Dead ends by Samuele Filomena

“After all, we assume that in the course of man’s development from a primitive state to a

civilized one his aggressiveness undergoes a very considerable degree of

internalization or turning inwards; if so, his internal conflicts would certainly be

the proper equivalent for the external struggles which have then ceased.” Freud, S. (1937). Analysis Terminable and Interminable.

(Freud made some further remarks on the destructive instinct in a letter written shortly after this paper to Princess Marie Bonaparte. An extract from it appears in the Editor’s Introduction to Civilization and its Discontents.)

I came up with this title of my paper looking a sign on the street here that indicates that the road does not have exit, and we find ourselves a lot of time in working with patients that experience a therapeutic negative reaction or a general acting out.

The impasse also is in our personal and professional development, in our personal analysis and in the supervision of clinical cases.

But the cul de sac is also a potential resource to restore our vitality and go back to the main road and carry on the journey of life.

Facing the termination phase of the training program, the lost of the colleagues and teachers is a difficult moment, but also an opportunity to find my own way of working that was stretch in different way during the recent time.

Developmentally dead ends with the psychological birth that occurs at 6 – 8 months with the process of separation individuation of the baby from the caregiver (m-other).

This is an ongoing process through our all life, and if things were well at that point, though we end it up in a dead end we have the ability to come out from it.

Things are more complicated if things were not have been going well at that time and in this case we need for our patient to experience ex-novo the process.

In this statements is implied that at the beginning of life there is any libidinal force or any object, and this puts me in a different perspective from Fairbairn or Klein.

If you read my previous papers you can see how many times I underline this difference and you are more familiar with the model that I create to describe and explain that.

The difference can be better elucidated with the analogy of making food and the implication on the tecniche. When I cook a meal normally a start from the dessert, and I go back to the second course, and to the first one, and to the appetizer, and when you start you have already ready.

The same is in psychoanalysis, what you present to the patient is the inverse of the work that you do inside yourself. Then the model that I am presenting is not a libidinal model but a model based on the aggression, it is not the investment of the object, but the disinvestment of the aggression and his internalization that allowed the possibility to looking for an object.

I know that you can feel confused because this is a completely different paradigm, but for my point of view more fruitful, and also we are just starting to understand this matter and a lot need to be done. This is my journey, and I am coming out from the dead end where I end it up, and I am starting again the trip to explore the internal world in my own way, sometimes solitary in this journey, other times with the hope that other will follow me, or I can come across to others interested in the unknown. I recommend the reading of Eugenio Gaddini and his wife Renata De Benedetti Gaddini, there is a bunch of articles collected in English A Psychoanalytic Theory of Infantile Experience  Conceptual and clinical reflections where one of the most famous concept is the imitation and the distinction between psycho-sensorial and psycho-oral way of functioning of the mind. This is my contribution to this institute and I want to express the gratitude to you in allowing me to explore and manage this concepts in a deep and profound way in the clinic with my patients.

Play with words by Samuele Filomena

Recently I have been thinking about words. For example the word mortgage, for an english speaker is just a word, for me is a composite word by mort and gage, and the meaning of mort id dead in italain.

I’ll give you another example, ball in italian is palla and also it is a composite word by pa, hat is the sound of hitting the ball and la (there) where the ball goes.

Words describe actions, movements and discourses are narrated, spoken.

Lets carry on this game and focus on two basic emotions and the correspondent actions.

At the beginning of life there is not any solid food, just liquid and the baby does not have any tooth. The emotion that I associate with this state of life is sadness and normally it is express by tiers.

The word thirsty is very similar to the word triste (sad in italian), also in South italy we use tristu to connote a child that is restless. We know that in childhood the depression can be expressed with movement.

At 6 – 8 months with the separation-individuation and the appearance on the mouth of the teeth, the child with the weaning process starts to intake solid food. I associate an important emotion to this state and it is the anger and the correspondent work in English for starving is hangry.

The child is now able to express his anger and byte.

As Freud stated to Marie Bonapart in a letter on the 1937 May 27

I will try to answer your question [about aggression]. The whole topic has not yet been treated carefully, and what I had to say about it in earlier writing was so premature and casual as hardly to deserve consideration.

The turning inwards of the aggressive impulse is naturally the counterpart of turning outwards of the libiido when it passes over from the ego to the objects. One could imagine a pretty scheatic idea of all libido being at the beginning of life directed inwards and all aggression outwards, and that this gradually changes in the course of life. But perhaps that is not correct.

