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 My first experience of a large group occurred while working with Dr. Maxwell Jones at Dingleton Hospital in Scotland in the summer of 1963. "Max" as he was affectionately known, was trying to transform an old fashioned hospital regime into a therapeutic community. Without warning, he suddenly suggested that I run a group of fifty ladies, many of whom had been residing in the chronic woman's ward for decades. I tried to get them to talk about themselves, and to each other, without much success. I am sure that they were as frightened of me, a brash, bearded young American, as I was of them. But that was my job, to shake things up in whatever way possible.
The occasion also provided me with a concrete experience of projection. After hovering about during one of these meetings, a wasp stung me in the neck. The sting hurt like hell, but I tried to carry on as if nothing had happened. Did the wasp emanate from one of the woman? Or, more likely from the elderly ward doctor who so hated my intrusions into her domain? At the time it did not occur to me that the wasp could have been an -envious ejaculation- or a projected expression of doctor's "evil eye". In fact this person used to hide behind the curtains in the ward in order to watch what was going on. If she found out that one of her charges had been talking to me, or had accepted a "fag end" from a male patient, the woman patient would disappear. What had happened? I was mystified until I discovered that the individual in question had invariably been given a dose of ECT on the next day.
By
1965 I completed my medical training and returned
to London to live and work with Dr R.D. Laing at
his Kingsley Hall community. I have described this
experience at length in the book I wrote with Mary
Barnes, the woman I helped go through a psychotic
regression, in Mary Barnes: Two Accounts of a
Journey Through Madness (2002). As I later
realised, this community functioned like a large
spoked wheel with Laing at the Centre. All
communications had to pass through him. All
relationships were centred on him. He knew what
everyone was thinking and doing, but most of the
residents were dimly aware of what was happening on
their periphery. This led to a lot of paranoia. The
principle projective processes had to do with
jealousy, who was close to him, and who had been
shunted to the outer circle. Much of the psychotic
interactions had to do with these highly charged,
but vigourously denied jealous emanations.
From
all this I learned how projective process dominate
relationships, whether with and within individuals,
small groups or large groups like a therapeutic
community.
By projective processes I refer to projections as active psychological and interpersonal events. These are operations involving mental mechanisms like denial and evacuation leading to a perceptual transformation of the focus of this activity, the object, as well as the person doing the projecting, the subject. Moreover, projective processes are not just mental events, They also include interpersonal transactions, something that the subject does to another, the object, in order to arouse a further something in him or by her. By "something," I refer to the contents of the transaction: feelings, thoughts, states of mind, primary process experiences, "beta" elements; all the noxious stuff that people can and do evacuate into others. But it is very important to note that these projections can involve good or valuable experiences too.
The
third component of a projective process concerns
the reasons for these transactions: They include:
getting rid of inner tensions, control of the
other, envious attacks, scapegoating, as well as
preventing separation and non verbal communication.
As far as the reasons for arousing good impulses,
like love in others, these include control,
avoidance of separation, and communication, but
also primitive reparative efforts and
protection.
Really I am discussing a projective/introjective system which my Kleinian colleagues and others have intensively explored under the term "projective identification" and "introjective identification". In this chapter I wish to emphasise the system or systemic aspect of projective processes. It is necessary to look at where they come from and where they end up. I am speaking about the originator of the projections and the recipient or target of them, as well as the interplay between the projector and the recipient.
With
this in mind I want to explore the power of
projective process in a special projector and
special recipient, the Arbours Crisis Centre. The
Centre has been the major focus of my professional
work. Here, as with Dingleton or Kingsley Hall, we
can see the operation of a large group in the form
of a specialised therapeutic community.
In
the first part of this presentation I shall
consider the Crisis Centre as a target of
projections originating from outside the Centre. In
other words the originator is or were persons
external to the Centre, and the Centre was the
focus of intensely evacuated impulses.
In
the second part I shall consider the Crisis Centre
as both originator and recipient of the
projections. In other words I will be discussing
what happens from the projections originate from
within the Crisis Centre and travel from one part
of the Centre to another.
