Language in The Analytic Hour

Clinical Vignette

Early in her analysis, Jennifer, a woman in her late twenties, related the following incident. As an anxious young child, Jennifer often turned to her mother, with whom she had a loving relationship, for reassurance to allay a wide range of anxieties. Although her mother was usually able to comfort her, at times she became overwhelmed by her daughter’s fears and demands. At the age of six Jennifer needed to have her tonsils removed. Terrified at the prospect, she repeatedly begged not to be subjected to the procedure. Her mother initially tried to reassure her that she would be fine but eventually lost patience and blurted out, “Oh, for heaven’s sake, it’s just a tonsillectomy!” Jennifer’s fear of the procedure was compounded by her recognition that her mother, in this instance, could not handle her daughter’s anxiety and demands for reassurance.

Throughout the first several years of her analysis, Jennifer struggled with her dependency needs, often feeling comforted by my words, tone of voice, and physical presence, but fearful and contemptuous of how much she craved this comfort. Frequently she oscillated between expressing her anxieties directly and disavowing them, conveying both how much she felt she needed my help and how intolerable this need was to her. Her disavowal often took on a tone of dismissal and self-criticism. The following exchange took place toward the end of her second year of treatment.

Patient: (after expressing a great deal of anxiety about a challenging project at work). I’m being ridiculous. I can’t believe I’m complaining so much about this. I shouldn’t be so worried. I’m making such a big deal of something that’s really not a big deal at all.

Analyst: (in a gentle tone of voice) Oh, for heaven’s sake, it’s just a tonsillectomy.

Jennifer gasped, seeming both startled and moved by my comment. She was silent for a moment. She then spoke at length and with obvious relief about just how fearful she was of overwhelming me with her anxiety and dependence. She was relieved that I could hear her needs without being overwhelmed and needing to diminish her fears in ways that would feel belittling to her. She spoke of being deeply moved by how well she felt I understood her, better than she felt she had understood herself.

Over the course of the next several years, the words “Oh, for heaven’s sake, it’s just a tonsillectomy” remained alive in the analysis. At various times either of us, on recognizing a moment of counterdependent protest, would utter them. These words became something we could toss back and forth, sometimes giving voice to Jennifer’s pain, anxiety, or anger but often suffused with laughter, pleasure, and a sense of shared appreciation of one another and of something that was happening between us.

Discussion

I chose this clinical moment around which to compare the panelists’ theories because it was so powerful in Jennifer’s analysis and because it is a moment in which the specific wording of an interpretation was at least as important as the content. But what might it illustrate about the ideas discussed by these authors, and what questions does it raise?

Harris writes about the function of pleasure as a curative element in language. For her, speech, at least in Tangiers, “conjures up” pleasure and pain, an affective and physical aliveness (p. 1032). Pleasure and pain, danger and desire, live very close together, and speech can shift the balance among them. Her patient Helen’s repetition of “I am thinking of soup” and Jennifer’s repetition of “It’s just a tonsillectomy” certainly express painful feelings, but they also call forth the pleasure of a shared language, felt as a living, embodied experience. The words are repeated not only for enhanced understanding but also for the comfort that comes with mutual recognition and the pleasure of sharing language that is meaningful only within a particular relationship. This shared language and understanding transforms an eruption of painful memory or anxiety into a moment in which pain and pleasure can intermingle, and in which the sharing of pain and pleasure is transformative.

I think most analysts would recognize aspects of Harris’s two modes of speech. We would all recognize our patients’ and our own use of speech that conjures up powerful feelings and abandons ordinary syntactic rules in favor of reverie or free association. Although many analysts would place the embodied elements of communication outside language, we would nonetheless recognize ways of speaking that evoke bodily experience. Similarly, we would all recognize speech that stresses symbolization, separating the word from the thing, now from then, you from me, making room for reflection. Harris’s contribution lies partly in articulating these modes of speech that we often are better at using than at thinking about. However, I think an even more significant contribution is her assertion that “some of the most salient and mutative moments in treatments might be those that . . . interweave the habitation in Tangiers and the ordering effects of Casablanca . . .” (p. 1031). Harris goes even a step farther and locates interpretation in the space “between and within Tangiers and Casablanca” (p. 1039). To highlight this, I turn again to the vignette. “For heaven’s sake, it’s just a tonsillectomy” can be seen as an interpretation. If one’s theory supports this way of thinking, it can translate roughly into “You’re afraid to allow yourself to feel dependent right now, afraid that like your mother did when you needed your tonsils removed, I will be unable to tolerate your anxiety and neediness and will minimize your fears. So you ward that off by belittling yourself before I have the chance to.” Language like this, rooted firmly in Casablanca, certainly highlights the as-if nature of the situation, separates past from present, and highlights the separateness of analyst and patient. At times it makes sense to speak this way. However, language like this lacks the vibrancy of Tangiers. I think it is the intersection of “habitation in Tangiers,” with all its intensity and immediacy, and “the ordering effects of Casablanca” that made this a moment that lived on through the analysis. Harris provides a way of thinking about such moments that has, to a large extent, been lacking.

