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High blood pressure: a hidden aspect of the psychoanalytic interaction

As psychoanalysts we know that the relation between analyst and patient affects the whole organism. Most of these processes are unconscious. In many cases they remain unsymbolized and stay in the somatic self. Recently, I was reminded of the relation between body and mind when I underwent a medical examination with a long-term registration of my own blood pressure. During the course of 24 hours 65 registrations were made. Taking away the measurements done during the first hour and during physical activity 47 registrations remained and they showed an average blood pressure of 130/90 mm Hg. Among these 47 registrations one measurement was significantly higher than the others. At five o’clock p.m. my blood pressure was 160/115 mm Hg. It was significantly higher than the pressure that was registered when I was biking or performing other physical activity during the same day. The nurse who told me the results of the examination asked what had happened at five o’clock p.m.? My diary showed that I had 7 patients that day. At five o’clock I was in the beginning of a session in which a patient told me that he was going to cancel 8 sessions in order to visit his parents and his hometown. He longed to smell and breathe the atmosphere of his childhood a longing that was easy to understand and sympathize with. However, it was a decision that was taken one-sidedly without any consideration of how it was going to affect the analyst and without concern for our future work together. Of course I reacted. I thought that the patient was ruthless and I got angry, however not so angry that my eyes went black, neither did I become mentally excited. In retrospect, I am amazed of how unconscious I was about the intensity of my own reaction. These cancelled sessions made it possible to talk about the patient’s difficulty to cooperate and freely use the three personal pronominal I, you and wedescribing his relation with the analyst. It became possible to formulate his difficulties to differentiate his own experience from that of the analyst. As a result of this deficiency the analyst in his turn experienced himself as being used and not being respected. The analysts associations during this session went to Donald Meltzer, a respected supervisor, and more specifically to the inability of the patient to sort out the geographical confusion. Instead omnipotence was used as a defence against anxiety connected with dependency, difference and separation. Analyzing this event, it became possible for both the analyst and the patient to identify how the patient first used projections of guilt as a method to control the analyst and when this did not succeed he instead increased the intensity in the emotional interaction with the purpose to blur the thinking of the analyst. This defence also failed with the result that the patient became aware of his feeling of worthlessness and fear to be abandoned. The analyst emotions, mainly of aggressive nature, made the relation more clear and possible to verbalize. Thereby this event brought the analytic process further. However many question remain unanswered. Is the raise of blood pressure a sign of repressed anger? Or is it also connected with the analyst’s unconscious effort to transform affects into images possible to use in thinking and communication. In this issue of International Forum of Psychoanalysis we have collected a number of articles dealing with clinical questions of similar nature. Manuela Flemming elaborates the essential and complex problems, which are related to the transformation of mental pain to psychic suffering in her article ‘‘Distinction between Mental Pain and Psychic Suffering as Separate Entities in the Patient’s Experience.’’ For the analyst it is necessary to tolerate mental pain especially seeing patients with psychotic states of mind. Per Einar Binder examines such situations both from a relational and interpersonal point of view in his article: ‘‘At the verge of unthinkable anxiety: On the relevance of a neurophysiologically informed relational perspective on meaning-making in psychosis.’’ He examines the relevance of relationally oriented psychoanalytic phenomenology as a frame of reference for understanding psychotic states in schizophrenia. The relational twist in psychoanalysis has had a great impact on the psychoanalytical technique manifested in the growing interest in the work of Ferenczi and his radical and seminal explorations of mutuality in psychoanalysis. In this issue of IFP we present two papers presented on a panel on mutuality in Psychoanalysis at the 25th annual spring meeting of the American International Forum of Psychoanalysis. 2006; 15: 193 194