Flexibility of the Psychoanalytic Approach in the Treatment of a Suicidal Patient: Stubborn Silences as “Playing Dead”

Abstract

The author presents the clinical case of a patient in his third analysis who seemed emotionless, did not feel alive, and complained of an uncontrollable urge to gamble, with disastrous financial results. His previous four-session-a-week “orthodox” analysis had left him prey to a sense of emptiness and to intense suicidal urges. He wanted only two weekly sessions, which became three after some analytic work. The author stresses the danger of rigidly following inflexible standards and the consequent activation of a pseudo-compliance in the analysand. A more slowly paced psychoanalysis should not be considered lower in the pecking order than “high-frequency” treatment, the author maintains: It requires great creative subjective involvement on the part of the analyst and close interaction in the context of the analytic couple. The author shows how this analysis involved a series of interactions in which the analyst was called upon to exercise a complex responsiveness, attuned in each instance to the patient's current needs. Finally he focuses on some clinical passages to show how the patient's internal theories represent a glaring assault on common sense and how death was not recognized perceptionally on a realistic level, but was instead replaced with acting out death against himself by keeping himself mentally dead and by suicidal urges.

Notes

¹Differentiating between knowledge and morality, recognizing whose business it is to feel motivated to proceed with analytic treatment, and distinguishing between the dead and alive components of his addictive gambling are examples of the need to introduce mental differentiations in Antonio's potentially paralyzed mind. Matte Blanco (1975, 1988) stressed the unconscious destructuring action of symmetry, as a result of which distinctions disappear, and how essential it is that the analyst introduce asymmetrizations (i.e., differentiations) so as to foster the development of realistic thinking in the patient. We see other examples of symmetrization and the consequent need for the analyst to activate an unfolding, during the session, towards asymmetrical forms that are compatible with the reality principle