A specific behavior, a specific symbolic attitude represents the totality of mental life, which is reflected in a trivial behavior, such as moving one's fingers, through a process of great condensation. What patients are expressing by way of this gesture represents their whole mental life. (Pichon-Rivière, 2017a, p.178)
Even if one might think that the ability to express emotional life can certainly also be expressed primarily verbally in healthier individuals, I find it enormously important to emphasize Pichon- Rivière's point, because even in more neurotic patients and in all of us there are, to a certain extent, unrepresented states of mind that can be lost by not working in a presence setting.Abstract
Summary The paper refers to the theoretical understanding of Enrique Pichon-Rivière and Hanna Segal by presenting a brief clinical sequence that focuses on the role of the eyes as a means of communication in the context of projective identification. Pichon-Rivière was one of the founding fathers of the Argentine Psychoanalytic Association and made a series of theoretical reflections that have been made accessible to a wider circle of psychoanalysts in recent years, as his work was only translated into English in 2017. Hanna Segal addressed the role of vision in one of her later papers, “Vision” (2007). In this paper, she also refers to a meeting with Pichon-Rivière in Buenos Aires in the 1950s. He drew her attention to the importance of the eyes for psychotic functioning, which seemed to leave a lasting impression on Segal and contributed to her further theoretical considerations. A patient's dream is used to show how the sense of sight is perverted and used in the service of defense. Projective identification via the eyes can be understood as an attempt to prevent communication, but at the same time this attack can also be understood as a form of communication. Pichon-Rivière's concepts of the 3 Ds and the role (2017a) are used to show how the clinical situation and, in particular, the role of the eyes could have been understood in this psychoanalytic situation. This paper examines how this understanding could have been further utilized via a greater inclusion of Pichon-Rivière’s work.
Keywords:
- Keyword: 3 Ds
- Keyword: El Vínculo
- Keyword: Projective Identification
- Keyword: vision
- Keyword: Voyeurism
How to Cite:
Benal, U., (2024) “Attacks on Vision or Communication? The Concepts of Enrique Pichon-Rivière and Hanna Segal”, EJP import test 11(1).
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Introduction
My aim is to present part of the theoretical contribution of the Argentine psychoanalyst Enrique Pichon-Rivière, in particular his paper “The Link and the Theory of the Three Ds (Depositant, Depositary, and Deposited): Role and Status” (2017a), in which he contributes, among other things, to the understanding of psychosis. Enrique Pichon-Rivière was one of the founding fathers of the Argentine Psychoanalytic Association and has made a series of theoretical reflections that have been made available to a wider circle of psychoanalysts in recent years, as his work was only translated into English in 2017. What is special about this interesting theorist of psychoanalysis is that he wrote very little himself; many of his publications came from notes taken by his students and colleagues in the Rio de la Plata region in the 1940s and 1950s (Greenberg, 2017, p. 187).
In the following, I would like to connect his conceptions with those of the Kleinian school, mainly referring to the theoretical explanations by Hanna Segal, who can be regarded as the most prominent representative of the genuine Kleinian work (Bell, 2022). In her short and relatively late paper “Vision,” she reflected on the role of the eyes and the sense of sight in the context of projective identification (Segal, 2007).
Both authors dealt theoretically and clinically with psychosis and psychotic functioning and also met in Buenos Aires in the 1950s. The meeting seemed to have left a lasting impression on Hanna Segal and she refers to it in her work Vision (2007). A passage from her work: “Pichon-Rivière ... showed me his hospital's collection of psychotic paintings and drawings. He drew my attention to the fact that in nearly all of them there was a representation of an eye or eyes – often either fragmented or hidden” (p. 61).
I will first present the theoretical considerations of the two authors and then discuss how some clinical material could be understood on the basis of the two theoretical approaches by means of a short clinical sequence. In contrast to Segal's clinically oriented approach, Pichon-Rivière's contributions are fundamentally theoretically oriented; he makes hardly any comments on treatment-related issues in his work.
