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PSYCHOTIC ANXIETIES ARE NORMAL

by Robert M. Young

One of the illuminating distinctions that post-Kleinian psychoanalysis has given us is that between knowing and knowing about. In psychoanalysis, knowing about something often operates as a defence against knowing it in a deeper, emotional sense. I well recall my first, greatly-valued supervisor, Bob Hinshelwood, saying once in a self-deprecating way that if you don't understand what the patient is on about in the session, you make a clever interpretation, and if you aren't inward with the patient at all, you can always write a paper.

The things I shall write about in this essay are not new. Most of my sources were published between the year of my birth and 1955, when I was a second-year undergraduate and seriously began reading psychoanalysis. I have known about much of the literature on psychotic anxieties for some time, having read some Klein and Bion before and during my own analysis. There is, however, a sensible bias against reading too much during one's clinical training, so one rarely studies a topic in a systematic way. As a consequence, it is only now, some years post-analysis, that I am beginning to feel (and I do not wish to exaggerate the extent to which I feel it) that I might take it in properly. I like to think that I am in the foothills of knowing it. One of my purposes in essaying about these issues is exegetical - an attempt to bring these things together for myself to see if they cohere for me.

Of course, what one comes to know one knew all along, as I shall illustrate, and knowing about it can be as much a barrier as a catalyst to being able to think about that tacit knowledge. I have known all along about the normality and ubiquity of psychotic anxieties, but I am beginning to be able to afford to realise it and to reflect upon some of the consequences of the omnipresence of these primitive, unconscious phantasies for life, culture politics and the theory of knowledge.

Having completed a reconsideration of the literature on psychotic anxieties, I have two tasks. The first is to try to describe and give some emotional meaning to the kinds of phantasies against which we - as individuals and in groups and institutions - spend so much of our energy defending ourselves. Second, I want to gather together and draw attention to the implications of Kleinian and neo-Kleinian ideas for how we think of human nature, by which I mean, with respect to individuals and all other levels of culture and civilisation. It turns out that defence against psychotic anxieties is offered by Kleinians as a deeper explanation than the incest taboo as the basis of that thin and all too easily breached veneer that constitutes civility and stands between what passes for the social order, on the one hand, and chaos (or the fear of it), on the other. This turns out to be a mixed blessing, since our defences against psychotic anxieties act as a powerful brake on institutional and social change toward less rigid and more generous relations between individuals and groups. I first heard of psychoanalysis nearly forty years ago on my first day at university, where new students from very different backgrounds were thrown together as roommates. One of mine cackled when he learned that I had never heard of Freud, whom he described as 'the guy who thought all doorways are cunts and all neckties are dicks'. In the early 1950s psychoanalysis connoted sex to American undergraduates - and smutty sex, at that. I quickly learned the close connection between these matters and violent, mad feelings such as murderous envy when, only a few weeks later, that same roommate tried to stab me with a Swiss army knife because he couldn't bear it that I had a girlfriend, and he didn't.

I offer this anecdote for several reasons. First, Freud's theory of civilisation drew attention to the taboo against violent sexual competitiveness and rapaciousness as the corner-stone of civilisation. The polymorphously sexual patriarch was said to have been killed by the primal horde, thus establishing the incest taboo, the basis for all other taboos and the system of custom and legality that gave birth to civilisation and culture, terms Freud refused to distinguish. He constantly emphasised that man is a wolf to other men, that the veneer of civilisation is thin and under threat from moment to moment and that all of life is a constant struggle conducted in the fraught space between erotic and destructive instincts. For Freud the basic conflicts occurred at this level of the psyche (see Young, 1994, ch. 2). As Meltzer describes it, Freud's world is 'a world of higher animals', 'creatures seeking surcease from the constant bombardment of stimuli from inside and out'. He contrasts Klein's world as 'one of holy babes in holy families plagued by the devils of split off death instinct' (Meltzer, 1978, part 3, pp. 115-16).

