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TACTICS

and
TECHNIQUES
in
PSYCHOANALYTIC
THERAPY
VOL. II:
COUNTERTRANSFERENCE

edited by
Peter L. Giovacchini, M.D.
in collaboration with
Alfred Flarsheim, M.D.
and
L. Bryce Boyer, M.D.

Jason Aronson, Inc.

Copyright ® 1975 Jason Aronson, Inc.

All rights reserved. Printed in the United States of America. No part of this book may be used or reproduced in any
manner whatsoever without written permission from the publisher except in the case of brief quotations in reviews for
inclusion in a magazine, newspaper or broadcast.

ISBN: 0-87668-202-6

Library of Congress Catalog Number: 72-144143


CONTENTS

Preface: Peter L. Giovacchini, M.D ix


The Psychoanalytic Orientation—Introduction, Peter L. Giovacchini, M.D xiii

Part One — THE PSYCHOANALYTIC PROCESS:


GENERAL CONSIDERATIONS AND COUNTERTRANSFERENCE FACTORS
Introduction: Peter L. Giovacchini, M.D 3
1. Various Aspects of the Analytic Process, Peter L. Giovacchini, M.D 5
2. The Patient as Therapist to His Analyst, Harold F. Searles, M.D 95
3. Comment on H. F. Searles’s “The Patient as Therapist”, Alfred Flarsheim, M.D 152
4. The Therapist’s Collusion With the Patient’s Wish for Suicide, Alfred Flarsheim, M.D 155
5. The Obnoxious Patient, Peter A. Martin, M.D 196
6. The Patient Who Is Difficult to Reach, Betty Joseph 205
7. Negative Therapeutic Reaction Herbert A. Rosenfeld, M.D 217
8. The Formative Activity of the Analyst Richard F. Sterba,M.D 229
9. The Patient’s Unconscious Perception of the Therapist’s Errors, Robert J. Langs, M.D 239
10. The Love That Is Enough, Bruno Bettelheim, Ph.D 251

Part Two—EGO STRUCTURE AND EVALUATION


Introduction: Peter L. Giovacchini, M.D 279
11. Ego Structure, Psychopathology, and Spatial Representations
David Roth, M.D. and Sidney J. Blatt, Ph.D 281
12. Comments About Ego Structure, Psychopathology, and Spatial
Representation, Peter L. Giovacchini, M.D 293
13. Affects and Therapeutic Alliance in Narcissistic Disorders: A
Structural Evalution, Arnold H. Modell, M.D 298

Part Three—SEXUALITY AND CHARACTER


Introduction: Peter L. Giovacchini, M.D 309
14. Perversion and Hostility, Robert J. Stoller, M.D 311
15. The Influence of Psychoanalytic Treatment Upon a Woman’s
Attitudes Toward Sex and Motherhood Alfred Flarsheim, M.D 326

Part Four—SPECIFIC CLINICAL SITUATIONS


Introduction: Peter L. Giovacchini, M.D 339
16. Treatment of Characterological and Schizophrenic Disorders, L. Bryce Boyer, M.D 341
17. Somatic Elements: A Case of Psychogenic Anosmia, Daniel Offer, M.D 374
18. The Residential Treatment of Anorexia Nervosa, Bertram J. Cohler, Ph D 385
19. Imposture as a Defense, Stanley W. Conrad, M.D 413
20. * Cosmic Laughter: A Study of Primitive Splitting Vamik D.Volkan, M.D 427

Part Five—SUMMING UP 443


21. The Psychoanalytic Process: Concluding Perspectives Peter L. Giovacchini, M.D 445
Index 455
Chapter XX
Cosmic Laughter: A Study of Primitive Splitting

Vamik D. Volkan, M.D.

There was a little girl And she had a little curl.


