809081

research-article2018
APAXXX10.1177/0003065118809081Riccardo LombardiEntering One’s Own Life

ja Pa

Riccardo Lombardi 66/5

Entering One’s Own Life as an

Aim of Clinical Psychoanalysis

The historical development of psychoanalysis has demonstrated that the

aim of clinical work can change as the patient population changes. One of
the main tasks of psychoanalytic working through today is to help difficult
patients trapped in imitative dynamics and “never-to-be-born selves”
enter a life of their own. Particular emphasis is given to activating a body-
mind relationship, catalyzing emergence from the unrepressed uncon-
scious, and constructing space-time parameters in relation to the most
primitive and undifferentiated emotional experiences. Two clinical cases
are presented, in the first of which the analyst found himself invested with
an intense devitalization that tested his capacity to be present. In the sec-
ond case the analyst was confronted by the necessity of stimulating the
birth of basic functions of mental notation in relation to blind and danger-
ous acting out. The confrontation in the analytic relationship mobilized the
patient’s internal resources of self-observation and self-containment, from
which the capacity to exist and be present to the self could emerge.

Keywords: body-mind dissociation, devitalization, life-death confu-

sion, working through, transference to the body

Bereite dich zu leben. [Prepare to live.]

—Klopstock/Mahler, Symphony No. 2

I have often been impressed by my patients’ statements along the lines

of “Thanks to this analysis, I can feel alive,” “Now I manage to feel
real,” or “This is my life, something I never noticed before.” Or even, in
a less flattering way, “You should have told me to live instead of giving
me all those interpretations!” So I have wondered whether many of our

Training and Supervising Analyst, Italian Psychoanalytic Society.

Translated by Gina Atkinson and Karen Christenfeld. A first draft of this paper
was presented at the San Francisco Psychoanalytic Institute, November 2016, discus-
sant Peter Goldberg, and at Columbia University, New York, November 2017, discus-
sant Christine Anzieu-Premmereur.

DOI: 10.1177/0003065118809081 883

 Riccardo Lombardi

most difficult patients today may require help primarily with their inca-
pacity to feel that they’re alive or to gain access to Being, and whether
this might be considered a goal of psychoanalysis.
The patient’s difficulty in entering his own life is a clinical problem
that pushes us to focus on the relationship the patient has with himself,
with his own body and sensorial feelings, because what is in play above
all else is the fact that the person is “there.” Thus, I am viewing from a
slightly different perspective the current tendency to consider primarily
the recognition of the other as the essential condition for accessing one’s
self. My approach concentrates on the analytic relationship in order to
address the patient’s most urgent needs, such as constructing—first of
all—a relationship with oneself, from which the recognition of the exter-
nal object’s otherness can be derived.
This hypothesis of mine must be distinguished from lives not lived
because of a breakdown due to the absence of a good enough mother-
child relationship (Winnicott 1974; Ogden 2014). Because the paralysis
of life to which I refer is more general, it must be analyzed in relation to
mechanisms the analysand uses in the present (Bion 1962), and here a
central role is played by body-mind dissociation (Lombardi 2017).
That the goal of psychoanalysis can be modified in the light of a
changing patient population is not a new idea, given that Money-Kyrle
(1968) commented some decades ago that the historical development of
psychoanalysis had already demonstrated varying approaches to mental
disturbance and to the aims of analytic treatment. He summarized these
changes by noting that in the first phase of psychoanalytic history, mental
disturbance was seen as the result of sexual inhibitions; in a second phase
it was considered a consequence of unconscious moral conflict; and in a
third and more recent phase—strongly influenced by Bion’s contribu-
tions—the analysand, whether clinically ill or symptom-free, was consid-
ered to suffer from misconceptions and unconscious delusions.
The current widening scope of psychoanalysis involves the flexibility
of working with a broad spectrum of patients, including those in the psy-
chotic realm, together with an update in the criteria of analyzability
(Limentani 1972; Kantrowitz 1987). Further, in the “Golden Age” of more
restrictive selection of patients, psychoanalysts were, in any event, “struck
by the degree of difficulty in making predictions which match[ed] results”
(Limentani 1989, p. 70). For decades, analysands who have not conformed
to classical models have been described in negative terms: they are characterized

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as having a fragile mental organization, as being in precarious or even

absent contact with the world of affects, and as having weakly introjected a
family constellation. They are spoken of as patients with a false self
(Winnicott), as those with operational thinking (Marty), or as alexithymic
(Sifneos). From these descriptions, the profile of a false identity emerges,
often one dominated by a primitive, preoedipal superego, and having a sys-
tem of social expectations unintegrated with the needs, sensibilities, and
personal orientations that characterize a real person.
If, in the classical model, thinking as experimental action has pri-
macy over action itself (Freud 1911), attention to being reconsiders this
primacy in line with a famous statement attributed to Aristotle or to
Hobbes: Primum vivere, deinde philosophari (“First live, then do philos-
ophy”). Given the analysand’s primary needs, the encouragement of more
intellectual and symbolic aspects of working through can lead to a harm-
ful “rush to the symbol” (Lieberman 2000), which blocks real develop-
ment. The difficulty in being does not coincide with what is described as
the incapacity to dream (Bion 1992)—especially in the light of certain
post-Bionian narrative readings—because, first of all, this difficulty
informs living itself, requiring the analyst to orient his reverie to more
concrete levels of experience. Here we are in a border area with regard to
psychoanalysis as an “analysis of the psyche,” since waking up to one’s
own life involves a particular emphasis on experience and change.
The primacy of action is physiologically focused during adolescence,
in which a lack of experience with the adult world establishes the neces-
sity for the adolescent to “act in order to know” (Ferrari 2004), even
before thinking. After having been thought, the new knowledge derived
from action becomes the basis for new actions and explorations. The
theme of being, then, involves a sort of adolescent feature, whose activa-
tion can contribute to waking up to life, especially in analysands who
have never completely lived through their adolescence.
Assigning value to these levels does not mean canceling out other,
more evolved and symbolic levels of psychoanalytic working through. A
deep analysis permits the working through of traditional levels as well,
layer by layer, including those more inherent in the transference—for
example, the reconstruction of past relationships—even though I am not
focusing on those here. It must be recognized, however, that not all analy-
sands are immediately interested in a deep exploration, however desirable
we analysts may consider it. Recognizing waking up to life as a goal of

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psychoanalysis can permit us to respond therapeutically to a population

of patients who would might otherwise turn to more makeshift forms of
psychotherapy. Further, analysands who leave analysis prematurely may
return after a while to complete their working through, motivated by the
positive results of the first period of analysis.