This is not merely a difference of emphasis. As the shocking example from my college experience shows, matters which may appear on the surface be about genital sexuality may also turn out to be about much more primitive psychological levels of distress. Similarly, the difference between the worlds of Freud and Klein may be described as one of level of explanation and of causality. Bion put the point clearly in the conclusion to his essay, 'Group Dynamics - A Re-view', which, as Menzies Lyth points out, was more explicit about the Kleinian inspiration of his ideas than his better-known collection of essays, Experiences in Groups. Bion says, 'Freud's view of the dynamics of the group seems to me to require supplementing rather than correction' (Bion, 1955, p. 475). He accepts Freud's claim that the family group is the basis for all groups but adds that 'this view does not go far enough... I think that the central position in group dynamics is occupied by the more primitive mechanisms which Melanie Klein has described as peculiar to the paranoid-schizoid and depressive positions. In other words, I feel... that it is not simply a matter of the incompleteness of the illumination provided by Freud's discovery of the family group as the prototype of all groups, but the fact that this incompleteness leaves out the source of the main emotional drives of the group' (ibid.). He then summarises the notions of 'work group' and the 'basic assumptions' that assail them - 'dependence', 'pairing', 'fight-flight' - and suggests that these may have a common link or may be different aspects of each other. 'Further investigation shows that each basic assumption contains features that correspond so closely with extremely primitive part objects that sooner or later psychotic anxiety, appertaining to these primitive relationships, is released. These anxieties, and the mechanisms peculiar to them, have already been displayed in psychoanalysis by Melanie Klein, and her descriptions tally well with the emotional states' of the basic assumption group. Such groups have aims 'far different either from the overt task of the group or even from the tasks that would appear to be appropriate to Freud's view of the group as based on the family group. But approached from the angle of psychotic anxiety, associated with phantasies of primitive part object relationships... the basic assumption phenomena appear far more to have the characteristics of defensive reactions to psychotic anxiety, and to be not so much at variance with Freud's views as supplementary to them. In my view, it is necessary to work through both the stresses that appertain to family patterns and the still more primitive anxieties of part object relationships. In fact I consider the latter to contain the ultimate sources of all group behaviour' (p. 476).

In Bion's view, then, what matters in individual and group behaviour is more primitive than the Freudian level of explanation. The ultimate sources of our distress are psychotic anxieties, and much of what happens in individuals and groups is a result of defences erected against psychotic anxieties, so that we do not have to endure them consciously.

I'll say something about the term 'psychotic' and then turn to the concept of phantasy and the anxieties which primitive phantasies generate. To most of us 'psychotic' refers to psychosis, a primary disturbance of libidinal relations with reality, and psychotic symptoms are an attempt to restore the link with objects (Laplanche & Pontalis, p. 370). When I was trained as a psychiatric aide in a state mental hospital in the 1950s, we were taught a small number of things about psychosis, and they seemed adequate in those pre-Laing and pre-Goffman times. Psychotics were 'out of contact with reality' for much or all of the time. They heard and saw things that were not there - hallucinations - and wildly distorted things that were - delusions. I want to turn now to the mechanisms in question and their evolution from the asylum to the nursery. Klein described schizoid mechanisms as occurring 'in the baby's development in the first year of life characteristically... the infant suffered from states of mind that were in all their essentials equivalent to the adult psychoses, taken as regressive states in Freud's sense' (Meltzer, 1978, part 3, p. 22). Klein says in the third paragraph of her most famous paper, 'Notes on Some Schizoid Mechanisms', 'In early infancy anxieties characteristic of psychosis arise which drive the ego to develop specific defence-mechanisms. In this period the fixation-points for all psychotic disorders are to be found. This has led some people to believe that I regard all infants as psychotic; but I have already dealt sufficiently with this misunderstanding on other occasions' (Klein, 1975, vol. 3, p. 1). Meltzer comments that 'Although she denied that this was tantamount to saying that babies are psychotic, it is difficult to see how this implication could be escaped' (Meltzer, 1978, part 3, p. 22).

Kleinian thinking evolved in three stages. As in the above quotation, Klein saw schizoid mechanisms and the paranoid-schizoid position as fixation points, respectively, for schizophrenia and manic-depressive psychosis. Then the paranoid-schizoid and depressive positions became developmental stages. Her terminology included 'psychotic phases, 'psychotic positions' and then 'positions' (Klein, 1975, vol. 1, pp. 275n-276n, 279). Thirdly, in the work of Bion and other post-Kleinians, these became economic principles and part of the moment-to-moment vicissitudes of everyday life. The notations 'ps' and 'd' were connected with a double-headed arrow to indicate how easily and frequently our inner states oscillate from the one to the other and back again (Meltzer, 1978, part 3, p. 22). In Bion's writings on schizophrenia an ambiguity remained as to whether or not the psychotic part of the personality is ubiquitous or only present in schizophrenics, but Meltzer concludes his exposition of Bion's schizophrenia papers by referring to the existence of these phenomena in

patients of every degree of disturbance, even 'healthy' candidates (p.28). Going further, he and colleagues have drawn on the inner world of autistic patients to illuminate the norm; Frances Tustin has essayed on autistic phenomena in neurotic patients, while Sydney Klein has described 'autistic cysts' in neurotic patients.

