Mental Pain, Construction and Interpretation
(Engl. orig. article; May 2005; Sep. 2005; EJCP Vol. 8)
Key Words: Transference, Tolerance, Threshold, Counter-transference, Sigmund Freud, Melanie Klein, Wilfred Bion, Photography, Psychological Suffering.
The concept of mental pain is revisited here by recalling the key contributions of Freud, Klein and Bion, followed by presentation of a precise definition that separates mental pain from other types of psychological suffering. Key to the understanding of mental pain in psychoanalysis is Bion’s model of the container-contained, and his theoretical proposal on the use by the mind of alpha function to digest beta elements. Central issues of mental pain are the manner in which this non-symbolized experience is transformed into other types of psychological suffering, and how this transformation process can be achieved with the help of the psychoanalyst. The very nature of mental pain, as defined herein, requires that it be addressed firstly by construction and only afterwards by interpretation. Classical photography is employed by the author as a metaphor to illuminate the dynamics of mental pain. Finally, clinical suggestions are offered to fellow analysts on how to face mental pain of the patient during therapy, emphasising the “negative inadequate capabilities” of the analysts and their work of construction rather than of interpretation.
The primary goal of the present work is to revisit the concept of mental pain because in my opinion it is a central element in psychoanalysis. Mental pain is often the reason why the patient seeks the help of psychoanalysis, it is around mental pain that the mental pathos is organized, and mental pain will be present during most of the course of the therapy. Later in this paper, I will submit a personal definition to the readership.
Mental pain has been commonly accepted as referring to a poorly or even non-symbolised experience, in contrast with other types of psychological suffering that may be defined as tolerable experiences that involve symbolization. Because of the nature of mental pain, it requires the mutual work of the analyst and the patient in order to achieve construction, as this concept was defined by Freud (1937) in his manuscript entitled precisely “On Construction“ that encompasses the work of the analyst in reconstructing the patient past, a past that is now recalled with narrative truth rather than with historical truth.
The concepts of mental pain and of psychological suffering deserve conceptual clarification. With this goal in mind, it is pertinent to follow the avenue proposed by Freud (1926), when in his “Addendum C”, he asked: “in which circumstances does the separation from the object lead to anxiety, to mourning, and in which circumstances does it lead to pain?” (p. 99). Earlier on, Freud (1911a) had addressed in his text “Formulations on two principles of mental functioning” the intercourse between frustration, modification and symbolisation, and, the relationship between intolerance to frustration, escape and non-symbolization. Melanie Klein studied mental pain by focussing her work on the primordial anxieties of the human being, on the mental organization to handle them (namely the paranoid-schizoid and the depressive positions) and introduced the concept of projective identification. A new theory of thinking was later put forward by Wilfred Bion who investigated the transformation of mental pain by the mental apparatus.
Freud and Mental Pain
In one of his first works, Freud (1895) considered that the chronologically first pain felt by Man, i. e. that pain that is set at the beginning of human existence, is the pain of helplessness felt by the baby when she/he is separated from his the mother. This, Freud considered, was the primordial experience of seeing oneself in the radical absence of the other. To name this helplessness is to speak of the negative: the primordial negative on which the human psyche is going to be structured.
To the condition of the primitive psychic apparatus, that lacks the capacity to elaborate pain, Freud added a second feature of the mind of human beings: the variable capacity to tolerate frustration. Freud (1911a) considered that the incapacity to tolerate frustration causes failure of the symbolic function, and consequent failure of the thinking process; he stated (p. 278) that “getting away from any event that may trigger displeasure is done by repression“. Later on, he added the concept of negation (Freud, 1925), that is associated with painful situations that the individual does not accept or is not able to think them (p. 296): “the ideas contained in repressed events do not reach conscience”. He also considered, on describing the mechanism of foreclosure (Freud, 1911b) that the psychic activity may be abolished, i.e., there is failure in the process of symbolization of a painful experience. In repression, unconscious processes of symbolization are at work whereas in foreclosure what occur are the abolition of symbolisation and the destruction of the psychic activity of representation. As Green (1998) mentioned, about “the work of negative”, this mechanism creates `holes´ in the mind or feelings of emptiness.
