In 1962 Harold Searles published his paper “The differentiation between concrete and metaphorical thinking in the recovering schizophrenic
patient” (Searles.1965).This is a paper I have long admired and enjoyed and I would like to use it as a focus for discussing the theme of concrete thinking. This is almost a colloquial term used in everyday clinical discussions about patients who cannot function symbolically, and I have found it a valuable ex- ercise to explore in more detail just what we mean.
As is characteristic of Searles' papers, this one is full of detailed clinical material as well as very perceptive observations and careful thought. After discussing this paper I will go on to relate it to Bion’s findings because I think we can see that Bion was experiencing the same clinical phenomena, and brought his own very distinct formulations to the problem. Throughout my pre- sentation I want to lay emphasis on one particular aspect the story, namely that split off states of mind are felt to be infinite in magnitude and violent in intensity. I believe that understanding this is crucial to our being able to work therapeutically with concrete non-symbolic states.
Concrete thinking and the psychotic patient.
The first point that Searles makes in his paper, is that so called concrete thinking is in fact a lack of differentiation between the concrete and the metaphorical . “Thus we might say that just as the schizophrenic is unable to think in effective consensually validated metaphor, so too is he unable to think in terms which are genuinely concrete, free from an animistic kind of so called metaphorical overlay.” He later goes on to explain that in this state the patient is “unable to distinguish clearly at a deep psychological level among the three great classes of objects in the outside world: inanimate things; living but non- human things such as animals and plants; and finally human beings.” He explains that this is the result of abundant massive projection not only on to human beings around such a patient, but also onto trees, animals, buildings and all sorts of inanimate objects. Thus the world appears to be animated by the projections of his internal world, his psychic reality, without the patient having any insight into this. This is the world of animistic thinking described by Freud in “Totem and Taboo”, a world in which everything is animated by human spirits with special supernatural powers. It is latent in us all, and totally captures the mind in delusional states.
For example, with Patient A:
Rather than experience his own precarious personality integration as such, he felt intensely threatened , for many months, that the building in which he was living might fall to pieces at any minute. In the course of time I came to realise that his great difficulty in leaving my office, at the end of the sessions, resided in the fact that he had come to experience the office as part of himself, that departure from it threatened him with loss of his identity.
His anxiety lest he lose his identity in close personal relationships caused him to isolate himself, to a marked degree, from patients and personnel, of whom and to whom, he habitually spoke with a kind of dehumanising scorn and rejectingness, as if they were inanimate objects, so that many of them would hotly remind him that they were human beings.Much of his time he spent in solitary walks into the village, and after many months he revealed that he loved to stand before the store windows, feeling himself to be in a vivid group interaction with the mannequins, both “adult” and “child” ones, which stood in the windows, and which his unconscious loneliness caused him to perceive as more truly human than were the alien objects which constituted , in his view, the people at Chestnut Lodge.
The next point that Searles makes is to describe his experience as the thera- pist in the presence of such concrete thinking. He makes it quite clear that in listening to the patient, metaphoric meanings are evident to the therapist, but not at all to the patient. For example he describes a patient who “although he became able after two years to communicate verbally throughout his sessions with me, I found him maddeningly and discouragingly unable to deal with any comments with I couched in figurative terms”. In another example Searles describes
“a patient was protesting about a prospective move to an outpatient residence of his own, apart from his family, asserting that other patients he knew had gone back to their families. I reminded him gently that because his father had died and his brother and his sister had dispersed to other cities during his hospitalisation, this was as I put it ‘just not on the cards for you is it?’ He was able to avoid the affective implication of this metaphorable to avoid for example the sense of loss implied here- by experiencing my comment in literal terms. He retorted as though I had accused him of some immoral activity “I’m not playing cards.” These are but two among many hundreds of examples of my work with him.”
Searles goes on to say that such patients consistently react to him, Searles, as if he is crazy, quite seriously and frighteningly crazy on the thousands of occasions when he tried to help the patients to see either the metaphoric or otherwise symbolic meaning of their own verbal communications.
