Abstract
The two books reviewed here present a collection of essays by the English psychoanalyst Paul Williams. Invasive Objects is on understanding, treating, and contextualizing the traumatized and more treatment-resistant patient; The Fifth Principle is a more or less autobiographical account of the abusive and chaotic first eight years of his life. Both books reward the reader by adding significantly to what has been written about the treatment of this cohort. Virtually all of the first book’s essays, which are divided into clinical and applied sections, have been published previously. The books are appropriately reviewed together, as much of the work in the first echoes and appears influenced by data from the second, giving readers a unique opportunity to understand how a clinician’s reconstruction of and adaptation to a version of his early life, as well as, implicitly, his personal treatment, can inform his later work. The perspectives Williams presents have clinical, theoretical, and anthropological implications, and by his own acknowledgment emerge also from his earlier career as a social anthropologist and later a clinician on an inpatient team that integrated psychoanalytically informed treatment with other modalities for patients in various stages of psychosis (Jackson and Williams 1994). The clinical examples in the book, however, are mainly from the outpatient treatment of patients with extreme treatment resistance; the applied examples come from from philosophy, theater, poetry, music, and art. In addition to the insights and specific technical strategies provided, the essays provide articulate and persuasive arguments that clinicians reconsider the current primacy of psychopharmacological, instrumental, and short-term treatments and not abandon psychodynamically informed assessment and therapy.
Many traditionally trained psychoanalysts believe there is limited theoretical basis for relational analysis, often stating that it is merely an extension of existing theory and that the person of the analyst has always been relevant. In these essays Williams implicitly provides a theoretical model that suggests that in the shift from ego psychology to object relations theory, the focus of the analyst shifted, but the analyst’s role, especially regarding anonymity and neutrality, did not. However, as the focus on use of the countertransference enlarged, the personhood of the analyst and the transitional space thus created between patient and analyst took on greater significance. Much as this perspective developed from Ferenczi, Winnicott, Loewald, Aron, Mitchell, Ogden, and others (Harris 2011), Williams presents a case for an increasing use of the self in the work, now with more obviously resistant, disturbed, and severely traumatized patients. When such a notion is applied to this cohort, as suggested in these essays, the therapeutic ground becomes less stable and the potential and transitional space between analyst and patient more complex.
As amply demonstrated in many of the essays and consistent with object relations theory, as the developing individual struggles to manage, to adapt, and to incorporate, in the interest of survival, an invasive object—whether it be abusive, depriving, or abandoning—major structural and communicative aspects of the self are altered and impaired, leading to a “smashed” self. In The Fifth Principle, Williams proposes aspects of that self, represented in five ways of being in the world, that ensured his survival but contributed to a highly dysfunctional, self-defeating, and interpersonally distancing self system. It is not hard to recognize these principles as symbolization gone awry, and, further, how they work in treatment resistance as a repetition and dissimulation required to obfuscate the vital transitional and authentic space between objects.
The several short essays in The Fifth Principle detail family history, descriptions of abuse and deprivation, and efforts at personal isolation and camouflage the young Williams used to combat the invasiveness of parental objects. As has been amply documented in current neuroscience, these kinds of overwhelming experiences short-circuit the symbolizing apparatus in ways the book vividly conveys:
Everything happened when [the rages] happened: thinking, continuity and connection disappeared. Terror, paralysis and vigilance took over . . .” [p. 22]. I was deeply, abidingly angry about what had happened to me, although I could not properly feel this [p. 24]. No idiom for living develops, and the infant comes to rely upon imitation, abandoning its own personality in favor of a performance that may last a lifetime, polished and honed as circumstances dictate [p. 74].
The book outlines not only how the five principles prevent a descent into psychosis, but also how the invasive object not getting what it wants makes it even more invasive until, as in soul murder, the invaded becomes, despite its best efforts, both invisible and identified with the invader. This, of course, replicates in covert ways the experience the invaded self is attempting to surmount or avoid, thus leading to a lack of connection of any sort. Indeed, the surprising last of the five principles dramatically characterizes this point.
How these experiences are processed by the recipient and how unbearable affect can be represented, understood, and worked through in psychotherapy, especially in using the countertransference, is at the center of Williams’s work. The similarity here with the “false self ” and the “as-if personality” is not lost on him, but he continues that if a mind is under siege by an invasive object, then the role of the therapist is particularly fraught, inasmuch as he or she wants to connect and ultimately help the patient challenge the invader’s control. From the point of view of the patient, this effort is from early on, and for several months or even years, experienced as itself intrusive and invasive. Such is the nature of the siege mentality. A patient comes for and desperately wants help but is either justifiably defiant or basically paralyzed in his capacity to collaborate in the work. And, as happens in cases of early childhood trauma of various sorts, this defiance, now experienced as vital to survival, is heightened by the incapacity to represent and symbolize the source and nature of the problem except in deeply camouflaged ways. How this is done, as well as how it is represented in art and culture, is detailed in several of the essays in Invasive Objects. It is deftly presented in chapter 8, “The Worm That Flies in the Night.”
The patient presented in this chapter, whose title is taken from the Blake poem “A Sick Rose,” bears much similarity to the child who is the subject of The Fifth Principle, as well as to aspects of several patients described in the first four chapters of the book: James in chapter 1 (“Incorporation of an Invasive Object”), Alec in chapter 2 (“Some Difficulties in the Analysis of a Withdrawn Subject”), Ms. B in chapter 3 (“Psychotic Developments in a Sexually Abused Borderline Patient”), and two patients in chapter 4 (“Making Time, Killing Time”). These patients have developed an evocative and highly resistant persona that Williams equates with the tribal masks and shamanistic rituals of primitive cultures. These personae and these masks are the result of efforts to find symbolization for what is experienced as unsymbolizable. At the same time they are taking up all the space between therapist and patient in the room and creatively covering anything resembling manifest content. With the available therapist, however, these representations also serve to provoke an opening into a new and previously less well known reality, a “potential space” that can then stimulate an internal and external “generative dialogue” (p. 168). This theme is carried into the next chapter, on the psychotherapy of Cluster A personality types, which ends with recommendations specific to the recognition of shame and humiliation, using both conflict and deficit models and differentiating between benign and malignant regressions during the treatment of these patients. Reprising an earlier theme of his work, Williams suggests “it is likely that the patient’s core pathogenic relationships will become discernible first and foremost via the countertransference” (p. 102).
As we enter the second decade of the century and the second hundred years of psychoanalysis, there is heightened interest in the dynamically oriented psychotherapeutic treatment of the more disturbed patient. On the other side, serious questions are raised in the treatment of the sequelae of trauma and posttraumatic stress disorder by those who advocate more focused treatments such as dialectical behavior therapy, cognitive-behavioral therapy, and somatic experiencing modalities. These two books are fascinating and highly recommended, especially for the clinician interested in working psychodynamically with trauma. Though to a certain extent a reconstruction, The Fifth Principle is as moving an account of the impact of abuse and deprivation as one might find. From the material already cited from Invasive Objects, an analysis of the “beautiful mind” of John Nash, reflections on the work of André Green, a discussion of Freud-baiting, and finally a review of “The Rat Man,” one becomes more and more familiar with the ubiquity and usefulness of the notion of minds under siege. The books movingly outline the implications for patients who struggle with an overwhelming identification with a rejecting object and for possible work with them. The idea that these identifications emerge in basically unrecognizable forms, shadowy and camouflaged, is not entirely new, nor is the idea that they may be projected onto an external world that includes the therapist. What is unique about this approach is how Williams helps the reader reach that part of him- or herself that has previously seemed unreachable and that creates new hope for the patient.