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(1992).

International Journal of Psycho-Analysis, 73:757-771

Psychic Changes in the Paternal Image


David Rosenfeld

INTRODUCTION
Cordelia: I have loved you as my father, nor more, nor less. King Lear: Here I disclaim all my paternal care. Shakespeare, King Lear, Act 1 We read in Freud: Of all the imagos of a childhood which, as a rule, is no longer remembered, none is more important for a youth or a man than that of his father. Organic necessity introduces into a man's relation to his father an emotional ambivalence which we have found most strikingly expressed in the Greek myth of King Oedipus. A little boy is bound to love and admire his father, who seems to him the most powerful, the kindest and the wisest creature in the world. God himself is after all only an exaltation of this picture of a father as he is represented in the mind of early childhood. But soon the other side of this emotional relationship emerges. One's father is recognized as the paramount disturber of one's instinctual life; he becomes a model not only to imitate but also to get rid of, in order to take his place. Thenceforward affectionate and hostile impulses towards him persist side by side, often to the end of one's life, without either of them being able to do away with the other. It is in this existence of contrary feelings side by side that lies the essential character of what we call emotional ambivalence. In the second half of childhood a change sets in in the boy's relation to his fathera change whose importance cannot be exaggerated. From his nursery the boy begins to cast his eyes upon the world outside. And he cannot fail now to make discoveries which undermine his original high opinion of his fatherand which expedite his detachment from his first ideal. He finds that his father is no longer the mightiest, wisest and richest of beings (Freud, 1914a, pp. 2434). What is the role of the father, if not a continuing quest and discovery that the patient pursues within himself for months and years on end? The historian Braudel (1985) tells us: 'History is nothing but a constant interrogation of past times, on behalf of the problems and curiosities and even the worries and anxietiesof the present, which surrounds and besieges us'. In this paper we examine the role of the father in a psychotic disorder. We present a clinical case which in our opinion is both representative and illustrative of this issue. Our material concerns a patient with psychotic episodes linked to the role of the father, both his real father and his internal fantasy of him. We have deliberately chosen a case where there is no early total absence of the father, nor sexual disorders leading to perversions. Of course, the early relationship with the mother is also taken into account. The role of the father is present each time there is a father with a given role, a mother permitting such a role, and a son capable of introjective identification: it requires a triangular conflict. I emphasize this concept, indispensable to understanding the numerous cases of perversions, transvestism, homosexuality and various bizarre identifications and projections, in which other types of adaptations to the father role and to reality take place. This patient, whom I shall call Cordelio, was 23 years old. His father had committed suicide by shooting. For the patient, this suicide was the equivalent of King Lear saying: 'Here I disclaim all my paternal care'. In this case study, we give a dialectic explanation of the modification in the internal father image.

CLINICAL CASE
The patient was brought to the consultation by his family. He exhibited a confusional state and some psychotic disorders.

(MS. received July 1991) Copyright Institute of Psycho-Analysis, London 1992


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During our first interview, the patient and other members of his family described the father as an individual with a strong personality, who has devoted an inordinate amount of time to his business, his professional affairs and his political activities. The patient related that during his puberty, he was unable to speak to his father about sexual matters or discuss his personal problems with him. During the whole course of the treatment, I had the impression that his parents formed a homeostatic system, a closed circuit, to which the son had no access. As the treatment progressed, with a great deal of patience and subtlety, we were able to collect, rediscover and resignify a number of episodes of melancholia ordepression that the father had gone through, which had gone apparently unnoticed by the son and the family; some of these episodes had taken place after the death of the father's mother. Later on, we rediscovered with the patient another of his father's melancholic episodes which, like all the others, had gone unnoticed, masked by his constant political and business activities. This episode took place after the accidental death of two of the father's brothers; one of them died in a sports-plane crash, and the other one was drowned in the sea. In this last case, the patient commented that his father had suspected it might have been a case of suicide. We also rediscovered another depressive episode that the father went through when the patient, who was barely 16 at the time, was arrested by the police. The fatherstopped working, and went into a deep depression. (We will come back to this episode further on.) The father used to comment frequently on the unfortunate destiny of his family, because of certain tragic deaths. It is interesting to note that during the weeks preceding his suicide, the father had spent a great deal of time alternately consulting with doctors and locked up in his office examining the radiological and neurological studies performed on his daughter (our patient's younger sister), who was suffering from a disorder which had been diagnosed as a brain tumour. Also, during this period, the patient had clear evidence of something he had suspected for a long time: his father was using amphetamines in order to study and work, and then resorting to sleeping pills. Further tests performed on his sister revealed that what had been taken for a brain tumour was simply a harmless congenital anomaly. Just a few days after this reassuring diagnosis, the father went to his country house, where the family used to spend the summers and weekends and, after swallowing a large number of sleeping pills, finally shot himself through the heart. The mother was described during the treatment as a good woman, not very energetic, always ready to help others, but lacking autonomy, apparently utterly dependent upon the father. It was only when the father died that she revealed herself as quite capable of managing the family's affairs. The patient always spoke of his mother as being devoted to her children, but each time the son had serious problems or went through anxiety crises, she seemed to react like a frightened little girl, more scared than her son. It is very important to understand this behaviour pattern, repeatedly adopted by the mother. The patient started coming to the sessions in September. He was in a state of obfuscation and mental confusion, including some frankly psychotic episodes, during which he kept saying: 'people stare at me, they accuse me; people blame me for things'. His language is reiterative and he communicates in an obsessive style (Freud, 1919); (Laufer & Laufer, 1989). He related a dramatic episode, which had a great impact on his life: when he was barely 18, a woman accused him of attacking and molesting her. We must point out that the woman in question used to have frequent sexual intercourse, not only with our patient, but with all his friends as well. This woman reported him to the police,thinking she could blackmail his rich family. This quite unfair accusation had a very painful impact on the life of both the patient and the whole family. The woman insisted on her accusations, declaring that she had been raped. This accusation was used by his father's political rivals to discredit and ruin him. While the legal formalities proceeded, the patient had to remain in prison for two weeks. He
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kept rehashing this traumatic episode, repeating that his family had to spend every weekend visiting him in jail. Even though this event was told over and over again throughout the treatment, it was possible to discover a new fact or a new experience each time, which shed light on the subjective experience of the patient, as well as the real events.

