Introduction

Abstract:

The frame represents reality to the patient in psychotherapy. The boundaries and ethical ground rules of the psychoanalytic frame have the potential to provide a contained space for thinking together. A patient will have transference not only to the therapist but also to the frame itself. This transference may express a hatred of reality. The psychotic part of the patient will inevitably attempt to subvert or attack the frame. Pressures on, and disruptions of the frame can give the therapist an objective assay of the psychotic process. Attacks on the frame occur in all analyses but can also be seen in many public acts of terrorism and violence against institutional frames, resulting in death or injury. This paper offers clinical vignettes and instances of public events which can be understood as attacks on a frame. 

Transference to the Frame in Violence

In this paper I will apply concepts of the frame to three social situations in which I was a participant observer and about which I continue to dream. The first is an individual clinical analysis with a frame in danger. The second is my experience in being part of a dangerous crowd. The third is about a challenge to my professional group posed by threats to asylum seekers.

The “Frame” is a term used for the ground rules and boundaries of the therapeutic relationship. Winnicott (1945) calls that “the setting” which is a summation of all the details of management including the economic basis of the professorial relationship and its ethics. In analytic work the purpose of the frame is to maintain the conditions for thinking together. Much is written about modifications of the frame in special circumstances and the consequences of inconsistent framework. Not so much is written about the meaning of a well maintained frame; the work of the Argentinian analyst José Bleger (1966) is exceptional in this regard.

The frame represents reality to the patient and provides an operational definition of it. It is inevitable that the psychotic part of the patient, or indeed of the analyst, cannot bear too much reality; then there is pressure on the frame. Such pressures may appear slight, or coincidental – a session may run a few minutes over time; appointments cancelled for persuasive reasons; small muddles over payment. Pressure to connect outside session times now is increasingly expressed electronically – SMS and email, the case for Skype analysis. The pervasive use of such disembodied connections is a major social and cultural change. Psychotic processes readily use these to effect intrusions at all hours and places, to subvert and preclude non-verbal emotional contact in face-to-face meetings, to corrupt the undivided attention of the analyst.

Bleger makes it clear how the patient has transference to the frame, quite distinct from their conscious awareness of the professional setting, and also quite distinct from the transference to the person of the analyst. The analyst also has their own transference to the setting, to the institution of constants that is the frame.

The frame is not a process and does not have a countertransference but it is fantasized to have one as in the thought “I think this room (or “that door”) hates me.”

I will describe the violence done to the frame by a patient I saw for many years twice or three times weekly. I shall call him “Mr N”. He was thirty when I first saw him. He had sought help for a depression marked by a ubiquitous feeling that he did not belong.

From the outset, the frame was under pressure. N would come a few minutes early or late, made cancellations at short notice, delays in payment of fees. In some sessions he would have episodes of coughing, for which he apologised. In others he had to leave to use the toilet. It took me many months to put observations together and note that in every session, without one exception, the frame was subverted.

The repertoire of subversive actions increased to include SMS messages sent between sessions, bringing photographs or certificates to show me, asking for the chair to be modified somehow because he had a sore back, distraction by birds outside the window, requests for a glass of water, making notes, and many others.

We observed a common denominator in all these frame-breakers – N would become suddenly preoccupied, intensely so, and would forget himself. He would become merged with some external agency and this was addictive. After the frame break, there seemed to be a hush – an enhanced sense of stillness.

N had a horror of all frames but seemed drawn to impinging on their boundaries. He recalled his father’s rages, of being pinned down when a small boy and his father head-butting him. He and his three brothers were made to queue up for punishment.

N had an automatic aversion to some frame every day. He had altercations with parking police, rubbish collectors, people at bus stops. His attendance at work was erratic. He had muddled relationships – would ask a girl out, she would expect it to be a date for the two of them, but N would bring her into a group of acquaintances and leave her there. Or the converse – an invitation to a group function would turn out to be a date with N on his own.

