**7. Vignette from an analysis from an adult patient Mr. a**

Mr. A is a 46 year old psychologist. He is in his second analysis because his first analyst was too ill to continue (Mr. A. still idealizes him). He is married for the second time to a warm and caring woman. He has a son with his first wife, a two-years-old son with the second wife and just got a new baby. He behaves as if he has no idea about insight, projects his omnipotent destructiveness into me and judges me from a moral high-ground. Often my words are felt as an attack and then he complains, he dismisses a shared responsibility. If I try to show him the situation of his ex-wife he accuses me of feminism--taking sides with women against men. Sometimes when he exposes his vulnerability and dependency he feels exposed. When I stick to the rules of time and fee – although I reduce it twice to make it possible for him to continue – he can accept them as strict but fair.

When his third son is born he is relieved and happy. It was a spontaneous birth, he is a robust baby—not as delicate as the second one. At the end of one session he says: "Maybe Prof (meaning me) was correct that the baby could develop well because I brought my aggression into the sessions." On the following day he relates a dream he had after mentioning the worries he had had at birth of his baby because the umbilical cord was during the delivery around the baby's neck, making a knot so that it could not be tightened.

P: (After a pause) I had a dream which is connected with yesterday's session, I think. (He says it in a superior way as if he knew everything already and lets me know he does not need me to understand his dream). (Before he starts to tell the dream he goes into the details of yesterday's session for 15 minutes. I become irritated and impatient but do not interrupt him). I felt abandoned by you.

*The dream is in my analytic session, you and I are there but the room is much bigger-- 5 to 6 times as large (my room is rather spacious), really big and with impressive furniture. I come in and then I see at the entrance two workers decorating the entrance. A baby is lying on the floor. One man passes by and kicks the baby a bit without doing it on purpose. Then the second worker puts his large foot on the baby and presses hard, he even turns his foot on the baby's chest. I go to him and shake him and pull him away telling him what he is doing. Then I walk in. It is very beautiful and impressive. I am speaking and suddenly you get up and without an explanation you leave the room. I do not know what the matter is. Then Dr R. walks in and sits down on your chair and listens. I talk until the end of the session. (Pause)*

(He continues) I understand the dream that it is my wish that you leave because you did not understand me yesterday and I felt abandoned. Dr. R. has always impressed me and a colleague who is in analysis with him spoke quite freely on how he is as an analyst.

A: You come in and tell me that you felt bad yesterday, abandoned by me and today you told me how tired you are not getting enough sleep … In your dream you show how you feel what you cannot feel during daytime--that you feel left behind

#### *Is the Death Instinct Silent or Clinically Relevant? From Freud's Concept of a Silent Death… DOI: http://dx.doi.org/10.5772/intechopen.94444*

by me, by your wife who is looking and breastfeeding the baby. In the dream I go away and let you be with another analyst who does not refer to the early years of life (Dr R is a Lacanian psychoanalyst).

P: That I am jealous of M (new baby) I cannot feel in any way. What I can see is how much work it is to look after two small children and my mother had 5 children, my older brother, my older sister, myself and the new baby and while she was breastfeeding she became pregnant with the youngest sister. When I spoke with my mother on the phone she said we should look after the older son so that he does not feel rejected. Respect! She can think about the older boy.

A: You are glad that I can look at the child part of you who feels rejected and left behind as your mother does. And can we have space to think about the two workers and what they are doing with the baby, first by accident and then on purpose hurting the baby?

P: Naturally this must be a part of me, I am the dreamer like the director of the dream, the author. I know this although I cannot feel any aggression towards the new baby M. I use this understanding when I interpret my patients' dreams and it is very helpful.

A: It is easier to see it with other people than when it happens inside you.

P: Yesterday I observed how my wife's attention was distracted when she breastfed M … I told her: Do not you realize that M is disturbed? She said: It's just a minute.

A: You describe how sensitive you are and how you can understand M's situation and another part of you feels terribly neglected and angry. And can you allow this angry part to become visible?

P: **You** are talking about murderous impulses!

A: When you say: 'I am talking about murderous impulses and not you' you show that you find it is difficult to keep in mind that it is your dream. You dreamed about the two workers putting their feet on the baby – expressing your unconscious phantasies. When you are awake you are shocked and want to push this aggressive impulses into me - you want me to be the author of this aggression: they should not show your wishes.