But
before I begin let me provide a few details about
the Centre. It is a facility of the Arbours Housing
Association, a mental health charity which I and
others founded in 1970. The Crisis Centre itself
was established in 1973 and is now located in a
large Edwardian house in Crouch End, North London.
It provides intensive interpersonal and
psychodynamic support to individuals, couples and
families in severe emotional distress.
The Centre is a unique community because the staff whom we call the "resident therapists" or RTs live at the house on a full time basis. It is their home. People come not as patients, but as guests, and stay with them for days, weeks or months.
The term "guest" conveys hospitality, and a "treat", not a treatment. Many residents or guests have been in hospital before. Our aim is help them to shed, or never take on, their learned role of mental patient, or institutionalised other. Moreover, we intend that they should achieve a position of respect and dignity, as well as the relief of whatever pain brought them to the Centre in the first place. More information about our work can be found in two anthologies written by therapists and guests connected with the Centre. The are Sanctuary: The Arbours Experience of
Alternative Community Care (1995) and
Beyond Madness: PsychoSocial Interventions in
Psychosis (2001).
My
first example has to do with the power of
projections or projective processes which arise
from outside the Crisis Centre. Here external
others are the originator and the Centre is
the target or recipient of these events.
The Centre Centre was the fruition of a year's discussions in 1972 between myself and therapists and residents of two initial Arbours' communities. At that time the communities were young and there was a lot of uncertainty and inconsistency as to how to join one of our households. Sometimes it happened quickly, sometimes slowly and sometimes not at all. Often people were very caring for each other, but not infrequently they remained unconcerned. Moreover, there were no clear cut lines of responsibility as to who did what for whom. I proposed to establish a household where people in acute distress could be accepted quickly and be offered very intense personal and psychotherapeutic support.
The
small circle of people interested in the project
first researched the literature on crisis
intervention. Then we decided to push ahead and
establish a new community where at least two
residents would provide direct care ( the resident
therapists, RTs) Other, experieced therapists would
visit often and back them up ( the Team Leaders,
TLs). But we had no money, nor a place where this
could happen.
In
the fall of 1972 one of the Arbours long stay
communities was in the home of Morty Schatzman and
his wife Vivien Millett. They lived in a large
house near Parliament Hill in Hampstead. Next to
them there was a large church, a vicarage and
unused church hall. During the course of a casual
chat with his neighbour, the vicar, Morty mentioned
the proposed crisis centre. The vicar immediately
exclaimed, "What a good idea! Why don’t you
use the church hall?"
Morty
told me and I told others in the discussion group.
We all agreed it was a grand idea and made imminent
plans to move to the church hall. When we told the
vicar, he was pleased, but suddenly sprung a
condition. He recalled that there had once existed
a neighbourhood association in the vicinity of the
church and suggested that it would only be fair to
get the neighbours permission for the proposal.
Thoroughly alarmed, because I knew how difficult it
was to get any neighbourhood group to agree to a
mental health project, I remonstrated that what was
most important was to get the Centre off and
running, before meeting with any such group. Then
we would have something tangible to present. But
all my arguments were to no avail. The vicar
insisted we first activate the neighbourhood group,
which had not met, as I subsequently learned, for
ten years.
So notices were passed about and on a wet and windy evening towards the end of November, we prepared to meet the neighbours. I tried to console my colleagues. How many would turn out on such a cold night, five, ten at the most. In fact close to eighty irate men, woman and children crammed the hall to vent their upset and anger at the prospect of "mentals" moving to the area.
One man in particular, a plumber who lived a block away, was apoplectic with rage. He screamed that he would not allow drug crazed perverts, sex maniacs, violent and immoral lunatics, to roam freely in his street. His wife and children would be endangered. And if their weren't enough, house prices would plummet. Needless to say, these words carried the meeting. The project was turned down and all the Arbours people present fell ill with the flu.
