II. A Brief Introduction to the thought of Armando B. Ferrari

This paper describes the work of Armando Bianco Ferrari whose central tenet is the very direct relationship between the body (Concrete Original Object) and the mind to which it gives rise, but which is also mind's first and essentially only real object. Ferrari's approach offers an important avenue of approach to the treatment of psychosis, psychosomatic illness and anorexia, for instance, as is recorded in a by now growing Anglophone literature. The direct relationship between body and mind is in contrast to the object relations model in which this relationship is mediated through the breast. The paper starts with a short biological sketch of Ferrari's life before describing his theoretical position. This is largely concerned with the relationship between the mind and its body, the so‐called ‘vertical axis’, and that with the external world which he calls, the ‘horizontal axis’. The relationship between body and mind is achieved through the means of a ‘contact net’ (as opposed to Bion's contact barrier) and the evolution of ‘language registers’ out of patterns of bodily experience. Ferrari's formulation also involves modifications of the ways he conceives the ego and the oedipal situation (‘Oedipal constellation’), especially in the light of what he takes to be an innate femininity and masculinity in either sex, as well as the way in which he frames ideas about health and illness. The fact that the emphasis is directed towards the subject's direct apperception of the sensational and emotional life of his body rather than one mediated exclusively via the object involves a parallel shift away from the transference as always necessarily central to interpretation, without of course dispensing with it or suggesting that it is not ubiquitous. This is one of the various clinical implications of Ferrari's model which is discussed before offering an illustrative clinical vignette, and finally relating Ferrari's thought to some other current theoretical and clinical formulations.     

A THREAD IN THE LABYRINTH: RETURNING TO MELANIE KLEIN'S CONCEPT OF PROJECTIVE IDENTIFICATION

This is an attempt to clarify the confusions which, I argue, have accumulated in the uses and meanings of the term ‘projective identification’. As a remedy, I propose a return to Melanie Klein's original concept which focuses on the mental activity of the person in whose mind the projective identification takes place. I cover the early territory of Klein's definition and Bion's alteration of this, with its sole focus on PI as a communication which is dealt with in various ways by its object. Thomas Ogden followed his example. This narrowed the field opened by Klein. The confusions caused at this time persist today and render the concept less useful than it could be. I distinguish between projections and projective identifications. Further, I discuss five main types of projective identification and try to show that only one of these is evocatory; that is, only one involves a responding object. I hope to show that the concept, as devised by Klein, has a family of uses, all of which can be grasped fairly easily if we concentrate on the state of mind of the subject ‘owning’ the projective identification. While evocatory PIs, which affect their objects and prompt certain responses, are part of the therapeutic process, other types of PI are equally important although harder to grasp.     

Intuition from Beginning to End? Bion's Clinical Approaches

This paper is intended to offer a foundation for comparison of the approaches of Wilfred Bion and Donald Winnicott. In particular, I try to plot the oscillation of Bion's clinical method from his early Group period at the Tavistock Clinic (up to around 1950) when he emphasized countertransference; his part‐object interpretation method in the 1950s after his analysis with Klein when he and colleagues were experimenting with the psychoanalysis of people in psychotic states (1953–59); and then his return to his investigation of the intuitive approach to clinical data, around 1965–70.     

The Enlightenment of Evidence and the Leap in the Dark

This article is a free inspiration following R.D. Hinshelwood's ‘Intuition from beginning to end?’. The author tries to show Bion's Kleinian skill to listen to every detail of the clinical hour, picking up clues and putting them together to render meanings and presenting them to the patient. While doing so, Bion created a richness of concepts for analysts to try out as tools for observation and understanding of their patients’ mental functioning. Several of these concepts along with the clinical inspirations are described here. The author believes, therefore, that even during his ‘loyalty to Klein’ period, Bion was also extremely creative though inspired by Klein. When it comes to intuition, the author prefers to be modest, listen to the patient's free associations and allow intuitions to mate with concepts before getting back to the patient.     

Once And For All Time,Always The Same?

This paper gives an account of the early stages in the analysis of a young woman whose parents were unable to make sense of her feelings as a child because they were unable to do so for themselves and bombarded her with theirs. The result was that she remained a stranger to her feeling, which was largely dissociated having never been ‘mentalized’ or converted into alpha elements, so that she mostly experienced it as undifferentiated and inexplicable panic, while to some extent, she was also terrified that emotions, when they did emerge, might alienate those she depended on. This paper explores the logic, using Matte Blanco's conceptual apparatus, of why uncontained emotion should be so prohibitively terrifying in that it, like the unconscious, threatens to dissolve identity and to be experienced therefore as literally annihilating. The technical issue then is how to establish a relationship between the afflicted individual and their body with its terrifying emotion. This the authors address via the thinking of the Italian analyst, Armando Ferrari, for whom the body is mind's primary, original and originating object. The clinical implication of this is that it is sometimes necessary to privilege this relationship, that between the body and its mind, over the transference relationship, insistence on which may invite the patient to ignore it.     

