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Sunday, 14 August 2016

A look at the limit - learning from the experience of clinical work with childhood disability (Notes from the seminar of dr. Simona Daneo & dr. Michela Fiore)

There are patients who teach. 
The road is not given. 
In its place, there is only one path. A process.
An exciting start of an intensive seminar, deep, experienced and felt to the limit between the clinical professional look, and the one of the father who moves within the same field.

A day which has been intense, and deep. A look that becomes a see, and a possibility to say something to the limit, of the limit and above the limit.
As usual, some days were useful to settle down the many suggestions that Simona and Michela have given in their workshop. A few days to prepare the time for sharing.
It all starts at the beginning, from the first look, from the encounter.
Important movements, mostly in the shape of counter-transfer, are activated within the reciprocity which arises from the activation of our most intimate and deep parts when they come face to face with the daunting, the deformations, the fear, with the extent of thinking any im-possible healing, while care is possible if as psychologists we ask ourselves honestly, with our nudity and our inner movements. With our body, always a bit uneven from the ideal body, always missing something.
Just as the answers we all get any time when facing a mirror, it is seemingly significant the presence of the psychologist in the field of disability. Just as a mirror seems to say something of our shortcomings, of our unevenness and lack, of our defences; the same way, dealing with disabilities speaks to us of our defensive movements in the face of fear, vulnerability, of being the subject of the social stigma and refusals, of the idea of the disease, of the unevenness of the body.
In an even more explicit way, which is always silent and often at risk of own denial, the relational space is a space for the transfer dynamics and for the bodily counter-transfer, like in any other intervention of care. It is displayed from the very beginning, from within the structural reciprocity which is the core of the relation of care. As in any other situation of care, it is a relation of caring between ideas, beliefs, identity, ideals, desires, failures, unevenness, emotions, bodies, concepts and visions, preconceptions and prejudices. Able and disabled. Open questions. Who is compared to who? … who is compared to what? …
Each time we meet another body, each time we meet the body of another, it is the moment of a contact. It is physical. Having a physical contact with the experience of the limit, of the disease and of the im-possible healing, it is a contact with the discomfort, which queries the body of the psychologist, as well as his/her desire. Together, it questions the words, the curiosity, the trauma, the body experience. To listen to these questions, to open up to the possible answers, to the unevenness and to the vulnerability, it means to accept an internal speech, which is always very intimate, salvific and sometime painful.
It means to accept a position which is moving toward a rediscovery of the profound knowledge that we did not know to know, starting from the initial discerning what we do not know, and our thoughts not yet thought. There are patients who can teach. The road is not given. In its place, there is only one path. A process.
It means to be in the hand of the Other, to be open to the Other, to what the patient can teach me, while maintaining a perspective and a internal-external proportion which is always perceived from within.
It implies a signification that one does not necessarily manage to recover for the emotional experience which is resulting.
The "non-" part of an action is no longer an act of denial, nor an exercise of the case, but it is a moment of a residual vitality, of a unique expressiveness which is never partial if it is seen from the perspective of the subject of care. Nothing happens by case, as it is repeated from Plato and Aristotle to Master Ogway.
It is a space dedicated to the "non-" part. Not full, not saturated, not filled; almost paradoxically, it is not a lacking space, but a space filled by the absence. It is an unsaturated space.
The experience of such an unsaturated space, of the dimension of the im-possibility, it is already a relation with the very essence of the language that acts as punctuation, marking the distance that precedes and enables the contact. This distance is not a failing, it is not a loss, it is not illness or disability. On the contrary, it is the sole condition to allow a space for the meeting with the existence of the limit, and with that generative lack in which the desire for life can be accomplished.
So we should open ourselves to this unsaturated spaces, to the lack, the impotence, the invisibility. Without reservation, without defences. Letting us been invaded, and permeated.
The emotional experience, the pain, the grief and sorrows are never proportional to their visibility, especially in those disabilities and mental diseases which are invisible by themselves.
Any acquired or inherited disability refers to those dimensions which are themselves acquired and congenital, or rather archetypal. It opens an almost physical space of viability which is located as an intermediate logos, in the difference between the "time-before" and "time-to-come".
The "time-before" defines itself as a time of care, of the competence, skill and ability of the care itself, an ideal space to recover. But this primary ideal to be recovered is not given, or better, is given at a “-less”, by a “make less” than one or more abilities. It is a time “-less” of the care, which is not given, because it is not-possible. The psychologist's ability is measured by being in that “-less” of the skills of care.
The ability to mend this difference implies the possibility of this unique area of nursing, which it is signified only from a reversal and logical overcoming. Even more than in others, in this specific context the dimension of "non-healing at any cost" it is not a denial, but as the only condition that allows the analytic act: it requires the coming out of a "self-less" perspective, and to be freed from a perspective focused on the past, in favour of dimension well alive in a present which ignore, and it is open, to the future.
It is necessary to live through some emotions (as suffering, grief, pain, sorrows…), not to defend themselves from them, but rather defending them: this will allow an existential sharing between the psychologist and the subject of the care, allowing to give dignity and right to the suffering of the disabled person.
Almost opposite to the degree of "-less" of the inevitability in the diagnosis of non-healing, the disabled person is over-exposed to a "more" of medical treatments, which often consist of a silent, invisible and inexorable violence, made of handling, looks, violations of the intimacy and of the integrity of the body, with a continuous reference to the violation of the IM-possible.
