Bassat: Linking Immunology with Psychoanalytical Psychotherapy

The groundbreaking metaphor of “the body keeps the score,” found in trauma research, aligns seamlessly with Bassat’s article exploring the profound impact of embryonic experiences on human development. Her work underscores the convergence of modern biological research with earlier theoretical and clinical insights into primitive mental anxieties, explored by pioneers like Tustin in the 1980s.

Bassat emphasizes that from conception, the human embryo faces a biological challenge: overcoming the mother’s immune system to implant in the uterine lining. This process lays the foundation for what Bassat terms a “neuro-immuno-psychoanalytic” discourse, revealing how the formative experiences of embryonic life shape both our psychological and physiological makeup.

Building on this concept, Bassat references authors like Wilfred Bion, who posited a link between autism and immune system dysfunction during early pregnancy. She further explores the idea that adverse environmental factors in the prenatal period can evoke unbearable states of dread within the fetus, disrupting psychological development and leading to the formation of autistic defenses.

Bassat redefines autistic states as psychophysical protective reactions rooted in bodily sensations rather than solely psychodynamic defense mechanisms. The overwhelming sense of vulnerability and threat experienced in the pre-verbal stage can lead to profound anxieties: a dread of annihilation, disintegration, a sense of boundlessness, or the absence of a safe, containing presence. This bodily experienced terror is not susceptible to rationalization.

Consequently, the autistic infant may resort to clinging behaviors, fixating on autistic objects or shapes. They experience a profound terror of separateness, which equates to a fear of death in their perception.

The author describes how the immune system, with its function of recognizing and responding to ‘self’ vs. ‘non-self’, mirrors the mental processes that determine our sense of individuality and connection with others.

As a psychotherapist with a background in biochemistry and microbiology, I find Bassat’s work both fascinating and deeply resonant. Her writings illuminate the profound impact of prenatal development on psychological wellbeing. Clinically, we frequently encounter clients with deep-rooted anxieties, dread, emptiness, irrational fears, and uncontrollable compulsions – states resistant to rationalization or traditional talk therapy.

These psychophysiological states defy cognitive resolution because their origins lie in pre-verbal trauma. Such experiences, occurring before language acquisition, cannot be consciously recalled. Many psychotherapists recognize the importance of physical presence, movement, and aesthetic connection alongside verbal processing. Metaphors and imagery often prove more potent than purely rational problem-solving in talk therapy.

The Podcast

Episode 129: From Immunology to Psychoanalysis: Reflections on Primitive Mental States with Shiri Ben Bassat (Tel Aviv)

MARCH 4, 2023 00:45:21

The Psychoanalytic Case study

This podcast case study @26:42 is compelling for several reasons. Firstly, it documents the author’s initial case as a psychoanalyst, highlighting the challenges and rewards of working with a child diagnosed with autism and psychosis. The dedication of both the analyst and the child’s adoptive mother to persisting through the child’s violent reactions to therapy demonstrates remarkable commitment. Additionally, the therapist’s innovative use of movement as an embodied mode of communication aligns with psychoanalytic theory, showcasing a thoughtful and adaptable approach within this framework.

In her paper, Bassat (2021) writes: “

  1. I created a stable, consistent setting of five sessions a week at a regular hour – a
    concrete action- needed to rebuild a functional container that would hold her, while
    also remaining flexible and changing, allowing her to take objects from the room
    (Quinodoz, 1992).
  2. I cultivated an accepting and total presence – offering the room, my body, and my
    internal objects so that they could be invaded and even destroyed. I thus enabled her
    to destroy my books, scrawl on my walls, bite me, dribble, and leave behind a
    destroyed, chaotic room – only to re-encounter it in a clean, orderly state upon her
    return. My internal objects had similarly been attacked and injured by evoking
    unbearable memories of my own personal traumas. I understood to what extent Yael’s unrepresented traumas were destructive and painful, in need of a mother-analyst womb to be contained in as Klein’s notion that our consulting rooms are equated, in the unconscious, with the maternal body (1961)
  3. An extensive use of a live, active presence and reparation in action (Alvarez, 1992,
    Pollak, 2009) aimed to distinguish and connect bodily functions, inside and outside,
    self and object, and different emotional states. So, by standing behind the wall to
    concretely separate myself from her, darkening the room, remaining silent, averting
    my gaze, and attempting not to breathe, I was trying to prevent the exterior world
    from intruding while she was still unready. Later, I helped her to envelop herself in
    tape so that she would feel less disintegrated.”