Seventy Years On: Some Clinical Consequences of The Controversial Discussions

Seventy years ago with much of the world engaged in a battle for survival in the Second World War, the British Psychoanalytical Society organized a series of scientific meetings to discuss the new theories of Melanie Klein. The paper starts with a historical background to the Controversial Discussions and moves on to discuss some of the main points of the debate. It revisits the concept of unconscious phantasy along with the debates on primary narcissism and the death instinct, also exploring its use and relevance in current clinical practice. Following Bion's idea that psychic change is felt as catastrophic, I attempt to link some of the anxieties and processes that were present during the Controversial Discussions with similar processes present in the psychoanalytic world today.     

Can the Breast Feed the Mother Too? Tracing Maternal Subjectivity in Toni Morrison's Beloved

Breastfeeding tends to elicit strong feelings in mothers as well as impassioned rhetoric in our cultural discourse. Psychoanalytic thinkers have focused extensively on the infant's experience at the breast. Surprisingly, much less theoretical attention has been given to the mother's experience of breastfeeding. I begin with my own experience of struggling with this early stage of motherhood and with understanding why this act seemed to hold such emotional power. By tracing the theme of breastfeeding in Toni Morrison's Beloved, I attempt to draw out ideas about the breastfeeding mother as a subject rather than an object. I argue that the novel's depiction of breastfeeding supports understanding the maternal body as a source of ambivalence and creativity for the mother as well as for the infant. Drawing mainly on the work of Melanie Klein, Donald Winnicott and Julia Kristeva, I explore through literary readings how breastfeeding comes to stir up such passionate and often difficult feelings for mothers.     

A Chance to Show His Mettle: War,Creativity and Reparation in the Work of Wilfred Bion

This paper looks in detail at Wilfred Bion's war writings, specifically at his preoccupation with issues of morale and leadership, and at the intense feelings of isolation and disillusionment that accompany his bleakest moments. This reading of the war writings demonstrates that Bion found resources that enabled him not only to survive this harrowing time but also to work creatively to improve the lives of his fellow soldiers, and it is suggested that Melanie Klein's concept of unconscious reparation may be helpful in considering Bion's life and work during this period. An impulse to repair may also be discerned in Bion's first published paper, ‘The “war of nerves”…’ ( 1940 ), as well as in his work in 1942 for the War Office Selection Board where, with the support of gifted army leaders, Bion was able to draw on his traumatic wartime experiences in order to make influential contributions to the reform of the British Army.     

The First Supper: The Role of the Digestive System in Mental Life and the Evolution of Eating Disorders

The following work explores the significance of the digestive system in mental life and in the evolution of eating disorders. Utilizing Bion's model of the mind, as well as the work of Bick and Meltzer, it is proposed that underlying the overt symptoms of this disorder is a mental structure that lies at the core of eating disorders and which is referred to here as the metabolic mind. The constitution of the metabolic mind, it is argued, is rooted in the transformation of the digestive system into a second skin formation, intended to defend against anxieties of disintegration and to enable a rudimentary level of mental functioning. This type of mental functioning is often characterized by the use of adhesive identification, and is manifested in the presentation of eating disorders in a variety of mental features, which have been less associated with this ailment and merit a close examination. A provisional sketch of some of the potential implications of this mental construct is discussed, with the aim of further expanding the clinical understanding of this disorder.     

‘Chaos,Through a Veil of Order’: The Dialectic of Theory and Spontaneity in Psychoananalytic Work

The theme of the paper is the quotidian debate about the role of theory in analytic practice. Based on examples from recent psychoanalytic publications, I argue that psychoanalytic theory may influence therapists as ideology, heuristics, or empiricism, or combinations thereof. Bion's eschewing of theory, and advocacy of an analytic stance ‘beyond memory and desire’ as a precondition for psychoanalytic creativity is questioned. Buber's advocacy of I–Thou relatedness is compared with the concept of mentalizing, and related to recent findings in developmental psychopathology. Parallels are drawn between the therapeutic relationship – bringing together theory and spontaneity in a hermeneutic enterprise – and the infant's use of security‐promoting care‐givers.     

