Supervisions with Donald Meltzer

The Simsbury Seminars

Rosa Castella, Lluis Farre, Donald Meltzer, Carlos Tabbia, Rosa Castella, Lluis Farre, Donald Meltzer, Carlos Tabbia

• Editorial: Routledge
• Año: 2018
• ISBN:
  9780429919534
• Edición: 1
• Categoría: Psicología
• Categoría: Historia y teoría en psicología

It is a tribute to the fourteen years of work carried out together in Barcelona and Simsbury, Oxford, and an invitation to other clinicians to share in the learning experience of talking freely about the vicissitudes of their daily work. The transcriptions are presented unedited, excepting grammatical corrections, in order to preserve the atmosphere of the meetings and enable the reader to experience them fully. They cover subject matter such as anorexia, hysteria and perversion that arise in the course of clinical work and the subsequent discussions envelop the whole range of the ideas of post-Kleinian psychoanalysis. This broad spectrum is indicated by the three separate indexes that end the book - on the central ideas, on the main subjects and on diagnoses. This is an absorbing representation of the valuable work carried out over the years by these meetings and will provoke much thought and further discussion from its readers, perhaps even inspiring some to begin similar dialogues.

Part I
1993–1996

1
[May 1993]

Lucia

The Kafkaesque confinement of anorexia: rebellion and sacrifice, violence and survival, in the claustrum

Lluís Farré

This is a girl who worries me a lot. Her name is Lucia, and she is 20 years old. It was her parents who brought her to analysis after a spell in hospital with a serious anorexic condition. The psychiatrist who saw her there recommended that she should have psychoanalytic psychotherapy as well as the hospital’s programme of group therapy for anorexics.

Lucia is of medium height; she has very long brown hair. She could be pretty if it were not for her rigid gait and her cross facial expression. When her parents suggest that I can see her alone, she insists that she has been brought to me against her will, that she does not want to eat and she will not eat, and that she does not want to get better because she will be forced to go back to the university course she was doing last year where she worked so intensely that it exhausted her. She just wants to sleep, stay in bed without moving or eating, and be left alone. She throws back at her parents their complaint that they suffer a lot on her account, while they do not seem to realize that she suffers when she eats. She accuses her father of not having paid attention to her until she became ill, and her sister of torturing her by saying that she is to blame for everything bad that happens at home. She adds that her sister has always criticized what she does, what she reads, what she studies, and that she belittles her. Lucia is scared of her. Before she buys or reads anything, she thinks twice: “My sister said I would not be capable of doing Physics and that any other course was not worth doing. I did the first year, and in June I passed four of the five subjects, which neither she nor my brother ever managed.” Not eating has become an obsession. She confesses she has obsessions. When she feels passionate about something, she repeats it many times. She likes films; she saw Dracula recently. She has seen it six times. She has bought seven or eight books on Dracula, as well as the film, the soundtrack, etc. “I do not want to get better. If I do, I’ll have to go back to studying.”

Her hard and determined tone when she speaks about not eating, about her anger against her family and her suffering, makes me say to her that I am not interested in making her eat but that I can offer her my interest in helping her to understand what is happening, in the hope that it will decrease her suffering. She immediately agrees to continue exploratory consultations and possibly therapy.

DONALD MELTZER: You have acted correctly. It is very good, because the only thing you have to do is stay away from laying down rules. You must not appear in her eyes as one of the people who force her to eat and study. In this way you will not be a friend to her, but at least you will be acceptable.

That is always the essential analytic attitude; where your interest and intentions are exclusively focused on understanding, that is all. You draw away from any kind of action and take up an observing and thinking stance. It is important with these anorexic children to make it clear from the beginning that you are not concerned with whether they eat or not, or even whether they will live or die, because there is nothing you can do. You must show them clearly that you are impotent, that the matter is not in your hands. Carry on, please.

Additional information

Lucia has a sister who is 27 years old and a brother who is 25.

She was born at full term, weighing in at 3.100 kg. Because of problems with her back, her mother was advised not to breast-feed. Due to a diabetic imbalance and in order that “the baby would not be fat like her eldest sister”, mother followed a very strict diet during the pregnancy. The baby milk that Lucia was given was not what the paediatrician indicated, and it caused problems. Added to this were Lucia’s own feeding problems: she would take three or four short sips and then spit. Her bottles had to be warmed up again five or six times for each feed. These problems persisted when she was put on solids.

To her parents’ surprise, she started walking suddenly at the age of 9 months. She quite simply stood up and walked. She was toilet trained very soon, but after the family moved from Granada to Valencia she started wetting her bed. This continued until she was 18 years old, and from the age of 14 she was prescribed Tofranil.

When she was taken to the park, she would run away the moment the adults took their eyes off her; on two occasions she was almost run over. At home she would climb onto the table and, if somebody was watching her, would throw herself off it whether they could catch her or not.

She never allowed anyone to take her by the hand, and she was not fond of being kissed or stroked.

D.M.: She would throw herself off the table whether they were watching her or not?

LLUIS: If she was on top of the table and nobody was looking at her she wouldn’t do anything, but when they looked at her she would throw herself off whether they were near enough to catch her or not.

D.M.: One assumes they managed to catch her. … This is a hard tale of provocation addressed to the others to save her life. And it goes far back in time. Mrs Klein used to say that many childhood accidents are no more than suicide attempts carried out with inappropriate means.
One gets the impression of a girl who arrived in the world protesting; her tendency to escape and having to catch her seem to be the dominant themes in her life from the very beginning. One could ask oneself, where is she running to? Or what is she escaping from? Maybe both of these questions are pertinent. She is running towards an exciting place or object relation, and she is fleeing her persecutors, her jailers, etc. … In general, to my mind, this looks like a claustrophobic phenomenon; she experiences herself as a prisoner, as somebody who is tormented, who will eventually be the victim in a sacrifice, will be killed, etc. And in keeping with this, her sister is the high priestess in the high temple of this satanic religion. Why she wanted to study Physics is something we do not know, but it seems to be a part of the tools of that system of torture she has been subjected to: she has to study something.