It was obvious what had happened. The plumber and most of the neighbours who spoke up against the project had attributed their own denied sexual, violent, perverse and perverted wishes to the Arbours therapists and unnamed "mentals" whom they imagined were about to invade their space. As for myself and my colleagues, one might say that we were made sick by their envious, hate filled ejaculations. But it is one thing to know this. How can one prove it?
Some months later Morty was referred a young, pretty trainee accountant who lived nearby. She had been having a torrid affair with a married man who also lived nearby. But he had begun to frighten her with his possessiveness. She responded with panic attacks, crying spells and sleeplessness. Things had gone from bad to worse. Finally the man had taken to keeping watch all night in his car outside her flat. Most alarmingly, he claimed to carry a loaded shotgun which he would use if any man dared to visit her. Who was her lover? None other than the plumber who had carried the meeting with his diatribe against sexuality, violence and immorality. Rarely can one see the evidence for a projective system so directly. This episode provides clear proof that the plumber had offloaded his denied perversities onto the Arbours project.
My
second example has to do with the power of
projections or projective processes which arise
from within the Crisis Centre. Here one part of the
Centre is the originator and another part of the
Centre is the target or recipient of these
projections.
"Akuna" ("A") is a 23 year old young man of "African" origin who was brought up in London by his Mother, a woman who has been depressed all her life. She is a woman who dreads abandonment and has done everything in her power to keep "A" close and dependent on her. In fact, various colleagues have referred to the mother's attachment to "A" as a striking example of "symbiotic enmeshment".
When
Akuna came to the Centre, he was tall and thin and
silent. Perhaps because he had shown a lot of
intellectual capacity, having read Shakespeare at
school (he was particularly fond of Hamlet), there was a lot of uncertainty about what diagnostic category he might fall under, that is, what was he? Eventually the favourite category was "elective mute", although "simple or hebephrenic schizophrenic" were also considered. As "A" grew older, he became more withdrawn, and inactive, and was described by psychiatrists and social workers as "passive and frozen."
Akuna
was an unusual person in that while appearing not
to respond to anyone or anything other than his
mother, large numbers of people have taken upon
themselves to provide for him, beginning with
social services, and continuing with the therapists
and guests at the Crisis Centre.
In fact we broke all our rules in accepting him as a resident. Our main criteria is that a person wishes to stay at the Centre. "A" never indicated in any way that he wanted to come to the Crisis Centre. He never spoke, never gestured one way or the other. His carers both wanted to keep him, and knew he had to leave.
It was never clear to me why we accepted him, although in retrospect I think we were engulfed by his need to be needed, and seduced by others feelings for him. Akuna’s team included Cath, his RT, Paul, a new, but experienced team leader, and Neil, an Arbours Trainee. Cath quickly became his primary contact and support. Their main exchange was "A"'s demanding and Cath's giving cigarettes. He could smoke a whole pack in one go. Aside from this, Cath said she felt as if she was on a "wild goose chase" of speculation, only to find at the end of the pursuit, further confusion and an utterly, contradictory action had occurred. Cath remarked that it seemed like "A"'s main aim was to defy understanding.
To
all this Cath responded by enmeshing herself as a
mother substitute and sex object. Concurrently,
Paul and Neil defended themselves by means of
boredom and indifference on one hand, or despair
and rage on the other.
The Centre, in turn, seemed to be taken over by paralysis and over activity. Although "A" missed most meetings and meals, did not join the cooking rota, smoked in non smoking zones, wore clothes till they stank, and often appeared in semen stained underpants, this all seemed to be taken for granted. Then some therapists and guests would get so concerned and angry, that they began to intrude in his life in a myriad of ways, like his mother so often did, when she visited the Centre, barged in his room, and dragged him off for an Afro haircut.
Akuna's exercise in non-being aroused a cascade of projections. Many of the ensuing emotions were very intense, both positive and negative. But there were considerable hints at their counter transference components, such as the fact that "A" continued his charming custom of putting raw eggs in the microwave and bombarding them with rays them till they exploded.
