29 June 2017

Ricardo Lombardi, FORMLESS INFINITY, Clinical explorations of Matte Blanco and Bion

Von Antonia Grimalt

The New Library of Psychoanalysis. 265 pg. London Routledge. 2016

Ricardo Lombardi, M.D., is Training and Supervising Analyst of the Italian Psychoanalytic Society (SPI) and the author of many papers on the body-mind relation, time, psychosis and other severe mental disturbances.

Formless Infinity is a collection of papers from 2003 to 2014, published in different psychoanalytic Journals. Clinical experiences have the place of honour in it. In his exploration of primitive mental states, Lombardi wonders about a series of epistemological questions which led him to reflect on infinity. So, he deepens in Matte Blanco’s concept of unrepressed unconscious, where is a shift from the contents of the repressed to the form of mental functioning, as a mental structure. The approaches of Bion and Matte Blanco find a common focus of interest in the formal structures that organize thought. Central to the analyst interest is the conflict between the a-spatial and a-temporal nature of the unconscious (and the a-dimensional abyss from which it derives) and the organizing concepts of space and time. He finds enriching bridges with Bion’s ideas which explicate and clarify concepts of Matte Blanco, sometimes difficult to understand. The interest for the body-matrix in the constructions of subjectivity is inherent in Bion’s epistemological approach who focused his research in the birth of emotions and thinking and tried to unlink the body -mind relationship from the Dualistic-Cartesian attitude which subtends it.

In clinical psychoanalytic work, one often encounters psychical material that is devoid of form or shape. This kind of material is often manifest as concrete somatic sensations on the border of the body and mind. At the same time, it is a primitive body-related self-experience that functions as a background, an essential requirement for more developed, differentiated self-experiences. Bi-logic is a theoretical method by which one can outline these early, partially formless processes and states of mind. This book includes an overview of the main hypotheses of Matte Blanco's bi-logical vertex, which focuses on the extreme symmetrisation of mental phenomena that emanate from the body. Clinical vignettes illustrate ways in which analysis can gradually bring forth such form from the previously formless, dissociated traumatic material into the range of the conscious mind. In this way, the capacity for thinking and reflection increases and the early elements of self-experience are enlivened.

In this extraordinary book, Ricardo Lombardi’s interest in the importance of the working through of bodily sensations to develop the subjective dimension, drives us hand in hand with Bion and Matte Blanco to some very enticing explorations of the deep unconscious, and primitive mental states. This is a gem of a book, rich in clinical material, illustrating the very archaic levels of functioning where body and mind are not yet differentiated. He calls for attention to the importance of bodily experience and the need for it to be addressed within the psychoanalytic encounter.

Matte Blanco considers that sensation-feeling is the link that connects emotion with thinking, unrepressed unconscious/consciousness, body/ mind. In the first chapter Lombardi works out some of the implications of this author’s main hypothesis in line with the impressions born from his clinical experience. The second chapter, pays attention to discover the interaction between Matte Blanco’s thoughts and that of Wilfred Bion. So, Symmetric frenzy and Catastrophic change explores the connections between Matte Blanco's notion of symmetric frenzy, i.e. the turbulence characteristic of the deepest levels of mental functioning, and Bion's concept of catastrophic change. For Bion, mental links are retrieved from the formless darkness of infinity. With catastrophic change, emotional violence and the confining nature of representation come into conflict, leaving the subject prey to an explosiveness that paralyses mental resources. Matte Blanco identifies indivisibility as the abyss in which all differentiation ceases; he bases his model on the conflict between symmetry and asymmetry. Infinity, he maintains, is where the first forms of mentalization develop. Both Bion and Matte Blanco emphasize the contrast between the immensity of mental space and the spatial-temporal order introduced by the activation of thinking functions. The author presents clinical material from the analysis of a psychotic patient, stressing the need to encourage both working through the defect of thinking (Bion) and ‘unfolding’ manifestations of symmetry (Matte Blanco) to foster the activation of the resources of thought, meanwhile postponing transference interpretation. He concludes with two later sessions, in which recognition of the analyst in the transference allows the analysand to develop his capacity for containment and asymmetric differentiation.

  The body as the starting point of experience and the original source of psychic life, is considered in the third chapter: the unfolding of the unconscious body. During analysis “the camel” must “go through the eye of the needle,” in the sense that the body must become the specific object of mental working through, although no link between the corporeal and the mental can be taken for granted. The body-mind relationship is explored in the light of Matte Blanco's hypothesis that symmetric and asymmetric relationships are always present in the mind in differing proportions, and that the realm of symmetry is the deep unconscious. In primitive mental states the body may be completely unperceived: just as H. G. Wells's invisible man could be seen only when dressed, so the body appears on the mind's horizon only when asymmetric thought is directed at it. Three clinical vignettes show the contribution of the body-mind relationship to the overcoming of serious impasses in analysis.