LI: I want to point out that she is studying Physics because her father is a physicist and both her elder sister and her brother have studied or are studying it. Also, her sister often says to her: “The only degree worth studying is Physics—everything else is rubbish.”

D.M.: She is the high priestess in the temple of Physics. I imagine the father is a successful physicist, isn’t he?

LI: I am not sure.

D.M.: Is it a wealthy family?

LI: I would say they are upper-middle-class. [The general comment in the group is that they must be well off to be able to afford that kind of education for all three children.]

At the age of 1 year she used to sleep in her grandmother’s room but would cry out in terror, until they realized that she was staring at the holy cross. When they removed it from above the bed, she was able to sleep.

D.M.: One can see evidence of this satanic religion at the age of 1, and of what for her was the symbol of that satanic religion.

Ps¹: We were talking about this case at the airport when we were coming here. We thought you should have a holy cross ready to bring out in front of this patient [laughter].

D.M.: To protect himself?

Ps: To exorcize her.

LI: Maybe both.

D.M.: I do not think this is going to be an easy case. Carry on, please.
Her parents describe Lucia as being extremely intelligent, hard working, and sensitive. “But she prefers to do people favours and look after them to being looked after herself.” She idealizes relationships, and if people disappoint her she will detest them forever. She was never a great eater, but when she started her university course the anorexia set in. She already had “quirky ideas” such as, when she was given a pair of binoculars as a present, thinking that maybe just as she saw people with them they could see her. She started having windows and blinds closed because she said people might be able to see her from a helicopter. Her mother says that Lucia hates having her periods and that she is happy to be anorexic because that way she avoids them. “She never liked children; from a very young age she used to say that she was enough.”
She often has nightmares. Nobody has ever heard—not even in horror films—screams as scary as Lucia makes in her dreams. “They could give you a heart attack”, her mother says.

D.M.: She is the youngest of the siblings. Her brother is the middle one, and her sister, the high priestess, is the eldest. How many years older than her?

LI: Seven.

D.M.: There are some aspects that do not fit in with the general picture of this girl; they are the ones that refer to her preferring to do favours and look after people rather than be looked after. I think that by that she is referring to her attitude towards her fellow sufferers in the world she lives in, towards anybody who can be felt by her to be one of the prison inmates. She can be very gracious and kind towards them, but first they have to prove that they really are fellow sufferers. From that position one can reach the extreme one of killing people so as to alleviate their suffering. I don’t know if you might have heard about the case of the nurse who worked in a children’s hospital here in England and killed some of them.
The matter of the binoculars and of being seen seems to be a part of the claustrophobic anxiety, of being spied on….
Is this the first session? Have you only just started to see her?

LI: No, this is the third session, and I have brought the fourth one too.
I have been seeing her since April.
I want to point out that she has lost weight—though not a lot—since I started seeing her, and there have been self-inflicted injuries. Yesterday, in the afternoon—the last time I saw her (I see her twice a week, which is what we agreed on at the beginning, with the possibility of making it more often if we thought it necessary)—her arms and hands were covered in cuts she had given herself with her father’s razor. She had scratched herself all over. They were superficial wounds, as the blade was the modern sort, not a knife. She looked like Christ on the cross. With that blade she would not have been able to cut her veins, but she was able to seriously damage her skin.

D.M.: When did you start working with her?

LI: On the 8th of April.

D.M.: At what time of the day do you see her?

LI: On Mondays at 9.00 o’clock in the morning and on Thursdays at 3.30.

D.M.: So this is the third session. Does she sit up or lie on the couch?

LI: She lies on the couch.

D.M.: She accepted that easily….

LI: Yes. Her mother said: “She won’t talk because she does not talk to the psychiatrist.” But with me she has no problems; she talks non-stop.

Session of Monday, 19 April 1993

PATIENT: I went to Valencia at the weekend. My friends called me but I don’t want to go out with anybody in Valencia.

D.M.: She has friends! That’s a surprise!

LI: She had. …

Before I was ill they never took any notice of me, now they do. I don’t want to see them.

D.M.: This is what she says about her parents, that they did not take notice of her until she became ill.

Ps: Why are you surprised that she has got friends?

D.M.: She does not seem very sociable. … Perhaps they are not friends, but school acquaintances, colleagues,…

LI: Yes, that is what it is.

My mother says that I have to go out, to see them. I say that I don’t want to; I don’t have good memories from Valencia. All my friends from there left me in the lurch. I don’t want to go back. I didn’t like the school either; I was dying to come to Barcelona to study. When I got here it was even worse, but I prefer to stay here without studying rather than going back there. I have no wish to remember anything about school.

D.M.: Does the family still live in Valencia?

LI: Some of the time; and some of the time they live in Barcelona. They have a house in Valencia.

D.M.: How far is it from Barcelona?

LI: About 300 km. They spend weekends there.

There, there were people who laughed at me. Here, they leave me alone; I know fewer people, and those I know do not insist if I say I don’t feel like going out. I have a good friend here in Barcelona. My other friend is from Valencia, and she goes there at weekends; I get on well with her.

D.M.: Who goes to Valencia, she or her friend?

LI: She does.

I get nervous when my friends from Valencia call. One of them told me once that she was afraid of me. I couldn’t understand it. I had not done anything to her. And another thing: they gossip about one another. I am sure they gossip about me too. … I don’t like their company...