David Bell

Who is killing what or whom? : some notes on the internal phenomenology of suicide

SUMMARY The psychiatric literature on suicide tends to focus on the external world of the suicidal patient and this, though valuable, is not sufficient for understanding and managing the individual case. This paper aims both to explore the ‘internal phenomenology’ of the suicidal act and to show how this deeper understanding is essential for proper management of the individual case. The body that is attacked in a suicidal act is a body that has become identified with a psychic object that cannot be tolerated. The author explores the psychoanalytic understanding of suicide starting with the work of Freud and then its development by Klein. He offers case examples to illustrate the theory and also to show how this deeper understanding of the individual case has immediate implications for management. The author gives particular emphasis to the functioning of a primitive cruel superego, showing how this comes to operate not only at the individual level but also at the level of the institution. Finally, the author suggests that the perspective offered in this paper has implications for Mental Health Policy. ‘The ego can kill itself only if … it can treat itself as an object.’ (Freud 1915, p.252).

Is truth an illusion? Psychoanalysis and postmodernism

The sort of reflection that I have been engaging in is just the sort of reflection that both Comte and Rorty see as pointless. For Comte, such reflection is a throwback to a pre-scientific age; for Rorty, a reluctance to enter fully into the postmodern one. Some of you will probaly agree with one or other of these thinkers. But in my view reflection on just what it is that makes thinkers like Rorty doubt the very idea of representing the world, and I think there is a Rorty as well as a Comte in each of us, however suppressed, is part of understanding ourselves, and not just part of understanding certain sophisticated and influential thinkers. For what is common to Rorty and Comte is the idea that much of what we think we know cannot have the status it seems to have. For Richard Rorty the recommended response is to take a more ‘playful’ attitude to what we think we know; and for August Comte it is to sternly restrict ourselves to ‘positive knowledge.

Primitive mind of state

SUMMARY This paper examines the introduction of the Market into the National Health Service, viewing it within the perspective of the destruction of the Welfare consensus. It is suggested that the ideology of the Market and the attack on welfare-ism derives considerable support from their appeal to primitive parts of the personality that view dependency or vulnerability as weakness, the process originally described by Rosenfeld who termed it ‘destructive narcissism’. The paper develops this theme and uses a clinical example to illustrate the phenomenon. It is also suggested the NHS reforms create fragmentation and alienation. This has led to primitive survivalism which, although a natural outcome of the process described, will prove very costly in terms of its effects on morale — an essential component of adequate health-care delivery.

The death drive: Phenomenological perspectives in contemporary Kleinian theory

Faust craves the infinite and so the meagre gains of his endless toiling for knowledge pale into insignificance when compared to the new object of his longing – omniscience. Faust is hidebound by ‘considerations of reality’ and this state of mind provides fertile soil for the devil’s work; Mephistopheles offers a world of no obstruction, where all desire can be realized. Mephistopheles introduces himself as the spirit “that negates all”, he continues:

Inpatient psychotherapy: The art of the impossible

SUMMARY This paper discusses some critical issues that arise in the psychotherapeutic treatment of patients in an in-patient setting. The paper describes aspects of the work of the Adult Unit at the Cassel Hospital, and the difficulties that arise from the less-private nature of the psychotherapeutic treatment in that setting. The author particularly focuses on the relation between the individual psychotherapy on the one hand, and the nursing and community treatment on the other, and argues for the need for clear demarcation of roles between these different functions. This imposes particular stress on the psychotherapist and nursing staff. Examples are given to illustrate this. The author emphasises the importance of maintaining as far as possible a classical psychotherapeutic setting, whilst recognising the necessity for communication between the psychotherapist and the other members of the therapeutic team. The author also describes the ways in which certain individual psychopathologies can resonate wit...

Reason and passion: a tribute to Hanna Segal.

Hanna Segal’s contribution to psychoanalysis was marked not only by its depth but by its extraordinary range. More than anyone else working within the Kleinian framework, she has demonstrated the relevance of psychoanalytic ideas to human knowledge in general; her papers on aesthetics, symbolism, literature and socio-political issues have made fundamental and original contributions which have influenced intellectual life far afield from psychoanalysis per se. It might, thus, seem reasonable to make a division in Segal’s work between the clinico-theoretical contributions and what one may think of as the ‘applied work’. This however should be resisted, for this latter aspect of her work has not arisen from her ‘setting about’ applying psychoanalytic knowledge to other objects, but has always been emergent from her immediate clinical and theoretical concerns. Her classic paper on aesthetics (Segal, 1952) can be read both as a clinical discussion of patients who have difficulties in their creative work and, at one and the same time, as a contribution to the central questions of aesthetics. Her study of Joseph Conrad (Segal, 1984) though on one level a psychoanalytic exegesis of his work, turns out to have immediate clinical psychoanalytic relevance as an examination of the roots of creativity in the depressive position and the relation of this to the mid-life crisis. Her papers on the nuclear mentality and the triumphalism of the West emerge directly from her explorations of the nature and phenomenology of the death drive when fuelled by manic omnipotence, the denial that is central to its nature and the destruction it brings in its wake. So, her work cannot be divided in this way for it evinces a compelling unity. This unity of thinking is I believe central to the kind of thing psychoanalysis is; Janus faced, it looks at one and the same time inwards towards the

