Strings 1

‘dreams jangling with lost connections’

March 2024

A Case History

On the 8th of March 2023, International Women’s Day, Sharon Kivland read her short essay, A Case History, with some interjections, off the cuff so to speak, at the Freud Museum in London. It was a response to Sharon Young’s book Mrs B. The Hysterical Episodes, and her reading of it (and she screened a short film), an act of curious identification, a hysterical entwining, some might say. The event was entitled Marginalia (When did you start having those feelings? She wrote). There was snow on the ground. Later in the pub a number of people were surprised (and some vexed or disappointed) that Sharon Kivland was not after all a psychoanalyst. Writing on the hysteric, Joel Dor remarks that through identification with the ideal object of the people's desire, all her efforts are in the service of phallic identification. It is not surprising, therefore, to note the hysteric's intense attraction toward any situation in which this imaginary identification can be brought onstage.

I was surprised, I must admit, when a certain book arrived in the post. My surprise was due to several reasons. First, on opening the envelope, on which there was no return address, I found no accompanying note, and for some minutes, in fact, I did not recognise the name on the cover, even though in part, it was my own. Secondly, when glancing through the opening pages, I saw it to be a case history, but I have not been in psychoanalytic practice for some years now, since my retirement.

I was amused by the form of the book, indeed, that it was a book, for some may remember my thoughts on the publishing of case histories, that often it took me time to make up my mind if to publish at all, and certainly, I would make many revisions before doing so, often feeling it to be awkward to publish my own enquiries without there being any possibility of others working in the field to check them, especially if the results were of a surprising or even ungratifying character.

Once I was accused of giving no information about my patients, and perhaps today, it will appear that I am giving too much (though those under subsequent discussion are not in any manner my patients, I must be quite clear), and even of giving information that should not be given. When I was still in practice, you may recall, I remarked about one case in particular (one whose history is published and may be found in the museum shop) that the complete elucidation of a case of hysteria is bound to involve the revelation of intimacies, the betrayal of secrets, the expression of repressed wishes. I have always been aware that some readers of such material (revolting though it may seem) choose to read case histories not as contributions to the psycho-pathology of the neuroses, but as a roman-à-clef designed for their private delectation. And the strangeness of the book I received in the post, unsolicited on my part, is that it appeared at second glance to be a novel in the form of a case history, albeit a novel about real events, one that even has photographic illustrations throughout. The key of a roman-à-clef, real events overlaid with the façade of fiction, is the relation between fiction and non-fiction, a key that is produced separately as an explicit guide to the text by the author or implied through literary devices or techniques. I have, of course, written about this extensively.

I settled down with the book when time allowed, for though retired from clinical work I have a great deal to occupy me. Yes, indeed it read as a novel, despite myself. Yet, as I continued reading, a memory returned, pricked by certain images of the supervision work I had continued after my retirement, and in particular, of one analyst who approached me. I am sure you know that work of this nature, that is, psychoanalysis under supervision, is the formal process by which a psychoanalyst presents their clinical work, a careful reflection on it, to a senior and more experienced colleague, and if you will forgive a certain immodesty on my part, this is a role I assumed, or rather, was called upon to assume, frequently, given my reputation. There are different forms this supervision takes:  conversation on the telephone, letter or email, encounter; of course, it is intended to enable each analyst to work towards the best clinical practice with their patients. There are standards to be maintained.

It came back to me: perhaps five years ago, I was approached by a psychoanalyst, who said I had been recommended as a supervising analyst by a mutual colleague – I was never sure whom, or if the proper name was ever mentioned. The person requested that they might share the summaries of their analytic work undertaken with a patient called Ms. B. There followed almost immediately, if I remember correctly (I no longer have the note of the communication I must have made at the time), the proposal to send a report of the situation, then transcripts of a number of sessions, and to schedule a meeting thereafter, once I had time to read and absorb the material. I must have replied. I heard no further. I did not pursue the matter. The book contained this material, it appeared, elaborated by images.  I read it carefully, making margin notes as I read.

The book bears an epigraph preceding the title page, a quotation from Gustave Flaubert’s novel Madame Bovary: lines of bliss, passion, intoxication. (It is not one I would have chosen, selecting in its place, Madame Bovary, c’est moi.) Under the epigraph is a dedication: ‘to my therapist’ (there is a name, but I will not cite it, affording a guarantee of sorts against unauthorised readers, but of course, if this work is in circulation, available, say, from the Freud Museum bookshop, this can be no guarantee at all). I noted that the therapist is not from my orientation, and on investigation, comes from psychodynamics, working from a comfortable consulting room less than a three-minute walk from Victoria Station, within easy reach of Pimlico, Belgravia, Chelsea, and Westminster.