Searles demonstrates that if the therapist continues to insist on metaphoric meaning, the patient reacts in a very typical way. One of his patients said for example “always angry, my therapist is always angry with me” and then he went on to describe some chairs in his sister’s apartment “chairs made of iron so heavy that no one could move them, only with great difficulty.” Searles observed in this instance “ and you feel perhaps that your therapist is like the heavy chairs – very hard to move.” The patient laughed as though his comment were ridiculous saying “no, I know you are not a chair Dr Searles, there’s a chair.” I think what we see here is a very important issue, that if the thera- pist tries to give metaphoric meaning when the patient is incapable of it, the patient experiences the therapist as out of touch, crazy, or angry and frustrat- ed, and more like a heavy chair, who cannot be moved to understand the pa- tient’s experience. This is a very important point and we will come back to it again as the paper develops.
The third point that Searles makes is to demonstrate that the de-differentiating, de-symbolising is in fact a very active powerful defence. In fact as Searles puts it “this loss of ego boundaries is one of the most vigorous, formidable defence mechanisms which comprise the schizophrenic process”. Searles gives one particularly memorable example of this and I will quote it at length;
“This man even after a year of living in the same single room showed little evidence of feeling at home in it. He evidently suffered from a persistent experience of the furnishing of the room as belonging exclusively to the hospital. He seemed to feel almost no freedom at all to rearrange the furniture in the slightest degree to his own greater comfort and convenience, or to make any easeful use of it where it stood.
One day I noticed that a small rough rug back from the cleaners was folded over the back of the upholstered chair in which he customarily sat during our sessions. As usual he did nothing about its uncomfortable bulk and only once commented in a quiet neutral tone, that the maid had not yet put it back on the floor.
During the next session the rug was still there. In the course of the hour while showing relatively little anxiety and talking quite freely he started to lean back comfortably in the chair. But he instantly caught himself and quickly leaned forward again saying in an anxious tone ‘I don’t want..’ – and he left the sentence unfinished. I encouraged him to say what he had in mind and he explained ‘I don’t want the rug to get into my hair’. This was said in such a tone, impossible to reproduce here, as to give me the startling realisation that he was afraid, not that lint from the rug would get into his hair, but rather the rug itself would do so – as if the rug actually several feet across was so much smaller than his hair that the whole of it could get lost and swallowed up in it.
It was some weeks later that he became able to recognise and express some of the quite evidently deep resentment which such behaviour on the part of the maid had caused him. He became able now, that is, to experience and describe it that such things that this incident of the rug “got into his hair” One might say in a figurative sense – that they irritated him. Previously he had seemed genuinely unaware of any irritation and had experienced instead something in the realm of a weird anxiety such as I had momentarily sensed. “
Related to this is an example that has always stayed in my mind of a deeply disturbed woman who chronically plucked hairs from her scalp saying that she was trying exasperatedly to get ‘bugs out of the inside of her cranium’. It was only later in her therapy that she became able to realise that she in a figurative sense was bugs, or had bugs in her head, so to speak. “She had left off her hair plucking and it was now something far more severe than exasperation which she was evidently feeling. She said to herself in a low voice full of shock and awe “I’m crazy”. Previously she had been too ill – her ego had been too weak – to let this realisation dawn upon her. It was preferable to her to believe she had bugs in her brain and that the impact of this was trivial when compared with that of her realisation that she did in fact have a devas- tatingly severe mental illness.”
In keeping with this observation that there is a very active powerful defensive process at work bringing about the de-differentiation, Searles also observes that in the course of recovery when a patient is now able to function metaphorically, if there is stress, the patient can revert to concrete thinking once more.
I come now to a particular point that Searles makes that I want to emphasise. This is the vital importance of working with the murderous feelings and fan- tasies that such a patient can experience. Searles describes one particular patient for example who for several years in the hospital went into murderous rages that were frightening to everyone about him including at times Searles. But as time went by it became possible for the patient to make clear that his delusional view of the surrounding world had altered, so that now to him, “practically everything in the world that we would call non-human (animals, plants, buildings and so on) was a human being who had been turned, through the greatest sort of violence, into something non-human and was waiting desperately to be liberated into human form again”. Searles points out that as the full extent of his murderous feelings were revealed to the patient and to Searles, his utterances could then be best understood not in the frame of reference of increasingly intense homicidal violence, but in terms of a struggle to become liberated from concretistic thought into the realm of interpersonally meaningful symbolism including metaphor. Bion(1967a) reports a similar realisation when he worked out with a bewildered and defeated patient that “without phantasies and without dreams you do not have the means with which to think out your problem”. This understanding Bion later transformed into Row C of his grid, which he saw as an essential stage in the development of thinking from the state raw emotional experience.
