死生観と儚さ 6

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

解離と他者性 ３

EPは本人を保護しているのだ」という言質の生む誤解と攻撃者の内在化の真の意味

解離性障害のエキスパートが書いている内容で、しばしば誤解を与える内容がある。それは結局は黒幕さんは自分を保護しているのだ、という言い方である。なんとこれが誤解を生むのだろうか。他者とは得体のしれない存在なのに、どうして自分を保護しなくてはならないのであろうか。私にはどうも黒幕さんは、外部から、いわばよそ者として入り込んだように思える。

Although this may not be initially apparent, most of the time the angry parts and those modeled after the abuser all function protectively at the deepest level. These parts live in the past and they are protecting the person from behaving in ways that would have been dangerous in the past. (P.62).

そして彼女はある例を出す。Eという黒幕人格を持っていて、自分は全能で主人格のことを生きる価値がないと考える。そこで　

'I bet you were very much able to make her behave perfectly in that family of hers. She should be very appreciative for all the help you gave her. I think she really needed your help."（「あなたは主人格が家で完璧にふるまえるようにできるでしょうね。彼女はあなたに感謝しなくてはね。」） するとジャニスの返事は、 "Yes. I was pretty good at that. But she is still just a piece of crap and deserved everything that she got.そうよ、でも彼女はその様に扱われるだけのダメ人間だわ" But soon afterward, she was able to appear protectively in situations when the patient was the object of someone else's aggression. In time, the patient was able to recognize simply that she was angry without E's appearance.主人格はピンチな場面で黒幕さんに助けられ、そのうち黒幕さんがいなくても怒りを体験できるようになる。しかし黒幕は全然保護的でない場合もある(Blizard, 1997; Bryant, Kessler, & Shirar, 1996; Rosenfeld, 1971)。Howell 先生はその様な場合もしっかりあることを認めて、犯罪行為を働いた黒幕さんがいる患者さんに自首することを勧めたと書かれている。Working with these parts is much more difficult. Curtis (1997) reported on a patient with whom he had been working who had a psychopathic part who committed a serious crime. Since the whole of him was not psychopathic, he reported this to his therapist and then turned himself in to the police.

Howell さんは、」「黒幕さんたちは結局は主人格の味方である」と言う一方的な見解に陥っていないという点は頼もしい。しかしやはり力動的、防衛的な考え方がその基礎にあるようだ。

死生観と儚さ 5

Many aspects of A’s life were focused and discussed during our analytic work, but the issue of our termination meant something special for both of us. As I communicated to A that soon after our termination I would leave the country for good, we could not think of the issue totally outside of the context of our destiny and transient nature of and our own mortality. I was about to leave the place where I spent for more than fifteen years. My going back to my home country without any plan to come back practically means that I would never see A personally for the rest of my 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 deceased 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. 
 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 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 A’s saying goodbye to C meant also that he has mostly done with his grief work from our relationship. I have never heard of or about A ever since. I never gave him any communication. In my mind he is both alive and dead and unmarried and married at the same time, like a Schlesinger’s cat. I never know if he is still alive. He might have no idea if I am still alive or not. In a sense we keep our “anonymity” to each other so we can enlarge our transferencial fantasy after the fact (après-coup, Freud).

死生観と儚さ 4

　I particularly remember one of my early cases, A, a middle-aged man who was severely depressed with suicidal ideation after his wife left him suddenly. Although this event occurred 5 years previous to my fist meeting with A for the analysis, and A was on a full-time job in the medical area, he stated that his life is never the same and he was “just living”, without any hope or purposes in his life. He is driving daily, but he never wore a seat belt and drove recklessly, which he meant as his own way of passively attempting to kill himself. A’s wish to live practically disappeared after he was forced by his ex-wife to sign the divorce paper, and for him, the reason for his pessimistic view is obvious. 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 without any explanation, what else could he believe. However, 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. A was at a loss why this divorce meant something totally unexpected and meant such a harsh blow to him.

　In the process of 6 years of analytic process, he slowly gained his wish to continue to live. He began wearing his seat belt while driving. 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 is allowed to develop some fantasy of reunification with his mother, or even that of a return to the womb. 　When he began his work with me, the length of the analysis for 3~5 years appeared to him as almost an indefinite period. 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. 

死生観と儚さ ３

What Freud referred to as the “foretaste of mourning” is something that we keep avoiding all the time. As Freud later abandoned the idea of thorough mourning, we can only temporarily or 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, or putting it in our pre-conscious, can live our daily life smoothly and safely. 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 becomes off guard should be guarded again and the fluctuating nature of going back and forth characterizes our life.

Within this context, I have been having a difficulty working with patients who have persistent suicidal ideations. 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 I avoid discussing the matter in a straightforward way, they feel it and they no longer want to discuss the matter. Some of these patients changed their therapist each time they feel that their therapist is avoiding the discussion.