Similarly, the situation at the Centre continued to simmer until it exploded one day when another resident suddenly called "A" "a black baboon".
"Abdul" was someone who had come to the Centre with the reputation of a monster: very loud and aggressive. During the first part of his stay most of the residents including the RTs were very frightened of him. Gradually he modulated his vocal repertoire of demands and insults and had been grudgingly accepted by the group. But there was one aspect of Akuna's behaviour that Abdul found impossible to take, that was "A"'s continual low level giggles and inexplicable outbursts of laughter. Abdul thought they were particularly directed at him, and felt put down and humiliated by these noises. He hated "A" for them.
One day Abdul joined one of the rare house meeting that "A" deigned to attend. Whereby upon Akuna dominated the meeting by prancing about making silly giggles and seemingly laughing at internal voices.
"Black Baboon! Black Baboon!"
Horror of horrors, Abdul had articulated what some people had been thinking, but were reluctant to say. For this everyone pounced on Abdul, How dare he call "A" a black baboon. Didn't he realise this was racism? All the anger and aggro turned on Abdul. "A" continued his silly grin.
The next day Abdul returned to the Centre in the evening after a trying visit with his family. He switched on the TV. He was wanting to bury himself in the visual and auditory projections emanations in front of him. But then another guest, Zoe, came in. She wanted to watch another programme, or as I would see it, a different set of projections. In front of the TV, they fought for the controls. There were heated exchanges. The hand set was thrown about. Zoe stormed up to her room with the house newspaper (This is a cardinal sin. The paper is always supposed to be kept downstairs in the lounge or kitchen/conservatory) Abdul ran after her demanding she return the paper. Zoe refused, but Abdul barged into her room, took the paper and whopped her on the head. A big commotion ensued, but Zoe, all 84 pounds and thin was determined not to be intimated by Abdul 238 pounds and stocky.
Eventually the whole house got involved. Some guests felt that the ruckus was no big deal. Abdul should apologise. End of story. But Cath, who had been aroused from her sleep by what was going on, in conjunction with other guests and students, argued that on top of calling "A" a baboon, Abdul had become abusive, dangerous and was a risk to others. He should be asked to leave.
Eventually
the issue was put to me. I should be the judge jury
and executioner. The situation reminded me of a
previous incident with Hamid a guest who had
surreptitiously eaten food laid out for a reception
after a lecture. I described these events in my
paper, "Psychotic interventions," which was
published in Beyond Madness (2001,
pp.188-201).
Again I was chosen to be the executioner of a decision the RTs had made. But, I refused. I made it clear that I didn't think that such an extreme measure was needed. More reflection was required. In the end Abdul was asked to leave for a few days while I was on holiday. He returned when I returned and said sorry, much subdued and appropriately depressed.
In retrospect it became obvious that whatever Abdul had done, he became the focus of and scapegoat for the anger and aggression of Cath, Akuna, Zoe, and many others in the house. Embodying "A"'s projections as the over solicitous Mother, Cath especially was determined to protect "A" from others' aggro which she saw as a threat to her own "guest/son/lover." Perhaps more important she sought to protect "A" from her own hostility which she projected identified onto Abdul. Why? Because Cath was in a constant state of frustration, as were others, about "A"'s giggly non being in spite of their best efforts to get him to do things or not do things which upset them.
Akuna's insistence on loud music exemplified this. No, he didn't speak. But his ghetto blaster often spoke for him. it was a continual source of irritation which led to a rare occasion when "A" was willing to speak up for himself. Once Lizzie, the nurse therapist at that time, who was staying over while the RTs had a night out, confiscated his stereo lead after repeatedly failing to get him to turn the volume on his set down. He replied in a loud, menacing angry voice:
"It's my lead, give me my lead back, I'll fucking kill you. I'll cut you up, you cunt, you came in here and just took the lead, its all on camera!"