Unconscious phantasy: Some historical and conceptual dimensions†

This paper seeks firstly to grasp both conceptually and historically the different phenomenologies that are captured by the term ‘Unconscious Phantasy’. The term is shown to refer to a number of distinct though overlapping conceptual domains. These include: phantasy as scene, phantasy as representation of drive, phantasy as representation of wish as its fulfilment, phantasy as split off activity of the mind functioning under the aegis of the pleasure principle; phantasy as representation of the minds own activities (which Wollheim calls’ the way “the mind represents its own activities to itself’’). Lastly unconscious phantasy is understood as being the basic foundation of all mental life, including drives, impulses, all anxiety situations and defences. Having mapped out this territory through following the development of the concept in the work of Freud and Klein, the author draws on the work of the philosopher Richard Wollheim who, the author contends, has made a fundamental contribution to our conceptual understanding of unconscious phantasy. In the last section of the paper, the author draws a distinction between what he terms ‘objects’ (namely psychic objects) and what he terms ‘facts’. It is suggested that this distinction, though implicit in much of our work, benefits from being made explicit and that in so doing an important dimension of analytic work is illuminated. We aim to help the patient to discover what he is like, to understand the ways in which he conceives and misconceives himself, to unravel the fact‐ness of himself and his world from its ‘object qualities’, to differentiate between unconscious phantasy and reality.

Auto-entendimiento de la experiencia

La noción de insight es a uno y el mismo tiempo central al psicoanálisis y al auto-entendimiento que es parte de la vida diaria. Mediante material clínico y compromiso crítico con el trabajo contemporáneo filosófico sobre el auto-conocimiento, este trabajo clarifica un aspecto crucial de la noción clave. Tenemos en mente el auto-entendimiento de esta clase que por supuesto incluye los elementos cognitivos, no explica suficientemente los afectos, las motivaciones u otros aspectos de las psiquis, no por la simple conjunción de tal cognición con afecto sentido, urgencias motivacionales, etc. Tampoco está mejor modelado en términos de auto-observación interna. Más bien, es el producto de un constante proceso de articulación desplegada de nuestra propia vida psíquica. La noción de experiencia es importante aquí de tres maneras: Primero, la experiencia vivida es aquella de la que surge el auto-entendimiento. Segundo, este auto-entendimiento es un avance y articulación de estos aspectos de nuestras vidas interiores; es una parte de la misma perspectiva vivida. Y tercero, este entendimiento a su vez moldea la propia experiencia de nuestro mundo interior: como se logra, la propia experiencia así cambia. Lo central aquí es el énfasis sobre un proceso en desarrollo que incluye la habilidad de hablar desde una perspectiva subjetiva mientras se experimenta en la perspectiva subjetiva tal como lo es.

Experiential self‐understanding

Translations of summary The notion of insight is at one and the same time central to psychoanalysis and to the self‐understanding that is part of everyday life. Through clinical material and critical engagement with contemporary philosophical work on self‐knowledge, this paper clarifies one crucial aspect of this key notion. Self‐understanding of the sort we have in mind, while of course involving cognitive elements, is not sufficiently accounted for by cognition about ones affects, motivations, or other aspects of the psyche, nor by the simple conjunction of such cognition with felt affect, motivational urges, etc. Nor is it best modelled in terms of internal self‐observation. Rather, it is the product of an ongoing process of the unfolding articulation of ones psychic life. The notion of experience is important here in three ways. First, lived experience is that out of which the self‐understanding arises. Second, this self‐understanding is a development and articulation of these aspects of our inner lives; it is a part of that same lived perspective. And third, this understanding in turn shapes ones experience of ones inner world: as it is attained, ones experience of oneself thereby changes. Central here is the emphasis upon a developing process involving the ability to speak from ones subjective perspective while experiencing ones subjective perspective as the perspective that it is.