Ghosts in the Consulting Room: Reluctant Ancestors

Abstract

Abstract. This article explores ghosts–-defined as internalizations gone awry and experienced as inchoate absent presences–-that haunt our patients and that can be profoundly disruptive to clinical process. The case of a patient whose traumatic “ghosts” communicated by way of the bodies of both patient and analyst, via a process the author calls “interpsychic-intersomatic” transmission, is presented and linked to theory. How the analyst's personal ghosts became involved with those of the patient, in both facilitating and interfering ways, is also illustrated. Some of the clinical challenges of “laying ghosts to rest as ancestors” (Loewald, 1960/2000b) are explored.

Keywords:

• ghosts
• vampires
• internalization
• enactment
• somatization
• interpsychic-intersomatic

Notes

¹ I use parentheses in the word (re)enactment to communicate its double meaning: the parentheses highlight that the word connotes both reenactment of something from the patient's past–-something in the patient's intrapsychic makeup that gets reenacted in life and treatment relationships and also a clinical enactment process–-involving the analyst's intrapsychic makeup and history as well as the patient's, which leads to a cocreated enactment process in their interaction. The parentheses refer to the mixture of both processes, reenactment, and enactment.

² Related, I believe, to nameless dread, Bion (1976/2005) asserted that, “In psychoanalysis, when approaching the unconscious–-that is, what we do not know–-we, patient and analyst alike, are certain to be disturbed. In every consulting-room, there ought to be two rather frightened people …” (p. 5).

³ It is interesting that Charlie's vagueness about his age, and his sense of timelessness, also resembles a vampire-like state.

⁴ Expanding Freud's (1915/1957a) groundbreaking idea that the unconscious of one person can, uncannily, communicate with the unconscious of another without passing through the conscious, Loewald (1970, 1979) defined the “interpsychic” dimension of the patient–analyst relationship as the unconscious or preconscious effect and influence on one another. Bolognini (2011) vividly illustrates the essence of interpsychic space with his metaphor of a cat flap–-the swinging flap at the bottom of a door that allows a cat to come and go, freely and unobtrusively. The treatment space provides a cat flap, a portal for this preconscious interpsychic communication. In other words, the preconscious uses the flap for interpsychic exchange of that which is undersymbolized and undermetabolized. According to Bolognini (2011), interpsychic includes “presubjective” experience. After Katz (2014), I distinguish interpsychic communication from the term “intersubjectivity,” which is defined differently by different authors but often includes conscious awareness of communications as well as a capacity to recognize the separate subjectivity of another (Stolorow & Atwood, 1992). Subjective is, after all, the second half of the word intersubjective, implying something that takes place between two subjects. But this is not always the case. Bollas (2001) has dubbed the term “interpsychic” “Freudian intersubjectivity” for its privileging of unconscious and preconscious communication. Loewald's and Bolognini's definitions of interpsychic communications focus on preconscious and unconscious experience, and encompasses “presubjective” experience–-making space for both one- and two-person dimensions of the experience in the analytic relationship.

⁵ Something that all these spectral creatures share is a lack of humanity and an attendant inability to recognize the humanity of an other. Humanity–-including the capacity for compassion and kindness that comes with recognizing and valuing an other–-is an essential aspect of aliveness, and something that distinguishes those with fuller vitality.

⁶ Because I see internalizations as ranging from potentially “good enough” (i.e., adequate for drawing on constructively), to poor (inadequately developed or otherwise insufficiently usable), I use the term “underinternalized,” rather than the more usual term “uninternalized,” throughout this article. Likewise, I use the terms “undermetabolized,” “underintegrated,” “undersymbolized,” “undermourned,” and so on to connote and emphasize a continuum of robustness and psychic usability for each these concepts.

⁷ There are many possible ways to conceptualize ghosts (Abraham & Torok, 1975/1994; Baranger & Baranger, 2008, 2009; Bollas, 1987, 1996, 2001; Bromberg, 1998, 2003; Durban, 2011; Faimberg, 2005; Freud, 1909/1955b, 1917; Fonagy, 2008; Fraiberg, 1975/1987; Gerson 2010; Green, 1986/2005, 1999; Reis, 2011; Shengold, 2000; Stern, 1997) but it is beyond the scope of this article to explore these variations and their similarities and differences.

⁸ Definition of the term “internalization” could easily be an article unto itself. For current purposes, I follow Loewald's (1973) definition of the term. According to Loewald, in a sturdy internalization the object is “destroyed” and assimilated as part of the self; it is an integration and organization for the psyche (rather than a repression or other defensive process that works against organization and synthesis).

⁹ Green (1986/2005, 1999) used the concept “unrepresented” to refer to the failure to represent an object internally (i.e., an absence or absent presence). This failure is never pure, I think. Therefore, I use the term “underrepresented” to connote the particular kind of inadequate internalizations that can occur in the face of emotionally traumatizing experience such as absence or “deadness” in primary caregivers. According to Green, one result of an unrepresented object is that the patient's “love is still mortgaged to the dead [i.e., continually dying, undead] mother” (p. 156). Decathexis, delinking, and discontinuity proliferate. I include this adaptation of Green's ideas and language here because themes of deadness/undeadness, absent presence, and work in the negative/destructiveness have suffused the transference-countertransference with Charlie.

¹⁰ Internalization of a relatively good enough object relationship can result in what some might be tempted to call a “good ghost,” but “good ghosts” are unlikely to disturb or wreak havoc in the consulting room; in fact, what might be designated a “good ghost” is more simply thought of as an “ancestor”: a good-enough internalization that has become a relatively integrated, metabolized part of the self.