The body as a compass for psychoanalytic working through, is raised in the Body emerging from the Formless infinity. The senso-perceptive experience of the body corresponds to the beginning of an early mental autonomous functioning.  Being unable to achieve a relationship with his or her body, traps the patient in an unthinkable anxiety that can drive him or her to madness and death. The sensory perceptions arising from the body are the first expressions of self-consciousness and mental existence in patients who are overwhelmed by a dimensionless abyss of nothingness, and can be the motor for activation of learning from experience. This perspective can help the analyst in catalysing the patient's integration with his deepest levels of mental functioning. Lombardi presents some highlights of a psychotic patient, for whom finding the body meant finding “the land that never was,” a “land” that could begin to exist in an analytic processing which involved a contact with levels that precede those of the projection and the introjection, in order to live a place for states characterized by what Tustin defines as flowing-over-at-oneness. Through the “hardness” of the transformation of a piece of ice at the beginning of the session, to the “softness” of an internal warmth, the patient’s experience comes close to internal levels that can be likened to autistic levels in which the integration and differentiation between opposing sensorial orbits (hard/soft, cold/hot, etc.) play a central, driving role.  

Space will not permit me to deepen in the interesting conceptualization of this 4th chapter, however I wish to single out just some idea: Lombardi, (in line with Tustin, Ferrari and Matte Blanco) highlights the inadequacy of a point of view that limits itself to projective-introjective and transference-countertransference dynamics, to emphasize the ‘symmetrizing impact’ that derivesfrom an approach to the deep unconscious. In fact, that level is characterized by a rise in the proportions of symmetry with respect to the asymmetrical and differentiating resources of thinking. Approaching the experience of indivisibility implies abandoning the external-internal antithesis, coming closer to non-tridimensional aspects of being. Symmetrical transference is not a duplicate of past relationships but an essentially generative process from which emerges a different way of looking at the role of transference interpretations which -when used at these levels- can be felt as counterproductive. The central focus is the use of the analytic experience as an instrument to give substance and visibility to the subject’s internal experience.

Body, adolescence and psychosis explores aspects of the clinical development of a male 17-year-old patient, in high frequency analysis, during an acute psychotic crisis. In the context of arrested adolescent development, a psychotic crisis can present an opportunity to set the process of maturation in motion again. Adolescent psychosis is examined in the light of Bion's theories of catastrophic change—in which the container/contained relationship becomes explosive and overwhelming — as well as of Ferrari's and Matte Blanco's hypotheses on the mind—body relationship. The role of denial of the body and its changes in the genesis of adolescent psychotic conflict, show how the analytic relationship can offer crucial reverie conditions for promoting recognition of the body, bodily sensations and affects, as a prerequisite for the activation of an autonomous mental system. This clinical approach entails recognizing the urgent need to make room for the elaboration of intrasubjective relationships and for mind—body dialogue, transference interpretations, being postponed. Clinical material and fragments of analytic dialogue illustrate the authors' hypotheses and demonstrate the patient's development towards recognition of his body and an incipient capacity to think associated with the perception of the limits set by time and reality.

Temporality and its related conflicts is considered in Time and primitive mental states. The so-called 'difficult patients' are particularly intolerant of the temporal limits of analytic sessions and often attempt to undermine the analytic setting. Some theoretical hypothesises about time and the mind’s levels of depths (in a series of clinical vignettes from the analysis of adolescent, borderline and psychotic patients) shows several ways in which the analysand perception of and relation to time surfaces and is worked through in the course of analysis. Analysing the relationship with time and the conflict between denial and acceptance of temporality proves to be a significant catalyst in the development of cases that had tenaciously impeded progress. It thus becomes possible to bring about important changes in the ways such patients experience affects in the analytic relationship and in object-relations, not by acting directly upon these relationships but by working instead on the formal parameters that organise the mind - and primarily on its spatial-temporal organisation.

The analyst’s musical reverie, on the 7th chapter, allows to give shape to the emotional movements of growing tension in the link. Time is an important source of containment vis-à-vis the pressure of affects and the no-dimensional immensity of mental space experienced by difficult patients. A more articulated spatiotemporal integration can be facilitated by the analyst's musical “reverie” during intense emotional exchanges in analytic sessions. This reverie can be visual, olfactory, kinaesthetic, etc., no less than auditory or musical. Music is indeed connected with both the concrete world of bodily sensations and the symbolic expressions of culture, and may be an important transitional phenomenon in analytic communication on both unconscious and conscious levels. Two clinical cases illustrate how the patient's awareness of the passage of time, associated with the analyst's internal musical experiences, made it possible in one case to reduce intense panic attacks and, in the other, to overcome the patient's rigid obsessive defences, giving him access to fluid and unforeseen emotions. In these two instances of working through, the perception of time helped establish confidence in the creative contribution of the “unheard melodies” (Keats) of affects to the functioning of thought. Lombardi stresses the importance of the reality test provided by the perception of time as an instrument of containment vis-à-vis the infinitizing pressure of affects.  He suggests that the development of this perception in the difficult patient can be facilitated by the musical associations of the analyst’s reverie in certain moments of the working through.

