Wilfred R. Bion - Second Thoughts: Selected Papers on Psychoanalysis

1. The patient from whose analysis I draw most of my material had had many years of psycho-therapy which ended when the therapist advised leucotomy. In view of a shocking family history and the strains to which the patient had been subjected in early childhood the doctor who referred him thought the outlook bad,

2. The patient had a sister 18 months older than himself who died of a disease, from which both suffered, when the patient was one year old; both had severe diarrhoea during the course of the illness.

3. The family associated closely with their neighbours whose children, two girls, one two years younger than my patient, the other seven years younger, were his only playmates until he was ten. The younger died in an asylum before the war; the other still survives but in a state of incurable insanity, supposedly schizophrenia.

4. Disunited parents complicated his childhood. This was spent abroad in a country which was developing its football and other sports so that when it was discovered that he was an athlete, and intelligent, then the way seemed clear for a popular and successful career. But the family fortunes deteriorated and the domestic relationships with them, until at thirteen the boy had had a breakdown from which he made no adequate recovery though he returned to, and has continued in, work. His Mother died after years of chronic and painful illness, when he was 17; the Father, many years later. His circumstances were further complicated at the time of his Mothers death by the need to leave his native land and start afresh here.

5. When he came to me I saw a man of 43, just under 6 ft. in height, of wiry build, sallow complexion and dull expressionless features: by profession a teacher. The discussion of his difficulties was perfunctory, carried on for his part in monosyllabic listlessness. He agreed without enthusiasm to give analysis a trial.

6. My account of the next two years must necessarily be compressed. The central theme of the analysis was contamination: he had to protect his head from the pillow by resting his head on his hand; he could not shake hands; he felt that he contaminated the bath on which he relied to give him a feeling of cleanliness and that it contaminated him back again.

7. He feared that he drank too much; he wondered if his penis was erect; he could not bear to have someone sitting behind him on a bus; it was equally contaminating if he sat behind someone.

He began to wonder if he felt sexual with his students; before long suspicion turned to certainty, and this made him feel unclean.

In his associations a big part was played by phantasied therapeutic injections which he had given, only to fear that his needle might not have been properly sterilized.

8. During the whole of the first two years, I had great difficulty in being able to determine, from his reactions, what validity to assign to my interpretations. I did, on two widely separated occasions, hear, from an extra-analytic source, that the patient was said to be greatly improved. I, myself, saw no improvement; nor was I able to remark, what I now believe to be true, that a change began to manifest itself in him at the end of this period. Till that time his intonation had been uniformly drained of emotion and his statements correspondingly difficult to interpret for they almost always had the ambiguous character which admitted of different meanings if one considered them now with one emotional content, now with another.

9. There was plenty of oedipal material, produced on a most superficial level, which I duly interpreted, to meet with a perfunctory response or none at all.

My awareness of a change in the analysis developed over a period of some three months. At first it seemed as if my interpretations were only meeting with more than usually stubborn indifference, and then as if I was a parent who was issuing ineffectual exhortations and warnings to a refractory child. In due course I pointed this out to him and a change, not easily formulated, occurred. There was still the dreary monotone of associations but there was now a quality which derived from what I can best describe as the rhythm of his associations. It was as if two quite separate co-existent scansions of his material were possible. One imparted an overpowering sense of boredom and depression; the other, dependent on the fact that he introduced regularly spaced pauses in the stream of his associations, an almost jocular effect as if he were saying Go on; its your turn.