Psychoanalysis, trauma and severe mental disorders: Papers from the XVIIIth IFPS Forum, Kaunas (Lithuania), September 17–19, 2014

I had never been to Lithuania before I went there a year and a half ago, to participate in the XVIIIth IFPS Forum. When I came back, I was so happy with the series of excellent initiatives that I had experienced in Kaunas that I felt I needed to write about them and the Forum without waiting for publication of the selected papers around which this issue is centered. And that is what I did, in the Editorial of Issue 4/2014, under the title “Accompanying our members, our readers and our patients in their evolution and development” (Conci, 2014b).

I underlined there how almost 200 participants from 24 countries meeting to discuss the topic of the Forum – “Psychoanalysis, trauma and severe mental disorders” – were able to develop the kind of close and personal international exchange that our Federation and this journal stand for. We heard not only several good papers on the conference’s topic, but also about the first steps of psychoanalytic psychotherapy in Cuba; we were party to the first scientific meeting of the Individual Members Section, chaired by Michael Ermann; we enjoyed a very good panel organized by this journal’s editorial board and chaired by Christer Sjödin; and we witnessed the presentation of a series of papers from which the two ex aequo winners of the Benedetti–Conci Candidates Award were chosen. Today, we are able to publish a selection of five papers dealing with the conference’s main theme, four papers given at the panel on “Writing, evaluating and publishing psychoanalytic papers,” and the two award-winning papers. Our aim is for this issue to be distributed at our next Forum, to be held in New York City on May 9–12, 2016, with the topic “Violence, terror and terrorism today. Psychoanalytic perspectives.”

Let us start with the paper “Psychoanalysis with the traumatized patient: Helping to survive extreme experience and complicated loss,” by Sverre Varvin (Oslo). One of Scandinavia’s best-known analysts, Varvin has worked for many years on the psychoanalysis of trauma, its underlying sociopsychological dynamics, and the best ways to therapeutically deal with traumatized patients, combining in a very enlightening way empirical and conceptual research in psychoanalysis. We previously (2003) published his paper “Extreme traumatization: Strategies of mental survival,” which he presented at the XIIth IFPS Forum (Oslo, August 2002) organized by Agnar Berle – a former secretary general of IFPS (2008–2012) and one of the pioneers of the introduction of psychoanalysis to Lithuania.

In Varvin’s presentation of the case of Fatima (a woman in her late thirties, a refugee from the Middle East), we concretely see how traumatic experiences are actualized in the transference and bring the analyst into a situation in which countertransference enactments inevitably occur, thus enabling the symbolization and integration of the trauma. When this happens, “an opportunity may appear for the ‘unthought known’ to be heard and contained in a common created narrative that relates present suffering to past misery. A time dimension can then be established in this area of the psyche, which also makes reflection possible” – as Varvin writes in discussing his case. This is how the author’s work in this field has contributed not only to substantiating the central role that the concept of “enactment” (see Jacobs, 1986) plays in the contemporary analytic discourse, but also to empirically grounding the advantages of working with trauma-related material in the transference.

How the “unquiet ghosts” of her paranoid and depressed parents inhabited and dominated her patient Anne’s life is the topic of Sandra Buechler’s paper “Unquiet ghosts: The treatment of a paranoid, depressed trauma survivor.” For Anne, an attractive and well-dressed woman in love with her work, it took “many years, thousands of hours, to reveal her traumatic childhood.” In other words, it took the particularly good clinical sensibility of the author – and her interpersonal point of view – to allow her patient to contact her sense of endangerment and her lack of self-worth, both of which had transformed her life into a terrible form of psychological agony – whose nature and causes Anne could grasp only through their co-creation in therapy. Of course, in this therapy the concept of transference also plays a crucial role, as the key to the internal world of the patient, although the author does not explicitly refer to this. Sandra Buechler represents the contemporary North American interpersonal tradition at its best, and we fortunately have had her regularly present her work at our Fora –for example in October 2008 in Santiago de Chile with the paper “Overcoming our own pride in the treatment of narcissistic patients” (Buechler, 2010).

The paper by Jan Bulla and Klaus Hoffmann, “Coercion as part of a psychoanalytically based therapy: Case report on the treatment of a forensic outpatient,” brings us in touch with another important professional tradition – the German-speaking tradition of the use of psychoanalytic psychotherapy in the field of forensic psychiatry. Klaus Hoffmann, a regional editor of this journal and chair of the IFPS Archives Committee, has published various papers on this topic in the International Forum of Psychoanalysis that represent a good introduction to the case described in the paper written with his colleague Bulla.

Having been treated for almost five years as an inpatient of a unit specializing in psychodynamic psychotherapy for offenders diagnosed with personality disorders, John (the patient in the case report) started forensic outpatient treatment in 2010. During this, an important structural change in his personality emerged (in terms of both his self-perception and his self-management), which the authors attribute to a constructive, dialectical combination of “classical techniques” and “direct interventions” – as had also been envisioned by Norman Elrod (1928–2002). At the end of the therapy, the patient explained that, despite being forced into treatment, he also felt recognized and held while he had been in deep distress, confirming August Aichorn’s (1878–1949) insight that the development of the reality principle depends on the quality of the relationship with the caregivers.

