Bion (1970) saw his concept of ‘O’ as the central psychoanalytic perspective. It is a waking dream state, seen also as an essentially “religious” or spiritual perspective. While religious ideas may seem far afield in a discussion of fundamental elements of psychoanalysis, the word “spiritual” here refers simply to metaphysical matters of the spirit, mind, or personality, three terms used interchangeably by Bion. This essential experience of ‘O’ is seen as a selfless state, which the author clearly distinguishes from pathological states of selflessness, mindlessness, or nothingness often seen in patients who suffered early emotional trauma. Philosophical ideas about being and non-being help to clarify the difference. The challenges in finding an effective language to communicate verbally with pre-verbal states are explored through detailed clinical examples of working with often intractable states of resistance to being.