On survival

In dictionaries, survival is defined as “the state or fact of continuing to live or exist, typically in spite of an accident, ordeal, or difficult circumstances,” and as “an object or practice that has continued to exist from an earlier time” (Oxford Languages, 2022). In psychoanalysis survival cannot be easily defined, as it seems to correspond to a spectrum of meanings, both clinical and metapsychological. The more or less perilous aftermath of severe psychic trauma, often consisting of a predominance of mechanisms of omnipotent avoidance of psychic reality, could be identified as a common denominator in most of these meanings.

According to Freud, helplessness is the prototype of the traumatic situation (Freud, 1926). Freud also suggested that loss of or separation from the object are at the origin of overwhelming anxiety and pain (Perelberg, 2015). One should not limit loss only to physical loss, but mainly to a lack of containing on the part of the object. Survival mechanisms would aim at denying or avoiding helplessness, at the cost of a restricted relation with internal and external reality. Symington sustains that survival as a psychic aim is somehow the opposite of freedom and creativity (Symington, 1999).

Winnicott established another dimension of survival in the frame of the early subject–object relationship. By coining the concept of survival of the object (1969), Winnicott, puts stress “on what the object is like” –that is, on whether it does “retain its character” (Abram & Hjulmand, 1996) and its containing function in the face of destructive attacks (or raw communications of need that may be perceived as destructive attacks) from the subject. Survival of the object would mean that the path for a transitional space and for the gradual acceptance of the object being out of the area of the subject’s omnipotent control is open. This type of object survival can of course be a paradigm for therapeutic work with survivors of trauma.

Concerning the role of the analyst in such a process, Borgogno (2021), following Ferenczi, underlines that analyst and patient both “come from afar” (p. 1), that is, they have both been babies and children; moreover, the analyst has been a patient, sometimes an “orphan of reverie” (p. 21), who has found a responsive object in their analysis, and this could be the foundation of their ability for taking in the patient’s life. Clara Mucci considers both analyst and severely traumatized patient as survivors meeting in the space of the analytic encounter (Mucci, 2018).

In these last few years the issue of survival, in its literal meaning, has acquired increased importance, as threats to human life itself and to the life of the collective psyche are undeniably present; the ongoing COVID-19 pandemic and the war in the Ukraine, with all its atrocities, are two overwhelmingly blatant examples of such threats that throw their shadow over everyday life.

A complex problem that analysts have to solve in these times concerns the dialectics between literal survival issues relating to themselves and the social group they belong to, and the need for the survival of analytic listening of the traumatized, often terrorized patient. In an IPA webinar at the peak of the pandemic’s first wave, Julia Kristeva spoke of readiness on the part of the analyst; according to Kristeva, readiness includes the eventuality of death as a crucial element of analytic listening at that moment. She also stressed that she considers herself a survivor as her childhood and adolescence were marked by social trauma (the World War II, the Cold War, migration) that she survived; and since these traumatic experiences acquired a meaning in her path in psychoanalysis and life, she has the readiness to listen to actual traumatic material (Kristeva, Scarfone, & Ungar, 2020).

Readiness for death is not a given. Moreover, dying is not merely an individual process. In this issue, in his article “Reflections on dying patients, hospices, assisted suicide and euthanasia,” Christer Sjödin, former Coeditor-in-Chief of this journal, ponders the above subjects. Sjödin sustains that although “the right to death provides freedom for some, for others it is a forced choice that interferes with the dying process.” With the presentation of two cases of dying patients he worked with, the author clearly shows that the analyst can be a surviving object for the dying patient. He advocates “the palliative model, wherein death is perceived as a part of an individual’s life and as a normal process, although this task is hard for the family to contain.”