A similar principle animates the therapeutic method of the “multifamily group” (see Garcia Baldaracco, 2000), utilized by Antonella Granieri since 2010 with the citizens of the Italian town of Casale Monferrato, many of whom were victims of progressive respiratory failure (caused by pleural mesothelioma) resulting from the inhalation of asbestos fibers produced and circulated in the environment for many years by a local chemical industry. This is the topic of Granieri’s paper, “Extreme trauma in a polluted area: Bonds and relational transformations in an Italian community.” A psychology professor at the University of Turin, a full member of the Italian Psychoanalytic Association, and a member of the IFPS Individual Members Section, the author speaks of the method she chose in terms of an:

…“open door” group whose participants meet once a week. Each session lasts 90 minutes, and attendance is open to patients, their relatives, health workers, and whoever else wishes to participate, offering the possibility to simultaneously work on the individual, familial, and social dimensions of the mind … the functioning of the multifamily group can be understood as an “extended mind,” whereby each participant enriches the whole by contributing his or her point of view.

Such exchanges of significant communications in a group setting allowed, for example, the patient Giulia – through whom the author exemplifies her work – to openly speak about her illness with her husband and her sons, thus strengthening her motivation to fight against it. Borrowing an expression from Franco Borgogno (2014), Granieri speaks of the possibility to bring about in the participants an “act of credit,” allowing them to establish “a space between the past and the present, in order to regain personal history and the capability to live a present and a future less tainted by the trauma.”

A similar therapeutic dimension characterizes the highly original and touching paper that the Parisian couple Françoise Davoine and Jean-Max Gaudillière (who unfortunately died in March 2015) presented in Kaunas – “Stoppage of time in schizophrenia: Similarities to the field of war trauma.” Davoine and Gaudilliére, both members of the Ecole Freudienne de Paris founded by Jacques Lacan (1901–1981) and faculty members of the Ecole des Hautes Etudes en Sciences Sociales, carried out such important work in the field of psychotherapy of the (schizophrenic) psychoses that they were repeatedly invited to present this outside France, especially in the USA. This scientific exchange is the focus of their book History beyond trauma, which they published directly in English in 2004 and in which they elaborated their view of the similarities between schizophrenia and war traumas – the topic of their paper in Kaunas. But here is now they formulated their concept of transference:

Transference is exactly to become a witness ‘for events without a witness’, as suggested by Dori Laub, an analyst of massive traumas at Yale, working with Holocaust survivors and their descendants. ‘To become a witness, is to answer the question “Who are you ?”, asked by the patient’, even in an apparently unconcerned way. In other words, ‘Are you familiar with the stuff ?’ The only way to break the deadly isolation of extreme traumas transmitted through generations is to base the answer on analogous experiences. This is why we think that the analyst’s disclosure, on some precise points, is a therapeutic duty.

If such a definition has the potential of offering a possible common denominator for the various definitions of transference that we have dealt with so far, readers can find this eloquently articulated in the case of Davoine’s patient Henry, whose presentation covers half the paper.

But what about the relationship between schizophrenia and war traumas? According to the authors, both belong to the same field of destruction of the symbolic order, that is, an area of death, where time stops, where there is no other except for a ruthless agency that erases truth and trust. In such a field, patient and analyst are co-researchers, exploring and challenging the existence of a reliable other as a positive outcome. How much and what kind of work this requires is what we learn through Henry’s treatment. We also learn how the therapist becomes the witness of the patient’s untold story, an analytic attitude that allows the authors to bring back to life the meaning of the old Greek word therapon as “the second in combat against denial.”

The editorial work involved in producing an analytic journal can also be defined in terms of a particular form of witnessing (see Poland, 2000). Here are the concluding words of Christer Sjödin’s introduction to the panel “The psychoanalytic journal, writing and evaluation of psychoanalytical papers,” which he chaired in Kaunas:

The collective effort to express us in written texts keeps the psychoanalytical scientific field alive. I have felt the satisfaction of participating in the cultivation of the psychoanalytic field as an editor-in-chief of our journal. For me, it has been a pleasure to read and discuss articles from all parts of the world. I have enjoyed the open and free discussion in the editorial board, also when contradictory and controversial standpoints were formulate Afterwards, I usually felt content with most of our decisions.

This is the rich heritage that Christer left to myself and Grigoris Maniadakis upon his retirement as editor-in-chief at the Kaunas Forum, having been a member of the editorial board of the journal since the very beginning, since the production of Volume 1 back in 1992. A very significant document of his collaboration with Jan Stensson, our founding editor, is the interview that Christer conducted with Jan in 2006.

In fact, my own paper “My relationship to the IFP in the context of the original construction of our identity as a journal” reflects my own function as a witness of the evolution and development of the International Forum of Psychoanalysis. This is also the function of the pictures accompanying the paper.

