Bion and Thoughts Too Deep For Words
A book by Robert Caper.
Caper's slim but wide-ranging book cover's Wilfred Bion's approach to psychoanalysis as a search for truth rather than a suggestion-based therapeutic method. Starting with non-verbal modes of communication seemingly at the core of developing human relationships, Caper leads us into an exploration of key concepts of Bion's approach, arguing that Bion's focus on psychoanalysis as a search for truth can aid in psychological development more transparently and with less subtle manipulation on the part of the analyst.
What follows is a chapter-by-chapter summary.
Chapter 1: Song-and-dance#
William Condon, studying conversations between adults using high-speed cinematography and a frame-by-frame analysis of their words and movements, observed that speakers and listeners act and react to one another in ways too subtle to be captured by the naked eye. This synchrony is akin to dance, in that people respond to its rhythms, not merely to random noises or tapping.
This phenomenon is displayed by infants only hours old.
Rhythmic movement between people also seems to have a kind of bonding effect on the participants. Quoting Ellen Dissanayake:
In ceremonies, bodies swayed to music result in minds relieved of existential anxieties, firmed by convictions, and bonded with their fellows in a common cause. (3)
Similarly, the "still face" experiment by Tronick shows that infants are highly sensitive to facial expression, and seek to make mothers make facial expressions in response to them:
a responsive face has an organizing or animating effect on an infant, while an unresponsive face where a responsive one was anticipated can lead to withdrawal, despair, and disorganization. (4, emphasis added)
This leads to Caper's first key observation:
Human animals draw each other automatically, regularly and irresistibly into each other's mental and emotional spheres, spontaneously forming communities marked by shared mental organization. This recruitment forms a substantial part of everyday mental life.... It is, one might say, the natural default state of one human mind in contact with another. (5-6)
That is, beneath the superficial mode of overt messages being passed between people in conversation is another mode of communication happening at the same time, and which seems to make the more superficial mode possible.
Caper's second observation is that the discovery of a largely unconscious mode of communication parallels the discovery of the unconscious mind as a potent force making the conscious lives we live possible:
It is tempting to align these two discoveries by postulating that non-verbal modes of communication, operating outside of consciousness, form a direct link between the (non-verbal) unconscious of one mind and that of another, ... a direct link between one person's unconscious internal world and that of another. (6)
This is a compelling idea: people communicating with one another unconsciously in a kind of language (more "pre-language") that we can't easily describe using words. If we think of this song-and-dance as our unconscious selves "speaking" to one another, we may be able to understand aspects of mental illness in terms of this song-and-dance going awry at an early stage in a child's development.
In the next two chapters, Caper fleshes out this idea.
Chapter 2: Song-and-dance and the internal world#
In this chapter, Caper connects the largely unconscious song-and-dance mode of communication with Melanie Klein's concept of projective identification, especially as Bion developed it.
Realistic projective identification as subconscious communication#
Bion describes "realistic" projective identification as follows:
If the mother and child are adjusted to each other, projective identification plays a major role in the management; the infant is able through the operation of a rudimentary reality sense to behave in such a way that projective identification, usually an omnipotent phantasy, is a realistic phenomenon. This, I am inclined to believe, is its normal condition. (8)
To bolster Bion's inclination with recent thinking about projective identification, Caper quotes Spillius and O'Shaughnessy:
We think the concept of projective identification gives a name to, and a clarification of, the dynamics of direct communication and the phenomena of transference and countertransference that are universal among humankind. (9)
As an aside, Spillius and O'Shaughnessy note that Freud himself was aware of this sort of communication. From his New Lectures on Psychoanalysis:
There is, for example, the phenomenon of thought-transference .... It claims that mental processes in one person--ideas, emotional states, conative impulses--can be transferred to another person through empty space without employing the familiar methods of communication by means of words and signs. (9)
Caper's conclusion is that "the concept of projective identification gives us a psychoanalytic model of the dynamics of primitive song-and-dance." (9)
Building an internal object world#
Caper:
Song-and-dance communicates animate, unconscious internal realities directly from one person to another. These realities are intuited rather than communicated symbolically; their significance is felt in the body rather than being decoded by the intellect (that is, their effect, like that of music, is immediate, emotional, and non-verbal). (9)
If human beings are fundamentally herd animals (as Bion believed, and as is the consensus view among anthropologists), it makes sense that group membership is one of our "overwhelming" concerns from birth. Thus, joining the herd would seem to depend on the ability of the infant to effectively communicate its needs, first to its mother, and then to others in the group:
Arising at the same time as the infant's recruitment into the external human community is the establishment within the infant of an internal world that is partly a reflection of the external human community. (9-10, emphasis mine)
As Caper puts it, the infant's internal object world is its "ticket of admission" to the community "of other minds." (10)
Growing into a(n un)healthy person#
Caper notes that the healthy mental and emotional development of the child depends on two factors: (1) the mother's love for the infant, conveyed in the (song-and-dance) "language" the infant can understand; (2) the infant's ability to recognize and receive this love. The importance of these two factors can be illustrated by the consequences of something interfering with one or the other mechanism.
