British Journal of Psychotherapy Volume 24 issue 4 2008 [doi 10.1111%2Fj.1752-0118.2008.00105_2.x] Judith Nesbit -- Intimate Transformations- Babies With Their Families – Edited

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Book Reviews

A Beam of Intense Darkness:Wilfred Bions Legacy to Psychoanalysisby James Grotstein. Published by Karnac, London, 2007; 382 pp;29.99 paperback.

This is an avowedly idiosyncratic work that refuses to dumb down Bionsideas or regularize them to suit established preconceptions. It is steeped inthe authors long apprenticeship to Bion and his works, which began he

tells us in the 1970s when, as an analysand of Bions, he first becameenthralled by his ideas. In line with this seminal identification, Grotsteintakes fast hold of Bions Platonic emphasis on becoming and invites us toparticipate in his current phase of digestion of Bion as a life-changingphenomenon. From this vertex his book could perhaps have been subtitledWilfred Bions legacy to an analysand. It is not intended to be a summaryof the Bionic canon but, rather, a model for immersion in Bionic turbulence.Much of its vitality derives from the authors personal wrestling with theconcepts, and he states frankly that, even after years of study, the conclusions

presented here are still tentative in my mind:

This is one of the rewards and joys of dreaming that is, absorbing andtransforming Bions works and maintaining the personal faith, not that Iwould understand Bion and his works, but that I would become as much of thewisdom, O, of his works as my mind can possibly progressively accommodate.(p. 329)

When confronted by a thinker of Bions magnitude, who disturbs theuniverse of our existing mentality, we are invited into regions where most

of us absolutely cannot follow (Meltzer 1997, p. 63). We cannot develop hisideas, but we can develop ourselves through internal review and consolida-tion in response to them. Meltzer advised:

It seemed to me that the way to enjoy Bion was very much what he himself hadadvised: just read it; dont try to understand it, dont try to figure it out; just readit, enjoy it and if you are lucky you will be inspired by it. (Meltzer 1997, p. 65)

Grotsteins book makes Bion very realin the sense that we experience theimpact of Bions ideas on his thinking: that is, not just his dogma or alle-

giance but his inner being and becoming, a process he calls incarnation ofgodhead or godhood which, in traditional Kleinian terms, would surelybe introjection of the object in its dual capacity to both feed the internalbaby and advance its capacity for mental digestion. Or, in traditional poeticterms, this is what is meant by inspiration by the Muse. Grotstein in fact

The authors

Journal compilation 2008 BAP and Blackwell Publishing Ltd, 9600 Garsington Road,

Oxford OX4 2DQ, UK and 350 Main Street, Malden, MA 02148, USA. 529


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draws attention to this comparison (p. 77) and would, I am sure, accept theappellation of being one who has been inspired by Bion, both by his workand his person.

In content, the book comprises a near-comprehensive survey of most ofBions major works and concepts, leaving aside the writings after Attentionand Interpretation (Bion 1970) for reasons of space. It is a long book andowing to its structure continually returning to the core thesis of Bionsvision from the perspective of most of his major works and theories hasmuch cross-referencing and repetition. The author apologizes for this; all thesame I think that if I were a psychoanalyst I would appreciate more spacebeing devoted to the clinical applications whose message Grotstein clearlyvalues (there are some clinical vignettes) and less to experiments in termino-

logy, such as transidentification (p. 182). The qualities of tone and atmo-spherics to which he rightly draws attention here are ordinary featuresof the transferencecountertransference. It seems to me that new namesshould be reserved for new phenomena, and these can emerge only fromclinical material. Possibly a distinction between practice and theory wouldhelp here. For example, if it were true that before Bion psychoanalysis wasentirely a left-hemisphere technique (p. 82), it would have died out longago; in practice, the method has always been intuitive. And while it may bethe case that some Kleinians tend to talk as though psychoanalysis were a

type of one-upmanship game of moral superiority (p. 175), this is certainlynot in the spirit of Mrs Klein. Indeed it was not Bion who first learned to seepsychoanalytic meaning in the non-verbal as Grotstein suggests (p. 44), butMrs Klein through her work with children and their phantasies expressed inplay. Grotsteins truth drive (p. 52) is itself a reformulation of Kleinsepistemophilic instinct rather than a substantially different phenomenon.

Having said this, the book is a treasure-trove of interesting foci for dis-cussion. One such point would be Grotsteins idea that projections can onlybe into an image of the object/mother/analyst (p. 181) and whether this

takes due account of the suprasensuous nature of psychic reality. Anotherpoint might be the nature of the origin of mental problems which, inGrotsteins account of what Bion said to him, is ineffable so cannot beexplained by environmental traumas (p. 55) and how this squares with theslightly Winnicottian bent that equates the external world with sharedreality (p. 207), which in turn brings up the fundamental question: what ispsychoanalysis? Grotstein frequently mentions that Bion in analytic practicewas very Kleinian. He feels however that perhaps Mrs Klein did not suffi-ciently analyse Bions war trauma from a time when the external world itself

had gone mad. Yet one might say that, according to Bions definition of O,this was not her job, and might have deflected her attention from her ownbeam of darkness. I would also suggest that Bions O itself is not adiscovery as Grotstein interprets it (p. 114), just a formulation a short-hand for a variety of synonyms: origin, object, godhead, the unknown, inef-

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fable, etc. This leads to another interesting topic the roots of the religiousmystical language that Grotstein adopts and adapts from Bions later yearsand that, far from being unsaturated like Bions mathematical language,

comes trailing clouds of glory from time immemorial. The term transcen-dence, for example, has a long history as Grotstein points out (p. 129), aswell as having current Jungian resonance, which gives it a validity thatinvented words cannot easily assume. On the other hand, there is a danger ofthe formulation of an evolved individual who is at one with O (p. 3) takingon a tinge of smugness.

Grotstein insists (correctly in my view) that it is impossible to maintain anapartheid between Bions earlier and his later thinking; and Meltzer also hasnoted how Bion, unlike Freud, never changed his vision, only his metaphors.