So much for bringing 'psychotic' into the realm of the normal and neurotic. Turning now to 'phantasy' I'll begin by pointing out that a full page of the index to Developments in Pychoanalysis (Klein et al., 1952) is devoted to this single term, and the entry fills half a page in the historical account of The Freud-Klein Controversies 1941-1945. The essays in Developments in Psychoanalysis are versions of the papers which formed the basis for that controversy. Many things were at stake, but at the heart of it, in my opinion, was the question of the primacy of the inner world, as opposed to the more interactive, adaptive framework of ideas which came to be associated with ego psychology and, in our own time, 'contemporary Freudianism'. Anna Freud rebuts the claim that she 'has an inveterate prejudice in favour of the modes of external reality ... and of conscious mental processes' (King and Steiner, 1991, p. 328), but I think it is a legitimate demarcation between Kleinian and Freudian orientations and became even more so at the hands of Hartmann, Kris, Lowenstein and the American school epitomised by the systematising work of David Rapaport.

As a part of the issue over the primacy of the inner world, I believe that people were genuinely spooked by the sheer craziness and nastiness of the inner world as described by Klein and her supporters. Indeed, there is a protest along these lines by Michael Balint, who drily comments in the discussion of Susan Isaacs' fundamentally important paper (to which I shall turn next) that 'perhaps Mrs Klein is laying undue emphasis on the role of hatred, frustration and aggression in the infant' (p. 347). Fairbairn, in contrast, seemed to feel (at least at that time) that Kleinian accounts of phantasy were so successfully descriptive of the inner world that he proposed dropping 'phantasy' in favour of 'inner reality' (p.359).

I begin with the elementary point that 'phantasy' refers to 'predominantly or entirely unconscious phantasies', as distinct from the sort of conscious fantasies or imaginings we associate with, for example, Coleridge's explorations of the imagination (Isaacs, 1952, pp. 80-81). Joan Riviere appeals to Freud's hypothesis that the psyche is always interpreting the reality of its experiences - 'or rather, misinterpreting them - in a subjective manner that increases its pleasure and preserves it from pain' (Riviere, 1952, p. 41). Freud calls this process 'hallucination; and it forms the foundation of what we mean by phantasy-life. The phantasy-life of the individual is thus the form in which the real internal and external sensations and perceptions are interpreted and represented to himself in his mind under the influence of the pleasure-pain principle'. Riviere adds that 'this primitive and elementary function of his psyche - to misinterpret his perceptions for his own satisfaction - still retains the upper hand in the minds of the great majority of even civilised adults' (p.41).

This general function is repeated in Susan Isaacs' definition. The '"mental expression" of instinct is the unconscious phantasy...There is no impulse, no instinctual urge or response which is not experienced as unconscious phantasy' (Isaacs, 1952, p. 83). The first mental processes... are to be regarded as the earliest beginnings of phantasies. In the mental development of the infant, however, phantasy soon becomes also a means of defence against anxieties, a means of inhibiting and controlling instinctual urges and an expression of reparative wishes as well... All impulses, all feelings, all modes of defence are experienced in phantasies which give them mental life

and show their direction and purpose' (ibid.).

When we turn to the content of the phantasies a problem of communication arises: 'they are apt to produce a strong impression of unreality and untruth' (Riviere, 1952, p. 20). This is because when we write or speak about them we are clothing preverbal and very primitive mental processes in the language of words in dictionaries. My way round this is to share some images and experience from my own clinical and personal experience. Phantasies are rendered as black holes, nameless dread, part objects, offal, shit, urine, a patients' dreams of wet cinders or barren desert mindscapes, pus, slime, feelings of being overwhelmed, engulfed, disintegrated, in pieces, devoured, falling through empty space, spiders, bugs, snakes. Language drawn from work with autistic patients includes dread of falling apart, falling infinitely, spilling away, exploding away, threat of total annihilation, unintegration (as distinct from the disintegration of schizophrenia), experiencing a missing person as a hole (rather than 'missing' them as not present).

