their names we have not been able to form any idea of the mechanisms and processes involved in them. Perhaps the only hint we have is that possibly defusion and frustration are fairly closely linked; whether the same is true of the technically highly important counterpart, gratification and fusion, is rather uncertain.

In these circumstances it is small wonder that nobody has been able to describe reliable methods for influencing these two processes. If ‘fusion’ and ‘defusion’ are amenable to influence by analysis at all, the only thing we can state with certainty is that this influence occurs through the transference, i.e. essentially through an object relationship. Conversely it means that processes initiated in the analytic situation must be conceived of as being powerful or intensive enough to penetrate into deep layers of the mind and achieve fundamental changes in them. How this happens and what sort of object relationship, of what intensity, would achieve this task, have not been properly discussed in our literature.

Thus we have arrived at one answer to the puzzle with which we began our journey: why it is that even the most experienced among us have difficult cases and occasional failures? We have some theoretical conceptions about possible processes in the mind during psychoanalytic therapy, but as yet there is no direct link, of sufficient reliability, between these theoretical conceptions and our technical skill. In other words, on the basis of our theoretical conceptions about the therapeutic processes and their localizations, we are not yet in the position to state what particular technique is advisable and what technical measures are better avoided. This fact is the raison d’être for the co-existence of various schools in analysis, each of them with its own technique differing considerably from that of the others, but each accepting the same basic ideas about the structure of the mind. It is important to add that analysts of all schools-without exception – have their successes, their difficult cases, and their fair share of failures. It is highly probable that the protagonists of the differing schools succeed – or fail – with different patients; moreover that the mode of success – or failure – may be different with the different techniques. Thus, an impartial but critical study of this field would be most revealing for our theory of technique. Unfortunately no such independent survey exists; the story of the statistical survey attempted by the American Psychoanalytic Association – a most cautious, even over-cautious, attempt – which had to be abandoned, shows well the amount of anxiety and resistance stirred up by a research of this sort.

Chapter 2

Interpretation and Working-Through

As I have attempted to show, the topical point of view does not seem to offer much help towards a better understanding of our technical difficulties and, in particular, does not place in our hands criteria reliable enough to decide whether any one individual therapeutic step is correct in the given circumstances or not. This, however, could have been expected. We must not forget that the last revision of our theory of the mental instances and localities was undertaken by Freud in the early twenties, some forty years ago. Since then no essentially new idea about the mental apparatus has been put forward (though cf. the new ego psychologies by Fairbairn, Hartmann, and Winnicott). On the other hand, it is unquestionable that since that time our technical potential, our actual skill, and, together with them, our technical problems, have increased considerably. I surveyed these new developments in a paper I presented at the Zürich Congress (1949), in which I tried to show that Freud’s technique and his theoretical conceptions were interdependent.

Freud himself stated in his two great monographs, The Ego and the Id (1923) and Inhibitions, Symptoms, and Anxiety (1926), that he based both his technique and his theory on his clinical experiences with obsessional and melancholic patients because – I use his own words – in these patients both the mental processes and the conflicts are considerably ‘internalized’ (verinnerlicht). That means that the original conflicts, as well as the defensive mechanisms and processes mobilized for coping with them, have become – and largely remain – internal events in these patients. Conversely, external objects are only weakly cathected by them. Thus, in the first approximation, all important events with these patients, both the pathological and the therapeutic, can be taken as happening almost exclusively internally. It was this condition that enabled Freud to describe the therapeutic changes in a simpler form. If external events and objects are only weakly cathected, the influence of their variation from one analyst to another, provided the analysts use a ‘sensible’ analytic technique, will be still smaller, indeed practically negligible. Forgetting that this is true only for this limit case and only as a first approximation, some analysts have arrived at the idea of ‘the correct technique’, i.e. one that is correct for all patients and all analysts, irrespective of their individuality. If my train of thought proves valid, ‘the correct technique’ is a nightmarish chimera, a fantastic compilation from incompatible bits of reality.

An important precondition for the internalization is a fairly good ego structure that can withstand, and contain, the tensions caused by internalization without breaking down and without resorting to a different type of defence – which may be called externalization-such as, for example, acting-out, projection, confusion, denial, depersonalization. With patients who are capable of sustained internalization, the famous simile used by Freud gives a fair description of what really happens during analytic treatment. Most of the time the analyst is indeed a ‘well-polished mirror’ who merely reflects what the patient conveys to him. Moreover, as shown by all case histories published by Freud, the material conveyed to the analyst in this kind of analytic work consists almost exclusively of words, and equally it is words that are used in reflecting the material back to the patient. Throughout this process of conveying and reflecting, each of the two partners – patient and analyst – understands reliably in the same sense what the other says. True, resistances are encountered, which may at times even be highly intense, but one can always count on a reliable and intelligent ego that is able to take in words and then allow them to influence itself. That is, the ego is able to perform what Freud called ‘working-through’.

This train of thought leads to the second answer to our problem. First, the description, just given, of our technique, presupposes that interpretations are experienced by both patient and analyst as interpretations and not as something else. This may seem rather like a statement of the obvious, but I hope to show later that it is important to emphasize this fact in so many words.