The family is often the site, and childhood often the time, of traumas to be survived. The traumatized, almost shattered childhood and adolescence of a man, his survival and the painful working-through of his traumas expressed in novel form constitute the subject matter of two book review essays by Robert Ehrlich – “Paul Williams’ portrayal of the psychological growth of the narrator in The fifth principle and Scum,” Parts 1 and 2. Part 1 deals with The fifth principle and Part 2 with Scum. As Ehrlich informs us, the author of both novels, psychoanalyst Paul Williams, states, in the preface to The fifth principle, that the subject of both books is “aspects of the author’s life” as a child and as an adolescent, but they should not be considered as autobiography or case study – as the narrator does not equate to the author. Ehrlich sustains that “the narrator’s willingness as an adult to acknowledge the depth of his terror, including the awareness that he has survived feelings of annihilation … provided him with a firmer psychological foundation.” He also underlines the importance of the use of various stylistic devices and of innovative use of language by the author. Artistic and literary activity are indeed a way for the working-through of trauma, through giving substance to the ineffable traumatic experience in the frame of artistic or literary form.

Art gave form to a mythical prototype of human nature with its traumatic and conflictual aspects – one survivor of filicide and guilty of parricide, namely Oedipus. In his article “Oedipus returns to opera: The repressed in psychoanalysis and musicology” (which is a sequel to “Oedipus goes to the opera: Psychoanalytic inquiry in Enescu’s Œdipe and Stravinsky’s Oedipus Rex” by Daniel Röhe, Francisco Martins and Maria Ines Gandolfo Conceiçāo, published in IFP Vol. 29, Issue 1), Daniel Röhe brings attention to operatic depictions of Oedipus before the birth of psychoanalysis (that is, before the publication of “The interpretation of dreams”). He also observes that “post-Freudian operas should be considered under the impact of psychoanalysis.”

Survivor guilt is a concept introduced by Niederland to account for aspects of the psychic condition of Nazi concentration camps survivors. Niederland linked this guilt to “the marked ambivalence toward … [their love objects that perished in the camps], intensified by the patients’ apparent failure to protect the victim from the persecution, but also result from the sadistic incorporative fantasies leading directly to guilt” (1968, p. 313); he considered this guilt as “one of the predominant factors underlying the clinical picture of the survivor syndrome” (p. 314).

Other analysts have attempted to expand this concept to common, not clearly traumatic situations. Arnold Modell writes:

There is, I believe, in mental life something that might be termed an unconscious bookkeeping system, i.e. a system that takes account of the distribution of the available ‘good’ within a given nuclear family so that the current fate of other family members will determine how much ‘good’ one possesses. If fate has dealt harshly with other members of the family, the survivor may experience guilt, as he has obtained more than his share of the ‘good’. (Modell, 1971, p. 339)

In their article “Survivor guilt: theoretical, empirical and clinical features,” Ramona Fimiani, Francesco Gazzillo, Nino Dazzi, and Marshall Busch, drawing mainly from psychodynamic theory and social psychology, attempt to approach aspects of survivor guilt, putting stress on its presence in everyday life and social interactions.

Gender dysphoria and factors underlying the demand for gender reassignment from an increasing number of very young people form the subject matter of the book “Gender dysphoria – a therapeutic model for working with children, adolescents and young adults” by Susan Evans and Marcus Evans, both experienced psychoanalysts. In his review of this book, Michael Buchholz, a former Associate Editor of this journal, underlines important points made by the authors, such as the interplay among social pressure (“cultural war”), extreme traumatic family situations, and the activation of powerful defense mechanisms that clearly play a pivotal role in the demand for surgical conversion. The authors’ convincing therapeutic approach, their will to stand helpfully by the young people, as Buchholz observes, is evident in this precious book, together with an extraordinary wealth of clinical material.

At the Forum in Madrid, I will step down from my post, so this is the last editorial I will write as Coeditor-in-Chief of this journal. I am grateful to the IFPS for trusting me with this endeavor and, of course, to Coeditor-in-Chief Marco Conci, who introduced me to the journal, as well to the colleagues on the Editorial Board for these eight creative years of shared work and experience.