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AUTISTIC TRANSFORMATIONS
AUTISTIC
TRANSFORMATIONS
Bions Theory and
Autistic Phenomena
Clia Fix Korbivcher
www.karnacbooks.com
CONTENTS
ACKNOWLEDGEMENTS
vii
ix
xi
xvii
xix
CHAPTER TWO
Some thoughts on the psychoanalytic object
15
CHAPTER THREE
Primitive mind and thought
25
CHAPTER FOUR
The theory of transformations and autistic states.
Autistic transformations: a proposal
47
vi
CONTENTS
CHAPTER FIVE
The analysts mind and autistic transformations
69
CHAPTER SIX
Bion and Tustin: the autistic phenomena and
Bions referential
93
REFERENCES
119
INDEX
123
ACKNOWLEDGEMENTS
First of all, I would like to thank Karnac Books for publishing the
English edition of this book. Milena Basaria translated the book
into English. I owe her recognition for her excellent work and for
complying with Karnacs instructions, thus making this edition
possible.
I thank John Wiley & Sons Ltd for kindly granting permission to
reproduce the paper Bion and Tustin: The autistic phenomena and
Bions referential, written by me and published in August 2013 in the
International Journal of Psychoanalysis, 94(4): 645665. I am also grateful
to Routledge for permission to reproduce the above-named paper,
also published as a chapter in the book Primitive Mental States. A
Psychoanalytic Exploration of the Origins of Meaning (edited by Jane Van
Buren and Shelley Alhanati, 2010).
I thank my colleagues and friends: Antonio Carlos Eva, Cecil Jos
Rezze, Darcy Portolese, Evelise de Souza Marra, Fernando Giuffrida,
Ione Vitorelo Castelo, Julio Frochtengarten, and Roberto Vilardo, with
whom I have established a rich dialogue in recent years. This dialogue
contributed to the development of many of the thoughts gathered in
this book.
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ACKNOWLEDGEMENTS
ix
FOREWORD
Giuseppe Civitarese
But how come you know these songs? Marieta asks her analyst.
That immediately reminded me of the similar surprised response of a
patient of mine: You mean you also watch these trashy pulp films!?
This is, first and foremost, a book about the importance of speaking
the same language as ones patients. Each is different from any other;
each has his or her own history, guards his or her secrets and carries
the burden of his or her troubles. We see these patients passing in
succession as we read. We meet Ana, silent, motionless, and
constantly chewing gum. Next comes Marieta, just mentioned, whom
we encounter first at the age of six, and then at nine. Marieta initially
presents with wild Jo (violent emotions), then calms down and is
able to ask for what she needs: Abracadabra, be sweet, sweet, sweet,
very sweet! The magic works. She, too, is asking to be fed: for a sweet
can mean either a candy or behaving sweetly. Five-year-old Mrio, on
the other hand, is more demanding and yells at the analyst, I WANT
FOOD NOW! GIMME, GIMME, GIMME NOW! Then there is Pedro, six years
old, who is afraid of dreams and has night terrors, so he can neither
get to sleep nor be awake.
It is odd, but that is the way it is. Night dreams and daydreams
are the minds way of going about the task of transforming emotions
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FOREWORD
into thought. Just as there are daydreams, so, too, there is daytime
sleep, which we call the waking state, and, just as they do at night, the
two go together. When dreaming is possible, in the sense of successfully conferring a personal meaning on experience, waking sleep is
the seeming facility with which we move between persons, our nave
realism, and the smooth surface over which everything appears to
glide.
Next in line is six-year-old Lus, who comes alive only when his
father licks his face. He is followed by Caio, aged four, who communicates only with the names of television characterssounds in
search of a mind. However, other fantasy characters, too, bring to life
the vivid and moving stories that allow us to participate intimately in
the joys and pains that Clia Fix and her guests share, sometimes for
years on end: the whale, the platypus, France or Brazil as places in the
mind or in the analytic field, or songs such as Chega de Saudade.
The names of all the patients, whether big or small, remain
impressed on our memory. It is they who are in the foreground. Clia
Fix knows how to summon them up in the way that only the best writers can, by the masterly use of just a few details. Through the manner
of her presentation, she enables us to see them as living persons. No
distance between them and the reader is noticed. That is no doubt
why, every time I picked up the book, I was pleased to discover
myself so thrilled by the stories that I could hardly put it down.
Another reason might be that, as in the most felicitous examples of
psychoanalytic writing, Clia Fix does not care to weigh down her text
with jargon. She takes with her only the basic essentials, like someone
venturing into the desert or the high mountains. That is when certain
tools become important. Clia Fix has obtained some of these from the
preferred authors whom she mentions, such as Tustin, Bion, and
Green; other tools, as we shall see, she has constructed for herself, as
Bion recommends all analysts to do.
Yet, even if the conceptual apparatus remains in the background,
due respect is accorded to it. Clia Fixs ambition is to put forward a
new development of the paradigm that has gained increasing acceptance in psychoanalysis since autism first came to be studied. From
Bleuler to Kanner, to Meltzer and Tustin, we can now trace the precise
line of its evolution. The past few years have witnessed a flowering of
literature that has taken up and expanded Frances Tustins insights on
autistic barriers in neurotic patients. Since the publication of her fasci-
FOREWORD
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FOREWORD
avoid the light pollution of big cities; in other words, we must give up
certain notions that do not help us to see and adopt new ones instead.
Clia Fix now contributes authoritatively to the expansion of this
theoretical field. As stated, she does so not only by gathering together
the heritage of the masters, but also by forging instruments of her own
which she puts at our disposal in this book. Chief among these is
autistic transformation.
The concept of autistic transformation is a valuable addition to
Bions series of psychic transformations. Unlike rigid-motion transformations (as produced by the classical transference), projective
transformations (responsible for the phenomena of splitting and
projective identification) and transformations in hallucinosis, autistic
transformations organise a set of phenomena, some of which are very
obvious, while others that are highly subtle have been observed in
pathological autism, but might also be encountered in neurotic
patients with autistic or encapsulated nuclei. In an analytic session,
these patients defend against awareness of their separateness from the
analyst by resorting mainly to the distorted use of sensations. They
envelop themselves in autosensual activities so as to divert their
perception away from something that might plunge them into terror.
Just as Dantes Beatrice refuses to smile at the beginning of Canto XXI
of Il Paradiso in order not to incinerate him with fascination for her
(the fate that befell Semele), so, for these persons, the object has a
Medusa-like quality against which they must defend at all costs.
Analysts might experience these moments, which sometimes appear
interminable (it is characteristic of these situations that the arrow of
time seemingly comes to a halt), by succumbing themselves to autistic transformations. They get bored and distracted, decathect the
patient and use theory as a source of what itself ultimately amounts
to autosensual stimulation and not in order genuinely to thinkthat
is, they are not in living contact with the emotional situation of the
moment, but are isolated in an unreal and closed-off world.
The concept of autistic transformation combines a number of hitherto scattered theoretical components into a conceptual framework
that helps us to recover a sense of vitality when faced with these
despairing situations, and, as we can see, to recognise the signs of
autistic transformations in ourselves, too, and not just in the patient.
If the analyst succeeds above all in escaping from this spell, the result
is an anti-autistic transformation that might help the patient to regain
FOREWORD
xv
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FOREWORD
xviii
Introduction
This book is a collection of six papers in which I present ideas concerning the clinical aspects of primordial states of the mind, more specifically, autistic and non-integrated states present in neurotic patients. In
such states, bodily sensations prevail in place of fantasies and
emotions.
I believe that it would be useful at this moment to describe the
path I followed until I decided to publish this collection of papers
about this topic.
My entire training was strongly influenced by the ideas of Bion.
Moreover, my contact with the contributions of Frances Tustin was
extremely significant.
In 1990, I had the privilege of meeting Tustin in person. This
opportunity arose purely by chance. A colleague, in supervision with
Tustin, mentioned a paper I was working on, in which I presented the
report of an analysis of a six-year-old girl who, during a session, asked
me whether I knew a strange animal called platypus. She defined it
as a very strange animal which spills milk through its pores. She
then added, Pores are holes.
At that time, Tustin had published her book, The Protective Shell in
Children and Adults. On the cover of the book, there is a photograph of
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INTRODUCTION
INTRIDUCTION
xxi
xxii
INTRODUCTION
phenomenon of hallucinosis, proposing transformations in hallucinosis, which is different from hallucination, in the autistic transformations the autistic phenomenon prevails, which should not be confused with autism as pathology. I point out that the autistic transformations do not apply to autistic patients, but to those who have autistic nuclei, despite operating with the neurotic part of personality.
It should also be mentioned that the phenomenon that prevails in
autistic transformations, despite being somewhat similar to the
phenomenon of hallucinosis, is of a different nature. The emotional
experience in autistic transformations is that of emptiness, an absence
of emotion, while in transformations in hallucinosis, the emotional
experience is intense, full of life. I immediately realised that this
apparently simple proposal was more complex than I had expected,
and that this topic would challenge and encourage me to keep investigating.
In Chapter Five, The analysts mind and autistic transformations, originally written in 2004, I develop ideas about the impact of
autistic transformations on the analysts mind. I investigate the need
to highlight and delimit the parameters of the autistic universe,
considering that this universe organises itself under the aegis of sensations and is, thus, ruled by laws of its own, different from those found
in the realm of neurosis and psychosis. From this perspective, I
explore the possibility that this universe will become a new paradigm
for psychoanalysis.
The final chapter, Bion and Tustin: the autistic phenomena and
Bions referential, originally penned in 2007, furthers the idea of integrating the autistic phenomena to Bions referential as I try to relate
these phenomena to some of the concepts used in Transformations
(1965). My purpose, in this text, is a stricter look at the appropriateness of the proposal of autistic transformations. To that end, I ask:
how do these phenomena relate to the beta elements? How will they
be part of the Grid? What is their relationship with the emotional links
proposed by Bion? In which of the dimensions of the mind are they
situated? I think that once the autistic area is included in Bions referential, this referential will be extended and begin to cover a new area
of phenomena predominantly linked to sensations.
CHAPTER TITLE
CHAPTER ONE
Introduction
t is common in our clinical work to encounter patients who, when
faced with strong inner or outer pressure, do not have resources
other than discharging this pressure into the analysts mind in
order to obtain relief. These are patients who have not developed a
mental apparatus able to contain this tension, work it through, and to
transform it into thought.
The analyst faced with this type of communication is often
engulfed by the power of the situation and has trouble maintaining
both his analytic standpoint and the ability to think. However, when
it is possible to rescue his position, he has no alternative other than to
step back and wait for an opportunity to attempt communication with
the patient.
In order for this communication to become accessible to the
patient, the experience shared by the pair must be transformed by the
analyst, who, with his capacity for reverie and alpha function, should
present it to the patient in a way that will render it more palatable.
In my opinion, repeated experiences like this will allow patients to
develop a psychic apparatus capable of containing these undesirable
AUTISTIC TRANSFORMATIONS
contents in their minds, rather than just discharging them. When they
develop a psychic apparatus with such capability, they increase their
contact with themselves and become more able to expand their
resources, to expand the functions of their minds.
Six-year-old Marieta, the patient whom I present here, has this
kind of mental functioning. My intention is to illustrate with her clinical material the process she experienced during analysis, in which she
was gradually able to construct a mental apparatus that could think
the thoughts and, thus, creatively transform many of her states of
mind into words and metaphors.
manner, excluding her sister and being alone with me made her very
anxious.
This was what I faced when I began this analysis. Many questions
were in my mind, mainly concerning the work with a twin.
For some time, we maintained an apparently cordial relationship
in which Marieta appeared to be enthusiastic and co-operative.
Slowly, as she felt more comfortable, she began to express herself
more freely and started to react with violence as a result of frustration.
We began to experience moments in which hate and destructiveness predominated, triggering situations of real bellicosity. Marieta
would kick and hit me, throw objects at me, and damage the room.
She became next to intolerable. She would leave the room, swing from
the top of a jabuticaba tree in the garden, and call me names while
doing that. As soon as she arrived at my office, she would invariably
ring the bell incessantly, until someone came. As she walked down
the hall, she scratched the wall and, when seeing me, she would kick
and hurt me. As much as possible, I tried to stop her and keep her
manifestations from transgressing the analytic setting, but often, by
the time I realised what was happening, it was too late to do anything
about her aggressive acts.
Often, after such incidents, Marieta would be co-operative in the
next session, trying to repair the damage she had caused, at least
until her feelings of persecution disappeared.
Then, there would be new attacks. I understood that this behaviour reflected the way her inner world was organised, and that was
the nature of her object relations.