P s yc h olo g i c a l B i r t h , B e i n g , a n d t h e m e a n i n g
o f s el f i n H u m a n E x pe r i e n ce

Though my discourse here derives primarily from what I observe in my

clinical practice, I will briefly refer to a few psychoanalytic hypotheses
that orient various aspects of my clinical experience. I certainly do not
presume to offer an exhaustive and objective theoretical account of this
subject, but hope to give at least an idea of the recent increase of psycho-
analytic interest in the area I am exploring.
Although the concept of being has played an important role in phi-
losophy, from Parmenides to Husserl and Heidegger, Freud consistently
defended the centrality of the oedipal realm and maintained that one must
“stay on the ground level of the building,” or even underneath it, in rela-
tion to the higher levels of philosophy (see his letter to Binswanger dated
October 8, 1936). At any rate, Freud focused his attention on the conflict
between the life drive and the death drive, in which the latter, as a push to
return to the inanimate, remains silent until it is externally deflected as the
destructive instinct. His pupil Ludwig Binswanger, a Swiss clergyman
and psychiatrist influenced by Heidegger’s Dasein (1927)—translated as
“being there” or “existence”—read serious disturbances like schizophre-
nia as forms of “missing existence,” emphasizing the essential compro-
mise of a relationship with life in such serious illness.
Klein (1923, 1926) and Ferenczi (1933) explored fantasies of staying
in the maternal womb and of not being born as a defense against the
primitive oedipus complex and hatred for the mother—fantasies not lack-
ing a necrophiliac component (Calef and Weinshel 1972). In developing
the Kleinian approach, Tustin (1981b) described psychological birth as a
condition for completion of the physical birth that occurs at the moment
of delivery, thanks to the early relationship with the mother. Winnicott,
discussing a patient who confused herself with her twin, as well as another
patient who was used to falling down because “she had no ‘eyes in her
feet,’” maintained that equally “important with integration is the development

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of the feeling that one’s person is in one’s body” (1945, pp. 150–151). He
hypothesized that a detachment of the intellect from the original psyche-
soma leads to the construction of a false self (Winnicott 1949). In the last
article he wrote before he died, he described a fear of breakdown and the
feeling of not being alive as expressions of a breakdown that has already
happened through early catastrophic traumas in the mother-child relation-
ship (Winnicott 1974).
Heinz Kohut, with his self psychology, made a significant contribu-
tion to understanding patients who were not managing to deal with their
lives. He stressed the importance of the simplest needs connected with the
communication of emotions. His courage in going beyond the drive
model allowed Kohut (1971) and those who followed and built upon his
teachings to work with severely problematic patients, highlighting the
role of empathy and the meaning of the self in human experience, and
even working with analysands with narcissistic personality disorders in
their regressive phases. At the same time, he expressed some skepticism
about applying this theory to patients unable to establish a stable narcis-
sistic transference (p. 18).
The importance attributed to intersubjectivity, introduced by rela-
tional psychoanalysis, made it possible to approach the most basic prob-
lems connected to entering real life and relating to one’s own body, a
development of a working through based on relational exchange (Aron
and Anderson 1998), thus extending the classical limits of analyzability,
as self psychology had done earlier.
In the context of the relational approach, Grossmark (2012, 2018)
explicitly recognizes that not all patients can tolerate a relational co-
construction of the analytic experience. Starting from a recognition of this
limitation, he elaborates stratagems that tend to create a greater concentra-
tion on the most primitive needs of patients with serious problems about
entering real life. In the case of patients who are “not alive in the usually
accepted use of the term” (2012, p. 631), Grossmark suggests that the ana-
lyst be “unobtrusive,” or, in other words, that he avoid relational moves
that involve him more directly, in order to activate “the deepest engage-
ment that is humanly possible” with the primitive needs of the patient.
Thomas Ogden (2014) recently developed the idea of unlived lives
deriving from breakdowns that could not be taken in and worked through,
breakdowns that awaited being experienced with the support of an ana-
lytic reverie. While the Freudian idea of Nachträglichkeit implies a

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working through of past experiences in the light of new ones, Ogden,

stressing that the troubling event was never experienced, emphasizes the
present rather than the past.
The Chilean-Italian analyst Matte Blanco considers the problem of
space-time and of being as central to psychoanalysis, placing them at the
crossroads of the human functions of feeling and thinking as they come to
be lived in the present, rather than according to an understanding of indi-
vidual development. Being is located at the center of his approach in
Thinking, Feeling, and Being (1988). Matte Blanco prioritizes being as a
basic psychoanalytic category: the body itself is considered the result of
a specific working through of emerging from the infinite and from the
“neverland” of nothingness (Lombardi 2009, 2010a).1 He thus arrives at
a simplification of psychoanalytic theory in which feeling and thinking
become the two poles of an oscillation, opposite ends of a spectrum that,
although contradictory, are equally essential to human life.
These different approaches and hypotheses seem to me to be in line with
the clinical conditions I find in analysands who seek analytic help because
they find themselves in the intolerable condition of not feeling alive. Thus,
the focus on being must not be confused with a philosophical stance, because
it is clinically urgent and requires therapeutic relief (Renik 2001).

T h e U n f ol d i n g o f T i m e a n d
L i f e - De at h C o n f u s i o n

While some authors emphasize a modality of experiencing time in line

with analytic regression, or the atemporality of unconscious mental pro-
cesses to be revived in analysis (see Sabbadini 1989; LaFarge 2014), for
my part I have emphasized the focal perception of a nonregressive linear
time, as connected to the perception of limits, especially when the patient
tends to persist in being averse to limits and to thinkability (Lombardi

1If early on Matte Blanco (1975) locates the coexistence of a deep symmetry of emotions

alongside the mind’s necessity to function asymmetrically, later on he develops a perspective

based on the concept of being, tied to thoughts and feelings, by which he formulates man’s basic
antinomy, and so the same reality is simultaneously treated as though it were divisible, made up
of parts, but also as though it were indivisible (Matte Blanco 1988). In this perspective, one can
understand why the most elementary and concrete levels of experience, felt as infinite and indi-
visible, may be so difficult to work through with abstract mental tools—not least because a
process of working through that concentrates on intellectual levels of reconstruction, or on the
pure acceptance of emotions, may be insufficient with seriously disturbed patients.