I have to say that, in terms of Bions model of the mind and its place in theorganic evolution of psychoanalysis as a whole, none of the accounts of thepast 30 years seem to me to add substantially to Meltzers clearly writtenKleinian Development (Meltzer 1978). In that book and in Studies inExtended Metapsychology (Meltzer 1986), with its focus on the clinical appli-cation of Bions ideas, Meltzer shows how the linked emotions of LHKtransform the drives; how thinking makes the mind, rather than vice versa,and is done by objects not by the self, hence the need for a theological modelsuch as Kleins; how negativity supersedes the death-instinct as the enemy of

mental development; how catastrophic change enhances the achievement ofthe depressive position; and how psychoanalysis is beginning to acknow-ledge its cultural roots. All this is also in Grotstein, though not necessarilyusing the same terminology. In the past two decades, however, much of theBionic background has been filled in from the fields of philosophy, mathsand science, and Grotstein is clearly familiar with these sources, just as he isdeeply versed in Bions own works from the binocular perspectives of bothindefatigable scholarship and personal transcendence that is, transcen-dence of his previous self or, in ordinary Kleinian terms, development.

What gives this book its unique value is the unusual warmth and gener-osity of the authors personal portrait of Bion as analyst, which is inextric-ably bound up with his self-portrait on the couch-side of the transferencecaesura. Of his four analysts from different schools, we have the impressionthat Bion infuses them all with life. As the author puts it: With Bion, mypilgrimage was to acknowledge, with reverence and awe, the majesty andenormity of my mind and to recognise how cut-off I was from it (p. 39).Grotstein goes to the heart of the distinction between subjective and solip-sistic. In lieu of many clinical examples he presents primarily Bions impact

on his own mind, in what is essentially a type of autobiography, a paean toBion-as-object and internalized supporter of his truth drive. Bions keyexhortations were to dream the session, to suffer the meaning, and tolisten to yourself listening to me (p. 30). And certainly in this book we geta most vivid picture of the analystanalysand in faithful pursuit of the

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evolutionary pilgrimage towards knowledge on which his mentor set himyears ago.

Meg Harris Williams[www.artlit.info]

References

Bion, W.R. (1970) Attention and Interpretation. London: Tavistock.Meltzer, D. (1978) The Kleinian Development. Strath Tay: Clunie Press [reprinted

Harris Meltzer Trust, 2008].Meltzer, D. (1986) Studies in Extended Metapsychology. Strath Tay: Clunie Press.Meltzer, D. (1997) The evolution of object relations. British Journal of Psychotherapy

14(1): 606.

Intimate Transformations: Babies With Their Families edited byJeanne Magagna et al. Published by Karnac, London, 2005; 242 pp;19.99 paperback.

This is an exciting, thought-provoking and ground-breaking book whichtakes a fresh look at aspects of Infant Observation. It is new in that it

concentrates on the new-born in the family, looking at the dynamics thatarise there, particularly the pressures of the older sibling, and how these mayaffect the personality development of the new baby. It is also new in that thebook is the product of a seminar group that was unable to meet physicallybut worked by using a pioneering form of video-link, with discussionssupplemented by the affective learning model an approach which looks atthe dynamics of the group to support and enhance insight in the work.

The book is written in three sections: first, case-study papers written by themembers of this remarkable seminar group on aspects of their own obser-

vations; then a section on the applications of infant observation in variousinstitutional settings, describing the way infant observation can enhanceskills in adult psychotherapeutic work. The last section describes the video-link technology used, and its impact on both the work and on the studentsthemselves through the particular approach of the affective learning model.The students were based on two sites in different states of the USA and wereled from the Tavistock Clinic in London by Jeanne Magagna, an experiencedand thoughtful clinician, writer and seminar leader in the field who herselfhad studied for three years with Esther Bick. Jeanne Magagna co-edits the

book with the seminar members and also contributes a fascinating paper onthe teaching of infant observation as well as co-writing two case studies.Thatsuch work should emanate from three sites thousands of miles apart is atribute to the participants stamina and sensitivity in what one imagines musthave been fairly daunting circumstances.

http://www.artlit.info/http://www.artlit.info/


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Each case study in the first section is used to illustrate a particular aspectof psychoanalytic theory so that we see this not in the abstract, but in theliving baby bringing its own innate capacities to bear on its immediate

environment and being itself dialectically formed by this environment.There are chapters on the origins of self-esteem; the role of the mother in thegrowth of the childs ability to bear emotional pain; the experience of selfand others; oedipal anxieties in the new family constellation; and the role ofthe observer. And although each of the case studies in the book has adifferent emphasis and concentrates on different aspects of personalitydevelopment, they all share the focus of examining the baby in the contextof the family, in particular in the impact of the elder child. These are painfuldescriptions not just of the frequent states of intense rage and despair of the

elder sibling but of the huge impact this has on the personality developmentof the new baby. This is an area of infant study, only recently opened up byJuliet Mitchell (2003) and Prophecy Coles (2003) in their books on siblingdevelopment. The connection between early infantile experience and lateremotional difficulty is particularly emphasized in Chapters 8 and 9, wherethe observed babies experience and adult case studies are linked. Manythemes resonate throughout the book, particularly that of space in the mindof the other whether in the mind of the mother in order for the infant todevelop the capacity to have a mind of its own, or in the mind of the observer

to enable a mother to find mental space for her new baby, or (Chapter 6) inthe mind of a consultant working with desperate staff and parents in anIntensive Care Unit.