In a session during this period, when a climate of intense hostility
was already looming, Marieta refused to come into the room with me.
She stayed outside, and I remained inside. At some point, she began
to hum French childrens songs. I did so, too. Marieta felt the impact
of that situation. She entered the room and asked me, But how come
you know these songs? She went on to say, It was my father who
taught me! Hes French!
She became very interested in teaching me other songs that I did
not know. She taught and I learnt! At other times she suggested
that we should sing Alouette together, one harmonising with the
other. She had great fun with this, and that is how we began to experience the first moments of a certain peace, a sort of armistice in our
AUTISTIC TRANSFORMATIONS
relationship. This situation surprised me. The hateful, cruel little girl
began to show some sweetness and light-heartedness.
At that time, her toy box was a complete mess. The lid was broken
and dirty, and the objects looked like rubbish. Marieta asked me to get
her a new box, and I did. She started a challenging process of selection to separate the good things, as she called them, from the
rubbish. I found it extremely curious, because not only did she
show great interest in this activity, but she also covered the outside of
the old box with white paper and restored it. She also covered the new
one, in order to have two similar boxes, one with the rubbish, and
the other with the good things. In my opinion, the two boxes had
the function of splitting what was good from the rubbish.
Slowly, the hostility ended and was replaced by a situation in
which she was very enthusiastic about coming to the sessions. She
then began to come alone to the office, taking care of her own appointments.
In several sessions, when she arrived, she would snuggle into an
armchair in the consulting room, hold the curtain cord, and hum
songs, often in French, asking me to sing along. On one occasion, she
started talking about certain changes that were taking place in her
house. She was now getting her own room, and her siblings would
sleep in another room. She started singing and I watched her.
Suddenly she asked me, What are you looking at? I replied, You!
She was surprised that I could be looking at her, only her, with my
full attention. She seemed to understand that she was the only one
there and that she did not need to share anything with anyone else.
Apparently, for the first time, she realised that this was a place that
belonged only to her. I think that it was through multiple experiences
of this kind that Marieta began to feel more secure in our relationship,
and processes of integration began to appear.
From that moment on, I noticed some changes in our relationship.
Her capacity to wait increased. When she arrived, she would go to the
waiting room and stay there until I called her. She no longer used
the two boxes. All the material was contained in a single one. She
began to express herself through songs whose words were related to
the feelings she experienced, or some metaphors, images, and even
stories. Her sensitivity and closer contact with her psychic life and the
beauty with which she transformed her emotional experiences were
touching.
AUTISTIC TRANSFORMATIONS
I tell her, It is very painful to be far away from people you love. As in the
fish song, How can I live without our company. Today is Thursday,
tomorrow, the day after, Sunday, you wont be coming here. Soon it will
be our vacation. You say that you get sad and miss me.
She answers, That is not at all what it is. I like it here, but I dont like
you! She takes the clay, models it, shows me the whale she made and
says that it is ugly. She says that she is going to make a house. She shows
it to me and says, This is the building of the house.
I tell her, It is like what the two of us have been doing since the first day.
We have built many things here together.
After some time, she says, intrigued, which surprises me, You know,
Clia, once I saw an animal in a book at school, it was so strange!!! It has
a duckbill, duck feet and milk spills out of its pores. The young babies lick
the milk. Its very strange!!! It stays in the water all the time. Have you
ever seen this animal? It is called a platypus!
I feel touched at her description. I spend some time trying to explain
something appropriate to her mental state. So I tell her, You find it
strange that so many cubs come here, like you, who really like, who
lick, what I have to give. You dont understand, you find it all very
strange!
While we talk, Marieta makes clay balls, several of them, throwing them
against the wall, where they stick.
She says, These are the platypuses, because they stick to the wall.
I tell her, You want to stay here, stuck; you dont want to have to leave!
I let her know that time is up, but she wants to stay a bit longer.
She takes a piece of clay and says, Im going to show it to my mother, so
that she can see if its any good.
I tell her, It seems that you want to take something of our company with
you and also show it to mummy, so that she can see what it is like.
At the following session, I had asked her to come late in the afternoon instead of in the morning.
She is eating a sort of doughnut, a sonho, as she arrives. (In Portuguese,
the word sonho, doughnut, also means dream.) She mentions that
she waited a few minutes at the door, until somebody came. We enter the
room and she immediately says, The sonho is cheap. It costs three reais
AUTISTIC TRANSFORMATIONS
She says, Mnica is very nice; shes also going to save her allowance and
buy each of us a present.
I reply to her comment, saying that she wants her siblings also to have this
sonho, which she is experiencing here with me.
In one of the sessions following this one, while playing with clay and
sticking balls, she says, Clia, I looked for the story about the platypus at
home and I couldnt find it. You know why? Because its down in the
cellar where I keep all the things from last year, the year before last year,
the year before the year before last year, before, before, before. I tell her
that the things which we are discussing and what she is feeling belong to
a very distant past, but it is only now that she is able to recover it and talk
about it.
Comments
In this material, Marieta takes off the mask she carries and her
mental life sprouts from inside her. From then on, analyst and analysand interact with each other and find a word which sums up
Marietas emotional experience as she lives in the session: Platypus!
A strange creature, a species halfway between bird and mammal,
something which she brings from her primitive world and which also
represents the different cubs who must share what emanates from
that creature. The bill is hard; it nudges, like the thorns. There is a
perception, then, condensed in this figure, not only about herself, but
also about the analyst. I think that the emergence of the figure of the
platypus is related to the movement in the relationship which gradually developed between Marieta and the analyst, each feeding the
other. Marieta sees this experience with strangeness and questions,
What strange figure is this? Her perception of strangeness arises
when, during the session, she feels that her analyst returns her undesirable inner contents to her in a more palatable form. When she talks
about ending up without our company, she associates this to the
death of her grandfather. Or, when she refers to Riacho Fundo, a
song which speaks of pain and of missing someone, Marieta
expresses her feelings and the analyst gives them meaning. The analyst tells her that being far away hurts; it makes someone miss another
someone, causing suffering. The analyst, at this point, becomes a
very strange animal, different from any other being with whom
Marieta had contact up to that point. She feels welcome and nourished, possibly fused with the analyst, from whom she no longer
wants to separate.
Marieta also feels the strangeness of observing herself. There is
gratefulness and collaboration from her when she realises that,
despite her hard duckbill, the analyst always manages to survive
her attacks without letting herself be destroyed and, furthermore,
being able to feed her needs.
Marietas capacity to transform her internal objects into this
strange figure, as well as the way she relates to them is surprising.
Pores are holes, as she says, from which milk may pour, or, if there
is no milk, there is a lot of pain. Lacking this, she creates sonhos
(dreams). As she says, they are cheap, they are her dreams/sonhos;
she can eat and retain them within herself, which allows her to bear
the absence of the external object.
In the second session, we see productive interaction between
Marieta and the analyst, Marieta through her associations, and the
analyst with her transformations, which allows the development of
the situation. Her sonhos, food, is transformed into a creative interaction between analyst and analysand in which Marieta asks the analyst
to guess or feel her Riacho Fundo emotion, and also to teach her
what pores are. Her curiosity about herself arises, and, once her
need has been satisfied, she feels very close to the analyst. She no
longer feels that something is missing, and even begins to feel that she
has something to share with her siblings.
Discussion
Marieta was initially confused with the figure of her twin sister. Not
only did she not discriminate between herself and her sister, she also
did not establish a separation between the analyst and her sister.
The experience of the analysis threatened to break down this
configuration. She reacted by launching violent and cruel attacks
against her analyst, probably manifesting her hatred, which might
have come from feelings of neglect and deprivation.
The analyst was able to contain these destructive attacks emanating from the patients mental life and to preserve herself. The French
songs made it possible to retrieve the good object from her internal
10
AUTISTIC TRANSFORMATIONS
11
The analyst conveys this idea to her. They continue to sing and
Marieta seems very enthusiastic about the duet, which she calls a
dissonant duo.
I decided then to use A dissonant duo as the title of this chapter, because, on further reflection, I asked myself if this name did not
express precisely what an analytic duo is. Isnt the analytic pair dissonant to a certain extent? Isnt there a distance/separation, a dissonance between its elements, which allows the analyst to apprehend
the shared emotional experience of the moment?
I believe that the analytic relationship implies a certain dissonance
in which the communication from the analysand occurs in one tone
and the analysts approach in another. It is in this space that the
psychoanalytic conversation takes place.
The title, A dissonant duo, in my view, defines the analytic experience. It is a pair consisting of dissonant elements from each of the
elements in the pair. This dissonance allows the achievement of a
more global view of the relationship.
12
AUTISTIC TRANSFORMATIONS
13
The nipple helps the child to wait to get the milk in the proper way
it makes the child work. The milk doesnt just pour into her mouth it
has to be worked for. It has to be waited for. It introduces the child to
the need to sustain tension and delay action. It holds impulsiveness in
check.
Your little girl, as you say, demonstrated all this beautifully. The clay
balls were thrown at the wall where they remained stuck, just as she
had remained stuck to her mothers body. When awareness of her
bodily separateness made her feel wrenched away, the nipple was felt
to be torn out. It left a hole. There was no daddy element to discipline
her and bring about psychic organization (the good and the trash).
By your patience and your willingness to try to understand her, you
helped her to gradually differentiate herself from you. Then symbol
formation could develop. When she was so stuck, and in such a rage,
when she felt wrenched away from you, symbol formation could not
develop.
. . . What a wonderful title A Dissonant Duo. Such children have been
too consonant and the dissonance of finding that their body was
separate from that of the mother has been unbearable. You have
helped her to bear and grow from the dissonance.
CHAPTER TWO
Introduction
y experience with Marieta, the patient discussed in the previous chapter, encouraged me to investigate further the
processes involved in the analytic task and the experience
that takes place between analyst and analysand during a session. My
idea is to reflect about the movements that bring the analyst close to
the analytic object. For that, I make use of theoretical developments
concerning the analytic object, especially those of Bion and Andr
Green, and I use Marietas clinical material to illustrate these ideas.
The opportunity to take a step back and think about the clinical
experience helps us sharpen our professional tools. The fact that we
become restless when participating in an analytic experience might be
valuable. It leads us to question the nature of our task. Therefore, I
think it is important to delimit the field of observation of the phenomena present in the analytic session, in order to look only at what is
essential without deviating from the focus of interest. I believe that
this attitude favours contact with the emotional experience at hand,
that is, with the field of phenomena shared between analyst and
patient in the analytical session.
15
16
AUTISTIC TRANSFORMATIONS
17
18
AUTISTIC TRANSFORMATIONS
parts, one constituted by the double of the analysand, the other by the
double of the analyst . . . What is called therapeutic alliance or
working alliance which I prefer to call the analytic association is, in
my belief, founded on the possibility of creating an analytic object
formed by these two halves. (1975, p. 288)
19
allow us to detach ourselves from the clinical practice and move into
a field of thought in which abstractions lead to great expansion in the
field of investigation.
As Viderman (1982) said,
Klee taught us that art does not reproduce what is visible, it renders
visible . . . The most profound function of Interpretation is not to say
what was, reproducing it, but to make figures appear in the psychoanalytic space. These figures are not visible anywhere else because
they have no existence other than the one given by the analytic space
which, by rendering them visible, makes them exist. (Translated for
this edition)
20
AUTISTIC TRANSFORMATIONS
is? A wild Jo? [in Portuguese, Jo Bravo]. She shows me her foot and
says, I have a thorn in my foot. She continues, My uncle taught me
. . . Jo is a plant, a tall plant, like this [she indicates its height with her
hand], with lots of thorns, and it hurts you if you get close to it.
I hear that and feel slightly perplexed because, although Marieta did not
realise it, I noticed that I had been in contact with this wild Jo from the
beginning of the session.
She tries to hit me and then throws water on me. I begin to feel very irritated, but manage to recover fast and tell her, I see you as this wild Jo
which you introduced me to. There is a Marieta in the middle, a flowerMarieta who brings gifts to Clia with one of her hands and with the other
hand, takes them away, because there are thorns around the flower that
hurt. She intends to please me, to join me, but the thorns prevent that.
She mocks what I am saying and screams, Shut up, you dumb thing!,
and then continues to nudge me physically.
I tell her You do not know how to join me, how you can lean on me.
She has a violent reaction and says, God forbid! She huddles behind the
sofa and remains there, lying on the ground, quietly. After some time, she
goes to her box where she finds a tangerine from the previous session.
She says, ironically, Did you think I wasnt going to eat the tangerine?
Heres one! She sits on a low wall in the room, peels the tiny tangerine
and shows it to me. She begins to talk. Abracadabra, be sweet, sweet,
sweet, very sweet. She opens the tangerine, takes a section and offers me
another. (Her expression has changed; she has become much sweeter.)