One anecdote was particularly important: when the police came to arrest him, his father reacted by slapping him and shouting: 'you see what you've done to me!' During this difficult and traumatic situation, the role of the father seemed to have had more importance than the facts themselves. The son experienced this episode as the absence of his father, who could not or would not defend him in such a serious crisis. And, as usual with serious traumatic episodes, the son was forced to reassess and re-examine all his father's past behaviour towards himself. As the treatment proceeded, he re-examined various other instances during his childhood and his adolescence, when his father exhibited a similar attitude. He rediscovered and reconstructed the role of his father, who often in the past had suddenly disappeared, just when his son needed him most. But at the same time, the patient had an internal image of his father as full of kindness, playing a protecting and guiding role. As is sometimes the case, the father abandoned the child; sudden disillusions, when caused by somebody we trust, cause especially serious depressions. From the very beginning of the treatment, the patient's habit of alcohol abuse made his surveillance very difficult for his sister and one of my assistants, who were caring for him at his home. Therefore, I decided to hospitalize him in a private clinic. He continued to receive the same medication and often had two sessions a day, at fixed and regular hours. During the first month of treatment, he began to talk about his obsessive rituals: cleanliness rituals, especially related to the bathroom and toilet, which he kept cleaning for hours on end. He explained these rituals as being caused by his fear of making his sisters pregnant with some of his sperm, which might remain on the floor, the towels or the toilet. It was only two months later, that it became possible to reconstruct these rituals somewhat more clearly: they went back to the time the patient was aged 10 or 12. To summarize the sessions of the first two months, we must underline his delirious episodes, when he repeated: 'people accuse me'. As I have already noted, myinterpretation tried to show the projective identification outwards, and the fragmentation into multiple roles of his internal father, who accused him inside his mind (self). Theoretically, it is an accusation of his superego projected outwards. During other sessions, I interpreted his confusional states as caused by his incapacity to achieve a dissociation or a useful splitting, which would enable him to preserve part of his father, who was also a good and healthy person, and not only someone who became psychotic and committed suicide. During these months, in particular when he was drunk in the sessions, we analysed the way he used alcohol to become confused and dilute his persecution feelings and his intolerable pain. Gradually, the patient contributed new material concerning the mental state of his father before his suicide. It was also very important with this patient to discover and to point out material that reflected intense hate and parricidal fantasies, which at times took the form ofunconscious fantasies, and at others of parricidal acting out. For instance, I often interpreted that when he came late and quite drunk to our sessions, he did it to evade analytical work, to kill me as an analyst, and 'kill' the session. This was my interpretation of parricide within his transference. I refer the reader to another part of this paper, where I show the importance of analytical technique and the use of countertransference, in order for the therapist to avoid playing the role that the patient instills and projects on to him, which he acts out and repeats in the transference (instead of thinking) just as Freud taught us. In other words, this was how, with analytical technique, I interpreted and managed the unconscious fantasies projected and acted out on the therapist. I wish to emphasize that if the analyst does not disentangle himself from this projected material, the rest of the interpretations might go unheard or misunderstood.
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The technical work on projective identification generated by the patient who thus inoculates his dead father meets with many countertransferential and technical difficulties. It requires a meticulous effort: the therapist must detect the material, manage it in the countertransference and, finally, through his interpretations, he must help the patient to become aware of the fact that the therapist is not a dead object. During the same period, we were able to analyse his intense fear of growing up, of finishing his studies, of being successful or of leading a normal adult sexual life. He feared that all these things might cause somebody's death, might kill his oedipal rival. During this stage of the treatment the patient was hospitalized in a private clinic. My team was in charge of his medication and one of the psychologists on the team spent two or three hours a day with the patient. This is my standard method in the treatment of psychotic patients: one person keeps the patient company for as long as he may need it, and the same person cooperates with the clinic's staff and with