N’s antisocial behaviour within and without sessions was actually intensely social.  This was evident in his membership of big groups. He was a fervent football fan and was keen to lose himself in the collective excitement of club supporters, chanting and rocking together in unison, attacks on the other teams’ supporters, a circumscribed fanaticism with homicidal threats to the referee, scrimmages on the street. These mob scenes often merged with collective rage against some minority group that supposedly cheated the group out of its inheritance. N had a bee in his bonnet about refugees and some ethnic groups. He was politically attracted to populist rationales for riddance and violence.

Frame breaking became clearer as time went on with instances we sometimes understood as arising from his anger in having to make separations, coming and going from the session. I attempted to observe the activities without being a nagging critic.

But the particular meaning of the frame to N was obscure. It was hinted at by the hushed atmosphere. This was the feel of the institution he was in.

As Bleger demonstrates: “A relationship which lasts years, in which a set of norms and attitudes if kept up is nothing less than the true definition of an institution.”

Each institution is a portion of the individuals’ personality and identity is always institutional in the sense that one part always shapes itself by belonging to a group.

For N, adherence to everyday frames was unbearable – he was addicted to “losing himself” and in that state of mind was at once helpless and dangerous to any other who had a distinct identity.

N did not enjoy much personal life. Instead he was drawn toward large groups, actual or virtual on the internet, especially when they were fervent in damning some minority who was the enemy. He was inspired by this, forgetting himself in the merger with the group. Listening to the fervour I was reminded of the stirring tune of the Marseillaise, but remembered the gruesome and homicidal climax to the first verse: the blood of the defeated enemy would flow into the ploughed soil. In this call to solidarity the distinct individual was the odd one out, the separate self was a menace to the group and had to be annihilated. I said it sounded as if he wanted to go to war. He said “No, I need peace.” N could find a sense of peace briefly when in the session, after we had gotten through the distraction and fuss of his frame-breaking. In that hush he would daydream about holidays with his grandparents in the city where he felt he could belong while being anonymous, a contrast to the small town where his father was respected or perhaps feared, his mother’s depression common knowledge. He felt his deceased grandparents as ghosts who gave him peace.

Bleger describes a patient like N for whom the fulfilment of the frame was to provide an omnipotent magic world, gratify his childish dependence. His most profound longing was that analysis would strengthen his omnipotence and would give him eternal life in his “ghost world”. “To live” in the past was the purpose of his existence. It was why he came to his sessions. The frame of the analysis had been hallucinated by N as his grandparents’ home. Nevertheless the frame of the analysis was needed to analyse the frame.

For N, other institutional frames were provided by the group at his work, by the sports club, and by his rowdy mates. They nullified N as a distinct individual and aroused in him a wish to do something “that would be unforgettable”, his personal signature, he called it.

N remarked how he had once done graffiti. I said I wonder if he ever thought of making graffiti in this room, of being unforgettable no matter what. He said “Not now, this is about listening. No one listens much, but here is different.”

I will now try to further apply Bion’s theory of thinking to the function of frames in the wider world. I am in debt to the thought of the Israeli psychotherapist Hanna Biran (2015) who applied the concept of alpha process and beta elements to public institutions. Moving outside the scope of individual clinical analysis needs to be done with circumspection. Contemporaries such as Ferro (2015) specifically warn against claiming expertise outside the clinical field. Yet psychoanalysis is a branch of psychology and may be applied to the way the mind works in groups and social institutions as well as to a single patient on a couch.

 Bion’s theory of groups is an instance of how the fundamental analytic method of observation can distinguish a group dominated by psychotic processes from a work group that works on the reality principle.

Bion’s concept of alpha function denotes the process that transfers what is absorbed perceptually by the baby into a precursor of words and thought.

This infantile prototype provides the basic clinical method in psychoanalysis. The analyst is receptive to whatever atmosphere is engendered by the physical presence of the patient in the frame. Alpha process, dream work, allows that sensation to form imagery, then that imagery may be understood as emotional communication, as a potential metaphor that can be verbalized.

This is the basic method that elucidated the meaning of the frame to N, starting with the feeling of a sudden atmosheric“hush”.