I tell her, You have found something which you have been looking for
since the beginning. A tangerine-Clia that becomes sweet as she talks to
you.
She comes down from the wall, and I tell her that the session is over. She
asks to play a game before she leaves. In this game we clap each others
palms and sing a song at the same time.
I tell her that she does not want to leave, that she would like us both to
stay there and that at last she appears to have found a way to join me.
Discussion
As we can see, at the beginning of the session Marieta expresses
intense emotion, which is only acted out, discharged. She does not
21
step back and think. After some time in this state, pointing to a thorn
stuck in her foot, she asks, Do you know the wild Jo?, and then
communicates her definition: Wild Jo is a plant tall like this, with
lots of thorns around it, and if you come close to it, it pierces, nudges,
hurts . . . This contribution from Marieta allows the analyst to
observe that her initial movements were related to this figure, and she
formulates that she saw herself as this wild Jo, who wants to be
with the analyst, but does not know how. This interpretation has a
strong impact on Marieta, who possibly wished that the thorns would
disappear as in a magic trick (abracadabra), and the sweet flower
which is inside it would emerge. Marieta, from then on, begins to
see her analyst as someone who is also sweet, who instead of
nudgingpiercing, can touch with the palms of her hands and go no
further. From the moment Marieta asks the analyst whether she is
familiar with the wild Jo, there is a change in the quality of her
communication, and the field between analyst and analysand
expands. A symbol emerges, through which it becomes possible to
start a conversation about her mental state. There is a split in Marieta.
She stops being the wild Jo and is able to name it. Possibly, the
analysts containment of Marietas discharges and her attempt to talk
about Marietas mental state brought back her ability to express
herself at a more developed level. A space arises where the analytic
conversation develops based on the transformations experienced by
both of them. Thus, the wild Jo Marieta created represents her
mental state on a symbolic level. This expression is the product of the
analysts complementation of the meaning lacking to Marieta. She was
not able to give a meaning to her own experiences. I believe that we
are now approaching the analytic object, that is, the idea that Marieta
has a loving core desirous of contact, of acceptance, a core that is
covered by thorns which prevent her from approaching. It is important to remember that the possibilities of a relationship between the
analytical pair in a session are of different qualities. One possibility
would be a relationship such as the one the analyst experiences with
Marieta, in which the communication between analyst and analysand
occurs in such a way that one modifies the other at every turn. The
subsequent communications are evolutions of the previous ones,
furthering some contact with the moments emotion.
Another very frequent possibility, as we know, is that the analysand will obstruct knowledge in the session, attacking the analytic
22
AUTISTIC TRANSFORMATIONS
work. This is the material that should be treated, but often it is not
accessible to an analysand, and so they utilise the session space to
repeat their obstructive attacks.
Concluding, I would like to discuss a few important points. The
first concerns the notion of space, potential space, analytic
space, highlighted by Green in the references mentioned earlier. It is
useful to point out that both the analytic space and the psychoanalytic object involve psychic qualities and not sensorial or concrete
ones. It is important to circumscribe and delimit the terrain of the analytic task so as to focus on aspects involving psychoanalysis. In this
manner, the latter will not be taken over by other variables, which
would render it difficult for the analyst to maintain his observation
point. It is necessary for a space to emerge between self and object so
that the movements of the analytic pair can occur, fulfilling the role of
a psychoanalytic investigation. Under this condition, it is possible to
think and to name emotions in the field of emotional experience. This
space emanates from a succession of multiple spaces, divisions, separations, and retreats having occurred in both analysts themselves and
in their relationship with their analysands. This is the only thing that
makes it possible to work through and, consequently, enable mental
development. Otherwise, there will be merely a repetition of the
phenomena with no new knowledge.
Another point involves the idea of doubles, of analogues,
proposed by Green, and of transformations, proposed by Bion. I
believe that both indicate a space in the mind in which the emotional
experience itself is separated from its verbal expression. It is in this
space that communication containing the mental representation of the
experience undergone and the formation of verbal thought will come
about. The psychoanalytic object emerges in this space, in the
encounter between the analysts and the analysands communication, an experience shared by the analytic pair.
My final point concerns the difference between childrens and
adults means of expression. Since children are less developed, they
need a concrete space to contain their inner world and its representations. Language as communication alone does not suffice, because
children have not yet attained the degree of abstraction needed for
symbols to form. Therefore, it is necessary to be aware of separation
between me and the other. This is an ability that results from
emotional development, in which absence, neediness, and space can
23
CHAPTER THREE
Introduction
he work in clinical practice with patients in long-term analysis
can provide a continuous incentive to elaborate some points
that arouse interest in further investigation.
As we know, the communication of each patient during the analytic session shows the level of mental development at which this
patient is operating at that moment. In some mental organisations,
more primitive states prevail, whereas other mental states are more
developed. In my view, it is essential that analysts try to identify the
level of mental development of their patients in order to get through
to them. The understanding of the material offered by the patients is
directly related to the levels that the analyst has reached, of his own
mental state, through his life experiences, his analytic experiences,
analytic work with other patients, and his own personal analysis.
However, it is not always possible for the analyst to apprehend what
the patient is trying to communicate. As I present in this chapter, there
are several factors which make this a difficult understanding.
Often, when we begin an analysis, we encounter patients with
mental configurations which present a fragile psychic organisation, a
25
26
AUTISTIC TRANSFORMATIONS
27
28
AUTISTIC TRANSFORMATIONS
29
through the excessive envy and hate from the baby in his very early
states, but also because of the strength of the stimuli aimed at her by
the baby. In this configuration, the babys states of non-integration or
disintegration prevail, creating such disorganisation and turmoil in
the mother that she is no longer able to contain and transform it.
Mrios clinical material will illustrate these manifestations.
States of mind
Tustin (1990), based on her work with autistic children and observations of the motherbaby relationship, made valuable contributions to
our understanding of primitive mental states which are manifested
even before the schizoidparanoid position. Manifestations at a protomental level prevail in these states, in which the physical and the
mental are not differentiated. The power of such stimuli on the object
is considerable given their degree of non-integration.
We should recall Freud (1923b, p. 25), who considered that
The ego is first and foremost a body-ego. It is not merely a surface
entity, but is in itself a projection of a surface. . . . The ego is ultimately
derived from bodily sensations, chiefly from those springing from the
surface of the body. It may thus be regarded as mental projection of
the surface of the body.
30
AUTISTIC TRANSFORMATIONS
if the separation is too abrupt, this infant will suffer what I have elsewhere called an agony of consciousness.
In this passage, Tustin asserts that there would be a part of the mind
that would refuse to be born (the protomind), as if remaining encapsulated in the space of the mothers body. There are consciousness
states of the corporal separation and, possibly, each psyche will be
organised differently according to each individuals capacity to tolerate separation. Tustin also says that some people who present certain
primitive mental configurations feel the experience of separation, not
as the absence of the object, but as though parts of their own body had
been torn from them. This would cause feelings of annihilation, of
being crumbled, of internal holes, black holes, or the emptiness that
some patients describe.
In such states, the individual builds for himself a protective shell
in which he takes shelter and remains absorbed in auto-sensual activities, seeking sufficiency through that. In this way, they protect themselves from a state of terror triggered by non-integrated experiences
of great vulnerability. Here, relations between me and not me
occur by means of sensation-objectsautistic shapes and autistic objects (Tustin, 1981, 1984).
This kind of manoeuvre is used to close the hole caused by the lack
of a concrete object. Tustin defines autistic shapes as sensorial impressions left by an object when it touches the skin surface. These are predominantly experiences of soft objects and of bodily substances that
are comforting and calming. The autistic objects provide sensorial
experiences of hardness and edges. The resulting experience is felt as
an armour that protects against a nameless terror.
Meltzer (1975b) and Bick (1968) address this and suggest that in
the autistic sphere, the contact between me and not me occurs
through what they call adhesive identification, that is, by the adhesion of surfaces that touch one another. This does not occur in projective identification, as it does in areas where the notion of separation
between me and the object exists, so that there is projection. Tustin
suggests replacing the term adhesive identification with adhesive
equation. She says that there cannot be an identification mechanism
in the autistic area because the notion of separation between self and
object does not exist: there is only an equation transforming the self
into the object.
31
32
AUTISTIC TRANSFORMATIONS
he explains in a lively manner, The king is telling the soldier to fix the
leak. The pipe burst and there is a leak. He draws several blue drops
representing the water.
I tell him, You have drawn a king-Pedro and a soldier-Clia; I think that
king-Pedro wants soldier-Clia to fix the leak, that is, all the thoughts your
little head cant hold which end up pouring out.
He laughs and says he thought no story would come of it, but it did. (Since
the first session we have talked through drawings and stories.) Its the
story of the thoughts which come out and do not let me sleep. But I slept
last night. Mummy gave me a tranquilliser in bed. Daddy was working
and she told me a story. (He is referring to the tranquilliser.)
He goes on drawing drops and says that it is a golden leak. Above the
king he adds a soldiers helmet and a chest. He mentions that the chest
is closed. He laughs ironically, with a somewhat sarcastic air, and says,
I know, youre going to say that my thoughts are closed in the chest and
dont want to come out.
I tell him, Ah! Have you learnt how to talk with me?
33
34
AUTISTIC TRANSFORMATIONS
He draws cockroaches, cockroach blood, and says, He shot the king, and
there is a cockroach with blood.
He turns the page, writes his name and his brothers several times. He
says, He is very angry! When I touch things in his room he gets angry.
When my grandma comes to our house, I take my bear, blanket, and
pillow and sleep in his room with him. Everything we have is the same,
and he says all those things belong to him; he thinks theyre his.
I tell him, I think that what you have the same is mummy. I believe that
you think he gets very angry if youre here with me, if youre with
mummy and he isnt, or if mummy gives you a tranquilliser at night.
And Pedro answers, Then everything is my fault. My mother scolds me
and says that I take his things.
I say that today we were able to talk about many of the fears that go
through his head. It seems that if you open this closed chest and the
thoughts about your brother come out, youre afraid of what may happen
to you, afraid that everything will spill out, like the broken pipe. You are
afraid that this brother will harm you very much.
He insists, saying, Everythings my fault because my mother thinks that
I take his things and she scolds me.
During the next session Pedro continues his drawing and his story-telling,
reproducing a videogame (Figure 3). He says, Im afraid of this game;
35
one day I didnt sleep because of this game, you must talk to me! He
becomes very excited and remarks, The best thing will not fit in there!
He fills the entire sheet of paper with the drawing of balls, bombs, a snake,
a whirlpool . . . He writes, Game over and says, The game is over! He
goes on drawing more and more elements until he draws a balloon. Then
he makes a hole in the middle of the balloon and says, Theres a hole in
the balloon! He complains that he cannot get anything more on the
paper. He turns the page (Figure 4) and writes his name with a circle
around it. I tell him that here in the session he dreamed the dreams that
frighten him a lot. He wanted me to know what these dreams are like. At
this point he is relieved. He lays his head down on his drawing and, holding the pen in one hand, falls deeply asleep.
Comments
Pedro sees himself as an adult, clearly verbalising his complaint: I
cant sleep . . . Im afraid of my dreams. He appears to foresee the
possibility that an adult can help him work through what he calls my
dreams. Through drawings, he communicates the dreams contained
36
AUTISTIC TRANSFORMATIONS
in his mind. He mentions that there is a burst pipe and a leak that
must be repaired. A king asks the soldier to repair the leak. The
analyst presents her version to him: Pedro asks Clia to repair the
leak, the thoughts his little head cannot hold and which end up pouring out.
She provides a meaning to his communication, which Pedro
immediately picks up and then proposes his transformations.
Relieved, he smiles and says, I thought that no story would come
from this, but it did. And he goes on, saying, Its the story of the bad
thoughts which come out and dont let me sleep. He is more confident about continuing the investigation and starts to insist that the
analyst should guess the meaning of his bad thoughts, as he calls
them. He then remembers his mother, who takes care of him at night,
giving him the tranquilliser which lets him sleep. This memory
breaks down the precariously organised previous state, triggering
excitement and intense mental disorganisation. He mentions the fear
of the hole, of the holes in the floor of the garage. He gets more upset
and cockroaches, blood, and arrows emerge and he sees himself
surrounded by them. The analyst contains this state and transmits the
idea to him that his fears and these anxieties show an oedipal situation. This formulation causes a certain initial impact, but what we see
next is that the pairs evolution and their movement allow those
contents closed into the chest to be examined. And now the previously mentioned elements acquire meaning. Pedro starts to communicate verbally, talking clearly about the situation, which involves the
dynamics of sibling rivalry and persecutory retaliation. As the relationship becomes closer, Pedro feels more relaxed and tells the analyst
about the live contact with his states of terror, probably those he
referred to at the early meetings as being the dreams which prevent
him from sleeping. He reveals that he is pursued by the threat that his
mental apparatus cannot contain all of the excitement caused by those
elements which do not have representation, and, since these are
concretely experienced, states of real despair are triggered. He tries to
get rid of this overload through a massive bombardment, both on the
sheet of paper and into the analysts mind. The formulations Game
is over and balloon is popped, and his complaint that there is no
more space on the paper indicate his perception of his state of mental
fragility and his urgent need for another mind to contain him. As the
analyst continues to accept him, she offers him the formulation that
37
WANT TO LEAVE!
