Abstract
The ways in which one can comment on a wonderful piece of clinical work such as this are many, and since Aisha Abbasi’s presentation makes her patient M. come so much alive, it is tempting to piggyback on her insightful understanding of the case and say a few things I hope will add to our understanding. Moreover, there are elements in the paper that are especially appealing to me, notably the mother’s seductive stance, the idea of contamination, and the reference to earthquakes and terrorist attacks. These are but a few of the many fascinating keys in which to read this case material from one’s preferred perspective, but tempting as this may be, I will leave this aspect for later. What I wish to highlight first is what this paper has taught me and what change it has brought in me, as every good paper should.
A first important element, not entirely new to me, has now entered my set of beliefs thanks to Abbasi’s convincing example. It is the belief that the patients we take into analysis, at least those we end up talking or writing about, frequently have something significant in common with our personal story. It seems that it is rarely by chance that we present one case rather than another, except of course when confidentiality issues are at stake.
The second thing I learned from this case narrative is that until now I had a rather simplistic approach to the question of long-distance analysis by phone or Skype. In view of what goes missing in sessions thus conducted, I doubted they could still be called analysis. I accord such great importance to the idea of embodiment, to the nonverbal experience, to the minute vibrations in the communication between patient and analyst, to the way in which body posture affects the analytic exchange, and things of the sort that I felt, until now, that long-distance analysis posed a real challenge, to say the least.
Mind you, M. himself states at one point that he likes in-person sessions “much much better,” and I certainly agree with him. So let me assure you that it is not as if I turned into a fervent advocate of Skype or phone analysis overnight. Nor, I believe, did Abbasi. What I find, though, is that again, the proof of the pudding is in the eating and that it is insufficient to base oneself on a purely theoretical point of view to decide whether phone or Skype analysis is, or is not, “real” analysis. More to the point, what this case presentation has taught me is that I had asked myself the wrong question. It is indeed not a matter of simply deciding if a given session with a patient located on the other side of the planet is still an analytic session, but rather if the process as a whole yields material and results that are of the same kind that obtain with “ordinary” analysis, if such a thing exists.
So I have come to reflect on the fact that, for one thing, analysis has always been and still is a talking cure and that talking is indeed what in the long-distance sessions not only happens, but is elevated to a state of incandescence, so to speak, given the relative dimming of the other sensory modalities. While I have had only one patient with whom I conducted Skype sessions (for one year of a nine-year analysis), I do a number of supervisions by Skype. What I found early on in that practice is that I listen much better to the material presented to me if my supervisee and I turn our cameras off, thus giving precedence to speech, voice, and discourse.
The other thing is that in this case—and I believe in most cases of long-distance analysis—occasional in-person sessions, however seldom, are the rule, so that an important feature of analysis is in fact truly implemented in long-distance treatment. The feature I am alluding to is the dialectic between presence and absence. We know how important the alternation between presence and absence is for implementing the analytic process, considering that, in a way, the process is about enabling the psyche to mourn the loss of the primal object.
In M.’s case, with Skype analysis, the contrast between presence and absence is even greater, presence being only virtual here, which amplifies the fact that in the end it is always a matter of tolerating and building on or around absence. On the other hand, what is missing in terms of presence is compensated for by new elements that emerge in the Skype sessions as they would never have in the analyst’s office. Indeed, one realizes that the analyst doing Skype sessions is actually doing home visits! So, for instance, Abbasi was able to hear birdsong from India; moreover, since the cameras were left on, she could see the Indian sky, the trees, and even reflections in the window of the patient’s room. This obviously modifies the setting. But, though I prefer the classic setting whenever possible, I am not saying that analysis can happen only in the setting established by a neurologist in Vienna in the 1890s! And what privilege could be invoked that would spare the analytic setting the impact of significant changes in society and in the cultural and technological environment?