Other patients explained that to hate means to change a person’s sex, or to hate still more intensely at an unconscious level meant the perceiving of the person as being changed into something non-human, such as a rock or a tree. One woman explained that it was now becoming clear to her that when she symbolised a dear person by a Christmas tree it is not really equivalent to killing the person, equivalent that is to literally rolling the person up into a tree. Searles observes how important it is for the patient to become aware of such murderous feelings and to be able to translate them into metaphorical think- ing, that is into adult metaphor. After all there is a sense in which metaphor “does violence to human beings by transforming ...a faithful person into a dog, or an ill-tempered one into a bear, or an unyielding one into a rock”. Searles observes that as the de-differentiation eases and metaphoric thinking becomes possible, the patient is flooded with great volumes of emotion and meaning. I think this vivid image captures the inner experience that emotional states can feel infinite and overwhelming. He goes on to say that this growing awareness of emotion, whether of murderousness, tenderness or grief, indeed of the whole spectrum of emotion, is the father to metaphorical thought.
A patient of mine, whom I will call Mrs B and whom I will have a bit more to about later, was not clinically psychotic but very cut off, and she conveyed this to me recently. For many months she could only see the literal meaning of her and my words, and clearly made every effort to prevent herself from seeing the connections between the stories and associations she brought. I on he other hand could see that much of what she spoke of would be distressing, let alone what else it might mean to her.As this began to ease she would become agitated and said she had so much in her head she did not know how to make me understand. On one occasion, she said it was like the nature programs, about the frozen wastes of winter beginning to thaw, causing the rivers to become raging torrents full of huge lumps of ice. This was her picture of her emotions and potential thoughts, being freed up at last, but huge and violent in their intensity, accompanied by her panic and despair of not knowing what to do with the onrush.
The final point Searles makes that I want to emphasis is his observation that there is a very particular kind of intimacy that is involved in working with a patient in such a concrete state. He observes that before a patient can enter the metaphorical realm of communication he must first become sure that he can make himself understood at the literal level of meaning. Searles remarks
“I have learned painfully and slowly that when a patient makes an intended concrete communication it is a mistake to respond in terms of its potential metaphoric meaning without first acknowledging its validity as a statement of literal fact.”
Thus the process of therapy at this level involves quite a long period of being with the experience of concrete thinking which, as Searles observes, brings a very particular kind of intimacy to it. Again this is something that we will explore further when we discuss the work of Bion, whose formulations of containing deepen our understanding of what is entailed in this essential therapeutic activity.
In summary, Searles shows the process of the development from the concrete to metaphorical thinking. The first step that he thinks is essential is the long period of receiving the patient’s concretistic experiences. Then comes the gradual awareness of the emotional reality the patient is conveying, and in particular that such emotions are felt to be extremely violent. As this is slowly worked through it becomes evident that the need to evacuate is eased so the patient withdraws the projections and is able to make the distinction slowly between the inanimate, the animal world and the human world. In other words, as Searles puts it, his ego boundaries are restored. In parallel with this he observes the emergence of metaphoric thinking. All of this I think demonstrates Searles' point that there is a very active defensive process at work which ex- plains the phenomenon of concrete thinking, and which can be shown to be a dynamic process as a result of working through. As he put it in a later paper (Searles 1972 p22):
Schizophrenia cannot be understood simply in terms of traumata and deprivation, no matter how grievous, inflicted by the outer world on the helpless child. The patient himself, no matter how unwittingly, has an active part in the devel- opment and tenacious maintenance of the illness and only by making contact with this essentially assertive energy in him can one help him to become well.
Concrete thinking and the borderline patient.