I don’t know if you remember my diagram based on what Freud said.

On Cartesian axis I put on the vertical aggression (high) and libido (low) and on the horizontal the time, a liquid time till 6-8 month and a solid and liquid onward.

If things go well and there is someone looking after the baby the aggression goes down and the libido up. An internal object is built inside from the bad object intorjected and the libido is projected on the good object outise.

At 6 – 8 months these two curves cross and for the first time in life the aggression is down the libido.

If I divided this space in four square at the intersection of the two lines and I name them with the four basic algebra operation +, -, *, /

Now lets take the word italian condivisione that is a composite word con (with) and division. In English can be translate with share. But the meaning is much more complex, there are two operations implicated a division, separation of the child from the mother at 6-8 month and not before, and the addiction of the baby with the mother with the investment of libido in her.

Now I let you imagine how many of these we can create with just four simbols.

Another example could be procreation in this case the two operations are * creation and pro +

 

Words with Play by Samuele Filomena

What I would like to address in this paper is the difference between two forms of autism and an important development maturational process that leads to walking, crawling.

For my point of view at the beginning of life there is a symbiotic relationship between the baby and the mother and there is no difference between them. I agree with Fairbairn that the child is object sicking but this is from the adult point of view. From the child point of you the outside world, included the mother, is just dangerous and he displays all the possible aggression to protect from it, and if the adult is able to supply some stable and reliable condition, the child can start to disinvest the aggression from outside.

The autistic child looses the connection with the object and this state is exactly the opposite to the symbiotic stage at the beginning, the prognosis for this type of autism is not good especially with the progression of the age.

If an early intervention is applied in order to re-establish the symbiotic relationship that helps the child to trust again the outside world and then to disinvest the aggression from it and able to invest the object, then it is possible to restore completely the maturational process of the child.

I would like to use the analogy of walking to explain that, in normally development the crawling comes before the walking and a child that was able to crawl has more facility to walk.

At the end of the day walk and talking is a way to take some distance from the mother and able to have a distant relationship, that before was made by contact.

When the child arrives in therapy that is not playing and talking, what comes before is the play and after the child is able to put some words, sounds, songs to that play.

And what is the play? Re-establish the symbiotic relationship with the child, that can allow the child to crawl away and to talk and walk, when before he was running so far away lost in the dark space, falling for ever without landing anywhere on the ground, without the possibility to develop roots.

How you can see my interest is on the relationship and been able to be in it, and able to communicate these raw experiences to colleagues in order for them to experience it.  

 

Two two­pages paper

Part B: Philogenesis: The origin of the species

The references for this paper can be found in Ferenczi Thalassa and in Lucio Russo The

forgotten Revolution and in doing that I will follow the history of my own town Carovigno from

the greek word Karpene (A lot of fruits) a greek colony from the VIII century bC of Athens, but

probably it was there before, and I suspect that we colonize Greece and not the contrary in more

ancient times.

The town is on the Adriatic Sea in the South East of Italy in the Apulia region.

During the Hellenistic period around the III century bC the town was a centre of commerce for

olive oil and other important materials, wine, fruits, almond and ceramics (I suggest to visit the

room 73 of the British Museum where there are the Egnatia Vase).

During this period the families were nuclear, like today, the people had a lot of scientific

knowledge, included psychoanalysis, as well documented, and there were state schools.

But with the conqueror of roman with the second Punic war all these knowledge spread over the

Mediterranean Sea went away on the East, far east, till China and India.

I want to remember you that these people were aware that the sun was at the centre of the Solar

system, the human being were coming from apes and the conscious is a small part of the mind

under the unconscious processes. (See Freud Interpretation of dream part 2 footnote)

The knowledge of physics, mathematics, chemistry were invented on that time and last till now.

A lt of people were made slaves and brought to Rome as tutor for their children and they were

architects, engineering, medical doctors, astronomer, and for this reason after a century we had

some flourish of science and arts in Rome.

But these knowledge were lost, though used for a while, and we ended it up in the medieval era

(a kind of latency for the human beings)

We need to wait for the Renaissance to have back with the fall of Costantinopoli all the books

that were kept there to come back to Italy and Leonardo, o Piero della Francesca and many more

artist and scientist. I want just to remember you that Padua is the first University in the world.

(Galileo Galilei)

If we had an industrial revolution and another Emperor, this time British instead of Roman,

based on navigation and notions of astronomy and bolts and screws, it is thankful to the

hellenistic thinkers that imitate the human body studied in details.