When I cannot find a piece of paper or go to a room and cannot recall why, I don't just think of age and preoccupation. The fabric of reality is rent asunder, and I feel in imminent danger of dying, of disintegration, of unendurable panic. When I was a boy there was a nearby grand house, set in large grounds in a gully, with walls and a gate with a heavy chain and a wrought iron sign: 'Driverdale'. I could not go near it without intense anxiety. (It was a feat of my adolescence to drive my motor-bike at high speed through the grounds.) The same intense terror was experienced with respect to a green house we had to pass on the way to the swimming pool, and we called the woman who lived there 'the green witch'. I believed in and feared the Bogeyman and could not go to sleep unless the door of my wardrobe was shut. I was mortally afraid of the Frankenstein monster and the Mummy (of 'The Mummy's Curse'), and until I went away to university I could not go into the kitchen without first reaching round the door jamb and turning on the fluorescent light, which took an age to go on. The same was true of the back porch, while going into the back garden after dusk was simply out of the question. My childhood and adolescence were filled with terrors, imaginings, fantasies and some activities about which I would blush to tell - all rending the fabric of civilised society. Prominent among the terrors was the sheer horror of hearing the word 'Terrell', the name of the nearby state mental hospital. I cannot recall a time when this word did not conjure up an unpicturable hell, into which my depressed mother and I were in imminent danger of being tossed as a result of my transgressions, in particular, my inability to be sufficiently respectful of my father. A version of this terror still overcomes me when I am in the grip of an argument and cannot let up. Behind these conscious experiences, I now know, lay psychotic anxieties.

I offer these reports, somewhat shyly, as a way of inviting you to make similar searches of your memories to glimpse the tips of the icebergs of your own phantasies and psychotic anxieties. They are my version of what Klein calls 'a cave of dangerous monsters' (Klein, vol. 1, p. 272). My general point is that if you ask the question, 'What is a psychotic anxiety when it's at home and not in the pages of an implausible and nearly unfathomable text by Melanie Klein?', you'll be able to be less sceptical if you interrogate the fringes of your own memories and distressing experiences and, of course, your dreams. I shall offer more illustrations anon, but for the present I want to assert that psychotic anxieties are ubiquitous, underlie all thought, provide the rationale for all culture and institutions and, in particular cases, help us to make sense of especially galling ways of being. I have in mind at the moment Meltzer's idea of the claustrum, wherein dwell ultra-ambitious and survivalist conformists who live in projective identification, which he takes to mean that their dwelling place in the inner world is inside the rectum, thus confirming the colloquial description of such people as 'arseholes'. His analysis shows that this degree of use of projective identification is a defence against schizophrenic breakdown. This suggests that many of our chief executives and leaders live perpetually on the verge of madness. madness. No wonder that they must get their way. Greedy ambition is zrunning scared.

Klein's views on these matters are based on Freud and Abraham's notions of oral libido and fantasies of cannibalism (Gedo, 1986, p. 94). She refers to sadistic impulses against the mother's breast and inside her body, wanting to scoop out, devour, cut to pieces, poison and destroy by every means sadism suggests (Klein, 1975, vol. 1, p. 262). Once again, the projective and introjective mechanisms of the first months and year give rise to anxiety situations and defences against them, 'the content of which is comparable to that of the psychoses in adults' (ibid.). Orality is everywhere, for example, in the 'gnawing of conscience' (p.268). Riviere says that 'such helplessness against destructive forces within constitutes the greatest psychical danger-situation known to the human organism; and that this helplessness is the deepest source of anxiety in human beings' (Riviere, 1952, p. 43). It is the ultimate source of all neurosis. At this early stage of development, sadism is at its height and is followed by the discovery that loved objects are in a state of disintegration, in bits or in dissolution, leading to despair, remorse and anxiety, which underlie numerous anxiety situations. Klein concludes, 'Anxiety situations of this kind I have found to be at the bottom not only of depression, but of all inhibitions of work' (Klein, 1975 vol. 1, p. 270). It should be recalled that these are pre-linguistic experiences developmentally, and sub-linguistic in adults. It is a characteristic of the world view of Kleinians that the primitive is never transcended and that all experiences continue to be mediated through the mother's body. Similarly, there is a persistence of primitive phantasies of body parts and bodily functions, especially biting, eating, tearing, spitting out, urine and urinating, faeces and defecating, mucus, genitals.

Having said that, I shall offer an example of undiluted Klein. She is in the middle of an exposition of the part which the paranoid, depressive and manic positions play in normal development (Klein, 1975, vol. 1, p. 279) and offers two illustrative dreams, which I shall not quote. (I should emphasise that I am quoting a passage from the middle of an exposition and interpretation which is six pages long.) I want to convey the flavour of the primitive phantasies which I have been discussing. Here is part of the interpretation: 'The urination in the dream led on to early aggressive phantasies of the patient towards his parents, especially directed against their sexual intercourse. He had phantasied biting them and eating them up, and among other attacks, urinating on and into his father's penis, in order to skin and burn it and to make his father set his mother's inside on fire in their intercourse (the torturing with hot oil). These phantasies extended to babies inside his mother's body, which were to be killed (burnt). The kidney burnt alive stood both for his father's penis - equated with faeces - and for the babies inside his mother's body (the stove which he did not open). Castration of the father was expressed by the associations about beheading. Appropriation of the father's penis was shown by the feeling that his penis was so large and that he urinated both for himself and for his father (phantasies of

