Corona Virus,Social Distancing,and the Body in Psychoanalysis

A Theoretical Perspective

Some analysts may have a concern working psychoanalytically in this period: how do we pursue something we would call “unconscious” (fantasy, belief, desire) when reality seems so immutably present and insistent? It’s then perhaps useful to make explicit my theoretical view, which places external reality as a privileged counterpart of the unconscious.

Reflecting on the loss of contact with reality, Freud writes:

The most extreme type of this turning away from reality is shown by certain cases of hallucinatory psychosis which seek to deny the particular event that occasioned the outbreak of their insanity. . . . But in fact every neurotic does the same with some fragment of reality. And we are now confronted with the task of investigating the development of the relation of neurotics and of mankind in general to reality, and in this way of bringing the psychological significance of the real external world into the structure of our theories [1911, p. 218; emphasis added].

Thus, today more than ever we are faced with the task of investigating the development of the relation of our patients to reality.

The discovery of the primary process of oneiric logic allowed Freud (1900) to elaborate the distortions of linear logic and of reality (Arieti 1955; Matte Blanco 1975) that characterize the domain of the unconscious. Highlighting the form of the unconscious and its spatiotemporal violation of the normal parameters of consciousness, I emphasise the structurally catastrophic nature of a psychoanalytic conception of the mind (Bion 1970): a catastrophic nature that matches with the catastrophe we are facing today.

Bion (1962) summarizes the deformations imposed on the mind by the unconscious in his theory of the defect of thinking in which every patient is a reservoir of personal theories that, influenced by the pleasure principle (Freud 1911), violate or alter in various ways the perception of reality itself: the working though of the unconscious consists in the emotive and cognitive restructuring of the patient’s theories in order to draw them closer to reality. The choice of the patient “between modifying frustration and evading it” (Bion 1962, p. 4) comes to the fore: tolerating frustration allows an emancipation from the pleasure principle, activating mental growth.

An aspect of reality that has a determining role in the functions of the ego is the relationship with the body, where “the ego is first and foremost a body ego” (Freud 1923, p. 26). This relationship is itself subject to distortions caused by anxieties, in particular death anxiety. Beyond the more renowned theory of the death instinct (Freud 1920), Freud (1914) considered awareness of death the weak link in the narcissistic mental structure and thus a means of fostering progress toward mental growth (see Lombardi 2013). The body, together with illness and death anxieties, becomes an elective arena in the confrontation between the unconscious and consciousness in the tragic context of a pandemic, placing the body-mind relationship at the center of psychoanalytic attention.

The Analyst’s Personal Involvement

My peace is gone,

My heart is heavy; . . .

My poor head

Is crazed,

My poor mind

Shattered.

—Goethe, Faust, Part 2

With respect to internal anxieties I consider the analyst’s involvement to not differ from that of the patient, even though the analyst possesses a greater emotional containment. Let us examine a clinical sequence.

Giorgio begins the session calmly by telling me that he is becoming aware that his conviction of being the only person with problems is wrong: this is being challenged by the current situation, in which nobody is exempt from problems and perils.

At this point the patient stops and asks me: “How are you coping with the situation at the moment?”

Slightly disoriented, I realize that we are all in the shit and answer: “It’s obviously a tragedy. I’m trying to cope with the severe difficulties and restrictions, just like anybody else.”

The Perception Of The Pandemic And Of Death

As soon as Elvira, fifty-five years old, lies down on the couch, she recounts a dream: “You paid a visit to me and my husband on your bike, and you were sitting in the living room near the window. At a certain point, a monster like Frankenstein comes down from upstairs and hurtles toward you. You manage to escape through the window even though Frankenstein has grabbed you by the ankle. You ride away on your bike.” Elvira is frightened by this dream and associates it with the first news of the coronavirus that, after China, is spreading in Northern Italy. Currently both she and her husband suffer from immune system problems that would make a viral infection extremely dangerous for them. I tell her: “Death, from which I am escaping in your dream, seems to represent the risk of death in your own home, presumably due to this pandemic. And it is a threat against which it is possible to protect yourself, as seen by my own escape from Frankenstein.” At this point Elvira asks me to continue the sessions remotely, to which I consent. Immediately afterward, she takes further practical measures to protect herself and her family.

Elvira is the first of my patients to bring to a session a real alarm concerning the spread of the epidemic, in a period when the Italian government had still not taken any action. This episode provided the first incentive toward moving to teleanalysis with all my patients.

Lightening Or Burdening Of Anxieties

All my patients in analysis have registered an increase in anxiety during the pandemic and discussed how best to cope with their fears: for example, by creating a kind of protective filter with regard to the bombardment of tragic news in the media; this would include limiting one’s access to the continual newsfeed and being selective about one’s reading, avoiding articles that might be experienced as too tragic or distressful.

One patient tells me: “I watched a terrifying TV show that searched for those responsible for the epidemic, the guilty ones who did not do enough to prevent it: a machine that only generates terror and hatred. I had to switch it off to protect myself from my own anxiety.” Above all, in the patients most vulnerable to guilt and internal paranoia, exposure to the tragic news of the pandemic led to the necessity of an unfolding (Matte Blanco 1988; Lombardi 2009, 2015) of the distinction between body and mind, between external and internal reality, between objective tragedy and the imagined fear of an attack by an offender. There, where the “symmetry” (Matte Blanco 1975) of the unconscious tends “like an acid” to cancel distinctions, the psychoanalytic task was to promote distinctions that stimulated discrimination, thought, and emotional containment.