I tell him that he wants to see what happened to the things he left with
me last time and that he realises that a thread links and separates us
between sessions. I say, It seems you dont like this. (I refer to the fact
that separation appears to displease him.)
He looks again inside the box. He finds a pencil box, which he assumes I
brought him as a new toy, a gift. First, he thinks it is a notebook, but when
he realises his mistake, he is quickly discouraged. He tries to tie the string
to the door, but, abruptly, he gives up, throwing himself into his mothers
lap. He insistently screams that he wants to leave, and threatens to scratch
the door. His mother reacts to this energetically, preventing him from
doing so.
I try to follow his movements from the beginning. I tell him that when I
say something that suits him, he appears to calm down for a few short
minutes, as though what I said were a gift. But that is soon over. He is
very unhappy and uncomfortable, and thinks that the way of getting rid
of everything is to LEAVE.
He is still sprawled on his mothers lap, whining and insisting in a voice
that is increasingly loud that he is HUNGRY, VERY HUNGRY, and that he
38
AUTISTIC TRANSFORMATIONS
TARZAN!
39
He begins to shout that he will never again come to the office, that he
wants to leave. I am very frightened at his threats and pressured by the
urgency and the despair of his situation. I realise that he wants me to get
him out of that state.
I decide to go to his box and try and talk through the toys. I begin putting
the dolls on the table, while he continues to scream, asking, IS THERE A
FRIDGE HERE? IS THERE FOOD?
I answer him, YES, there is EVERYTHING you want. I point into his box.
He immediately reacts, saying, Im not going to play!
I tell him, All right, but Im going to play! I take the dolls, the cubes, and
make a fridge, a stove, a table, and plates. I break pieces of chalk and put
them in a pot. With chopsticks I begin to stir and make comments, saying
that there was the food. I ask him, What do you like to eat? At this time,
I see he shows some interest in what I am proposing. I continue playing
out a scene in which a boy comes to meet Clia and he wants FOOD. I
wonder what kind of food he likes?
He becomes involved in the game and answers, I like spaghetti!
I ask, How do you like spaghetti?
He says, With tomato sauce.
I continue, Ah! Then lets make some tomato sauce! Here is the spaghetti.
Ill put a bit on Mrios plate and on mine too. I break the chalk and put
a piece on each plate. Mrio pays close attention to all of this; he also
begins to cut up the chalk and put it inside a toy truck. He then says cheerfully, The foods here! Great!
I tell him that he no longer wants to leave, that he was able to wait and
did not really have to eat. It seems that the food you really wanted was
play food. You thought that it was real food, like crackers, bread, chocolate, but thats not what it was. You needed the food that we made
together, where you could imagine, in your little head, what you wanted
to eat. With the toys, we were able to play at cooking. Just like this you
can imagine whatever you want and use the toys to play everything that
is happening to you.
Comments
Mrios communication shows that the he truly needs to depend on
external objects. The dummy and his mothers presence in the room
40
AUTISTIC TRANSFORMATIONS
41
Discussion
Both cases bring up issues that I discuss below. As I mentioned previously, there is a marked difference in the level of mental development
observed in each of these patients, and an analyst must take an
approach adequate to the ongoing communication. Pedro, from the
beginning, is consciously involved in investigating his mental world,
his terrifying dreams. He is very co-operative, as shown by the dreams
that he draws and has during the session. Indeed, he represents precisely and names his states of mind. Pedro regularly understands the
analysts transformations of his utterances, and this stimulates him to
make his own transformations. Thus, the conversation develops and
sets the stage for creating a common field of observation. At this point,
we can approach the emotional experience of the moment.
Then, in the words the pipe burst, the analyst, with her capacity
for reverie and alpha function, offers her transformation, and Pedro
42
AUTISTIC TRANSFORMATIONS
43
44
AUTISTIC TRANSFORMATIONS
45
cannot communicate. This was the only way I could talk to her. In the
patients state, it might have been useful for her to be with someone
who could recognise her isolation.
Continuing with the idea of developing a gradation of beta elements, I think that the most archaic level of mental functioning is
connected with autistic states. At this level, there is no perception of
the object.
The phenomena of projective identification occur at a higher
developmental level. The self splits and expels its undesirable parts,
placing them by projection inside the object. The fate of these elements
will depend on the intensity of the projection and on the transformations performed by this object. I wonder whether this area does not
include the beta screen, the reversion phenomenon of the alpha function, the formation of bizarre objects, the states of nameless terror, and
the states of fragmentation.
The phenomenon of hallucinosis present in the transformations in
hallucinosis (Bion, 1965) is, to a greater or lesser extent, present in all
states described, except the autistic ones, in which there is no notion
of the existence of the object.
I believe that other phenomena could also be highlighted, but, for
now, I will discuss only these.
It should be emphasised that the reference to the phenomena
mentioned is always connected to the idea of states of mind, to transient states.
In this context, where can we situate Anas, Mrios, and Pedros
communications? One should recall that, during a session, each of
these patients operates at times on different levels of mental functioning, which can be seen in the clinical fragments I have presented.
If we think in terms of the psychotic and the non-psychotic parts of
the personality Bion (1957) proposed, we would say that Pedro operates mainly with the non-psychotic part of his personality, and that he
appears to realise this when he says, I am afraid of my dreams. When
he becomes immersed in these states in which the psychotic part predominates, his mind operates in transformations in hallucinosis.
In this kind of transformation, the fantasy world acquires concreteness,
the conscious and the unconscious are confounded, the contact barrier
is not formed, and there is no separation between self and object.
Returning to Mrio, in the theoretical context presented so far, I
wonder what we are to make of his use of a dummy, of the food, and
46
AUTISTIC TRANSFORMATIONS
of his inability to separate from his mother. Obesity might be considered a cloak to protect an extremely fragile interior. We could ask
ourselves whether the dummy and also the food are objects and autistic forms used to cover the hole resulting from the consciousness of
bodily separation from the object. It does not seem to me that they are
objects with a symbolic meaning, created to establish a bridge
between self and object. They are not transitional objects. The resulting manifestations of despair and the constant state of excitement and
fragmentation appear to be resources used to avoid the pain of being
separated, which makes him prevent his mother from leaving.
As for Ana, I believe that her manifestation of isolation, when she
continues to chew gum, is a characteristic phenomenon of the primordial stages of development. Chewing gum is a self-generated autosensual object, and she completes herself with it, as Tustin suggests
when she addresses autistic forms (Tustin, 1984). The next movement,
when Ana emerges from a state of profound silence and produces an
endless monologue without establishing any contact, could be considered equivalent to the chewing gum she carries in her mouth. It would
be a kind of autistic manoeuvre to avoid states of intense vulnerability coming from non-integration, resulting from the consciousness of
bodily separation from the object.
As I said, it is essential for the analyst to discern the nature of the
phenomenon taking place during a session, so that her approach will
be appropriate for the specific levels of mental functioning. Still, such
discernment does not ensure that the analyst has the appropriate
instrument for that particular situation, which, as a matter of fact,
occurs most frequently when dealing with primordial levels of development. I believe it is better to be aware of the unknown and the limitations imposed on the analyst by the situation in order to face these
states, rather than substituting the approach with another, misleading
one, and with this, running the risk of unwittingly engaging in a situation which does not evolve. If we can sharpen the tools we use for
observation, we may be able to learn more about the quality of the
phenomena present in the analytic sessions and, thus, expand the clinical field of work to deal with other areas of previously inaccessible
phenomena. As Green (1998, pp. 655) said, psychoanalysts should as
far as possible be able to continue to analyse and to think, even in
painful situations.
CHAPTER FOUR
Introduction
hrough my clinical experience, I have been interested in investigating specific psychic phenomena in which primitive, protomental states of mind predominate and are often inaccessible to
the analyst. Some patients, even though communicating predominantly on a neurotic level, hide a part of their personality in which
prevail certain impenetrable encapsulated nuclei, preventing the
analyst from accessing certain aspects of their minds and making it
difficult for real changes to take place in the course of their analyses
(Klein, 1981; Tustin, 1986).
* I presented an earlier version of this chapter to a meeting of the Brazilian Psychoanalytic Society of So Paulo in June 2002. Fernando Giuffrida and Carmen Mion were
respondents. I also delivered it at the Brazilian Congress of Psychoanalysis in So Paulo,
where it received the Fbio Leite Lobo award. In addition, I presented it at the First
International Bion Conference, which also took place in So Paulo. There, it received the
First International Parthenope Bion Talamo Prize from the Centro Turinnese de
Psychoanalysis (the Turin Psychoanalytic Centre) and from the Italian Psychoanalytic
Society. The version presented here is an expanded version, which was published in the
International Journal of Psychoanalysis (2005, pp. 15951610).
47
48
AUTISTIC TRANSFORMATIONS
49
50
AUTISTIC TRANSFORMATIONS
session. The theory of transformations (1965) is proposed as the observational standpoint for phenomena in that field, allowing the analyst
to identify what kind of emotional experience he is undergoing.
By adopting this standpoint, the analyst can make his observations
knowing that the facts to be observed are distorted by the very act of
observing them, since the tool he has for his work is his own mind,
which is susceptible to psychic movements equal to those of his
patients. It is from the contact with these movements that the analyst
formulates his version of the ongoing emotional experience. This way,
the analyst abandons his position as authority, as possessor of knowledge, and as the vehicle of an absolute vision of mental phenomena.
In my opinion, this was how Bion (1965) dared to disturb what
was already established. He inserted into the analytic field the notion
of the analyst in movement, active, subject to the dynamism
imposed by all live contact. From the perspective of the theory of
transformations, any movement, whether by the analyst or the
analysand, is considered to be the link in a chain of successive movements resulting from the interaction established between the analytic
pair from the moment that the session begins. The analysts transformations come about in this field when it is no longer possible to assign
a definitive meaning to a particular phenomenon experienced in the
relationship. What he can do is offer the analysand his personal transformation as one of many possibilities to be considered in his dealing
with the material.
The participation of the analyst in the session is impregnated with
elements from his own personality and by the baggage he accumulated through his life, by his intuition acquired during his psychoanalytical training, and by his own analysis.
As we are aware, the concept of transformation contains the idea
of invariance. To bring about a transformation of an emotional experience, some elements in this transformation must remain, should not
vary, otherwise the experience is no longer a transformation of the
original situation, but, rather, just any experience. Therefore, it is not
just a random transformation, but a transformation in which the very
invariants of the theory adopted by the analyst are conjoined. This
theoretical system will partially determine the focus of his approach.
Bion, in my opinion, by proposing the theory of transformations as
a method of observing mental phenomena, reproduces in the analytic
situation an experience somewhat closer to a meeting of two people:
51
Transformations
Starting from the idea that, when sharing experience, the analyst has
access only to the transformations of the ongoing emotion, since he
does not have access to the emotion itself, the question presented is:
what type of transformations of the emotional experience is the
analyst sharing with the analysand on each movement? What would
be his transformation on that experience?
Bion proposes several groups of transformations: transformations
in rigid motion, projective transformations, in hallucinosis, in K and
K, as well as transformations in O. I shall discuss only the first three
groups.
In transformations in rigid motion, the field of observed phenomena includes the classical transference described by Freud, in which
situations from the past are transferred to the figure of the analyst
without being deformed (Symington & Symington, 1996).
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AUTISTIC TRANSFORMATIONS
The mechanisms of cleavage and projective identification proposed by Klein (1946) prevail in projective transformations. Ones
mind projects undesirable parts of ones self on to the object in order
to obtain relief. It is the analysts task to accept the patients projections, receive them, and transform them, giving them some sense, so
as to inform the patient and make it possible for him to keep that
content in his mind and no longer expel it.
In transformations in hallucinosis, the emotional relationship
experienced with the figure of the analyst as a real object is transformed in such a way that the real person is replaced by another
figure created by the analysand. From this moment on, the relationship that the analysand establishes with the analyst becomes independent of ongoing facts, gaining their own existence, autonomous,
ignoring the reality.