Similarly, within the group itself, the ability to find mental space for eachone of the other participants and the infants they observe provided crucialcontainment, enabling individual group members to find space for thoughtas opposed to projection concerning the infants and families observed.Indeed, the transformative function of space and containment in thegeneration of thought and personality (Bion 1962) could be said to be the

central premise of the book.Another unusual emphasis throughout is the frequent reference to the

ability of not-knowing the Keatsian negative capability of being able tobear acutely uncomfortable states without intervention or leaping afterpremature solution. Jeanne Magagna in her discussion of the value of InfantObservation sees this receptive attitude as inherently linked to transforma-tion of feeling and the generation of thought, and as an indispensable part ofa psychoanalytic stance. Receptive space in the mind of the observer canchange things, even without interpretation, as Magagna describes in a

painful observation of a mother, locked in an inability to attend to her littledaughters needs, who comes to feel contained and is thus helped to be moreresponsive both to her new baby and to her other children.

A major theme discussed in the book is the impact of the older sibling andthe situation this creates a triangle into which the second baby is born and

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which Juliet Mitchell has described as being possibly of equal importance tothe Oedipus complex. Freud described this as the family complex butlooked at it far more in relation to the elder child than to the baby, whereas

Mitchell makes the point that the baby can be thrust into a painful aware-ness of separation from the mother far more forcefully by the elder siblingthan by the father. This idea is examined throughout the book but particu-larly in two of the case studies which focus particularly on sibling rivalry anddisplacement. Hope Cooper and Jeanne Magagna look at the developmentof self-esteem in the new baby, describing the painful and acute hostility feltby an elder child for the newborn, and his consequent regular and dangerousattacks. Because of the lack of separation between the first child and themother, the latter is unable to prevent these nor understand their impact on

the new baby. Here the question is how the baby can come to feel anyself-worth when under such regular physical attack and the impact of amother who cannot sufficiently bear her in mind? It is certainly only recentlythat such sibling issues have been given much attention in psychoanalyticwriting, and yet it is clear how crucial they must be on the development ofthe new babys personality.The baby in the above observation was an infantwith perhaps much innate determination, and was able eventually todemand her mothers attention and withstand her brother but the effect onmore congenitally sensitive babies can be imagined.A link here is made with

the origins of later shame and lack of self-esteem.The second chapter focuses on the elder siblings feelings and their effects

in a case study of a young child supervised by Magagna and Adamo ahighly complex study of the unmitigated, verbally explicitly murderousresponse of a 4 year-old girl to the awaited birth of a little boy.The childs attimes almost psychotic reactions once again stemmed from a mother whowas unable to allow space or containment or control into her relationshipwith the first child, and was also compounded by the failure of the father toact as an acceptable transition from the mother because of his seductive

relationship with the child. This observation also raised another interestingconsideration the observer was directly requested to step outside normalboundaries of observation, and act almost as an active therapist to the childand mother and indeed did so. Although questionable in the first instance,the authors justify this in the extreme circumstances of the situation, anddescribe it as the observer taking over the missing paternal role in the childstransference reaction, and providing a private (paternal) space for the littlegirl where she could work through her feelings.

Together with the need for space in the mind of the mother for the new

baby the case studies also speak of the need for containment. These twinthemes run through the book, and reflect the thought of Bick and Bion asparticular influences. Bick (who taught Magagna for three years) pioneeredthe technique and practice of infant observation current today (i.e. natural-istic observation of babies in their families, rather than in laboratories with



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stop-watches . . .) and was acutely aware of the primitive anxieties of thenew-born, of the terror incurred in the baby when dropped from the moth-ers mind i.e. when the latter fails to be sensitive to the babys reactions.

Mrs Bick suggests that for the tiny baby the infant skin feels as if it is only themost fragile container of the self (the reason for their distress when leftdefenceless and naked, or why they hate being changed) and the need is thenfor the close holding of clothes or wrappings but, above all, for the mater-nal mind that can intuit the babys feelings in this instance the need forcontainment (Bick 1968) She was acutely aware of the mechanisms babiesmight find in order to provide some sort of distraction or protection fromfeeling dropped from the mothers mind sometimes silently freezing, stiffand immobile, the gaze unfocused (as in Hope Coopers description in

Chapter 2, or Carolyn Shanks in Chapter 8) or sticking in adhesive iden-tification (Bicks term) on lights or other objects a sort of symbolic clingingto protect against the feeling of uncontainment. Bicks concept of secondskin formation is also described, when the baby later clings to prematureintellectual or physical development to hold the self together (or like theinfant in Chapter 2 who clenches all her musculature as she comes under afrightening physical attack from her older brother). Such vignettes appearthroughout the case studies as the observers describe the interactions of thebabies in their families. Thus the observations bring to life the insights

particularly of Bion and Bick, but also of Winnicott, in relation to infantneeds and terrors, particularly in relation to maternal containment and thecapacity for providing the all important space in the maternal mind enablingmental and emotional growth.

A further theme is that of the terrific stresses placed on the mother as sheattempts to share attention and emotional space with both children. Theobservers bring vivid accounts of the pain and rage of the elder child and theimpact on the infant and his internal world, and of the various ways mothershandle sibling aggression. How this takes shape depends very much on the

mothers own inner world and object relations, which in turn impacts on thepersonality development of her children.

These are powerful case studies, and the book gives a vivid impression ofthe pressures and emotional impact on the observers of the primitive unme-diated and conflicting feelings aroused in the work of infant observation.Theobservers own infantile feelings and anxieties get stirred up (their ownbabies in the mind to use Magagnas phrase), and they need to be able towithstand both distressing material in the observations, and the resonanceswithin themselves. This adds up to a considerable emotional weight, and

support may be needed if they are going to be able to stay the course.Personal analysis, one would assume, must be vital, but more than that maybe needed, and in the book this is described as coming from the group itself,so that the seminar members, while in one sense providing pressure in termsof possibly disturbing observational material, also function as a support.

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Section Three of the book is given over to the unusual form this supporttook that of the addition of the affective learning model to the ordinaryobservation seminars. This is an unfamiliar term on this side of the Atlantic

at least, and appears to be essentially the processes of an experiential/analytic group applied both to the interpersonal dynamics of the group itselfand to the material brought in the observations all of this in the service ofthe work-group. The method looked at how each individual reacted emo-tionally to the specific mothers, babies and family situations described, inways which reflected their own internal object relations their own babies-in-the-mind in Magagnas phrase. In this way projected anger, condemna-tion, hostility or idealization within the group for a given observed familymember could be analysed and understood before it disrupted the group.