There follows a colour photograph across two pages: a round table covered with a red and gold cloth in a paisley design, largely in shadow, a band of light from a window behind it to the left falling on it. On the table, there is a matching pair of transparent plastic salt and pepper grinders. Something is implied in the image but at this stage, I could not interpret it, and in fact, in my orientation, we do not interpret images as such, for they are traps for the gaze, putting their viewers into the position of the eye, a hypothetical position obviously. It is not possible or even desirable to say anything about the psychology of the artist on the basis of the examination of a work of art, but you know my work on this. There are more photographic images, scattered throughout, though I suspect there is intention in their positioning in the narrative and ‘scattering’ can only be my somewhat resistant term. This is not within my capacity to explore. I leave images to others.

It appears straightforward, describing the patient, a married woman in her early thirties with two children, the wife of a vicar, from a middle-class background with no known history of mental disturbances, though of course, they always say that. She presents symptoms of depression, confusion, dissatisfaction with her marriage, and yes, they always do that too. Her illness – I am surprised that this term is used – is categorised into four phases: latency, symptomatic acting out, refusal, states of exuberant creativity. However, who is speaking or writing is thrown into doubt.

The chronology of the analysis follows: endures three years, then stops, then starts again two year later. The therapy ends once again, by the choice of the patient, then resumes. The writer describes what follows as a case study in four parts: a narrative report – the writer’s summary of the analysis, then transcripts of sessions in which reported speech is adopted, the first-person voice of the patient, with minor interjections and observations from the writer. My doubt increases – I have underlined ‘first-person’. Who will speak for whom?

The writer speaks the words of the patient, who often feels she cannot get her point across and is met with confused faces and disbelief, and yes, they always feel that. My margin note is highlighted with a pink marker pen: a shift from her to my: ‘complained of a deep darkness inside my head, of having two selves’. In the main body of the text, it is she, not I, in what seems a faithful report of the story or rather, of the telling of the story, the story as she told it and was heard to tell it, had learnt to tell it. It is possible to become quite practiced in telling one’s story – I came to understand this in my clinical work, listening to hysterical or obsessional patients droning on and on, endlessly rehearsing their narratives, honing them, watching their reflections in the window glass of my consulting room, trying to catch a glimpse of me behind them in my ergonomic chair, to ensure I was paying close attention, that my eyes were open (I became adept at appearing to be awake while I dozed).

Margin note 2, the author’s, a soi-disant observation: ‘suffocating in the dead of night’; her note 3: ‘certain it would never end’. I have underlined both, writing against the sentence: ‘she fell in love with another man approximately every two years for ten years and told him about every single one of them, having never acted upon her feelings’. ‘hysterics, dominated by the unconscious determination to frustrate themselves’, and moreover, now, I would add that it is always a question of desire, but whose? whose? In the loving without measure?  Was there to be a silencing if I had stopped my attentive listening, seeing myself in the glass behind the reflection, if I were to have closed my eyes?  Is it the patient or the analyst-writer in this margin note: ‘an unspoken connection between herself and her audience’. ‘Counter-image’, I have noted against this in the light stroke of a pencil, but what on earth did I mean?

The patient asks the writer, her analyst, what more she could want, gazing into the distance. Perhaps the question is not directed at her analyst at all, who is no more than a function. The writer notes that in all their sessions there is a dissociation between her identification with herself as a mother which she rarely discusses and her acknowledgement of herself as a desiring woman. I have underlined this with the same pencil. I went back to one of my case histories, hearing an echo in the relation of women and children and maternal devotion. I always asked my patients to give me a full account, the whole story of their lives and illnesses, but even so, the information was never enough to allow me to see my way about the case. The first account was always like an unnavigable river, its stream at one moment choked by masses of rock and at another, divided, lost among shallows and sandbanks. The connections, even the ostensible ones, were often incoherent, the sequence of events uncertain. I learnt to be suspicious of coherency.

The writer realises the seriousness of Ms B’s condition, remarking on two distinct states of consciousness, one in which she was aware, self-critical, of her destructive behaviour, the other where she was enslaved to it. The patient shows her analyst her art, and it seems that she was using it in order to understand herself. But these things are always surrounded by doubts, and any insights I might have had into the complex of events composing the case can be no more than fragmentary or speculative under the circumstances. It is, of course, not to be expected that the patient will come to meet the physician half-way with material which has become pathogenic for the very reason of its efforts to lie concealed; nor must the enquirer rest content with the first ‘No’ that crosses her path. Literary strategies were drawn upon in her art works, these unconscious voices lending themselves to plays and dialogues. I remembered that long ago, while I was working at the clinic in Paris, I had observed how writing operated vicariously in the place of speech for some patients, who were able to write fluently, quickly, better, their words on paper more eloquent than those that stuttered from their mouths.