Focusing on Reflections: Mentalization and Mirroring in Brief Dynamic Therapy

The author begins by noting the growing recognition of the contribution that addressing a client's capacity to mentalize can make to therapeutic effectiveness in short‐term psychodynamic work. He outlines the developmental origins of the capacity for reflective function or mentalization in the earliest experiences of infancy and how the primary carer's changing levels of contingency to the infant's feeling states promotes the infant's development of a sense of his or her own mind as well as a sense of the minds of others as sources of the motivation of behaviour. The author compares and contrasts the concept of mentalization with that of mirroring and how the latter contributes to the realization of the self. The contribution that a focus which captures the aesthetic of a client's idiom can make to the experience of being mirrored and contained by the therapist is highlighted. The author also identifies ways in which working with the components of a focus, as it is tracked through a client's narrative, can enhance a client's capacity to mentalize. These themes are illustrated by a case example which involves complex loss and trauma resulting in unmet adult attachment needs and a diminished capacity to mentalize.     

The Mother,The Psychoanalyst,The Poet and The Artist: Containment and Growth of The Mind

This paper considers the difficulties which humans have in using and developing their capacity for thought. Growth of the human mind, through attunement of the mother's unconscious experience with the infant's, is explored along with the distortions which arise because of aversion to uncertainty and suffering. It then looks at psychoanalysis and the verbal and visual arts in the light of the maternal function, and the way in which they also promote the growth of the mind. Four products of the human mind – an excerpt from an infant observation published in 1998, some post‐Kleinian psychoanalytic clinical case material from the 1980s, John Keats's 19th century Ode to a Nightingale and Lucas Cranach's 1526 painting, Adam and Eve – are used to illustrate some of the similarities and differences among them in giving conscious form to the unconscious.     

The medical philosophy of Francis Bacon (1561–1626)

Francis Bacon's view of man is dualistic but, although he takes note of mental faculties, he makes the relation between mind and body, rather than the substance of mind, the basis for enquiry into mental processes and, more particularly, for the medically relevant study of mind. (He uses ‘mind’ and ‘soul’ as equivalent terms.) The healing of the body requires study of the body, and the ineffectiveness of physicians is due to their failure in this respect rather than to the body's complexity. To learn about the body requires clinical observation and recording, together with the comparison of bodies, experiments on living animals and attention to pathological changes. The aims of medicine should include not only the restoration of health but also the relief of suffering, and they are not to be limited by putting aside a disease as incurable. To learn from treatment it must be fixed in its ordering with controlled and limited variation. Bacon has no separation of medicine from natural science; his philosophy of medicine is his general philosophy of the advancement of knowledge, but limited to a particular field of application. If medicine is separated from natural philosophy it is changed wholly or greatly into empiricism.     

Psychosomatic symptoms and the group mind

Objectives. In this work, we propose a model, designed to understand mental symptoms and adapted for the analysis of psychosomatic symptoms, to be used as a tool to represent group phenomena, named the ‘group mind’. Design. A revision of the relevant literature on the concept of ‘group mind’ and psychosomatics, and the presentation of the Cambridge model. Methods. We describe how unformatted experiences can appear as somatization, and how this process can be corrected via mental representations. Group dynamics can function creating these representations and thus contribute to solving psychosomatic symptoms. We refer to W. R. Bion's concepts, mainly the ones on proto‐thoughts and the proto‐mental system, comparing them to the proposed model and giving a foundation to this conceptual representation. We illustrate with four cases of clinical interaction. Conclusions. Psychotherapeutic groups are privileged places to comprehend and transform psychosomatic symptoms. The Cambridge model allows a representation of these processes. Further studies are necessary to assess its validity, test its adequacy, and expand its possibilities.     

Mirroring and mu rhythm involvement in social cognition: Are there dissociable subcomponents of theory of mind?

Tager-Flusberg and Sullivan [Tager-Flusberg, H., Sullivan, K., 2000. A componential view of theory of mind: evidence from Williams syndrome. Cognition 76, 59–90] have argued for a distinction between the social-perceptive component of theory of mind (ToM), involving judgment of mental state from facial and body expressions, and the social-cognitive component, which is representation-based and linked to language and theory-building. This is analogous to the distinction made by others [Gallese, V., Keysers, C., Rizzolatti, G., 2004. A unifying view of the basis of social cognition. Trends in Cognitive Science 8, 396–403] between representing the mental state of another as if it was one's own (simulation theory), which requires involvement of the mirror neuron system, and explicit or declarative reasoning about mental states (theory theory), which does not. This componential view of ToM was tested by examining mirroring, as indexed by EEG mu rhythm suppression, in subjects performing tasks assumed to tap both dimensions. Mu suppression was positively correlated with accuracy on the social-perceptual task but not in the social-cognitive task. In a ToM control task requiring judgments about person–object interactions accuracy was correlated with mu suppression. This implies that mirroring is involved in making judgments about emotions and person–object interactions. However, mirroring is insensitive to the distinction between correct and incorrect inferences in the social-cognitive task suggesting that additional mechanisms are needed to make mental attributions of beliefs and intentions. These results are consistent with a refined componential view of ToM.     