Right in the middle of her forehead,
And when she was good She was very, very good;
But when she was bad she was horrid!
(Jane’s favorite nursery rhyme)

During early development the child creates integrated object and self-concepts in a
piecemeal fashion, and only after repeated trials accomplishes the mending of the
split between “good” and “bad” object and self-images. Although they disagreed on
many fundamental points, both Klein (1932) and Jacobson (1964), in studying the
earliest stages of psychic development, showed how these trials continue until the
tolerance of ambivalence is at least attained.
The term splitting is used here in the restricted sense in which Kernberg (1966,
1968, 1971) employed it to refer to the process of active separation of introjects and
identifications of opposite quality. The patient’s self and object images built up under
the influence of libidinal drive derivatives are not integrated with the corresponding
self and object images built up under the influence of aggressive drive derivatives.
This division, occurring at first because of the lack of integrative capacity in the early
ego, later becomes defensive . . .
... to prevent the generalization of anxiety and to protect the ego core built around positive
introjections (introjections and identifications established under the influence of libidinal drive
derivatives). (Kernberg, 1966)
The child’s attempts to develop an integrated concept of self and relatedness to the
simultaneously “good” and “bad” objects are not exactly like those of the adult
patient who possesses aspects of an ego sufficiently differentiated to be used for
observation or defensive functioning even when he

A preliminary version of this paper was first read at the annual meeting of the American
Psychoanalytic Association in Washington, D.C., on May 2, 1971.
428 TACTICS AND TECHNIQUES IN PSYCHOANALYTIC THERAPY VOLUME II

is pregenitally fixated or regressed to an earlier level. The clinical picture can be


confusing; but the dominant clinical manifestation of the adult who uses primitive
splitting is, nevertheless, that external objects are either “all good” or “all bad” ones
“with the concomitant possibility of complete, abrupt shifts of an object from one
extreme compartment to the other; that is, sudden and complete reversal of all
feelings and conceptuatlizations about a particular person” (Kernberg, 1966).
The analyst treating a patient given to excessive use of primitive splitting observes
that whenever the patient’s “good” object becomes “bad” he will reverse the qualities
of another object to maintain a balance. Moreover, with splitting the patient oscillates
between extreme and contradictory self-concepts. In this paper I will describe a
patient who made extensive use of primitive splitting, as well as introjective-
projective relatedness. In the thirty-third month of her treatment she had a unique
experience on the couch that she called “cosmic laughter.” I believe that an
examination of the genetic roots of this experience discloses its origin in recollections
of experience at the breast — the sudden change of a gratifying breast into a bad one
that no longer gratified. Thus “cosmic laughter” will be seen in the light of the
Isakower phenomenon (1938) and Lewin’s dream screen (1946, 1948, 1953). It
presented itself as a turning point of her analysis since it was reflected in her ability
to tolerate, with the help of identification with the analyst’s analytic attitude and
interpretive work, primitive feelings from which she had previously protected herself
by primitive splitting.
On the surface cosmic laughter seemed to be a disorganization. Nevertheless, the
beginnings of new organization were evident behind it.

CLINICAL ILLUSTRATION
The patient, whom I shall call Jane, showed a repeated pattern of making wide
cathectic swings between libidinally investing an object, and then investing it with
aggression.
She was a twenty-one-year-old art student attending a college within a hundred
miles of her house when I first saw her. The college psychiatrist had made the
diagnosis of acute schizophrenic reaction and sent her to us for hospitalization. He
felt that her anxiety had increased as her college graduation approached; she reported
seeing bizarre alterations in his office such as undulations in the walls and in the
ceiling, and changes in colors.
Jane’s father managed an estate whose present and long-time owner had inherited
it, along with substantial holdings elsewhere, from her husband, whom she had met
when as a young self-supporting woman she had nursed
COSMIC LAUGHTER : A STUDY OF PRIMITIVE SPLITTING 429