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2003a, 2005a, 2008b). In my clinical experience, I have seen the positive

impact induced by a process of working through centered on time and on
the body—as will appear below—in order to catalyze emergence from the
dark and formless infinity of the unrepressed unconscious and to promote
experience and thinking in the present (Lombardi 2015).
A further point is the importance of discriminating between life and
death as a useful element of working through. Freud (1938) wrote of a
phase of ego-id indifferentiation, in which the energies of eros neutralize
destructive tendencies, proposing the existence of an extremely undiffer-
entiated level that awaits being worked through. Though life and death
are obviously different, they belong, if they are seen from the perspective
of set theory, to the same existential class. In addition, at a certain level of
depth, the principle of symmetry (Matte Blanco 1978) cancels out the
distinctions among elements belonging to the same class, and so life and
death, although they have opposite existential meaning, come to be felt,
paradoxically, as the same thing.
To emerge from this dangerous confusion, an “unfolding” of the differ-
ence between death and life must be encouraged in analysis (Lombardi
2007, 2010b). This unfolding seems to be clinically useful with patients who
suffer from unstable distinctions at the most concrete levels of experience,
even when they demonstrate a capacity to think in more developed areas; it
proves useful in allowing the patient to enter into life and in making possible
a relationship with the self, when death and life form a confused and para-
lyzing amalgam. The two cases we will consider later suffered also from this
type of paralysis induced by an indifferentiation between life and death.

A B i o n i a n P s yc h o a n a ly t i c V e r t e x
o n T h e B o dy- M i n d Rel at i o n s h i p

“I am nothing” (Je ne suis rien). These are the opening words of Patrick
Modiano’s novel Missing Person (Rue des boutiques obscures) (1978).
They epitomize the preoccupation of contemporary literature with para-
doxical forms of existence characterized by a devastating sense of inner
emptiness. This is consistent with the fact that a sort of psychological
deadness and alienation from one’s own body are increasingly seen in
clinical psychoanalysis.
In an approach that seeks to assign value to the mind’s role in the pres-
ent, Bion (1957, 1962) emphasizes the importance of the psychotic part of

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the personality and the function of the lie and of hallucination in creating
detachment from reality, such that the loss of the feeling that one exists
comes into play, even in apparently nonpsychotic clinical conditions. The
patient cannot feel really alive because of having started from a system
“born of intolerance of frustration and desire” (Bion 1970, p.18). For Bion,
the failure to make use of emotional experiences leads to a disaster in the
development of the personality, which, in the most extreme cases, can be
described as the “death of the personality” (1962, p. 42).
In his reading of Bion, Grotstein (1979) emphasizes the role of “con-
tinuing redemptions by the self of the hostile self which wants to be born
but which is incarcerated by the ‘never-to-be-born self’” (p. 161): he thus
underlines the importance of continuous mental “notation” (Freud 1911)
and of the self-publication of one’s experience, in order to validate real
experience.
In his last years Bion went radically beyond symbolic levels, stress-
ing the decisive role of the body as the forerunner of thought, and the
danger of losing contact between one’s physical body and the symbolic
levels of mental functioning. “Is it possible,” he asked, “that we have so
much respect for the mind that we forget the human body?” (Bion 2017,
pp. 99–100). Human beings, he points out, are very imperfect animals:
“they have to provide themselves with clothes, food, work” (p. 22).
The intuition of a mind that can forget about the body was taken up
and systematically developed by the Italo-Brazilian psychoanalyst
Armando Ferrari (2004)—and also by me—as one of the various dispa-
rate ramifications of the Bion tradition (Levine and Civitarese 2016;
Lombardi 2016). Ferrari (2004) hypothesizes a discord in the body-mind
relationship in which either the body or the mind can exclude the other
one, paralyzing the continuous flow between thinking and feeling. In his
hypothesis of the eclipse of the body he puts forward his idea that the
body is the primary object of the mind. The function of the mother is to
help the baby, through reverie (Bion 1962), develop a mind of its own,
which should eclipse the body, diminishing its incandescent tension.
Hence there are two axes of elaboration that proceed in tandem: a vertical
body-mind axis, which should have interpretational precedence during
the first phases of an analysis, and a horizontal analysand-analyst axis, in
which the analyst is recognized as “the ultimate limit” with whom the
analysand must deal in relational terms (see Lombardi 2002).

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For my part, I emphasize the role of body-mind dissociation, which

can cause such an obstacle to the analytic working through that it creates
an insurmountable impasse and even compromises the analysand’s sense
of actually being alive (Lombardi 2017). The importance of body-mind
dissociation was intuited quite early by such authors as Tausk (1933) and
Winnicott (1949) and, more recently, by Resnik (2001), who calls it
“Cotard’s Syndrome,” after the French neurologist who first described, in
1880, a délire de négation, which involved a radical denial of the existence
of one’s body. Such conditions are among the most serious disorders of
those described by André Green as the work of the negative (1999).
While the term dissociation is often used for disorders of traumatic
origin (Bromberg 2001; Davies and Frawley 1994), I view body-mind dis-
sociation as a discord, formed in a premental period, that cannot be identi-
fied with any known disease; it is a “pocket” of pathology—or better, a
disharmony—encountered in most analytic patients. It is reminiscent of
Bion’s distinction (1957) between the psychotic and the nonpsychotic
parts of the personality, and it can affect different kinds of analysands,
from the seriously psychotic to those who appear well integrated.
It tends to be analyzable from a standpoint that focuses on the present
and on different ways of internal functioning (Bion 1962). It does not
respond to a reconstructive approach, although there are patients who can
work through what probably was a cumulative trauma. At times there is a
conscious voluntary component, as in the case of lying (Bion 1970), so
that some analysands persist in their discordant mental functioning, dis-
sociated from their bodies and from their own feelings, paradoxically
even after having experienced a working through that could have allowed
them to make a real change.
The hypotheses I advance here are, interestingly enough, in synch
with some recent developments in neuroscience, as can be seen from an
article by Blechner (2011), and they have much in common with the theo-
ries of Antonio Damasio (1999), for whom “consciousness is rooted in
the representation of the body” (p. 37; see also Lombardi 2003b).

