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Tustin

This column also appears in the May/June, 2011; Volume 23, Issue 3 of The Therapist, published by the California Association of Marriage and Family Therapists (CAMFT).  Abstract page 74.

Abstract:

The capacity to use words and language as symbols of communication is a developmental achievement borne of the elegant and mutually regulating mother-infant dyad.  This paper examines what occurs when emotional catastrophe compromises this sensitive process, and speech and words come to be used instead to defend against annihilation anxiety, dread and psychic “black holes” associated with primitive mental states.  The perspectives of Bion, Ogden, Grotstein and Tustin are used in conjunction with case material to explore these early modes of self-other experience that might be construed as pre-object relations, as they are primarily sensory in nature.   Consideration is given to the ways speech is used as an autistic object/shape engendering isolation rather than as a symbolic mode of communication promoting enhanced relationality and subjective meaning.

Language was the conjurer, indeed the philosopher’s stone, language was a form of alchemy.  It was language that elevated meanness to the heights of art.  Like the irritating particle that bred the nacre of the pearl, language ameliorated the gnawing irritant of existence; it interceded between the wound and the dream. Henry Roth

Laurie’s uninterrupted speech knocked me about like a strong wave slamming into an unwitting swimmer who has unwisely turned her back on the sea to gaze anxiously toward the safety of shore.  She would commence speaking the moment she arrived in my consulting room and, if I didn’t intervene or attempt to interject a comment during the ensuing forty-five minutes, would continue until she departed.  I felt intrusive if I intervened, invisible if I didn’t.

For months I looked for meaning in this verbal splatter, something elemental in her eruptions that I might transform and return as both useful and usable.  I struggled to know her, tried to like her.  Feeling superfluous, I was ashamed to find myself looking at the clock repeatedly during sessions and exceedingly relieved when they ended.

Conceptual imagery and word shapes

Taking shape in my mind, her speech appeared as meaningless glyphs, disenfranchised words comprised of loosely formed letters, their varied sizes and shapes barging forward or receding.  Oblivious of the time frame, Laurie’s sessions began to seem endless, requiring gentle reminders to allow her ample preparatory time to reorganize herself and leave.  Any specific reference to the separation anxiety associated with endings would evoke another gush of speech that was almost impossible to interrupt.  I looked for the needy baby behind the noise.

Our sessions had no discernible beginning or ending, just an ongoing flood of speech.   There were few thoughtful troughs between waves, just endless sets rolling toward shore across the surface of a vast sea of words flooding the room.  For a long time, she and I were lost at sea. When she wasn’t speaking to me (or at me), she was talking on her phone, filling the waiting room with sounds that made me wince, and I felt violated by her incessant vacuity.

Collapsed psychological space

The Mona Lisa

Maternity

When we spoke on the phone, her compulsive speech would begin the moment I greeted her, regardless of the purpose of the call.  Unable to differentiate between a formal phone session and a simple business-related call, she leaked words in a manner that suggested her inability to sustain any sense of foundational boundedness.  She experienced words, thoughts and actual bodily contents as equivalencies and was unable to plug holes in her still rudimentary sense of self.  As Odgen described, she was “creating a substitute for the space between mother and infant in which the infant ordinarily finds a place to live between self and other (Ogden 1989, p.66).

Desperate verbiage filled any potential space in which we might have engaged one another meaningfully.   I felt like a theatrical prop that existed simply to absorb her bizarre recitation of the loosely associated and circuitous events of her life daily life, her errands and shopping excursions, her family irritations and interactions.

She would frequently wander through time leaving me to find links in the massive holes in her narrative.  A present time reference to her sister in once sentence would shift decades in the next, the pronoun “she” no longer representing her sibling but her aunt.  Why are you telling me this? I wondered.  What are you really trying to tell me?

She buried me with words, and any attempt to proffer an empathic interpretation or comment was bulldozed with a quick nod and continuation of her monologue.

Any pause in her continuous production of words seemed to provoke terrible dread and annihilation anxiety.  I began to dread her sessions with equal intensity.  No psychological space (Heller 2010) existed in which she and I might engage.  I frequently felt useless and unnoticed.  Who failed to acknowledge you? I wondered.  Who left you alone?  Who couldn’t or wouldn’t speak your language?