him through an illness. She occupied the main house little more than three months a
year, and Jane’s family had all the resources of a lavishly equipped farm at their
disposal much as though Jane’s father were himself the owner. The arrangement was
one of long standing, since Jane’s grandfather had been the manager before his death,
and his son had lived on the estate since he was five years old. Jane felt a sense of
unreality, however, as she noted the class and role differentials that came into focus
when the real owner was in residence and Jane’s mother lapsed from being the
“queen” into being perforce a “lady-in-waiting” at the beck and call of the owner.
At the time of their marriage Jane’s father was in his late twenties, her mother only
seventeen. The couple’s first child, a year and a half older than Jane, had a congenital
heart-lung deformity and died in her mother’s arms on the way to the hospital when
Jane was a year and a half. The mother had experienced great anxiety over the frailty
of the first child, and was unable to grieve over its death and unable to mother Jane
adequately. (She later had two sons, three and seven years younger than Jane,
respectively.) Moreover, while she was nursing Jane she had a breast infection. The
first dream Jane reported in her treatment was one of being fed a huge bowl of
oatmeal, falling into it, and starting to choke before her anxiety awakened her. She
had had temper tantrums during the anal phase of her development; her mother had
laughed helplessly at them, unable to harness the little girl’s aggression. As Jane
grew, her more differentiated parts related to external objects as other than self-
representations, but the core of relationship to objects on the “symbiotic” or “early
separation-individuation” levels (Mahler, 1968) remained unchanged.
When she was five, her father began to play sexual games with her. He would
show her his erect penis, make her touch and fondle it, and he would kiss her genital
area; there was no actual intercourse. Their “secret” at the oedipal level resulted in
Jane’s regression and aided the preservation of the earlier symbiotic core and kept
alive the primitive object relationships. The incestuous relationship continued until
the patient had her first menstrual period at which time Jane’s father approached her
in her bedroom and kissed her breast so hard that she screamed; her father never
touched her sexually again.
As a teenager she aspired to a marriage that would bring her wealth and social
position; in this goal she was an extension of her mother, and reflected the example of
the estate’s owner who had married so successfully. Her mother encouraged her to
shine socially, but social climbing was hard for her. She was sent to a college
traditionally acceptable to wealthy Southern girls, but had to wait on tables to meet
her expenses; she raged silently over this necessity. Her acute psychosis appeared a
few months before she was to have graduated.
430 TACTICS AND TECHNIQUES IN PSYCHOANALYTIC THERAPY VOLUME II

THE TREATMENT
Jane’s treatment lasted for six years and a month, during which time she was seen
four times a week, except for a six-month period at the end of the first year when she
was out of town finishing her requirements for graduation and could come to therapy
only twice a week. Throughout the first 16 months she was admitted to the hospital
from time to time for brief stays. However, I saw her in my office except for one or
two occasions when she was too violent to leave the ward and I saw her there.
After she graduated from school and we had completed a year and a half of face-
to-face work she switched to the couch; we were able to establish a psychoanalytic
relationship and in due course to arrive at termination.
At first she declared that she was “empty,” and complained of losing her identity.
She reminded me of a silent kitten who would become a bloody tiger at times,
physically harming herself or others. For a year she talked endlessly about dreams
and fantasies of detached nipples, penises, and breasts. Bulls, horses, wolves, and cats
appeared in her fantasies and dreams as devouring and bloody creatures, to be
followed suddenly by objects that were soothing. She described all objects, animate
or inanimate, as either “benign” or “aggressive.”
While she was returning to her school during the six-month period she kept
making “mental snapshots” of me during our sessions in order to “keep in touch”
with me while she was away, and to be able to tolerate her life at school and to study.
After graduating she lived in the home of her parents and began going about with a
psychotic young man with transsexual tendencies whom she had met in the hospital.
On one level he represented her own split-off and degraded self-image; on another,
she saw herself as his “savior.”
After initially reacting to the couch with increased helplessness, she gave evidence
that her thought processes were becoming better organized and her primitive splitting
more crystallized. The head nurse of the hospital ward on which she had spent so
much time became an “all-good” mother, and I was perceived as the “all-bad”
mother, at times being condensed with “the devil” — the all-bad father. At the same
time, after the transsexual left town, she tried to carry out her mother’s unspoken
command by dating a young man with “credentials,” who took her from one
humiliating event to another. She was able to deny her humiliations in order to be
ready to go out with him again. Her past experiences with him were not integrated
with present activities and expectations. Two years after her treatment began she
found employment as a secretary to a surgeon.
In her repeating dreams her father’s sexual attacks on her continued while the
“noncaring,” almost paralyzed mother watched without interfering. Then the nature
of her dreams underwent subtle alterations, and Jane made attempts
COSMIC LAUGHTER : A STUDY OF PRIMITIVE SPLITTING 431