From this point of view, I am very happy that Grigoris Maniadakis accepted my proposal to become the new coeditor-in-chief of the journal, after Christer’s retirement. A full member of the Hellenic Society of Psychoanalytic Psychotherapy, working not only in private practice, but also as a supervisor at the Psychoanalytic Psychotherapy Unit of the Athens University Department of Psychiatry, Grigoris is the author of many analytic papers and also the co editor (together with G. Chalkia) of the Greek edition of Robert Hinshelwood’s Dictionary of Kleinian thought. After his presentation of the paper “Notes on a case of alienating identification” (Maniadakis, 2010) at the 2008 IFPS Forum in Santiago de Chile, I remember asking him to join our editorial board as an editorial reader. In his Kaunas paper “In the mind of the reader: On some aspects of relating to a psychoanalytic text,” Grigoris clearly and richly articulates the specific psychoanalytic dimension of evaluating analytic papers and producing an analytic journal, which – given the link it establishes between authors and readers – can be regarded as “the third object of a commensal container/contained relationship.”

Another fortunate event was to have Miguel Angel Gonzalez-Torres join our Kaunas panel with his paper “In the mind of the teacher: Psychoanalytic papers as key elements in a scientific endeavour,” which he and his collaborators Aranzazu Fernandez-Rivas and Alberto Penas of the Basurto University Hospital of Bilbao (Spain) have published in the issue. A training analyst of the Centro Psicoanalítico de Madrid, and for many years a member of the executive committee of IFPS, Miguel Angel has long collaborated with our journal (see, for example, Gonzalez-Torres, 2013), and we value him as one of our best Spanish-speaking editorial readers. Of the many interesting and important points raised in this further contribution to our Kaunas panel, I would underline the following: that papers published in analytic journals should play a more important role in the field of teaching, and that we should give more space in our journals not only to contemporary, but also to younger, authors.

This is one of the ideas behind the organization (for the first time, at the Kaunas Forum) of the Benedetti–Conci Candidates Award, dedicated to the memory of Gaetano Benedetti (1920–2013). An Italian-born and Swiss-trained pioneer of the psychotherapy of schizophrenia, Gaetano Benedetti was not only the founder (together with Johannes Cremerius, 1918–2002) of the Milan group from which the Associazione di Studi Psicoanalitici (ASP) emerged at the end of the 1980s, but also (through his friend Gerard Chrzanowski, 1913–2000) our direct link to the International Federation of Psychoanalytic Societies – of which the ASP became a member society at the Rio de Janeiro Forum of October 1989. Personally (Conci, 1994, 2014a), I consider Benedetti, the author of several hundred papers and dozens of books in several languages (see Benedetti, 1983, 1987), as a living demonstration of the fundamental role played by a real and constructive international exchange in the construction of psychoanalysis as a professional identity and a scientific discipline. Freud himself had arrived at the new synthesis we inherited from him by connecting the Viennese medical tradition, the Parisian psychological tradition, and the English empirical tradition – as Erwin Ackerknecht established back in 1968. This is why I decided to personally propose and finance such an Award in Benedetti’s name. And here now are the two winners that our Award Commission (Christer Sjödin representing the journal; Valerie Tate Angel for the federation; and Agnar Berle, Jan Johnasson, and Alexandras Kulak for the organizing committee of the Forum) chose after the six nominated papers had been presented in two panels.

In her paper “Therapeutic progress in repetitive dreams: A diachronic study of a clinical case,” Maria Fernanda Clavijo López combines the Frommian interest in the dream dimension of our work (as she assimilated it in her training at the Mexican Institute of Psychoanalysis) with the methodology of contemporary empirical research in psychoanalysis (which she learned through her training as a psychologist at the Intercontinental University of Mexico City). This allows her to demonstrate that repetitive dreams are a useful tool in assessing our patients’ therapeutic progress. Maria Fernanda is also the current representative of the IFPS Candidates Section.

In his paper “From earthquakes to good vibes: Transformations through a resonance process,” António Alvim convincingly shows how the therapist’s ability to use his reverie in order to learn the patient’s language behind her words – to resonate with the patient – can represent a key aspect in the therapeutic transformation of the patient’s traumatic experience of uncontainable threatening emotions. In other words, through his training at the Associaçāo Portuguesa de Psicanalíse e Psicoterapia Psicanalitica, our Lisbon colleague has been able to assimilate the post-Bionian approach developed in Italy by Antonino Ferro with children and adult patients in such a way as to make international exchange in psychoanalysis a credible and valuable training approach.

If we now take not only our work for the International Forum of Psychoanalysis, but also our candidates’ work, as the best way of witnessing psychoanalysis, we can establish an important (and fascinating!) continuity between the crucial role we can play with and for our patients (as suggested by the five papers on psychoanalysis and trauma presented above) and our role in the further development of our identity and our discipline in the context of our international community.