They were aware of the difference between sensory and motor neurons. The eye had a specific

book written by Erofilo, who also knew about dreams and their interpretations.

I suggest you to read some paper of Francis Bacon where there are flights machines and people

exploring the North Pole.

You can ask what this is to do with psychoanalysis and my reply is that psychoanalysis is the

queen of the science (see Abraham and Torok) and this is part of our recent past, just 80

generations away from us. If you think the second war world was just 3 generations ago.

And what is the difference between the Hellenistic period and the Egyptians or Babylonians,

mainly they were collecting data, the river Nile went out this year, ect.

With science we have a model of reality and we can intervene on it and modified it, with an

enormous advantage. The job that before needs 10 men now can be done by 1.

Alexandria of Egypt was built ex novo by Alexander the Greater during that time and the Faro

was able to illuminate at 50 Km of distance, and the Rhodi colossus was similar to the statue of

liberty.

Archimede used glasses convesse to burn the roman ships, Euclid invented the geometry.

Aristarco of Samo the heliocentric theory.

Two two-page papers

Part A: Ontogeny, the development of an individual from conception to adulthood.

In this first paper I will describe my view on the development of a human being from a psychological point of view. My main reference is Eugenio Gaddini and his wife Renata De Benedetti Gaddini.

At birth the individual goes to some importants changes (Physical), the respiration is from the lungs and the intake of food from the mouth, and the environment is not anymore stable as before.

The role of the mother is to keep this transition as smooth as possible and in this sense during the first eight weeks there is no difference with the intrauterine situation (from a psychological point of view).

The mericism or infantile rumination is the first psychosomatic dated illness and cannot occur before that time and the presence of this illness shows to us that at that point an important process starts: the imitation. The baby is able to use his own body to perceive the environment though the sensations and operates a detachment from it.

Only at 6-8 months the true perceptions start to operate , now with the separation from the mother, the baby is able to perceive the internal and external environments with his own senses (five).

The psychosomatic dated illness at this time is the dermatitis. The mother is a not-me object, there is an internal and an external and the skin delimitations them.

From this time on the baby starts to recognize the father as a separate object from the mother, at the beginning as a meiotic process that we are able to see in the clinic with the primal scene fantasies and after the first year of life as a distinct object. We are not any more in the range of sensations and perceptions but the thoughts and emotions play an important role in dealing with the loss.

The psychosomatic dated illness at this time is the asthma. Breathing, walking and talking are strict linked, and in a way it makes sense because the child can now distance himself in space and time.

This view is very similar to Fairbairn, he made a distinction between a mouth without teeth and a mouth with teeth, and we can see how with the feeding and the respiration the mouth is involved.

These two way of functioning operate at the same time for the rest of the life of an individual and what we are able to observe in session is the combination of these two ways of functioning.

Winnicott called them pure female and male elements, Gaddini psico-sensorial and psico-oral.

I made a model following a letter that Freud wrote to Marie Bonaparte on the aggression on 1937 in Jones Vol .

The two components are aggression and libido and at the beginning of life the libido is low and the aggression is high and this makes sense because the baby needs to protect himself and if there is someone that is taking care of him can de-cathected the aggression because the object is not bad and can cathected the libido to the object.  Only at six month the libido will cross the aggression.

Of course this is a model and I use this model in assessment and therapy all the time to see the two different components, the amount of them and the interaction. And though this model I can make change on the reality.

Psicoterapia Breve

Seguendo un approccio psicoanalitico è possibile utilizzare la psicoterapia breve per ottenere dei risultati in solo quattro sedute. Naturalmente queste sedute possono essere anche viste come una consultazione iniziale per una terapia a lugo termine, e nello stesso tempo dipende dalle risorse disponibili nel paziente.

Dopo il primo incontro preliminare le tre sedutesuccessive sonon volte alla individuazione degli oggetti interni e della loro espressione.
Stabilire il rapporto di fiducia è essenziale per poter facilitare l’espressione dei possibili conflitti interiori e l’emersione di una fiducia di base in se stessi e negli altri.
Il ritrovamento dell’oggetto buono e rassicurante nel paziente se presente nella propria storia personale permete il riequilibrio interiore.
Certo non tutti hanno un oggetto interno buono e rassicurante e questo permette una fase diagnostica dove è possibile intravedere un possibile percorso più lungo che permetta la creazione del suddetto oggeto interno.
E’ uno strumento diagnostico quindi e curativo allo stesso tempo e questo in genere informa tutte le psicoterapie dove vi sono omenti di sviluppo e allo stesso tempo momenti di valutazione.
Per poter operare questa tecnica il requisito del terapeuta è quello di avere una vasta esperienza e poter riconoscere da subito le necessità e i bisogni dei pazienti.
Sperimentare intense emozioni nella stanza di terapia, riconoscerle e nominarle permette al paziente e al terapeuta di creare uno spazio di lavoro essenziale per il raggiungimento di un equilibrio psico-fisico.