Her capacity to utilize the creative potential of psychological space had collapsed like a weak lung, or perhaps a lung that had never filled.  For many months, there was no space for me to offer anything other than my presence and willingness to be used as a container, an exogenous lung.  I felt suffocated, as if the air were being sucked from the room and experienced uncomfortably deliberate urges to fill my lungs to capacity and inhale great breaths of air.

I was to learn eventually that she had sustained a collapsed lung following a childhood accident, so the lung imagery that arose in the analytic third (Ogden 1994) during moments of reverie* were salient and permitted me to begin to comprehend and decode what she was broadcasting unconsciously.

Behind this blinding white water spew of distraction, I found that for a moment, I could grasp the sand with my toes and withstand the currents.   I listened and attended to her pressured and compulsive speech as if I were caring for a screaming infant.  Using a soothing and modulated tone of voice and carefully paced speech as swaddling, I began to open a small space in which we might initiate and share a relational exchange.

The importance of learning from experience

The repetitious nature of her narratives signified her inability to build upon her own ideas and thoughts or upon the co-constructed foundations of shared interpersonal moments.  She would repeat what appeared to be almost scripted sequences again and again, as if she’d never spoken them and I’d never heard them.  Each narration was isolated and unlinked to any other.  She could not make use of earlier versions to work through, learn from or adapt subsequent renditions.

From a Bionian object relations perspective, Laurie could not think with her thoughts (Bion 1962.) They functioned as impulses to speak, nothing more.

Her proto-thoughts existed as beta elements (Bion 1962), sensory bits that had yet to be symbolized and transformed by alpha function and language into meaningful ideas upon which she and I could build.  Paradoxically, Laurie used words not as symbols of communication but as protective amulets to avoid a dark psychic void, a whirling vortex of nonbeing from which she feared she might never return.   As her word waves crashed in, I felt the concomitant pull of dangerous rip tides.

Into the void

Psychic voids represent gaps and fissures in the emotional floor of an infant’s foundational and rudimentary sense of being that expand into gaping and engulfing black holes (Grotstein 1990).  They signify the reverberations of an emotional catastrophe (Tustin 1981) between mother and infant, precipitating what the young child experiences as an endless free-fall in unbounded space.

Despite her mother’s actual presence, Laurie’s needs exceeded what her distracted mother was able to provide.  Lacking adequate maternal protection and containment, Laurie was left to manage confusing and frightening sensory experiences without the aid of her mother, the one person who could symbolize, interpret and transform them into meaningful psychic structure.  Instead, Laurie’s inner landscape was filled with dangerous sensory-affective potholes into which she feared she might trip and fall forever.  She defended against these terrifying threats of annihilating engulfment by filling the holes with meaningless noise and word-spackle.

The autistic-contiguous mode of experience

Evidence of this ancient catastrophe was manifest in Laurie’s default defenses and select mode of experience that reflected presymbolic and sensory rather than more fully mentalized object relations, consistent with what Ogden (Ogden 1989) designated the autistic-contiguous mode of experience.

Lacking a psychological skin (Tustin 1994), Laurie used words as palpable, sensory objects to scab over her flayed emotional self.

While repetitious speech defended against perilous psychic voids, it preserved her stasis in isolation and precluded any viable relational connection.  Like an insect preserved for eons in amber, Laurie was frozen in time and continued to rely on the autistic-contiguous mode of experience with little variation and without the addition of more mature modes that would permit empathy, mutuality and relational engagement.   Once after having learned coincidentally a fact about my personal life, she remarked, “We don’t usually talk about you, do we?”  For a moment, she saw me not simply as an extension of herself but as a separate object with discrete subjectivity of my own.

Working in the transference-countertransference matrix

In response, I experienced potent sensory and somatic countertransference sensations, often feeling drowsy though not bored.  Cringing was my strong response to feeling “tyrannized by an automaton” (Ogden 1989, p.44).  I frequently felt as if I could “crawl out of my skin” or twitch out of my chair as I sat with her, tortured by her inane recitals until I realized that she needed to use my skin and body as a substitute for the psychic skin she lacked.  To contain her unformulated and fragmented self, the beta bits she could not integrate or use, she was trying to burrow under my skin where she might feel shielded by its consistent surface.