P: Sometimes I do feel tired because of this constant feeding at night. My wife told me to sleep in another room to be able to get some sleep, because I cannot help her with the breastfeeding anyway. But I cannot do it, I stay with her.

A: You cannot leave the two of them alone--you want to control what they are doing at night.

P: (laughs) To control them – well, I let them be together the whole day when I am working.

A: When you laugh you allow yourself to take the analytic breast and take my words in and it calms you. Now you felt understood and this dreaming part is glad to have been listened to.

P: I feel different now.

The **following day** he says: "Yesterday the session made me feel calm"…

A: Yesterday's session you felt you could get in touch with me for a moment and accepted what I offered. The part of you who wants to know and expresses himself in dreams, wanting to understand yourself, opens up sometimes.

P: Indeed-- and this only happens after a session with fighting, conflict and arguments. The image I was thinking about was the picture of the two workers who kicked the baby hard. I do not feel anything corresponding to it, no jealousy, and no anger towards M. In the dream I took the first one on the shoulders and pushed him away. It is hard to believe that this worker is really a part of me, of my wishes. But when I work with my patients and know how to interpret it I have to accept it in my dream as well even if I cannot feel anything.

A: You can see how difficult it is for you to see these primitive and murderous wishes in you. In your dream you were successful in pushing the two workers aside so we can assume that inside you have a part which does not to let you really harm the baby. This only happens in your fantasy and not in reality and this calms you. And you said how good it felt to be able to talk about it with me and that I can accept it.

#### **8. Discussion**

The patient struggles to accept his unconscious murderous wishes expressed in his dream by the two aggressive workers and his jealousy against his new baby M. which he also dearly loves. He is used to dealing with his aggression and destructiveness by projecting it into others, first into his first wife when he blames her for the problems of their son. He allowed his former wife to be sadistic and did not stand up against her. He could not manage it. He cannot think about his contribution to the problems of the marriage or the difficulties of his first son. Now he is married to a warm and sensitive woman. Mostly he holds on to his pompous superiority. In the session I described, he is enormously agitated and reveals himself in a puzzling way: he has a new baby but behind his pride and joy of having a new baby he feels burdened by it--it is another mouth to feed. He is struggling to earn the money for his living and his analysis. Does he know that he is fighting against the wall struggling with the new baby? Can he differentiate between his outer and inner reality? He himself is a disturbed baby with unbearable guilt. He cannot see how difficult he is and he successfully projects his anger and alarm into his analyst – I have the murderous thoughts, not he, he says at first. He can use his ability sometimes in a touching way, it is a real struggle for him to get to know himself. He makes slow progress. In his dream his aggressive fantasies are expressed by the two men. Can he accept this part of him? Sometimes he can use his abilities and have insights. He has to put himself in my position – he as the therapist – then he can understand the meaning of the dream. He has to gain enough perspective to distance himself from his dream in order to see his destructive part.

He has got this lovely baby – strong and robust – but it stirred up so much rage and hatred. He felt he did not get sufficient understanding and support/containment from his mother and hardly can accept my help. He wants to see himself in a manic way as somebody who makes wonderful babies and is hardly able to accept himself as a disturbed man desperately clinging to his analyst/mother. As a baby he could not let go of the breast so his mother – after she had another baby – also allowed him to drink from her breast until the age of three, which made him feel guilty.

He chose me as his analyst because he thinks I am a Kleinian who is not afraid to see and deal with his primitive, dark sides, understanding the "two strong workers" as parts of him. Finally he can integrate his love with his aggressive, jealous feelings. When I asked his permission to use his dream in this paper he answered, that he remembers this dream vividly and also his strong resistance against my interpretations. He used the opportunity to tell me how well his life and his family had developed and thanked me for his analysis "which had been the greatest enrichment in my life and professional development."