In a subsequent paper Searles discusses the manifestations of concrete thinking in his borderline patients (Searles 1986). He comments that the ways in which a borderline patient manifests his difficulties with ego-differentiation are fascinatingly subtle, and in this regard there is a contrast to the relatively manifest struggles of a schizophrenic patient,
“Typically it is only after several to many months of therapy that we begin to see how pervasively unable he is to differentiate, at a more than superficial level, between nocturnal dreams or daytime fantasies on the one hand, and perceptions about realty on the other; between memories of the past and per- ceptions of the present; between emotions and physical sensations; between thoughts and feelings, and behavioural actions; between symbolic and concrete levels of meaning in communication”.
I think he is alluding to the fact that in some borderline patients the functioning aspects of the personality can mask the dedifferentiated psychotic states that the patient is vulnerable to.
I would like to place emphasis on one particular aspect of the phenomena with borderline patients and that is how extremely volatile is the patient’s experience of himself or of his object. What we observe is that one particular state of mind, one experience or perception, can be felt to be the whole truth and simply factual, that is to say the part becomes the whole. This is also what I mean by my comment that a split-off state of mind can be experienced as of infinite magnitude, it fills the whole of the mind and determines all perception and thought. In this regard I am reminded of the phenomenon of the image intensifier, where one part of a picture can be enlarged to fill the whole screen and therefore to block out any other experience or perception. In this state, there never was any other way of being and never can be.
What follows are some examples of these phenomena , drawn from Searles’s paper and my own experiences:
It is a striking and characteristic experience to observe how a traumatised patient can re-experience traumatic interactions as if they are hap- pening right now in the present, or only yesterday, with no sense of any time lapse at all.Such a patient cannot give a linear history of themselves for a long time.
The therapist’s words or looks can be experienced as material objects with physical impact, such as a slap, a missile, or a bullet being fired , a rock or a knife being thrown. Similarly the patient can feel that they have an affect upon the therapist which is like a physical impact, which can therefore do actual physical harm to the therapist and be feared by the patient as lethal and overwhelming.
Rosenfeld observed that if we interpret aggression in the patient too ear- ly, this is experienced as the patient feeling they are being told they are 100% bad. Similarly, to interpret sexuality prematurely is experienced by the patient as the therapist being 100% sexually aroused by the pa- tient and therefore a danger.(Rosenfeld 1978)
The therapist’s silence can be experienced as extremely persecutory in that the therapist is felt to be dead.
Separations such as weekends and breaks can be experienced as the therapist actually being dead. The experience on the return after a weekend is felt to be like starting again as if the patient and therapist have never met.
Akin to this experience is the patient’s need to keep the therapist alive by actual presence and actual perception.
The patient can idealise the therapist as a saviour, as completely 100% good, and as offering a new life totally free from all anxieties and traumas. But such idealising love can be feared by the patient as utterly engulfing and possessing, and as exercising omnipotent control over their object. And by projection, the patient dreads such engulfing control being exercised by the therapist. Nevertheless, this mode of interacting which is felt in such extreme terms is also the basis of the essential intimacy of the therapy for quite some time.
Disillusionment of such an idealised fantasy is experienced as the patient having caused the actual destruction of the therapist, or of themselves as collapsing into empty resourcelessness and despair.
These examples are a manifestation of the particular concreteness of experience in borderline patients. Searles employs Freud’s phrase ‘the omnipotence of thinking’ to describe such phenomena as we observe here. This is the experience from the patient’s part that what they are thinking is exactly identical with external reality, and as a result the patient is not aware of their thinking as such, only of what seems to the patient as a perception of reality.
In keeping with the points I highlighted about Searles’ observations in the previous section, I want to make the link here with the experience of interpreting metaphoric meaning to a borderline patient when in a psychotic state. It characteristically happens when we try to “interpret the transference” in an effort to explain and add meaning, that the patient either ignores the interpretation, or becomes irritated, feels we are not listening, that we are changing the subject , or always bringing ourselves in for no reason. If we persist, the patient can become enraged and persecuted, to the point of conveying that we are identical with the traumatising and abusing figures in their past. Only at a later stage after much internal development are more explanatory interpretations acceptable. Indeed, there comes a time when NOT interpreting the active transference is experienced as the analyst avoiding the patient’s communications and being defensive- a reversal of the previous state.
