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Reflecting on psychotic anxieties

When Ben was three and a half months old, I had a powerful experience that I only came to understand more fully afterwards. Ben's mother had previously looked better, although I could not pinpoint anything. Ben was awake, with his arms held upright in the air. For the first time I saw him wearing his gloves, which looked like gauntlets. She talked to him but there was little response; he looked at her blankly as if not fully recognising her. Later he had a long spate of talking to her with the usual perfect turn taking. Her face lit up when she cued into him, saying "Hel-lo". Sometimes it was very hard to know what he was thinking. When Dave walked away from Ben and his mother said, "He's gone away, hasn't he?" Ben looked at her with no expression for a few seconds, and I wondered whether he was trying to make what she had told him into a communication that they both wished that the pain but not the hope would go away. Mostly Ben just included me in a sweeping gaze. When Dave tried to hit Ben, his mother would say, "Gentle, gentle," occasionally putting her hand between them. Ben was quite interested in him, sometimes craning backwards to see him, but not smiling much and often with a blank look, although looking quite intently at him. Once I felt guilty and ashamed as I thought about how delayed Dave was, wondering whether his mother, a professional, found this un-gratifying, despite her seeming so patient and I then remembered a time with my toddler son years ago. I put this to one side to carry on observing. I was surprised towards the end of Ben's feed when his mother was busy with Dave, Ben looked at me with a secret smile, and when I talked to his mother, Ben looked at me more intently. Time flew this visit, but afterwards I felt flooded by thoughts pouring out of me and felt that I could go mad if I could not turn them off. Listening to some music evoked psychotic-like anxieties about my children and me dying, anxieties of a very early origin and out of touch with reality.

It was a difficult experience but it helped extend my understanding. There was the sudden revival of a memory of being exhausted and cross with my active toddler son, who was the antithesis of Dave. I made an effort to put it out of my mind to try and understand it later as I felt I would miss what was happening in the observation and I would be preoccupied thinking about it. I was embarrassed and did not want to record this but recalling that the psychoanalyst, Safier (1993) had written about a difficult experience when, during an observation, she had felt taken over by hostility to the infant, gave me support to continue. As Safier understood that she was feeling what the baby's brother felt, she no longer dreaded the visits. I think my memory acted as an unconscious alerting to Ben's mother's difficulties with anger and shame about being the mother of boys with disabilities.

I wondered whether images of dying were in her mind, such as fears of losing her infant. I wondered whether I was in touch with an anxiety that she might have another child with a disability, and the need to defend against the wish to not have children. As it was after the visit that I experienced these thoughts and anxieties about dying I might also have identified with Ben experiencing anger with a psychotic-like quality about his fingers being restricted, and taken this away with me.

Being open to affectively charged sensations may feel crazy especially when it is not initially clear what has triggered them but may be the only way for communication by projective identification. Sometimes there is a memory without a clear link to the reason for having it. An observer was puzzled that, when she observed a sleeping infant with painful eczema, she had remembered the burial of her pet dog, which did not happen at other times in her work. We came to understand it as a communication about her thoughts about the emotional difficulties for the infant and his mother, including his mother's disappointment about his severe eczema, and his passivity. Similarly the memory about my son seemed potential information that Ben's mother may have been more disappointed and cross than she could share with me, and might point to feeling ashamed. Unconscious memories may be continuously activated, influence cognition and behaviour, and therefore play a part in intuition (Solms & Turnbull, 2002). It seems likely that on this occasion such a memory broke through. Siegel (1999) has suggested the structure of the brain may underpin why we are often so critical about trusting what we feel. He wrote that the right hemisphere is 'filled with polysemantic images of the world, perceptions of others' emotions, sensations of the body, and holistic patterns of intuitive insights that often defy words. These mental representations are context-dependent, filled with horizontal, multilayered associations to a wide array of bodily sensations, sense of self and other, autobiographical memories, and emotional meaning. There is often no easy way for the right hemisphere to "speak", especially if only the left hemisphere of oneself or another is listening' (p. 204).

Nearly a century ago psychoanalysts described the powerful effects that one person can have on another person without either of them being aware of how this happens. Freud (1915) suggested that the unconscious of one person could be directly in touch with that of another. The fantasy of projecting something into another person affects that person so that unconsciously they identify with whatever has been projected. The examples above indicate how these processes communicate information for which there seems no other channel.

It was in this visit that Ben gave me a secret smile that I felt was a sign of development of his sense of self. It was interesting that the word "secret" came to me to describe this and I never used it again about him. Infants can process emotional messages within two milliseconds outside the ability to detect them consciously (Niedenthal, 1990), and Ben may at an empathic level have grasped that I understood something of his confusion about the messages coming from his environment. Research suggests that as attuned mothers know what infants are feeling because they feel it almost instantly, a single mind model is supplementing the psychoanalytic model of two systems trying to get together. As observers understand the mother-infant dyad's nonverbal communication and are affected by it, it could support their intuition. The infant also reads the observer's emotional communication.

We are acted on unceasingly by information coming from others with whom we are in contact. Intuition or dreaming may be needed to circumvent the observer's defensive systems and observers have sometimes reported distressing dreams which put them in touch with something they were not consciously aware of in the family or themselves. Developing the capacity to contain includes being able to see the clues not previously attended to without needing to discard them too early.

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