Clinical implication
What Freud referred to as the “foretaste
of mourning”(1916) is the ideas and sensations that we tend to avoid in our mental
life. As Freud later abandoned the idea of thorough mourning that he initially appeared
to have insisted on his “friend” (1916) we can only transiently accept the fact
that we might eventually lose what we currently possess, including our own
life. It might also be true that for most of us only by pushing aside these
unacceptable thoughts we live our daily life without overwhelming anxiety. If
there is any place where we are reminded of them, it should be in the analytic
space, where our defense is to be under scrutiny for the purpose of better
knowing about ourselves. Of course, what is pushed forward in our consciousness
can be pushed back again, and this constant and fluctuation occurs when we get
in and out of our analytic frame of mind.
Within this context, I have been having a difficulty
working with patients with persistent suicidal ideation. Although I do not feel
comfortable giving them any impression that I am actively encouraging them to
pursue their idea, it often happens that if they feel that I avoid discussing
the matter in a straightforward way, they no longer want to discuss their suicidal
plan and move on with their own plan of executing it. Some of these patients had
changed their therapists each time they felt that their therapists are avoiding
the discussion of the very matter, and they found seeing them meaningless.
I particularly remember one of my early cases, Mr. A, a
middle-aged man who was severely depressed with suicidal ideation after his
wife left him suddenly. He lost his job and got hospitalized for his serious
wish to kill himself. Although this event occurred five years before my fist
meeting with him for the analysis, he was still suffering from the emotional
pain, despite that he regained a full-time job as a driver and he was
apparently well adapted to the society. He stated that his life is never the
same and he was “just living”, without any particular hope or purposes in his
life. He is driving daily on his job, but he never wore a seatbelt and allowed
himself to drive recklessly, which he meant as a way of passively attempting to
kill himself.
Mr. A’s wish to live practically disappeared after he
was forced by his ex-wife to sign the divorce paper. For him, it was enough to
lose his purpose of life, at least to himself. If a woman who swore to God
never to leave her husband and stay together until “death do them part” but
decided to abandon him for another man so quickly without any explanation, what
else could he believe. However, Mr. A was also puzzled by his own rather
extreme response to this abandonment, as he had some experiences of separation
and abandoning and being abandoned with his ex-partners. Mr. A was at a loss
why this divorce meant something totally unexpected and meant such a harsh blow
to him.
In our analytic sessions, I keep listening to Mr.A’s
various plans of killing himself, which was enormously varied in terms of measures,
locations and timing of executing it, besides not wearing a seat belt. Gradually
his suicidal ideas became mingled with his strong urge to harm or kill his
ex-wife. He stated that he tried to avoid any information about his ex-wife, as
anything related to her might prompt him to come up with a detailed plan to
take revenge on her. At least some of his suicidal plans were revealed to be those
initially directed toward his ex-wife, then turned to himself.
In the analysis his severally devalued sense of self is
understood and processed, which was rooted deeply in his relationship with his
mother. His ex-wife reminded him of some aspects of his mother, at least on an
unconscious level. When he got married, he felt that he can develop some
fantasy of reunification with his mother, or even that of a return to the womb.
A couple of years into our analytic process, he slowly gained his wish to
continue to live. He began wearing his seatbelt while driving. When he began
his work with me, the length of the analysis for 3~5 years appeared to him as
almost an indefinite period and began our analytic journey with much interest.
Mr.A was a highly intelligent man with three bachelor’s
degrees of science. He was fascinated by quantum physics and his accounts of
various topics also fascinated me, such as “Schelinger’s cat” and newly budding
theories of “quantum entanglement”. Mr.A regained his interest in scientific
reading, and read avidly while I was on vacation to my home country.
It turned out that there was a strange coincidence in
our relationship, as my home country (Japan) is where he spends a couple of
years when he was small while his father was working for one of the navy bases
in Japan. We happened to have spent our youth very close-by on the other side
of the globe long before in our analytic relationship.
Four years into the analytic process, he found a
partner that he believed that he can restart his life again. That period coincided
with our discussion of our termination within a year or two. In a sense, his
seeking a new relationship might have been his own way of dealing with another
potential blow to his life.
Many aspects of Mr. A’s life were highlighted and
discussed during our six year period of analytic work, until we began discussing
the issue of termination, which meant something special for both of us. Mr.A learned
by a grapevine that I would leave this country for good soon after our
termination. I acknowledged that I was about to leave the place where I spent most
of my professional life. My going back to my home country without any plan to
come back practically means that we would never see each other in our life. I
was considering this small city as my second hometown, and once I leave here,
my friends and colleagues would feel that I am gone forever, like a dead
person. I felt that I was in a limbo situation between life and death, and that
strange sensation might have some impact on our analytic process.
Mr. A stated that through the analysis I gave him some
reason to live, and it is strange that the termination seems to mean something
of a grief process. As we talked on and off about our separation, it might mean
that we have each other’s image in our mind and live together for the rest of
our life, as it is easy for both us to put the other in a place that we once
spent in the past, for me in the small town, and for him the American base
near-by.
After I returned to my home country, I received a mail
from Mr. A. He stated that he got exhausted of his relationship with C who grew
more and more emotionally clingy to him. He was very amazed that he found
himself in a position of saying good-by to his partner, something that he
dreaded being done to by his partner again. I felt that Mr. A’s saying goodbye
to C meant also that he has mostly done with his grief work from our
relationship.
Twenty years
have passed since our termination and I have never heard of or about Mr.A ever
since. I never gave him any communication, including any greeting messages. However,
in my mind he is not absent, but rather a present with full potential. He could
be both alive and dead and unmarried and married at the same time, like the “Schlesinger’s
cat”. He might have no idea if I am still alive or not, but I hope I am still
living in his mind at its fullest, despite, or rather because of the lack of any
information about myself. In a sense we keep our “anonymity” to each other so
we can enlarge our transference-like fantasy, “after the fact (après-coup)” (Freud,
1895a, 1895b, 1918).
Freud,S (1895a) A
Project for a Scientific Psychology.
Freud,S (1895b) Studies
on Hysteria.
Freud,S (1918) From the History of an Infantile Neurosis
