The Psychoanalytic Approach to Psychosomatics and Eating Disorders

The Newsletter of the Psychosomatic Discussion Group of the American Psychoanalytic Association.




The Role of Distractions in the Maintenance of Dissociative Mental States

Goldberg, P. (1987) Int. J. Psycho-Anal., 68: 511

Abstracted by Harvey Schwartz, M.D.


Goldberg details two forms of dissociation - thc first is the well known type created as a compromise formation which expresses and obscures unconscious wishes through symbolic representations. The second, which is the subject of the paper, is a regressive shift of mental functioning out of the symbolic sphere which is then further disguised by a distractive activity. This accompanying distraction serves to block awareness of the alteration in mental state and acts to repress the experience of affective withdrawal. The author outlines a concept of potential space - an intermediate area between external reality and fantasy - the relative absence of which leaves a paticnt forced to submit either to a caricatured reality or fantastic fantasy. Such patients live on the margins of symbolic functioning which leads them to form relatively stable states of pseudo-integration. This precarious "twilight" form of mental functioning lends itself to frequent withdrawals from affective contact into indifference which is screened by distractive activities such as giggling, staring, seductiveness etc.

The technical implications of appreciating the function of these distractions are considerable. Goldberg describes that interpreting such decoys as if they themselvcs contained representations of feared wishes is like "addressing somebody who has already left the room". Instead what is called for is a "framework" type of intervention which engages the person now sitting in the office about the one who has just left, including the why and how this leave taking occurs. This is in an effort to begin to put into words the split off aspects of self that are commonly part of this ego syntonic type of dissociation.

The author presents a patient with an eating compulsion with whom the primary therapeutic focus was addressing the dissociative activity within the sessions and the alterations of mental states within and outside the treatment setting. He reports on the patient's alternating shifts from symbolic and multi-faceted self experience to one of a disguised but nevertheless casual indifference with a loss of ambiguity and self awareness. Interpretively addressing the patient's hidden withdrawals allowed her to be able to recognize her terrors associated with both needing and fearing her analyst. The patient's coming to symbolize this paradox through a dream represented her ability to accept contradictory aspects of her self experience that had been relegated to split off paranoid representations.

Goldberg concludes that by distinguishing distractions and the regressive mental states they screen from their more neurotic counterparts one can assist patients in evolving from their pseudo-integrated sanctuaries to a capacity to bring significance to their subjective experience.

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