myself. He usually is a source of important clinical information. While this patient was hospitalized I visited him at the clinic, and at other times the psychologist on my team escorted him to my private office, which is close to the clinic. One anecdote is very important to explain the emergence of an intense regressive or primitive transference which took place during a session. On that particular day, the patient was able to come to my office, and he was escorted by an assistant he had never met before, who worked for the clinic and was not a member of my team. When the patient came upstairs to my office, the assistant remained waiting at the street door. During the session, the patient talked about his stay at the clinic, of the medication he was receiving, but then started to say that the assistant who escorted him was a homosexual, very affected in his gestures and attitudes. He added that the man wore so much perfume he was like a 'perfumed woman'. After these comments about the attendant, clear indications cropped up in the material about his homosexual fantasies and fears, which were of course related to thetransference. He told me about his sisters when they were small, commented on his being the only boy in the family, and on his father always being busy, working and travelling. He said, and I quote: 'There were only women in my family, with three sisters and besides, men always died in the rest of the family, just as my two uncles had ' And he repeated: 'the men die, the uncles died and there was only a b ig family of women left ' This made me think that the homosexual transference was quite clear, and that the patient was repeating his search for a father in the transference. In later material, he talked about his sisters almost as if he also were one more sister, mingled with the women in the family. It was as if his sexual identity was merged with that of his sisters and the other women in the family. An hypothesis was gradually confirmed during the years the treatment lasted, related to his oedipal and pre-oedipal relations with hismother, which played a very important role in his identification with her. The patient seemed to try to find his mother by adopting some of her aspects. During the last years of his treatment we began to work on these oedipal and pre-oedipal aspects. The material seemed quite clear to me, and I began interpreting very carefully: I told him that perhaps there was a part of himself that was afraid to ask for my help, and to need me as a therapist; perhaps he feared being too mannered, not very manly, or homosexual, and perhaps it was easier for him to say that these things happened outside himself. In short, I interpreted the projective identification which he made with his sisters. The patient answered with gestures and very few words, showing that he felt the impact but doubted the interpretation, and he immediately went on talking about his sisters. At that point I corrected my interpretation, and I said that perhaps he related to me just as he had related to his father when he was a boy, through his sisters. The change in the interpretation consisted in interpreting that the patient related to me mixed up with the sexual identity of his sisters, and not as a homosexual. This difference is technically very important, as I will detail below. The patient seemed to accept this interpretation with less difficulty, and said: 'Oh, a family made up of just women ' and immediately went on to evoke erotic fantasies and memories of sexual games with his sisters. It is important to note that one of the episodes
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involving necking and erotic games with his sisters took place behind the bathroom door. I want to mention that this material concerning memories of erotic games in the bathroom is related to the system of obsessive order and cleanliness mentioned in another part of this article. The session seemed to develop along these lines: the patient defended himself from a homosexual eroticization with the therapist; the defence consisted in fleeing into eroticization with his sisters. I might sum up this session by saying that the patient tried to come close to the therapist just as in his childhood he tried to come close to hisfather, by identifying with the sexual identity of his sisters and his mother. Perhaps he thought he had to feign being a woman as the only way of being loved by his father, just as he does today in his transference to me. At the theoretical level, we may suppose he entertained a masculine-feminine relationship with the therapist. It is also important to reflect on the theoretical importance of his incestuous and oedipal fantasies involving his mother, and how they influence the transference and, of course, the guilt all this generates in the patient. I am referring to the fact that the patient thought his father had fallen ill because of his guilt concerning his incestuous games (Schafer, 1968).

We think this session was extremely important and that it produced significant changes in the inner world of the patient; so significant that perhaps they made the following dream possible. During this session, the transferential link fluctuated between melancholia and an apparent euphoria: I saw him as a manic-depressive, full of doubts and obsessivedefence mechanisms. He related this dream during a session in November, on a Monday. He said the dream took place near to an anniversary which reminded him of hisfather's death: as background information, he said that on Sunday he went to the cemetery. In his dream, it is also a Sunday, and he goes to the cemetery, where he first thinks he wants to die, and then he sees two crosses. He first decides to 'go ahead';1 in a second stage of the dream, he decides to come to a session with me. He finds himself in a bar or restaurant, where he orders an omelette, one of his favourite dishes. He produced very few associations. I interpreted for him: today, he had made an important contribution: he remembered a dream, and told me about it. Besides, in hisdream he knew it was a Sunday, a day when he had no session as he had been out all day with his sister. As to his visit to the cemetery during the dream, I interpreted that during the first part, he went in search of his father, although he believed he could only find him by dying or burying himself with him. From the onset of our treatment I have been concerned because he thinks he can only be with his father in this way; I associate this fact with his inability to use his University degree; he is a young, intelligent professional, and not using his brains is almost the equivalent of dying, just like his father. In his daily life he does just what came up during the first part of hisdream: 'wanting to die, like Father did'. He seems to want to follow his father, by killing his young life, his sexuality and his professional potential. During the second part of his dream, he seems to try to escape from his melancholia and his selfdestructive feelings, by resorting to his psychoanalyst, wanting to come to his session. Furthermore, his psychoanalyst becomes a savoury dish, an oral gratification. Also, he is hungry for the nourishing interpretations I can provide for him. This dream shows all its value if one remembers that one week earlier, on the preceding Monday, he had come to the session in a state of confusion, obfuscated and drunk. Therefore, the dream has a prognostic nature regarding the transferential link between the patient and myself. The second dream took place during the sixth month of therapy: the patient was not hospitalized any longer, but he was still under medication. The main feature of this dream was that here, for the first time, his father appeared to be alive. During the session preceding the dream, we analysed the fact that, besides the guilt related to his father's suicide, there emerged with growing

