Winnicott and Kohut on Intersubjectivity and Complex Disorders

New Perspectives for Psychoanalysis, Psychotherapy and Psychiatry

Carlos Nemirovsky

• Publisher: Routledge
• Year: 2020
• ISBN:
  9781000166439
• Edition: 1
• Topic: Psicología
• Subtopic: Psicoterapia

Given the complexity of scientific developments inside and outside the psychoanalytic field, traditional definitions of basic psychoanalytic notions are no longer sufficiently comprehensive. We need conceptualizations that encompass new clinical phenomena observed in present-day patients and that take into account contributions inside, outside, and on the boundaries of our practice.

This book discusses theoretical concepts which explain current clinical expressions that are as ineffable as they are commonplace. Our patients resort to these expressions when they feel distressed by their perception of themselves as unreal, empty, fragile, non-existent, non-desiring, doubtful about their identity, beset by feelings of futility and apathy, and emotionally numb. The book aims at contrasting the ideas of Winnicott and Kohut, which are connected with a clinical practice that sees each patient as unique and are moreover in direct contact with empirical facts, and applies them to the benefit of complex patients. These ideas facilitate the expansion of paths in both the theory and the practice of our profession.

Uniquely contrasting the works of two seminal thinkers with a Latin American perspective, Winnicott and Kohut on Intersubjectivity and Complex Disorders will be invaluable to clinicians and psychoanalysts.

1 Early psychic development after Freud¹

…it would be pleasant if we were to be able to take for analysis only those patients whose mothers at the very start and also in the first months had been able to provide good-enough conditions. But this era of psycho-analysis is steadily drawing to a close.

Winnicott (1955, pp. 290–291)

…in contrast to the personality structure of the fin de siècle patients whose investigation led Freud to his formulation of the dichotomized psyche and later of structural conflict, the prevalent personality organization of our time is not typified by the simple horizontal split brought about by repression. The psyche of modern man – the psyche described by Kafka and Proust and Joyce – is enfeebled, multifragmented (vertically split), and disharmonious. It follows that we cannot adequately understand our patients and explain them to themselves if we try to do so with the aid of a model of unconscious conflicts that cannot do the job.

Kohut (1984, p. 60)

The temporal context

This chapter discusses approaches² derived from Winnicott and Kohut’s basic ideas on psychic development. Many of the formulations advanced by Winnicott, in particular, had been addressed earlier or contemporarily by prolific analytic thinkers such as Fairbairn and Bowlby, and especially by Ferenczi. These earlier thinkers postulated similar approaches. Yet due to a variety of reasons that would be worth exploring in our search for our origin as analysts, their viewpoints did not consolidate as schools of psychoanalytic thought until the advent of the authors who are the focus of this book.³

Elsewhere, I argue that

since the death of the founder of psychoanalysis, our discipline has undergone considerable shifts that are largely the product of the cultural transformation of analysands and analysts. We have witnessed the birth and development of mutations that have challenged basic paradigms. Slowly, our way of thinking (psychoanalytic theory) and of operating in the session (psychoanalytic technique) have changed.

(Nemirovsky, 1993 p. 2)

Etchegoyen (1991), for his part, states that if we “take a bird’s eye view of how the psychoanalytic science has evolved, we are faced with a clear-cut dividing line that coincides with the end of Freud’s life” (Etchegoyen, 1991, p. 88). Nevertheless, choosing 1939 as our starting point could certainly be biased or arbitrary, since some strong schools of thought were developing before then that challenged basic aspects of psychoanalysis and gave rise to fiery debates (Jung, Adler, and Ferenczi’s reformulations constitute highlights in the history of our discipline). Even so, we must acknowledge that the years of World War II are highly significant. From the 1940s on, some of the paradigms of the psychoanalytic “schools” that can be identified today were beginning to take shape.

Green (1975) also points out that “since Freud’s death, and doubtless even before that, one can no longer refer to psychoanalytic theory in the singular” (1986 [1997], p. 13). The history of psychoanalysis always involved debate, and this debate enriched theories and techniques. In this sense, among the milestones that populate the first half of the twentieth century are the founder’s controversies with Jung, Adler, Rank, and Steckel, and later with Ferenczi. There are also the British School’s innovations concerning the analysis of children and psychotic patients, spearheaded by Jones and Klein, as well as the latter’s debate with Anna Freud. These were followed by the original evolution of psychoanalysis in the US with Hartmann, Kris, and Lowenstein, and later, back in Europe, by Lacan’s novel concepts.