Pichon-Rivière's Contribution in “The Link and the Theory of the Three Ds (Depositant, Depositary, and Deposited): Role and Status”
Based on his experience as a psychiatrist and under the strong influence of Melanie Klein's theoretical understanding, Pichon-Rivière considered not only the intraindividual processes, but also the latter in the context of family and society. In the 1940s and 1950s he developed a number of concepts, including those related to group theory and group functioning, and he was so convinced of the close interrelationship between subjectivity and society that he eventually founded the Argentine School of Social Psychology. He defined vínculo, the connection between individuals and society as a whole, as “a complex structure involving subject, object, and their mutual interaction through processes of communication and learning” (Pichon-Rivière, 1979, cited by Losso & De Setton, 2017, p. 243). Vínculo means connection, bond in the sense of family ties, and is translated into English with the term link, but is fundamentally different from Bion's concept of the link (Bion, 1959).
As mentioned above, in 2017 Pichon-Rivière's work was translated into English for the first time, making it accessible to a larger group of psychoanalysts. The article “The Link and the Theory of the Three Ds (Depositant, Depositary, and Deposited): Role and Status”(Pichon Rivière, 2017a) doesn't represent a finished manuscript intended for publication. It is rather a "formal structure of an academic manuscript," as Jay Greenberg points out in a commentary, that "may reflect Pichon's way of conceptualizing and presenting his thinking" (2017, p. 188). The text contains important remarks by Pichon-Rivière, including his understanding of the role between analyst and analysand. “The therapists' attitude must therefore be that of unscrupulous depositories who feel little anxiety and are able to accept anything patients attempt to place in them – good or bad, maternal or paternal, feminine or masculine,” he writes (Pichon-Rivière, 2017a, p. 177).
According to Pichon-Rivière, even in the most severe psychotic states, analysands would seek for communication with the analyst. Mutual role assignments create connections, for which he, as mentioned above, uses the concept of the vínculo, which, in contrast to the concept of the object relationship unit, emphasizes the mutual entanglement of subject and object. In other words, connections that do not only point in one direction (Pichon-Rivière, 2017a, p. 179). Moreover, such vínculos also exist in larger social contexts, so that the term, and also the further theoretical understanding, is extended by Pichon-Rivière (2017a) to larger social units, as already mentioned above.
I would now like to discuss Hanna Segal's theoretical contribution in her paper “Vision” and then present a short case sequence.
Hanna Segal's Contribution in Her Paper “Vision”
At the beginning of her paper, Segal (2007) refers to her encounter with Pichon-Rivière in Buenos Aires. She describes how she initially made little sense of Pichon-Rivière's information that an eye or eyes could be seen in every picture and drawing of psychotic patients. Over the years, however, she became increasingly aware of the crucial importance of voyeurism in the context of psychosis. Psychotic functioning, she states, is closely linked to perversion, including voyeurism, and at the level of defense also to concrete and concretistic projective identification. Incidentally, Pichon-Rivière (2017b) also uses the originally Kleinian concept of projective identification in his work when he writes, "Finally, I will refer to a mechanism whose systematic analysis is pivotal to the treatment of schizophrenics: that is, projective identification" (p.41).
Segal describes that in the course of her clinical experience with psychotic patients she gained a growing understanding of the crucial role of voyeurism in psychotic functioning. She believes that especially in the transition from non-psychotic to psychotic functioning, the role of the eyes can play an essential role. A threatening or upcoming psychotic breakdown would regularly be accompanied by an increase in voyeuristic activity and could then also be recognized and worked through in the psychoanalytic session. This would make it possible to contain the breakdown in the session and thus to prevent it. She generally assumes a permanent struggle between healthy curiosity in the sense of Klein's (1928) epistemophilic instinct, that is, the urge to discover one's own inner perception and to compare it with external reality, and a disturbed, perverted form of seeing, namely voyeurism. In this sense, voyeuristic activity is to be understood as a perverse use of the visual sense. The more inner parts are drawn into the voyeuristic activity, the fewer parts are available to oppose and help resist the psychotic pull.
Now, I introduce a short case sequence in which the role of the eyes was very present in the psychoanalytical situation and which I initially understood in a Kleinian sense.
Case Material
A young psychotic patient came to one of his sessions, it was a 4-times-a-week psychoanalysis. He began his session by reporting that he had dreamed of a witch, who haunted him with intense looks. Suddenly, he sat up on the couch, turned to me and looked at me intensely. His gaze was very powerful and at first I was irritated, very struck by his look. After I had regained my composure, I said, "It must be very frightening to be persecuted like that." The patient looked at me again, he was accommodating, as if he wanted to restore the ability of his eyes to perceive. Then he said, "Yes, but everything is all right now" and was lying down on the couch relatively calmly to continue with stories of his everyday life, in the sense of a more or less free association.