in them to protect herself from being attacked. Shortly after this an event in the
external world had a significant influence on me and my patient. One of my small
children was in an automobile accident and had to be hospitalized for some months
because of a leg injury. As luck would have it, he was seen in the Emergency Room
by the surgeon who employed Jane, so she learned of the event in the course of her
work. She regressed, and in the transference I became the grieving mother who was
concerned and waiting for the death of her first child as she withdrew her “breast”
from Jane herself. In a gesture of saving the early mother-analyst she brought peaches
for me to eat. She attempted to put them in my parked car at the hospital, and, finding
it locked, temporarily broke with reality, connecting a widely publicized recent
disastrous earthquake in Turkey with a view of me as an undependable, shaky,
Turkish analyst-mother. I was now a “bad object” and the “boy with credentials” an
“all-good object.” She denied the reality aspects of the young man until he
unexpectedly married another girl. This event had a shock effect. She had to keep me
as “all bad”; her family, which could not give her emotional support at this time, was
“all bad,” also. She was unprepared to find an “all-good” object to soothe her. It was
then she experienced her cosmic laughter episode, in which laughter burst from an
oyster-colored cloud that represented the breast. Analysis indicated that she was also
responding to the genetic aspect of her experiences at her mother’s breast — its
presumably sudden withdrawal from the nursing infant because of the pain of
infection. With the help of interpretation she tolerated the generalized primitive
emotions that stemmed from this experience. The ego was strengthened because
primitive emotions were faced, and the need for splitting lessened. Energy previously
used for the mechanism of primitive splitting was thus freed.
The next step was Jane’s physical separation from her parental home, a few months
after the experience of cosmic laughter. Her move to an apartment of her own
represented intrapsychic separation from the symbiotic mother. The symbiotic tie to
her mother was represented by the family cat, to which Jane referred as “my root into
my mother.” She submitted it to veterinary treatment she suspected would prove fatal,
and went into genuine grief reaction when it died.
She began to exhibit “adult interest,” speaking of current community affairs and
public issues such as the war in Vietnam. Her father’s sexual attacks upon her in her
dreams came to an end when in one of the dreams she said “No!” to her attacker
instead of waiting for her mother to come to her rescue. She befriended one of her
brother’s friends, and they fell in love “like two teenagers.” I became again “an
intruder.” The remnants of primitive splitting continued, but now she could relate
with ambivalence to me, to her boyfriend, and to others.
In the fourth year of her treatment much of the work focused on her
432 TACTICS AND TECHNIQUES IN PSYCHOANALYTIC THERAPY VOLUME II

ownership of a penis and the anxiety of giving it up to become “a perfect woman.”


She dreamed that she was lost in a forest with her boyfriend when they came upon a
turbulent river which she could cross to reach a peaceful shore, but he could not. She
separated from him in reality and went into a stormy grief. She was now ready to
look for a man instead of a “boy” like the companion she had left behind.
When she gave up her “penis” she wanted to be the analyst’s mate, to bear his
children. A tolerance of affectionate feelings, particularly toward men, slowly
appeared. She perceived me as an ideal and perfect man; this perception was
punctured by the interpretations I made. She left her secretarial job and became an
elementary schoolteacher after taking further qualifying studies. This behavior
evidenced her identification with her analyst, a teacher in a medical school. She
became a very good teacher.
A generalized grief over the termination of analysis anticipated it. In the
termination phase she briefly “visited” her primitive splitting to mend it once again.
In one of her dreams she faced a dangerous convict who represented her previously
untamed aggression, and “tamed” him. In the last hour of therapy she spontaneously
recalled her experience of cosmic laughter. She spoke of the Cheshire Cat in Alice in
Wonderland, and how its grin had faded away. It was this way with her cosmic
laughter, she explained.

Follow-up
I saw Jane briefly six months after the termination of her analysis. She
unexpectedly appeared in my doorway, explaining that she had come to say goodbye
before leaving town to begin life anew in a distant city where she had secured an
excellent position. During the next two years I had a few letters that spoke of her
doing well, and two years and a half after ending analysis she married a very suitable
young man.

Cosmic Laughter
Preoccupation with Laughter
During the first two years of her treatment, especially during her disorganized
moments, Jane expected to hear my laughter. This expectation, as her treatment
progressed, was understood in relation to her mother’s laughter as it appeared in one
series of Jane’s repeating dreams. In these dreams she sat in the middle of a circle of
chairs, all of which were empty except for one occupied by her mother, who laughed
helplessly while her child made convulsive gestures. In her analysis I came to
understand these dreams as Jane’s attempt to convulse out of the symbiotic core. The
laughter was the grieving mother’s discharge of tension brought about by her
helplessness. Grotjahn’s (1972) formulation concerning laughter may be usefully
applied to Jane’s
COSMIC LAUGHTER : A STUDY OF PRIMITIVE SPLITTING 433

preoccupation with laughter in the early mother-child relationship. Grotjahn stated


that:
The customary Freudian interpretation about the sudden release of dammed-up hostility,
combined with some form of infantile pleasure, the saving of repressive energy, symbolic
disguises and social acceptance, the release of no longer repressed hostility and the final
liberation of this repressive effort in laughter remains valid.
He adds, however, that, “the symbolism of introjection and extrojection can help to
interpret the specific unconscious symbolic significance of the act of laughter.”
Laughter, especially the explosive kind Jane expected to hear, might be in the service
of releasing the bad introjects; in Grotjahn’s words — one lets the cat out of the bag.