What the Skype dimension of this analysis shows is not only that a viable process can be established, but that the new aspects that come to the fore due to the specific setting can lead just as well, though by different routes, to the core issues that brought the patient to treatment. Obviously, as much as we would like to compare the course of analysis with the same patient in a traditional analysis and in a long-distance one, this is impossible. In fact, it is impossible even to compare two consecutive analyses with the same patient. Though M. lives thousands of miles away, he still wishes to work on the basis of the earthquake transference that started at the time of his first fortuitous encounter with Abbasi. So, until a better solution can be offered to a patient like him, we do what we can with what we have.
As a matter of fact, seeing this sort of arrangement at work simply confirms a belief I have held for a long time now: that analysis is not a constant feature of the analytic hour. We can view the analytic threads of a session using an analogy with DNA: in the long strands of DNA, most of the material seems to serve a rather obscure role, while a limited number of short segments, distributed along the impressively long sequence of code, carry the genetic material that matters. But since it has recently been discovered that the long stretches of apparently “silent” code in fact play an important role, I am tempted to extend the analogy and suggest that, most probably, a lot may happen during the less spectacular hours of analysis and that the more significant, “truly analytic” moments are somehow prepared by the other, “duller” moments. This long digression is to say that it is imaginable that what Skype or phone analysis does is the same kind of interstitial work, if I may use the expression, setting the table for moments that may be the more remarkable ones.
Interestingly, M. did not fully appreciate the fact that one of the analysts he consulted upon returning to India sat behind a screen. This is ironic, to say the least, for a patient who was made so anxious by a movie about a contagious disease. But I suggest that the problem was not this idiosyncratic transformation of the setting itself. What seemed to have mattered more is the impact the peculiar setting may have had on a patient so desperate and at the same time so terrified of being close to the object. One can surmise that the screen so blatantly incarnated his fear of intimacy that M. thought he could not be helped by an analyst who apparently had a similar issue.
And, speaking of intimacy, I wish to thank Abbasi for having given us access to parts of her personal story, especially those regarding her father. When such a thing is possible, it so enriches the clinical account. The meeting of the patient’s and the analyst’s stories is a sign of a special fit between the two members of the dyad. I would add that when this happens it gives the analyst a sort of privileged access to aspects of the patient’s unconscious, and of the analytic process, that otherwise would not as easily have come to light. But even when it does happen, such access is not necessarily obvious, nor is it necessarily conscious. And it is important to distinguish between the two lifelines and the two psychic configurations at work in the analysis. To see Abbasi connect with things in her past that she already knew but were not initially present in her interaction with M. only shows that the unconscious is not a repository, not a static black box, but an actively implemented state of affairs that, like M. himself, plays at “now you see me now you don’t,” depending on the situation. What really matters is the activation of memory traces, so that they become actual in the present time of the relationship (Scarfone 2015). The connection between the two stories also shows that it takes a flexible mind, possibly aided in this by the analyst’s personal analysis, to be able to work on the basis of the common or similar elements.
In the present case, the common theme at play for both partners regarded the father. I certainly do not intend to analyze or supervise an admired fellow analyst, but since she has volunteered some personal data, I feel she has given me permission to make a few remarks. I find it notable that in both analyst and analysand, where the father is concerned, it is a story of failure, though not of the same kind or magnitude. In the case of M., the father was an architect, a father therefore related to structures who had to face a destructuring, the unraveling of his enterprise and the loss of his possessions. It is the mother who financially saved the day by becoming an event planner.
Structure versus event: what more beautiful dynamic couple can one dream of? Also, considering that in terms of events, M.’s mother takes center stage when, coming out of the shower half-naked, she seems oblivious to the terrifying view she presents to her young boy, stirring in him an unspeakable mix of angst and desire, introducing an irritative, rather tormenting spine in the back of his mind. At that moment she was not the familiar mother; she was what I will call the sexual mother, that is, not the ordinary, good enough mother who provides child care, but the woman endowed with her own unconscious sexual desires, her repressed sexual drives, and most probably a passionate love for her boy-child.