T h e P l a ce We A s s i g n t o T h e B o dy

My hypotheses about body-mind dissociation lead me to reconsider the

Freudian assumption that “the ego is first and foremost a body-ego” in a way
that some analysts might consider too radical, given the traditional tendency

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to locate working through primarily at the more symbolic levels of mental

disorders and to focus on the conflicts implicit in object relations. Certainly
ever since Freud, in discussing the case of Elisabeth von R., stressed the
importance of allowing the body to “join the conversation” (Breuer and
Freud 1895, p. 148), every analyst would be willing to state that the “body
in psychoanalysis” has hardly been “marginalized.” However, if you con-
sider analytic practice, you do not necessarily find a realization of this theo-
retical assumption, given the tendency to favor the relational and symbolic
levels, rather than focusing specifically on bodily experience.
As Rosemary Balsam (2012) puts it, “The biological body has fallen
from grace since Freud’s era. . . . In the texts of some contemporary theo-
ries that are preoccupied with ‘here and now’ interaction, or, say, with an
unrelenting search for deep archaic fantasy, or in theories of the mind that
downplay the individual’s history or the unconscious, connections
between the biological body and its mentalized representative ‘virtual
body’ are often lost” (p. 2). One wonders whether the body isn’t in fact
somewhat awkward for “experts of the mind,” so that Balsam, on the
basis of her own difficult experiences, as well as those of others, speaks
of “the very syndrome of erasure” (p. 105) to which articles that deal with
the body from a psychoanalytic perspective can fall prey.
The notion of the body-mind relationship is particularly helpful in
approaching clinical problems in which the mind essentially denies the
existence of the body or, vice versa, the body is so blindly dominant that
the mind hardly registers, so that there is no awareness of actually living.
This notion places the body at the very center of psychoanalytic consider-
ation, with a force that is traditionally recognized as present in early
infancy, during which “the infant has only his body with which to express
his mental processes” (Heimann 1952, p. 155). We should not, however,
forget that what is so evident in early infancy continues to play an impor-
tant role, even if a less evident one, throughout one’s life, “since the fact
could not long be overlooked that psychical phenomena are to a high
degree dependent upon somatic influences and on their side have the most
powerful effects upon somatic processes” (Freud 1940, p. 283).
The viewpoint I’ve presented shows some relation to various ele-
ments of psychoanalytic research, which I have discussed in some detail
elsewhere (Lombardi 2002, 2008b, 2016). I will introduce here a few
references to provide the reader with elements of similarity and differ-
ence. French psychoanalysts like Marty and de M’Uzan (1963) describe

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“operative thought” (pensée opératoire) as an expression of a mechanical

and depersonalized mental functioning, without the connection to phan-
tasmatic activity shown by patients with psychosomatic disturbances.
Whereas Marty (1976) describes states of “essential depression”
characteristic of psychosomatic conditions, in which one finds a general
decathexis of all libidinal areas, and which he developed at the Hôpital de
la Poterne in Paris into a form of psychotherapy different from normal
psychoanalytic practice, de M’Uzan (2015) keeps faith with the param­
eters of traditional analytic technique, in which the analyst is most often
silent. He places the organization of an identity at the heart of his theories,
by means of a double who calls upon the necessary psychic energy for
change, and the interpretation is conceived as stated by the patient him-
self, which seems not, in a sense, very different from Ferrari’s “vertical”
relationship.
Joyce McDougall (1982, 1989) stresses the consequences of a rela-
tionship with a mother unable to interpret her baby’s emotional signals, so
that there arises a dissociation between the representation of words and of
things. She stresses the role of loss of affect: affects are not represented,
with a resultant tendency toward action. In some cases resomatization can
arise as a psychotic defense against emotions. The analyst’s countertrans-
ference leads to annoyance and problems with concentration.
The American theorists Krystal (1974, 1988) and Gedo (1988, 1996)
interpret psychically motivated somatic impulses not so much as a defense,
as instead an inability to achieve symbolic thinking in the working through.
Krystal in particular underscores the fact that trauma or mistreatment in
childhood, particularly at an age at which the baby is not yet conscious of the
borders of her body, can give rise to serious disturbances of the relationship
with that body and with affect in general, which he regards as alexithymia.
Gedo describes deficits in psychological skills that he calls apraxic—
borrowing a term from neurology used to describe an inability to make
movements in accordance with a definite intention—so that these patients
are subject to regression in the transference, which, however, does not give
rise to the progress that some might have expected, despite the analyst’s
painstaking interpretation, thus leading to an absence of any working through
of the passage from physical levels to mental elaboration.
All of these authors write, however differently, about the same prob-
lem of body-mind disturbances, a problem that is all the more complex
because of the difficulties in obtaining therapeutic benefit by employing

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the symbolic and relational interpretive techniques of classical psycho-

analysis: not by chance did Sifneos (1994) state that the psychoanalytic
approach should be considered counterindicated in these disturbances.
Diverging from the emphasis these theorists place on such patholo-
gies as pensée opératoire and alexithymia, which are characteristic of
psychosomatic disturbances, I consider the problem of the body-mind
conflict to be first of all an existential disharmony typical of the human
animal in general, because of its twofold nature: animal and symbol-
making, as a result of which the body-mind conflict is part of our nature
as “very imperfect animals” (Bion 2017; see also Nagel 1974), rather than
only a specific pathology or the consequence of particular traumatic
experiences.
In terms of technique, during the early phases of analysis with diffi-
cult patients, I find transference interpretations to be most often counter-
productive; I favor instead a direct focus on the patient’s current
relationship with himself, and I encourage a first awareness of sensory
perceptions and consciousness of him- or herself, which can foster con-
tainment as opposed to an internal sensory confusion. In other words, the
patient should be encouraged to activate a first transference onto the
body: this burgeoning of a body-mind relationship may be accompanied
by a somatic countertransference, because the analyst too must undergo a
considerable sensory impact in order to accompany the development of
the analysand, whose inner processes do not at once entirely succeed in
becoming representable (Lombardi 2017).
The analyst places the patient at the very center of his experience, so
as to help the analysand establish a body-mind connection, digest proto-
sensory elements, and desaturate his mind (Bion 1962). Only when this
desaturation has taken place is it possible to proceed to a more traditional
mental elaboration: at that point one can employ the potent irradiation of
the sensations that act as a driving force for representation and thought. In
contrast to the analysts mentioned above, my orientation is hence, at the
most primitive levels, not basically to foster a therapeutic regression and
a working through of the analysand’s past through interpreting repetition
in the transference. Instead I concentrate on the current internal function-
ing of the analysand, encouraging self-perception and a first awareness of
the body, helping the patient develop the forms of communication he at
that moment commands. In the most extreme forms of discord in the
body-mind relationship, we encounter not only apraxia, like those

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described by Gedo, in which access to the symbolization of bodily affects

is blocked, but also an incapacity, of varying degree, to recognize one’s
actual body and its needs: to use once again, as Gedo did, neurological
terminology, we are faced with actual forms of anosognosia, a neurologi-
cal syndrome characterized by the failure to recognize one’s own body,
such as in the notable case of Phineas Gage, in whom this condition was
brought on by the destruction of the left frontal lobe of his brain (see
Damasio 1994).