Events Prior to the Cosmic Laughter Experience


Four months before Jane underwent the experience of cosmic laughter, my small
son was hospitalized for some months following the automobile accident previously
mentioned. Jane sensed my distress although I did not convey it verbally; she
vacillated between temporarily identifying with my son and trying to assuage my
concern, feeling frustration in both positions. In the transference I became her mother
who was anxious with the fatally ill older sibling as she fed and cared for Jane, and
who suffered from a breast infection during much of the time Jane was at the breast.
Jane became fascinated with the pictures of cancerous breasts she found in medical
books. The sight of them made her feel disorganized and gave her headaches. The
introjective-projective relatedness to me was dominant. A primitive splitting of self
and object representations was reflected in this type of relatedness.
The events of several hours during the 1½ months before the cosmic laughter
experience will illustrate the cathectic shifts and changes reflected in the mechanism
of introjection and projection. Such shifts and changes must occur until it becomes
possible to tolerate ambivalence (Jacobson, 1964), and their excessive appearance
prior to the cosmic laughter experience indicates Jane’s inability to relate to objects
with love and hate simultaneously, and her reliance on primitive splitting.
Without conscious awareness that November 22 was the anniversary of John F.
Kennedy’s assassination, Jane announced, at the beginning of that month, that her
death would come about on that date.
November 3: She reported that “bad air” was trapped in her body. She wanted
someone to stab her with an ice pick so that the raging evil could escape. She heard
my voice saying, “Shall we start?” as an inner hallucination. I understood that she
had taken me in as a soothing object to combat the evil.
November 4: Jane reported a deadness within herself after the previous session. I
understood this as being possibly an autistic defense against the war raging within
her. She spoke of wanting to become a surgeon, in a demonstration of her desire to
excise the raging introjects and primitive self representations. Then she wanted to
murder me; this wish I understood as a possibility that a sadistic image was projected
on me, and that my annihilation was necessary for her protection. Lastly, she talked
about having written a letter to a local radio station requesting “good music.” This
seemed to indicate a wish for auditory introjection of good object representations to
combat the evil within.
November 7: Jane talked about having rearranged her furniture. I felt that the items
of furniture represented her self and object representations and that their
rearrangement was indicative of an effort to control the eruption of primitive affect
states.
November 8: I was “all bad” and she was panic-stricken. She spoke of wanting to
be fat. This I understood as a symbol of protection against internalizing the “bad”
image. She talked about a visit to the zoo and about snakes, alligators, monkeys, etc.
(animalized, fragmented, and projected self and object representations. The inner
world described by Kleinians also includes wild beasts perceived as very violent.)
November 9: Her muscles were filled with evil. She begged to be taken out of her
body.
November 10: I became a vulture. Jane saw “little people” on the floor.
November 14: I was again all bad. She reported dreams of people being killed.
November 21: She expressed fear of being robbed by her mother.
November 22: She expressed surprise that she had not died, and acknowledged that
this was the anniversary of the President’s death.
At the beginning of the next month I went away for a week, according to my
announced plan. On my return I found her denying aspects of my absence. The young
man who was so “socially eligible” and had the right “credentials” was invested with
primitive idealization. She hoped and believed that they would marry, and was
shocked to hear from her mother in the middle of the same month that he had married
someone else. It later appeared that it was at that moment that she heard the cosmic
laughter as an inner hallucination. She managed to withdraw from the experience,
only to have it develop fully as she lay on the couch next day. I found it significant
that Jane did not become fully disorganized at the moment of hearing the news of the
wedding and that she waited until the next day on the couch to respond to it. It was
evident that she brought the incident into the transference and the analytic working
through, so the experience she had was in the service of observing, tolerating, and
mastering this disappointment.
Description of the Cosmic Laughter
Jane began to stutter when she tried to tell me about the marriage of the “boy with
credentials.” She shook her head in violent negation as though she were using the
first symbolic assertion (Spitz, 1957, 1965) to arrest her overwhelming emotionality.
She clenched her fists as an infant does and tried to stop the shaking of her head by
pressing it between her hands. Her body seemed in torment; she made crying sounds
like an animal’s and seemed no longer to be human.
When she finally mobilized her early ferocious introjects she put a stop to what she
was doing by slapping her face and crying, “Shut up! Shut up!” Interestingly enough,
she reported that part of her had been able to observe the experience. However, what
she observed was not the logical connection between her emotional storm and her
young man’s rejection, or the rejection I had exemplified by my short leave from my
office. Through defensive regression she was expecting a nursing experience in the
transference, and I believe that what she observed was the symbolic representation of
the earliest frustration at the breast, the sudden transformation of a “good” breast into
a “bad” one, and that this was the earliest genetic root of her cosmic laughter
experience.
434 TACTICS AND TECHNIQUES IN PSYCHOANALYTIC THERAPY VOLUME II