1 This expression has an ambiguous linguistic meaning.

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clarity a feeling of guilt linked to the patient's incestuous fantasies and masturbation involving his sisters and one of their girl friends. In his dream, there is first someone suffering from a heart disease; then, someone who has a brain tumour. The patient does not know if it is his sister or himself who has this tumour. We should repeat here that shortly before the father's suicide, the patient's sister had been mistakenly diagnosed as suffering from a brain tumour. As the dream proceeds, he sees two people in a space, or a room; the person on the right hand side falls down, or dies. Later, he only sees the person on the left hand side; the one on the right is not present any more: in his place, there is only a hollow, an empty space. He immediately associated this with his hypochondriac fears, focused on his penis, and said: 'I'm afraid I won't get a hard-on'. I commented that, in his dream, he seemed to feel identified with his father's dead heart. Perhaps he even located his dead father in his own penis. I told him that he also seemed to be mingled with his sister: in his dream he did not know who had the brain tumour, his sister or himself. What is important in the dream is that someone dies, but someone else remains alive. As I noted earlier, this was the first time he saw his father alive in a dream. Much to my surprise, this dream helped me to understand my patient's numerous cleanliness rituals: he separates things that are on the right hand side from those on the left hand side. As we can see, in this dream there is a dead father, but on the left side there is a fatherwho is alive, and he tries to keep both apart through his rituals: he uses this mechanism to

try to keep separate what is dirty from what is clean, love from hate, what is alive from what is dead, the 'good' from the 'bad'. Similarly, we say during the treatment that he used his rituals to keep his feelings of guilt concerning masturbation separate from his sexual fantasies linked to his sisters. During other sessions, he could not avoid self-recrimination, and seemed unable to achieve contact with his father. He believed he could thus keep this object alive, which he thought guarantees the integrity of his ego: it is a defence against the fragmentation of his ego. To summarize: we can see that all through these months there were melancholic mechanisms which alternated with obsessive defence mechanisms. During a session in December, instead of feeling accused by his father, he felt sexual guilt. He said 'I feel guilty because I have deflowered a girl'. These self-recriminations, especially when associated, as is the case here, with oedipal guilt, are sometimes difficult to differentiate from a diagnosis of true or puremelancholia (Freud, 1917). During a session in December, some new memories emerged, clearly masking sexual games with his sisters. We seemed to be at the source of his fantasy about making his sisters pregnant. From this starting point, it became possible to analyse a whole set of obsessions and rituals which have dominated the patient's self since the age of 6: he was convinced his sexuality has caused his father's ruin. Some examples: when the patient was 6, his father imagined he had a 'testicular cancer' (he had no such thing); at 12, he felt guilty because of masturbation and voyeurism; at 18, he was accused of rape and really believed he had injured his father; finally, the ultimate tragedy: his father's all too real suicide. This event took him back to the age of 6, and the fantasy he entertained at that age returned to dominate his mind (self): his sexual games have caused the cancer in his father's testicles, and later on, his father's suicide. In another part of this paper, we develop some comments about parricide and guilt, especially guilt from the early, pre-oedipal superego. Our reconstruction shows that the cleanliness rituals represent similar episodes in the past, around the time he was released from prison, at 18, but which go further back in time, to a period when he was 10 or 12 years old, and he already had the same obsessive doubts and indulged in the same rituals. In other words: the cleanliness rituals, after his father's death, which forced him to separate his dead, accusing father, from another father, alive and kind, mixed with his obsessive defences, when at the age of 18 he was falsely accused of raping a woman. And all this is based, in turn, on the oedipal fantasies and the obsessive defences dating from the age of 10. At the end of January, he described another
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secret ritual involving shoes: he separates the right shoe from the left shoe, just as in his dream, he separates the right hand side from the left hand side (the dead fatherfrom the living father). But this ritual represents a regression which goes from the oedipal sexual to the anal level, in which the filth on his shoes, or the excrement, are equivalent to the sperm he has to clean from the toilet. At this time, there was still no clear material related to anal masturbation. When he omits taking precautions, and believes he has made a young girl pregnant (end of January) it seems to me he wants to resurrect a life, his father's life, with a new birth. At that time, the rituals and the persecution delusions in the street get much worse. The patient associated his father's behaviour towards him (he hits him instead of defending him) with a similar attitude towards his younger sister. She had once come, sad and in tears, to tell their father that she was going to divorce her husband and the father had answered: 'Do not cry: if you cry, I do not know what to do'. This episode sheds additional light on the father's behaviour during critical situations. The reconstruction and re-examination of both these episodes made him realize that the same thing had happened many times: his father liked him quite well, as long as he was the best pupil at school, and caused no problems. In other words: the father role only existed if the son was on his best behaviour; as soon as this was not the case, the son felt not only the disappearance of the external father role, but also the internal image, the 'father' he carried within his self. This reassessment of his relationship with the internal 'father' image was useful in understanding those moments of disappearance and loss of his internal objects, which he experienced as a total void. This happened once more when the father committed suicide, thus telling his son, tragically and irreparably, in the words of Shakespeare's King Lear: 'here I disclaim all my paternal care'.

