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‘I do not know where to start’ - the phrase, spoken by the patient at the beginning of the session, is both prologue and synopsis - an introduction to and essence of the patient's psyche. The parallel processes first described by Searles (1955) are
revealed to the reader. Trying in vain to understand the patient, one is confronted first with confusion and boredom, then with resentment and despair. The escape from this seemingly lifeless world becomes reverie, a means to what Bion called alpha-function. The first association that came to my mind was the recent story of the discovery of a 15 tonne plug (a fat-berg) in a London sewer. This was a solid mass of congealed used cooking oil, hygiene products and condoms which took several specialists plus two months of hard work to remove. I think one possible cause for the stagnation of the analytic process could be viewed as a similar ‘plug’ of beta-elements that have hardened and glued together in the patient's psyche, which is also brimming with uncontained fragments of inner experience. I will try to consider various factors that may have led to the formation of this pathological conglomerate, both in the patient's psyche and in the analytic process.
The poverty in which A. grew up was not only involving her external environment, but also her relational environment and mind. According to A., her childhood was mostly unhappy, filled with emotional deprivation, lack of safety and security as she was not allowed to simply ‘be a child’. She learned about hard work early and then became a good student, but it seems only to appease the insecurities and anxieties of her relatives. Although the story of A's later life presented here is sparse, we can assume that she was also unhappy in her adult life, doing only what seemed ‘right’. We know she sought therapy after repeated years of her trying to build a calm and secure life had failed. The patient was in her sixth decade, her children were presumably grown up, her husband ha