In his book Learning from Experience, Bion "describes a patient whose thought processes lacked the qualites of depth, resonance, and evocativeness that one associates with the human mind, and so seemed to be the product not of a mind, but of a machine." (12) From the analysis, Bion drew a portrait of someone who, as an infant, was unable to bear the emotional strain of realizing that its well-being and survival depended on "something as intangible as its mother's love":
In its horror of needing what is intangible, and therefore not possessable, the infant blinds itself to these needs and to the love, solace and understanding that would remind it of them. Starved of the requirements for mental and emotional growth, but unable to grasp them, it redoubles its desperate efforts to obtain what it can still perceive: material satisfactions divorced from emotional gratification. (12)
This patient eventually becomes much like the lifeless material objects which he craves and which cannot satisfy him. Thus, his internal world is lifeless, full of dead objects.
Caper doesn't discuss here what might happen to someone whose mother's love was poisonous or inconstant, but I think we can guess: such a person would grow up feeling as if the world were full of toxic, threatening, unpredictable objects. New Yorker cartoonist Gahan Wilson conveyed this in one of his classic panels:
Chapter 3: The dynamics of unconscious communication#
In this chapter, Caper draws on Bion's study of group dynamics to highlight the role of suggestion in the relationship between patient and analyst.
Groups and their "basic assumptions"#
It's worth reminding ourselves that human beings are herd animals, fundamentally social beings. Thus, all relationships are in one way or another reflective of our tendency to form and maintain groups.
Bion observed that groups exhibit what he called a "group mentality". As Caper puts it, a group mentality is
an unconscious belief of great emotional import held in common by members of the group that provides them both with an emotional raison d'être--a passion--for group life and a sense of security about their ability to solve the problems they face as a group. (14)
Central to the group mentality is that it is driven by the group members' need for a sense of belonging, not by any conscious belief or evidence for it. These core beliefs Bion called basic assumptions of the group. Considering the Christian Church as a basic assumption group, its main basic assumption would be that "there is a benign and omnipotent deity that loves and will care for members of the Church." (15) This belief is vital for members of the Church to feel a sense of security in belonging to it. Activities sustaining this belief (e.g., prayers) are known as basic-assumption activities.
Work activity vs basic-assumption activity#
Of course, as a rule groups do far more than engage in basic-assumption activities. Things have to get done! But doing practical things--working towards shared realistic goals--has a starkly different character from basic-assumption activities. People in groups working together to solve problems will have different and of necessity limited understandings of the problems they are tackling; they will have only so much time to solve them; their abilities to solve the problems will be limited; and so on. Thus, in contrast to basic-assumption activities, which tend to soothe group members' anxieties, work activities tend to exacerbate them.
In any well-functioning group there will always be some tension between basic-assumption activities and work activities. Group cohesion demands some basic-assumption activities, but a group dominated by basic-assumption beliefs would be disconnected from reality.