I s W h at A n a ly s t s d o Re a lly Goo d E n o u g h ?

Levit (2018), in “What We Can Do When What We Do Is Really Not

Good Enough,” stresses that the results achieved with established
approaches, including self psychology and relational psychoanalysis, can
be of little use with a wide range of patients. He underscores the obstacles
that symbolic working through gives rise to and uses instead a nonana-
lytic technique called “somatic experiencing,” devised by Peter Levine
more than forty years ago, in order to gain more immediate access to a
body that has become dissociated through trauma. I agree that the ques-
tion Levit brings up is pertinent, in that he emphasizes the risk of impasse,
when analysts use with difficult patients a form of psychoanalysis focused
essentially on the relational level, on empathetic exchange, or on the
interpretation of affects and the transference.
Unlike Levit, however, I maintain that clinical development for
patients who suffer from body-mind dissociation can be fostered, essen-
tially, not so much by introducing a nonanalytic technique like somatic
experiencing, as by broadening the psychoanalytic working through to
include a very primary level, by focusing chiefly on the analysand’s rela-
tionship with her own body, which procedure is in keeping with Ferrari’s
theory that the body is the original object of the mind. Hence it is not a
question of healing the effects of a specific trauma, but of creating, with
the help of the analyst’s reverie, the conditions for a mental functioning
whose roots are within the patient’s body, thus bringing into being and
supporting the foundations of the ego and of thought.
Further, employing a nonanalytic technique for problems involving
the body, in the course of a psychoanalysis, risks a dangerous split
between corporeal and relational levels, as well as being theoretically
inconsistent (Lombardi 2018). My hypothesis, which allows for the

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simultaneous presence of vertical and horizontal relations in the context

of the analytic relationship, moves the cursor toward the body or toward
the relationship, in keeping with the patient’s most urgent present need,
thus responding to varying developmental instances with a single theo-
retical and clinical model.
In a relational context I maintain that one can use the analytic rela-
tionship in a flexible and clinically strategic manner to further the analy-
sand’s access to her body, as should be evident in the first of the following
clinical cases, and that the analyst will find himself having to tolerate a
sense of disorientation, inauthenticity, and devitalization that an analy-
sand of this kind can transmit to her analyst (Goldberg 1995). Thus, in
contrast to the current relational approach, I am in agreement with a par-
ticularly “unobtrusive” attitude in the analyst, who doesn’t emphasize the
relationship per se, as Grossmark (2018) clearly understands, but without
the focus on regression that he favors: instead, what is needed is nurturing
the specific driving force toward the patient’s recognition of his body and
the development of an awareness of articulations of the body-mind rela-
tionship that typically vary from patient to patient.

Introduction to The Clinical Cases,

To g e t h e r w i t h A C ave at

Before starting on the clinical accounts it might be useful to the reader to

be prepared for what follows. Both of the patients under consideration
came to my office for analysis because they felt they had reached a
cul-de-sac: the first had gone through a series of failures in her emotional
life, leaving her with an oppressive sense of the uselessness of living,
which had repercussions on her life in general, on all of her relationships,
and on her ability to work. The second felt he was the victim of an emo-
tional upheaval, dominated by behavior that had dismayed him, like a
thunderstorm that came from outside of him, though he knew he had
instigated his own actions. These two conditions, though in some ways
polar opposites, were similar in that both patients showed a personal inca-
pacity to relate mentally to their bodies and physical affects.
Both of them were sufficiently in touch with reality to exclude a diag-
nosis of psychosis, but they showed problems of mentalization reminis-
cent of the defects Bion describes (1962). Hence the risk of impasse due
to a sudden blockage of communication with them and due also to their

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difficulty in associating in a traditional manner: their dreams in particular

were at times immune to free associations and could not be elaborated
unless the analyst actively supported the working through by forming
provisional hypotheses using very limited data. “A major modification in
contemporary psychoanalytic work with dreams,” Blechner states (2018),
“is that we do not need the dreamer’s associations to understand most
dreams” (p. 188). Hence the need to use all the patient’s communications
as potential sources of information about his or her internal functioning,
by means of interventions that might be considered premature from a
traditional point of view, in which the analyst makes active use of his
perception (what Bion would have called evidence), nevertheless will-
ingly changing direction if hypotheses are not confirmed by the analy-
sand. Thanks to these adjustments, in the cases at hand the working
through could then continue with each of these two patients, with signifi-
cant clinical results, whereas a more traditional approach would have
called for greater emphasis on regression and the painstaking use of an
ample panorama of free associations that could easily have led to an inter-
ruption of the analysis.
Another point involves the extremely limited number of elements that
could be said to have led to a psychopathological development in the clini-
cal history of the two patients, apart from their both having grown up in an
emotionally stunted family environment, as regards their parents, and their
being unmarked by notable triggering events. This type of patient may
remind the analyst of science fiction clone-like figures—like Philip K.
Dick’s replicants depicted in Ridley Scott’s celebrated movie Blade
Runner—not human, though almost indistinguishable from us, but with-
out personal histories or memories. In these clones, in fact, even when
memories appear, they are the result of artificial grafting, rather than real
memories. In the second case, the paralysis of memory became under-
standable in a later phase of the analysis, thanks to the working through of
the question of time. Only when the idea of time could be integrated into
the analysand’s mental functioning (Lombardi 2003, 2008b) was it pos­
sible to activate significant memories from the patient’s adolescence,
which had played an important part in the psychogenesis of his troubles.
These peculiarities confirm Bion’s suggestion (1962) that the analyst
leave behind a focus on the psychogenesis of an affliction and concentrate
instead on analyzing the patient’s current functioning, which is the con-
densed result of his history, as well as resulting in his evolution toward

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change. It is, in fact, change that matters—and the therapeutic results that
respond to what these patients hope to find in analysis—rather than a
thorough explanation of their condition; also because, as Jacobs has noted
(2001), one of the crucial problems in clinical psychoanalysis today
involves analysands whose analysis has taught them all about themselves,
but leaves them still unable to change, which means for them that their
analysis has been of no practical benefit.
In cases in which the intellect is in danger of psyche-soma dissoci­
ation, Winnicott (1954) underscored the central role of regression. In the
cases I present, I follow the approach of Bion (1962), for whom the ana-
lyst’s reverie is at once both emotional and cognitive. My orientation is
more toward progression than regression, the latter of which in my expe-
rience would not be productive for today’s difficult patients. Psychoanalytic
working through tends not to make use of transference interpretations,
even when the transference onto the analyst is a silent force that assists a
working through focused on the patient.
Finally, a few elements that might have been of use to a more general
understanding of the cases have had to be omitted, in part for reasons of
space, but also to protect the confidentiality of the patients. Nevertheless,
I hope the details that are presented will be meaningful for the reader.