As Bion says (1965, pp. 136137),
The patient whose transformations are effected in the medium of
hallucinosis might almost have as his motto actions speak louder than
words with its hint of rivalry as an essential feature of the relationship. . . . The general picture the patient presents is that of a person
anxious to demonstrate his independence of anything other than his
own creations. These creations are the results of his supposed ability
to use his senses as organs of evacuation, which are able to surround
him with a universe that has been generated by himself: the function
of the senses and their perfect counterpart is to create the patients
perfect world. The imperfection is an evidence for intervention of
hostile and envious forces. Thanks to the patients capacity of satisfying all his needs from his own creations, he is entirely independent
from anyone or anything other than his products.
53
Autistic states
In physics, the interpretations of experiments are called models or
theories and the realisation that all models and theories are approximate is basic to modern scientific research. Thus the aphorism of
Einstein, As far as the laws of mathematics refer to reality, they are
not certain; and as far as they are certain, they do not refer to reality.
Physicists know that their methods of analysis and logical reasoning
can never explain the whole realm of natural phenomena at once and
so they single out a certain group of phenomena and try to build a
model to describe this group. In doing so, they neglect other phenomena and the model will therefore not give a complete description of the
real situation. (Capra, 1975, p. 41)
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AUTISTIC TRANSFORMATIONS
nuclei of the self prevail. These nuclei are resistant to changes and are
responsible for lack of emotional contact in the patient. These
emotional states produce phenomena similar to autistic defences,
whose purpose is to protect the primordial self from intolerable states
of non-integration.
According to Tustin (1981, 1984, 1986, 1990), autistic phenomena
are characterised by the presence of a state of emotional withdrawal
inside a self-generated protective shell. The self flees from affective
contact with the object in order to avoid painful experiences likely to
trigger feelings of disintegration and intolerable vulnerability. Such
phenomena occur mainly among individuals who manifest extreme
sensibility and exacerbated auto-sensuality. For these individuals,
awareness of separation from the object occurred abruptly without
means to bear it. This separation is experienced as if parts of their own
body had been wrenched from them, making them feel annihilated.
The notion of the object in the neurotic part of the personality is quite
different from the notion of the object in autistic states. In the latter,
there is no notion of the internal object, or of the external object;
instead, sensations predominate which do not acquire representation
on a psychic level. The relationships between me and not-me
occur mainly through relations with objects and autistic forms
(Tustin, 1984, 1986), both strongly impregnated with sensations. The
contact through these objects and autistic forms is essential, not
because they represent the object or because of the fantasy they might
trigger, but because they become the actual object. The awareness
of the lack of the object is shrouded by the autistic object, so that the
terror felt in its absence is suppressed. The relationships that are established through autistic forms are sensorial experiences that acquire
forms entirely personal and particular to that individual. They are
created from bodily substances or from objects experienced as such. It
is not a matter of forms shared with other people; they are sensed
forms which acquire a soothing function. They constitute predominantly experiences of soft objects and of bodily substances felt as
comforting and soothing. These autistic forms provide rudimentary
notions of limits and space.
Often, in clinical work, analysts come across configurations such
as the ones considered here. Through my experience with some
patients, I have discovered that, in my efforts to apprehend their
mental states, I have failed to notice some preverbal communication
55
expressed by body language. Later, I discovered in the analytic relationship that these idiosyncratic communications revealed deep experiences for which the patient lacked sufficient verbal resources to
express. Given the degree of non-integration of these manifestations,
the analyst is often overwhelmed by the situation, using evasion as a
means of maintaining himself in a cohesive state and with a certain
psychic balance.
The analysts recognition and inclusion of such phenomena in her
practice can considerably widen her field of observation concerning
mental states and allow her to plumb primordial stages of her
patients emotional development. The awareness of these states of
mind and the access to them encourage the separation between self
and object, allowing the analysis to go on in order to promote the
elaboration of these states and prevent their mere repetition.
If we use the theory of transformations as a reference, I think the
apprehension of the autistic phenomena is modified. One can abandon the description of an isolated phenomenon, and the analyst
becomes no longer an outside observer from whom interpretations
are expected. The analyst then becomes actively involved in the
context of the emotional experience shared with the patient. Her
observations emerge as a link in a chain of successive movements
deriving from the pairs interaction. Thus, the analysts task becomes
circumscribed to experiencing these chains of emotional movements
and their consequences.
The atmosphere experienced by the analyst in the autistic sphere
is that of absent affective life, which triggers in her mind a high
level of anguish, favouring a tendency toward evasion, making it
difficult for her to keep in contact with the situation and to communicate with the patient. Such situations require the analyst to engage
in the discipline of constant self-observation, an essential condition
to keep her mind available, allowing her to keep herself present
and operative in the situation. In this case, it is left for the analyst
to communicate to the patient that his autistic manoeuvres are a
result of his state of terror. Admittedly, however, it is not always
possible to penetrate the autistic barrier. In the case of autistic transformations, rather than actual autism, one hopes, as Tustin (1990)
suggests, that fluctuations of consciousness and some contact can be
established. In the event, the patient can become aware of his state of
terror through the analysts interpretation; he might feel accompanied
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57
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belong in this scenario, except as one of the students who performs the
very role reserved for her among all the students: The worst of all!
The atmosphere that prevails in this experience is that of rivalry and
superiority of the analysand in respect of the analyst. Her goal is to
maintain this relationship at any cost, so she reacts violently to any
threat of rupture to this state. The emotional atmosphere of the session
is intense; the situation is very vivid. Marianas action can be characterised as evacuative, with the function of trying to maintain control
over the analyst, so as to make her an object of her creation, and, in that
way, avoiding contact with the analysts live and dynamic presence.
She uses hallucinatory mechanisms to this end; had she not, she would
need to face her own helplessness owing to her true fragile and powerless condition. Her triumph over the analyst when she confirms the
superiority of her methods (Bion, 1965) is significant. All these elements together indicate that the transformations produced by the
analysand are characterised by phenomena in hallucinosis. In this
circumstance, the analyst is faced with a transformation in hallucinosis.
The analyst experiences a state of helplessness imposed by the
intensity of the situation. Keeping some distance, she is left only with
the possibility of informing the patient at a timely moment that, from
her point of view, all the action and emotion in which she had been
wrapped are the result of a state of hallucinosis. The awareness of the
patient of this situation changes and an interlocutor emerges, so that
the communication between the pair can be established at another level.
In this clinical vignette, it was mentioned that transformations in
hallucinosis prevailed, although some of the patients movements
could be characterised by the presence of projective transformations.
I point out that in these, it is possible to observe that the patient projects her undesirable internal content on the figure of the analyst. The
analyst feels the impact of what it is like to be a small child subjected
to violence coming from an authoritative adult. The intensity of this
projection overwhelms the analyst and incorporates her into the
scenario set up by the patient, so much so that the analyst loses
momentarily the perspective of the separation between them and the
fact that the action has nothing to do with her. These elements point
toward the presence of phenomena characterising projective transformations. In circumstances such as this one, the analyst should take in
the analysands projections and, using her own capacity for reverie
59
and the exercise of the alpha function, transform them and assign
them some meaning. Communicating that meaning to the patient will
probably allow the projected content to resurface in such a way as to
become more bearable and likely to be kept in the mind.
As Bion (1965) points out, the phenomena related to projective
identification and hallucinosis permeate all communication to some
extent. For the analyst, it is important to determine the prevailing
ongoing phenomenon. This is important because the approach will be
different according to the type of transformation presented.
Ana has been in analysis for several years, coming to sessions
four times a week. In her field of work, she is a competent professional. She operates most of the time with the non-psychotic part of
her personality.
Her appearance is very well cared for. Her gaze is distant; her facial
expression demonstrates a certain absence of emotion. When Ana enters
the consulting room, she slowly and carefully places her handbag on the
couch. She lies down, straightens out her skirt on both sides and crosses
her feet, as if she were bandaged in some way. A few minutes later, she
presents matters related to timetables, honoraria, coming vacations, giving
the impression of being concerned about some practical aspect of the situation. I answer her questions, even though I am aware that her vacation is
still far in the future and that there is no evidence that such matters have
anything to do with separation anxiety. This subject wears out quickly and
she retracts herself once again. She remains in a state of absolute silence,
staying practically motionless for a long time, without any expression of
life, looking as though she were under the effect of a potent anaesthetic.
She only moves her mouth when chewing gum, as if she were ruminating
something and, at the same time, with one of her hands, fiddles with an
earlobe. I feel isolated, without anyone with whom to communicate. I
realise that it is necessary to make a conscious effort to keep in contact and
not evade things. If I do not intervene, asking about what she is thinking,
this situation extends until the end of the session. Sometimes, even with
this questioning, Ana does not react. This experience irritates me. I fantasise about shaking her. The atmosphere in the room is that of emptiness, of
absence of life. This triggers in me a state of dismay, a feeling of impotence
due to its repetitive pattern because I notice that pointing this out to her
does not help her, as was the case on other occasions.
During a session that took place at a later time, Ana repeats the same
ritual. She stands still, without uttering a word, until she interrupts this
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61
totally safe, and that is only possible if the person Im with is inside of me,
but I know that will never happen.
I understand Anas suffering. I tell her that she is seeing things from a
totally different perspective now and that perhaps she can experiment
with being separate. After this, I notice that we begin to have some
proximity and that Ana seems more capable of gradually giving up her
defences. She seems to be a little closer to her own emotions and to be
better tolerating her vulnerability.
Comments
Being with this patient makes the analyst oscillate between feelings of
intense emotion and paralysis. In case the analyst is incapable of maintaining herself in a self-observing state, her tendency is to disconnect,
distance herself, and abandon the patient. Other times, however, when
the analyst observes the patient in that anaesthetised state, with nothing to say and with no means to reach her, she imagines herself shaking the patient in an attempt to wake her up from that state. She also
notices that her condition of staying in contact with the patients
empty space is not stable, and depends on the amount of suffering
involved, in addition to other imponderable factors. When contact is
possible, the analyst is able to rescue her capacity of thought and to
step back from the situation in order to see that such manifestations are
manoeuvres which the patient has developed to protect herself from
her extreme internal vulnerability. In this circumstance, the analysts
emotions change and she begins to observe that Anas detailed narration, prolonged silence, the gum, the manipulation of her earlobe, and
her body language take on another dimension: they express her experience of terror because of the awareness that she is physically and
psychically separate from the object. She withdraws from contact and,
through sensations in her own body, creates a state of corporeal continuity with the external object, thus avoiding the intolerable mental
pain brought on by the state of vulnerability in which she finds herself.
That way, she manages to preserve some cohesion of her self.
From my point of view, this clinical material shows how one can
understand autistic phenomena from the standpoint of the theory of
transformations. I will now examine some of the movements in the
session and identify autistic transformations.
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AUTISTIC TRANSFORMATIONS
The analyst, when she meets the patient in the waiting room, sees
a person with a blank look and lacking emotion. She notices nonverbal manifestations: the gum, the fiddling with the earlobe, and her
body movements when she lies down on the couch. The analyst
observes that the patient attempts to communicate through questions
about practical matters related to her analysis. On examining this
cycle of transformations, it is evident that the emotional experience
shared in the session becomes the key element directing the analyst
toward what Bion (1965, 1970) called O (being). It is unnecessary to
say that the theoretical invariants are part of what she sees. Within
this chain of movements, in the analysts opinion, the patients speech
is not related to its content, but seems to be a manoeuvre which, along
with auto-sensual activity, protects her from the pain deriving from
her awareness of being separate from the object and, thus, protects her
from the threat of annihilation. These manoeuvres are an attempt to
maintain continuity with the object. I suggest, therefore, that the
patients transformations are autistic transformations.
In the following cycle of transformations, the patient is still
absorbed in her autistic enclave. The analyst, not able to penetrate the
patients mental world, is overtaken by a discouraged feeling as she
remembers similar sessions from the past. She decides to wait. In this
chain of movements, I suppose that the patients transformations are
autistic transformations. I question whether the analysts transformations would be transformations in hallucinosis.
After a long period of withdrawal, the patient realises that she
must say something and begins a long narrative. The emotions experienced by the analyst are those of isolation and emptiness. She
suspects that the patients act of speaking, due to its sensorial
aspect, aim at maintaining a state of continuity with the object in the
same way as the gum and the fiddling with the earlobe. That way, the
patient would avoid experiencing feelings of terror brought on by the
awareness of the bodily separation. The analyst stays in the situation
and tries to find a way of letting the patient know what she is seeing.