Ms B. asks the analyst/writer if they thought her to be deluded in her own unhappiness. She does not want to replicate her position of unfulfilled desire with another. At this point, she leaves the analysis, breaking it off the first time, though oddly (I made an asterisk here in blue pen, the ink smudging a little on the page), there is no break in the account, which simply continues without rupture, leading to the description of a two-year affair (which I took to be the period of absence from analysis), one that was violent and addictive. She describes a feeling of connection, tied so closely to her lover, of being something that someone else wanted, that it was she whom her lover wanted. Her analyst interprets this rather as her lover wanting a sense of his own power, if I understand the narrative correctly. The word ‘naïve’ is used to describe her desire, but it is unclear if this is the patient or the analyst speaking, evaluating, judging.

I was perturbed at the elision between the two voices. The tone was not entirely objective if it were the latter speaking. The italicised notes of the author, to which I was adding, were not notes of an objective nature, but perhaps verbatim report, slipping in without comment, and to quote an example, ‘softly spoken words, carrying me away in their arms, dissolving in love, incursions of grace, my head fell back, faster, larger, into his hands, ecstatic transports, rid me of all suffering’. Yes, my concern increased, and I think I would have signalled my alarm in a supervision session had the occasion arisen.

She returns to analysis, the second period, having left her husband. The period of therapy is described as ‘extended, complicated, conflicted’. The margin note says: ‘with an effort I conquered the spasm’. This section ends; in the blank space below I have written, in capital letters and with a black pen, ending, I fear, with an exclamation mark, that ‘the hysterical symptom does not carry meaning with it, but meaning is lent to it, soldered to it, as it were; and in every instance the meaning can be a different one, according to the nature of the suppressed thoughts which are struggling for expression!’

There follows transcripts of three sessions, each introduced as a mise-en-scène. In the first, Ms B. enters and sits behind her analyst, reading a text presumed to be hers, yet some phrases are recognisable as those of Flaubert or, extraordinarily, of myself (or indeed, of my patients). I was taken aback. After the reading there is silence. She is asked if it was her voice, but she does not reply. I made a note here in red ink, that in any consultation as a supervising analyst, ‘at this point my interpretation would have touched upon the subject of transference and counter-transference’.

It is reported as a practiced reading and appears in the book in the mise-en-page of poetry. In the second and third session, the patient returns, reported as suffering from malaise, melancholy, despair, as they always are, without exception. The transcripts of these sessions are supposedly verbatim, unmediated by interpretation, I, I, I. endlessly, without observation, interjection, commentary, no, that is not quite true – there are indeed margin notes, the same italicised references, confusing patient and analyst. There is she, not I, in these asides: ‘she fell to the ground’, ‘she hallucinated’, ‘she complained of a deep darkness inside her head’, and I no longer knew who speaks, who is who in this relation, one that ends suddenly thus: she left feeling resigned, rejected, but accepting of the situation. Almost relieved, and I drew a thick black line to underscore ‘almost relieved’.

I almost missed what seems to be the final session, hidden among images I could not attempt to decipher, bodies, caverns, beds, a father swinging a baby into the air, a mother’s body truncated by a pram in which a baby sat, misty landscapes, a blank wall, dining tables in a restaurant with a view towards the sea. These images must be supposed to have meaning, to be part of a vocabulary with its own eloquence. ‘Transfixed,’ I noted, in the green biro I had to hand. The analyst reports the patient’s anger, approvingly. She/I describes a blue diamond-knit jumper. Her note reads: ‘echoed and re-echoed’, repeated twice more. It is the end: and an I notices that this I becomes aware of that this I is wearing their blue diamond-knit jumper again. And the end, the very end, is a dark blue sky with a tracery of branches.

I remembered my own patient breaking off the treatment, just when my hopes of its successful termination were at their highest; I wondered if I had been sent this account from similar sentiments of failure or if the gesture was a challenge to my work. I wrote then, following the rupture with my patient and my thoughtful publication of her case history, that naturally I could not prevent her from being pained if the account should accidentally fall into her hands, but I reassured myself that she would learn nothing from it that she did not already know and indeed, she might ask herself who besides her could discover from it that she was the subject of my paper. 

I was left with uncertainty when I finished reading, and placed the book at my bedside, to sleep on it, as it were, for dreams, as you know, are the royal road to a knowledge of the unconscious activities of the mind. On waking, it occurred to me, and the feeling was strong, that there was no patient, no Ms B. She did not exist. Or rather, she did not exist in the analytic encounter with another. There were never two people in the consulting room, one sitting in a chair behind the couch upon which the other lay, sometimes looking at her and their reflection in the windowpane, the other dimly seen, overlaid in the glass. I am sure you understand what I am saying. Once I wrote that I could only analyse myself with objectively acquired knowledge (as if I were a stranger).

SHARON KIVLAND is an artist and writer. Her work considers what is put at stake by art, politics, and psychoanalysis. She is currently working on the natural form, fables, and the furies. She has been called a poet, to her surprise. She is also an editor and publisher, the latter under the imprint MA BIBLIOTHÈQUE. Her novel Abécédaire was published by Moist Books in July 2022. She has just completed a new book, Almanach, which will be published by Grand Iota in March 2024.