If we go further back in time, we should keep in mind that Freud’s first ideas emerged in authoritarian Victorian society, whose basic values guided his research. These values were the discovery of truth and the achievement of psychological individuality (Kohut, 1984). In the same way, it is worth highlighting that in the last years of Freud’s work, as Erikson ([1982] 1997, p. 22) points out,

the historical period in which we learned to observe such revelations of the inner life was well on its way to turning into one of the most catastrophic periods in history; and the ideological division between the ‘inner-’ and the ‘outerworld’ may well have had deep connotations of a threatening split between the individualistic enlightenment rooted in Judaeo-Christian civilization and the totalitarian veneration of the racist state.

Science based on positivism,⁴ which inherited the enlightenment’s viewpoint, had its most conspicuous representatives in Darwin, Pasteur, Koch, Lister, and Curie; in pragmatists such as Peirce; and, in the transition into the twentieth century, in Russell, Bohr, and Einstein (to name a few). These authors also constituted reference points and, doubtlessly, a valuable guide for Freud in his choice of methodology for the new discipline. In this sense, Freud had to interact with two opposite historical developments. These were the prevalence of scientific methods derived from the natural sciences (which excluded anything that could not be grasped through objectification and measurement), and the irruption of subjectivism and its gradual domination over the cultural world (the end of Romanticism and the emergence of Impressionism and later of Surrealism).

In the Central Europe of his time, Freud’s cultural education blended Victorian values with his family’s and his personal values. From this perspective, he laid the foundations of the analytic method based on his self-analysis (ultimately, the analysis of an adult male who had not experienced major suffering) and the analysis of his patients, also adults. In the heart of Hapsburg Vienna, working, like every late-nineteenth-century professional, in his own home surrounded by his family, Freud started to delve into the human psyche, the Oedipus complex, childhood sexuality, psychic reality, and the formation of systems or agencies and of complexes or structures. This happened 100 years ago.

It should not seem strange to us, then, that practitioners of psychoanalysis, whose creator, in this particular juncture, was fervently seeking the truth rather than the confirmation of established dogmas, would reformulate many of the founder’s viewpoints as the discipline evolved. Paraphrasing Guntrip (1971), Freud set down the cornerstone but did not build the entire building. Cultural expressions (fine arts, architecture, and poetry) always integrate axiological changes taking place in the society where they originate. Thus, early-nineteenth-century architecture in Vienna reflected a centripetal everyday life. Focus on the home facilitated the development of an extremely stimulating family life.⁵ Today’s family life, by contrast, shows a very strong centrifugal tendency and takes place in buildings whose inhabitants are anonymous.

Back then, the social climate favoured the development of the “prima donna” of the early twentieth century, hysteria, which always needs presences. As a consequence, the first analysts focused on what would obviously attract their attention – the Oedipus complex and its by-product, neurosis. Based on their clinical practice, they could explain this pathology’s origin and evolution and formulate narrow working explanations that were consistent with the scientific methodologies of the time. They created a metapsychology for neurosis, and, therefore, nascent psychoanalysis could not encompass those clinical pictures that remained outside this psychopathology.

Today, schizoid and borderline pathologies, born from failed encounters and separations (and feeding on absences), have displaced hysteria from its favored position and require new explanations that will contemplate present-day family and social organizations, that is, that will take the environment into account as a necessary factor. With an empathic effort, which contemporary historians deem necessary to understand our past (Carr, 1967), we can grasp many of Freud’s reasons for anxiety when conducting his first investigations. As we mentioned earlier, this anxiety arose from an attempt to place psychoanalysis within the natural sciences by resorting to the appropriate lexicon, which included words such as cathexis, psychic apparatus, and libido.