Il duale: la formazione del bambino nel primo anno di vita

Lo sviluppo della mente individuale deriva da una relazione duale tra il bambino e la madre e porta alla creazione di due oggetti interni nella mente infantile nel corso dello sviluppo durante i primi anni di vita.

Alla nascita le sole funzioni corporee vengono attivate e nel giro di pochi mesi una prima modalità di funzionamento emerge, dove non vi è distinzione tra il soggetto e l’oggetto, una funzione altamente imitativa della mente delle funzioni corporee.
È solo con il processo di individuazione-separazione dalla madre intorno ai sei otto mesi che l’oggetto viene riconosciuto differente da Se’ ed iniziano a funzionare dei meccanismi più evoluti di introiezione e proiezione. Un primo oggetto interno inizia ad insediarsi nel Se’ infantile.
Prima di questo periodo le cure materne hanno permesso al Se’ di illudersi e di creare uno spazio interno distinto da quello sterno da una barriera dove il primo oggetto si insedia. Ma l’oggetto madre viene dal di dentro, la madre diventa prima estranea e poi esterna al bambino con la catastrofe della separazione.
Con lo sviluppo del linguaggio e del camminare, strettamente connessi al respirare, il bambino inizia a diventare più autonomo intorno al primo anno di vita.
Qui inizia a fare la comparsa sulla scena del padre che è il primo oggetto esterno. All’inizio egli è un duplicato della madre, e a questo periodo sono connessi i vissuti della scena primaria, dove i due oggetti sono sovrapposti.
Un oggetto che all’inizio si duplica per poi sdoppiarsi
Questo permette l’insediarsi nella mente del bambino del secondo oggetto e questo processo occupa tutto il secondo anno di vita.
Tra il secondo ed il terzo anno un’altra funzione viene rappresentata nella mente infantile, quella della riproduzione, del rapporto dei due oggetti che gli hanno dato vita. È solo in questo momento che inizia il Complesso di Edipo che nel giro di un anno si dissolverà per fare posto nella mente del bambino della ricerca di un oggetto esterno, ma tutto questo verrà congelato dal periodo di latenza ed è solo durante l’adolescenza che questa ricerca potrà avere inizio.
Come possiamo vedere ci sono due modalità di funzionamento della mente. Una di tipo aggressivo rivolta verso l’esterno ed una di tipo libidico rivolta all’interno. E’ solo con le cure materne che quella aggressiva diminuisce che permette alle cariche libidiche di essere investite fuori sull’oggetto.
Questo modello presuppone due tipi di interventi, uno di tipo interpretativo ed uno di tipo contenitivo durante il corso del trattamento.

G. and my first tool box

A four year old child in care and in adoption. I prepare for him the first toy’s box and I started to see him in the Family Centre three times per week. I brought the clinical case in discussion with other colleagues for the entire length of therapy. Still I remember vividly the ending of the work from me and for him a drawing of tears.
The face of this child remembered me a clown, with a pronounced smile, but fix, stuck, sometimes muscular. He behaved in a way to pleased me in order for me to take care of him, to accept him, to not be refused I offered him a space to play and he started to use the game from the box and he built a farm and he kept separated wild and domestic animals.
He used massively drawings.
This case remember me another case that I treated in this country, a four year old boy, with a single mother and a distractive behavior at school and home.
At the beginning he putted just colors on the paper without any shape, something abstract and terrifying. Slowly he started to differentiate the colors and to represent objects (house, tree) and person on the drawings.
R. was another clown, a facial expression of a dwarf in a circus, behaving and looking as an adult. When he asked to me to bring at home his drawings that he did in the sessions I said to him that he could make them at home. In this case the therapy was in a school, an institution with teachers, social workers and Senco involved.
I work in a therapeutic community setting with severe mental health adults. We are in between an hospital and a flat. They come from hospitals and like to get independent.
But, I think, the most important experience was my personal life. I grew up with and in the home of my grandparents. For personal reasons my parents left me there and I felt that my family was to my grandparents and I belonged to them.
When my parents took me back in a certain way I felt adopted or fostered by them and for long time I questioned myself “Why?” Just recently I started to remember and understand these feelings and in this way I have a privilege route these children and they experiences.
The needs to be protect, to put together two different families, to enrich themselves instead to feel deprived.
I think that it is difficult to work in this field for the amount of emotions, but at the same time, it is a good opportunity for me to use my personal and professional knowledge to help them.
I had in therapy a child and I went to visit his father who was in a therapeutic community for drug users. What I remember of this case is the diffidence of the grandparents.