And the word-shapes I perceived in reverie* were the autistic shapes (Tustin 1984) that constituted Laurie’s early object relations.  These are sensory, felt “shapes” arising when an infant touches soft objects.  Not yet perceived as separate, they represent the sensory edge of experience whereby warm and sensual contact objects such as bath water and skin or mouth and nipple are experienced by the infant as conjoined.

Surface contact is identified as a soft shape with its own mode of proto-object relations.  This sensory position is operational throughout life but serves a primary function in infancy, preparing a baby to distinguish hard from soft, animate from inanimate, me from not-me.  Imagine the contact friction where the surface of your skin meets the clothes you are wearing as a soft, warm shape representing conjoined rather than separate objects.

Long after the infant acquires the capacity to discriminate self from other and has developed more mentalized modes of experience, the autistic-contiguous mode remains her portal to tactile sensuality and sexuality.   We might think of it as “regression in the service of sensation.”

My countertransference feelings of intrusiveness had their correlate in Laurie’s early life when she felt her infant self to be an unwelcome intruder in her mother’s world.  My feelings of invisibility were linked to Laurie’s experience of herself as ignored and unacknowledged.

Evidence of premature separateness

Before she had acquired the capacity for self or object constancy and a subjective sense of individuality, Laurie’s infant self could only experience premature separateness as annihilating.  Lacking an emotionally attuned mother to modulate and reflect her existence back to her with delight and joy, she felt obliterated.

To bridge the perilous gap between existing and not existing, Laurie made noise.  If she didn’t intrude, she felt herself disperse and disappear into the ethers.  Noise verified her existence.  Though exiled, she was alive.

Laurie’s fall through space was as endless as our sessions often seemed.  I tried to break her fall by acknowledging her sensory needs and bundling her in my psychic skin.  She longed for contact, but had isolated herself behind an autistic, synthesized crust that seemed impossible to penetrate.  Despite the endless topical speech, terrible feelings of isolation and meaninglessness (Grotstein 1990) permeated our sessions leaving me feeling drained and ineffectual.

Laurie’s inability to distinguish between major and minor, foreground and background, significant and insignificant suggested the severe degree to which her sensory-affective experience and nascent thoughts remained conjoined at the surface and undifferentiated qualitatively.  What had originally begun as an early mode of sensory experience, a primitive awareness of self and object-other, had become a concretized and unyielding state in which she was rigidly stuck.

She would talk to a complete stranger just as she talked at me.  Everyone existed to provide archaic psychological functions for her, all interchangeable heads.   I was indistinguishable from a store clerk or gardener or anyone who would listen.

Autistic objects and shapes

Speech served several vital functions for Laurie.  In addition to representing autistic shapes, she also used speech-words as autistic objects (Tustin 1980), sensory dominated object-things used in impersonal and idiosyncratic ways.  Just as individuals with dementia will touch the surface of a nearby table or an edge of cloth as a means of sensory orientation, a feeble attempt to locate themselves in space, Laurie attached herself to objects at a sensory level, using relentless speech as adhesive.  She used speech like sonar to locate herself in proximity to me.  Speech conveyed painful affect not meaningful content.  The significance of my empathic attunement was evident in her choice of words that suggested skin contact and sensation, frequently remarking that something I did or said “touched” her, though she rarely could articulate why.

Considered retrospectively, I am now aware of the frequency with which Laurie referenced geographic and personal space, using them as metaphors for terrifying sensory-affective experience and unmet needs.  She would describe in detail aspects of the homes in which she lived as if she were describing physiological topography, using distance, walls and the impress of small rooms as autistic shapes and objects.  Some rooms felt containing while others did not.

Laurie would occupy herself making mental “shapes” from the lines and holes on the acoustic ceiling tiles on the occasions when I was out of the consulting room and would describe them to me when I returned.  I came to comprehend that these shapes were metaphors for early sensory experience that had never been symbolized.  She was trying to construe something meaningful from the discrete self-states and events in her life that felt random and disconnected.

Young girl dreaming

These “holes” were indicative of primitive mental states associated with sensory experience, particularly touch and the skin.  She entered a very childlike state of reverie associated with bouts of childhood illness when she would lie feverishly in her bed and look for design patterns and shapes in the ceiling above her head.  Neglected for long periods of time by a narcissistic and depressed and disengaged mother, she was left to make meaning of her sensory-affective experiences alone.