having his father's penis inside his own or joined on to his own had come out a great deal in his analysis). The patient's urinating into the bowl meant also his sexual intercourse with his mother (whereby the bowl and the mother in the dream represented her both as a real and as an internalised figure). The impotent and castrated father was made to look on at the patient's intercourse with his mother - the reverse of the situation the patient had gone through in phantasy in his childhood. The wish to humiliate his father is expressed by his feeling that he ought not to do so' (Klein, vol. 1, p. 281). And so on for another half page. A similarly daunting example could be drawn from Meltzer's account of the dream materials which can be attributed to unconscious phantasies of anal masturbation (Meltzer, 1988, esp. pp. 104, 106-7).

This is veritably hard to bear, hard to credit, hard to follow. Klein is operating - well and truly - in the most primitive parts of the inner world, where dream symbolism meets up with primitive bodily functions and body parts. Her way of describing these phantasies is easy to caricature and becomes wooden when adopted in a parrot-like fashion by inexperienced acolytes. In the subsequent history of Kleinian psychoanalysis, however, her outlook on unconscious phantasy has continued to prevail. Elizabeth Spillius reports that this is one of Klein's concepts which has been 'very little altered' by subsequent Kleinians.

However, many Kleinians (though not all, for example, Donald Meltzer) have altered their language and have become more likely to make interpretations in terms of functions rather thananatomical part objects. Edna O'Shaughnessy has suggested the notion of 'psychological part objects' as an analogy to bodily part objects. Spillius takes this up and argues 'that we relate to psychological part objects... to the functions of the part object rather than primarily to its physical structure. It is the capacities for seeing, touching, tasting, hearing, smelling, remembering, feeling, judging, and thinking, active as well as passive, that are attributed to and perceived in relation to part objects'. Spillius concludes her remarks on this change in emphasis in technique by

relating it to Klein's concept of projective identification. The functions 'are frequently understood as aspects of the self which are projected into part objects' (Spillius, 1988, vol. 1, pp. 2-5; cf. vol. 2, pp. 8-9).

Klein was untroubled by being called an 'id psychologist' (Gedo, 1986, p. 91). She unrepentantly conceived the analyst's task to be to confront the patient with the content of the unconscious. She eschewed 'corrective emotional experience', did not encourage regression and the reliving of infantile experiences, or explicit educational or moral influences, and kept 'to the psycho-analytic procedure only, which, to put it in a nutshell, consists in understanding the patient's mind and in conveying to him what goes on in it' (Klein, 1975, vol. 3, p. 129). She felt that confidently articulating interpretations of very primitive material in the face of resistance diminishes the patient's anxiety and opens the door to the unconscious. Nor did she shy away from such deep interpretations or transference interpretations from the beginning of analytic work with a patient (Klein, 1975, vol. 2, pp. 22-24; Gedo, 1986, p. 92).

Why is all this such an innovation? Riviere points out that anxiety was of great significance to Freud, but that much of his rhetoric was physiological. He did not concern himself with the psychological content of phantasies. By contrast, 'Anxiety, with the defences against it, has from the beginning been Mrs Klein's approach to psycho-analytical problems. It was from this angle that she discovered the existence and importance of aggressive elements in children's emotional life... and [it] enabled her to bring much of the known phenomena of mental disorders into line with the basic principles of analysis' (Riviere, 1952, pp. 8-9).

From that point, Kleinians went on to propose elements of a general psychology, including the claim that there is 'an unconscious phantasy behind every thought and every act' (p.16). That is, the mental expression of primitive processes 'is unconscious phantasy' (ibid.). It is not only a background hum, as it were. Isaacs claims that 'Reality thinking cannot operate without concurrent and supporting unconscious phantasies' (Isaacs, 1952, p. 109). And again: 'phantasies are the primary content of unconscious mental processes' (pp. 82, 112). 'There is no impulse, no instinctual urge or response which is not experienced as unconscious phantasy' (p. 83). 'Phantasies have both psychic and bodily effects, e.g., in conversion symptoms, bodily qualities, character and

personality, neurotoc symptoms inhibitions and sublimations' (p. 112). They even determine the minutiae of body language (p. 100). The role of unconscious phantasy extends from the first to the most abstract thought. The infant's first thought of the existence of the external world comes from sadistic attacks on the mother's body (Klein, 1975, vol. 1, p. 276; vol. 3, p. 5). 'Phantasies - becoming more elaborate and referring to a wider variety of objects and situations - continue throughout development and accompany all activities; they never stop playing a great part in mental life. The influence of unconscious phantasy on art, on scientific work, and on the activities of everyday life cannot be overrated' (Klein, 1975, vol. 3, p. 251; cf. p. 262).