The clinical act works to recover this space of internal viability, which is not performative, but existential. As one person once told me during an open working-group «…I dribble … I can not speak … I can not express myself … or move like you … but I feel the same emotions that you feel … and that think I can not help …»
As in any other field of intervention, the dimensions which pertains us is beyond the Other, being in front. The main question is how the psychologist can live and deal with the dimensions of the impossible healing, with the inexorability of a disease, with death.
The counter-transferal dimension queries with a deeper intensity: if the care intervention works, the degree of sorrows, sufferings and grief will increases while the person emerges from his/her silence, from the implied-but-unsaid im-possibility of a complete healing. To open the door for a possible recovery, the psychologist should follow, accompany and learn from the patient how to deal with the impossible healing.
The ability to accompany the person to the awareness of this im-possibility implies a path to recover the individual identity from an enormous wound.
Unlike other situations, here the original wound is real, before being symbolic. This determines a "containment" operation that the person puts in place to defend against the daily routine, favouring splitting movements and compensatory narcissistic instances to overpass the weight of anger and envy.
These dynamics lead to a conflict with the ego-ideal, which is often borrowed by osmosis or by tilting from the parental proposals; on the other hand, it can result in a compensatory projection of disability into mythical characters and superheroes.
I won't deepen the parental influence here. But it is fundamental to see how the contact and the continuous comparison with the parental dimension can leave the disabled child in a difficult space of signification: the child will be involuntary forced to face the defences which are expressed and acted by the parents. They are themselves called to confront with their anguish and mourning for the lost ideality; it often results into falsely-salvific projections ("you'll see what you'll do when you'll grow up") or into self-accusatory and comforting introjections of the disability of the child ("it's all my fault, as I generated you").
The self-accusatory dynamics is often present in the parents, and it obviously implies a self-comforting defence. What the parents need to realise is that their child disabilities, once entered in a speech of guilt which might be repeated over and over, it is of no support at all for the disabled child.
The intellectual inhibition, together with the right to refuse any rehabilitation scheme, complete a picture that questions what the psychologist is able to do with an identity which is (and never will be) something unique. This concept has been dramatically but impressively summed up by the expression cited by Simona Daneo: a disabled boy who told her in a moment of deep intensity: « … I do not want another mother … I want another birth …».
These words express the significant condition of the need to survive from the mirror-alike position with the parenting part, which often lives the disability in terms of introjection «… look what happened to me…». The point is that it actually happened to their children; and that this constant repetition might help parent, but takes away extra space to their children. I always remind that each person, at his/her peculiar way, know its own truth, and that it can be speakable. The psychologist just has to listen: « … I do not want another mother … I want another birth …».
The self-observation is a basic part of any psychological work, as it should be part of whatever parental role. This will allow to discover the invisible, to make visible the emotional dimensions and the counter-transferal dynamics.
Likewise, the component of "educational" parenthood, which is part of the psychologist, may be loosened starting from the emotional and counter-transferal dimension, which can -and should- always be recalled to evidence a space of awareness, just to allow the professional to do something, while and within its implication.
Just as every act questions our desires, the psychologist can empower itself to toil his suffering in meeting the Other without memory nor expectations. This position allow the subject of care to enter its own field of own care, in which the professional is, and will always be, existentially external. The psychologist can itself create a space beyond the projections of its shadow-parts, or its uncanny parts, which will be implied upstream in order to be comfortable in our "un-learnt" speech of care.
In the space that we leave unsaturated, the disabled person will have a chance to involve him/herself, to signify him/herself from the negative capability as a means, tool and instruments to stay in the uncertainty.
Been able to stand in front of the uncertainty, not differently but more intensely than in any other field of intervention of care, introduces a double logical register: the diversity of equality sits in the presence of the equality of diversity. One in front of the other. One faces the other.
On one side, we will might hear an inner-speech like «…I don't look at you … I don't see you … I wriggle myself … my less-part... wriggles in anger … »
on the other side, from a look in the eyes, and from the eyes of another internal speaker, we might hear: «…if I would look at you, what would I see? … This perspective of non-healing is so pervasive, that I would rather abandon the camp and go outside to smoke, but “what I would like you can not, you do not do it”…».
That is exactly the point where an existential contact is then possible. Through the expression“what I would like you can not, you do not do it”. Genetically. Existentially.
Here's how the disability goes to question the narcissism, leading straight to the heart of the existential parts of the psychologist: the manifest disability can manifest and unfold the doubts and the desire of the professional to be recognized skilled and capable.
Our task is to learn to live these unsaturated spaces. To enter the negative capacity and inhabit it comfortably. To accept the deepest existential contact.
“what I would like is not given” is the truth of the mirror, which alone, if accepted, will authorize both to venture into the abyss of care .

  • A really huge hug to thank Simona and Michela for giving live & reactivate to all these many movements during their seminar. I think attending your seminar was to receive a valuable gift.
  • these are the notes and suggestions which arised during the seminar "A look at the limit - learning from the experience of clinical work with child disability" that Drs Simona Daneo & Michela Fiore held on Saturday, July 2, 2016 at Coirag Turin
  • The video "uno sguardo al limite (a look at the limit)" offers suggestive images of the seminar; no words are necessary when the suggestion is high.

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