Francesco Comelli
DEVELOPMENT FROM BLINDNESS TO NEGATIVE CAPACITY TO REPRESENT AND IDENTIFY THE INSTITUTIONAL FIELD
I would like to describe an experience I had in a psychiatric community between 2000 and 2004. My aim is to explain the changes that occurred in my inner world as I began to interact with this institution, the subsequent therapeutic approach that I adopted, and the links that emerged between my inner world, the institutional field and the therapeutic approach.
I should point out that the relationships between my inner world and the community derived from my group analytic training that made me consider the institution as a group: this process led me to adopt a group therapeutic approach that would not have been possible if I had not been familiar with the works of Bion.
The approach that I adopted was not deliberately planned, but developed gradually, unlike a hypothesis that is known before it is tested. Instead, in the works of Bion, the not-known is essential to developing hypotheses and thoughts.
In my opinion, we can understand Bion only by directly experiencing the not-known in order to verify whether Bion’s methods can reappear in the form of a personal reverie and not simply as a theory.
This way of seeing things was not familiar to the operators of the community who oscillated between two opposite poles, namely, experiencing their own emotions when dealing with the patients or simply the mechanical dictates of the mental health centre whose only function was to send patients to the community.
The result was that the operators experienced a sense of impotent or found it difficult to understand the emotional significance of the un-going relationships.
The rest of the paper will focus on my inner mental processes in order to point out the relationships between my own inner world, the community and the emergence of my therapeutic approach.
During the first year my mental state was more similar to the clinical attention I would give to a single patient or a group , but this time it was towards a community .
I experienced directly the physical space of the community, feeling very cold with too many doors and windows left open, with very cold draughts and with the tendency of the patients to stay under the covers.
I realized that this sensation was not related to the fact that I had left my former work, but was an expression of a preverbal collective sentiment which emerged through primary sensorial impression.
At the same time, the mentality of the operators made me experience a condition of nakedness, with no defences, and indirectly encouraged me not to use any protection. By so doing, however, they failed to understand the protective mechanisms and defences of the patients. Therefore, the fragility of the patients was regarded only as a refusal to cooperate.
In my thinking, three elements emerged: the mental health centre appeared as an assembly line, the operators who idealized the complete freedom of the patients without realizing that this made the patients feel they were defenceless and therefore terrorized, and lastly, the patients themselves who expressed their need and willingness to grow and develop.
The “assembly line work” and bureaucratic procedures of the mental health centre was similar to what I had left behind in my previous job and had escaped from but it was also the exact opposite of what occurred in the community.
Similarly, in my inner world I experienced the tendency to split the bad outside structure (mental health centre) and the good internal one (community) .
This led me to consider my own inner feeling as a schizoparanoid state encouraged by the group mental state of the community: considering that the institutional field (1) was already characterized by serious form of PS (schizo-paranoid state) that seriously affected the mind of the people inside the community, I felt the need to change these states by finding a more D state (Depressive state), namely, a more balanced situation that allowed me to see the real problems of a community characterized by patients and operators who used to come and go.
Although it was evident how the mental health centre adopted a strong bureaucratic method, it was also necessary to realize that the methods adopted in community were too free and overly idealized.
The institutional symptom (idealization of freedom, but patients and operators who would come and go) was not understood by the work-team as their psychic state, but was experienced by me internally.
The institutional field could not perceive the depressive element due to the presence of a Beta screen, which meant that the emotion that emerged when a patient or operator left the community could not be seen nor represented.
Only at that time, could I propose to the operators a “digestible” and visual hypothesis of the PS position of the institutional field, by pointing out the two extreme poles : one is the hyper-visibility claimed by everybody (to be all naked, idealistically totally authentic), the other is the blindness of the meaning of continuous separation of patients and operators from the community.
The fragmentation of the visual function (hyper-visibility\blindness) requires the presence of a single observation point in order to develop an ‘alfa’ function: I tried to encourage a shared and progressively cohesive visual point, even tolerating the separation of myself from identifying too closely with my observation point.
The coexistence of the difference between my subjective observation point and the operator’s viewpoints, was possible only if I could experience negative capability in order to be neutral without taking either side or providing too many meanings before the questions were asked or encouraging biased viewpoints. This made it possible for free associations to emerge.
These associations included how patients were used to staying with non-specialized figures, i.e. clerks, the cook, or non-psychiatric workers of the “community village”.
While at the mental health centre the patient-psychiatrist relationship was mainly pharmacological, in the community, good relationships gradually developed between patients and people with an identity that was not that of the extremely specialized psychiatric operators.
When an operator left the community, nobody could discuss it or even represent the event. Therefore I perceived the distance between emotional events and the blindness of their perception: many stories emerged, with their emotional connotations, but without anyone narrating the story nor having place to narrate it.
I was able to perceive a common group feeling between patients and operators, i.e. a non –verbal feeling of depression stemming from the loss of the operator, and this allowed me to consider the community as a place having a group mental state, unrelated to the role played similar to what occurs in tribal villages.
