PRE-NATALS/POST-NATALS: THE TOTAL PERSONALITY
A memory of the future/The future of psychoanalysis
Dr. Elizabeth T. de Bianchedi
Lic. Ricardo Antar
Dr. Marcelo Bianchedi
Lic. Lía P. de Cortiñas
Dr. Silvia Neborak
Dr. Anna G. de Kaplan
Lic. Martha M. de Saenz
Dr. Robert Oelsner
"Is it possible to talk to the the soma in such a way that the psychosis is able to understand, or vice versa?" With this disquieting question Bion ends his article Evidence (1976c). In this paper we will try to find some answers -- which we hope will not be the death of the question -- as suggestions to continue thinking about the infinite domain of the mind.
Analyzing the aforementioned sentence, a first interpretation would imply that psychosis is in the soma, or that psychosis is a basically somatic process. However, as psychoanalysts we believe that it should not be understood as a materialistic reduction of mental disease (so dear to psychiatrists and neuro-physiologists). We rather believe that it implies a strong conjecture about the most primitive aspects of the mind -- mind which originally, in its "proto-mental" state, is yet little differentiated from the body. Bion himself, in Doing the Best of a Bad Job (1979, p. 250), says: "I dislike terms that imply the body and the mind, therefore I shall use Self to include what I call body or mind, and a mental space for further ideas which may be developed. The philosophical statement of this approach is Monism."
The term psychosis has a not very happy penumbra of associations, and a generally negative attribution of values -- to which we are well used to .
In fact, Melanie Klein has been criticized for calling infants psychotic, for example when she speaks of the psychotic anxieties which infants often suffer, and when she calls the schizo-paranoid and depressive positions psychotic positions (1934). Even if Melanie Klein herself (1934) , as well as many members of her school raised voices against this criticism, holding that she had said it making an analogy with mental disease, it is not easy not to interpret her formulations about babies in this sense.
Bion, working psychoanalytically with severly disturbed patients (schizofrenics, borderline personalities, etc.) also included, in his hypotheses on schizofrenia (1956, 1957) a number of essential features, among which was a preponderance of destructive impulses. A few years later he included, as factors, (Kleinian) envy and extreme greed. We know that in that period his thought was strongly influenced by Kleinian theories, and that in function of these theories he was able to formulate original hypotheses about psychotic illness in the adult, relating these with severe difficulties during the schizo-paranoid position, which would then affect the transition to and the passage through the depressive position. Bion (1959) specifically speaks of a psychotic infant, but this is not the Kleinian normal psychotic infant (a contradictory expression, if there is one...), but a baby with already severe difficulties in the first months of life. Bion sees these difficulties partially related with the infants drives and its very low tolerance of frustration, and partially with the environment, basically the mother, with a not good enough capacity for contact and containing mental functions.
Already in 1955 Bion introduced the strong conjecture of the existance of a "psychotic part of the personality" in every human being. This part can take command of mental functioning and give rise to all the disturbances we know as psychosis or psychotic functioning. This is one of Bions hypothesis which has enormous acceptance, and is being used, as a formulation -- and sometimes, unfortunately, as jargon -- by a large part of the psychoanalytical world. By holding that every human being can, in certain circumstances, have a regressive or severely disturbed behaviour, Bion takes away some of its medical/psychiatric significance. However, while sustaining its universal existance and yet maintaing the adjective psychotic, he retains its negative valoration.
Returning to the initial quotation of this paper, we can see that in that period (Evidence, 1976c), the word psychosis is still present. However, in his last books/papers , Bion began to give more importance to the pre-natal part of the personality in the total mental functioning. This has made us think these terms over -- psychosis, or psychotic part of the personality -- and the possibility of substituting them by other ones.
In these last papers (see note 5) he tries to call our attention to aspects which last in the personality, aspects which have a very archaic origin and whose manifestations he calls vestiges of pre-natal phenomena. He also invites us to expand psychoanalytic intuition, thinking beyond what is already known and making new imaginative and rational conjectures.