Letizia

Letizia, a young woman of about thirty, asked to begin a thrice-weekly

analysis because of problems in her emotional life. Although she was
pretty, she was afraid of being looked at on the street and tried to make
herself invisible, consistently dressing in gray.
The beginning of the analysis was very difficult for me, engendering
burdensome feelings of boredom and sleepiness. It took some months for
me to notice that, despite her seeming normality, this patient almost did
not exist, as was apparent in a dream of hers in which she was seated on
a chair when another woman approached her, wanting to sit on the same
chair; at this point, Letizia was transformed into a sheet of paper, and so
the other woman sat down on the chair as though no one were there.
At the time, I tried to interpret this dream as revealing the patient’s
tendency to confuse herself with someone else—but to no effect, because
only much later was it actually possible to analyze her confused relation-
ship with her mother and the role of projective identification (Rosenfeld

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1964). In retrospect, I would tend to view this dream, first of all, as an

expression of a more basic and concrete level that pertained to being—or
rather, as the patient’s failure to pass from nondimensionality into her own
actual three-dimensionality and her own real body (Lombardi 2009).
Let’s look at some subsequent developments in which the body began
to appear. Right in the middle of a session, my stomach suddenly emitted
a rather noisy rumble, and Letizia said that she had heard a noise. Although
I was certain that what she had heard was my stomach, I asked her what
noise she was referring to. “It’s a strange noise,” she answered, “maybe it
came from the refrigerator . . . or maybe instead from outside of it.”
I realized that with this response Letizia was making my body disap-
pear, just as she was used to doing to herself. “Actually,” I said, “the noise
came from my stomach . . . but perhaps you prefer to attribute it to the
fridge rather than recognize me—and yourself—as made up of real bod-
ies with real stomachs.”
Letizia appeared embarrassed and said: “Actually, it never happens
that I hear my own stomach making noises.” Her reply didn’t surprise me
because I had the impression that this patient was almost without bodily
substance. I answered her in a deliberately provocative way, looking
inside myself for a connection with my hate in the countertransference
(Winnicott 1947) regarding her lifeless “flattening”: “You act as though
your body didn’t exist, and so it’s clear that you can’t make any noise. In
order to avoid hearing it, you freeze every form of life inside yourself, to
the point of transforming yourself into a refrigerator.”
Letizia seemed ill at ease, but in the silence I felt that her reaction
caused her to be emotionally present. Almost as though she felt wounded,
she answered: “What you’re telling me is terrible! No one has ever told me
anything like that.” I was comforted by her reaction of annoyance because
at least she was beginning to show signs of “feeling” something.
In the next session, Letizia told me of having dreamt that she met me
on the street and we spoke. In the dream I touched her arm, and then I put
her arm through mine. She was surprised, as though I were doing some-
thing one shouldn’t. Then, still in the dream, she thought it was not so
terrible after all, because it was “as though” I were a normal person.
I answered: “I am a normal person, even though you’re astonished
when you discover that I am not a ghost and that I have a real body, which
can also be touched.” Letizia answered by shifting attention onto herself,
telling me that she had always had difficulty recognizing her body and

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that she had not “touched” herself to masturbate until the age of twenty,
when she discovered that she felt genital excitement while taking a hot
bath.
After this phase, Letizia decided to undergo lymphatic drainage mas-
sages for her legs and seemed more comfortable inside her own skin. She
was also more carefully dressed; she began to wear short T-shirts that
revealed her stomach, which seemed to me a sign of change in that she
was allowing her body to show.
In the following dream, the theme of touching herself recurs: In the
dream, I was sleeping and I couldn’t wake up. It was as though at a cer-
tain point I noticed this and tried to awaken myself, by pinching my arms.
Listening to this account of the dream, I had the impression that Letizia
was expressing the emergence of an awareness of her internal state of
non-life (“I was sleeping and I couldn’t wake up”). Through pinching her
arms in the dream, she was trying to come out of this paralysis by stimu-
lating bodily sensations. Letizia associated by saying that she had awaken
during the night, aware of having a full bladder. At the same time, she had
noticed being excited and using the enlargement of her bladder to mastur-
bate in an “automatic” way. Returning to bed, she thought that if she was
excited, it was better to masturbate. While masturbating, she had thought
that she lacked a real sexual relationship, commenting that it was better to
recognize this lack than to masturbate with a full bladder.
In the dream of her transformation into a sheet of paper and in this
episode of masturbating with a full bladder, we can observe the effects of
body-mind dissociation (Lombardi 2017): a mind without a body, flat and
empty, like sheet of white paper, or a body without a mind, which acts out
sexual excitement automatically. An important element is introduced
when Letizia rebels against her nonexistence, agreeing to awaken herself
from her coma and to renounce her mechanical self-sensual gratification
(Tustin 1981b). Arousing herself from an indifferentiation that is neither
dream nor wakefulness (Bion 1962), the patient decides to go to the bath-
room to urinate and then masturbate. In this situation, masturbation seems
not a regressive hallucinatory act, but proof of a nascent awareness of a
relationship with her body through touching herself. By masturbating,
Letizia agreed to locate herself in a reality with limits—for example, that
of having a real body that could be touched and of not having a real sexual
relationship, since at that time she did not have a sexual partner. At this
point, for Letizia, feeling the body functioned in conjunction with