Making meaning of trauma and discontinuous self states

Having experienced little continuity of being, Laurie used word-shapes and objects to bridge holes in her discontinuous self states.  Uninterrupted speech served a critical survival function.  It prevented her entire sensory floor from falling away beneath her, pitching her into a dark sea or an engulfing black hole (Grotstein 1990).

Her torrent of words represented the only net she could use to defend against the terror of discontinuity and the nullifying anxiety associated with fathomless psychic voids.  She chattered at the edge of a gravitational vortex she could not overcome any other way.

Instead of suggesting creative potentiality, psychic space (Heller 2010) threatened to devour or engulf her in a state of utter nonbeing.   Unspeakable traumata were smothered in meaningless talk.  Unless her discontinuous self states were tied together with word-strings, Laurie ceased to exist.  Together we worked at the edge of meaning, trying to find symbols to represent unformulated experience.

Speech-noise represented the only girdle holding her together.  She could use words like Lycra, but she couldn’t think with them.  When I once asked who hadn’t cared for her, she stopped talking and wept.

As I began to comprehend her great need for foundational and sensory stability, we began to work at that level, using language that described her bodily and skin sensations in an effort to improve the quality of relatedness and transmute vowels and consonants into psychic scaffolding that might provide a reliably sturdy structure upon which she could rest.  When she initiated a stereotyped recitation, I stopped her and shifted to affect and bodily sensations, and eventually, she began to say, “I feel…”

Using language to create ongoing and increasingly complex stories and narratives from her ceiling picture-shapes and beta elements, she began to acquire the capacity to forge links and symbolize her unformulated experiences rather than simply repeat isolated segments.  Continuity and creativity began to replace abbreviated repetition.

Using my own thoughts, feelings and pictorial imagery as finely tuned instruments to track her unconscious communication in the intersubjective matrix, I learned to gauge her needs.  We worked as alchemists, using alpha function to transform base words into meaningful language.

Every single moment of reflection or reciprocity constituted a decisive achievement, rising like a small island in an otherwise illimitable and unremitting sea.

By slowly symbolizing and linking Laurie’s experiences and self-states over time, using circles of communication (Greenspan 1997) to expand her capacities to both think and relate to me as a discrete other, we began to see a varied and enduring archipelago of meaning emerge from her sensory seabed and coalesce into psychic structure.

 

* Reverie: Bion’s (1962) idea describing the analyst’s state of receptivity to her patient’s unconscious experience that parallels a mother’s receptivity to her infant’s raw, asymbolic or pre-symbolic experience.

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Citations

Bion, W.R. (1962). Learning from experience. Classic Books. (Locale unknown)

Bion, W.R. (1962). The psycho-analytic study of thinking. International Journal of Psycho-Analysis, 43:306-310.

Greenspan, S (1997).  Training conference, Anaheim, California.

Grotstein, J. (1990). Nothingness, meaninglessness, chaos and the black hole Part I – the

importance of nothingness, meaninglessness and chaos in psychoanalysis.  Contemporary Psychoanalysis, 26:257-290.

Heller, M.L. (2010). Working in psychological space Part I.  The Therapist, volume 22/issue 3, March-April.  Also posted online: Inside Out Journal at insideoutjournal.com

Heller, M.L. (2010) Working in psychological space Part II. The Therapist, volume 22/issue 4, May-June.  Also posted online: Inside Out Journal at insideoutjournal.com

Heller, M.L. (2010) Working in psychological space Part III.  The Therapist, volume 22, issue 5, July-August.  Also posted online: Inside Out Journal at insideoutjournal.com

Ogden, T.H. (1989) The primitive edge of experience. Jason Aronson Inc., New Jersey, London, p.66.

Ogden, T.H. (1994). The analytic third: working with intersubjective clinical facts. International Journal of Psycho-Analysis, 75, pp. 3-19.

Roth, H. (1994). From bondage. Picador USA, New York, p. 77.

Tustin, F. (1980). Autistic objects. International Review of Psycho-Analysis, 7:27-39.

Tustin, F. (1981).  Psychological birth and psychological catastrophe.  In Do I dare to disturb the universe: a memorial to W.R. Bion, ed. James Grotstein, Caesura Press, 181-196.

Tustin, F. (1984). Autistic shapes. International Review of Psycho-Analysis, 11:279-290.

Tustin, F. (1994). Autistic children who are assessed as not brain-damaged. Journal of Child Psychotherapy, 20:103-131.

 

 

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