London, 23 June 2012
Chair: Dr. Gigliola Fornari Spoto
Speakers: Dr. Michael Feldman and Mrs. Edna O’Shaughnessy
Discussants: Dr Catalina Bronstein and Mr. Richard Rusbridger
‘The Many Faces of Mania’ explored the aetiology and manifestations of mania through the presentation and discussion of two clinical cases.
The conference was held at the Royal College of Physicians, London and was fully attended by psychoanalysts and psychotherapists from all over England, continental Europe, USA, Russia, Israel, and Brazil.
To start the morning, Dr Michael Feldman presented a clinical case illustrating the complex unconscious processes at work in mania. He described the quick and subtle shifts which occur in the interaction between a manic patient and the analyst, as well as the unconscious fantasies, thoughts and emotions that surface during an analytic session. Dr Feldman also paid attention to the ways in which these occurrences affect both transference and the analyst's counter-transference. He observed how, for his patient, the thinking process was experienced as suffocating and dangerous because it obstructed her manic defences.
Dr Feldman's presentation was followed by a discussion from Dr Catalina Bronstein. Dr Bronstein in turn explored the subject of mania by highlighting the intensity of the drives, as well as the difficult dilemma faced by many manic patients: they have an urgent desire for excitement, but also a dread of being consumed by such powerful feelings. Dr Bronstein also helpfully shed light upon some of the differences between mania or manic states of mind, the normal stage of the manic position, and manic defences. Another illuminating distinction was drawn concerning whether a patient’s mania relates to the superego or the ego, and whether the manic defence is against paranoid or depressive anxieties.
In the second paper Mrs Edna O’Shaughnessy presented a manic patient who came for analysis ‘on high and in the fast lane’, and also weeping. The analyst discovered that her patient’s words were not free associations, but a flight of ideas, impelled by disbelief in, and a terror of, contact. Words, plus speed and loftiness, dispersed the patient’s inner world and attacked the link between patient and analyst.
The paper described a long first period in which the analyst was almost always trailing after the patient, and how only later, when the content of the patient’s anxieties were more understood, could her speed lessen, and associations and thoughts, and contact with the analyst - all intense and distressing - become possible.
Mr Richard Rusbridger discussed the case, pointing to the similar aetiologies in many cases of mania: many manic patients suffered some form of early emotional neglect or parental unavailability, that was experienced not as a loss but rather as the presence of a malignant and hating object (here with reference to Bion). In addition, Mr Richard Rusbridger postulated that a constitutional factor - a greater quantity of hatred and envy - is present in many of these cases, and that this makes the internalization of a good object very difficult. He also talked about projective identification as a central mechanism in mania, and how identification in mania is typically phallic due to the patient’s attempts at reparation.