The Birth and Death of Hope

I discuss the origins of the capacity to hope, its roots in the infant's experience of a loving and secure relationship with their caregiver. The infant's awareness of his or her own mental and emotional agency can gradually develop and so the capacity to channel desires and impulses, and to expect an attuned response. I suggest that the failure of this intersubjective developmental process gives rise to an enduring sense of hopelessness, an expectation that emotional needs and desires will never be met. The key role that play has in the development of hope is discussed from psychoanalytic and neuroscientific perspectives. The impact that a patient's persistent hopelessness has for psychoanalytic psychotherapy practice is explored, its function as a defence against any new, spontaneous relational experience which might activate trust and hope. Internal and external change and transference dependence are resisted as the patient fears becoming vulnerable to being abandoned or rejected by the analyst. I explore some socio-political aspects of hope and hopelessness, such as the belief that people deserve their success in society and the self-blame, shame and hopelessness that result from an experience of economic or social failure. I discuss the possibility that hope in human relationship and in our humanity can survive in the face of overwhelming catastrophe.     

GENEROSITY OF HEART: SOURCE OF SANITY

abstract The component parts of love are generosity, gratitude and forgiveness, and the focus of the paper is on generosity, arguing that the source of sanity lies in generosity of heart. Madness as a condition springs from the absence of love. Psychoanalysis itself can promote either mean‐minded or generous responses to the patient, and I give clinical vignettes to illustrate this belief. Scientific and religious approaches to ‘the real’ are discussed, and I emphasize the idea of the mind as an active power in grasping reality. Religion safeguards the creative power of the mind, in particular the world's mystical traditions. I consider the relationship between inner autonomy and creativity, and make links with Bion's concept of O, emphasizing that the spiritual is woven into the very fabric of what we do as psychoanalysts and psychotherapists.     

Nonverbal aspects of therapist attunement

In a follow-up to an earlier study (Davis & Hadiks, 1990) that reported positive and significant correlations between the patient's body positions during psychotherapy and Experiencing Scale (Klein, Mathieu, Gendlin, & Keisler, 1970) ratings, a similar analysis of her therapist's nonverbal behavior was completed. Results revealed positive and significant correlations among the therapist's body positions, the intensity and density of his gesticulations, and the Therapist Experiencing Scale. Data from the patient study also were included in the analysis, and these results revealed positive and significant correlations between the therapist's and patient's positions as well as the therapist's positions and the patient's Experiencing Scale scores. Results are discussed in terms of the significance of body movement as a measure of rapport and its role in therapist interventions.     

From Dualism to Dynamism: Fairbairn's Critique of Libido Theory 1930–1950

In 1930 Fairbairn wrote ‘Libido theory re‐evaluated’, which remained unpublished until 1994. It contains the beginnings of theoretical arguments that, I argue, resulted in his more famous 1940s papers. I posit that Fairbairn's 1930 critique of Freud's analytical dualist theoretical foundation is consistent with, and lays the ground for, his later work. Using the papers ‘Schizoid factors in the personality’ (1940), ‘The repression and return of bad objects’ (1943), ‘Endopsychic structure considered in terms of object‐relationships’ (1944), and ‘Object‐relationships and dynamic structure’ (1946), I show how Fairbairn's 1930 critique is relevant to his later propositions and elucidate Fairbairn's metatheoretical assumptions, about which he was not explicit after 1930. I argue that his theoretical propositions arise as a result of his longstanding, consistent critique that led him to replace analytical dualism with dynamical structure. Further, I argue that Klein, and Khan and Winnicott's criticism is unjustified; Fairbairn did not challenge the content of a theory he describes as ‘truths of fundamental importance’, he challenged its theorization. Because it resulted in his important theoretical propositions, Fairbairn's longstanding critique of libido theory is important within the history of psychoanalytic thought and deserves scholarly attention.     

THE BODY SPEAKS: BION'S PROTOMENTAL SYSTEM AT WORK1

Psychoanalysis has primarily explored somatic experience in relation to love and intimacy. This paper focuses on the body in relation to work. It explores the experience that what patients increasingly present for analysis are the traumas and pleasures of being caught up with and belonging to a body larger than their own, whether in a couple, a group, a work organization or the body politic. It begins with an exploration of Bion's idea of a relationship between protomentality and group disease. It goes on to consider what can be conceived of as his ecological methodology, which enables movement between different ‘fields of study’ ( Bion 1962 ). These are applied to the health risks encountered by psychotherapists and the profession as a whole. Finally, there is a proposal for mentoring to address professional health, as an under‐developed element in the profession.