Her explanation of what she observed was hard to follow. She offered to make a
drawing to explain it more clearly. In the accompanying drawing (Figure 1), A
represents Jane as seen through a higher level splitting. Because of this she was able
to observe and report her unique experience. B is also Jane, represented as a circle. C
is the “cosmic plateau,” which she perceived as a puffy, oyster-colored cloud in
which a window (E) appears. Over this window knelt an “omnipotent person” (D),
mischievous and teasing, with whom at times Jane merged and became
interchangeable. During the experience Jane felt that this omnipotent person’s
relationship with her self (the circle B) ceased abruptly, and that when it ceased the
omnipotent person broke into cosmic laughter that echoed in Jane’s mind long after it
had stopped. The past, the present, and the future converged in what was happening.
The omnipotent person seemed to Jane to speak or laugh through other people at
times — through her analyst, for example.

Associations
In telling about cosmic laughter she recalled: (a) having had similar experiences in
the first grade when the class had rhythmic singing and she would swing abruptly
from a happy mood into one of distress; (b) having been at church with her family
during the previous week, and being upset to learn from her father that she was sitting
where communion would be offered, since she had decided never to take it again; (c)
at the end of the hour she referred to certain Indian tribes where children are allowed
to go hungry, given the breast briefly, and then deprived again in order to frustrate
them and make it certain that they will develop into fierce warriors in adult life.

The Understanding of the Experience


Since the appearance of Isakower’s (1938) widely known report on patients who
recapture perceptually the experience of nursing at the breast, many other analysts
have observed this phenomenon in their own patients. In a recent paper (Volkan,
1973) I described the appearance of the Isakower phenomenon during the analysis of
a narcissistic patient who felt colored balloons filling his mouth as he lay on the
couch. This was described as a regressive defense, recalling Fink’s (1967) report on
the Isakower phenomenon as a regressive defense against other disturbing
recollections.
Related versions of the Isakower phenomenon are found in the dream screen
(Lewin, 1946, 1948, 1953), blank dreams (Rycroft, 1951), blank hallucinations
(Stern, 1961), and blank silences (Van der Heide, 1961). Garma (1955) and Sperling
(1957) reported the appearance in their patients of experiences at the breast,
condensed with other memories from a higher developmental level. Easson (1973)
recognized the Isakower phenomenon in patients under the influence of LSD or other
drugs.
COSMIC LAUGHTER : A STUDY OF PRIMITIVE SPLITTING 435