Today, almost no one would include our discipline among the exact sciences. Our method is closer to historical research, to narrative than to the methods of the so-called natural sciences. We start from history (the history of a patient, a family, a group), and from there we hypothesize the context of our clinical inquiry. We are constantly asking what this history is, what it is leaving out, and how to narrow it. We often wonder, what then is history? The tautology that defines it as what historians do (same as defining psychoanalysis as what psychoanalysts do) underscores the difficulty in finding clear paradigms to frame our work. Historians and analysts use provisional, junctural, temporary criteria that are based on traces, documents, narratives … Can we try to be more precise, for now, without running the risk of using definitions that are unfairly exclusive?

We know that history is never homogeneous or unidirectional. Nor does it respond to the action-reaction principle – to simple, mechanical facts. Historians have to deal with opinions and pressure. Some attempt to homogenize data; the creators of so-called historical truth think they gain by writing texts that reflect “the official story.” We often find that it is the owners of this truth who believe they have won and who usually write the history texts. In this sense, one of the issues we must address is how we define fact in our discipline. Significant facts, those narrated by the author, are obviously interpretations of what took place. Furthermore, we call them facts because they are psychologically active, effective, and have an effect of truth, of reality, of having happened.

I would like to go back to Carr (1961), who quotes Professor Sir George Clark. In referring to historians “of a later generation,” Clark points out that these historians “consider that knowledge of the past has come down through one or more human minds (…) and therefore cannot consist of elemental and impersonal atoms which nothing can alter” (Carr, 1961, p. 3). We know that there is no objective historical truth, that the so-called material truth is not a topic of analysis. We must, therefore, view facts as accepted judgements that resemble an event that took place. History, after all, is the history of thought, and it implies a certain perspective – the historian’s perspective, which is in consonance with its context.

This reconstruction of the past in the mind of historians/psychoanalysts relies on what is, for them, empirical evidence. Yet their evidence is not a mere list of data. Rather, the process of reconstruction is governed by the selection and interpretation of facts. It is this process that makes them, precisely, historical facts. In psychoanalysis, selection and interpretation resorts to clues instead of evidence. In my view, clues are more valuable for our work than mere statistics or the enumeration of the obvious (Ginzburg, 1992). From this perspective, then, we understand that the primary task of historians (or psychoanalysts) is not to collect but to assess, to collect while assessing, because if we do not assess, how can we identify material that deserves to be collected?

It should not sound odd to us what has been said so often about history, that is, that historical facts do not exist for historians … until they themselves create them. Ricoeur (1977) claims that psychoanalytic theory selects and codifies facts within the context of the analytic session, and that these facts are mediated by language and addressed to others. They are not necessarily observable but result from the meaning that events acquire for patients – the same events that psychotherapists consider from the position of observer. Ricoeur examines psychoanalytic facts in four dimensions: they can be narrated; they are addressed to others; they are fantasized, figured, or symbolized; and they are collected in the narrative of a biography (historicized). This author coincides with Habermas’s analysis regarding the separation between historical-hermeneutic sciences (sciences of the spirit that respond to practical interest and are regulated by intersubjectivity) and sciences that aspire to objectivity.

Guntrip (1967), based on Home (1966), suggests that psychoanalysis is the study of the subjective experiences of living objects by way of a subjective, internal process that we call recognition or understanding of our immediate experience. At the same time, Benedetto Croce’s contribution teaches us that history is always contemporary history; we can only grasp something of the past through the lens of the present, in light of the problems and needs of the current context. Then, is history a biased perspective? If we look at how we see the Middle Ages today and how they were seen during the Renaissance, we will probably find that the selected facts are completely different.⁶

If we asked what Freud repr...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Dedication
• Table of Contents
• Prologue
• Introduction: My personal context
• 1 Early psychic development after Freud
• 2 Early psychic development in the work of Winnicott and Kohut
• 3 Similarities and differences between Winnicott and Kohut’s approaches
• 4 Healthiness in Winnicott and Kohut: Deficit and conflict
• 5 Trauma after Freud
• 6 Narcissistic disorders, severely ill patients: Psychotics and borderline personalities
• 7 Edition-Reedition: Some thoughts based on Winnicott’s contributions to the understanding and treatment of psychosis and other severe pathologies
• 8 The setting and interpretation: Some thoughts on Winnicott’s concepts
• 9 Relational and intersubjective psychoanalysis
• 10 Psychiatry after Winnicott
• References
• Appendix I: Major works by Winnicott
• Appendix II: Relevant works by Kohut and further reading on Kohut’s Ideas
• Index