ミラーニューロンの補足

私はファンになるとユーチューブで動画を探す。イアコボーニさんの講演もアップされていたが、イタリア訛りがきついなあ。英語が全然聞き取れない！

ミラーニューロンシステムの議論で最後にしておかなくてはならないのが、スーパーミラーニューロンの議論である。イアコボーニによると、ミラーニューロンはそれを統括している、いわばスーパーミラーニューロンが存在するのではないか、と主張する。

Marco Iacoboni（2008）Mesial frontal cortex and super mirror neurons. Behavioral and Brain Sciences Volume 31, Issue 1 p. 30

イアコボーニ先生は、前頭葉の内側皮質に、ミラーニューロンのような活動をしている細胞群を見つけ、そのうち三分の一は次のような特徴を示したという。すなわち他の人がある活動をしているのを見ている時には抑制に働き、自分がその活動をしている時は活動が抑えられたという。自分がAをしても、他人がAをしているのを見ても発火するのがミラーニューロン、とするとこの神経はそれを上から制御する役割を果たすことになる。だからスーパーミラーニューロンというわけだ。これは急いで描き換えなくてはならない。

死生観と儚さ ２

6年間にわたる精神分析のプロセスの中で、彼は少しずつ生きる意味を見出すようになった。彼は車に乗る時、いつの間にかシートベルトを締めるようになっていると語った。分析作業の中で、実はAが自分自身の価値に対する深刻な疑いを持っていたことが扱われていった。それは彼の母親との関係に深く根差したものであった。BはAに母親を無意識レベルで彷彿させ、Aの母親との再結合や一種の子宮回帰願望にもつながっていたことが理解された。Bとの結婚によりある種の未来永劫の安定した境地を保証されたとAは感じていたのだ。精神分析というある種の終わりのなさそうな関係性に入ることで、彼の希死念慮は徐々に消えていき、生きる希望を少しずつ取り戻していった。それから数年して、分析治療が終盤に差し掛かるころには、Aは新しいパートナーを見つけることが出来た。そしてその時期と分析の終結時期が微妙に重なっていた。そしてAが結婚を前提としたパートナーを見つけることは、ある意味でその終結を乗り切るための手段という意味を持っていたことが明らかになった。そうすることで彼は私が彼を見捨てて帰国することを後押ししてくれたのかもしれなかった。

それまでの数年間の作業でAの過去の出来事の様々な面に光が当てられた。その流れで私たちは別れということと、終結ということと死ということの関係性を考えざるを得なかった。終結のあと数か月で私は十数年過ごしたアメリカの地を離れることになり、私の帰国はもう私とAとはおそらく二度と会えないことを意味していた。私自身は第二の故郷となっていたアメリカの片田舎のC町を離れたら二度と戻らないと思っていたし、ここで親しんだ友人や同僚にとっては、おそらく私は死んだのも同然になるだろうとも考えた。彼らにとっては死んだも同然の存在になる私が、地球の裏側で新しい生活を始めること、私という存在が生きていて同時に死んでいるような存在になることは私自身にとっても奇妙な体験だった。そのような私自身の体験はAとの治療作業にも何らかの形で反映されていたかもしれない。

Aとの治療を終結するということは単純な終結とは違ってきていた。終結からほどなくして私がC町を離れて地球の反対側の生まれ故郷に帰ることを私はAに伝えた。Aは私がある意味で彼に生きる意味を与える助けとなったといったが、その終結が一種の死別体験を意味することは不思議な体験だと語った。しかし私の生まれ故郷は、実はAが幼少時に２年ほど過ごした国であるということが複雑な意味合いを持つようであった。Aと私は終結と私たちの別れが意味をすることについても多くを語った。そして結局お互いを覚えている、心の中に持ち続け、生かし続けることがこの一種の死別体験を乗り越える方法なのだろうという結論に達した。

終結後私が帰国したのちに、Aからの便りが来た。そこにはAがかなり自分に対して依存的になり始めていたCとの関係に疲れ、散々迷った末に彼から別れを告げることが出来たと書かれていた。見捨てられることをあれほど恐れていた自分が、Cをある意味で見捨てるという行為をしていることが信じがたい、という気持ちがそこに書かれていた。

それから十年以上Aの消息は聞かない。私からも連絡はしていない。私はAがCに自ら別れを告げることは、私との死別体験の喪の作業が終わったことを感じた。それ以来私とAとは一切の交流はない。彼が実際にあれから生き延びたのか、どのような生活を送っているのかはお互いに分からない。しかしそのおかげで私の中のAはあたかもシュレジンガーの方程式に表される量子の確率密度のように、生きてもいて死んでもいて、再婚をしてもいて、独身を続けてもいる。私は彼に連絡をしてその存在様式を確定していないし、それでもしっかり私の心の中に生き続けている。そしてAも必要に応じて確率論的な私の存在を確かめているのではないかと思う。精神分析と量子力学には何の繋がりもないのであろうが、世界の根源が究極的な揺らぎや無常を契機としていることは無意味には思えなかった。