The lack of a paternal role during episodes of critical need or anguish (anxiety) contributes to create intense symbiotic fraternal links among the siblings, who thus achieve self-containment (as a group). These intense relationships have a strong influence on the eroticization process and, conversely, eroticization strengthens the relationships still more. Part of the firmness inherent in the paternal role and the affective reliability of the mother were assumed by the eldest daughter (Anzieu, D., 1986). Some other theoretical considerations can be drawn from this case; our patient reminds us of 'The Rat Man': they share a pathological mourning process. In both cases, affects associated withsymptoms appear during adolescence, as do self-recriminations which resemble melancholia. Also, both share their doubts related to travelling by train: the Rat Man is beset by obsessive doubts when he wants to go to Vienna: should he call his friend? Should be board the train, or shouldn't he? In the case of our patient, the city in question is Buenos Aires; he also obsessively hesitates to take the train to go and see a girl friend. This is added to his obsessive qualms (doubts) about having made her pregnant. We can speak of obsessive doubts, since there is no loss of his sense of reality; there is therefore no delirious idea, no delusion. During a later session, he related a dream, in which an air-sea battle takes place. I interpreted this dream as a battle against me, which is going on inside the patient, caused by the fact that I had interrupted the sessions for some days. His fear of harming me through his hate and his lack of control appears more clearly here. At some point in the analysis it became technically important to tell the patient that I was not a depressed person, and that I could receive all his suffering. In otherwords, during the treatment I allowed him to unfold and to repeat in the transference all his infantile history with his father and mother. Based on the transference material, we can say that the patient was a child who always tried to take care of a depressed, weak and fragile mother and father. Just as Freud tells us (1914b), I allowed thesechildhood bonds to unfold in the transference, throughout the long treatment. They were the bonds of a child trying to care for his depressive and fragile parents, represented by the therapist in the transference. From the technical point of view, I prefer to work with these bonds only within the transference. In other words: during the treatment of
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some patients, I can go for months without mentioning the words 'mother' or 'father', because I try to have the patient first relive these bonds and affects intensely with me in the transference. It was only after some time that I was in a position to interpret for this patient that 'I am not a depressed, melancholic and suicidal person that you have to take care of ': later on, the patient discovered for himself (with the help of my interpretations) that I am not a depressed father, that I am not someone who is going to commit suicide. Through the analysis of transference, I made him understand that I was there to take care of him, by communicating the image of a firm analyst, with a strong voice, providing security and containment. By using a strong, firm and determined voice, it is possible to communicate, through the voice's music, an image of security and containment (Liberman, 1972);(Guiard, 1977). Probably the voice's melody (or phonology, as it is called in the theory of communication) is the most important element we have to communicate a strong and solidimage of the analyst. This is a technical aspect of treatments that I suggest my colleagues should consider.

SOME COMMENTS ON THE DEVELOPMENT OF THE OEDIPUS COMPLEX


We must highlight the important role the father plays at a very early stage; this subject was addressed by various authors. Freud was the first to describe the early function of the father in many of his writings (1898), (1899), (1900), (1905), (1908), (1913); this concept was also developed by Klein (1945) and her followers. Klein says the child searches for aspects of the father in the mother's body. In addition, she develops in her theory an idea about an early Oedipus complex. She links the early anxieties to this complex: very early anxiety and guilt situations cause an exaggerated fixation at the initial stages of the libidinal organization, and reciprocally, an excessive tendency to regress to those early stages. Therefore, the oedipal development is hindered, and the genital organization cannot be firmly established. In the cases we present here, as well as in other instances, the Oedipus complex begins developing normally when the precocious anxieties decrease It appears that the search for new sources of satisfaction is inherent in the progressive movement of the libido. The satisfaction felt through the mother's breast allows the child to turn his desires towards other objects, and in particular towards his father's penis.

Nevertheless, this new desire receives a particular impulsion from the frustrations inflicted by the maternal breast. It is important to note that frustrations depend both from internal factors and real experiences, and a certain frustration linked to the breast is inevitable, even under the most favourable circumstances, since what the child really wants is unlimited satisfaction. The frustration felt concerning the maternal breast causes the boy as well as the girl to abandon it, and stimulates in them the desire of an oral satisfaction through thefather's penis. Therefore, the breast and the penis are the primary objects of oral desire in the child (Klein, 1945, pp. 3778, paraphrased). Klein thinks of something more than a relationship with partial objects, and suggests that the child associates the perception of those partial objects with his motherand father. She notes that frustration and satisfaction give shape to the relationship between the baby and the good and loved breast and the bad and hated breast, and she adds: 'These two conflicting relationships with the maternal breast are transferred onto the ulterior relationship with the father's penis' (Klein, 1945). Meltzer (1973) thinks that the coitus, or the primal scene, is a scene imagined within the internal world of the child, where the internal objects are in movement. The self can achieve a projective identification within internal objects. Sometimes the projective identification enters certain erogenous zones (the anus, the vagina, the mouth). This is the continuation of Klein's original line, according to which identifications are not only introjective, but also projective (Segal, 1988). The primal scene is then only a fantasy, which can dominate the self. Just as the child imagines that his mind is full of moving objects, he also imagines the inside of the person in front of him as being full of objects. He projects what happens in his mind, and he believes it to happen in his mother's body. This only happens if the child
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finds a receptive space, in other words, a mother who offers him a space within her. If such a space is lacking, we enter the newly discovered world of children without projective identification, that is, the world of autism (Lpez, 1985); (Resnik, 1987);(Tustin, 1986). Let us now examine the subject of castration: we can also speak of oedipal or pre-oedipal (more primitive) castration. The primitive castration is perceived as the lossor disintegration of parts of the body. McDougall (1985) describes it as follows: 'The anxiety of separation is the prototype of castration anxiety, and the presence andabsence of the mother are the factors around which the first Oedipal structuring will be built The trauma of primal castration, expressed as fear of disintegration of thebody and loss of identity, unfailingly leaves its traces in sexual perversions'. Jones (1927) defines a certain type of primal castration, and describes it as an utter loss of libido and of stimulation through sexual contact: he calls it aphanisis (in Greek). On the subject of the father's role, I would like to quote Freud's Leonardo (1910), where he describes different situations: 1. The role the father plays in the erotic development of the son. 2. Mothers with masculine aspects, who are, Freud tells us, 'able to push the father out of his proper place'. 3. Fathers who are absent from the very beginning: 'I was strongly impressed by cases in which the father was absent from the beginning ', says Freud(1910, p. 99). 4. The function of the father in the choice of the opposite sex. I quote Freud: 'Indeed, it almost seems as though the presence of a strong father would ensure that the son made the correct decision in his choice of object, namely someone of the opposite sex'. In this dialectic interplay, feminine as well as masculine figures are necessary. Freud describes in Leonardo (1910) the model of the traumatic rupture which causes early alterations of the ego. It is important to underline Freud's interest in the early alterations of the ego, not only in this work on Leonardo, but also in analysis terminable and interminable(Freud, 1937). In the clinical material that I describe here, there can also be later traumatic alterations, as can be seen in the case of Cordelio. In an important work, Ahumada (1990) also develops the association between early and late traumas and their relationship with narcissistic identification. Even though he was basically devoted to the investigation of the early psyche, Winnicott was also interested in the role of the father. In Through Paediatrics toPsycho-Analysis, he comments on the role of