Psychoanalytic therapy, even in the classic sense of the ‘well-polished mirror’, is essentially an object relationship; all the events which lead ultimately to therapeutic changes in the patient’s mind are initiated by events happening in a two-person relationship, i.e. happening essentially between two people and not inside only one of them. This fundamental fact could be neglected only as long as the main objects of study were patients using chiefly internalization, i.e. patients with a fairly strong ego structure. These people can ‘take in’ what their analyst offers as well as what they experience themselves in the analytic situation, and are able to experiment with their new knowledge. Their ego is strong enough to bear – at any rate for a time-with the tensions thereby created. The tensions and strains caused by the interpretations may be severe at times, but still these patients can carry on. At any rate this is the picture we gain from Freud’s published case histories.

Thus we arrive at the second possible cause of difficulties and failures in analysis. Our technique was worked out for patients who experience the analyst’s interpretation as interpretation and whose ego is strong enough to enable them to ‘take in’ the interpretations and perform what Freud called the process of ‘working-through’. We know that not every patient is capable of this task, and it is with these patients that we encounter difficulties.

Chapter 3

The Two Levels of Analytic Work

In order to describe the characteristic atmosphere of the level of classical therapeutic work, psychoanalytic literature habitually uses the terms ‘Oedipal or genital level’, contrasted with the ‘pre-Oedipal, pre-genital, or pre-verbal level’. In my opinion these latter terms already have a loaded meaning, and I shall presently propose a new, unequivocal term which, I hope, will free us from some latent bias; but before doing so, let us examine the real meaning of these common terms.

The Oedipus complex was one of Freud’s greatest discoveries, which he justly described as the nuclear complex of all human development – of health and illness, of religion and art, civilization and law, and so on. Though the Oedipus complex characterizes a fairly early stage of development, Freud had no hesitation in describing the child’s mental experiences, emotions, and feelings at this stage in the language of adults. (As I want to keep clear of the vexed problem of chronology, I deliberately leave open the definition of this early age. It suffices for my purpose to state that it is a very early age.) In fact, Freud’s assumption was a bold projection, a daring extrapolation. He made the tacit assumption, without further proof, that the emotions, feelings, desires, fears, instinctual urges, satisfactions, and frustrations of the very young are not only closely similar to those of adults, but also that they have about the same reciprocal relation to one another. Without these two assumptions the use of adult language for describing these events would be totally unjustifiable.

I repeat, this assumption was a very bold step, but its results were subsequently fully validated, both by observations of normal children and by clinical experiences during the analysis of neurotic children. Further, it should be emphasized that, although it had started with the analysis of Little Hans (1909), all this validation took place during the same period as Freud’s last revision of our theoretical concepts about the mental apparatus, namely in the twenties.

To avoid a possible misunderstanding, I would add that while working on this Oedipal level, pre-genital material is not, of course, disregarded or neglected by the analyst, but is worked with in adult language, i.e. is raised to the Oedipal or ‘verbal’ level. This is an important point for our technique as it immediately raises the problem of what an analyst should do in a case in which the expression of pre-genital material in adult words is either unintelligible or unacceptable to the patient, i.e. in a case in which there is apparently no simple road for the patient, direct from the pre-verbal to the Oedipal.

Since the twenties our technique has progressed greatly and it is fair to say that today we can treat patients who were then considered untreatable, and we can certainly better understand the average patient, at greater depth and more reliably, than our colleagues of forty years ago. In the course of this development we have collected a rich harvest of clinical observations and of puzzling problems. All of them pertain to events happening, and observed, in the psychoanalytic situation. In the first approximation these events may be described in terms of the Oedipus conflict, and using adult language. However, pari passu with ou...

Table of contents

• Cover Page
• Half Title Page
• Series Title Page
• Title Page
• Copyright Page
• Contents
• Preface to the 1979 Reprint
• Preface
• The Three Areas of the Mind
• The Therapeutic Processes and their Localization
• Interpretation and Working-Through
• The Two Levels of Analytic Work
• The Area of the Basic Fault
• The Area of Creation
• Summary
• Primary Narcissism and Primary Love
• Freud's Three Theories
• Inherent Contradictions
• Clinical Facts about Narcissism
• Schizophrenia, Addiction, and other Narcissistic Conditions
• Ante-Natal and Early Post-Natal States
• Primary Love
• Adult Love
• The Gulf and the Analyst's Responses to it
• Regression and the Child in the Patient
• The Problem of Language in Upbringing and in Psychoanalytic Treatment
• The Classical Technique and its Limitations
• The Hazards Inherent in Consistent Interpretation
• The Hazards Inherent in Managing the Regression
• The Benign and the Malignant forms of Regression
• Freud and the Idea of Regression
• Symptomatology and Diagnosis
• Gratifications and Object Relationships
• The Various forms of Therapeutic Regression
• The Disagreement between Freud and Ferenczi, and its Repercussions
• The Regressed Patient and his Analyst
• Therapeutic-Regression, Primary Love, and the Basic Fault
• The Unobtrusive Analyst
• Bridging the Gulf
• Bibliography
• Special Bibliography
• Index