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Group Psychoterapy with Psychotic and Borderline Patiens

The elaboration of depression in the group
Stefania Marinelli


 

Introduction
Psychoanalytical research on groups during the past thirty years has produced many different themes that were linked above all to the need of founding a theory, in short, a specific model and a specific theory of the technique. It became necessary to differentiate this characteristic sphere of research and experience from the classical Freudian theory, and at the same time find a way where the new ideas wouldn't lose touch with the tradition. This is what happened in the English circles, which were close to Foulkes and Bion's theories. The prevailing idea was, that a group (as a whole) represents an object that is different from an individual and the sum of those individuals that compose it, and that it is to be placed in a perspective that is fundamentally diverse and specific. In French psychoanalytic circles, research was carried out mainly within the Freudian tradition, the concept of which was virtually widened to include the group. The studying of its imaginary (Anzieu 1976), and the group (pluri)psychic apparatus (Kaes) prevailed, with a line of development stemming partly from the Barangers' idea of the bi-personal field (1963-87), leading up to the trans-generational research (Faimberg, Kaes 1995). Studies in Argentina took a different trend where the orientation was prevalently for considering the social and family aspects of the unconscious life, the limits existing between the relational and subjective on one hand, and the groupal and intra-psychic on the other, was faced on a theoretical plane. In all these different spheres,(and for different reasons),the accent was put on the necessity to value and study the aspects that were useful in establishing a physiognomy and a delimitation of the object of the research, and it was thought to be superfluous and unproductive to confront the two methodologies, (the dual analysis and the group analysis). Perhaps it was for this reason (and other reasons of a different order), that the concept, depression in the group, and the experience of the depressive position in the group were not taken into account in these works. What these studies do accentuate more frequently are the following topics: the birth and functioning of group thought and its mythopoeic capacity (Corrao 1996); the specific themes of the archaic fantasm relative to the group, seen as the interior of the maternal body and place of forbidden desire (Anzieu 1976); the aspects regarding the psychic multi-dimensional sphere and its intercorrelations (Kaes 1993); the narratological function (Morpurgo 1986; Corrao 1996), and semantic function of the word and the group's discourse; the temporal, mythological and mnemonic function of the institutional group (Correale 1991); the development of the evolutive stages of the affective and mental side of the group (Neri1995) the multiple perspective of the internal relations of the group seen as horizontal and vertical, or actual and historical (Puget 1994); the theatrical element (Chianese 1997); and the subjective construction (Lichtenberg 1996); the specificity of dreams seen as a collective story belonging to the group subject (Neri 1995, Zanasi1995). These are just a selection of studies carried out. Depression, or the function of depression on the group, seen in the light of this research appears as a sort of counter-figure, possessing a negative limit. It often appears under the guise of something else and is therefore inaccessible or emarginated from the groupal process, or it appears in its more evolved and constructive form as an acquisition of the individual differences. The difficulty in facing depression in groups lies in the fact it has never been spoken about before, therefore it is necessary to clearly-define the main points of this research. First of all, with an exposition of sequences and clinical observations, I want to describe how depression in the group is a particularly tenacious aspect and has it's own course of progression. It is often concealed, (for long periods) by defences that the group could even try to keep on strengthening. Depression in the group cannot be faced as we do in the individual context, waiting for it to appear, it necessitates a speedier integration, it moves at a different rate, because the psychical and verbal regime in the group is more active and has a major productive capacity compared to the more intimate dual relation. Depression in a situation of collective exchange finds a major capacity and spaciousness for oscillation, and finds a diversification that is more versatile on the level of experience, of expression and of fulfillment. Inert periods in the group are a devastating experience for the participants and the threat of disintegration of the community is much feared. The emerging of depressive experiences are extremely difficult to recognize and accept specially if the illusion in the group is particularly intense (Anzieu 1976) along with the fusionality or better, the "fundamentalism" (Kaes 1996) and the sense of belonging (Marinelli 2000), making the de-idealization and de-fusion, and the expulsion of the depression even more intolerable. During this phase importance is put on the syntony, the legitimization of the affects, confidence in the good relations established, not losing sight of the heritage of the affective, ideational, and mnestic resources and the growing sense of solidarity among the participants, (these conditions not only are indispensable but on their own are therapeutic). If, on the other hand, importance had been put on an exploration (conducted well and done in the positive previous conditions), there would have been a greater risk of favouring the narcissistic defence of the group resulting in an impossibility to reject the self-idealization and an acute intolerance towards any change.