The papers in Section Three describing this aspect of the seminars empha-size the intense and primitive feelings evoked by the observations and pointout that, if projections are not resolved, the observations and even thegroup itself might break down. Similar resonances and projections natu-rally occur within the group both between group members and betweenindividual group members and seminar leaders, and these also were analy-sed, as described in Section Three. Jeanne Magagna, in her paper on theteaching of infant observation describes herself as needing to be sensitiveboth to the observed baby and to the internal world of the the observer

participants too. It is clear from the different papers that the group membersfelt that this aspect of the work, although painful, enhanced their ability torelate to one another and to the babies and families observed and at amuch deeper level than they had ever expected. They regarded it as one ofthe enormous bonuses in the four years of the seminar. Nancy Bakalar, in apaper on the group experience, describes this affective aspect as not onlyenormously enriching, but also healing for the observers themselves.

Two papers in this final section describe the difficulties and the challengesimposed by the video-link technology used to link the two groups of stu-

dents thousands of miles apart in the USA with a seminar leader evenfurther away in London. Surprisingly, the outcome was a positive triumphover the problems, in that the video-link enabled the most high-quality andfocused seminar work to take place in areas lacking in teachers of sufficientexperience and calibre, and where students may have been few in numberand geographically isolated. Clearly the authors of the book feel that thisway of working could be a precedent elsewhere. Inevitably not all problemswere resolved two papers describe how some students, arriving once thegroup was established, felt like second babies suffering the hostility of older

siblings and finally left. Not everyone, says David Scharff, could cope withthe intense and primitive material, nor with the powerful feelings elicited inthe group affective model element of the group.

Overall, the book provides a series of passionately lived and authentic,highly thoughtful and intuitive papers. It gives an unrivalled picture of the



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gripping nature of infant observation well managed and led, and demon-strates its immediate relevance to the understanding of the development ofhuman personality and of how interactions between infants and their imme-

diate family shape our inner world. Beyond that it demonstrates its power toinform and deepen analytic work in general, and its therapeutic and trans-formative influence on the practitioners personal development.

In addition, the book almost entirely avoids simplistic interpretations ofthe behaviour observed, and is a superb introduction to theory which cansometimes seem difficult, since we see the theory in action as it were brought to life. There is an excellent bibliography and index, and the oddeditorial slip cannot detract from the importance of this exciting and stimu-lating book.

Judith NesbitLondon Centre for Psychotherapy, London

[[email protected]]

References

Bick, E. (1968) The experience of the skin in early object relations. InternationalJournal of Psycho-Analysis 49: 4846. Reprinted in: A. Briggs (ed.), SurvivingSpace: Papers in Infant Observation, pp. 15771. London: Karnac, 2002.

Bion, W.R. (1962) Learning from Experience. London: Heinemann.Coles, P. (2003) The Importance of Sibling Relationships in Psychoanalysis. London:

Karnac.Mitchell, J. (2003) Siblings: Sex and Violence. Cambridge: Polity Press.

You Ought to! A Psychoanalytic Study of the Superego and Con-science by Bernard Barnett. Published by Karnac, London, 2007; 173pp; 14.99 paperback.

A comprehensive survey of the concept of the superego, one of those veryfamiliar and yet elusive and complicated psychoanalytic concepts, is much tobe welcomed, especially one by such a well-respected authority as BernardBarnett, training analyst and teacher at the British Psychoanalytical Society.

The first chapter introduces the main features of the system superego,clarified by examples from case vignettes, press reports and English litera-ture. Here, as throughout the text, Barnett draws in the most illuminatingmanner on George Eliots last novel, Daniel Deronda (Eliot 1876), invokingthis novelists stated aim to widen the English vision a little . . . and let in alittle conscience and refinement (p. 13). It is a novel particularly well suitedto exemplifying Barnetts points, and his interweaving of its moments andpersonalities is one of the great strengths of You Ought To!

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mailto:[email protected]:[email protected]


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Chapter 2, The Freudian Superego traces and expounds Freuds ideasfrom his early theoretical speculations, through his work on dreams to hisfurther refinement of his ideas in On narcissism (Freud 1914), the text in

which he first introduces the term ego ideal (a forerunner of the superegoconcept), the selfs formulation of how it wishes to be. It is in his work of1923, The Ego and the Id, that Freud (1923) first refers to the superego (Uber

Ich, literally over the Ego), and it is here that he refines his ideas onidentification, contending that a superego arises from the childs identifica-tion with parental figures, a formation occurring developmentally in theearly oedipal stage when the ego is still in a weak state. Here Barnettconsiders Freuds thinking on the male and female Oedipus complex and itsresolution, the process summarized in the sentence, The Superego is heir of

the Oedipus Complex (p. 28). Freud also makes clear that the superego canbe a malign force acting with great severity and cruelty towards the ego. InFreudian thought this cruelty derives from an unconscious sense of guilt, onealso capable of impeding the individuals wish to recover. Barnett illustratesFreuds distinction between unconscious and conscious guilt by means of acompelling case history from his own work with a female patient whoseextremely punitive superego resulted in a prolonged period of intensivesuffering, both physical and mental. The application of superego theory tothe state of hysteria is illustrated by a fascinating discussion of George

Eliots fictional heroine, Gwendolen Harleth, from Daniel Deronda.The roots of the system superego lie early in infancy and in Chapter 3

Barnett traces its formation and development. He skilfully contrasts andinforms his reader of varying views on superego development, structure andfunction for example, here, pointing out divergences between Kleinianand Winnicottian views. From 6 to 12 months the infant grows in terms ofsocialized morality, whilst from 12 months to 2 years the toddler is social-ized. Between 2 and 3 years there are precursors of the superego, premoralmanifestations of guilt; although, here, the author is careful to emphasize

that the child at this stage does not yet have a superego structure that isstable and can be recognized as his own. 3 to 6 years is the period of oedipaldevelopment and in classical theory, at least in the case of the little boy, thesuperego is formed as a result of identification with the father to avoidcastration. Barnett adroitly handles the issues of male and female oedipalidentification, giving information on alternative views on the origins andnature of oedipal development in women: Gwendolen Harleth and DanielDeronda himself are helpful examples; whilst issues of the superego inadolescence and early adulthood are discussed with reference to James

