“The danger of death does not become acute until it is clear to every beholder that a resounding success is at hand.” Bion, 1991
As Bion reminds us, growth and change in a successful psychoanalysis are likely to be experienced unconsciously as a catastrophe. This ‘catastrophic change’ can result in dysregulation and chaos at every level of a person’s existence. In this presentation, a case illustration will be used to explore a catastrophic response in the body, an autoimmune illness. In other words, the immune system’s rebellion against the self.
Surprisingly, an examination of autoimmunity at a cellular level reveals self- destruction to be an innate capacity, even tendency, lending support to Freud’s death instinct. Yet our existential capacity for self-destruction is also necessary for tearing down and building new structures, both physically and psychically. This understanding of the immune system’s capacity for destruction and rebuilding has even more meaning in the time of COVID-19. We will discuss how the analyst can work with catastrophic change and the tenuous balance between life and death instincts towards new levels of organization and vitality.
Learning Objectives
- Describe autoimmunity as an expression of catastrophic change in analysis.
- Discuss how the biology of autoimmunity lends support to the death instinct.
- Recognize autoimmunity as an opportunity for new psychic organization and vitality.
About the Presenter
Nancy C. Winters, MD, FIPA, ABPsa is an adult and child psychiatrist and adult psychoanalyst in full-time private practice in Portland, Oregon. She is a training and supervising analyst of the Oregon Psychoanalytic Institute in Portland and the Northwestern Psychoanalytic Society and Institute in Seattle. Nancy is a Clinical Professor at the Oregon Health & Science University where she was previously residency director of Child and Adolescent Psychiatry. She is on the editorial boards of the International Journal of Psychoanalysis and the Psychoanalytic Quarterly. Publications include the book Child and Adolescent Systems of Care and articles on depression, eating disorders, and evaluation strategies in children’s mental health. Most recently she is co-editor and chapter author forRoutledge’s Body as Psychoanalytic Object: Clinical Applications from Winnicott to Bion and Beyond.
About the Moderator
Drew Tillotson, PsyD, FIPA, BCPsa is a board-certified psychoanalyst in full-time private practice in San Francisco. He is a graduate and a Past President of the Psychoanalytic Institute of Northern California (PINC), a Past Vice-President of the North American Psychoanalytic Confederation (NAPsaC), and a past member of the IPA Education Committee. He has published on aging, intercultural phenomena, book reviews for Fort Da and the International Journal of Psychoanalysis and is co-editor and chapter author for Routledge’s “Body as Psychoanalytic Object: Clinical Applications from Winnicott to Bion and Beyond” (2022), as well as a chapter author for Routledge’s forthcoming book,“Braving the Erotic Field in the Treatment of Adolescents and Children” edited by Mary T. Brady.