In concluding this section I would like to lay emphasis on the observation that such a patient is acutely sensitive to the nature of the object relation. The patient can believe very concretely that the effect upon the therapist of their words and emotional states is extremely violent, and likewise the therapist’s effect on the patient is extremely violent . In both cases this is a very persecutory and overwhelming state to be in, and our awareness of the violent intensity of such interactions I think leads us on to understanding the nature and particular value of Bion’s insight.
Violent emotions and the Inadequate Container.
I have borrowed this title from Antonino Ferro’s chapter of the same name in his book “Seeds of Illness, Seeds of Recovery” (Ferro 2005). In this and other writings of his, he develops his understanding of Bion’s formulation of the container and contained with particular emphasis on the genesis of apparently violent emotions when the container is inadequate in its functioning. So let me now go on to remind us of Bion’s ideas in this regard, because it is Bion who provides us with a more detailed dynamic model of how such concrete states of mind can develop. I want to go back to the initial account of his discovery in his papers “On Arrogance “and “Attacks on Linking”. Talk of container and contained is at risk of becoming a cliché these days, of losing some of its vitality, whereas his first formulations retain some of their original evocative power. In this we can preserve the quality of the formulation being more like a Row C formulation in the Grid, or a dream, an image which keeps stimulating our imagination without saturating us with too much familiar meaning.
In his papers “On Arrogance” and “Attacks on Linking” (Bion 1967b and c) begins to develop his realisation that projective identification can be a means of communication as distinct from a means of evacuation or intrusion. He begins by describing his encounter with a patient who experiences an increasing sense of obstruction in the analysis, which they eventually work out to be the analyst as the obstructing object. Bion suggests it is the analyst’s efforts to know at all costs that is felt by the patient as obstructing. Specifically, it is the analyst’s efforts to put things into words and to expect the patient to function verbally, that is felt to be obstructing the only means of communication the patient feels is available to him, which is his capacity to employ projective identification.
Bion draws a number of significant conclusions from this scene as we know. Firstly the obstructing object is experienced as hostile to projective communication. Internalisation of this hostile object becomes a superego hostile to primitive emotions and their communication, an ego-destructive superego By identification with the aggressor, this can become the central and idealised figure in the narcissistic organisation that Rosenfeld describes (Rosenfeld 1971), a figure that is arrogant and self sufficient and scornfully denies any needs and vulnerability. This super ego in particular attacks any communication of the experience of dependency or vulnerability. These attacks upon communicative links, Bion suggests, attack the foundation of thinking and thereby prevent the development of being able to think about emotional experience.
Secondly, in the presence of such a hostile container the projections become more and more forceful and eventually appear as violent. Bion remarks that seen in isolation this can look like evidence of primary destructiveness in the patient. In fact we are seeing the development of increasingly urgent and desperate efforts at projective communication. At the same time the communications become more and more denuded of meaning and of detailed content, and thus appear to be more concrete in the manner we have been discussing.
Bion noted that in these circumstances, the patient loses his curiosity about the nature of his experiences and its causes. There is no observing aspect of the personality, and no internal dialogue. If this function is to exist at all it must be in the analyst, and his reflecting state of mind and effort to understand con- stitute an essential component of the analytic frame. It is in fact an internal dialogue taking place in the analyst, and can be represented as an internal parental couple observing and thinking about the infantile experience which the patient and analyst are immersed in. Ron Britton is one analyst who has described this aspect of the process in his account os a borderline patient of his in “The Missing Link” (Britton 1989).
As we know, Bion went on to abstract from these clinical experiences his model of the container and contained, and to develop his Grid embodying the stages in the development of symbolic thinking. I won’t rehearse those details here but just emphasise how much his work has shifted our focus on to the state of the container, and onto the conditions in the container that are necessary for the development of symbolic thinking.
This model of container- contained allowed Bion to develop his ideas about transformation. Containing the raw proto-emotional experience (the contained) leads to the gradual transformation of emotional experience into elements suitable for dreaming and later for conceptual thinking. We could think of this as a positive transformation, or +T to borrow Bion’s way of sometimes using algebraic notation. Failure of containment through inadequacy of the container leads to a negative transformation (-T), and this takes the form of increasingly urgent, desperate and violent efforts to communicate, and it also takes the form of a loss of metaphoric thinking towards increasingly concrete undifferentiated states of mind.