Joyces Portrait of the Artist as a Young Man.Freuds formulation of the superego has been called the true beginning of

sound object relations theory (p. 85; Coltart 1992, p. 50), and Chapter 4 dealswith object relations focusing on the development of classical ideas by a fewpsychoanalysts working mainly in the UK. Barnett covers the Contempo-



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rary Freudian tradition in the work of the Anna Freud Centre, Anna Freudherself and that of Joseph and Anne-Marie Sandler and extends his discus-sion to the work of analysts such as Ann Hurry and Rose Edgcumbe who

addressed superego issues in their work with children.Barnett points out that no unified theory ever emerged from the discus-sions of the Object Relations theorists but he does provide a most usefulcommentary on the most important disagreements among these clinicians,notably those centred around the function of objects, the nature of theinternal world, and the relationship between the inner and outer worlds.Whilst key central psychoanalytic concepts were maintained, notably con-flict and anxiety, others were modified, even rejected. Crucial to these chal-lenges was the work of Melanie Klein and her major revisions, in the light

of her research into earliest infancy, to the classical theory of the superego,most notably her conclusion that a primitive form of superego existed inthe first year or life, a great deal earlier than had previously been assumed.Also, appreciably earlier than had hitherto been believed to be the casewas the Oedipus complex: in Kleins view, Freuds view of a superegooriginating with the resolution of the Oedipus complex was the last stageof a more complex development. Before moving on to Post-Kleiniandevelopments, Barnett gives an extremely helpful summary of the essentialdifferences between Kleins theory and classical and, in particular, Anna

Freuds theory. The following commentaries on Bion, and more recentPost-Kleinian theorists, are characteristically clear and informative as arehis sections on the Independent Tradition, and, in particular, the work ofFairbairn and Winnicott. Admirably comprehensive, Barnett also includeshere comment on the work of James Strachey and analysts such as NinaColtart.

Up to this point in the text, Barnett has addressed the ideas of theorists whohave made valuable contributions to superego theory. Chapter 5 takes adifferent,much more sombre turn with its Freudian epigraph setting the tone:

God has done an uneven piece of work, for a large majority of men havebrought along with them only a modest amount of it [i.e. the individualconscience] or scarcely enough to be worth mentioning (p. 115, Freud l933).This section on the superego, the object and the Holocaust addresses some ofthe most serious effects than can result when superego guilt and the capacityfor concern are absent in the group and when the external object may beattacked and destroyed, when, in short, deficiencies in the superego systemcan give rise, under certain conditions and in the case of certain pathologies,to mass murder. Barnett uses the Holocaust to show how a murderous activity

was directed against a hated object with the aim of total annihilation,the scaleof the murder enacted with superordinary cruelty and sadism implying acorruption of the superego system, both group and individual. Barnett doesnot assume that psychoanalysis can provide the answer to these matters; he isnever reductive but always questing for the truth.

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Ego ideal theory teaches of a situation whereby a group can submitindividual will to the will of a leader by a process of substitution; the unionof ego and ideal can submerge the individual superego. The section on the

Nazi ego ideal and morality focuses on these matters before the bookmoves from the murderous attacks on the object and its splitting effects onthe perpetrators superego functions to a second focus the effects on thesurvivors and their childrens superego systems. Particularly powerful isthe authors consideration of the unconsciously transmitted effects on thesecond generation: significant are accounts of second-generation childrengrowing up with an awareness of a hovering presence of death in their ownlives, and of how certain children of survivors are preoccupied by two centralphantasies: firstly, that they can act as a replacement child for one who was

lost in the camps; and, secondly, that they can carry out a special, reparativemission. Exemplified by the account given by the journalist Anne Karpf anda vignette from his own clinical practice, Barnett shows the reader theprofound reverberations of second-generation Holocaust experience on thesystem superego.

Barnetts final chapter opens with an epigraph from David Lodge: Theindividual self is not a fixed and stable identity, which heralds the centralconcerns of this section of the book as he looks at classical Freudian, andsome British, post-Freudian psychoanalytic explorations of subjectivity

focusing especially on ego self/superego interactions. His wide-ranging lensencompasses, among other areas, Freud and Modernism, Fairbairns critiqueof classical superego theory and the challenges posed to notions of a unitaryself by the Post-Modernists.

This is a very comprehensive and rigorous book of the greatest use to allin the field. Informed and illustrated by an extensive knowledge of not onlypsychoanalysis but also of English literature and film, its varied pace andstylistic lucidity make it a pleasure to read as well as a book from which tolearn a great deal. It is also a text that demonstrates irrefutably that Freuds

view on the aetiology of mental ill-health (as a disruption in the balance ofego, id and superego) is as relevant today as it ever was.

Emma LetleyArbours Association, London

[[email protected]]

References

Coltart, N. (1992) Slouching Towards Bethlehem . . . and Further Psychoanalytic

Explorations. London: Free Association Books.Eliot, G. (1876) Daniel Deronda. London: Everyman, 2000.Freud, S. (1914) On narcissism. In: SE 14, pp. 67102. London: Hogarth.Freud, S. (1923) The Ego and the Id. In: SE 19, pp. 366. London: Hogarth.Freud, S. (1933) New Introductory Lectures on Psychoanalysis. SE 22. London:

Hogarth.



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Psychiatry and the Cinema by Glen O. Gabbard and Krin Gabbard.

Second edition. Published by American Psychiatric Press, Washing-ton, DC, and London, 1999; 399 pp; 24.50 paperback.