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thinking, through which she could differentiate urinary functions from

sexual functions (confused, on the other hand, in masturbation with a full
bladder); she could differentiate masturbation from sexual intercourse,
and differentiate the satisfaction of masturbation from the frustration of
the absence of a sexual partner. Thus, feeling and thinking are combined
into a single picture that allows Letizia access to being.
Let us now consider some material from a later phase in which the
patient had become more lively in sessions. She was engaged to be mar-
ried and showed signs of more realistically grounded thinking. She begins
a session by saying that she has finally managed to get into a restaurant
she has wanted to go to for some time, where she had never been able to
reserve a table. She then proceeds to give a wealth of detail about her
meal in this restaurant: the various courses and the great wines that she
and her fiancé enjoyed together. Next she tells me of a tooth that was
causing her pain and that then degenerated into necrosis. Her tooth, she
tells me, besides being painful, emanated an intolerably bad smell, as
though she had “a dead body” in her mouth. Fortunately, she found a
dentist who took care of the situation.
I was struck by this account, in which Letizia approached the flavors
of life, including the pain and necrosis of her tooth and the dead body in
her mouth. I suggested to her that the cadaver in her mouth had to do with
the hatred that she felt for herself when she took the initiative to feel alive.
Her awareness of this hatred was an important conquest, because in rec-
ognizing her hatred of life, she could allow herself to have satisfying
experiences, instead of keeping herself away from a good restaurant or in
fact from any experience she found vital and satisfying.
At this point the patient associated to the hatred she had had for the
image of her body in the mirror when she went to the gym to work out,
and so she had tried to hide behind other women who were there in order
not to see herself. I told her that when she made her body disappear by
rendering it invisible, she was acting out hatred toward herself, but now
she also knew that she had the resources to cope with this hatred, just as
she had coped with her dental problem. This association of Letizia’s also
permitted her to see that her invisibility and her transformation into a
sheet of two-dimensional paper were tied to hatred of her body, to the
point of making it disappear from the horizon of her perception.
The subsequent phases of this analysis, which lasted five years in all,
permitted a broadening of the working through process, including her

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family relationships, in parallel with the meaningful development of her

relational capacities. The clinical material I have presented demonstrates
body-mind dissociation and, through the patient’s reference to the sleep/
coma from which it was difficult for her to awaken, the pressure of a non-
vital undifferentiated state. The body-mind dissociation and the state of
failing to differentiate sleep from wakefulness can be covertly maintained
over time, resulting in alienation from life and the paralysis of learning
from experience, given that the mind cannot be developed without the
support of the body and real experiences. In this case, the analysis pro-
vided the relational conditions and the reverie (Bion 1962) with which to
achieve, first of all, access to being, thereby launching a coordination
between the functions of feeling and thinking.

Do n at o

The tendency to stagnate in a condition of atemporal paralysis and dis-

sociation from the body—to the point that the sensation of being alive
disappeared—seemed characteristic of Donato, a married professional
man in his forties who had several children. Recently, he seemed to have
explosively emerged from this paralysis, starting from the period when he
had begun going to pornographic movies and having oral sex with various
men at the public baths. These episodes of acting out arrived like sudden
storms, devoid of any warning or mental mediation. The patient also suf-
fered from serious panic attacks and from a mail phobia, as a result of
which he avoided opening his correspondence, incurring professional dif-
ficulties in consequence; the panic occurred especially when he had to
open his mail.
Donato’s analysis was initiated at three sessions weekly. In an early
dream immediately after our initial consultation sessions, Donato saw
himself from the outside, as though from an upper window, urinating in
the bathroom of my office. And in fact, the first time he had come to see
me, he had asked to go to the bathroom. I commented on this dream by
telling the patient he was setting in motion an initial form of coming
closer to his body and its genitourinary functions—a self-perception he
had evidently not achieved during his sexual storms, but that he could
now activate in parallel with his coming to analysis.
In a short time, in fact, he demonstrated greater capacity to observe
and manage himself during his sexual exploits; he became able to use

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condoms, for example, and to be more aware of his sexual partners. From
what I could understand, Donato was using the feeling of being accepted
that he experienced with me to launch an early transference to his own
body (Lombardi 2005b, 2017). He became able to focus his attention on
recognizing his body and on beginning to think in relation to his sexual
acting out.
In describing a subsequent dream, Donato recounted: I was in the
company of a friend on an airport runway, and I was trying to make an
airplane take off, but it wouldn’t. The patient’s association sounded like
an intuitive interpretation of his dream: First I was afraid to take off,
afraid of feeling alive, but essentially I liked that way; I felt comfortable.
After a while, though, I couldn’t manage it any more and the situation
became so intolerable that I was overcome by panic.
Donato was having to discover that his devitalization, which until
then had seemed to him a privilege, in reality corresponded to the paraly-
sis of his life, like the airplane that was incapable of taking off. Viewed in
this perspective, the panic attacks revealed their positive function of
spontaneous movement toward a life of bodily origin, seeking to counter-
act his paralyzing and lethal control.
Another dream arose from his perception of a temporal change in
approaching the summer break: I am in a car together with my brother-in-
law, who is driving on a mountain road with many curves. He turns his
head away, and as a result he goes straight instead of following the
curves. We fall off a cliff. I thought that the brother-in-law in the dream
represented the patient himself in his refusal to adjust to changes; at the
same time, he represented me as the imaginary twin (Bion 1950) who
accompanied him in the analytic relationship.
Since Donato failed to associate to anything, I suggested to him quite
directly that he was speaking to me of his hatred of change; when a new
and unexpected element appeared (the curves), he denied it, turning
his head away. “But then it’s really a trivial problem!” he answered.
“How can I say it? A problem of perception. And here I was thinking that
psychoanalysis makes you discover the oedipus complex and all that
stuff!”
“You thought this,” I said, “because your standard approach would be
precisely to assume something, whether a thought or a situation, once and
for all, in a prefabricated way. And so psychoanalysis corresponds to the
oedipus complex, rather than your making yourself available to see things