the father as providing 'holding' for the mother, and giving her support, by confronting problems (Winnicott, 1975). Otherreferences and comments on the role of the father in several of Winnicott's articles and papers can be found in Davis & Wallbridge (1981) and Panceira (1989). Where I comment on the early psyche, I would like to emphasize the importance of preoedipal material in the case of the patient Cordelio, as well as the importance of the mother's early role. The clinical material suggests transferential homosexual fantasies. In other words, we may infer the existence of homosexual transference fantasies that the patient uses to relate to the therapist, both wanting and fearing to succeed. It is possible that the emergence and discussion during his treatment of erotic and incestuous fantasies involving his sisters are a way to show himself as a male who gets excited about women, thus escaping his feminine homosexual erotic feelings for the therapist. We can also theoretically explain the emergence of erotic material concerning his sisters from other standpoints. 1. A way to evade his feminine or homosexual transference to the therapist. 2. We can surmise that he searched for his father by playing the role of his sister (a woman), believing that this was the only way that he would be loved. We can expand on this theory by thinking in terms of a masculine-feminine confusion or ambivalence. 3. The previous hypothesis emerged during the session at the time he was hospitalized, and an assistant escorted him to my office. The patient described the assistant as mannered and homosexual. At this session, his homosexual fantasies related to me appeared more clearly. It was precisely after this session that the patient
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began speaking about masturbatory and erotic rituals involving his sisters watching from another room. 4. Today, in 1992, when I re-examine these ideas, I think that the interpretation of the previous material made it possible for the dream with a live father to emerge. 5. Of course, we cannot exclude the guilt fantasies for his father's oedipal murder, which, once they were carefully analysed in the transference, helped the patient to dream for the first time about his live father. 6. The work which followed in the transference made it possible to differentiate the parricidal fantasy (the introjection of a primitive superego) from reality: his dead father. 7. It is very important from the technical standpoint to analyse the guilt caused by the real death and suicide of a father as distinct from pre-oedipal and oedipal fantasies. 8. The pre-oedipal level is developed in my quotation from Klein; the early role of the mother is raised when I cite Freud: Perhaps it would be safer to say 'with the parents'; for before a child has arrived at a definite knowledge of the difference between the sexes, the lack of apenis, it does not distinguish in value between its father and its mother (Freud, 1923, p. 31). In order to emphasize the pre-oedipal importance of the mother, as well as identification with the father, I would like to transcribe one of Freud's best descriptions of the mother's early role, that is so important in the case of Cordelio. In the chapter on identification of his work on 'Group Psychology' (1921, p. 105), he says: 'Identification is known to psycho-analysis as the earliest expression of an emotional tie with another person'. He also stresses the early importance of the mother in a description that is fundamental for the creation of the patient's mental life (I refer the reader to the clinicalmaterial in this paper, which points out the mother's role), in the following text (Freud, 1921): He then exhibits, therefore, two psychologically distinct ties: a straightforward sexual object-cathexis towards his mother and an identification with hisfather which takes him as his mode. The two subsist side by side for a time without any mutual influence or interference. In consequence of the irresistible advance towards a unification of mental life, they come together at last; and the normal Oedipus complex originates from their confluence (p. 105, my italics).