However, I myself was very struck by the force of the patient's gaze in this analytical situation during and after the session, and I had to remind myself that it was “just” a dream he was telling. I was very preoccupied and hardly able to follow the patient in the further course of the session and I wasn't able to return to this initial situation. At first I understood the dream and its acting out in the session in the sense of an attack on vision, as described by Segal, an attack on the possibility of patient and analyst to come to a further understanding. My brief intervention—so I initially thought—served to contain the patient's psychotic fears, and I found myself confirmed in this when he switched to a healthier mode and largely associated freely.
In the following sessions, however, this clinical sequence could no longer be discussed with the patient. This and the study of Pichon-Rivière's paper made me unsure whether the interpretation I had given was really helpful in terms of containment.
I thought about if my interpretation serve more to get rid of the anxiety in me, because of the intrusive looks of the patient. As Pichon-Rivière (2017a) describes it: “We could say that analysts get rid of the anxiety deposited in them by patients by giving back this content to them through interpretations” (p. 181).
Was I able to perform for the patient the function of one of the unscrupulous depositories, as Pichon-Rivière (2017a) suggests, "who feel little anxiety and are able to accept anything patients attempt to place in them” (p. 177)?
Could all important aspects be understood in this session and afterwards? With a little distance from the clinical situation, I think that the patient was in a more psychologically stable situation and that something like successful containment had probably taken place, but beyond that the question remained open for me as to whether more could have been understood and more working through would have been possible if I had not reacted so quickly, had withstood the gaze of the patient a little and waited.
Further Discussion of the Case Material
Accepting willingly and openly what is deposited, as Pichon-Rivière (2017a) illustrates it, seems on the surface unavoidable with regard to the clinical situation described above.
The patient who came to the session leaves more or less no choice. He laid down on the couch, but shortly afterwards sat up abruptly, turned to me, and by means of intensive projective identification (Klein, 1946) via eyes, deposited intensive persecuting emotions in me as his analyst. In any case, something is deposited in the analyst; the decisive issue, it seems to me, is whether these rather raw emotions, in Bionian terminology beta-elements (Bion, 1962), were taken up a bit by the analyst, held, and ultimately in a first rudimentary step could be digested. The latter would be a sequence of relatively successful projective identification, from which both, patient and analyst, could draw something and which, ideally and frequently used, could lead to an increasing progression in the treatment. In the dream enactment mentioned above, this seems to have been possible to a certain extent. The patient was able to get rid of something, the analyst was able to pick up on this and formulated a rudimentary interpretation and gave the patient a basic form of understanding.
But is this also a relatively ideal communication in Pichon-Rivière's view, as he sees it as crucial for the treatment? He describes a connection with the object which is a pleasant experience as a good connection, a good link, while he describes the bad link as a frustrating experience (Pichon-Rivière, 2017a, p.177ff). Pichon-Rivière describes these two aspects of early experience during the first six months of life, following Klein's (1935) theory of the early, primary splitting of the paranoid-schizoid position as essential to the child's development. The inner world would be organized by the separation into good and bad, feelings and perceptions can be increasingly discriminated. This process is seen as a normal form of splitting because it leads to the preservation of the good object and later enables the infant to unite both aspects. Later, in the course of development, this primary split can gradually be overcome. In psychotic or severely traumatized patients, this form of developmental splitting is disturbed. Often, the question is not so much whether there is a good or bad connection to the object, but rather whether a form of connection can be established at all.
The patient, who used his sense of sight not to have to see but to put something down in me, his analyst, attacked his own ability to see, to look the pursuing witch in the eye, and he was also blinding my ability to see and to understand. Taking Pichon-Rivière's (2017a) contribution into account, however, it would remain open to what extent the analyst's rapid interpretation actually contained what the patient deposited in her, whether I was actually able to be an unscrupulous depositary (p. 177) in this session, as Pichon-Rivière describes it as crucial for taking on the role that the patient assigned to me. I think that Pichon-Rivière's description of the unscrupulous depositary also refers more to allowing oneself to be infected by the patient's anxiety without becoming anxious oneself, something that seems difficult to achieve to me, perhaps also reminiscent of Richard Sterba's (1934) concept of the therapeutic ego split.