¹¹ “Repression” and “dissociation” are distinct terms. I frequently use them together because I see the two processes as embedded in one another. Both develop, and coexist in the same person, and both contribute to the creation of underinternalizations and ghosts (and, concomitantly, reenacting and living in a petrified past). In addition, one consequence of both repression and dissociation is that ghosts may be passed from generation to generation. Although Fraiberg's (1975/1987) ghosts are bred of intergenerationally transmitted Trauma with a capital “T” (massively derailing, overwhelming experience with extensive long term sequelae, including severe dissociation), ghosts need not be the result of capital “T” Trauma. Small “t” trauma (relatively less massively derailing, in experience and in long term consequences) and psychic conflict that eventuate in repression also result in intergenerational transmission of ghosts. Ghosts emanate from both kinds of trauma, and from both repression and dissociation. Clinically, dissociated ghosts seem to fight harder against symbolization, insight, mourning, and being laid to rest as ancestors. Either repression or dissociation tends to be the prominent experience with a certain patient or at a certain time in treatment.

¹² Freedman (personal communication, 2002) expanded upon Breuer and Freud's (1893/1955), Freud's (1914/1958), and Loewald's (1953/2000a, 1973/2000d, 1976/2000e) ideas of “reminiscences” to explicitly include dissociated, as well as repressed, experiences and memories. Such an inclusion also led him (Freedman & Russell, 2003) to reject a clinical dichotomy between interpretation and insight, on one hand, and implicit relational knowing and intersubjective relatedness, on the other, stating that neither can be “catapulted into the sine qua non of all treatment” because there is no “one path toward change” (p. 82). This certainly seems borne out, over time, with Charlie; different approaches seem to be more helpful at different times in treatment.

¹³ Indeed, in addition to underinternalization and compulsive reenactment, another feature that I believe differentiates ghosts from “internalized objects” is that ghosts necessarily entail unmourned (or, more precisely, undermourned) losses and melancholia. Adequate internalization is a precondition for mourning. However, unlike Freud's (1917/1957b) conception of melancholia via repression, ghosts may also include losses undergrieved due to dissociation.

¹⁴ For a fuller discussion of trauma, dissociation, and disorganized attachment see, for example, Bach, 2006; Bromberg, 1998, 2001; Davis & Frawley, 1994; Ferenczi, 1929, 1933/1955; Harris, 1996; Howell, 2005; Hurvich, 2003; Knafo, 2004; Lachmann & Beebe, 1997; Laub & Auerhahn, 1993; Lyons-Ruth, 2003; Stolorow, 2003.

¹⁵ The three functions of witnessing are defined, for current purposes, as recognition, containment, and metabolization. These functions may, together, provide a partial corrective for the trauma of a “confusion of tongues” (Ferenczi, 1949).

¹⁶ It is interesting that, with respect to the literal body and its psychic sequelae, Abraham and Torok (1975/1994) wrote that “ … the mother's constancy is the guarantor of the meaning of words…. The passage from food to language in the mouth presupposes the successful replacement of the object's presence with the self's cognizance of its absence” (p. 128). In the current conceptualization: if constancy is developmentally sufficient, then we can relatively more easily recognize the absence and thus mourn it; but if the mother's constancy is inadequate, loss is more difficult to recognize (it is more nebulous and difficult to feel loss of something one rarely or never had) and what is taken in is a mostly wordless underinternalization that haunts.

¹⁷ Abraham and Torok (1975/1994) discussed how “swallowed and preserved” trauma and the associated “[i]nexpressible mourning erects a secret tomb inside the subject … the loss is buried alive” (pp. 130–131) and “encrypted” in the preconscious. Although Abraham and Torok call this process “preservative repression,” it sounds, to contemporary ears, similar to the traumatic dissociated feelings “swallowed” by Charlie.

¹⁸ Baranger and Baranger (2008) wrote: “The participation of the body in the analytic situation is by no means limited to the patient. Every analyst participates in the physical ambiguity and responds with his or her own body to the patient's unconscious communication … we could call this phenomenon ‘corporeal projective counteridentification.’ In these bodily manifestations the analyst responds to an invasion by the patient … as if the analyst had taken on a physical reaction that the patient should be feeling” (p. 802). (It is interesting that this statement immediately follows the Barangers noting the dizziness of a patient.)

¹⁹ Numerous authors who have written about psychosis have touched on similar dynamics of identification and distance in the transference–countertransference (Ogden, 1980, 2007; Searles, 1961, 1976, 1977; Williams, 1998, 2004; and others).

²⁰ Is fainting a vertical split, an extreme dissociation? Or is fainting a horizontal split, an unconsciousness? Group discussions (Galit Atlas, Michael Feldman, Heather Ferguson, Arthur Fox, Adrienne Harris, Susan Klebanoff) suggest that passing out may be either an avoidance of dissociation or an extreme form of it. Either way, my fainting signals that Charlie has “destroyed” (Winnicott, 1969) me, or that I “collapsed” (Green, 1986/2005) due to my identification with the undeadness in him.

²¹ We absorb so much from our patients. Thus, the ghost that a patient leaves, in leaving treatment–-perhaps always but particularly unsettlingly when long-term work is interrupted abruptly–-leads to a haunting absent presence and complicated grieving in us.

Additional information

Notes on contributors

Margery Kalb

Margery Kalb, Psy.D., is in private practice in New York City. She is on the faculty at the NYU Postdoctoral Program in Psychotherapy and Psychoanalysis, and also teaches and supervises clinical work in the doctoral program at Pace University. She is co-editor, along with Adrienne Harris and Susan Klebanoff, of a forthcoming book on ghosts, to be published by Routledge