The state of non-integration in the early mind

Introduction
D. Winnicott (1974) stated a difference between a non-integration state of mind and a disintegration  one. In the first stage there is no  difference between the subject and the object, but a state of fusion and non-differentiation. In the latter there was a differentiation, but the subject regress back in a non-integration state of mind as a defensive manoeuvre in order to survive.
The psychotic clients live in this state of non-integration, and the symptoms that they experience, like hallucinations, voices, detachment from the world, absence of time, belongs to the state of mind of a child of six months old before the process of separation-individuation stated from M. Maheler (1971).
E. Gaddini (1992) in his writings tries to develop the meta-psychological theory in a further way and he stated a difference between imitation (psycho-sensorial area) and introjection (psycho-oral area). In the first one the baby perceives the external world with a modification of his body. The latter one occurs only when a difference is extablished between the subject and the object (usually the mother) and the baby can put inside himself stuffs beacuase there is an internal world separated from an external one.
Moreover D. Winnicott (1971) stated a difference between a male and a female pure elements. In the pure female element there is no space for the libido because there is no differnce between the baby and the mother, the baby is the breast. In the male one, with the intervention of the figure of the father, the baby starts to differentiate himself from his mother. The world is perceived more objectively and the functions of time and memory are in progress.
I think that these differences are important in the comprehension of a non-integrated state of mind in psychotic clients. This is the continuity with a foetus experiences of a limited space through the womb and the placenta, and this state continues to exist after the birth till the psychological born around six – eight months of age. If we have in mind these ideas when we deal with this kind of clients, I think, would be more simple to understand them and to do not be angry with them.
For example, in the community therapy where I work, the symptoms of these clients, like untideness of the room, sleep roughly in the street, do not take care of physical patologies, reflect a non-integrated state of mind due to a disfunctional relationship with the mother at the beginning of their life.

Bibliography
Winnicott D. (1971). Play and Reality, Routledge.
Mahler, S. and Pine, M.M. and F., Bergman, A. (1973). The Psychological Birth of the Human Infant, New York: Basic Books.
Gaddini E. (1992). A psychoanalytic theory of infantile experience, Routledge.

The setting as a womb

Working in a psychoanalytic way allows the patient to regress to a dependency condition and in order to facilitate that, I think, that it is important to establish a contained setting. I give more importance to the frame than to the transference and for me the room represents for the patient the womb.
It is not just how we arrange the space, but also how we set up a beginning and an ending and we give a continuity to this. I consider a session as a sensation process and keeping in mind the link of these different experiences gives to the patients the possibility to perceive and to think and feel.
At the beginning of life,with the physical birth of the child, the mother keeps a continuity with the embrional existence till the psychological birth of the child and the realisation of his/her separation from the mother. This development process creates a sense of containment
The formation of the self with a border between the inside and the outside represented by the skin is the first step to recreate the function of the womb in the intrauterine life and the function of the mother in the extrauterine one.
The acquisition of the language, walking and breathing is the ultimate step in the accomplishemt of the development process and to open up to an individual existence.
The therapy goes in the opposite direction of the development process and for this reason it is important to recreate all the condition to allow the process of regression.
When the child draws a circle at two year of age this is the first representation of himself, an inside separate from an outside world, where he can picture on it the mouth, and after the eyes, the noise and the ears.
In the same way our setting represents this round shape figure where we welcome the patient and we facilitate the regression from an independent to a dependent condition free from conflicts as the dyad mother-child at the beginning of life.
In this space and time of the sessions we have the privilege to observe the dynamics of the patient and of our self and making sense in what it was till than moment not understandable.
An important role has in this process the presence of a third person, that in the case of the therapy is the supervisor or the analyst, and in the case of the child mother dyad is the presence of the father, who support the mother and pull the child out of the dependency from the mother.