Further reading on Immunology and Psychotherapy

This podcast covers the following topics that warrant specialization and inspires further study:

Epigenetic link to Object Relations

Martin, S. (2014) R. Yehuda, N.P. Daskalakis, A. Lehrner, F. Desarnaud, H.N. Bader, I. Makotkine, J.D. Flory, L.M. Bierer, & M.J. Meaney (2014). Influences of maternal and paternal PTSD on epigenetic regulation of the glucocorticoid receptor gene in Holocaust survivor offspring. American Journal of Psychiatry 171:872-880.

Karla Ramirez , Rosa Fernández , Sarah Collet , Meltem Kiyar Enrique Delgado-Zayas , Esther Gómez-Gil , Tibbert Van Den Eynde , Guy T’Sjoen , Antonio Guillamon , Sven C Mueller , Eduardo Pásaro (2021) Epigenetics Is Implicated in the Basis of Gender Incongruence: An Epigenome-Wide Association Analysis. Front Neurosci Aug 19; 15:701017

Primitive Anxieties

Durban, J. (2019) ““Making a person”: Clinical considerations regarding the interpretation of anxieties in the analyses of children on the autisto-psychotic spectrum” The International Journal of Psychoanalysis 100:5, 921-939.

Prenatal and Postnatal Influence on the Psyche

Meltzer, D. & Williams, M. H. (1988) 2. Aesthetic Conflict: It’s Place in the Developmental Process. The Apprehension of Beauty: The Role of Aesthetic Conflict in Development, Art, and Violence 146:7-33

Bion, W. R. (1976) “On a quotation from Freud.” In Clinical Seminars and Four Papers, Ed. F. Bion. Abingdon: Fleetwood Press, 1987.

Joanna Wilheim (2004) The trauma of conception. Presented at a Meeting of the Brazilian Society of Psychoanalysis of São Paulo (SBPSP) on October 7, 2004.

Trnsformation of the mother’s immune system. Mandelboim, O. et al’ (2006). Decidual NK cells regulate key developmental processes at the human fetal-maternal interface. Nature Medicine 12: 1065 – 1074.

Bibliography

Bassat, S.B. (2021). “War in times of love”- Prenatal cell relations as a prototype of
autistic anxieties, defenses and object relations. Paper that won the 24th Frances Tustin Memorial Prize, 2021. Tel Aviv University, November 5th, 2021. Download pdf.

An Entrepreneur in Therapy: Case study by Kets de Vries

This is a case study excerpt form this featured book, Reflections on Character and Leadership by Manfred Kets de Vries (pp.20).

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Why this case study? 

Kets de Vries gives a very detailed psychoanalytic account of a case study of an entrepreneur he names Nr. X. This case study illustrates how the inner and private life of the leader have significant effect on the performance of the leader. As the leader gets older, it is not unlikely that unresolved inner problems from childhood affect many areas of the individuals life, including his/her relationships and health.

Reason for Seeking Psychotherapy
Client:  Mr. X, a 44 – year – old. Youngest of 6 siblings (2 brothers, 3 sisters). Occupation: Entrepreneur. Family Life: 21 years married but recently separated, 4 children.

Events leading to therapy request:

  • Mr X. had thrown his wife out of the house.
  • her increasing need for more independence had become a bone of contention.
  • He complained about her lack of caring and suspected that she was emotionally involved with a younger man working at the office (she worked in his company).
  • He is strongly annoyed that his children had taken the side of his wife.
  • History of depressive episodes (but not thought of as serious as now).
  • Has now feelings of worthlessness. No life prospects.
  • Fears losing his mind.
  • Problems at work due to wife’s (and young colleague’s) departure.
  • Worries about the company health. Fears of bankruptcy / humiliation as result.
  • Feels paralyzed at work. Not able to function. Feeling painful going to the office.
  • Psychosomatic complaints: nightmares, sleep problems, severe headaches which affects eyesight. Temporary loss of vision. Diarrhea and nausea. Impotence.