Spivak and Kirshner challenge us with opposing, even incompatible theories of mind and of the unconscious. For Spivak, the unconscious is a holding tank, filled with intolerable wishes, motives, and affects that trouble the individual despite his lack of conscious knowledge of them. Symptoms are themselves a kind of language that the patient speaks without understanding. An interpretation, particularly a transference interpretation, offers the patient a new recognition of impulses, defenses, and motives for defense that already exist, though in a language the patient does not recognize, within the patient’s mind. For Kirshner, there can be no language of the unconscious, no preformed thoughts waiting to be spoken. The unconscious, rather than a holding tank, is a lack—that is, an area of bodily experience that is unrepresented in language. Because we exist in language, that is, because our identities are formed out of dialogue, the experience of this felt but un-languaged area of existence is often unsettling. Interpretations do not tell the patient what is in his mind; instead they open up new pathways of speech, enabling new thoughts and new ways of representing the self.

One would think, given these mutually exclusive ways of thinking about the mind and about language, that an intervention that fits with one of these models would, of necessity, be incompatible with the other. And yet I’m not so sure it works this way in practice.

“For heaven’s sake, it’s just a tonsillectomy!” Which way of thinking, if either, might lead to such an utterance? To be fair to the authors, it is altogether possible that neither could see himself saying something like this to a patient. Yet from my perspective, the intervention fits well within either model. In Spivak’s these words would be seen as a shorthand that, by pointing to the presumed origin of Jennifer’s need to disavow her anxiety, highlights the defensive nature of her disavowal, the wish to obtain reassurance that the defense is designed to hide, and the anxieties underlying that wish, all within the immediate transference moment. The analyst, from a position of identification with the patient, translates what she believes the patient is already expressing but is not yet able to hear. Even Jennifer’s gasp and her experience of feeling simultaneously surprised and understood are predicted by Spivak’s assertions that interpretations are experienced as “disturbing and disruptive” and that “receiving an interpretation often is profoundly and movingly experienced . . . as having been found and recognized” (p. 1066).

Within Kirshner’s model, the words address not what the patient is thinking but what she is doing, namely, relating to me as though I were her mother or, more precisely, an unsymbolized but keenly felt experience or fantasy of her mother. This was nothing new; Jennifer’s disavowal of her quite conscious anxiety, her insistence that she should not feel what she was feeling and that the circumstances did not justify her reactions to them, was a familiar refrain. From a position of too much identification with her—what Kirshner describes as a “stalemate of mutual mirroring” (p. 1051)—I might have fallen into a complementary role, feeling annoyed or critical and silently agreeing that her anxiety was out of proportion to the situation. From this position I could not have found anything useful to say. Only through finding a different position, outside the identification, was it possible for me to have other thoughts. From the standpoint of Kirshner’s model, when I found myself thinking of the story of Jennifer’s tonsillectomy and of her mother’s words, I was not thinking Jennifer’s unvoiced thoughts. These were my own thoughts, my own memories and associations to what was going on between the two of us. This enabled me to say something unexpected—not, in this case, a new utterance, but an old one that could be heard by both of us in a new way. Hearing me speak her mother’s words enabled Jennifer to recognize how she was relating to me. The shift in her own speaking—her increased ability to speak about different feelings and thoughts—along with an affective aliveness that had been missing just moments before, suggests that these words, at least for the moment, opened up a new pathway of speech.

Even if I am correct that similar interventions might emerge, at times, out of Kirshner’s and Spivak’s quite different models, the fundamental incompatibility between their understandings of the functions of language and the nature of the unconscious raises, for me, a challenging question. If, as Kirshner asserts, the unconscious is not a receptacle for thoughts as yet unspoken, but already formed in language, how do we explain the powerful feeling of recognition that an interpretation so often brings and that Spivak highlights? For our patients do tell us how vital it is that they feel found, understood, and helped to understand themselves by our words. On the other hand, if, as Spivak asserts, interpretation returns the patient’s thoughts to him, how do we understand the value that so often seems to emerge out of language that startles the patient and leaves her unsettled, without easily found meanings to fall back on? Why do our patients sometimes benefit as much from feeling confused and intrigued as from feeling found and understood?

Finally, the repetition of “it’s just a tonsillectomy,” spoken periodically over the years both by patient and analyst, looks different through different lenses. Viewed through the lens of Harris’s ideas this repetition has a quality of play and mutuality that suggests Tangiers, while retaining the ordering effect of Casablanca, reminding both participants that the present is not the past and, transference notwithstanding, the analyst is not the mother. The repetition itself is useful. Spivak is less explicit about the role of repetition of this sort. Kirshner, however, reminds us that resistance is ubiquitous, that in an analysis “both participants . . . can resist what is relatively unfamiliar and unfolding as a threat or turn it toward action or enactment that precludes symbolic elaboration” (p. 1050). Repetition of language seems particularly well suited to this shared resistance. Language that in one moment opens up new pathways may later be used to say, in essence, “Move along, there’s nothing new to see here.” In the end, any instance of this sort of repetition can be judged as helpful or frozen only by observing what follows from it.