In Jane’s experience the cosmic plateau (C) may represent the mother’s breast. The
concepts of the Isakower phenomenon and the dream screen are related to Freud’s
assumption that the first object in life is the breast. Direct observation of infants
shows that . . .
... up to three months of life (and longer), a nursing baby will not look at the breast but at the
mother’s face. This is an observational fact. He does not look at the breast when the mother
approaches him, he looks at her face; he continues looking at her face while he has her nipple in
his mouth and is manipulating her breast. From the moment the mother comes into the room to
the end of nursing, he stares at his mother’s face. (Spitz, 1965)
Boyer (1956, 1960) observed that psychotics as well as babies watch their mother’s
faces and reactions as they feed. Elkisch (1957) and Greenacre (1958) wrote about
the significance of the face in the developing object relations. Searles (1963)
suggested that the therapist’s face has a central role in the symbiotic interaction. Such
observations made it necessary to modify the propositions of Isakower and Lewin;
the Isakower phenomenon and Lewin’s dream screen are not representations of the
breast, but rather those of the visually perceived human face. Spitz (1965) offered the
following modification . . .
. . . While the Isakower phenomenon is a reactivation of the record of early infant contact
perception . . . Lewin’s concept of “breast” actually is a code symbol for the totality of the oral
experience . . .
Almansi (1960) worked further on this modification, stating:
... on a primitive perceptual level the face may be equated with the breasts, and . . . there is a
particularly strong correlation between the nipples and the eyes . . .
Spitz refers to Stern’s (1961) finding it improbable that the Isakower phenomenon
— and, by implication, Lewin’s dream screen as well — might be a regression to a
blissful memory of a state of tension reduction and quiescence. Spitz continues:
On the contrary, he (Stern) advances the proposition that it is a regression to mnemonic traces of
deprivation in the same situation. This is a plausible idea even if for no other reason than that
experiences cathected with unpleasure are more likely to leave memory traces than those
cathected with the affect of pleasure . . . I see no objection to such an interpretation either . . .
what seems essential to me is the regression to the nursing situation. (1965)
In Jane’s drawing of the cosmic laughter experience the window (E) may represent
the nipple/eye above her, the circle (B) represent her mouth-self. Jane made other
drawings at a time when she said she was experiencing her “plugging stage.” This
occurred at a later time in her analysis when I had surgery and became for a short
time an unavailable mother. She felt empty then
436 TACTICS AND TECHNIQUES IN PSYCHOANALYTIC THERAPY VOLUME II

and in need of ‘‘having her batteries recharged.’’ These drawings added to my


understanding of the cosmic laughter experience. They show the orifices of the body
as electric outlets. Nipples are plugged into the body to supply needed energy. Breasts
are seen from the inside. There is anger and frustration on the face of the infant
recipient, who has secondary sexual characteristics. Her experience of nursing was
certainly not a blissful one for Jane as she recalled it symbolically in these pictures. It
is a matter of record that her mother had had infected breasts while nursing her, and it
is highly possible that she may have jerked her nipple away from the baby because of
pain, as I have indicated before.
The omnipotent person (D) in all likelihood represents the omnipotent mother with
whom the child sometimes fused. Although the drawing shows a stick figure, it may
represent the total mother as well as a part object. The cosmic plateau appears to be
the nipple, the breast, and the mother, or at least the mother’s reaction to nursing as
her facial expression reveals it. The laughter comes whenever the omnipotent person
abruptly terminates the relationship, and the affective response to it is “total
humiliation.”
In 1905 Freud stated that “the conditions for laughter are such that a sum of
psychic energy hitherto employed in the cathexis of some paths may experience free
discharge,” and Kris (1952) suggested that the word suddenly should be added to this
formulation, explaining that “the word is essential since it is precisely the ‘shock
nature’ and suddenness of the discharge which is the specific precondition of
laughter.” Jane used the word abruptly in telling about her cosmic laughter
experience and again in her associations.
It is quite possible that the mother may have laughed in an attempt to provide a
symbolic and socially acceptable disguise for the sudden release of hostility. I am
certain that aspects of Jane’s experience that derived from the oral level were
condensed with aspects from higher levels. The mother’s laughter has been
mentioned before in connection with the “circle of chairs” dreams; it represented the
discharge of the helplessness that led her to leave her child to deal with her temper
tantrums as best she could by herself during the anal and phallic stages.
In the last year of her analysis while talking about her fear of not finding a
husband. Jane had a feeling that cosmic laughter experience would return. This was
accompanied by dreams in which she felt “something” was dangling” before her. Her
associations indicated that the “something” was her father’s penis. He had “dangled”
it before her, but she, in actuality, never possessed it. In spite of her fears of her
father’s penis, she was disillusioned by not having it. Briefly, the phallic aspect of
cosmic laughter involved her perceiving her father’s penis being “jerked away” from
her; her primitive relatedness to the breast was condensed into the relatedness to the
penis. The interpretation of this stopped her fear that cosmic laughter experience
would return.
COSMIC LAUGHTER : A STUDY OF PRIMITIVE SPLITTING 437