Our story deals with psychoanalysis, the method by which modern sciencetreats the emotional problems of the sane. The analyst seeks only to induce thepatient to talk about his hidden problems, to open the locked doors of his mind.Once the complexes that have been disturbing the patient are uncovered andinterpreted, the illness and confusion disappear . . . and the evils of unreasonare driven from the human soul. (1999, p. 55, emphasis added by the authors)

So begin the opening credits for Spellbound (1945), a film directed byHitchcock. Yet, despite or perhaps because of its portentousness, Hitchcockdescribed the film rather dismissively as just another manhunt storywrapped up in pseudo-psychoanalysis. Psychoanalysis and psychiatry havelong fascinated filmmakers as becomes clear in the description of the manyfilms described and analysed by Glen Gabbard and his brother, Krin, inPsychiatry and the Cinema. This is the second edition of their earlier bookfirst published in 1987, and is a response to readers interest in the portrayalof psychiatry in American film.The book incorporates an alphabetical list of

films depicting psychiatry, and 43 black and white stills. The authors draw ontheir separate expertise Glen Gabbard as an internationally known writerand teacher of psychoanalysis, and Krin Gabbbard, a teacher of film, litera-ture and cultural studies and the author of several books on jazz.

The authors point out in their introduction that, although psychodynamicpsychiatry originated in Europe, following its introduction to the UnitedStates it became firmly established within a few decades. They ask whyfilmmakers are so fascinated with the psychiatric profession, their discussionincluding all mental health professionals, while noting a prevalent confusion

in understanding the differences between psychiatry, psychoanalysis, psycho-therapy and psychology.They argue that both filmmakers and mental healthprofessionals have an overwhelming interest in emotions, behaviour andhuman motivation, and that, although Hollywood reflects certain attitudesabout the mental health professional, it is also selective in how these arereflected. In the first part of their study, they ask how the profession comesto be represented in film. In the second part, they consider how the psychi-atrist atthe cinema understands, from within the perspective of psychoana-lytic theory, some dominant themes within American cinema.

Much of the analysis is detailed, nuanced and well researched, sometimesincorporating a wry humour, and refers to both obscure and to well-knownfilms. They see film as illustrative of how the American public struggled tounderstand what psychiatry was about, with all its subtleties, ambiguities andcontradictions, and describe how this understanding changed over time in

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response to sociological and historical forces. The second part of the bookadopts a different methodology. Using psychoanalytic theory as the basis fora film critique, it is an in-depth discussion and an analysis of particular

themes as, for example, narcissism and the cult of the celebrity.They define the late 1950s and early 1960s as a Golden Age for psychi-atry, since its practice was seen during that time as effective and benevolent.Prior to this, but especially in the early twentieth century, psychiatrists wereconfused with hypnotists, clairvoyants, and others with obscurely definedcredentials. The authors refer to a number of films as illustrative of theirargument, many of which are obscure, but this enables them to identify someinteresting and perhaps quirky material. For example, Ginger Rogers, thefemale dancing partner of Fred Astaire, played the role of analysand more

often than any other actress (see In Person (1935), Free Love (1930),Reunion in Vienna (1933) and Lady in the Dark (1944)). And in Carefree(1938), Fred Astaire played the role of a dancing psychiatrist, with thecoaxing, arm-waving gestures of the show business hypnotist, whichtogether with their falling in love surprisingly enabled him to save hispatient. It remains unclear what was the curative factor. The authors notewith some amusement that When Astaire lends his aura to psychiatry, theprofession becomes more than a little magical (p. 48). On a more seriousnote, it is of some interest to wonder why Ginger Rogers was cast in this role,

given her screen persona of graceful elegance and beauty, her successfuldancing partnership with Fred Astaire and, as the authors put it, her repres-entation of wholesome screen normality.

In Spellbound (quoted at the beginning of this paper) we are given thefirst detailed discussion of countertransference, although tantalizingly this isnot summarized by the authors (ibid., p. 54). The producers of Spellboundalso enlisted the help of a psychiatrist for technical assistance. Despite this,the films depiction of psychoanalysis does little to further understandingbeyond seeing its practice as a cathartic cure. The authors note that, despite

many of Hitchcocks films presenting a view of psychiatry as rather positive,the subtext is rather more ambiguous. For example, in Hitchocks master-piece Vertigo (1958) the main protagonist, Scotty, is cured by psychiatry, butfor all this he appears empty and desolate. And other films by Hitchcocksuch as The Wrong Man (1956) and Psycho (1960) reveal more complexambiguities in the directors understanding and portrayal of psychiatry.

They also refer to a little known film on Freud called, rather prosaically,Freud (1962). Directed by John Huston, the script was written rather sur-prisingly by Jean-Paul Sartre, who is known more for his critical stance

towards psychoanalysis. Montgomery Clift played Freud, and Susanna Yorka composite patient. The authors write that the film is frank about Freudswork, in particular, the development of his theories of infantile sexuality, butconcludes that it romanticized and sensationalized him. Freud is comparedto Copernicus and Darwin because of the blows dealt us in our vanity. The



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film is also given the full Hollywood treatment with an over-ripe narrationand string crescendos. It was not a box-office success (one wonders why)and Callenbach, the editor ofFilm Quarterly, wrote that it would be impos-

sible for any sophisticated person to sit through the film without at somepoint bursting out laughing (p. 101).By the late 1950s psychiatrists were seen as the authoritative voices of

reason, adjustment and well-being, which was typified by the success of thefilm The Three Faces of Eve (1957), a film which won Joanne Woodward,playing the psychiatrist, an Academy Award. Other similarly positiveaccounts of psychiatry can be found in The Interns (1962), Girl of the Night(1960) and David and Lisa (1962) where Howard da Silva plays the role ofa compassionately competent psychiatrist.