The process of facilitating +T means being with and containing the projected communications, or as Rosenfeld expressed it, we take in the projections and endeavour to remain in lively contact with them.This takes time and requires a modification of our technique away from trying to give symbolic meaning prematurely. I think we can see that this is the same process that Seales de- scribed as a very particular form of intimacy in the therapeutic encounter, and which he considered the essential foundation to the later development of metaphoric thinking. He drew upon the concept of therapeutic symbiosis to help him formulate this understanding.This is not the place to enlarge in detail about these technical issues, but suffice it to say that many writers have addressed them. Bion himself spoke of the need for reverie, of working in negative capability, and later of working in O. And Anne Alvarez has distinguished between explanatory interpretations with someone capable of two track think- ing, and more simply descriptive observations when the patient can only function at the level of one track thinking (Alvarez 2012).
Another valuable insight that we can derive with the help of this model is our being able distinguish more clearly between violent emotions due to the inadequate container, and the violence of destructiveness. The first is fundamentally the manifestation of desperate efforts to make a link with the needed object, the second is essentially attacking all links with the object. I think it is now appreciated that this distinguishing between desperate communication on the one hand, and destructiveness on the other, is essential in our work with primitive states of mind, so that we do not persecute the patient with incorrect interpretations of the nature of the patient’s aggression.
Representing the Apparatus for Thought
I want to conclude by returning to a particular aspect of Searles' observations on the experience of being with his patients when in their undifferentiated state. As described earlier, he noted that he could very often see the metaphoric meaning in the patient’s words and actions, but was frustratingly confronted with a complete absence of this in the patient. Indeed, the patients re- acted with scorn and derision at the analyst’s thinking, and could become increasingly persecuted if the analyst tried to force the thinking back into the patient. One of Bion’s proposals was that the apparatus for thinking can be split and evacuated, and come to reside in the analyst. There it can be preserved for safe keeping, it can be attacked, and can be restored and protected as something vital and precious. Ultimately it can be internalised in strengthened form.
I wonder if Bion used such impersonal language as “apparatus” to emphasise that it is a function of the mind subject to splitting, projecting and internalising like internal objects.This apparatus and its fate can be represented in the internal world and not always in personified form. I believe it is helpful and sustaining for the analyst to be able to observe this, and helpful to gradually show this to the patient as that capacity to represent and think begins to develop.
I have chosen some brief clinical vignettes to illustrate my point and to draw my presentation to a close.
1. In his book “Vulnerability to Psychosis” de Masi has the following quote about the mathematician Nash, of Beautiful Mind fame.
Mackey: How could you...a mathematician, a man devoted to reason and logical proof...how could you believe that extra-terrestrials are sending you messages? How could you believe that you are being recruited by aliens to save the world?How could you?
Nash: Because...the ideas I had about supernatural beings came to me in the same way that my mathematical ideas did. So I took them seriously.
In this example I think we can see the state of mind that is left behind when there is no apparatus for thinking and no capacity for observation and judgement of one’s mind. If such a person were to begin to glimpse the metaphoric meaning of his thoughts, we can only imagine what these alien creatures might come to be, and what world it might be that is threatened with catastrophe that would require superhuman powers to save it. I think it is the internal world that is threatened, with the sane parts of the mind. We might guess that part of what captures the mind and prevents insight is the conviction that all his ideas are the same because all are brilliant, full of special insight beyond that of ordinary mortals.
2. Mrs A came to me after a very serious suicide attempt that occurred when she was in a state of major depressive breakdown. She had experienced this before, and was once again stabilised after hospitalisation and medication. This time she recognised that there were important issues she needed to address. On one session early in her analysis, she reported a dream which had woken her in panic that night. In the dream, she was in her living room watching TV with a man she took to be her husband, although he was a bit out of sight behind her. On the TV was a freight train, and suddenly the train came towards the viewer, and at increasing speed came right out of the set, became huge, and was headed straight at them. She woke terrified.
I think this was a communication of her conviction that the tv/containing apparatus was totally inadequate for representation of all she carried inside her, like the freight train, and that this threatened her and me with being completely overwhelmed, sending us both psychotic.
