Moderator: Nancy Winters, MD, FIPA, ABPsa
Being and staying emotionally alive in the clinical hour is not always easy nor a welcoming experience. At times the analyst’s aliveness collides with patients’ anxieties, their psychic walls, or dead spaces. Hopefully, these encounters penetrate psychic barriers and awaken nascent or truncated development. For some patients the process of enlivening is experienced as dangerous, risky, destabilizing: a Bionian ‘catastrophic change.’
In this presentation, an analytic case is used to illustrate the impact of a chronic bodily illness on the patient’s object world and its interdigitation with struggles to come alive, both psychically and bodily. For Tillotson's patient, illness sealed an early object identification with a dead parent that preserved an un-mournable object tie, blocking emotional aliveness and bodily vitality. Thus, coming alive engendered significant risks. Transformations were unconsciously dreaded due to an inability to mourn an object tie that shaped the patient’s internal life. To successfully mourn and become psychically alive, the patient had to face anxieties linked to bodily pleasure, mental excitement, and experiencing the analyst as an enlivening object. The ensuing catastrophic change involved relinquishing deadening object ties and manic flights into a phantasied disease-free body.
Learning Objectives
1. Describe Bion’s concept of 'catastrophic change' as it applies to the patient’s struggle between aliveness and resignation to a deadened existence.
2. Explain John Steiner’s concept of 'identification with the object' as a failure to mourn.
3. Discuss the complexities of an acceptance of chronic bodily illness with regard to Freud’s concepts of mourning and melancholia.
About the Presenter
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), Past Vice-President of the North American Psychoanalytic Confederation (NAPsaC), and recently 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, 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.
About the Moderator
Nancy C Winters, MD, FIPA, ABPsa is an adult and child psychiatrist and board-certified psychoanalyst in full-time private practice in Portland, Oregon. She is a training and supervising psychoanalyst of the Oregon Psychoanalytic Institute (OPC) in Portland and of 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 for Routledge’s Body as Psychoanalytic Object: Clinical applications from Winnicott to Bion and beyond.