#### **9. Final remarks**

In these three vignettes, it becomes clear how variously the death instinct is manifested—with Felix' Infant Observation as woeful cries, with fingers pressed into fists that we understand as the fear of disintegration or of death; with Patrick, chaos rules his interior life, with his great fear erupting in attacks of screaming or weeping

#### *Is the Death Instinct Silent or Clinically Relevant? From Freud's Concept of a Silent Death… DOI: http://dx.doi.org/10.5772/intechopen.94444*

as well as nightmares, and his destructivity and cruelty projected "successfully "onto his father—to whom he has established a sadomasochistic relationship which excludes the mother, who is "dead" in role playing; with Mr. A., his murderous rage is pushed onto the analyst through massive projective identification and he remains as a nice, protective father of his baby. The analytic work consists in containing these unbearable impulses, digesting them emotionally and mentally and rendering them discussable. Felix' mother was able to take up the feelings projected into her through "reverie" (Bion) or "primary motherhood," to digest them and ameliorate his fears through her loving attention, so that Felix could ultimately move about happily in the water. Only through recognizing his psychic pain could Patrick work through his painful experiences and establish a loving relationship to his parents, integrating his aggressive impulses and using them to develop a new independence. His mother takes Patrick seriously now as an independent child, whose various wishes she can understand and help him to deal with and solve conflicts without manipulating him. Mr. A can recognize his "baby part" and finally integrate it. His massive jealousy and competition from his childhood is worked through transference to his analytic "siblings," so that his great emotionality and care for his family and his patients become visible. We can see how this competition can be constructively solved or lived by his youngest son M., for whom Mr. A is a loving father. At the age of two, M starts a special ritual: he leads his father and his older brother in the morning to the front door as if he were the head of the house and says goodbye to them there, remaining as the man of the house behind with his mother. He then proceeds to be a very good, loving child all morning. The following little episode shows how well not only Mr. A but his son managed to integrate contradictory feelings:

*When M. was four years old, his father came home one evening, greeted him and asked what he was building with his blocks. The son replied enthusiastically: a castle for himself and for his mother. The father, who had never been convinced by the concept of an oedipal phase, reflected and then asked where he would live then. The son thought seriously for quite a while and said: "In the garden there is a little house—you can live there! "This constitutes a mature emotional accomplishment, granting the beloved father and rival a space.*

Hannah Segal describes the conflict between the life and death instincts and the way the individual can respond:

*"One, to seek satisfaction for the needs; that is life-promoting and leads to object seeking, love, and eventually object concern. The other is the drive to annihilate: the need to annihilate the perceiving experiencing self, as well as anything that is perceived." ([12], p. 18)*

Mr. A was able, after working through his repressed aggressions, experiences of humiliation and feelings of abandonment—which he projected onto others—to use his life-affirming object relations in his family and profession.

There is still a controversial discussion concerning its philosophical status and its clinical usefulness. Michael Feldman however points out – and I agree – "that the gratification of this psychological drive does not lie in the annihilation of the perceiving and experiencing self, or indeed in literal death or annihilation. On the contrary, what is often clinically more compelling is the extent to which certain patients, rather than seeking to annihilate their perceiving selves, attack and distort their capacities for perception and judgement…The aim seems to be largely, but not entirely, to eliminate anything that gives rise to admiration, dependence, rivalry and, particularly envy." ([24], p. 97f).

When the patient then holds on to illness and suffering, Feldman considers this not to be a derivative or compromise, "fused" or "bound" with the life instinct, but "a direct expression of a primary destructive drive towards the self and the others" (p. 98). The means to achieve this are distorting the words of the analyst, a fascination in omnipotent destructiveness, distorting the meaning and value of the analytic work. A shift can be brought through the patient becoming more able to acknowledge and tolerate his awareness of his own hatred and anger. Mr. A can hardly agree to an interpretation but does think about it between the sessions and bring it back as his own insight in the next session. The occurrence of curiosity and the wish to know and understand himself indicates a movement towards the life instinct. As Bion puts it in his article "On arrogance" (Bion 1957, p. 86–92) "when pride appears within an individual who is dominated by the life instinct, pride becomes self-respect, but if the death instinct predominates pride then becomes arrogance. These arrogant dismissals of the analyst's interpretations can undermine the ability to care for the patient and stir up anger in the analyst. Brenman describes his dealing with the angry countertransference by reminding himself "how ill the patient is" ([25], p. 105). If we discover with the patient how he became the character he/she is and why he behaves in this particular way, being a victim of deprivation, loneliness and deal with the emotional pain of his earlier traumata he can recover the good inner object. "The good object … is the combines (intimate) relationship of the infant and mother and the subsequent development extending to other object relationships, in which persons give personal meaning to each other… nothing can be meaningful without this foundation," says Brenman [25].
