Best Neuroscience and Psychoanalysis

A 30-year-old computer science student (Mr. X) was looking for psychotherapeutic help in a desperate life situation. Because of heavy psychosomatic symptoms (eating and sleeping disorder, migraine, attacks of dizziness, skin irritation) he had not been able to pursue his studies for the past 5 years. He was living completely isolated and seemed increasingly to be developing paranoid fantasies. The only relationship he maintained at that stage was to his brother, who is 3 years younger than him. However, this relationship was crumbling, chiefly because he had insulted and even physically attacked his brother in outbursts of rage that neither he nor his brother was able to understand.

Mr. X arrived with the explicit desire to start a psychoanalysis. He had read about it and considered the method to be the one right for him. I had my doubts concerning this indication because I considered Mr. X to be a borderline patient and asked myself whether high frequent treatment would be the right treatment decision for him. During the first year of psychoanalysis Mr. X controlled the distance between us by means of marked intellectualization and an almost complete repulsion of emotions during the sessions. It was almost impossible to obtain new analytical insights: the analysis seemed mostly to cover conscious processes. Still, the patient arrived on time for the appointments and insisted vigorously on replacing any appointments that I had to cancel. He seemed to existentially need the holding function of psychoanalysis. He changed his behavior–although this did not appear to be connected to any insights gained in the psychoanalysis. He attended lectures and courses again and was more able to concentrate. Also, the psychosomatic symptoms remitted somewhat, which led Mr. X to say before we entered the summer break: “The treatment does me good . . .”

The sequence I would like briefly to describe now took place after this first long summer break. Mr. X arrived obviously distraught at our first appointment. He began straight away to heavily insult me and seemed to become absolutely beside himself with rage and anger because I had dared to disappear, to go on vacation for 4 weeks. This was irresponsible, selfish, and showed that I was not at all interested in my job and in my analysands. “I doubt whether you have had proper training as an analyst at all . Maybe you are just a ‘run-of-the-mill’ analyst” . . . I was surprised by the violence of his anger and despair, and during the session failed to reach him emotionally or by means of an interpretation of the experiences he had had due to the separation etc. Although it was possible to address his severe reaction to the separation and to prevent another outburst of rage, Mr. X instead fell into a long silence, which for me was of an even more frightening quality than his insults.

Some extremely difficult weeks followed. Mr. X seemed to only be able to choose between two states of mind on the couch: either heavy insults, anger, and attacks, or else silence and retreat. As to the content, I noticed that his attacks were mostly aimed at my analytical function.Mr. X insulted me not only as stupid, restricted, and unable to understand him even in the widest sense, but also as incompetent and not professionally trained. As a consequence of his attacks and extreme silence, I found myself confronted with a severe feeling of impotence, inadequacy, and even depressing self-doubts. However, the most difficult thing was to bear the physical reaction: his attacks during the sessions finally caused an inner tension to that extent that I began to feel sick and from time to time even suffered from stomach cramps–psychosomatic reactions which are unusual for me during psychoanalytical sessions. I then sought a better understanding of what had happened in the psychoanalytical session by means of a supervision session with an experienced colleague.

We presumed that the enormity of the attack and the silence indicated a traumatization suffered in a very early stage of Mr. X’s development, probably during his first year of life, in a phase of development in which physical and affective states of mind can not yet be either enclosed or symbolized. Had he suffered from an early traumatization, perhaps caused by separation from the primary object which I felt in my depressive countertransference feelings? The discussion with my colleague had, for me, mediated a certain distance and enabled me to increasingly reflec critically on my fierce reactions and countertransference fantasies. Not long after, Mr. X, following a session that had included heavy outbursts of rage, arrived a bit calmer to the next appointment. I carefully communicated my supposition that the long summer break could have led to an intense reactivation of unbearable feelings of dependence and desolation, which he could have tried to cope with by means of extreme aggressive attacks. I asked, following an intuitive idea, if he had, after sessions like the one before, felt any physical reaction. He told me that he had “felt sick throughout his whole body,” that he had not been able to eat, and that he had suffered from heavy stomach cramps. I was surprised by the analogy to my own psychosomatic symptoms during and after such sessions. I told him that the total quality of these states of mind led me to assume a reactivation of very early experiences, “ which could have been preserved in the body” and which “might try to become accessible to our analytical comprehension by this means which both of us find unbearable. Do you know, by chance, whether you suffered from a severe illness or an eating disorder during your first year of life, or whether you and your mother were separated?” Mr. X answered in the negative, but called his mother and found that 6 weeks after giving birth she had had the impression that she did not have enough milk. She abruptly stopped breast-feeding her baby and used baby food. Her baby reacted with a strong allergy, with a painful, itching skin irritation over his whole body. The mother told the analysand that she had not been able to touch the infant, that he always screamed, and that it had been almost impossible to calm him. She almost fell into despair, but after 3 months she had, in her words, “everything under control,” and gave a different formula food to the child.As a consequence, the symptoms disappeared. “And you’ve been shouting at me since the summer holidays that I did everything wrong, that I gave you ‘the wrong analytical nutrition,’ that I had changed completely in the holidays and that I refused to give you the right ‘analytical nutrition’ which could make everything turn out well again . . . The analytical sessions no longer do you any good as they used to before the holidays–they are just horrible now. Every contact with me seems to be unbearable . . .”–Mr. X began to cry for the first time in the psychoanalysis.

During the following weeks we were able to successively understand the reactivation of the early traumatization: the trauma laboriously found its way into his images, visualizations, and finally his language: it had become conscious and in the following years became successively better understood as one of the unconscious sources of the patient’s severe psychosomatic suffering.