Clinical Improvement
In examining the similarities between the dream screen phenomenon and Jane’s
experience of cosmic laughter, and in viewing the latter as a turning point for the
patient, I quote from Rycroft’s (1951) report that in analysis . . .
... the occurrence of a blank dream marks ... a turning point, namely, from a narcissistic state
toward a recathexis of the external world and a thrust in ego development.
Prior to the dream, Rycroft’s patient had related to him largely on the basis of
narcissistic identification. The dream indicated a shift of importance in the
transference relationship. Van der Heide (1961) indicated a similar opinion when he
held that the borderline patient’s blank silences not only are defensive in nature but
lead to clinical improvement. Boyer (1960), after observing the visual dream screen
phenomena presented by seven schizophrenic or borderline analysands, offered the
tentative hypothesis that dream screen experiences appear in therapy (a) when the
patient reaches a stage of development in which narcissistic identification is giving
way to true object relationships by means of transference; (b) when there is a threat of
losing the new object; and (c) when an event in the external world reminds the
analysand strongly of a severe childhood trauma that he interpreted as desertion by
the mothering figure.
The end result of the cosmic laughter experience resembles the kind of thinking
involved in the end results of what Wetmore (1963) called effective grief. He
described effective grief in the unique ambiance of the psychoanalytical situation as
different from the working through of ordinary day-to-day grief described by Freud
(1917). He hypothesized that . . .
... the child cannot grieve effectively, and therefore cannot relinquish the earliest essential object-
relationships. This means that the repetition compulsion must continue in full command of the
personality until the time when the ego discovers that it can tolerate the postponed separation
anxiety, and, so strengthened, can face the work of grieving. . . . Effective grief-work results not
only in giving up the object, but in a deintensification of the drive which determined the person’s
neurotic attachment to the object. The libido is not just transferred, but the inherent quality of the
attachment is changed.
As already described, the events in the external world — the loss of the loved
boyfriend at the time the analyst was representing an “all-bad” object — defensively
resulted in regression to the experience at the mother’s breast. However, because of
the mother’s grief and her infected breast, Jane’s experience of nursing at her breast
had been traumatic for her. Nevertheless, as Rycroft (1951) suggested concerning the
appearance of the dream screen in analysis, the cosmic laughter experience
represented for her a reestablishment of object relationship with the nursing mother in
the course of her transfer-
438 TACTICS AND TECHNIQUES IN PSYCHOANALYTIC THERAPY VOLUME II

ence. Furthermore, cosmic laughter represents the eruption of primal feelings


connected with libidinal and aggressive drives, occasioned by the sudden changing of
the mother’s breast (the analyst) from a gratifying object to a nongratifying one.
Because the analyst remained calm and maintained an analytic attitude, Jane’s
nursing experience on the couch was not a mere repetition of something from the
past. Through her identification with the analytical attitude her ego could now
tolerate the tensions and emotions from which her primitive splitting had previously
protected her. The reestablishment of relationship to the nursing mother in the
transference thus had a corrective influence and enabled her to start essential changes
in her relatedness to objects. The tolerance of the primitive feelings in analysis
accounted for the reduction of need for primitive splitting and Jane’s progress toward
ambivalent relatedness to objects, as well as her increasing ability to mend
contradictory ego states instead of regressing to an autistic position. Kleinians may
refer to this process as moving from a paranoid to a depressive position and reaching
a “crucial juncture” (Klein, 1952) for the choice of neurosis or psychosis.
In the usual course of treatment the reach toward the “crucial juncture” is gradual.
In Jane’s case the dramatic and sudden experience of cosmic laughter, precipitated by
external events, was quickly followed by actions on her part that represented an
energetic attempt to break off symbiotic ties with her mother. Thus Jane’s experience
of cosmic laughter is consistent with the remarks of Rycroft (1951), Boyer (1960),
and Van der Heide (1961) suggesting that the appearance of the dream screen of
blank silence leads to clinical improvement.

SUMMARY
It has been suggested in the psychoanalytic literature that the appearance in
analysis of the Isakower phenomenon and/or the dream screen phenomenon may be
an indication of clinical improvement besides serving a defensive function. This
paper describes a patient’s unique experience, which she called “cosmic laughter,”
that occurred in her defensive regression, and relates how it led to the
reestablishment, in the transference, of her nursing relatedness. It is demonstrated that
during her cosmic laughter experience the patient felt and tolerated primitive feelings
from which her primitive splitting had previously protected her. Thus the need for her
to use primitive splitting was reduced, and her progress toward the capacity for
ambivalent relatedness promoted.

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