Abstract
Francesco Mancuso has offered us a vision of a thoughtful integration of some of his most cherished teachers and mentors, a psychoanalytic patrimony he has made his own by virtue of his research, intellectual discipline, and psychoanalytic work in the clinical encounter. He has synthesized a uniquely personal and clinically rich dialogue among several major theorists of development and treatment that convincingly weaves together a freshly contemporary and compelling fabric, integrating the ideas of Freud, Ferenczi, Strachey, Winnicott, and Bion. Mancuso’s extensive theoretical reach is in concert with a clinically close embrace of case examples that offer the reader a moving firsthand narrative experience. His thesis rests primarily on a sustained and evocative conversation between his own novel and highly original rereading of the major ideas in Ferenczi’s “Confusion of the Tongues between the Adults and the Child” (1933) and Freud’s “A Child Is Being Beaten” (1919), which in a later chapter are linked to a reinterpretation of Strachey’s technical insights in “The Nature of the Therapeutic Action of Psycho-Analysis” (1934).
In the early chapters, devoted mainly to Ferenczi, Mancuso persuasively establishes an etiological model of a traumatizing, pathological narcissism in a parental adult who is incapable of creating and maintaining the normal developmental gradient of needs whereby the child can depend on the adult to receive, understand, and help transform overwhelming anxieties. Instead, this narcissistically fragile adult sees a precociously competent “wise baby” as available, agreeable, and receptive to being defined and shaped by parental needs, thereby reversing the developmental gradient, perverting the nascent object relationship, and confusing generational boundaries and roles. Ferenczi’s contributions, Mancuso underscores, help sharpen our focus on an early dyadic narcissistic pathology: “the excesses of love offered by the adult are not toward a child that is present, but to an idealized child, the object of a narcissistic investment . . .” (p. 29; translations mine throughout).
Mancuso then extends Ferenczi’s insights into the confusion of tongues between the passionate desires of the adults and the tender ones of the child to encompass a much wider scope, and deepen our understanding, of this highly problematic and destructive primary relationship, from which ensue a complex series of identifications with the aggressor. The tragic outcome, according to Mancuso, inevitably results in a confused, overstimulated, and overwhelmed child who, becoming confused and dissociated, resorts to multiple split-self experiences—those manifested in the “world that is” within the narcissistic dyad, and others that must be secreted into an inner “world that is not.” To supplement his clinical examples, Mancuso offers an appealing literary illustration of this developmental dilemma: J. M. Barrie’s Peter Pan (1911), who vows to run away and never come back to this world, after a poignant scene of a disappointing reunion with his mother, whom he spies through an open window nursing another child. More distressing still are the numerous clinical examples that Mancuso presents from his extended, and deeply affecting, treatment reports of both child and adult cases, in which parental “colonization,” exploitation, and annihilation of budding childhood individuality are painfully described. Mancuso states two convictions that for him are fundamental in his psychoanalytic work: his belief in “the importance of external reality in the psychic organization of the person” and “the immaturity and psycho-affective fragility of the baby and his extreme dependence on the adult” (p. 32).
Mancuso next turns our attention to what he regards as Freud’s interest in exploring, and investigating theoretically, some quite similar clinical phenomena, namely, the vicissitudes of a perverse object relationship as described in “A Child Is Being Beaten” (1919). Mancuso declares that Ferenczi’s “wise baby” (1933) is also a child who is beaten, and he regards Freud’s and Ferenczi’s papers as testimony to their mutual influence on each other. Mancuso closely follows, as resonant with his own findings, Freud’s pursuit of the multiple transformations of this fantasy of a child being beaten, often reported to him by adult patients, and the part it plays in the evolution of a perversion. Mancuso is particularly struck by Freud’s interest in clarifying the obscure prehistory of this fantasy, which Freud (1919) hypothesizes as likely resting on a more ancient injury: “In this way the beating-phantasy and other analogous perverse fixations would also only be precipitates of the Oedipus complex, scars, so to say, left behind after the process has ended, just as the notorious ‘sense of inferiority’ corresponds to a narcissistic scar of the same sort” (p. 193).
Moreover, Mancuso draws our attention to the repeated references Freud makes, if between the lines, to his awareness of the significance of the development of a potentially overstimulating object relationship, alongside psychosexual development and the oedipal constellation. For example, Mancuso notes Freud’s observation (1919) that “the affections of the little girl are fixed on her father, who has probably done all he could to win her love, and in this way has sown the seeds of an attitude of hatred and rivalry towards her mother” (p. 186).
These references to the object-relational background between parent and child, evident in Freud’s hypothetical genetic reconstructions of the beating fantasy, are precisely the foundation on which Mancuso has located Ferenczi’s analytic investigation of the confusion of tongues between adult passion and childhood tenderness, and the basis for Mancuso’s own theory of traumatic etiology and the treatment recommendations that flow from it.