Childhood History

Mr. X’s thoughts about his father: a salesman / entrepreneur. Often away from home due to work. Remembered as a boisterous man who laughed a lot and brought him presents from his frequent business trips. Felt that he was his father’s favorite. When he was seven years old, his father became bedridden. Having his father in the house gave the boy the opportunity to spend more time with him. He began to feel close to his father. When he was 98 years old, his father died in a mental institution. This event was to Mr. X shrouded in secrecy. Mr. X is suspicious of the fact that his mother and elder sisters transferred his father to the mental hospital, thinking it was unnecessary and that it caused his death. He had tried a number of times to find out what had really happened, but had not been able to uncover the truth. The whole incident seemed to have been suppressed as a dangerous family secret. Mr. X suspected that his father had committed suicide which, given his family’s religious orientation, would explain the secrecy around the incident.

Mr. X’s recollection about his mother: Described as a very controlling, overprecise, critical woman who constantly worried about money and the future. After the death of his father she struggled maintaining the family also with coping financially. He felt that she saw everything in a
negative light. She never made a positive comment. Nothing he did was
ever good enough. He also described her as a perfectionist. He had never
been able to live up to her standards.

Mr. X’s recollection about his childhood life: Apart from the death of his father,his childhood was described as uneventful and quite happy. He felt proud of the fact that he had been something of a rebel as an adolescent.

Major Issues

  1. Relationships with women:
  2. Attitude to work: He used to be enthusiastic about his company, now feels it is too complicated and wants to give it away. Similar feelings about possessions.
  3. Depression: feeling pessimistic, life is a sacrifice, fear of being alone. Feeling completely deserted due to wife’s departure from his life. According to Mr. X, he once used to have everything. Now things were different; his health had been ruined; his life was in a shambles. He felt worthless. He wondered what had kept him so busy at work in the past.

Personality Issues

“He revealed that throughout his childhood he had been scared of losing control. He was reluctant, for example, to fight with other children for fear that he would lose control and kill someone.

Denial of inner reality and flight into external reality through work had
become a way of life. His defensive structure, however, of escaping into
action — ‘ the manic defense ’ (Klein, 1948) — no longer seemed to work.”

Dramatic mood swings, an all – or – nothing attitude. Very little was needed to push him in one direction or the other.

Repressed Emotions & Inner Reality
Denial of feelings of depression through unrealistic optimism, laughter, humor, frantic activity, and excessive control had always been an important element in maintaining Mr. X ’ s psychic equilibrium.

Attempts to fight his depressive state by eliminating negative thoughts. Turns to self-help books in order to improve ability to repress depressive reality.

This point of a person, and this happens often with people who are functioning and try to excel in aspects of their life through forcing themselves into change. i.e. When I feel hurt/stressed/sad/angry (any “negative” feelings), I try to escape by pushing myself to do better, to think positive. This works, but only very temporary. The breakdown that comes is usually catastrophic and very difficult to overcome. In Gestalt psychotherapy, there the paradoxical theory of change (Biesser, 1970).

Unfolding through Therapy

As Mr. X worked his way through therapy he was able to admit to himself several things that was repressed:

  • that his childhood was not so happy as he made it out to be. He realized his urge to think positive and believe positive (unlike how he sees his mother, as a pessimist). He realized how he was treated “like a baby” (which also means not being respected, and made to feel small), feelings of envy of his brother for the role of he man of the house.
  • He remembers using complaints of physical ailments to get attention, and being sensitive to children crying.
  • Was able to acknowledge his father’s darker side. That his father had beaten his children, stifle his behavior, strict rule enforcing.
  • His Oedipal memories.
  • His identification with his father’s tendency to be fake, hiding feelings.
  • He was able to grieve his father’s passing (which he had not the change to due to secrecy)
  • He comes to terms with his anger towards his mother, and also (as a child) feared that his other would die. He had fantasies that he might kill his mother when sleepwalking. His feeling of being unwanted by her, and wanting to prove to her that he was “worth it” to have as a child, and to admire him.
  • All emotions of aggression, guilt, grieve that accompanied these unfoldings.