An imaginative conjecture formulated by Bion (1976c) is that a foetus, almost at term, "...could be aware of extremely unpleasant osscilations in the amniotic fluid medium, before transferring to a gaseous medium -- in other words, getting born..... suppose this foetus is also aware of the pressures of what will one day turn into a character or a personality, aware of things like fear, hate, crude emotions of that sort." He can also feel some particular disturbance, i.e. noises coming from the mothers digestive apparatus, of the parents not getting along well, fighting or making loud noises, etc. The foetus can then ominpotently and agressively direct himself to these disturbing emotions, these germs of ideas/feelings, and split them, destroy them, fragment them and try to evacuate them. But is this not the specific mechanism Bion described as the best method one has to evade contact with non-tolerated internal and external reality ?
In his paper On Hallucination (1958) (written during his -- so called by Bleandonu -- psychotic period) he describes visual, auditive, olfative and cenestesic hallucinatory phenomena, which he understands as evacuations of non-tolerated aspects of the personality, made by non-realistic proyective identifications through sensorial organs. But later on (see note 5) he refers these visions, hearings or impressions to possible pressures on the optic and auditive pits of the foetus or embryo. And he also relates this with seeing stars after a strong blow on the solar plexus, and to certain light patterns in migraneous headaches. He suggests that these situations could really come from pre-natal levels of the mind.
As to proto-emotions, Bion calls them "sub-thalamic terror". With this term he means a kind of fear or auto-agression which is not controlled by the higher levels of the mind, and therefore has no mental meaning, being a vestige of pre-natal parts activated in a certain moment. He refers this sub-thalamic terror to physical reactions related with the adrenals and the secretion of adrenaline, which carries the individual to immediate and un-thought fight and flight reactions. Could these be correlated with psychotic (again, the negative term..) behaviours of extreme violence, like murders or suicide? This conjecture seems to refer more to the body than to the mind, or belong to a period in which the function we call mind was not yet in operation.
In Caesura (1975) Bion holds that: "...In analysis we are seeing a total personality who has at some time, consciously or unconsiously, chosen a particular view or a particular vertex from which to see the view. This always involves inhibition of the capacity to see the views that one does not want to see. The psychotic patient may be anxious to suppress, be blind to, or unaware of what the sane person is able to see; the character is psychosis minus neurosis, or psychosis minus sanity, or sanity (rationality) minus neurosis or minus psychosis. The important thing is not that the patient is a border-line psychotic, or a psychotic or neurotic, but that he is a total character minus....". And we think that, if the total personality includes everything; pre-natal aspects, normal and psychotic baby parts, little girl/little boy parts, latent, adolescent and adult aspects, etc. , then it is possible to see the patient as an adult minus child, or minus baby, and/or minus foetus/embryo. Certain analytic theories -- not Kleinian ones -- deny that very primitive or baby aspects of the adults personality can exist and present themselves in the analysis of an adult patient; these theories see the adult minus baby or new-born.
In the Memoir of the Future (1975/7/9) Bion no longer speaks of psychotic and non-psychotic parts of the personality, and we find that his model of the mind made of pre- and post-natal characters displaces the previous one.
The pre-natal characters, like Somite Three and Em-Mature, do not seem to have a psychotic functioning; rather, they have valuable gifts, like the intuition of danger, sub-thalamic fear and contact with dream life, but also a strong resistance to be born, that is, to live in an gaseous medium, the shared world which demands individual renunciations in favour of the need of adaptation.
In the first chapters of Book III of A Memoir of the Future (1979), one can see the impossibility of understanding between the pre- and post-natal characters as well as, in a lesser degree, between the infantile and adult post-natal characters. This could be another interpretation of the Babel myth, no longer seen as punishment of curiosity, but rather taking the incomprehension of languages as coming from the minds own splitting.
Here there seem to be at least two caesuras: perhaps the less dramatic one would be the one which in the Freudian model is the repression of infantile sexuality (Bions infantile characters) carried out by the Ego in name of the Super-ego (Bions adult characters). The other, the more dramatic caesura, is the one existing between the pre-natal and post-natal characters. What happens, for example, when Em-Mature, who understands nothing about the external world, and Twenty-four, who denies his relation with the pre-natal, collide in the mind? They cannot share their respective points of view, and they argue and fight without realizing that both have their reasons. Since this problem is generalized among the different characters, taking the form of an incurable fiendship, we think that here we here have another model for describing the usually so-called clinical psychosis.