The characteristics of depression in the group
One of the most distressing situations during an analysis in progress is when depression appears, and is strong enough to make the mental work flat and void, too concrete and fragmented. It is concealed under seemingly more vital states, (idealization, violent or erotic stimulus, chaotic sensations, and particularly intense repetitions) and it emerges like a hydra with seven heads. When the depressive state becomes explicit and is established in the group, itís extremely difficult to maintain a stable level of attentiveness, to conserve the reliance on existing bonds and the analysis, (and consequently the contribution the analysis brings to the elaboration). During the individual analysis, the depression is experienced in an internal context that is rich in subjective and affective language, produced by a situation of personal intimacy in the setting. The relationship and the continuity between the analytic setting and the outside world are seen to be distinctive even if they are reciprocal . Whereas in the group where mental and emotive events assume a total and dramatic dimension, depression also assumes a particular form. Depression in the group follows a particular course and development, because the context is more amplified and undifferentiated, and because the primitive profoundness is more visible with its own characteristics, its own story and its unique prospects.

The depressive position in the group
When the analysis of the experiences of the group is sufficiently advanced, a depressive position will almost certainly develop. The question is, does a depressive position in the group exist? And if so, is its existence possible or beneficial for the group? I believe, as opposed to the equivalent in the individual setting, the insistent repetition on this element in the group could be destructive for it. The elaboration of this element may render ineffectual the principal quality that is peculiar to the groupal concept: that special vitality that is both ideational and mythopoiec, and is responsible for the narrative and theatrical construction, for the mirroring and the origin of the unique and extraordinary affects. To find an answer to my query different opinions could be considered; the first one deals with a specific point of view of the group, seen as a psychic organism passing through various stages in continual evolution Neri (1995). In this perspective the possibility of depressive elaboration is put in the fraternal community stage, in which the bonds are abolished, the fusion of the emerging state of the group is transformed, knowledge is de-mythologized, the illusion of the global belonging leaves space for the recognition of individual differences, and language becomes more realistic. Another perspective where the theme of depression in the group can be enucleated is found in the writings of A.Correale (1991). He speaks about the institutional field and the oscillation of the institutional group between its traditional boundaries and the pressure towards ideational freedom; or between the elaborative time of the founding myths of the institution and the transformative time of the heritage of affects, memories and thoughts that characterizes its story. In his writings, Chianese (1997) also treats depression in the field perspective. He puts the accent on the theatrical and virtual aspects and the construction of the scene that brings the depressive sentiment closer to a dramatic elaboration and possibility to be shared. Aspects relative to a playful situation (conceived by Winnicott), or to a think able situation (Tagliacozzo 1993), seem to be very close to dealing with the element depression, specially when it is present in its most widespread and collective form, or present in a common situation. At this point I will try to describe (with the help of clinical examples) the characteristics relative to a particular type of elaboration of mourning that can occur within a group, hypothesizing in this way a process that is endowed with good-qualities and a way of expression.