Bion noted that our health depends on belonging to groups, that they define each one of us. We need to be in a group and will perforce construct one in social reality or fantasy when a common work project is not strong enough to define a group identity. The basic assumption will address the question: “Why are we a group?” One answer is “Because we have a common leader”. Another is “Because we have a common enemy”, or “We are here to form couples”, or “We are bound by a code of silence”.

N was able to lose himself in a group united by a common leader: the sports team, and a common enemy: the opposition team.

To apply the concept of alpha process to large groups assists us in understanding frame breaking in the wider world.

There are whole enclaves inside society that are operated by beta elements.

When something sensed is not transformed by alpha process into an image capable of being given a name, the something sensed remains a thing in itself and will persist: as an action, a psychotic symptom, as a physical thing. This is the beta element. It will recur as an event, not a memory.Beta elements are stored within the collective memory in this unprocessed form. They are not modified by experience. They appear as concrete as acts, the use of words as physical things. Then the frame is broken by those who “lose themselves”.

When the distinct individual becomes alienated or humiliated, the group may act without reflection on a basic psychotic assumption.

These actions: to annihilate an enemy or to merge with an omnipotent object- are psychotic solutions to all uncertainties, to irretrievable loss and loss of faith. Unprocessed beta elements evoke nameless dread. The basic assumption group cannot process beta elements; their presence stimulates the group to obliterate frames and with them, the ability to think.

By contrast, processes which are typified by alpha process are experienced in dialogue, negotiation, peace talks; these have a frame and are ceremonies.

 Bleger discovered that for his patient the frame served a very different purpose from that believed by the analyst who naively thought it was the professional setting for analytic work. The patient knew the space very differently – it was the ghost world he came to be in, not a place for thinking but for being with the living dead.

For N, the frame held the atmosphere of a room in his grandparents’ house. They had died when N was 7. It was they who had given him sanctuary from his violent father, brawling brothers and his still-faced depressed mother. He had never felt that his grandparents were gone. He had never said goodbye. A session would place him with grandparents in their room but for this reunion to occur he found that the actual world and his social self-had to be dispelled by frame breaking actions of which he said: “I’ve got to shake something off before I can be in here properly.” He pushed the actual analyst away too. I was an item of antique furniture. The hush, an uncanny sense of sudden stillness, had been a beta element. To notice it and to cause it to evoke imagery was to allow an analysis of the frame.

I reflected that he was getting into his grandparents’ tomb to be cared for by them, for refuge in a haunted house. He put his head in his hands and seemed sad as he remembered his grandparents living and said “I’ve really lost them now, haven’t I?” The way through for N was through grief. There were no ghosts but there could be memory and dreaming.

N had dealt with boundaries and bereavement by a delusional transference to the frame, experienced as the precinct of a haunted tomb.

 Analytic understanding may be applied to danger points on geographic borders in the world. To deal with borders, limits and boundaries using alpha function is to negotiate, to understand consensually and make a convention.

Last month I visited the Indian – Pakistani border. I was in a crowd of hundreds – a participant as well as a tourist observing. We were spectators of a ceremony held each evening at the border, a line which had been agreed upon years ago by both sides. At sunset at the fence the Indian soldiers took down their flag, played their bugle, saluted; in a mirror image the Pakistani soldiers did the same on their side. Spectators on both sides of the fence applauded. It was like a dance, in its way playful, expressing both separation and togetherness, in a customary form agreed by both sides despite wars, terrorism and the tragic history of partition. The border was a marker of the deaths of many, but the ceremony expressed no grief, and in this regard had psychotic undercurrents.

This was a frame, an institution operated by alpha function. However Beta elements were close, the crowd began chanting. As it gained momentum I was standing up shouting “Zindabad”, manic with the best of them. It started to feel like N’s footie hooligans but was effectively regulated by security staff on that day.

But later that month ceremonies were disrupted by the crowds throwing rocks at each other - the physical form of beta elements.