At that moment "A" catapulted out of his trance like state and became a different person, angry, violent, threatening, but embodied, direct and dangerous. But it was not politically correct to see this, even if it starred you in the face.
Abdul eventually completed his stay successfully and moved to another community. However "A"'s undercurrents remained all pervasive. They boiled over towards the end of his stay, for he was responsible was a series of fires in his room and in the kitchen. As a result, he was asked to leave. Much to everyone's regret, he was taken to hospital where he remained for some time. This was his way of cutting and running. In so doing he may have protected himself, but he
made a monkey out of us: for allowing him to be
an exemption, for breaking the house rules and for
us not challenging him much more,
Anyway "A" is out of hospital now. Cath ran into him a few weeks ago outside a supermarket in North London. He greeted her warmly and told her all he had been doing. At that moment he was on the way to his sports club.
As
for Zoe. little Zoe. In spite of her size, as she
came to life, so did her combativeness, anger, and
aggression. She tried to hide this by starving
herself and keeping to her room. But her feisty
mannerisms belied her innocence.
I have just given two examples of how powerful projective systems have taken charge of a large group, the Arbours Centre. In the first instance they emanated from outside entities, neighbours, and were directed at therapists and residents. In the second example I showed how the projections took charge and, like an illl wind, or "malign and poisonous spirit", and how they threatened to decimate the life of the group.
In
conclusion I would ask if is it possible for
projective processes not to take charge in a large
group like a therapeutic community? Stanley
Schneider and Rina Bina address this very point in
their chapter, "The Hierarchal Authority Pyramid in
a Therapeutic Milieu," also in Beyond
Madness (2001, pp 255-268).
First they point out that projections don't always have to be "ejaculations or irradiations" of evil. They can also be idealisations such as accompany the medical model of the therapeutic dyad. Here the patient lies in the firm hands of the all knowing, all giving, all controlling doctor or institution.
In
fact many attempts have been made to circumvent the
structural rigidities and anti-therapeutic
implications of such a dyad. These go back as far
as 1792 with the opening of The Retreat in York.
There patients were encouraged to take power and
control over their own disorders.
More
recently I can cite the pioneering group work of
Wilfred Bion and S. H. Foukes and the practical
applications of Tom Main and Maxwell Jones. At
Dingleton Hospital in Melrose, Scotland ( where I
spent a summer) and at the Henderson Hospital in
Sutton, Surrey and Cassel Hospital in Richmond,
Jones and Main established therapeutic milieus
where to quote Stanley Schneider:
"Patients,
guests, residents, group members: "Now become
active agents in the treatment process. Staff
members make great efforts to flatten the
traditional authority pyramid. There is an
effort to develop a community cohesion by
frequent community meetings, and the deployment
of patient government. In addition there is more
open communication between staff and patients
and constant re-evaluation of role and patterns
of functioning" (1978, p. 257).
Essentially this means that the therapists make the effort to share power, rather than aggrandise it. Moreover, they don't have to take charge of or control of the projective processes. They are much more concerned with empowerment.
As
we have seen when events take a benign or creative
course in a a large group, empowerment signals
that:
- The
therapists are receptive to projections, instead
of trying to squash them.
- They
are willing to suffer when projections hurt,
rather than defend themselve from nasty
narcissistic wounds, or counter
attack.
- They
try to negotiate boundaries rather than impose
them.
- Whenever
they are knocked off course by the power of this
or that projection, they are willing to expand
their interpersonal field in order to regain
their thinking process, rather than revert to
omnipotent interventions.
- Finally,
we must realise that death impulses can be
accepted, but especially be tempered by
libidinal desires and reparative
efforts.
I have tried to show how these positive steps ameliorate the hurt, distress and desperation for all members of the group. I think this capacity to overcome the power of harmful projections and potentiate authentic relationships is what therapeutic work with a large group is and should be all about. Maybe this doesn't happen all the time, but it does happen enough of the time, so that as Schneider and Bina point out, treatment can be a 'treat', and not an excuse for sustaining projective systems, nor perpetuating harm.
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