Mourning and rites in the group
Inside a group the experience of its inert (devitalized) objects or dead (persecutory) objects, and the exploration of their characteristics, can come about only when the group recognizes the type of defence it had adopted up to that moment. A definite resolution to the problem of mourning (whether complete or partial), will be possible when the group as a whole is able to perform a rite of unveiling or a collective recognition, and afterwards a funeral rite of leave-taking. The nature of the rite depends on the experiences the group inherited from previous phases, from the profound contents, from the representation given to them by the group and from the particular affective tone that resulted from it. The depressive experience cannot save the group from the wound regarding the phase of expansion of the narcissistic groupal illusion. The idea of a hemorrhagic loss of all the contents and a violent failure of the initial hopes is produced. The force of this sentiment generates a destructive attack against the internal treasures of the group, and the bonds with the other members and the analyst. It is as if the experience becomes suddenly futile, destructive and empty of contents. I have observed that is useful to employ two different directions when these situations come about: To supply and articulate the flow of assistance (whether it encourages suffering or the resources of the group), activating new affective currents or new items of interest, (for instance, introducing new participants to the group). During the process of the recognition of the deadly and lethal elements and their specific function, encourage contemporaneously a meticulous work of interweaving of those elements. This could come about in the historical sense (regarding the story of the individuals or the story of the group), by recognizing the bonds and the cross-identifications within the group, or utilizing a wider knowledge (the myth, the rite, the cult, the fable and even the element Row C in Bion's grill), all the time stimulating and re-elaborating the group's own myths. In fact the distressing experience of having the sensation that everything is dead, or almost dead, or not dead nor alive, (caused by primitive thought Bion (1961), and the oscillation towards disorder and the basic assumptions), becomes a hyper-concrete and immobilizing experience, unable to be utilized for an evolutive transformation. Its important to maintain the emotive environment flexible and permeable, to consent the circulation (or the revocation) of sentiments of stability and continuity. All this could be of help (or even indispensable), to attenuate the feelings of impotence and uselessness and allow a more liveable and transformable condition to prevail. Another element I would like to propose was inspired by G.C. Soavi's "Mito dell'Eterno Ritorno"(1990), (myth of the eternal return). It regards the undeniable usefulness of the repetition: it's only through continual repetition that the group is able to organize a rite like a mourning experience or a leave-taking, with all the different meanings and different aspects that are involved. When the rite is complex, unhurried and repeated numerous times it can attract, possess and adhere to all the elements it contains. It's return and eternity can become a myth for the group. When the group has become sure of its own presence and its capacity to abandon its dead or extinguished contents (or non-contents), it recognizes that cohesion is necessary in front of a negative experience; it wants to be aware that it has perceived and faced the negative experience; it wants to become accustomed to how painful the change and the leave-taking are from what has to be abandoned, in order to distinguish between being negative and knowing or making a negative experience. Three Elements I will consider three elements of the depressive object: the melancholic devaluation, the insolvent devitalization; the revengeful persecution. All these aspects are present in freudian and kleinian literature and contemporary trends of thought, particularly Self psychology. I think that these perspectives must be carefully evaluated, if we want to denote a conspicuous characteristic of the depressive object that appears in a group. The group attention seems to be attracted by cycles towards certain elements, or to use Greenacre's image in her psychosomatic studies (1971), in accordance to a course in concentric circles, a rhythm brings following and repeated moments of acme. Before synthesizing in a collective rite the elements that will compose it, the group makes sure that these elements have been put in an adequate and exhaustive manner in their culture, so that its possible to register and represent them in a significant ritual, that will become part of a custom. As it is for all customs and rites, they develop a containing and stabilizing function, which is possible to enrich and repeat, and they also contain a communicative outward function: these functions seem to be essential in order to meet the depressive danger inside the group; for this reason birth and development of a wide and deep burying rite of depressive anxiety is very important in order to consolidate the analysis work and above all the interiorization work and its positive results, like significant figures and good relationships with brothers and with the community; the analyst's validity and his positive qualities; the founding experience of a shared method and other things more. The interpretation of these elements in group, is requested to propose itself again and again and in different ways according to time and to the context. I think that interpretation in group, admitting to call it this way (Neri 1995), is not, as in the classic setting, something that realizes itself in a specific moment inside a relationship or in a bi-personal field; but it is rather an announcement or a signal of a field route, of a direction that can mobilize collective interest, or maybe an affective and cognitive project that could realize itself. Interpretation, or words which are endowed of sense and that diffuse sense in the group, is disseminated of past and future, that still have to interweave one another (see Gaburri's idea on the unsaturated interpretation) and its physiognomy, its efficacy and its boundaries have a shape as its elements clarify and produce themselves; even its aim is mobile and temporary during the session; and its addressee, that is an over-determined subject, has a major reversibility and polyvalence than the individual subject. In this sense repetition is not only a culture of returning in the same places, but it is even a knowledge construction that will take part in a rite: and ritual is necessary in order to abandon a mythological knowledge in favour of a real knowledge. From the depressive object in the group, till it's not freed, with oscillations always more reduced and close to one another, and its persecutory and narcissistic imbrications, emanates a cyclic attraction that winds the group attention and asks an adequate answer; the answer, repeating itself in the same way or always better differentiated, provides resonance with mourning and at the same time is a different construction from it, but tuned in with its rhythm, that would tend towards eternity. Rite and cult though, that contain eternity, interrupt it and scan it.