The risk of “burdening” a reality that is already difficult emerged in the analysis of Anna, forty years old, who has suffered acute psychoses that in the past have required hospitalization. Alongside her three-times-a-week analysis, she also receives pharmacological assistance from a psychiatrist. At the onset of the epidemic, Anna initially expressed doubt about whether she could continue her sessions remotely, fearing she might not be able to do it. Now, in a remote session, Anna describes how she had made some pancakes, adding an egg yolk more than the recipe called for because she thought the batter was too “light.” The heaviness that resulted had been a disappointment. I suggest to Anna that she fears that she herself is “light” and inconsistent, lacking in resources, which makes her tend to overload with excessive demands and anxieties. The result is that she becomes paralyzed or even loses her mind, as has happened in the past. At this point she recalls having dreamt of her father, who has died, and who tells her in the dream that it is better for her to take into account her own mistakes. Anna comments that she is happy to have dreamt of her father, since he seemed encouraging in her dream. She adds that she could suggest to her psychiatrist that he substitute her Haldol shot with Serenase drops, giving greater flexibility in progressively reducing her medication. She adds that she is thinking of accepting a work proposal that would make her more optimistic about the future. I note that when she does not burden her anxieties, she is able to discover a “light” approach that implies more trust than she would normally allow herself.

Lockdown And Hatred Of Limits

For the most problematic patients, lockdown with its limits and frustrations has been a particularly testing experience.

Ronaldo, twenty-five, is now in fours-times-weekly analysis with me, after three psychotic breakdowns and several failed trials of psychotherapy. The requirement to stay in lockdown at home can lead to violence that explodes suddenly in the form of suicide attempts.

In a remote session Ronaldo’s obstinate conviction emerges that there is life after death. The prospect of suicide would allow him access to a new life without the discomforts and limitations of his present life. In his mind he imagines a sequence from the film Gladiator (2000), in which the protagonist crosses a summer meadow representating the Elysian fields, the paradise Ronaldo believes he will enter after death. I tell him that in attempting to escape from frustrations, he creates a greater frustration by embracing death, since death in reality is something from which no one can return.

In the following days, Ronaldo’s hatred explodes against his parents; he threatens to kill them and then himself. This episode creates panic in the family, who rely on the psychiatrist and the consultant analyst for support.

Ronaldo skips the last session of the week, writing that he cannot make it, and does not respond to my attempts to contact him. The following Monday he declares intimidatingly that he wants to cancel Thursday sessions from now on. I discuss with him his tendency to attack the analysis and me, as he had done the previous Thursday; in the same manner he is driven to attack his parents and himself, rather than to think about and reflect on his hatred. He replies that he cannot tolerate the lockdown and will ask his psychiatrist for a government-required certificate authorizing him to move to his beach house. I tell him that when there is a frustration he acts out his hatred to cancel limits: instead of recognizing his hatred and remaining where he is, he goes against reality. Ronaldo seems to calm down and observes that now he can understand why he is unable to remain in the same place for any length of time. He could accept remaining in Rome and wait until next month, when conditions might allow a trip to the beach. In the following session he shows me a book of poetry about the seaside town where he has a house; thinking about the beach through poetry, he says, has calmed him down.

Social Distancing And Individual Space-Time

Elisa, forty-five, begins a session with: “Let me tell you a paradox: I’m afraid of ending the lockdown. In this period I have discovered more than ever my need of my own personal space that is not spoiled by social situations.” Like Elisa, other patients have used the lockdown as an opportunity to treasure their personal space-time in contrast to the fast pace of their normal lives. Three patients, having never cooked before, who had made their own fresh pasta at home, particularly struck me: tagliatelle, gnocchi, ravioli. In discussing these experiences, a greater awareness of space-time limits was recognized as something to be thought about more carefully and to treasure in the future.

Anchoring to personal space-time, correlated to the discovery of internal silence, has likewise been an important springboard for doctors and professionals in analysis with me, who were occupying positions of responsibility in the management of the national emergency: a focus on their own space-time needs allowed them to enhance their relational and social engagement in their professions.

Creativity

The Italian government has required a mandatory self-declaration form, downloadable online, for those who leave the confines of their home: a permit that states their reason for going out. Its formulation has been updated several times, so that a series of out-of-date permits has accumulated.

Matteo, thirty-five, is an artist who is almost at the end of his analysis. He finds himself drawing spontaneously on the out-of-date certificates. He then publishes these drawings on Instagram, encouraging others to upload their own illustrated self-declaration forms. The initiative grows. Within days a thousand, then five thousand illustrated forms appear, hundreds of which are works with artistic and social value. His website (https://www.autocertificazioniillustrate.it/) starts with an explicit creative program: “Here the government self-declaration forms are transformed in paintings. Don’t leave our ideas and creativity locked down in quarantine.”

Struggling with body boundaries and acute anxieties has thus become a springboard for creativity. “The contrast between man’s ideological capacity to move at random through material and metaphysical spaces and his physical limitations, is the origin of all human tragedy. . . . Half-winged–half-imprisoned, this is man!” (Paul Klee 1925).