Therefore, the institution as a group mental state included not only the operators but also the patients and non-psychiatric operators, regarded as a whole, sharing and building common psychic structures (3), totally unrelated to the different roles that everyone continued to play.
The links formed between patients and non-psychiatric operators allowed me to involve them in the weekly meetings of the work team, something not usually allowed. Although some people from outside the community disagreed with this decision (“it is absurd to include a cleaning woman or a cook in the clinical team”), this change led to a decrease in the blindness of the operators.
Therefore, I regarded the two terms “blindness\negative capability”, as elements of a transformation brought about by the ‘alfa’ function, where the blindness of the operators is transformed into a useful and qualitative blindness of the negative capability. In this way, the tendency was for everybody not to be always conditioned by events, but to slow down the pace of concrete actions in order to reflect on the psychic states of the institutional field .
There is a very interesting example of what we could term “negative capability” in the novel “Blindness” by J. Saramago (4). In the novel, as a result of a epidemic, most of the population became blind and the blind were locked up in former mental hospitals. The only healthy person is a woman who has to pretend she is blind in order to continue to stay near her husband.
She stays with the group of blind people in order to help them, give them affection, assistance, and help them to grow.
Just like negative capability, this blindness implies a tolerance of solitude, something designed to help the group, a mysterious area due to the fact that the expression of internal subjectivity is not immediately expressed. Therefore there was a tendency to substitute the time of acting with the time of thinking.
The operator’s group was therefore able to have more time to think, without having to immediately answer questions that apparently required quick solutions or that were not ready to be asked yet.
This approach therefore resembles ascetic\mystic experience: the mystic finds within himself the capacity to experience solitude along with the perception of belonging to a group, without being only himself or only the other from himself.
A veritable negative capability like that of an ascetic without god: paradoxically, this experience was possible because being a layman, from the religious standpoint, I believed that what I was doing could help patients, and therefore my position was based on faith.
Therefore, without being religious , I was a believer and I believed that my work could be related to psychoanalytical training, even though the group that I proposed was heretical, since it was not the usual psycho-analytical group.
My internal psychic work thus considered the operators and patients, starting from their common experiences, i.e. the blindness that they all shared.
I therefore realized that I had represented an inner process\object where bionian psychoanalytic theories and basic institutional mental states intersect.
This intersection makes a mixed internal object visible that contains the analyst’s training and therapeutic approach and the institutional field that is also made up of patients (and does not just derive from the interaction of psychiatric operators).
The clinical extension of this internal process\internal object led to the formation of a group that included all the actors of the institutional field, namely, operators, patients, and non-psychiatric operators and was conducted by adopting techniques not very different from the small analytical group.
The group was open to anyone with a position in the “village- community”.
I was aware that this wasn’t a small psycho-analytical group, but one that had emerged from psycho-analytical experiences, like negative capability, and from the need to have a place in which to represent thoughts before they are formed.
I was worried that the group might be considered to be just an assembly of people instead of a lens used to identify the common emotional states of the “village inhabitants”.
In a previous experience (6) a group, including nurses and operators, in a psychiatric ward, had made it possible to identify the emotional environment of the fundamental institutional field.
Instead, our group consisted of about 20 people, who met once a week, for one hour and a half over a period of about 4 years. It is to be considered an experiential group that continuously represented the field element of the community and did not replace other therapeutic approaches .
From the beginning, in our group, we noticed a considerable reduction in the number of operators and patients who had previously come and gone: the group processes were not only the expression of the group itself, but of institutional group processes i.e. the admission of a patient to the community did not completely occur when he entered the community, but only when the patient was emotionally involved in the group. Group themes were representations of institutional processes and became the emotional “fulcrum” that linked the rules of the community to institutional group dynamics. Members of the institution could therefore represent themselves as belonging to the institution due to they fact that they belonged to the group.
Indirectly for the psychotic patients, the perception of a common sense in the group was an alternative to their delusional and individual perception.
What became this experience, that ended in 2004 due to outside circumstances, was the visibility of an emotional institutional truth: if what emerged in a group session was that the group itself could be a mother protecting them from mourning , this referred not only to the group , but to the role of the community as having a maternal function.
Therefore the idea that this large group was supposed to treat the institutional field (7), and not merely the patients, could be an experience that could be reproduced.
Bibliography
1 Correale A. , Il Campo Istituzionale , Borla ed. 1991 Roma
2 Coppo P., Tra Psiche e Culture, Bollati Boringhieri, 2003, Torino.
3 Kaes R. , L’ Istituzione e le Istituzioni, Borla ed. 1991, Roma
4 Saramago J. , Cecità, Einaudi ed. Torino 1996.
5 Corrao F., in Orme, Gruppo e Istituzioni, R. Cortina ed. 1998 Milano
6 Comelli F. , Mazza U. Gruppi psicoterapici di pazienti a patologia grave in un servizio Psichiatrico Diagnosi e Cura, Koinos , n.1, gennaio – giugno 1996.
7 Faucitano S. , in Comelli F. e Faucitano S. , Etnopensieri, Quattroventi ed. 2006 Urbino