In a later publication, Freud (1926) defined mental pain as “a reaction that is proper to the loss of the object” (i. e., anxiety that comes from the danger associated with the loss of the acquired love object). My interpretation is that Freud considered that mental pain corresponds to the absence of the object that is needed (not as much a situation of danger or menace but rather a traumatic situation). In my view, Freud (1895) stressed two fundamental aspects: on one hand, that painful stimuli that are beyond the tolerance threshold of the mental apparatus and cut out from the mental tissue thus generating wounds, holes or blanks, and, on the other hand, that environmental inputs are crucial to the mind, namely the quality of early relationships. In this sense, mental pain corresponded to the traumatic effect of absence, at the level of the need; an absence that can not be imagined, a negative that can not be either represented or recalled (Freud, 1914).
In conclusion, what makes mental pain such a special mental experience would be its genesis from an excess of stimuli that can not be contained and, as a result, outflows the frontiers of the mental apparatus and causes failure of the functions of mental representation. Upon the identification of mental pain, it remained to be investigated what factors modulate the intensity of this “reaction proper to the loss of the object”.
Bion and Mental Pain
The role of tolerance to frustration in mental pain was further elaborated by Bion (1963) who considered that the concepts of frustration and pain are interconnected. Bion created new theoretical tools aimed at answering the following questions: How is it possible to make the unbearable to be accepted and represented by the mind of the patient? What are the preventive strategies that can be employed to avoid escape, insanity, false statement or lies that are often used by the patient to run away from his mental pain? Bion considered that mental pain would depend on innate dispositions, on the quality of links relating self and object, and, most importantly, on what he considered to be a main function of personality: the function of container that assured the capacity to take in painful emotions and to digest them in the mental space.
Bion’s container-contained model was inspired in by the concept of projective identification introduced by Melanie Klein. The container function would offer the capacity of the mind not releasing these painful experiences (either by the somatic pathway, that of projective identification, or other), but rather to work them through what Bion called the alpha function that transforms and integrates the menacing beta elements, such as painful aggressions, instead of rejecting them. The successful transformation of an intolerably painful emotion into one that is both tolerable and capable of being thought will, thus, according to Bion, depend on the transformation ability of the mental apparatus.
The predominance of hate and envy stimulates the assault on the alpha function. This phenomenon may destroy contact with the self, and impair the relationship of the self with live objects thus stealing from the container its function to clean up the toxicity caused by mental pain. Bion (1970) considered that mental pain emerges when the patient does not have the capacity to suffer. Thus, psychological suffering is associated with a higher level of capacity of containment and symbolization than that of mental pain.
New Proposals on Mental Pain
Having considered the previous classical contributions of Freud, Klein and Bion, and taking into account my own clinical and theoretical research (I refer, in particular, to my book, entitled “Dor Sem Nome” [Nameless Pain], recently published – and also the papers by Amaral-Dias & Fleming, 1994, 1998; Fleming, 2003a, 2003b, 2003c), I propose now several precise definitions of mental pain and psychological suffering to enhance clarity in this area of psychoanalytic theory.
Mental pain and psychological suffering have often been employed as synonyms. Mental pain is defined here as a specific phenomenon of the mind that is different from all other instances of psychological suffering, thus deserving a particular and specific status in the corpus of psychoanalysis. Distinction between mental pain and psychological suffering is to be found in the following statements: psychological suffering is referred to self (“I suffer”) whereas mental pain is referred neither to self or other (i. e., there is nobody to be charged with the pain or to be named in association with the pain). Psychological suffering is associated with symbolized experiences that can be communicated by the patient through images or narrative. Psychological suffering can find words to express itself. Mental pain lacks sense, thus it cannot be communicated to others; it appears absurd and pathetic in its nature. In psychological suffering, pleasure may occur when the patient communicates his suffering to someone else, whereas mental pain is beyond pleasure or displeasure, even during communication. Psychological suffering can be elaborated, namely through mourning, whereas mental pain is not accompanied by elaboration of the pain.
I propose that mental pain is a limitrophe phenomenon, located in the frontier between soma and psyche, a constellation of undefined sensations of “longing, helplessness and distress”, for which the patient does not find words or representations. In this case representation are suppressed as Green (1998, p. 658) stated “pain is no longer available to be represented in a way different from repression or splitting […] some capital thoughts are lost because they have been erased”. Mental pain encompasses a perturbation of topography: the erasing of the frontier between the psychic and somatic selves, which leads to destruction of pictorial images and creates blank states or feelings of void. In my view, blank states erase pictorial images that must be created/recreated, using Bion´s words, the art of transformation, or, in Freud words, using the art of construction.