Depressive Situation and analytical process in a therapeutic group
In a therapeutic group that worked since many years, after a long period of working-through its mournful issues, there has been a particularly synthesizing session and I would say ritualized from memories, coincidences, and from deep mirrorings in which two dreams were narrated , that in their essence soon appeared , identical one another.
In the first dream Giovanna was ritualizing her own traumatic scene, (her mother's violent death) imagining that she was exhumed, alive, and that she could decide if definitively put an end to it making herself die again or not. In the dream Giovanna's mother became violent and murderous against Giovanna and for her it was easy to decide for condemnation.
In the second dream Paolo was molested by his father ( which recently died) and agreed for his murder that had to be done by the man to whom the father wanted to transfer the fault of the annoyances that took place.
The two dreams were at once felt by the rest of the group as expressing something that was beyond the immediate and recognizable association with the historical themes both related to the two dreamers and their need of reorganizing a vision of their selves in relation to the suffered losses and to the group itself, that in difficult moments traditionally laughed of himself like if it fell prey of lacerating guilt and unsuccessful wishes. Particularly there was perplexity for their being alike and for their concomitance, and also for their rituality: the burying, that took place in both cases, for the second time, for guilt and for secure choice, compulsive. The images that were brought by the two most recent group members, group that worked for six years before their arrival, that in the meantime had formed a proper style, language and history which were not of easy access for the new. These two members, with these dreams seemed to reveal that they wanted to make an effort to fit themselves better in the group's traditions and to assume an important and renewed role and to perform some tasks.
The first task is to revitalize the group from depression, accomplishing a leave-taking rite, that the group wouldn't decide to do.
The second was learning to insert one's own mourning, accelerating the representation of serious contents, in order to be accepted and fully legitimized beside the old group members, more experienced and more loved or more linked to one another and linked to the psychoanalyst.
The third one has been to present clearly and in a synthesized way the task of a burial rite, specific of that group, which was public, active, legitimated and definitive. It seemed in fact that in this way the new of the group could exploit their capability of understanding, in a better way not being involved, the deep nature of the woeful whole group's issue and that, on the other hand, the already elaborated group's tradition would permit them to do it.
The group's problem, serious and tormenting which was lived for a long time in a complex event with many dimensions, had soon centred itself on one theme: being children not desired. The children, like the dead, always came back in the same way, without life and hope. (Neri, Group, On the new members as return of the dead.) A central session in the group's history revealed incredibly that all his members were born by chance or were not desired or had been actively fought (with attempted abortions). (But they resisted and lived.) In difficult moments this pain instigated all his lethal power. The roles, links, couples and subgroups that were formed all arranged themselves around this model scene (in Lichtenberg's sense). The most suffering patient, a borderline patient that for his particular porous manner and hardness was inclined to identify himself with the whole groupal field and that tuned himself with his most fragile and dramatic aspects, became a sensor, in this pathological level, of the general situation. All the others were attracted by similarity or contrast to bring their most consonant contents. Suicides that really took place and family psychiatric issues, abortion attempts, psychological tortures, abandons which were never forgiven, experiences of serious denigration and destructive and exploiting manipulations now came to the surface- the pain inventory has been huge but life could reaffirm its rights because a departure rite from the dead and from dead objects permitted it. The characters of this rite, that synthesized in a particularly adherent way the historical needs and the group's style, re-established a way, which was original and exclusive, to actively lose dead objects and abandon them to their own destiny in order to re-establish life's order and development, and the discrimination from death and from time which had been invaded by it's negative power. If you meet your Buddha, live him.