Relationship with Women
Given the kind of relationship Mr. X had with his mother, it came
as no surprise that he perceived women as dangerous, over-controlling,
not really to be trusted.

Mr. X would divide women into two split categories, the easy and the proper. He had always been fascinated by prostitutes (and still was), but the fascination was accompanied by fear. Prostitutes were tempting but they could also be infected with diseases. He recalled an incident when he visited a prostitute. He felt that he had not treated her like other men. He had not taken advantage of her; he had gained her admiration.

As a young adult he had had many short relationships with women, treating them rather callously, usually dropping them when they became too clingy. He disliked feeling ‘ choked. ’

Dreams and Projections

He felt threatened by women. His dreams illustrated the role women played in his inner life. In many of his dreams, phallic women, portrayed as women with guns, would appear and lie on top of him, having intercourse while putting him in a passive position. He would wake up, frightened, feeling smothered. In other dreams, however, women would admire him from a distance. He described one dream in which he was persecuted by a number of large bees who kept striking at him. They were almost impossible to brush off. He associated this imagery with all the women he had dealt with in this life. Women could cling and sting, but also give honey. They could repel but also give pleasure. Gradually, however, dreams emerged in which he became more assertive with women, not taking such a passive role. Most importantly, in these dreams the degree of anxiety he had previously experienced was missing.

Being in Control
Starting and managing an enterprise had multiple meanings to Mr. X. It signified much more than a means of making a living. He had found out early in life, while employed by a German company, that working for others was too stifling.

These are projections, and much is known to be related to projections he has of his mother being controlling and having secretly done away with his father. Again identification with the father, being the victim of another’s control.

To be independent, to be in control, meant to be free from mother. His inability to work for other people (who would tell him what to do) made him decide to start on his own as his father had done before him. That was the only way to get some power, and no longer be subjected to the whims of others.

Transference of control and being controlled was reported to exist in therapy sessions.

What becomes apparent is his entrepreneurial mindset and work style slowly made sense to him, as his way of dealing with past traumas. It is his way of closing gestalts, and finishing unfinished business. This unfortunately leaves the real unfinished business open, and the only way that a person can live in inner peace is to work constantly. It is like filling water in a pot full of holes.   

Mr. X also worked through other personality traits that developed as a result of being himself, basically. He was able to realize his meed for admiration, tendency for grandiose and depressive moods (bipolar disorder, perhaps), competitiveness, self-defeating behaviors,.

With the newly owned awareness and re-experiencing of past traumas, and the re-integration of his repressed emotions, Mr. X was reported to have slowly managed to get back to work, work with less stress, welcome his wife back into his life. 

The process in which the patient manages to make positive changes to his life is through sitting through and experiencing what is there. What is in his real memories, his real childhood experiences. This is only possible with the accompaniment of a therapist, who is trained to support the client through the process. This process is very tedious and painful. The client has spent almost all his life trying to make changes by pushing his un-bearable realities to the unconscious. To not feel, to forget.

This is what it the paradoxical theory of change is about. When we try to elicit changes, in Mr. X case, when he tries to think positive, push himself to success, and try to do everything he can to overcome painful experiences, all he has achieved is a mountain of disappointments and stress. It is only through not changing. in just sitting in therapy and looking at all these childhood experiences, did his life really begin to change.

References

Beisser, A. (1970). The paradoxical theory of change. Gestalt therapy now, 77-80.

Klein, M. (1948). A contribution to the theory of anxiety and guilt. The International Journal of Psycho-Analysis, 29, 114.

Kets de Vries, M. (2009). Reflections on character and leadership.