Bion suggests that the presence of these vestiges can also generate creative aspects. Already in Attention and Interpretation (1970) he comments that: "Genius has been said to be akin to madness. It would be more true to say that psychotic mechanisms require a genius to manipulate them in a manner adequate to promote growth or life (which is synonimous with growth)." Later on, in Caesura (1975), he says: "...We could regard artists, musicians, scientists, discoverers as those who have dared to entertain these transitive thoughts and ideas. It is in the course of transit, in the course of changing from one position to another, that these people seem to be most vulnerable..... At the same time they are vulnerable to the observations of others who cannot tolerate the totality of the human personality and therefore cannot tolerate someone who is so mad, so curious, so eccentric....... there is ... something to be said for noticing the hostility and resistance which is stirred up by the creature which is different from ourselves, or the state of mind which is different from our own, or our own state of mind which is so different from that which we like to think we can always present to our fellows" . In these quotations, the more primitive aspects of the mind (previously called psychotic) are also possible fountainheads of human originality and creativity -- if the means for trascending caesuras are found. In this respect, to continue using the psychiatric nomination psychosis when refering to the proto-mental states of the total personality, leads to serious mistakes, which are equivalent, in another context, to the application of the medical model to a psychoanalytic treatment (Bion, 1970).
In 1975 (p.55) Bion wonders: "...how to trascend the caesura when one is in movement from one state of mind to another; how to surpass the various obstacles in the course of a psychological or spiritual journey of development?". And almost immediately he asks: "...whether to regard those obstacles as pathological, (needing pathological terms to describe them, or whether they are in fact non-pathological?" . He is referring to "....what we do not know and are not aware of, because it is unconcious and ... may even be pre-natal, or pre-birth of a psyche or a mental life, but is part of a physical life in which at some state a physical impulse is immediately translated into a physical action, ... and this ... even when we are dealing with potentialy rational and articulate persons".
We find that in these last quotations Bion himself suggests we use pathological terms (as psychosis, neurosis, borderline psychosis, autism, etc.) to make reference to states which perhaps are vestiges, in the personality, of more primitive and unknown aspects. These reflections bring us once more to the initial phrase of this paper, because then, another interpretation of it is that in it Bion uses the term psychosis -- so well known by him and by those of us that have studied and extended his theories -- to indicate that the body and the more primitive aspects of the mind co-exist, but not necessarily as pathology.
We believe that another consequence of considerng the psychotic part as a pre-natal presence, is that envy, understood in its Kleinian-Bionian conceptualization, would no longer be a central factor in its understanding/interpretation. If the pre- and post-natal intolerance is to feelings, perceptions, and proto-emotions/proto-thoughts -- because of the emotional turbulence they generate in the inchoate personality -- and if this intolerance becomes hatred of internal and external reality, then we are referring to an excessive intolerance of frustration and/or pain, and not to an envious and greedy attack on the good object. This is stated by the character Em (Em-mature), in Memoirs of the Future (Book III): "...Shape nothing lips......be shelled eyes ......". Another model of excessive intolerance could be the absolute ear: one who has it cannot listen to the melody because he is deafened by the slightest discording sound. The topic of tolerance/intolerance of frustration requires a wider discussion and perhaps a specific paper. For example, do foetuses recognize frustration?
Taking the article Evidence (1976c) up again, and the imaginative conjecture there stated, the pre-mature and well gifted foetus, which tried to get rid of his inchoate personality during intra-uterine life, can then traverse the caesura of birth and suffer new vicissitudes and traumas.
"Being so precocious, so premature .... it tries to get rid of its personality to start off with, and then, after birth, can be highly intelligent .... being able to learn (¿by imitation? ) words, phrases, concepts of good and evil. But as far as he is concerned, he may preserve a mind at the deeper level which knows nothing about that......feeling, however, a primitive fear which is transformed into action." And these somatic or muscular actions -- generated by sub-thalamic fear -- can mistakenly be considered as products of envious attacks by the analyst and/or by the social group as clear evidence of psychotic illness.