However, not all portrayals are so positive. A familiar theme in film is theapparent belief in Hollywood that psychiatrists, especially women, have aninability to contain the countertransference. In a chapter devoted wholly tothe representation of the female psychotherapist, the authors begin with anobservation: that since the 1930s more than a hundred Hollywood filmsfeature a female psychotherapist. Rather typically the portrayal of women atwork reflect dominant beliefs found in the rest of society, i.e. women cannothave it all, that they have a biological function,and that sooner or latertheyllbe tripped up by love.So, more often than not,a female analyst finds her true

nature only when she falls in love with a male patient (Knock on Wood (1954)or Spellbound (1945)) or, alternatively, when she is nurturing a youngerfemale patient, as inI Never Promised You a Rose Garden (1977). Even whena woman psychotherapist treats a female patient, she is presented as anunfulfilled spinster or divorcee, as in Three on a Couch (1966). In at least 29films identified by the authors, women analysts become romantically involvedwith their male patents, compared with less than half that number of maleanalysts with female patients. Yet, as the authors point out, in real lifeboundary violations of a sexual nature are far more likely to occur between

male mental health professionals and female patients, rather than the reverse.The question remains, how do these cinematic images impact upon how

our patients see us? Many of us will have had the experience of patientsasking what we thought of, for example, the recent highly successful tele-vision series The Sopranos.1 Or, more dramatically, an experience I hadfollowing the release of the film, Analyse That when a patient swept outof my consulting room at the end of her session, challenging me to do justthat. In fact the authors advocate that, when a film is brought into asession, it is useful to consider the clinical implications in relation to its

depiction of psychotherapy. I would go further. It is useful to followthrough all references to film regardless of its narrative or the theme.Perhaps films do accurately reflect the ambiguity of our work and societysambivalence towards this. As the Gabbards note, within film culture, thereis a widespread perception of analytic omniscience, and the apparent

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ability to mind read may therefore be envied and feared. But maybe it ispossible to perceive these negative portrayals as reflecting a healthy scep-ticism and iconoclasm, since they conclude by reminding us of the follow-

ing definition, A psychoanalyst is someone who pretends he doesnt knoweverything (p. 185).

***

Part Two begins with an overview of theories of film criticism. Much of theauthors discussion focuses on how Lacanian thinking has been adapted as atheory of film criticism, although they write, It is . . . difficult to define clearlythe terms for Lacanian theory that have proved most useful for semiotic film

criticism (p. 192). Concepts which they see are of importance, are theMirror stage, the Imaginary, and the Symbolic, noting especially theconcept of suture, which is defined as the process by which cinematic gapscreated by cutting or editing are sewed shut to include the viewers whoidentify themselves with some aspect of the cameras gaze (p. 194). Never-theless, it is psychoanalytic theory which is their preferred mode of analysisand, notwithstanding that this perspective has come under sustained attack(p. 171), they advocate a pluralistic approach. Although the rest of theircommentary is a rich and discursive approach to film, including discussion on

dreams, phallic women, horror, narcissism and the celebrity culture, forreasons of space I intend to limit this discussion to the authors discussion ofWoody Allen, and to their analysis of Casablanca.

It is clear the authors have an overriding interest in the whole oeuvre ofWoody Allen. References to his many films are scattered throughout thebook. But apart from their interest in how he represents psychoanalysis, andhow this has changed over time, and how his films can be seen as a portrayalof narcissism, they express a curiosity in whether the various characters inhis film are in fact, in one way or another, portrayals of himself. Allen,

unsurprisingly, denies this but, as the Gabbards point out, his charactersconsistently play as a disenchanted analysand. The authors quote many ofAllens humorous one-liners, and write that until the 1990s one mightassume that Allens own psychoanalysis was working. But in 1993 in Man-hattan Murder Mystery we hear the character played by Diana Keaton,suggesting she returns back into therapy, only to be told by Allens character,You dont have anything that cant be cured by Prozac and a polo mallet (p.126). And in Deconstructing Harry (1997), the protagonist tells one of histherapists that, although he has seen six different analysts, nothing has

changed. As the authors comment, this has a chilling ring, given his quasi-incestuous relationship with Soon-Yi Previn (p. 127).

The question remains whether Allen is the characters he plays but, takinginto account the complexities of the multitude of characters his films portray,they observe it is likely that they represent fragments of himself. As they say,



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it is probable that, like all artists, Allens major subject is himself. They quoteAllen who, when searching for the lead role player in Deconstructing Harry,went through more than half a dozen people, before finally deciding to play

it himself. Allen stated in an interview with Martin Scorsese, Theyll thinkIm the character . . . but I dont care. That is one of the blessings of what Ido. That is why they come or why they stay away (p. 248).

In an interesting but too short commentary on what makes a cult film, theauthors consider Casablanca, directed by the apparently prolific MichaelCurtiz. The film was released in 1942 but it was not until the 1960s that itreached the status of a classic. They forward some possible explanations: thestar presence of Bogart as Rick and his co-star, Bergman, the nostalgicmusic, the resolution of oedipal material, and the Hollywood message that

the American outlaw as hero can survive. Although these are undoubtedlyimportant, I will argue that it is the films evocation of the unconscious, andthe possibility that some films are subject to different interpretations andcan be understood as expressing different levels of the unconscious, thatmake a film a classic.

In fact their dominant analysis ofCasablanca depends, rather predictably,on a Freudian interpretation of an oedipal triangle, which is played outbetween Ilsa, Rick, her erstwhile lover, and her present husband, Laszlo.And in this, as the authors point out, there would be a similarity to a

Lacanian analysis. They write of Ricks desire to possess a blissful unionwith the all-good nurturing woman completely unattached . . . to a threat-ening paternal figure, and argue that no other woman could have fulfilledthis film role so completely as Ingrid Bergman. The authors point out Berg-mans screen image projected an image of the most desirable qualities ofmother and lover (p. 207). However, ironically in real life, Ingrid Bergmanwas reviled and attacked for leaving her daughter with her first husband tolive with her lover, Roberto Rossellini. In March 1950, in the AmericanSenate, she was described as evil and her actions were seen as a powerful

attack on the institution of marriage (Jackson 1994, p. 40).Thus to restrict theanalysis of this iconic film to the resolution of an oedipal triangle is, to mymind, to miss an alternative and possibly richer analysis, as I shall argue.