Mancuso offers clinical examples throughout the book to document his conclusion that the child is a true narcissistic object for the adult, an object whose internalizations of parental projections are needed by the fragile and rigid adult to eradicate the parent’s narcissistic scar, alluded to by Freud, which often presents as a multigenerational wound. Forcing such a burden for cure upon the child renders impossible the creation and development of a genuine and private internal life. Instead, Mancuso maintains, an internal perverse relationship with a parental object is established in which the adult hates the needy child and loves one who makes no demands (pp. 75–76).
It is in the clinical encounter between analyst and patient, subsequently explored by Mancuso in detail, that we encounter the intersection of his theory of traumatic etiology and his theory of treatment. It is in the internal setting of the analyst’s mind that these experiences eventually come to be realized. Re-evocation of the traumatic and fragmenting primary dyadic relationship of early life, now within the dyad of the analytic relationship, confronts the analytic pair with an arduous task. Mancuso shows us repeatedly how necessary it is to maintain a prolonged and stable period of living with the patient’s suffering, without taking flight, and without offering premature, saturated interpretations or reconstructions, so that a shared experience can become meaningfully transformed. It is particularly critical, according to Mancuso, for the analyst to allow room for hatred. Since an inversion has been created between subject and object, child and adult, whereby the object is expected to depend on the subject for vital psychological life support, a fragile and undependable narcissistic object is then all that is present for a relationship.
The child’s hatred in his encounters with the narcissistic object could become a devastating experience, one to be thought of not as an experimental, potentially developmental organizer, but rather as a constant detonator of catastrophic and imminent collapse (p. 87). Since in Mancuso’s view the patient “consigns his madness to the analyst” (p. 88), it falls to the analyst to establish within the setting of the analytic office, as well as within the internal setting of the analyst’s mind, a space for hatred, a hatred that is “vital and tolerable” (p. 101) and capable of being integrated into a self experienced as true and genuine. This requires a capacity to play with a polyphony of voices, including the ability to play with the truly “bad child” who insists on having his way.
Further, echoing one of Freud’s technical maxims, that “it is the physician who has to raise his voice on behalf of the claims of childhood” (1919, p. 184), Mancuso calls for the analytic work to be focused specifically on giving voice to these hitherto weaker, less represented, hateful and hated, confused and confusing, self and object aspects within the dyadic experience. This focus on unrepresented aspects of self and object forms the basis for Mancuso’s later introduction of what he calls “extratransference” or “inclusive” interpretations, that is, interpretations of aspects of the transference that have remained outside the conscious experience of the transference because until now they have remained unintegrated, fragmented, dissociated, and split off.
Mancuso finds a theoretical foundation for this concept of extratransference interpretation by exploring its use in Strachey’s “The Nature of the Therapeutic Action of Psycho-Analysis” (1934). Mancuso regards any interpretation outside the dominant transference, of feelings, impressions, ideas, or fantasies not shared by both members of the dyad, as an extratransference interpretation (p. 151). He notes Strachey’s belief that the extratransference area is vast and complex, and that extratransference interpretations may be useful as preparatory to making mutative transference interpretations, by, for example, loosening the grip of an overharsh and primitive superego. Mancuso cites Strachey’s conviction that “often when we give an explicit extratransference interpretation, we give an implicit transference one” (p. 153).
These ideas seem congruent with both a Winnicottian sensibility regarding the cultivation of a sufficiently ample holding capacity within the internal setting of the analyst’s mind, and a Bionian emphasis on a robust “negative capability,” receptively disposed to transformations within the analytic dyad. Both concepts are well represented in Italian psychoanalysis. However, with regard to the concept of extratransference interpretations, which only the analyst can voice, Mancuso introduces the potential for discord and conflict within the dyad. This vicissitude of the dyad draws attention to the dilemma of a therapeutic impasse, a subject that has received relatively little space in the Italian literature, at least in that portion of it most familiar in the United States, and adds to the unique contribution of Mancuso’s work. Obviously, “playing” with polyphonic psychic tonalities, as Mancuso encourages analysts to do, can easily lead to disharmonies, or even cacophonies. In fact, if such interpretations succeed as intended, namely, to include previously excluded voices, it seems an inevitable risk. Mancuso emphasizes that extratransference interpretations are not evident “in the transference” (p. 161), because they are not perceptible to both members of the dyad and mutually shared, but rather are the product of the analyst’s reverie. With their inclusion, we enter relatively unthought or unknown analytic territory, which Mancuso acknowledges has the potential to destabilize the dyad. Differences in the psychic reality of the Other confront both subject and object with the potential for overwhelming confusion, and this presents the possibility of retraumatization or of a negative therapeutic reaction.
Francesco Mancuso has given us a book that is rewarding for many reasons: its psychoanalytic ecumenism, its emotionally moving and evocative clinical narratives, its posing a challenging and unanswered puzzle about reconciling diversity within and between subjective realities. In these, and in many other ways, as Mauro Mancia (2007) has declared in a review in Rivista di Psicoanalisi, Mancuso has succeeded in “writing a psychoanalysis,” as well as in writing about psychoanalysis.