Gisela Pankow (1914–1998): Towards a psychoanalytic treatment of the psychoses^*

* Translated from the French by Dorothée Bonnigal-Katz.

ABSTRACT

Gisela Pankow devoted her life to finding ways to overturn Freud’s statement on the impossibility of treating the psychoses psychoanalytically. Without ever straying from Freudian metapsychology, yet mending certain technical aspects (e.g. by introducing clay modelling into the session), she developed an approach in the area of psychosis thanks to which the difficulty encountered by psychotic subjects when attempting to communicate their experience of the world can be bypassed. She referred to this approach as dynamic structuring. Her views on the “lived body” and the “symbolising functions of the body” stem from her clinical experience and offer a unique synthesis of psychoanalysis and phenomenology.

Gisela Pankow devoted her life to finding ways to overturn Freud’s statement on the impossibility to treat the psychoses psychoanalytically. Without ever straying from Freudian metapsychology, yet mending certain technical aspects (e.g. by introducing clay modelling in the session), she developed an approach in the area of psychosis thanks to which the difficulty encountered by psychotic subjects when attempting to communicate their experience of the world can be bypassed. She referred to this approach as dynamic structuring. Her views on the “lived body” and the “symbolizing functions of the body” stem from her clinical experience and offer a unique synthesis of psychoanalysis and phenomenology.

Gisela Pankow a consacré sa vie à trouver des moyens de renverser la déclaration de Freud sur l'impossibilité de traiter les psychoses psychanalytiquement. Sans jamais s'écarter de la métapsychologie freudienne, mais tout en en modifiant certains aspects techniques (par exemple en introduisant de la pâte à modeler dans la séance), elle a développé, dans le domaine de la psychose, une approche grâce à laquelle la difficulté rencontrée par les sujets psychotiques peut être contournée lorsqu’ils tentent de communiquer leur expérience du monde. Elle a appelé cette approche structuration dynamique. Ses points de vue sur le «corps vivant» et les «fonctions symbolisantes du corps» découlent de son expérience clinique et nous offre une synthèse unique de la psychanalyse et de la phénoménologie.

Gisela Pankow hat ihr Leben der Suche nach Wegen gewidmet, Freuds Aussage zu revidieren, Psychosen seien psychoanalytisch nicht behandelbar. Indem sie nie von Freuds Metapsychologie abwich, jedoch bestimmte Aspekte der analytischen Technik verbesserte (beispielsweise, indem sie das Modellieren mit Ton in Therapiesitzungen einführte), entwickelte sie für Psychosen eine Herangehensweise, mit der die Schwierigkeit umgangen werden kann, auf die psychotische Subjekte stoßen, wenn sie versuchen mitzuteilen wie sie die Welt erleben. Sie bezeichnete diesen Ansatz als dynamische Strukturierung. Ihre Betrachtungsweise des „gelebten Körpers“ und der „symbolisierenden Funktionen des Körpers“ hat ihren Ursprung in ihrer Erfahrung aus der klinischen Praxis und ermöglicht eine einzigartige Synthese aus Psychoanalyse und Phänomenologie.

Gisela Pankow ha dedicato la sua vita a trovare modi per rovesciare l’assunto freudiano secondo cui sarebbe impossibile trattare le psicosi con la psicoanalisi. Senza mai allontanarsi dalla metapsicologia freudiana, ma al tempo stesso modificando alcuni aspetti tecnici (introducendo ad esempio la possibilità di modellare l’argilla durante le sedute), ella sviluppò un approccio per l’area delle psicosi che ha reso possibile aggirare le difficoltà tipicamente incontrate dai soggetti psicotici nel comunicare la loro esperienza del mondo. La Pankow diede a questo approccio il nome di “strutturazione dinamica”, e le sue idee sul “corpo vissuto” e sulle “funzioni simbolizzanti del corpo”, ricavate dalla sua esperienza clinica, rappresentano un esempio assai originale di sintesi tra psicoanalisi e fenomenologia.

Notes

* Translated from the French by Dorothée Bonnigal-Katz.

1 Yet authors such as H. Segal, H. Rosenfeld or W. Bion retained the usual frame when working with psychotic patients.

2 On the subject, see Marie-Lise Lacas’s thorough and documented book: (2004, 2014).

3 Pankow (1957). French translation: (2010).

4 This is the patient named Suzanne.

5 We can therefore see here that the notions of form and content in Gisela Pankow have nothing to do with Bion’s, even though their work is contemporary. To Bion, the container–contained concept is closely tied to the notion of projection and reintrojection in the relationship between newborn baby and mother. It is in fact an extension of the Kleinian notion of projective identification. To Pankow, the lived body as form is understood in a context in which the differentiation between inside and outside has no meaning or has lost its meaning. It is an observation in the here-and-now of the session without any reference to the temporality of a development, as is the case with Bion. Pankow is indeed not concerned with the developmental aspect at all. In her theorisation, there is no attempt to extract the dissociation of the lived body in the psychotic subject to turn it into a hypothetical stage of development. As a logician, she was wary of the lures of analogy, which, on the basis of psychic events occurring during the analytic session, infer an analogous event at another level, that of the infantile psychosexual development.

6 During the same period, numerous authors took an interest in this question, such as P. Schilder, F. Dolto (1984), W. Hoffer, S. Fischer and S. E. Cleveland as well as D. Anzieu (1985) subsequently, but they did so from a different perspective, the libidinal body in the case of the first three authors, a distinct interpretation of the Rorschach test in the case of Fischer and Cleveland. Anzieu’s work is closer to Pankow’s perspective, even though it does not specifically focus on the analytic treatment of psychosis.

7 Kretschmer opposes Kernpsychose – nuclear psychosis – and Randpsychose – marginal psychosis – a differentiation that allows one to locate the place of the psychotic part in relation to the rest of the personality. In nuclear psychosis, the psychotic part is at once more extended and more central than it is in marginal psychosis. These notions roughly overlap with Pankow’s differentiation between schizophrenia and non-schizophrenic delusions. She takes less of an interest in paranoia, an area which, in her view, was largely tackled by Freud from a psychopathological perspective, if not from a therapeutic one.

8 The title of her first psychoanalytic presentation in 1954 is precisely: “Darstellung der Übertragung in der analytischen Behandlung einer paranoischen Patientin” [A Discussion of the Transference in the Analytic Treatment of a Paranoid Patient], a report presented at the International Congress of Psychotherapy in Zürich. In her work, Gisela Pankow does not insist on these notions, which are currently central in some of Laurence Kahn’s work. Granted, she read Freud in German and probably did not notice that Darstellung and Vorstellung were equally translated as représentation in French. Strachey’s translation does not convey this distinction any better: representation, presentation and idea are used with a certain degree of confusion to translate Darstellung, Vorstellung and Repräsentanz.

9 Having returned from two years in Congo, I discussed this case at length with Gisela Pankow. She was delighted that her intuition should thus be confirmed by an ethnological feature she had no knowledge of. For my part, I was impressed by her capacity to make out, with such precision and without knowing the specifics of the matrilineal functioning prevailing in central Africa, that there was something at odds with the family law in the way in which this patient gave prominence to his father.