The identifications and introjections in the present clinical case are not the only possible explanation enabling us to understand all psychoses. Psychoses are not always caused by a disturbance of identifications, or by an identification with a psychotic father and/or mother. Freud begins to consider identification as a more important and vital mechanism for the psychic apparatuswith constitutive and modifying effects on that apparatusespecially in his paper on narcissism (1914b), when he describes the ego ideal and moral conscience. In Mourning and Melancholia(1917), he uses the term 'identification' for this mechanism. He describes the passage from a narcissistic object choice to the working out of that object's loss, and how the pathological working out of mourning leads to a narcissistic identification. Hence, the object becomes part of the psychic apparatus. The expression 'the shadow of the object fell upon the ego' is a metaphor. The object has entered the psychic apparatus, as a part of the ego itself. This part is dissociated, and forms a link with the rest of the ego. This is how Freud explains the origin of the superego: through the mourning of oedipal objects. Narcissistic identifications take place through narcissistic object choices. These identifications reinforce primary identifications (Freud, 1939); (Brudny, 1980), (1989); (Ahumada, 1990). It is not quite true that secondary identifications have a better prognosis than primary ones; perturbed identifications are the problem, and the prognosis is not dependent on their being primary or secondary. They are developmental facts (Avenburg, 1992). These identifications, added to introjections resulting from the mourning of oedipal objects, constitute the superego. Primary identifications take place at an earlierstage; secondary identifications are set up later on (resulting from object mourning) (Freud, 1921), (1923); (Bion, 1967); (Brudny, 1980). In his lectures on Freud's theories, Ricardo Avenburg says that the Freudian concepts of primary and secondary identification are sometimes
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not univocal, and their definition depends on Freud's interest and the level of his analysis in his various works. He adds that in some of Freud's texts, pre-oedipal identifications can be understood as primary, while in others, it is clear that all secondary identifications follow an oedipal identification. Etchegoyen (1985) developed the concepts of primary and secondary identification, and he points out that in The Ego and the Id, the identifications taken by the ego derive from the introjection of the parents at the end of the Oedipus complex. In the melancholic's identification with the lost object and in that of the child with his oedipal parents, there existed first a cathexis and later the abandonment of the object which, by introjection, remains installed in the ego: this type of identification, therefore, is always secondary to an object cathexis (p. 3). Then Etchegoyen says: 'Understanding in such a simple way the mechanism that leads to secondary identification, Freud is now able to contrast the latter with primary identification (which he had already described in Group Psychology and the Analysis of the Ego(1921)'. In this paper Freud points out that identification 'is the most primitive form of emotional tie with an object: or identification replaces the tie with the object introjecting it regressively in the ego' (Freud, 1921). And also, identification 'may arise with any new perception of a common quality shared with some other person who is not an object of the sexual instinct' (p. 108 and quoted by Etchegoyen in 1985). Identifications are mnemonic traces of perceptions, and as such, according to Freud, they are not lost; whereas the relationships among mnemonic traces are lost(Freud, 1911), (1924a). Money Kyrle (1965b) develops an interesting opinion on the subject of identification, and we quote: analytic experience seems to suggest three special stages in the development of representational thought, that is, the use of 'concepts' to represent absentor separate objects. In the first, what later may become a representation of an absent or separate object is experienced in a concrete way as anidentification, introjective or projective, with the object. Much of Melanie Klein's work was concerned with that kind of 'concrete representation byidentification' (p. 400, my italics). I believe all identifications can be lost as a result of a traumatic episode, as I have already described in an earlier paper on identification in the context of Nazism. These patients may lose their introjected fathers, among other problems, because of the pragmatic paradoxes they are submitted to: if the

individual identifies with his father as a man, he is killed because he is a man, and if he identifies with him as a Jew, he is killed because he is a Jew (Rosenfeld, 1984), (1985), (1986), (1988). The same happens to our patient Cordelio: this patient loses his identifications with his father, even though the loss is not permanent. His father's suicide triggers in him the same pragmatic paradox (typical of psychoses): 'If he kills himself, it is because he does not love me, it means he has never loved me; therefore I can use nothing of what he has given me. It was all a lie'. This is how his self decodes his father's suicide. The oedipal murder. The guilt caused by the fantasy of an oedipal murder compounds the problem; in the present case, the fact of the actual suicide committed by thefather disarticulates the structures of the ego. The recovery of those structures is, as far as it is possible to achieve, the function of the psychoanalyst. This could be seen in my work in the transference. Introjective identifications do not remain immutable. There is ongoing movement and change. Introjections can also be lost, or lose the links of the relationships between mnemonic traces (Rosenfeld, 1986). I shall leave to the readers the task of drawing their own conclusions from these theoretical discussions, after examining the clinical case I present here. Sometimes theory alone cannot encompass in its entirety the richness and the dialectics of clinical psychoanalysis. Clinical practice, with its interplay of projective identifications, introjections, and the transference/countertransference dialectic exchange, is often much richer, more dynamic and more dialectic than most theories. As a clinician, I am interested in the creation or the reconstruction of the father's role in the context of transference. Order, what is permitted, the limits within time, fixed schedules, the rules
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of the framework, are as many different ways of creating an order and a rationale of differences, and of making it possible for a common semantic universe to exist. Other concepts about the father's role. In the dynamics of small groupsa family, for instance roles are functional and interchangeable according to different situations, different realities that have to be confronted and personal traits, or the 'specialization' of each member of the family. In this sense, the relationship with the outside world is not only the relationship of the child-towardsthe-world, or, as the philosophers say, man-facing-the-world; I conceive it differently: it is a dialectic relationship, as Sartre tells us (1960), where the child is first integrated within the small group, the family, and it is from that starting point, through the group, that contact with the outside reality and knowledge of it is achieved. It is not a mechanical relationship, but rather a dialectic one: the small groupis the intermediary. It is the small group, and not man alone, who faces the world. If we accept this model, inclusion within social, affective and symbolic codes is achieved through the family group, or through each of its members, according to the personal ability of each of them to include the child in symbolic, affective, and social codes, as well as in codes of knowledge and thought. Each family member can fulfil partial aspects of the 'role of the father' and even substitute for him in some cases. What is important is the paternal task or role, responsible for clearing out, untangling and disassembling what is known in the theory of communication as the paradoxical messages, or the pragmatic paradoxes, and for helping the child out of them. Those are the messages which specialists in the theory of communication define as being capable of causing real, concrete effects, and of modifying the self and the behaviour of the message's receptor (Liberman, 1972); (Watzlawick et al., 1968). I specially want to stress double bind messages, contradicting orders, tangential answers, disqualifying comments, etc., capable of driving the child who receives them literally mad. Hence the term 'pragmatic' used to identify them, since these messages cause real and concrete effects (Watzlawick et al., 1968). The role of the father could be called the role of the decoder. In psychosis, this role is not played, it does not rectify the paradoxical messages emitted by the motheror by other members of the primary group. It may be sending double bind messages, and thus not helping the child to extricate himself from the pragmatic paradoxes in which they are both immersed. Let us note that the essence of paradoxical messages is that nothing the child does or says is considered right or adequate; whatever he answers, his answer will be considered to be wrong, and the child is left with only one way out: to fragment his self, to go mad, or to try to eliminate the source of the message, either outside or inside himself. The role of the father is fulfilled only when the child's primary anxieties find an