These anxieties are not only ubiquitous: they interact in complicated ways. As Riviere points out, 'It is impossible to do any justice here to the complexity and variety of the anxiety-situations and the defences against them dominating the psyche during these early years. The factors involved are so numerous and the combinations and interchanges so variable. The internal objects are employed against external, and external against internal, both for satisfaction and for security; desire is employed against hate and destructiveness; omnipotence against impotence, and even impotence (dependence) against destructive omnipotence; phantasy against reality and reality against phantasy. Moreover, hate and destruction are employed as measures to avert the dangers of desire and even of love. Gradually a progressive development takes place... by means of the interplay of these and other factors, and of them with external influences, out of which the child's ego, his object-relations, his sexual development, his super-ego, his character and capacities are formed' (Riviere, 1952, pp. 59-60).

Turning to the bearings of these ideas on groups and institutions, I want to begin with two points. The first is that the move is a simple one. Bion says, 'My impression is that the group approximates too closely, in the minds of the individuals composing it, to very primitive phantasies about the contents of the mother's body. The attempt to make a rational investigation of the dynamics of the group is therefore perturbed by fears, and mechanisms for dealing with them, which are characteristic of the paranoid-schizoid position. The investigation cannot be carried out without the stimulation and activation of those levels... the elements of the emotional situation are so closely allied to phantasies of the earliest anxieties that the group is compelled, whenever the pressure of anxiety becomes too great, to take defensive action' (Bion, 1955, p. 456). The psychotic anxieties in question involve splitting and projective identification and are characteristic of the paranoid-schizoid and depressive positions, now as group processes (p.457). The move from the individual to the group does not raise new issues about explanation. He says a little further on, 'The apparent difference between group psychology and individual psychology is an illusion produced by the fact that the group brings into prominence phenomena which appear alien to an observer unaccustomed to using the group' (p. 461).

My second point is that those of us who have tried to change institutions, and have learned that there are things that'll knock you down that you didn't see coming, will be relieved to have this illumination and to be better informed about what we are up against. I remember with some chagrin the occasion when Bob Hinshelwood (who has since published the best book on groups) insisted that I train in group therapy and go to a two-week residential Leicester Conference on group relations (Miller, 1990). I was offended by his saying I'd had no experience of groups, since I'd spent my Sixties and Seventies in all sorts of collectives, co-ops and even a commune. I felt he was being dismissive of some of my most painful scar tissue, and we had a blazing row about which of us was being arrogant... Looking back from the vantage point of a number of years of conducting and being supervised on group therapy, as well as trying to assimilate the experience of a Leicester Conference (which all acknowledge takes years), I gratefully (and only residually resentfully) say that unless we understand the psychotic anxieties Bion is on about, we will never know what we are up against in human nature and in trying to change things. Bion says that falling into the forms of basic assumption functioning which he describes is instinctive, involuntary, automatic, instantaneous and inevitable (pp. 449, 458).

Elliot Jaques and Isabel Menzies Lyth are also very sober and stoical in their assessments of the barriers to change. Jaques begins his essay on 'Social Systems as a Defence against Persecutory and Depressive Anxiety' by reiterating that 'social phenomena show a striking correspondence with psychotic processes in individuals', that 'institutions are used by their individual members to reinforce individual mechanisms of defence against anxiety', and 'that the mechanisms of projective and introjective identification operate in linking individual and social behaviour'. He argues the thesis that 'the primary cohesive elements binding individuals into institutionalised human association is that of defence against psychotic anxiety' (Jaques, 1955, pp. 478-9). He points out that the projective and introjective processes he is investigating are basic to even the most complex social processes and directs us to Paula Heimann's argument that they are at the bottom of all our dealings with one another (p. 481, 481n). His conclusion is cautionary and points out the conservative - even reactionary - consequences of our psychotic anxieties and our group and institutional defences against them. He suggests that as a result of these reflections on human nature 'it may become more clear why social change is so difficult to achieve, and why many social problems are so intractable. From the point of view here elaborated, changes in social relationships and procedures call for a restructuring of relationships at the phantasy level, with a consequent demand upon individuals to accept and tolerate changes in their existing patterns of defences against psychotic anxiety. Effective social change is likely to require analysis of the common anxieties and unconscious collusions underlying the social defences determining phantasy social relationships' (p.498).