The theme song of As Time Goes By in Casablanca defines the filmscontent. It is essential to the narrative and its location, and is evocative of theatmosphere of a sweet, sad nostalgia. It also powerfully expresses thecharacters preoccupation with loss, change, transformation and betrayal.Casablanca can be understood psychically as a transformational object(Bollas 1987).2 The action takes place during the early years of the Second

World War, and we are told of Casablancas importance strategically; that,as an outpost of Vichy France, it was also a stopping off point betweenNazi-occupied Europe and the Americas. It was therefore a centre for blackmarket dealing, and for the buying and selling of transit visas. At the centreof this is Ricks saloon.

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The film is shot in black and white, and is atmospherically stylish. Muchof the action takes place at night, where Humphrey Bogart (Rick) as thesaloon owner epitomizes cool. An outstandingly attractive man of few

words, dressed in a white tuxedo and black bow-tie, he appears bitter,disillusioned and cynical. However, we learn that he was a gun-runner toEthiopa and had fought against the Fascists in Spain, thus indicating that,despite his appearance, he is in fact a man of ideals and principle. Into thisenvironment appears Ilsa, a woman representing to the Gabbards at leastboth sensuality and their fantasy of the look of motherhood. She ismarried to another outlaw, Laszlo, the organizer of a network of resis-tance groups in Europe.

Where my interpretation differs radically from that of the Gabbards

is how the films ending might be understood. Whereas they point to theresolution of the oedipal triangle, it would seem to me that Rick ulti-mately betrays Ilsa, just as she had earlier betrayed him. Although eachbetrayal can be seen as consistent within a psychoanalytic and social con-vention (Ilsa was married), my argument is also consistent with an appre-ciation of the underlying tragedy of the three characters and the filmsexpressed romanticism both in its aesthetics, its characterization and itsnarrative. Ricks response to Ilsa when she realizes she is to leave Rickand Casablanca to accompany her husband, is Well always have Paris

a reference to their brief love affair. It is a bittersweet moment and com-municates the profound loss of what might have been. It is this profoundambiguity rather than any other explanation that may explain why the filmhas become a classic, and why it has held the imagination of generations offilm audiences.

***

This book is, as stated previously, in two parts, each with totally different

methodologies. It is the second half which is the more successful since thereis a sureness of approach; an overview of film critical theory and a subse-quent rich analysis of themes and films from a pluralistic psychoanalyticviewpoint. The first half of the book, although looking at many films thatportray the work of the mental health professional, is in actuality a discus-sion largely about psychiatry. It is presented as sociological, but lacks coher-ence in terms of any underpinning of sociological theory. There are too manyreferences to too many films without a clear indication of what the criteriawere for their inclusion.

If we take as an example: the authors define the early 1960s and 1970s asa golden age for the portrayal of psychiatry. They define their character-istics for this period, but seemingly the rest of the twentieth century is not soclearly characterized. Is this because the authors were unable to identify apattern? The authors also note the publics confusion (prevalent even today)



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between the work of the psychiatrist and other professionals. A thorough-going sociological analysis could have tracked the increasing professional-ization of psychiatry, from its early twentieth-century association with

hypnotism and quackery, to its present position. The development of anoccupation into a profession does not just happen. Some or all of the fol-lowing is set in motion: the restriction of entrants via examinations, or class,initiation ceremonies and rituals (dining at the Inns of Court for barristers inthe UK is a good example), dress codes, ways of speaking, income levels tosubsidize a long training, the development of an arcane or highly technicallanguage specific to that occupation, a code of ethics, and the establishedright to self-police. Such a development is usually the outcome of a small butactive group of the self-interested. But perhaps to analyse these sociological

changes and then to link them with the portrayal of psychiatry in film isasking too much. However, as the book stands in the first half, more ques-tions are raised than answered.

Having said that, the book is well researched with copious references notjust to well-known films but also to the obscure. It will be of interest to allfilm buffs and hopefully will inspire mental health professionals to analysetheir own patients references to film. The authors conclude:

While the actor in the movie may be sublimating his exhibitionism, the psy-

chotherapist in the privacy of his office sublimates his voyeuristic interests.While seemingly disparate in this respect, psychiatry and the cinema are bothcapable of offering a compelling glimpse into the human psyche. (p. 314)

Notes

1. Neither the television series The Sopranos (19992007) nor Analyse This (1999),and Analyse That (2002) which followed, the latter two films focusing on a psychi-atrist played by Billy Crystal and his misfortune in working with a patient, Robert DeNiro, playing the now familiar role of a troubled gangster, are discussed here since

they were released after the publication of this book. Although The Sopranos wasshown on British television, it was only in the States that it developed a cult audience.A loyal and informed audience regularly gave their opinion to all media outlets as tohow the analyst related to her patient (another Mafia boss).The ending of the seriesin particular caused huge controversy, just as if it were real.A glance at You Tube onthe Internet shows an alternative and humorous ending, as well as other vignettesfrom the series, and illustrates the hold this film had on an educated and analyticallysophisticated audience.

2. Bollas defines the transformational object as an experience that will be identifiedwith processes that alter the self (p. 14). Bollas also associates this with an aestheticexperience, which enables the subject to feel an identification with the object. Hence

the importance for a films aesthetics in its appeal to the unconscious.

Marguerite ValentineArbours Association of Psychotherapists, Bristol

[[email protected]]

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References

Bollas, C. (1987) The Shadow of the Object: Psychoanalysis of the Unthought Known.London: Free Association Books.

Jackson, R. (1994) Mothers who Leave: Behind the Myth of Mothers Without TheirChildren. London: Pandora.


Documents

British Journal of Psychotherapy Volume 24 issue 4 2008 [doi 10.1111%2Fj.1752-0118.2008.00105_2.x] Judith Nesbit -- Intimate Transformations- Babies With Their Families – Edited