Best Neuroscience and Psychoanalysis

In this first vignette, I will describe aspects of three sessions which illustrate the emergence of feeling memories following a head injury.

Peter is a talented middle-aged married man in one of the caring professions. His father was a gentle, scholarly man and his mother a kind, self-effacing woman who suffered from bouts of severe depression which required admission to mental hospital at irregular intervals during Peter’s childhood; this meant that he was required to stay with relatives for some weeks at a time.

The week before the three sessions I shall briefly describe, Peter had a sudden, violent, but not life-threatening accident in which he struck his head and body on a concrete post and suffered transient unconsciousness. After a week’s convalescence, he returned to therapy in a sorry state, with stitches in his head and a cut and bruised face. He lay down very slowly and with great difficulty. He recounted details of the accident and clearly was still quite shocked. He told me he wanted me to know what it was like to feel he was dying.Near the end of the session he attempted to sit up but said it was impossible. He tried several more times but each time he sank back in a very distressed state saying he could not get up. I fetched him a glass of water and he made it clear that he did not want me to help him up. I moved the armchair closer to the couch, reassured him that there was no hurry, and told him I was leaving the room for a few minutes. Three or four minutes later he had managed to sit up with the use of the chair. When I returned, he asked me to leave again because he said my absence made it easier for him to get up. Five minutes later he called a farewell and left. My medical knowledge reassured me that he had not had a cardiovascular episode; however, I felt quite painfully while I was outside the room that I had been neglectful of him, but I also sensed that at that moment my presence was symbolically too close to a desperately needed object.

In our next session he again slowly and painfully lay down. He told me that he had felt very reassured that I had left the room last session because it meant that I had not regarded him as a medical emergency. He spoke further about his accident and how he had thought he was dying. Then he said to me with great feeling: “There is one area where you have not understood me, you haven’t realized that I want to look for what is actually true. Bottle feeding isn’t real milk. My mother seems to be saying: ‘Drink it up: it doesn’t matter that there isn’t a real breast2.’ She would say, ‘No such thing as can’t,worse things at sea and such like.’ I was longing for you to hold my hand last session. I don’t want to be told my thoughts are at fault.”

I told him that he was telling me what if it felt like to be “fobbed off,” not to be allowed to have feelings of self pity or helplessness or need, and what it felt like to be told that “others had it worse” and that “you aren’t really feeling what you’re feeling.” I also told him that the terrifying fear he had had after his accident that he was dying was probably an echo of a terror from childhood.

However, what I did not tell him at the time, and which I now believe in restudying the material, was that he was also struggling to disentangle the difference between his experience of me now, as a representative of his autobiographical “internal mother,” and the reemergence of actual “bits” of feeling memory from the past, possibly from amygdala circuits, as a result of his head injury.

As the end of the session approached, once more he struggled to sit up and sank back again onto the pillow.He tried several more times and with the help of the chair eventually sat upright. He then said hesitantly: “I think you ought to leave me.” I replied that I would if that was what he really wanted. Slowly and painfully he inched his legs onto the floor, smiled, and said: “You’re a cunning b . . . aren’t you? You were absolutely right not to leave. I don’t feel embarrassed any more by this incident.”

In the following session he spoke more about his accident and his various medical advisors, but near the end of the session he struggled to the sitting position and said a little desperately: “I’m so sorry I’m putting on
this show.” I said straightaway: “This is not a performance, it is a “show”; you are showing me in the only way you can what it is like to have powerful feelings that never have had and never will have words.”

Space does not allow for a full discussion of all the important material in the sessions following Peter’s accident, so I will confine it to a few comments on aspects that are directly relevant to this essay.When Peter found that he was unable to move from the couch, it came as no surprise to me because I realized we had been there before and that I had been “primed” in the sense that there had been clues in his material from past sessions which indicated his need for close attachment to me; for example, he would often make jokes as he was getting off the couch; he would write out his cheque at the end of a session always borrowing my pen; if he had been angry in a session, he would always “make up” before leaving. His overinclusive accounts of happenings in his life as a defense against feelings came to be known to us both as “my seminars.” Though I tried to understand his feelings using transference interpretations, it always seemed that he wanted and needed “something more” . Two sessions before his accident he realized halfway through a session that he had been using his “seminar” technique to talk his way away from his feelings. He directed his frustration and amused vexation at himself and struck his forehead with the palm of his hand: “Ahrr, there I go again, I feel so frustrated, I feel I want to be hysterical . . .” I particularly noticed his unusual phrase.

I suspected that most of the transference references were for the years from 5 onwards when his autobiographical memory was firmly established and deference for others and concealing painful feelings had become egosyntonic.Intrapsychically he had to find a way of getting at these earlier feelings which had no autobiographical content . . . As with repressed contents so with implicit memory, it cannot directly be brought into consciousness.

In the sessions that followed he did much useful self-interpretation.He identified the tears in his eyes following the rendition of some French religious music with words that spoke of the relief of suffering, through the supporting hands of God. One morning he asked if he could bring his bicycle into my hall and he almost preempted my interpretation in the session with a clarity of understanding to which I had nothing to add.