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while continually updating your perceptions over time, according to the

needs and problems you gradually encounter as you move forward.”
In a new dream, the patient’s conflict about time and the limit it introduces
became more explicit. Donato recounted: Walking down a street, I arrive at a
room, together with someone else. I enter and there is a man who shows me
two watches on a countertop: a normal round one and a rectangular one that
has the numbers in lines, six along the top and six at the bottom. This second
watch has no hands—or, if there are hands, they aren’t functional. Nevertheless,
the clerk sings the praises of this second watch to me.
Here, too, the patient had no associations, so I proposed to him that
his denial of time led him to live in a dimension where the passage of time
doesn’t exist, and thus to a situation of not living. Further, he exalted this
condition of non-life, highly praising it, as happened in the dream with
the clerk who extolled the virtues of the nonfunctioning watch—rather
than recognizing it as the primary obstacle he had placed between himself
and his life.
“At age sixteen,” he said, “I was dejectedly bemoaning the passage of
time, but then I began to tell myself that there’s no way anyone can live
with this suffering—and then I simply threw away all my emotions.”
Thus Donato made explicit the dissociation he had achieved during ado-
lescence in order to remove himself from the pain of passing time and
life’s transitory nature. In subsequent sessions, a series of memories
emerged, among them his experiences in early adolescence when his
mother had had a serious bout of “nervous exhaustion”; she had suffered
hysterical, convulsive attacks, screaming that she was about to die. The
mother’s explosive theatricality about death seemed to have colluded
with Donato’s death anxieties, so that entering a life composed of emo-
tions had felt to him like being concretely exposed to annihilation.
What’s more, Donato actually had a twin; significantly, during ado-
lescence he had used the existence of this twin to deny being himself—
passing himself off as the “other” when he found himself in a situation
that could make him emotional, as when he encountered a girl he liked.
The depersonalization he introduced through the fantasy of being some-
one else nurtured an undifferentiated confusion between himself and his
family members: his twin brother, his depressed mother, and his emotion-
ally absent father. His denial of himself, and this identity confusion, had
blocked his learning from experience, causing him to lose the connection
with feeling and thinking.

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As a result of his analysis, which lasted three and a half years, Donato
became fully alive. After his homosexual experiences he began a hetero-
sexual relationship outside his marriage, his work developed positively,
and he completely overcame the panic attacks and mail phobia. Whereas
in the past he had always been precluded from gratification because,
according to him, it would have been “too costly” for him, now he was
inclined to pay the price for the things he found attractive in life. He at last
became capable of being emotionally present in his role as a father,
whereas earlier he had been absent. He was especially energetic in fight-
ing to protect his youngest son—who had begun to show signs of serious
autistic disturbance—by drawing on the advice of specialists and arrang-
ing for the boy’s psychoanalysis.

D i s c u s s i o n a n d C o n cl u s i o n

The final outcome of these two cases was very positive: Letizia is now
married, has a lovely child, and is a brilliant professional. Donato has had
a positive affective development, reinforcing his family life and his pro-
fessional career, both of which were in serious jeopardy. Both patients
have been in contact since they finished analysis and have been able to
express their gratitude.
Being biologically alive is not, in itself, sufficient for establishing a
relationship with life, as in the cases we have considered, which reveal a
condition of nonexistence and of being extraneous to the body, and to
space and time. A certain condition had been sought out and adopted as an
illusory source of a pleasurable sort of resignation. Thus, we could say
that patients do not exist when they do away with the precondition of
thought that enables life. “The ‘place’ where time was (or a feeling was)
. . . is . . . annihilated. There is thus created a domain of the non-existent”
(Bion 1970, p. 20). In regard to this “domain of the non-existent,” psy-
choanalysis can succeed in bringing about a decisive change.
In patients entrapped in devitalization, symbolic thinking seems too
abstract. Accordingly, Letizia and Donato carried out a process of work-
ing through that focused on very basic and concrete levels, in order to
activate the mental resources they needed to discover they were alive.
Analytic working through gives precedence to the analysand’s relation-
ship with himself, mobilizing the body as the point of origin of internal
experience and space-time (Lombardi 2015), in line with the priority of

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catalyzing an aware access to existence. Letizia, for example, could extri-

cate herself from her unconscious hatred of life through the discovery of
sensual-emotional experiences, such as being “touched” in the analytic
relationship, and through the vitalizing contribution of stimuli deriving
from the bodily level of massages, masturbation, and being at the gym
and in the restaurant. The same thing happened with Donato, who brought
his explosive sexuality into the analysis, discovering a springboard for
opening himself up to discovering changes of time and life.
In these processes of working through, the analytic relationship is
focused on the present in order to permit an unfolding from which the
discriminations essential to mental life can be derived—discriminations
such as those between body and mind, action and perception, life and
death, sleep and wakefulness, dream and reality. In Letizia’s case, I found
myself invested with an intense devitalization, testing my capacity to be
mentally present. Similarly, in the case of Donato, I was confronted by the
necessity of stimulating the birth of basic functions of attention and men-
tal notation (Freud 1911) to counter her blind and unconscious acting out.
The confrontation in the analytic relationship mobilized the patient’s
internal resources of self-observation and self-containment, from which
the indispensable capacity to be present and attentive to the self could
emerge.
The original symmetry that characterizes the raw, unmentalized lev-
els of sensations and bodily emotions requires the analyst’s continual
attention to the construction of basic discriminations, to be mentally
worked through in the context of new experiences. In these two cases,
what proved indispensable was the analyst’s weaving a continual dia-
logue with the analysand, speaking his private language, and assigning
value to the evolving components of bodily experience and sexual acting
out. In this way, the analysand can be accompanied toward existence sus-
tained by the initiation of an internal body-mind dialogue (Lombardi
2003b).
If in Donato the sexual acting out already incorporated the advantage
of an early receptivity to vital experiences, even though devoid of mental
mediation, in the case of Letizia a sort of body to body in the analytic
relationship was necessary, in which the spontaneous emergence in ses-
sion of the analyst’s body through stomach rumbling became a kind of
“royal road” to undoing the analysand’s radical denial of the body. The
use of very direct communication, such as telling the patient that she

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treated herself like a refrigerator, was supported by rigorous observation

of the material that emerged in the session, at the same time allowing
expression of the hatred that the analyst experienced when confronted by
the patient’s lethal paralysis. Thus, it became possible to throw her hard-
ened, antivitalizing control into crisis. This working through opened the
way for Letizia to explore the body-mind level, a process that revealed the
paralyzing nature of her self-stimulating actions and unearthed her deep
“necrosis” (the dead tooth / the cadaver in her mouth).
In conclusion, the perspective on being that I have presented can help
us face the challenges presented by patients who cannot feel themselves
alive. With these patients we must conduct ourselves on very concrete
levels of working through in which integration of the body is key. At the
same time, it must be recognized that since the risk of losing contact with
the body and with life continues to be present even in more evolved men-
tal conditions, the working through of these archaic areas that straddle
body and mind is never completely exhausted.
“There is nothing the busy man is less busied with than living: there
is nothing that is harder to learn” (Seneca, “On the Shortness of Life”).

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