In this cycle of transformation, I understand that the patients transformations are autistic transformations, whereas the analysts are
transformations in K.
The communication of these perceptions to the patient allows the
autistic barrier to become more permeable and the atmosphere in the
session changes. The emptiness disappears, and the contact between
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the pair becomes more vivid. With this new cycle of transformations,
we can observe that the analyst performs a splitting in her mind in
such a way that she is able to keep herself in the situation and recover
her analytic function, thus becoming able to communicate her observations in a more precise way. The patient shows interest in what the
analyst says. The protective armour the patient constructed in the
beginning of the session becomes more permeable. She seems to
develop confidence in her analyst and let herself reveal her vulnerability without feeling so threatened. She says, That is only possible if
the person Im with is inside of me, but I know that will never
happen. In this sequence, we observe that the patient is able to get in
touch with her condition of being separated from the object. In this
new cycle, I suggest that the analysts transformations are in K and
those of the patient are in KO.
It is important to point out that the transformations presented in
this session are peculiar to that particular analyst. Another analyst,
with different personality traits, who uses a different theoretical
framework, would address this material from a different, yet equally
valid, standpoint. I acknowledge that this session could have
unfolded in very different ways.
Discussion
At this point, I will try to share with the readers some concerns over
the ideas which were proposed.
I begin this discussion by characterising, through the two clinical
vignettes, what I call autistic transformations. To this end, I shall
contrast some of Anas material with Marianas. Then I shall try to
share some misgivings that arise from the ideas I have developed
here. The emotional atmosphere of Anas session is quite different
from that described with Mariana. During a session that took place at
a later time, Ana repeats the same ritual. She stands still, without
uttering a word, until she interrupts this state, stretches slowly, as
though waking up from that anaesthetised state. In a tone of voice as
if talking to herself, she says, I need to say something. Facing this
situation, I reply that it seems as though she has momentarily become
aware of my presence in the room and that she might want to tell me
something. I notice, however, that she does not listen to me. She
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65
sensorial level, but they are certainly transformations. With this fact in
mind, and in spite of the idea that an autistic transformation might
seem paradoxical, this notion is extremely useful because it gathers a
set of phenomena linked to the protomental sphere.
The merit of this distinction is related to the possibility of including autistic phenomena within an observational methodology of the
theory of transformations. That will allow us to shed light on a common area of our practicethe autistic area. This area is not always
accessible to us, due to the intensity of the stimuli and the strong
impact they create, and mainly because of the analysts struggle to
maintain himself in contact with the situation.
It is important to emphasise that not every auto-sensual activity in
the session is associated with autistic transformations. What determines the nature of a particular transformation is the emotional experience the analyst identifies within the session. There are auto-sensual
activities that produce intense emotion in the analyst, and they are of
a different nature from those found in autistic transformations as I
have formulated them.
A further point for consideration is the need to not confuse the
impact on the analysts mind in the face of autistic phenomena with
phenomena coming from projective identification. The degree of
primitivism present in protomental states causes intense reactions in
the observer. These reactions are also disorganised, which might lead
one to consider them a phenomenon of successful projective identification. I believe this is a mistake because, in the states where autistic
phenomena prevail, the object is not considered a separate object. In
these cases, there is no possibility of a patients release of undesirable
content by projecting it on to the analyst. The patient in this state is
wrapped up in himself and in the sensation he creates, and for him
there is no difference between me and not-me. This is a fundamental distinction to be made, positioning the analyst according to the
level of mental development in which the patient is. For the analyst,
as well as the analysand, it is preferable to be aware of the unknown
brought on by these situations, as well as by the limitations imposed
by these mental states, rather than running the risk of substituting
them for some misguided approach leading to a situation that does
not progress (Korbivcher, 1999).
I will now return to those transformations brought on by the
analyst when confronted with autistic transformations. As we are
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aware, mental stimuli are powerful in this area in which the absence
of emotion prevails. For the analyst, it can be intolerable to be faced
with a mental state of affective emptiness. The way in which the analyst responds to the ongoing communication will vary according to
the interplay of movements shared by the pair.
The analyst often creates in his mind a different analysand with
whom he communicates, ignoring, in this manner, the patients
mental condition. In an attempt to reach his patient, he offers interpretations based on specific theories and does not realise the error he
is committing. The analyst uses this mechanism to free himself from a
situation the way it presents itself, replacing it with one of his own
creation. In my opinion, phenomena of hallucinosis prevail in the
analyst in this circumstance.
There are also situations in which the analyst, overwhelmed with
anguish at not finding an interlocutor with whom he can communicate, cannot contain the feelings these situations bring about, so he
tends to avoid the discomfort he feels. He often expels and projects his
own hostile impulses coming from that experience on the analysands
mind and pressures his patient to operate with resources which are
not available to him at that time. When this happens, the phenomenon of projective identification prevails. Can we then consider the
analysts transformations to be projective transformations?
At other times, depending on the degree of suffering in the particular situation, an abyss is created within the analytic pair. Each
member remains self-absorbed, analyst on one side, analysand on the
other, in a private universe, with no connection to each other. To deal
with these situations, the analyst can be caught up in activities related
to his own body, with his own mental activities, totally unrelated to
the patient. He can also be carried away by pleasure in the act of
speaking and produce long speeches which clearly address his own
needs, rather than those of the patient. I question whether the analyst
in this situation would be operating in autistic transformations.
It is also possible for the analyst to maintain some distance in relation to the experience the client presents. In this case, he can perform
a split in his mind in a way that discriminates the nature of the transformation in the ongoing emotional experience. If this occurs, the
analyst recovers his capacity to think and stays with the patient in his
isolated universe. In the event that the analyst can transform this
experience into some communication and offer it to the patient, some
67
contact might be established between the two of them. The analysands experience of sharing with the analyst his state of mental
emptiness, his lack of affective life, even of being informed about the
workings of his inner world can be extremely valuable. This would be
a rare opportunity for these patients to feel close to someone. In my
opinion, under these circumstances, the analyst would be operating
under K transformations.
The ideas I have developed in this chapter, in which I propose the
new concept of autistic transformations, are designed to unite a
particular group of mental phenomena with specific characteristics, to
limit them, name them, and fit them into an established theoretical
framework so that, perhaps, they can acquire a life of their own. I am
fully aware, however, that, in spite of the effort involved in this
attempt to unite these phenomena, I must remember part of Capras
quote at the beginning of the section Autistic states: the model will
therefore not give a complete description of the real situation (Capra,
1975, p. 41).
CHAPTER FIVE
Introduction
ccording to Chau (2000),
A scientist, in ordinary times, when confronting a fact or a phenomenon not yet studied, employs the existing model or scientific paradigm. A scientific revolution happens when the scientist discovers that
the available paradigms are not able to explain a new phenomenon or
fact. Thus, it is necessary to produce another scientific paradigm,
which does not exist at that moment and the need for which was not
previously recognised by researchers. (p. 257, translated for this
edition)
* This work was presented to a scientific meeting at the Brazilian Psychoanalytic Society
of So Paulo in June 2004, with comments from Joo Carlos Braga. It was also presented
in Los Angeles, November 2005, an occasion at which it received the Frances Tustin
Memorial Prize granted by the Frances Tustin Memorial Trust.
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specifically autistic states (Tustin, 1981), has proved to be an effective incentive for reflection.
In our clinical practice, we frequently find ourselves working with
neurotic, psychotic, or autistic patients for whom we cannot always
find representation in our theoreticalclinical apparatus, or in our
personal repertoire, to enable us to identify the phenomenon at hand
so as to approach these patients and finally reach them.
In these situations, a chaotic atmosphere often takes over our
minds. This disorganisation is caused by the reference systems we
employ, which make it difficult to maintain the psychoanalytic vertex.
Protomental phenomena, and autistic phenomena in particular, even
when found in neurotic patients, could cause this kind of disorganisation.
When confronted with these primitive areas of the mind, what can
an analyst rely on to identify, recognise, transform, and give meaning
to communications he cannot always find in his mind to guide
himself, once the fantasies which might underlie such communications are not perceived as having any psychic reality? How can the
analyst embrace or restrain these phenomena and exercise his reverie, keeping his alpha function operative when he faces emotional
experiences for which he cannot find in himself similar experiences to
support it? How to proceed through this universe and penetrate the
autistic hideouts some patients have developed from their own corporeal sensations? And, from this standpoint, how can analysts use their
alpha function?
These questions are not looking for answers, but, rather, are
intended to present some elements to expand this reflection.
In the previous chapters, I examined such phenomena. In Mente
primitiva e pensamento (Primitive mind and thought) (Korbivcher,
1999, p. 29), I draw upon the need for an analyst to differentiate, within
the primitive mind, different levels of the patients mental development so that his communication reaches the level in which the patient
is. In The theory of transformations and autistic states. Autistic transformations: a proposal (Korbivcher, 2005b, pp. 15961600), I suggest
incorporating into Bions theory of transformations (1965) the group of
autistic transformations in which autistic phenomena prevail in the
emotional experience shared between analyst and analysand. Bion, in
Transformations (1965), proposes a theory of observation of the mental
phenomena in the analytical session. He affirms that we have no access
71
to a phenomenon itself, only to its transformations. The comprehension of the mental phenomenon by the analyst is also considered a
transformation. Bion proposes different groups of transformations:
transformations in rigid movement, projective transformations, transformations in hallucinosis, transformations in K, in K, and in O. My
conjecture is that Bion leaves open the possibility that other groups of
transformations might be included in this theory.
The autistic phenomena (Korbivcher, 2001), as I conceive them, are
characterised by development in an autistic environment, which
implies the absence of notions of internal and external objects, and by
the experience of states dominated by sensations which do not acquire
mental representation. Some of the invariants highlighted in them are
related to the experience of absence of affective life and experience
of affective emptiness in the presence of auto-sensual activities,
observed through the relation with autistic objects and autistic forms.
In this chapter, I deepen the examination, already started in the previous chapter, of the processes that occur in an analysts mind when
subjected to the impact of manifestations of the primitive mindmore
specifically, of autistic transformations. I explore the need to provide a
framework for the autistic universe, a universe dominated by sensations. Therefore, the laws that control this universe are peculiar to it,
different from those of neurotic or psychotic universes. Within this perspective, I explore the possibility that this universe might come to constitute a new paradigm in psychoanalysis. These questions will be
illustrated, in order to widen the discussion, using clinical material
from three patients: Luis and Caio, two autistic children, and Ana, the
same patient presented in Chapter Four, who has autistic nuclei and
functions using the neurotic part of her personality.
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form of speech capable of describing them. They produce only sensorial images. Analysts experience these in a way different from the way
one might react to metaphors. (1991, p. 157, translated for this edition)
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77
and thus acquire some notion of how such patients see the world. If we
can do this, we might be able to set up some sort of dialogue with their
areas of non-representation within their sensorial universe which
seems chaotic to us.
Gleick (1987, p. 5) goes on to say,
Chaos poses problems that defy accepted ways of working in science.
. . . The first chaos theorists, the scientists who set the discipline in
motion, shared certain sensibilities. They had an eye for patterns,
especially pattern which appeared on different scales at the same time.
They had a taste for randomness and complexity, jagged edges and
sudden leaps.
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Within the horizontal and vertical axes of the Grid, where shall we
situate the group of autistic phenomena? As Bion suggested, we might
need to provide a new Grid for this sort of phenomena. This would be
a negative Grid (Braga, 2004, personal communication). Or we may
need a Grid for beta elements, or perhaps a gradation of beta elements
(Korbivcher, 1999).
Bion introduces the emotional links L, H, and K to represent the
three basic types of emotional experience susceptible to alpha function. He also proposed the negative links L, H, and K, and he pays
particular attention to exploring the minds activity in K.
Green (1998, p. 658) says, K symbolizes not only ignorance but
a trend to remain actively in ignorance with the adoption of an attitude in which there is advantage of avoiding awareness or a disadvantage of approximating truth. He defines this situation as one in
which the patient wants to actively preserve his ignorance, believing
that there is some advantage in avoiding conscious awareness. For
Bion, these patients have to show that they are superior to their
analysts. If this is the case, it seems that such states entail a notion of
object, which means that K would not belong to the autistic area.
I wonder, however, whether the L, H links would be related to
the autistic sphere, or whether we might conjecture that emotional
links might be imperceptible in the autistic scope, or if such links even
exist.
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car keys and ask, Would you like to buy a toy at the shop near the
bank after we leave?
I felt as though witnessing a universe that was totally alien to me,
but little by little I became attuned to Caios eccentricities. I would
often think of a colour-blind friend of mine with whom I used to play,
asking what colour he saw when he looked at a green object. His
answers would never clarify anything for me, since his frame of reference for colours was different from mine. Often, I would liken my
experience with Caio to my prior dealings with colour-blindness. By
that time I had intuited that the frame of reference organising Caios
universe was totally different from that of other patients.