I turn, penultimately, to the investigator whose work strikes me as the most important body of writings on the social bearings of psychoanalysis, Isabel Menzies Lyth, who built her research on the shoulders of Bion and Jaques. She has investigated a number of fraught settings, for example, the fire brigade, motor-cycling, children's institutions, as well as a number of industrial ones, and most recently the tripartite group structure of the Institute of Psychoanalysis in London.

The piece of research which has deservedly made her world-famous is described in a report entitled 'The Functioning of Social Systems as a Defence against Anxiety'. It is a particularly poignant document, which addresses the question why people of good will and idealistic motives do not do what they intend, that is, why nurses find themselves, to an astonishing degree, not caring for patients and leaving the nursing service in droves. It would be repetitious to review the mechanisms she describes. They are the ones discussed above. What is so distressing is that they operate overwhelmingly in a setting which has as its very reason for existence the provision of sensitivity and care. Yet that setting is full of threats to life itself and arouses the psychotic anxieties I have outlined. She says, 'The objective situation confronting the nurse bears a striking resemblance to the phantasy situations that exist in every individual in the deepest and most primitive levels of the mind. The intensity and complexity of the nurse's anxieties are to beattributed primarily to the peculiar capacity of objective features of her work situation to stimulate afresh those early situations and their accompanying emotions' (Menzies Lyth, 1988, pp. 46-7).

The result is the evolution of socially structured defence mechanisms which take the form of routines and division of tasks which effectively preclude the nurse relating as a whole person to the patient as a whole person. 'The implicit aim of such devices, which operate both structurally and culturally, may be described as a kind of depersonalisation or elimination of individual distinctiveness in both nurse and patient. For example, nurses often talk about patients not by name, but by bed numbers or by their diseases or a diseased organ: "the liver in bed 10" or "the pneumonia in bed 15". Nurses deprecate this practice, but it persists' (pp. 51-2). She lists and discusses the reifying devices which reduce everyone involved to part-objects, including insight into why the nurse wakes you up to give you a sleeping pill (p.69). There is a whole system of overlapping ways of evading the full force of the anxieties associated with death, the ones which lie at the heart of the mechanisms which Klein described (pp. 63-64; cf. Riviere, 1952, p. 43).

Menzies Lyth also draws a cautionary conclusion: 'In general, it may be postulated that resistance to social change is likely to be greatest in institutions whose social defence systems are dominated by primitive psychic defence mechanisms, those which have been collectively described by Klein as the paranoid-schizoid defences' (Menzies Lyth, p. 79). In recent reflections on her work and that of her colleagues, she has reiterated just how refractory to change institutions are (Menzies Lyth, 1988, pp. 1-42, and personal communications).

The Leicester Conferences on group and organisational behaviour, with particular emphasis on authority and leadership, have been held at least once a year since 1957. They are heir to the traditions discussed above, especially the work of Klein, Bion, Jaques and Menzies Lyth. (Other influences are mentioned in Miller, 1990, pp. 165-69.) One among several interrelated ways of characterising the two-week residential conferences is that they are so arranged as to facilitate experiential learning about the ways in which group processes can generate psychotic anxieties and institutional defences against them (p. 171). The struggles that ensue in the members' minds between individuation and incorporation, as a result of the conference group events, is hard to credit by anyone who has not taken part in a Leicester Conference or related 'mini-Leicester' events. Similarly, descriptions of events and feelings are likely to seem odd to anyone not familiar with the sorts of events around which the conferences are structured. I believe, however, that the relevant emotional points will be sufficiently clear without a (necessarily) long description of the conference rubric.

My own experience involved feeling continually on the edge of disintegration as a result of behaviour in the various group events (ranging in size from a dozen to over 100 people) which I found appalling and from which there seemed no escape, while efforts to persuade people to behave well produced flight, sadism collusive lowering of the stakes or denial. The potential of the group for uniting around (what was called on occasion) 'cheap`reconciliation' or for cruelty, brought me to the point of leaving on several occasions, and I frequently had the experience of having to use all my resources to hold myself together against forces which I experienced as profoundly immoral, amoral or pathetically conformist. No appeal to standards of group decency was of much avail.