3.I want to return to Mrs B and mention something of what preceded the terrifying thawing of her frozen state. As I described, I had a long period of meeting deadness and frustration when I could see metaphoric meaning and she could not. I learned to proceed carefully and respectfully, not forcing anything, but nevertheless believing that my observing this state in her was important, together with letting her know that I understood this might feel like the only way she could survive what threatened her. One Monday she brought a dream from Sunday night.Over the weekend she had been unsettled and disturbed in a way she could not grasp, and in the dream discovered that her mobile phone was not working. She could find nothing wrong with it but it could not send or receive.This was bewildering and frustrating to her.
After some time in the session of deadened talk and no interest in the dream, I suggested that we could see happening now what was portrayed in the dream, that her capacity to send meaningful experience to me, and her capacity to receive meaning back from me, were mysteriously out of action like her mobile. This left her unable to find help to make sense of her distress.
As usual this was greeted with rather cold frustration, but there was a moment of pause as well. I count this as the beginning of her slowly being able to see what might be going on inside her. It was some time after this that she wanted me to realise what we were risking here, and told me of the dangers of the thaw.
4.Finally, I have been reminded of a patient from long ago, a very cutoff and isolated young man, equally as adept as Mrs B at deadening all feeling and meaningful interaction between us. At one point later in his analysis, he had a dream in which he had possession of radar apparatus, and this led him to ac- knowledging that he believed he had been able to understand how I thought and that he could jam my radar and so stop me from having any real view of what was inside him and therefore have no real impact on him. Radar both penetrates barriers and represents what is there.
After much subsequent work and substantial development, we were approaching a long end of year break. This had always been a hazardous time, when he was vulnerable to taking himself on dangerous isolated expeditions with grandiose illusions about his self-sufficiency. He brought a dream in the last week, in which he was driving a little car, headed for the main road where there was a lot of traffic, all holiday makers. He turns onto a small road along-side the main road, and after a short time notices a police car following him. He gets anxious that they have radar, he checks his speed but after a while realises that the police are just staying in place behind him. He sees a couple of police in the car, a man and a woman. It then becomes clear to him that they are just there to remind him not to speed and to keep a check on himself.
Here I think we can see the opposite of the evacuation of the apparatus for thinking, an internalising in the form of a police/parental couple who use their equipment to function as the guardians of the insight that we have so laboriously developed in his analysis. In this way he can be helped to see himself through their eyes, when he is at risk during a separation of being taken over by omnipotent manic self-sufficiency.
ALVAREZ A.(2012) The Thinking Heart. Ch 1. Routledge
BION W.(1967a) Notes on the Theory of Schizophrenia. In Second Thoughts: selected papers on psychoanalysis . Jason Aronson
BION W.(1967b).On Arrogance.In Second Thoughts:selected papers on psy- choanalysis. JasonAronson
BION W (1967c). Attacks on Linking. In Second Thoughts:selected papers on psychoanalysis. JasonAronson
BRITTON R.(1989).The missing link:parental sexuality in the oedipus com- plex.in The Oedipus Complex Today. Karnac Books
DE MASI F.(2009) Vulnerability to Psychosis: a psychoanalytic study of the nature and therapy of the psychotic state. Karnac Books
FERRO A.(2005).Container inadequacy and violent emotions. In Seeds of Ill- ness, Seeds of Recovery. New Library of Psychoanalysis
ROSENFELD H.(1971).A clinical approach to the psychoanalytic theory of life and death instincts. An investigation into the aggressive aspects of narcissism. International Journal of Psychoanalysis 52:169-178.
ROSENFELD H. (1978). Notes on the psychopathology and psychoanalytic treatment of some borderline patients. International Journal of Psychoanaly- sis 59:215-221.
SEARLES H.(1965) The differentiation between concrete and metaphoric thinking in the recovering schizophrenic patient.Ch 19 in Collected Papers on Schizophrenia and Related Subjects. Jason Aronson Inc
SEARLES H.(1979) The schizophrenic’s individual experience of his world.in
Countertransference and Related Subjects: Selected Papers.Jason Aronson Inc
SEARLES H.(1986) Non-differentiation of ego functioning in the borderline in- dividual,and its effect upon his sense of personal identity.in My Work with Bor- derline Patients.Jason Aronson Inc.