In contrast with psychological suffering (that can be submitted to interpretation and/or reconstruction), mental pain requires from the analyst, preliminarily, and predominantly, the work of construction before interpretation could be done. In order to clarify this idea I recall again Freud´s proposals on construction and on the differences between interpretation and construction. According to Freud (1937), construction is a methodological concept that describes the work of the analyst in reconstructing the past of the patient. In this same work he wrote: “what is then the analyst task? The task is to complete what has been forgotten from the leftover traces, or, more correctly, to construct it” (p. 293).
Taking into account that mental pain reflects a poorly symbolised experience, it will not be integrated into the conscience of the patient and will appear to have been forgotten by the patient. The components of this experience must be recovered, in order to reconstruct the patient narrative truth. “Construction is a preliminary labour” (p. 294), Freud wrote, and consequently, construction has to be performed before interpretation is initiated, even if construction often resembles interpretation, and I quote again: “interpretation applies to something that one does to some single element of the material” whereas “construction occurs when one lays before the subject of analysis a piece of his early history that had been forgotten” (p. 295).
Freud thus suggested that the analyst must complete the patient’s puzzle by searching for forgotten pieces (in his words: “the fragments of his primitive history”), risking even incorrect constructions because “no harm is made to the patient if we occasionally are mistaken and offer the patient a wrong construction as being the probable historical truth” (p. 295). Inspired by Bion´s theory of transformations, a mutual connectedness between reconstruction and construction can be envisaged, for instance, as Karlsson (2005) wrote “each transformation, by means of the alpha-function, brings what is transformed into another level; for example, the non-symbolised somatic pain is transformed to a more symbolised level” (p. 7).
A Metaphor of Photography to Illustrate Mental Pain
Because it belongs to a domain of no-words, it is helpful to address mental pain through the use of metaphors that may help illuminate the workings of the human mind that are associated with this type of pain. I propose photography as a metaphor that suits well my view of mental pain.
In classic photography, the object is “images/impressions” that are first kept hidden in the photographic film, as a negative, a place where nothing can yet be seen but where the object is known to be. A similar phenomenon occurs when the human being is faced with a traumatic event leading to mental pain. This event strikes with sudden violence that may come from a surprising external situation, or from a very new idea. The mental apparatus immediately starts working on the transformation of these strong sensorial impressions, using pictograms, signs, words, and tries to get significance out of the startling experience by creating new concepts.
The mind is not, however, always able to work like a reliable camera: it may lack the psychic capacities needed to transform the incoming images, sensations, proto-emotions or emotions that strike it with exceeding violence. This may cause frustration and inability to undergo the transformation into new concepts. The collapse of the function of transformation (alpha function, according to Bion), like the action of developing the negative, may be due to intrapsychic conditions (stimuli that are too strong in quality and quantity and thus induce their overflowing out of the mental topus, and the consequent paralysis of the containing function of the mind), and/or to interpersonal conditions (depending on the quality of predominant links between the self and the object).
In this situation, what remains are impressions of “no things”, of negatives (an active negativity that generates destructiveness that can not cannot be undone), that asks both for relief (the defences were not able to anaesthetize them), and for containment and transformation (image, meaning, thinking). When mental pain emerges, it shows up in a diffuse, undefined manner that lacks form or colour (such as the photographic negative before being immersed in the developer), and without a voice to be communicated to the other. Mental pain is, thus, a phenomenon associated with “negative realization”, that is not tolerated by the self, and to which the self is not able to link a name, an image, or associate to an experience. Mental pain gives evidence of a painful experience that has not been submitted to the alpha function and digested by the mind because of the collapse of the container function. What does alpha do? “Alpha looks at the sensorial impressions. But to be able to do it, the impression must be a durable one” (Bion, 1992, p. 77). Not being contained (because of rupture of the barriers of protective shield), the experience becomes a “product” looking for excretion due to its toxicity and (aiming at other container), i. e., revealing that it is not suitable for storage, but being kept anyway, in spite of its deleterious effects that show up as mental pain.
In my view, mental pain may be seen as a sort of proto-mental photography that is in the negative stage: sensorial impressions that can not be tolerated, images that one can not bear to look at, and that overflow the mental space out into the frontiers of mind-body. The result will be, and I quote Green (1998) “a destruction of the image, a blotting out of it or a fading that creates a wound in the mind, produces a haemorrhage of the representation, a pain with no image of the wound, but just a blank state or a hole” (p. 658).