I had innumerable experiences similar to the one I have described
above: Caio would say words, his mother would write them, and Caio
would read them. Although I was puzzled by that strange game, I
noticed that Caio would refer to proper nouns over and over again in
his lists: Daddy, mummy, uncle X, curumim. These words seemed
like bunches of sounds thrown together to form words devoid of any
meaning and unrelated to any apparent fantasies. They seemed to be
empty signs, signifiers devoid of meaning.
Caios remarkable ability to read words seemed incompatible with
his difficulty in using speech to communicate. Likewise, his inability to
engage in simple activities, as well as his involuntary twitches, similar
to a babys movements, accentuated that discrepancy. Together, these
symptoms made a very unusual picture, especially because we had
discarded any possibility of Caios being neurologically impaired. In
view of Caios peculiar form of communication, which seemed devoid
of symbolic content, I devised the following game: right after his
mother wrote down Caios lists and he read them, I would get a doll
out of his box that would correspond, from my perspective, to that
name. I would then start a dialogue that gave some life to his words. I
would say, Hey, Caio, how are you doing? Uncle X is here, do you
want to play? This game interested and excited him. And that was
how I began to introduce some affective meaning into his utterances.
Each figure began to be associated with some living person and began
to acquire some existence for the two of us. I have my doubts as to
whether these figures actually became symbols for Caio, but, as time
went by, Caios vocabulary grew somewhat and he was able to put
short phrases together. He would pronounce each word one after
another and communicate a little better.
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At that point, I can see that the emotional climate in the session has
changed. Her emotions had defrosted somewhat and, a bit more trusting,
she begins to talk about her fears.
I let her know more or less what I have seen, and I venture that she probably felt sheltered and protected in my waiting room because she was
near me. I also wonder whether she feared that I would know that and be
uncomfortable with her being there.
She answers emphatically and in a bored voice, For Gods sake, Clia!
Thats too much! I dont think of our relationship in terms like that!
I tell her that she seems afraid to think that I might have become an important person in her life. And this idea makes her feel emotions she cannot
deal with so she works things out in such a way that she avoids these feeling all together.
To my surprise, Ana answers sarcastically. I might be a bit boring, but
you analysts are funny: if the patient arrives on time, he is obsessive. If he
arrives early, he is anxious, or he wants to be there longer. If he gets there
late, its . . . You know that I come here because my daughter sees her therapist at the same time, so I wait for her. Its true that I could wait in her
waiting room, but . . .
In view of Anas response, I feel that I have been cast far away, and this
makes me feel useless. Quickly, however, I understand her reaction as
being the consequence of the previous movement.
I say that she experiences a lot of emotions that she cannot handle, and
that is why she needs to keep me far from her. I go on to say that she needs
to find ways to protect herself from her emotions and to protect herself
from being a living person. I remind her that, just as she had said, she is
afraid of life. She is afraid of acknowledging that we are separate people,
that I see other patients.
Discussion
Both Ana and Caio provoke a strong impact on the analysts mind
because they confront her with phenomena of a primordial nature.
They both develop autistic manoeuvres as a form of protection. However, it is necessary to recognise that Caios and Anas levels of mental
development are quite different. Caio operates on a level typical of
pathological autism. There is no sign of a developmentally operant
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89
living being who is separate from her. In this clinical description, due
to the transformation of the ongoing emotional experience, I believe
one can see autistic transformations both in the patient and in the
analyst.
With this patient, the analyst finds herself confronting a universe
in which autistic transformations predominate. For Ana, the experience of coming early to her session and staying in the waiting room is
apparently turned into an action belonging to the concrete world, with
no perceptible link to any emotion whatsoever. Her inner world
seems inaccessible. What the analyst experiences is lack of emotion,
affective emptiness, isolation, which permeates the field. All this
has a strong impact on her mind, and makes her hypothesise that she
is dealing with autistic transformations. Given these circumstances,
the analyst can do nothing more than ride out the situation, waiting
to find some way of penetrating Anas autistic barrier. These stimuli
exert so much pressure that, at various times, her mind submits to the
analysands movements: During her protracted narrative I am
tempted to interrupt so as to deal with the entire situation we had
experienced up to that point. But, without my realising it, I give up
and go with the flow . . . The analyst mentions that she has bodily
discomfort, lethargy, and is tempted to avoid the situation. At this
point, it seems to me that she is operating predominantly with autistic transformations.
Subject to Anas drawn-out narrative, the analyst shares with her
the experience of all emotions seeming to be frozen, which is how she
protects herself from the vulnerability she feels owing to her
conscious recognition that the analyst is a living being corporeally
separate from her. Beginning with the transformation of the current
emotional experience, the analyst tells Ana that her need to withdraw
might be a protective measure brought on by terror, by fear of life, by
fear of existing, as she herself has acknowledged. The analyst tries
to help Ana make her protective manoeuvres more permeable and to
encourage her to become closer to being alive. One can consider
Anas request to turn sores into emotion as proof of her interest
in becoming someone with a psychic life, in escaping her mental bidimensionality (Meltzer, 1975b). At this point, she begins to use
projective transformations.
The analyst, by operating a splitting in her mind, can break out of
her mental lethargy and rescue her analytic function. Beginning with
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AUTISTIC TRANSFORMATIONS
the emotional experience she has described, she can make out the
nature of the phenomena at hand and try to approach Anas mental
world. Ana, perhaps because she no longer feels alone, becomes less
inaccessible. Now her autistic barrier is more permeable, and Ana
starts to function on a different level. She is in a different state and
feels encouraged enough to defrost, or perhaps humanise, her
inner world. She can acquire an existence without feeling vulnerable.
She starts to explore her fears when, for example, she says, I thought
that you might be upset by my coming early . . . I wondered if I might
be in the way and that I shouldnt stay. The relationship between the
analyst and analysand has been altered. Now they experience
phenomena associated with projective identification, projective transformations. But one can also see elements of hallucinosis, transformations in hallucinosis. We come together in a different sphere, that is,
in psychosis rather than in the autistic sphere. Since Anas state of
terror is so intense, she wavers between being more or less alive, as
when the analyst suggests that perhaps she enjoys being there close to
her, which causes Ana to react violently and once again seek refuge in
her autistic state.
I point out once more that in my clinical practice I have adopted
the emotional experience as my working vertex. I also rely on the
development of thought, and the theory of transformations is the
observation method of the phenomena in this field. As far as autistic
transformations are concerned, autistic barriers are erected in this
field to protect the primordial self from states of terror brought on by
the threat of non-integration. In their clinical work, analysts are often
confronted with autistic barriers within which patients withdraw and
satisfy themselves through auto-sensual activities. The analysts task
is, then, to get as close as they can to their patients autistic universe
so as to become living company (Alvarez, 1992) and add some
humanity to these patients inner world. Put another way, the analyst
tries to help these patients go from a protomental to a mental universe
by using his or her alpha function to transform those concrete, sensorial elements into mental elements; alpha elements full of emotional
life and fantasies that become capable of being thought. If we think in
terms of the theory of transformations, we could suppose that the
patient abandons the field of autistic transformations and begins to
operate using projective transformations, or transformations in hallucinosis, in K, K, and in O. One must also keep in mind that one often
91
CHAPTER SIX
Introduction
93
94
AUTISTIC TRANSFORMATIONS
95
96
AUTISTIC TRANSFORMATIONS
97
98
AUTISTIC TRANSFORMATIONS
Through contact, individuals can achieve a feeling of corporeal continuity with the object, and this allows them to attain a minimally
cohesive psychic state. Their awareness of the corporeal separation
between self and object oscillates according to a particular individuals ability to tolerate the pain entailed in separation).
In a different way to Bion, Tustin engages in an area in which
sensations prevail, the autistic area. In this area, sensations are not
mentalised and do not achieve mental representation. Individuals
wrapped in autistic states recoil inside a protective shell, where they
remain absorbed in auto-sensual activities through which they
become self-sufficient. Through that, they protect themselves from
unbearable experiences of non-integration and states of great vulnerability. If these areas are expressed in clinical work, I wonder how it
would be possible to consider them in our clinical practice in order to,
in Morins words, prevent analysts from becoming blind to some
features of the complexus they are analysing.
99
My understanding of this explanation of Bions is that K phenomena, for him, imply the functioning of a mind capable of splitting and
of projection. There is also the expression of violent emotions and the
presence of a breast into which the feelings awakened by envy are
projected. It is important to explain further that Bion uses the notion
of envy as Klein (1980) applies it in Envy and gratitude, which is
that the notion of object exists from the beginning of life and that this
object is a target of envy. Thus, we can presume that the phenomena
100
AUTISTIC TRANSFORMATIONS
101
In this paper, Tustin also proposes that the loss of the sense of existence is much worse than the threat of death. In death there is a feeling that the body remains. In the loss of the sense of existence, nothing
remains. The threat of annihilation is the worst threat of all because it
represents the extinction of the psychic sense of existing.
The autistic mind will then provide, through auto-sensual manoeuvres, protection against the terror arising from the threat of not
being. It is, in fact, through these auto-generated bodily sensations
that the autistic individual ensures some feeling of existence and, at
the same time, guards against the experience of terror with which the
non-existence threatens him.
At several moments in his work, Bion deals with the phenomena
of non-existence. He differentiates no-thing from nothing. According to him (1970, pp. 1920),
The emotion aroused by the no-thing is felt as indistinguishable from
the nothing. The emotion is replaced by a no-emotion. . . . Nonexistence immediately becomes an object that is immensely hostile
and filled with murderous envy towards the quality or function of
existence, wherever it is to be found.
102
AUTISTIC TRANSFORMATIONS
103
104
AUTISTIC TRANSFORMATIONS
105
106
AUTISTIC TRANSFORMATIONS
107
Still in the realm of tropisms, Bion, in Transformations (1965), proposes that the properties of what he calls conscience, as well as the
beta element, belong to the nature of a tropism which has been transported into the field of mental phenomena. He says,
This consciousness is an awareness of a lack of existence that demands
an existence, a thought in search of a meaning, a definitory hypothesis in search of a realization approximating to it, a psyche seeking for
a physical habitation to give it existence, container seeking contained.
(1965, p. 109)
At this point, I question: where can we fit the autistic area on the
Grid (Bion, 1963)? Where can we locate autistic phenomena?
When one ponders this matter, one must face right from the start
the following contradiction: if the theory of transformations and the
Grid are instruments to examine mental functioning and the genesis
of thought, how can we include in them phenomena in which the
psychic dimension is either not accessible or is, even, non-existent?
How can this theory accommodate the area dominated by sensation,
the area located on the border between the minds early stages and a
non-mental area? Furthermore, where can we fit the autistic area?
As a mental exercise, I suggest we insert a space on the Grid just
before Line A (beta elements). This would be the area for tropisms,
autistic phenomena, and corporeal manifestations. This space would
be located on line A0, which would come immediately before Line A
(beta elements). It is necessary to explain that, by making use of the
A0, I am referring to the line just before line A. I added the zero just
to indicate that this line comes before line A. The 0 (zero) bears no
relation to what Bion proposed concerning the notion of O.
In the event that tropisms cannot find an object capable of harbouring them and modifying them, we would, consequently, end up with
108
AUTISTIC TRANSFORMATIONS
109
Then, after exploring the toys in the box and going back and forth to the
waiting room where his mother was sitting, he picked up a piece of paper
and a pair of scissors, made two cuts and said, Its hurt.
He pointed to his abdomen and said, Im hurt here. His words made me
think that he wanted me to know that he felt a pain, that he was hurt by
something, so I said that to him.
A session
This is the first session of the week. In the previous session, Paulos
mother had warned me that he would stop coming to analysis in a few
weeks because they were about to move to another city. There are
some points worth mentioning in this session.
Paulo does not want to leave his mother to go to the consulting room. She
comes with him and sits near the door. Paulo throws himself on to her lap,
110
AUTISTIC TRANSFORMATIONS
but falls on to her legs, giving the impression that he cannot stand up. He
gets up and falls several times in succession, as if his body were falling
apart. He repeats this activity insistently, until he gets some support and
manages to stand up. This behaviour attracts my attention and shows me
how fragile Paulo is.
Then, once on his feet, he hangs on to the door handle and pretends to
open and close the door. These movements turn into a tactile exploration
of the texture of the surface of the door and the wall.
He questions whether the door is rough or smooth and does the same
with the wall. This manifestation impresses me because of its primordial
nature. For a moment I have no guiding references, since I do not perceive
any fantasy associated with these activities.