Psychoanalysis as a group activity#
This brings us to the psychoanalytic relationship. The patient and analyst form a group--of only two people, but no less a group--so we should presume that such groups share fundamental characteristics with other groups. But psychoanalytic group activity has a uniquely self-reflective aspect, because it is a group that as it were studies itself:
If psychoanalysis is a group of two whose work is to study itself, one way of characterizing its work would be to say that its purpose is to study, in a thoughtful way, the basic assumption activity that comes in to play as a response to the anxieties and insecurities of the psychoanalytic work itself. (17)
Successful psychoanalytic work will surface its own basic assumption activities, making it possible to deal with the anxieties driving those activities instead of being trapped within them:
All groups perform work, but the work of the psychoanalytic dyad is specifically to observe the emotional field in which it operates and thus to increase its capacity to observe the forces shaping the psychoanalytic relationship. (17)
Suggestion as a basic-assumption activity between patient and analyst#
As Caper describes transference, it is "the process whereby the analyst comes to represent the patient's current internal objects. It is a living biopsy of the patient's internal world." (17) That said, transference is but one aspect of the psychoanalytic relationship. Transference may work as projective identification, evoking emotional states in the analyst "congruent" with the analyst's role in the transference. Likewise, the analyst will inevitably project their own internal objects into the patient in response (counter-transference).
One way this typically works is via the basic assumption of the analyst as an omnipotent healer. The patient (unconsciously) needs the analyst to play this role; the analyst (unconsciously) needs to play this role and for the patient to be in need of healing. This type of group forms the natural basis for suggestion:
The patient is vulnerable to suggestion from the analyst because he accepts the analyst's ideas uncritically in the desperate belief that doing so will cure him of his maladies. The analyst is vulnerable to making suggestions because of his need to cure himself of the problems associated with his internal objects by curing them in his patients. (18)
Suggestion has a long and fraught history in psychoanalysis. Treating it as a basic-assumption activity, however--as a generally unexamined bit of glue that binds patient and analyst--raises the issue of what role it should play in this relationship. That is the subject of the next chapter.
Chapter 4: Psychoanalysis and suggestion#
This chapter explores the prevalence of suggestion in psychoanalytic practice, tracing it from its roots in Freud's early work to the present tension between its utility as a "therapeutic technique" and psychoanalysis's dubious status as a scientific endeavor.
A (very) brief history of suggestion in psychoanalysis#
Freud began his psychotherapeutic work in the 1890's by employing suggestion and hypnosis, though he quickly became suspicious of both. Freud found that suggestion (especially as practiced through hypnosis) seemed to have affect only the symptoms of mental illness, and not address its causes.
Freud's nervous-system theory of hysteria was an early attempt to locate causes that could be rooted out via suggestion: the idea was that inducing the patient to relive an early trauma would as it were "lance the boil" and allow the damage to heal. Freud eventually abandoned this idea when he realized that the suggestions leading to these revisits made for only temporary relief.
By 1900, his discovery of transference had changed utterly how Freud viewed suggestion:
What his patients could not remember they acted out in their relationship with their analyst. What had supposedly been buried was in fact present at any moment in the analytic consulting room, enacted in full and exact detail, however thoroughly disguised.
Recognizing the transference meant that it was no longer necessary to use the force of suggestion to persuade the patient of the reality of his repressed impulses. Freud could point out in real time how these impulses were coming to life in the patient's current relationship with the analyst. (21-22)
Positive transference and leading the patient to "the truth"#
That said, it's arguable that Freud hadn't quite abandoned suggestion as a therapeutic practice. Freud distinguished between positive_ and negative transference. Positive transference--the patient's projection of enjoyable aspects of past relationships onto the therapist--was seen as _helpful in the psychoanalytic relationship, because it helped motivate the patient "to do the painful work of overcoming his repression and acknowledging his impulses, which he would presumably do out of love for the analyst-parent." (22) It was only negative transference--especially those aspects which made the patient less cooperative--that was subject to the analyst's interpretation. This leaves the patient in a deeply vulnerable position:
Positive transference renders the patient highly susceptible to the analyst's power of suggestion, because he and the analyst with whom he is in love now constitute a group of two functioning in basic assumption mode, in which emotional and mental is prominent at the expense of independent critical thought. (22)
In this situation, the analyst needn't do much more than gently guide the patient towards what the analyst regards as "the truth" about themselves. Freud rationalized this by arguing the positive transference could as it were be handled later on, after patients have done the work necessary to deal with the truth about themselves. But this raises some difficult questions: - What exactly is the truth here? - How would the analyst recognize it? - Why can't the patient see it without being led via suggestion?