 The newspapers reported a sequence of borderline events that paralleled my meetings with Mr N. Pakistani fighters crossed the border and attacked an Indian military position, killing soldiers. The Indian government made statements to the press saying that this incursion must not go unpunished. The press then reported a minister of the Pakistani government as saying that Pakistan had nuclear warheads for a reason and could use them to “annihilate India”. The Indian government soon released details of an incursion into Pakistan by Special Forces who attacked several bases used by Pakistani fighters.

The cycle of payback seemed to be escalating and inescapable.

I was reminded of the impasse in N’s analysis: to draw attention to his boundary violations felt like retaliation and aroused more boundary violations and an anger that grated on the nerves. Often I proceeded like the three wise monkeys, as if the frame breaks actually had not occurred.

This is what happened in the subcontinent: on this occasion the Pakistani government would not acknowledge that they had been invaded by Indian Special Forces. There was no retaliation called for because nothing had happened. What a relief it was.

 But this was a psychotic solution which precluded thought and dialogue. A casualty was the public border ceremony. That frame could not contain beta elements; that group process for the time being ended. The beta elements remained unprocessed – stashed away in the collective memory. They may reappear as missiles, rocks or nuclear warheads.

I will relate another instance of the frame being compromised and barely able to contain and transform beta elements: the idea of a border is paradigmatic in clinical work with individuals and in geographical borders where it literally can become concrete.

Among other psychiatrists in the public sector I have been asked to admit to hospital mentally ill patients from overseas detention centres for asylum seekers who have attempted to get to Australia by boat. There was a mother with a baby several months old. The mother had post-partum depression. Together with paediatricians we accepted the admission, cared for the patient and her baby, but then found we could not in all conscience discharge the patient in the knowledge that they were to be sent back to an abusive situation which we discovered had traumatized them. Our refusal to discharge triggered off a sequence of Kafkaesque bureaucratic discussions with”Borderforce” and others, at times menacing.

In Bion’s terms alpha process struggled to transform beta elements into matters for negotiation. In the end these patients were not send back to overseas detention. Public discussion was legally prohibited. This occurrence of negotiations was never publicised, not acknowledged (Refugees? What refugees?).However, the prospect of some mindless act of riddance has for the time being been averted.

When a group cannot contain and process beta elements, words become things. I saw a placard at a demonstration: “Your dead burn in hell. Ours are in paradise”. Here “hell” and “paradise” are beta elements – emissions of the psychotic process in a basic assumption group.  This placard was about bereavement, but the grief was repudiated. The narcissism is blatant. It seems to deny sadness and loss, to replace history with propaganda. This is a reversal of alpha process. Narcissism seeks to become unforgettable by an attack on the frame, even by atrocity.

Without a competent frame:

“Things fall apart; the centre cannot hold;

Mere anarchy is loosed upon the world,

The blood-dimmed tide is loosed, and everywhere

The ceremony of innocence is drowned;

The best lack all conviction, while the worst

Are full of passionate intensity.”

Yeats wrote those lines in 1919, in the aftermath of the First World War. Frames had been destroyed by further wars and revolution throughout Europe and Asia. The split between our shared unconscious life as dreamers and the harsh pragmatics of survival had become extreme.

 This split causes violence.  The ceremony of innocence is dreaming.

 

In public life, care of the living as makers of their own dreams is a contrast to valuing life only as a human sacrifice. To name the agenda calling for riddance is a start. We can choose not to be bound by a code of silence. The ceremonies of innocence need care in the life of the groups we work and play in.

# October2016

References

References:

Hanna Biran (2015) The Courage of Simplicity: Essential Ideas in the Work of W.R. Bion. Karnac Books.

José Bleger (1967) Psychoanalysis of the Psychiatric Frame. The International Journal of Psycho-analysis 48-511.

W.R. Bion (1961) Experiences in Groups. Routlege.

W.R. Bion (1963) Elements of Psychoanalysis. London: Heinemann / reprinted London: Karnac 1984.

A. Ferro(2015) Torments of the soul. New Library of Psychoanalysis.

 D W Winnicott(1956) Clinical Varieties of transference. Collected Papers. London: Tavistock