I am not suggesting that the seductive mother is necessarily responsible for her son’s sexual orientation. Actually, I am of the opinion that homosexuality is not a major issue in M.’s case, in spite of his initial self-presentation. What is at issue is the Sexual, which I write, following Laplanche (2011), with a capital S to distinguish it from ordinary sexuality. It is the unformed sexual excitement that is so frightening, a contagious element in its own right, for which the young boy not only had no words but would have preferred to have had no eyes. Thus, intimacy is dangerous for him not only because aggression may ensue but because it is itself the cause of an earthquake of sorts and because it carries its own brand of terror when it evokes, as it does here, the proximity of the sexual mother. This is compounded by the fact that in retrospect the father appears unable to protect his family from economic disaster, which may also suggest an inability to protect the boy from the terrifying encounter with the sexual mother. It is therefore telling that in the very last paragraph of Abbasi’s clinical report she returns to the scene of the half-naked mother, connecting it to the question of seeing and being seen that has been a major theme regarding the patient’s story with his father, with his lover, and with the analyst.
In spite of the parallel that seems to run between the patient’s and the analyst’s stories regarding the father, a major difference should be highlighted. While the patient’s father was structurally defective, so to speak, it is not exaggerated to suppose that, as a boy in an Indian family, M. was very strongly invested by the mother. In view of what I have said about the sexual mother and the frightening event that she incarnates in the showering scene, we get an idea of the terror, the earthquake that ensues in the patient’s mind when, in his search for a love object, he feels he is coming too close to the maternal sexual imago. This makes for an anxiety-provoking configuration that certainly relates to the patient’s problem regarding intimate relationships, of whatever kind.
If we now turn to the analyst and her father, here is the important and, in my view, decisive difference. The analyst’s father, as a prisoner of war for three years, likely himself experienced a sense of failure. But whatever happened to him in his detention, the only visible sign of his dismay, in the eyes of his daughter, was a minor symptom: the biting of the inside of his lip. Now, it is tempting to think that one bites his lip in order not to talk, and indeed we get the sense that as a child and adolescent the analyst heard little about her father’s captivity. We do not need to know if this was a major issue for the analyst. What we see is a symptom that speaks of control, of refraining from being too explicit or from attracting attention to oneself. In this case, then, the father stands in quite strong contrast with the patient’s overtly seductive mother.
The analyst/child was certainly intrigued and puzzled, but not overwhelmed, by her father’s minimal display of the consequences of his captivity. On the contrary, what the analyst was able to summon while connecting her story with that of her patient was what she calls her father’s “wonderful laughter.” A laughter that, she wrote, “could awaken a thousand storms of passion within the womb of the Earth” (p. 296). This may well be a “reaction formation,” made to aggrandize a father figure in the face of failure, but an important fact must be noted: it is a whole different story when, out of her relationship with her father, a daughter can write poetry instead of developing neurotic symptoms. “A thousand storms of passion within the womb of the Earth”: now that is what I call a magnificent earthquake! So the analyst’s father figure points to both the structure and the event. And, most important, his capacity to contain fostered in his daughter’s mind the conception of a primal scene malleable enough to allow for displacement and condensation (“the womb of the Earth”), for hyperbole (“a thousand storms of passion”), and so on. In other words, psychic elaboration was possible because what seduction there was, it had been offered at an optimal dosage; as Freud would say, it was aim-inhibited.
Inhibition as to the aim, I suggest, accounts for the major difference between the patient and his analyst; it is the difference between, on the one hand, what Laplanche calls implantation of the sexual in ordinary seduction and, on the other, its violent form, which he calls intromission (Laplanche 1992). In the first case, sufficient room and freedom is given to the infant’s psyche to elaborate its own version of what is at stake. The child can create her own fantasies out of the eventful but not terrifying encounter with the sexual dimension of adult caretakers. In the second, violent version, the psyche is thunderstruck and paralyzed. The trauma, then, is not as easily turned into a source of inspiration as is the minimally traumatic event of ordinary seduction.
M.’s problem with intimacy, by contrast, was aimed at avoiding repetition of the traumatic encounter with the dangerously sexual parent. The analyst’s different experience in this regard explains how it was possible for her to listen, associate, and ultimately link the patient’s story to her own without losing her stance as an analyst, without losing sight of the specific needs of each member of the dyad.