Based on the words of my patients during the psychoanalysis sessions, it can be stated that the “mental photographs” are suppressed (“erased”, “broken into pieces”) but also stored (“always there”) in a frozen time, damaging the apparatus that handles the thinking process, and waiting (in expectation) for the suture of the broken links (“holes”, “gaps”, “emptiness”, “wounds that bleed”) in order to be constructed (in the “here and now” of the transference/counter-transference reality), as new myths: pictures with contents, emotional context, and text with characters and narratives.
An adult female patient ( A) is silent, session after session, during a particularly difficult phase of her analysis. I find it difficult to tolerate all of this silence. The patient triggers intense countertransference feelings in me, namely the desire to hold her because I feel her as a helpless and suffering baby, and, at the same time, I feel desperate for not being able to communicate with the patient. After several efforts to know what the patient is feeling, she tells me in a session:
Patient: I feel something that is very far and deep and that never disappears… (and she goes back to a silence that lacks any expression).
Analyst: And with what do you associate that something? What images come to your mind?
Petient: Nothing. I associate with nothing. I see nothing, no images, I remember nothing, I feel an empty hole that is very painful…
I feel that the patient is facing an experience that is not bearable, an experience that she cannot name, or give any significance. She just feels pain. I try, once more, to search for a word that will help me make sense of the patient’s experience.
Analyst: And that something that you feel, does it have a name?
The patient is silent and then says that she does not know.
I decide then to risk using a word, hoping to find a piece of the puzzle still unknown to both of us, a piece that may fit in an hypothetical construction.
Analyst: Maybe you feel helplessness...
The patient moves on the couch and I feel that she is back in touch with me.
Patient: Yes, helplessness… The sensation of floating in a void… I would like to erase that, that feeling that is so deep… The day-to-day problems work as erasers of that feeling, they entertain me.
I decide to complete the fragments that the patient is offering me, guided by my counter-transferential feelings.
Analyst: The feeling of a helpless baby, floating in a void, not finding a maternal harbour, takes harbour in herself, runs away as you have ran away here from me.
I feel that the patient is coming alive (I hear her breathing and moving in the couch).
Patient: Yes… I feel that you have understood me and suddenly I felt that I was not floating anymore… now I feel more secure…Yes…
I feel that the patient is changing because she is starting to consider me a sure container for her non-figurative painful emotions. What was felt as not tolerable becomes now acceptable - mental pain is transformed into psychological suffering. Guided by the transference and most of all, by my own countertransference, and supported by the methodology proposed by Freud, I will risk proposing to the patient more pieces that may help complete the puzzle of a lost story, in search of her past events. From pre-representational and pre-linguistic (for this patient, the photographic negatives are expressed by the phrases such as “something that is always in the depth”) to the adequate representation (e. g., “a helpless baby floating in the void”), and to the transformations that occur from construction to reconstruction and vice-versa, leading afterwards to the work of interpretation.
Technical Suggestions for Clinical Psychoanalysis
It is pertinent to present now technical suggestions that are directly related with my proposed views on mental pain and psychological suffering: (i) the patient-analyst pair will gain from achieving first of all the transformation of mental pain into psychological suffering and new organizing myths, rather than using interpretation right away to search for meanings or hidden truths. Using the metaphor of classical photography, the aim of the analyst facing mental pain of the patient is not to develop the image from the past, but rather to recreate it in the present during the analytical session, in what can be described as the art of construction; (ii) The analyst, as container of painful emotions of the patient, has to increase to the highest level the threshold of tolerance to mental pain, so that the he or she will be felt by the patient as a container that the patient can trust in. (iii) The analyst must open up to the semiotic dynamics, i. e., must be able to dream what the patients are not able to dream by themselves, to what Bion called the alpha-dream-work, the musical dimension of communication, thus developing the “negative capabilities” of tolerance to doubt, incertitude and novelty, all of this done inside a field of emotional contention.
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The author of this article can be contacted:
M. Fleming, PhD, Titular Psychoanalyst
Department of Behavioural Sciences
ICBAS, Abel Salazar Institute for the Biomedical Sciences,
University of Porto, L. Abel Salazar 2,
4000-099 Porto, Portugal,
E-mail: firstname.lastname@example.org or email@example.com