Myths and Rituals
Death anxiety has been studied from many points of view: my interest is to find in which way and for which characteristics death could be enrolled in myths and could be transformed like something that can become a ritual practice. Rite, for its dispositions, is collective and its object (in this case separation from the dead) contains general and universal characters, linked to social customs. The rite's participants are part of a tradition and know how to take part in its strengthening, because they are protected and strengthened by it. Besides rite has its own communicative power, which is addressed beneath the actual one towards an expanded public in time. The emotional aspect that concerns its object gains particular characteristics, less subjective and unilateral, which are more powerful and not temporal and that are supplied with major dignity and solemnity. In the great Greek myths the idea of death, mostly because of the tragic poetry from the II century before Christ, organized itself through sagas or events cycles, that could enable to dramatize an extended gamma of characters, relationships and facts that are destined, like the Homeric epos, to represent at all times a communicational model of drives, feelings, and thoughts that otherwise would lack an adequate expressive dimension. These myths often occupied groups and cycles of family generations and were interwoven to one another (for examples see the Oresteia, or the Labdacidi history, Oedipus, Antigone, Eteocle and Polinice in the Seven of Thebes and many others) forming a complex and articulated map of actions and ideas, full of contrasts and questions, that the tragic model was not obliged to loosen. The importance that Greek theatre had inside the polis life, for its social value of aggregation and redeeming catharsis (according to the Aristotle's idea) in respect of violent and destructive drives is well known. The theme is also debated in our times relatively to the modern myth: Imbasciati's and research on Schermi Violenti (Violent Screens) examines today's cinema double value of a redeeming or stimulating provocation, that puts on stage events of destructive dimensions more similar to a catastrophic myth than to history, (catastrophic myth that is frequently put in relation with the theme of a sexuality's negative birth, with the family's separation and with generation; or with the millenary extinction of a human residual that survived in the technological era). I would say that in both cases, in the classic and modern myth , the final or subjacent redemption is one of a ritualization of death in a collective way, shared, theatrical, that abreacts, in which the abandon dimension is celebrated in a public way and in a period of time that contains or that is able to capture eternity. In the pagan ancient times, in the anthropomorphous greek-roman religion, the dead's transit conception required that when a body remained without a burial, his soul was condemned to wander without any right to enter in the dead's kingdom; whereas only the survivors pietas could assure peace and eternity. In the Egyptian religion the care was concentrated on the dead's body, he was in fact preserved eternally by mummification; like if, differently from the ritual use of monotheistic religions, that abandon the body in the ground with burial, reserving for the soul the issue of memory and closeness, if the Egyptian rite placed in the body the element of inseparability and compassion. In the group finding the suitable rite for the type of separation, the rite that is possible for that situation and for that moment, is a very important task that has been woven for the whole time of the depressive elaboration, of fantasies, feelings, ideas and of the most nuclear emotions of its members and of their common productions.

Conclusions
It seems that depressive emotions in the group are on one hand avoided and on the other slowly built, just until they can be lived and worked-trough. Besides it is specific of this group that these emotions or mental states, try to fragment experience and make the sharing of it empty or useless, and that for this reason their presence is felt like a threat to the major and most specific group activity, that is the putting in common and for the production of reassuring and strengthening affections and of ideas ready to be enriched by different contributions and free to move around. Depression seems to attack this custom or this expectation and can be more feared than other kinds of attacks. In order to pass through this condition without too much terror and delusion, the group will have to produce useful elements to form a rite, which is recognizable and exclusive, and through which the access to emotions due to losses becomes less fearful and their elaboration will not tend towards explosion and emptiness. The experience of loss, in time, repeats itself in many ways in the group: from a request of accommodation and an initial legitimization of painful contents to the need of depositing and inscribing objects known as proper because they can create group foundation, continuity, tradition and memory: while knowledge and experience refine themselves, the mourning work- its repetition, its coming back, and its certainty of being there- moulds itself , it enriches, becomes more sharp and sensible, it connects with all the group aspects, listening and sharing, reassuring and investigating it. So then the first oasis in the desert can appear; construction and interiorization become more active, confidence and tenderness can develop once more and the more unilateral part of groupal narcissism can be abandoned for more true and realistic contact. In a group when the depressive position emerges from an orderly leave-taking, or from a collective burial rite it can deeply transform the mental and affective aspects of its elements.

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