The psychoanalytic duo, dependency, and evaluating psychoanalytic theory#
As Caper puts the problem:
If the analyst is supposed to know the truth about the patient, how is he supposed to know it? The use of suggestion to lead the patient to the truth means that the clinical and ethical integrity of the analysis depends entirely on the analyst's version of the truth being true. But, of course, there is no way of assuring that this is so. There is no guarantee that the analyst's immunity to subjective bias is firm enough to carry this burden. (25)
The analyst could point to psychoanalytic theory to ground their version of the truth, but this merely puts the question of justification off the analyst and onto psychoanalytic theory itself. Which brings us to the question of how psychoanalytic theory fares as a theory of the mind. Worse still, there is no one overarching psychoanalytic theory, but many conflicting theories.
This line of reasoning is a sure way for psychoanalytic practitioners to paint themselves into a corner from which they can't escape. Caper suggests we don't even try:
Is it possible to do psychoanalysis without relying on the power of suggestion and the positive transference to convince patients of theories that may, in the end, turn out to be little more than dogma? (27)
Chapter 5: Psychoanalysis beyond suggestion#
Caper draws the radical conclusion towards which he's been building since the beginning: an honest and ethical psychoanalytic practice abjures the idea that psychoanalysis provides a cure for the patient's ailments, and is instead a cooperative search for the truth about the patient's psyche. This is the only way for the analyst to resist the lure of suggestion latent in the presumption that analysis can diagnose ailments as well as cure them.
The most interesting part of this brief chapter is Caper's idea that suggestion itself should be a subject of the analysis:
The intent is to put into perspective (through understanding) the forces on which suggestion and supportive psychotherapy rely, whether they are used deliberately as a "therapeutic" technique, or occur unwittingly in what is known as enactment. This is psychoanalytic interpretation. (32)
Supportive psychotherapy "attempts to get the patient to think or feel in a certain way" and "acts by exploiting the positive transference through song-and-dance." Psychoanalysis, by contrast, "explores that very activity." (32)
Chapter 6: The analyst's Oedipal dilemma#
Caper reveals here that his radical conclusion about psychoanalysis comes from Bion himself:
The "desire" for cure is one example of precisely the idea that must, in common with all desires, not be entertained by a psychoanalyst. (35)
Caper then notes that Bion's conclusion is "as remarkable for what it rules out as for what it rules in":
It means that psychoanalysis does not try to improve the patient's personality, or diminish any kind of illness, nor does it aim to relieve sufferint or make the patient more agreeable, successful or capable. It aims at one thing only: to hold up a mirror in which the patient might recognize himself. (35-36)
Thus, the psychoanalytic relationship is between equals: the analyst is not trying to "re-parent a frightened child." (36)
The consequences of this approach are stark. The analyst's choice is between showing the truth to the patient while making "sure the patient never loses sight of the fact that he is only expressing an opinion," and employing the therapeutic approach, whereby the analyst "does not want the patient to think critically about what he says, but wants to shape the patient's experience." (37)
Bion's reinterpretation of the Oedipus myth#
Freud's focus on the Oedipus myth had to do with Oedipus's murder of his father and his incestuous relationship with his mother. Bion, by contrast, reads the myth as a relentless search for truth "in the face of any danger". (Bion's interpretation is spelled out in some detail in Chapters 10-12 of his Elements of Psychoanalysis; Caper offers a very brief summary.)
This interpretation has parallels in the psychoanalyst's single-minded commitment to the search for truth. The conflict here is between the need for knowledge and the need for security:
What the myth portrays as the natural law of hubris and nemesis is a cautionary tale about the potentially catastrophic effects of discovery. Discovery puts at risk our sense of security, in unpredictable ways. The motto for our need for security might be "knowledge up the point it becomes disruptive, then tranquillity above all else." (38)