appropriate holding, or when the paternal role exists as a psychological presence, and not merely a physical one. The father's real presence within a family does not guarantee the existence of the paternal role; some fathers are present all day long, and are still absent psychologically. The true nourishment for the self is affective and psychological caring. To summarize: the role of the father is specially important and significant at the pre-oedipal stages. Its absence is at the root of psychosis, and the role of the father at the oedipal stage comes only later. I shall return to this subject later on. We said before that the role of the father is one of the roles that the small group, or primary group, within which the child develops, must play. It is a role of holding, of containing the affects, anxieties and fears. It is complementary to, and indissoluble from, the maternal role, and both constitute a dialectic process. The father must be available to receive projective identifications, and to modify them before sending them back, and must also be capable of resisting projective identifications that are encroaching or parasitical in nature (Abelin, 1971). He must have both time and space available. One aspect of the father's receptive capacity which must be complemented by the maternal, receptive and feminine role, is his capacity to contain, within his internal space, the child's fears, affects, psychotic anxieties and parasitical
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projective identifications. Being receptive does not mean being a woman, or feminine. Receptivity is indispensable to contain the child, to create a psychological envelope for him, a sort of protective skin, and this task involves both parents. Some concepts of the interior space, of receptivity, linked to the female body, alone capable of carrying and giving birth to the child, obviously pertain exclusively to the woman-mother. Annie Anzieu (1989) says: 'Hate against maternal contents and the envy they generate are strong enough to elicit a catastrophic sentiment of limitation or smothering in the womanbeing, due to the modeling her maternal "container" is subjected to' (p. 138). If there is not a father's and a mother's space, as a whole, available to receive his projective identifications, the child will not learn to develop these useful identifications, nor introjective ones. Just as the united siblings can substitute for the mother's absence, the cohesive group can substitute for the absent father's role. The role of the father is only useful when it fulfils the needs of each one of the stages of developmental evolution the child goes through. A constant and dependable role of the father, and a steadfast affection are indispensable in order to be credible for the child. Inconsistency can cause disappointments. Serious disappointments or traumas may blur or erase and cause the loss of previous introjections, or internal object relations. There is a permanent need for support, for assistance and help given to the internal world, so that it may contain objects possessing functions and roles from which the development of fantasies can emerge. The primal scene enacts paternal and maternal roles in movement, it is a stage full of characters. The absence of a third party makes it difficult to conceive a three-dimensional space, as I have observed in the course of my work with children. It is well known that the father role, or the real father, play the leading role in the Oedipus complex; its structuring and its resolution are fundamental for mental structuring. Hence, I emphasize that the father role is the role of a decoder of messages, a facilitator of the primary group. One facet of the father role consists in imparting an affective coherence to sensations and perceptions in the world of living objects surrounding the child. This role can not be severed from the role of the mother. The male person playing the role of the father must allow and foster a masculine sexual identification, make sexual differentiation possible, thus leading to the completion of a long developmental process. This can only be achieved when it becomes possible to differentiate the outside from the inside, I from you, a full mental space from the void, and through the creation of the psychological concept of a skin enveloping and containing, with a known voice, odour, touch and melody. Only when pre-oedipal roles are fulfilled, or played, does it become possible to enter the world of total objects and the Oedipus complex described by Freud. It is only then that depressive anxieties and introjective identification of the total object can be experienced. In some societies, social codes ascribe to the man-father the role of confronting outside reality. But through my experience with seriously ill

patients (drug addicts, psychotic patients, etc.), I have become increasingly aware of the existenceof micro-cultures that have their own particular codes. Obviously, a structure and a set of relationships and links are involved, and the son is included within this global whole. The child has his own fantasies, his own way of organizing feelings, perceptions and affects, his own manner of managing schizoid, paranoid and depressive anxieties. The child can have his own disorders, affecting the reception of introjections within his internal world; he may also have his own particular manner of using projective identifications, either through normalcommunication, or else in an exaggerated, massive or omnipotent style. There is also envy and hate. The role of the father can also sometimes be assigned by the child. An infant turning his head away, refusing the breast and rejecting his mother's care, is a child who does not allow his mother to be a mother. The same happens with children who do not allow their father to be a father. The role of the father does not exist as a thing-in-itself. Quite the opposite: this role is a long, and probably never-ending dialectic process of
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creation and learning. What we call the role of the father is a dynamic process, and not a static definition. Of course, it would be desirable, or ideal, for the role of the father to be fulfilled by the real father of the child, with a unitary image focusing and concentrating all the various functions and roles we have listed, as well as many other functions which are beyond words, and beyond the scope of this presentation. Many things can be written about the role of the father; allow me to quote a Baudelaire poem:
Bien qu'on ait du coeur l'ouvrage, L'art est long et le temps est court.

SUMMARY
My main objective in this article is to show the changes which take place in the inner world of a young patient after his father's suicide, and the identifications he goes through. I hope the clinical material presented succeeds in doing so. We can also see the solid primary identifications which made it possible for this patient to get better and achieve a cure. It was not my aim to embark on a theoretical discussion of primary and secondary identification, an extremely complex subject in the writings of Freud.

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