In his explanations, Pichon-Rivière also speaks of the interpretation of the material deposited in the analyst, although it is not clear from the text translated into English (Losso, De Setton, & Scharff, 2017) whether this interpretation must always take place or whether he rather assumes a process reminiscent of Bion's (1962) containment. Pichon-Rivière’s bad link doesn't so much mean an attack in the sense of Bion's “Attacks on Linking” (1959), rather he assigns the difficulty to the analyst that something, out of the analyst's fear of his own madness, etc., cannot be accepted. In this regard, I find his work helpful to keep coming back to the question of what we as psychoanalysts cannot accept and the implications of this. He brings us as psychoanalysts further into play when it comes to the fact that no connection can be made between patient and analyst in treatment.
Pichon-Rivière's Contribution in Relation to Other Psychoanalytic Theorists
Pichon-Rivière, like Hanna Segal and Wilfried Bion in other geographical regions, dealt with the communication of psychotic patients. Other psychoanalytic theorists of the early period also dealt with severe pathologies, for example Harold Searles (1961) with the specific, very concrete communication of schizophrenic patients, as described in his work Schizophrenic Communication.
Pichon-Rivière began writing at a time when Melanie Klein and also William Fairbairn had formulated their essential writings in London, and his theoretical writings went beyond an object relations theory. Despite theoretical points of reference, he did not quote Bion once in his writings. Pichon-Rivière's link theory clearly differs from Bion's (1959) concept of the link, but his concept of the 3 Ds and in particular the formulation of an unscrupulous depositary is at least reminiscent of Bion's (1962) concept of containment.
Donald Winnicott wasn't quoted by Pichon-Rivière either, although he also made an important contribution with his concept of the holding function of the object (Winnicott, 1960) and also with his paper “The Use of the Object” (Winnicott, 1969). I think that Pichon-Rivière had something similar in mind when he spoke of the analyst's ability to take on the function of an unscrupulous depositary.
A quote from Winnicott (1969): "For instance, it is only in recent years that I have become able to wait and wait for the natural evolution of the transference arising out of the patient's growing trust in the psychoanalytic technique and setting, and to avoid breaking up this natural process by making interpretations" (p. 711).
The ability to use an object on the part of the patient requires a corresponding counter-position on the part of the analyst in order to be able to evoke this function in the patient.
But Pichon-Rivière's students also seem to have adopted essential theoretical concepts. I would like to emphasize Willy and Madeleine Baranger with their concept of bastions (Baranger, Baranger, & Mom, 1983). With this unprocessed aspect in a psychoanalysis, within a psychoanalytic field, even after completion, they described the danger that analyst and patient enter into a kind of unconscious collaboration, when circumstances are assumed to be too certain. With the psychoanalytic field as a fundamental concept, the Barangers are also key pioneers of more recent intersubjective and relational approaches in psychoanalysis, some of which can be traced back to Pichon-Rivière's pioneering ideas.
The two neo-Kleinian authors Ron Britton and John Steiner (1994) have also described the importance of remaining open with the concept of the overvalued idea: we should not be too sure about an interpretation and the fact that a projective identification, which emanates from the patient, only points in one direction, we should also not be too sure that the patient makes something impossible; it is important not to become too complacent.
In my point of view, Pichon-Rivière's link theory with the interdependence of relationship strands and his theory of the 3 Ds can provide a very enriching basis for constantly rethinking these aspects.
The Role of the Eyes and the Sense of Sight in the Psychoanalytic Setting
Finally, I offer some brief reflections on the role of the eyes and the sense of sight in the psychoanalytic setting.
A key aspect of the clinical example in my paper relates to the role of the eyes as a means of communication. This doesn't only play a role in dreams and not only in psychotically structured patients. We welcome and say goodbye to patients who are being treated on the couch and look them in the eyes. Some of us also treat patients in a face-to-face setting and, especially during the Covid pandemic and in some regions of the world even before it, remote analysis plays a major role. What happens when we look into a camera and direct eye contact is no longer possible? I think Pichon-Rivière would find this extremely problematic. Because he believes that a certain, even seemingly insignificant symbolic attitude can express psychological material in a highly condensed form.