On death-life symmetrisation, chapter, Lombardi presents a third analysis of patient with an extraordinary capacity to convey violent hatred, very hard to contain, through a deadly silence. The comments aimed at indicating his hatred of the analyst, seemed to meet with rigidity or total rejection. His reaction seemed more constructive when speaking of hatred in general, his propensity to ignoring it and the ways it manifested itself. This is consistent with Bion’s idea of a need to focus on a working through at the level of the analysand relationship to himself, or on the axis of body-mind relationship. 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 he was called upon to exercise a complex responsiveness, attuned in each instance to the patient's current needs which meant facing the analyst's own violent participation in his hatred, which he felt quite tangibly in the form of strong physical sensations, culminating in intense nausea. Then, 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 perceptively recognized on a realistic level, but was instead replaced with acting out death by keeping himself mentally dead and by suicidal urges. Finally, he concludes that, in this case, the reconstruction of the past central to the two previous analyses, had fostered an atemporal crystallization and sterile repetition of emotional discharge. In his new experience, the patient was able to enter temporal reality and, by experiencing the present, to face himself and the other realistically.

In Death, Time and psychosis, working through the awareness of death and the consciousness of time, plays a decisive role in the analytic process and in the mental growth of psychotic analysands, as well as in the integration of the psychotic areas in healthier patients. An interesting clinical material from a psychotic woman who suffered several acute relapses, during which the analytic work was not interrupted. Her fourth psychotic episode in the course of analysis, which involved a delusion about grey men and the theft of time, is explored in particular depth. This phase fostered the patient's recognition of the value of time, together with the acquisition of her own centre of psychosensory integration, as the basis of an ability to learn from experience. The mental integration of the body and the working through of death anxieties proved decisive in overcoming the patient's critical body-mind dissociation, which had paralyzed his mental functioning and analytic evolution.

The clinical psychoanalytical evidence in the cases presented, reveal the limits of regarding the analytic process exclusively from the symbolic interpretive angle. Where a patient’s subjectivity does not yet have distinct bodily roots and the ego resources are weak, verbal interpretation has no transformative power. Bion placed the basic levels of his grid in the sphere of pre-symbolic transformative processes, emphasizing the role of the analytic relationship in creating internal container / contained configurations capable of generating experience and thought.  Ferrari’s concept of development, starting with his or her concrete original body is decisive to consider the usefulness of fostering the development of the subject’s primitive sensations towards progressively more articulate forms of emotions and feelings, which can generate the capacity for abstraction and thought.

The body-mind relationship that is formed in the forge of the analytic relationship leads to a new manner of experiencing, which begins at the bodily roots of subjectivity, and proceeds towards containment and thought. As the analytic experience develops, the working through increasingly highlights the otherness of the analyst, together with the limits this implies. The subject takes with him, beyond his analysis, a practiced capacity to effect exchanges along with body-mind axis, constructing his relationship with others in continuity with the bodily sensitivity that characterizes his being himself.

Focusing on the continuity between body, action, feelings, and thought helps us to bear in mind the extremely important concreteness of the bodily feelings connected with living, or rather the raw feelings that precede the more organized form of defined emotions. In a context where the actual human body comes to the foreground, confronting feeling is a constant challenge to the subject’s containment resources.

I think the lector will find deep authenticity in this book and will identify many clinical situations in his /her experience with patients, not only psychotics, if he or she is able to register in his/her own body the vicissitudes of inchoated emotions in the very archaic levels of functioning. Excellent case descriptions permit us to form our own ideas about the importance of containment and to follow step by step the processing of emotions in the verge of this primary containment which many times priorized the patient’s link with his body before the transferencial intersubjective dimension. In his vivid and compelling clinical examples, Lombardi shows a model of personal flexibility, receptivity to the patient’s contributions, and willingness to undertake reciprocal internal change ─ sometimes requiring real courage in the analytic part. He drawn insights that can enliven every psychoanalytic treatment. Moreover, dealing with explosive feelings trains the analyst to make the most of the precious contribution offered by profound emotions even in the analysis of neurotic patients. Lombardi’s deep sensitivity to her patients’ often-unbearable projections, and his enormous capacity to find the words which really capture the uncertainties, depth and complexity of the archaic enactments in the transference are of an enormous value.  This is essential to foster the development of a psychic space in which experiences ‘in the shadow’ can come to the fore and be given shape first pictorially, kinaesthetically, musically and later ideationally. This requires staying with and fostering the ambiguity of the different times and spaces without collapsing them into the clear, logical and explanatory. This constitutes really binocular vision not double vision’.

Antònia Grimalt agestelrich@hotmail.com