I ended up forming a group in my mind which consisted of all the people I admired in history and in my lifetime, e.g., Socrates, Lincoln, Gandhi, King, Bonhoeffer, Marcuse, Mandela, who had stood up to intolerable social forces without quitting the field or having their spirits broken. I dubbed this 'The ps - d Solidarity Group' and, armed with their mandate, managed to talk my way into a meeting with the staff, for the purpose of mounting a critique of the rubric of the exercise. I felt contained by the inner solidarity provided by my imagined group, while I was, in truth, actually on my own in the phenomenal context of the conference events. I had blown out of a group in considerable distress, because it had utterly failed to live up to its self-designation of advocating and practising decency and civility among its members and urging such standards on the larger group of conference members. Just as I was on the point of sitting down to confront the staff group in the name of my ionner world group (vainly hoping they would show some interest in its name, membership and values), a representative of the group I had left appeared and bestowed 'plenipotentiary powers' (one of the designated forms of delegation of authority) on me, freeing me from the dreaded status of 'singleton'. A singleton is a person with no role status in he large group (see Miller, 1990, p. 179 and Turquet, 1975, where the plight of the singleton is insightfully and poignantly described). I had felt unutterably alone, almost totally in the grip of paranoid persecutions, holding on for dear life to my hallucinated historical group. The bestowal of my conference group's trust reincorporated me into the social whole on terms I could accept.

My confrontation with the staff group, acting in this exercise as 'Management, was predictably without issue, but I went away feeling that I had spoken my piece without suffering the humiliation that many others had experienced. I had offered my analysis of the situation and their role in it, one dimension of which was that they would - as a part of the exercise's point - continue to behave as that were doing, i.e., act as an immovable object on to which the groups would project their phantasies about authority and (hopefully) begin to take responsibility for themselves. I felt that I had done that and negotiated my own rite of passage - just. Having gone some way toward resolving my own temporary insanity (though not my ,omnipotence) I was only able to bask pleasantly in group membership for a few minutes before members of another group, who had sought refuge in being regressed and silly (they called themselves 'The Potty Training Group'), stormed into the room where the staff/Management group were holding court. The person whom I had considered to be the mildest member of that group physically attacked a German member of staff with shouts of 'fascist' and other violent epithets. He was aided and cheered on by other members of his group, until one, a woman I felt sure was a Jew but I now recollect was probably not but was a German, broke down sobbing and shouted for all this to stop.

The descent from work or task-oriented groups to groups in the thrall of psychotic basic assumptions is, as Bion pointed out, spontaneous and inevitable, even in a situation which all concerned know to be temporary and 'artificial'. I continue to find this profoundly sobering. I also continue to ruminate it and am far from having digested the experience, though I have found it increasingly helpful in my work and related activities.

After canvassing the literature on psychotic anxieties and reflecting on it and my own personal and clinical experience, I am left with a daunting sense of the power of the inner world and an awesome awareness of how very deep, primitive, abiding and alarming its nether regions are. The anxieties I have attempted to outline (and, to a degree, evoke), exist throughout human nature - in all of life from the cradle (some say earlier) to the grave, in all of play and culture, and act as a brake on benignity and social change which it is hard to imagine releasing, even notch by notch.

The history of psychoanalysis has left us with a small number of ideas about the veneer of civilisation. Freud said it was thin and under threat. One rreading of those who still speak in his name and quote his slogan: 'Where id was, there ego shall be. It is a work of culture - not unlike the draining of the Zuider Zee' (S.E. 22, p. 80), takes this to mean that the result can be dry, flowering land, i.e., that there can be a 'conflict-free sphere of the ego'. A second, rather disparate, group proffer a continuum extending from Reich's advocacy of desublimation and a promise of a return to Eden, to the Winnicottian position that eschews Klein's undoubted stress on the power of thantic, destructive forces, and sees rather more decency and hope in liberal society.

I dare say that Klein said rather less about the other side of human nature - the constructive or erotic impulses - because she found herself in mutually critical dialogue with colleagues who she felt overemphasised those aspects. Finding the twig bent, as she thought, too far one way, she bent it the other way, perhaps to leave it straight for those that followed. A third group are orthodox Kleinians and point out that the veneer of civilisation is very thin indeed and that the maelstrom beneath is perpetually and rather pathetically defended against. It can be argued that this provides the basis for an optimism of the will, coupled with a pessimism of the intellect and a belief that it is essential to know what is bubbling away underneath the surface if we are to have any hope of cooling some of the crust.

I also believe that this position is consistent with a careful reading of Freud's Civilisation and Its Discontents, written half way through his sixteen-year struggle with cancer. He says there that the history of civilisation is 'the struggle between Eros and Death, between the instinct of life and the instinct of destruction, as it works itself out in the human species. This struggle is what all life essentially consists of... And it is this battle of the giants that our nurse-maids try to appease with their lullaby about Heaven' (S.E. 21, p. 122).

This is the revised text of a talk given to THERIP (The Higher Education Network for Teaching and Research in Psychoanalysis) in November 1991.

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