We think that the proto-mind (which is pre-natal), originally not discriminated from what is body, remains in the born personality, but their relationship is conflictive throughout life. We are permanently risking to lose our embrionary intuition (The Grid, Bion, 1971), and not only through extreme envy or greed, but because of an intolerance of dialoge between the different parts of the personality, with their consecuent confusion of languages. New caesuras risk our capability to intuit/think -- that not always desired gift -- and may generate olfative, auditive and visual, evanescent or persistent hallucinations. Or give rise to different actions -- of the action/reaction type -- without interposing thought.
From this new vertex, the problem psychoanalysis has is how to transform somatic or muscular actions first into feelings and then into thoughts. Dogs smell fear, human beings dont. How are we to regain the smell of fear without having it promote an unthought action?
We started this paper wondering if it is possible to speak to the soma in order that the psychosis can understand, or spek to the psychosis in order to have the soma understand (the vice-versa in Bions question). We are not sure of how to do this in our clinical wok, but we do believe it is possible, by widening our registers, and through this, our tolerance of what we previously heard and excluded as interferences.
We psychoanalysts retain the hope of being able to integrate the different pre- and post-natal characters of the mind. As PA (psychoanalyst), one of the characters of A Memoir of the Future (Book III), holds:
"P.A.: I think it might some day be possible for them all to be awake and carry on a fairly disciplined debate.
Robin: I doubt it. I sometimes think it saves my sanity that most of them are usually asleep. Its bad enough when its only two or three talking at once.
Roland: Thats only because they all talk a different language."
In this dialogue we see the psychoanalyst express the hope that the pre- and post-natal parts of the mind may interact in the total personality; while Robin seen that maintaing the caesura guarantees sanity. We believe that what psychoanalysis tries is to help the personality to become total, tolerating the co-existance and evolution of the different parts.
The caesura has to be traversed in both directions, from the pre-natal to the post-natal, and viceversa. To resolve these problems of communication psychoanalytically implies the development of negative capability and language of achievment. "The artists have a great advantage because they can resort to the aestethic as an universal linguistic". (Bion Evidence, p. 1976c). In the Memoir of the Future, when the different characters fight, in comes Leonardo telling them to be quiet and to look at his drawings. We believe his drawings represent a pictorial language of achievment, capable of trascending the caesura in both directions and tolerating the emotional turmoil.
In this paper we are wondering in what direction psychoanalysis will evolve. To name the part once called psychotic pre-natal does not solve the problem, although it invites us to think of the total personality. One of the proposals of psychoanalysis is that we examine our biological roots and our primitive being, together with the more civilized aspects of the personality. We human beings have developed intelligence, and, through it, technology. Does our mind, although rudimentary, have the possibility of evolution to achieve wisdom?
The fear of the disruptive force of new ideas --- and psychoanalysis is one of these -- tends to make us take refuge in familiar and well known ones. The notion of psychopatholgy is one of these. There are forces, opposed to the development of psychoanlaysis and the evolution of the personality, both in the patient and in the psychoanalyst. The possibility of achieving an evolution is connected with the difficult job of achieving a dialogue between the different parts of the total personality. All of us have had intra-uterine and infantile experiences which we have forgotten (infantile amnesia) or eliminated (through splitting and proyective identification), or omitted; this implies an empoverishment. It is a loss of the vital contribution these archaisms give the personality (Bion, 1976b). The great thinkers of psychoanalysis -- Freud, Klein, Bion -- have not forgotten them, and thus permitted the evolution of the psychoanalytic idea.
In Making the Best of a Bad Job, Bion (1979) suggests three principles of Living: first, to feel, then, anticipatory thinking, and then feeling plus thinking plus Thinking. This Thinking is synonimous with prudence and foresight which leads to action. We believe that feeling is originally a primitive response to pressures; anticipatory thinking an equivalent of the pre-monition (Bion, 1963) with alpha-function at work, and prudence/foresight that which leads to action beyond the reality principle, generating real creativity. And wisdom.
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