I ask him whether he likes smoothness. He says yes.
I ask whether he likes roughness, he says no.
I tell him that smoothness is related to a situation he likes and roughness
to a situation he does not likein other words, to situations which are
good or bad. I go on, saying that perhaps the bad experience is linked to
the interruption of our work and the good one to the fact that the three of
us are there together.
Paulo becomes enthusiastic as a result of the conversation and goes on
with his exploration of the surfaces in the room and ends up rubbing his
own skin. At the end of the session, after having explored and named the
different parts of his body, he asks his mother what skin is and what it is
good for.
In the session I describe next, Paulo is in the waiting room with his
brother and nanny. I am again unable to tell him from his brother.
Both are excited and have dummies tied to nappies. They are sitting
on the floor with several toys scattered around, including a doll. As
soon as they see me, Paulos brother says to me, Auntie Clia, I want
water and bread.
I do not know which one is Paulo, until he walks towards me,
takes out his dummy and says, I want water and stale bread.
As soon as we go to the consulting room, we hear his brother echoing, I want stale bread and water.
The whole situation made me very uncomfortable, not only
because I was unable to distinguish Paulo from his brother, but also
because I could tell how confused they are.
111
On entering my office, Paulo leans back against the wall and remains
standing as if he needed firm support in order not to collapse. Standing
in this position, he whiningly repeats his request for stale bread and
water. I ask him what stale bread is and why he wants it, and he says that
he likes stale bread.
I am intrigued by the fact that he likes stale bread. It occurs to me that stale
bread means old, hard bread (in Brazilian Portuguese the expression po
duro, translated literally as hard bread, is used to designate stale
bread), but I do not know what to make of it. I notice that his apparent
privation and his look of helplessness are like that of a street child, an
abandoned beggar. The expression hard bread echoes in my mind.
After some time, I think of telling him that he seems to be thirsty, hungry,
that something seems to be missing inside him. I tell him that perhaps
those days we were apart since last Friday made him miss what we have
here, made him miss Clia.
Paulo calms down, opens the box, sees an entangled string and says, Its
a spider. He asks me to help him disentangle it. I thought that perhaps
this movement was a reply to my previous statement, in which I began to
unravel a little of what was going on between us.
Then he asks me to roll the string around his hand. I do that slowly, until
he asks me to help him put his hand in a cast. He walks proudly around
the room with his hand in a cast.
I ask him what that spider and the cast are all about.
The spider disappears from the scene. The cast seems related to some injury.
He then asks me to bandage his other hand and to take some string to his
brother. He tells me that he brought his Barbie doll.
I notice that these stimuli take my thoughts in several directions. I guess
that the hand in the cast and the Barbie doll could be contents suggesting castration and masturbation fantasies. I try to find my way using
these ideas, but I soon realise that they do not have much to do with what
is happening at that moment. I then notice that Paulo seems to feel intense
pain and the threat of collapse, insistently asking me to help him protect
himself.
I tell him that perhaps he needs stale bread and water inside his tummy
and a string to tie him up, to apply a cast, to hold, to cover a wound. I tell
Paulo that his wound seems to come from being far from Clia, far from
mummy, and from stopping coming here because of moving to another
city. All these things hurt a lot. The cast helps to cover and protect this
wound, to hold together all that has been undone.
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AUTISTIC TRANSFORMATIONS
At that point his mood changes. He becomes excited by the game. I help
him put his other hand in a cast. He asks me to meet all his needs. He
is in high spirits, making plans for the next session, when I should bring
him even more string and we will go on playing this game.
This persists until he asks me very insistently to tie up his whole body, his
legs and arms. I follow all his movements with a certain perplexity, without being able to work out what he is proposing to me. I am only aware
of his satisfaction with the game and tell him that he seems to really
enjoy the fact that I am doing everything for him, instead of him doing it
all by himself. I then mention that the stale bread and the water he had
asked for at the beginning of the session could perhaps represent the relationship established between the two of us in which he is being attended
to and cared for by me in everything he needs.
He then says, I want you to wrap me up like a mummy!
I ask him about the mummy.
He says, My auntie at school said that mummies are all bandaged up,
and he points to different parts of his body, saying, the legs, the arms,
the tummy, nipples, eyes, mouth, head and only a small hole remains in
the nose to breathe. Our game gets very intense.
The tenor of this communication touches me because I realise he is
desperately trying to have his body strongly wrapped to keep him
together. He asks for help to unroll the string around his hands and I
pretend to use it to wrap up his legs and arms. He emphatically orders me
to wrap his head as well. This extremely primitive form of communication characterises the entire session. I then remember the previous session,
in which he asked a question about skin.
I tell him, This string you ask me to wrap your whole body with is like
the skin that will cover, bring together, and protect everything you have
inside. When you are hungry, when you feel something is missing, you
seem very upset. Its very disagreeable. Everything is all mixed up,
confused, like the spiders web you talked about before. . . . I tell him that
he needs this bandage to be very tight, just like stale bread, so that all parts
of his body stick together. I add that when he is all tied up, he seems to
feel that he is who he isPaulo.
The session ends. Paulo takes quite a bit of the string with him, and
as soon as he gets to the waiting room, he tells his brother what we
did and says that I will bring more string for the next session.
113
Commentary
Paulos material exemplifies some of the proposals I have made so far
in this book. He is a child in whom a neurotic part of the personality
prevails, but who presents important autistic nuclei and who operates
from time to time using autistic transformations.
At our first meeting, Paulo introduced himself and proclaimed his
emotional state of affairs by saying, But my brother didnt come! He
told me how he experiences bodily separation from his brother: he tore
the paper and pointed to the wound in his belly. His pain due to bodily
separation seemed to be the central concern. He experiences separation from his brother as if parts of his body had been yanked out and
torn (Tustin, 1981, 1984, 1992). He might feel that he had been
yanked from his brothers body when he found himself apart from
him.
Paulos manifestations oscillate between states of withdrawal, in
which autistic transformations prevail, and other states in which projective transformations are dominant. His requesting help to develop
powerful protection in the face of experiencing threats of crumbling
and his state of tremendous vulnerability can be seen as projective
transformations. These experiences seem to come from early situations
in which he was bodily separated. They happen now with the prospect
of having to end his analysis and be separated from his analyst.
In the first clinical fragment, Paulo used his body to show his fear
of crumbling down. That is, he presented himself as a body that could
not stand alone. In search of some support, he leaned on his mothers
legs. Once he felt supported, he tried to develop some early stages of
mental organisation by exploring the rough and smooth surfaces of
the door and the wall. While this was going on, the analyst was confronted with an unknown universe dominated by sensations. She had
no inner repertoire capable of conferring some meaning on that experience. Little by little, beginning with the emotional experience she
was sharing with Paulo, and with the theoretical references she
normally relies on, she realised that Paulo, by exploring those sensations and by differentiating good smooth situations from bad
rough ones, was trying to create some sort of internal organisation
to guide him. By doing this, he transformed the sensations obtained
from his contact with surfaces into rudimentary but thinkable psychic
elements. Paulo seems not to like rough surfaces/separations, but
114
AUTISTIC TRANSFORMATIONS
115
the crumbling that threatens him. Paulo showed that he had received
the protection he needed at the beginning of the session, an armour to
protect his wound, allowing him to feel some cohesion. It becomes
more evident that the hardness of the bread, the wall, and the cast are
what Paulo needs to feel minimally sustained and, thus, reduce his
feeling concerning the threat of non-existence. His comfort and enthusiasm once he felt protected are manifested. He then asks the analyst
to wrap up his whole body like a mummy. This wrapping would
have the function of a strong second skin, which would keep him
together and maybe even allow him to acquire notions of his shape,
with which he could gather some rudimentary notions of his existence. Perhaps, as Bick (1986) suggests, Paulo was searching for a
psychic skin which would contain his corporeal and mental
contents. In his interaction with the analyst during this session, Paulo
communicated what he lacked, and the expression stale bread
evolved into his search for the shape of his entire body as a mummy
with its skin as a container.
Paulos movements in these sessions generally fluctuate between
states of greater and lesser withdrawal. His major anxiety is linked to
his need to devise powerful protection that can attenuate the constant
threat of psychic non-existence felt by him.
Discussion
Paulos clinical material allows us to discuss the points brought up
throughout this book. Let us begin with the first fragment I described.
When the analyst asked Paulo to come into her consulting room,
he does not want to leave his mother, so she comes in with him. He
presents himself in an apparently disintegrated state. He immediately
rests his body on his mothers legs in order to find support for his
state, giving the impression that he might crumble. He repeats this
movement in which he falls on his mothers legs and quickly gets back
up several times. I hypothesise that these movements might be manifestations of tropisms. There is a movement of the body and an expectation that some object will rescue that crumbling body. The analyst
remains present and might also have been a container for Paulos
mother, who, in turn, supported Paulos manifestations by letting him
lean on her and go on trying to support himself. It is worth noting
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AUTISTIC TRANSFORMATIONS
117
on his hands. The cast can be thought of as substitute for the skin he
lacks, a second skin which is thick and hard and which will protect
him from his state of extreme inner vulnerability and from the threat
of crumbling. I am suggesting that Paulos manifestations in this chain
of movements could be thought of as autistic transformations.
Later on, Paulo asked the analyst to wrap him up like a mummy.
He wanted his whole body wrapped up with only his nostrils exposed
so that he could breathe. Here, it seems that Paulo at least wants one
part of himself to be open to the world outside him. He needs to have
one point open (the holes in his nose) in that bodily armour so that he
can have some contact with the outer world. His nostrils might represent the permeable part of Paulos autistic barrier, a part that is still
alive and allows him to have some give-and-take with the living
world (I owe this interesting observation to Bianchedi, 2005, personal
communication). These movements demonstrate Paulos oscillation
between existence and non-existence. The analysts experience with
Paulo indicates that these are autistic transformations.
Now that we are at the end of this book, it should be perfectly clear
that my proposal to incorporate autistic phenomena into Bions frame
of reference is not a simple matter. To do so, it is necessary to widen
the area of phenomena within the mental sphere so as to include an
area that does not yet count as mental. This expansion will change the
system Bion devised, constituting a complex system which entails
imprecision and incongruity (Morin, 1990, p. 20).
To further this investigation, we need to be able to contain this
imprecision in our minds. Otherwise, I do not see how we can go
forward. Or, as Morin said, We shall have to tolerate the non-scientific within science . . . which does not mean dispose of the scientific,
but rather, allow it to be expressed . . . (1990, p. 91, translated for this
edition).
Note
1.
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119
120
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REFERENCES
INDEX
affect(ive), 87
contact, 54, 72
emptiness, 64, 66, 71, 89, 94
experience, 17
genealogy, xvi
impression, 17
life, xv, 5556, 64, 67, 71, 94
meaning, 82, 87
relationship, 97
Alvarez, A., 53, 77, 9091, 119
anxiety, 23, 28, 36, 40, 42, 49, 52, 72,
74, 77, 86, 109
intense, 26, 31
major, 115
separation, 59
autistic (passim)
barriers, xii, 55, 62, 73, 8991, 104,
106, 117
-contiguous position, xiii, 77
defences, 54, 7273
elements, 108
environment, 71
isolation, 104
123
124
INDEX
INDEX
125
126
INDEX
processes, 99
transformations, xiv, 5152, 5658,
66, 71, 79, 8890, 104, 113
psychic see also: functioning
absence, 64
activity, 28
apparatus, 12
balance, 55
content, 26, 87
dimension, 107
elements, 75, 88, 103, 106, 116
impairment, 28
integuments, xv
level, 44, 54, 97, 103
life, 4, 89, 103104, 106
loss, 100
movements, 50, 75
non-existence, 103, 115
organisation, 1213, 25, 94
pain, 10, 31, 49
phenomena, 4748, 52
processes, 79
qualities, 22, 72, 108
reality, 70
representation, 43
sense, 100101
separation, 61, 94
skin, 115
state, 88, 98
suffering, xiii
transformations, xiv
tropisms, 105
Rezze, C. J., 74, 78, 99, 117, 121
self, 22, 30, 4143, 4546, 52, 5455,
61, 7172, 79, 94, 9798
-absorbed, 66
analytic, 85
-awareness, 51
-generated, 46, 54
-knowledge, 10
-observation, 55, 61
primordial, 54, 72, 90
-sufficient, 79, 98
INDEX
127
inanimate, 103104
inner, 3, 910, 18, 22, 40, 64, 67, 84,
8990
living, 117
mental, 41, 62, 64, 81, 84, 88,
90
perfect, 52
phenomenic, 96
primitive, 8, 43