Reply to Dr. Schimel's Discussion

I AM PLEASED TO HAVE THIS opportunity to respond to Dr. Schimel's critique of my paper because I believe discussions of this kind can only improve and enlarge upon our understanding. In this regard, however, it is somewhat regrettable that his doubt that the patient's psychodynamics were "sufficient to explain the phenomenon of patient's sleep" precluded his commenting on this aspect of my presentation, since it deprives me and the reader of the contribution he might have made in this area. On the other hand, his skepticism has rewarded us in another area, when he asks: "Is patient wakefulness an artifact induced by the psychoanalyst's countertransference?"

It will facilitate matters to summarize briefly certain aspects of my hypothesis. Patients who "sleep" in the psychoanalytic session operate with powerful denial of frustration, as well as infantile envy and jealousy, which renders them incapable of dealing in a satisfactory manner with the loss of the primary object. This denial operates via devaluating attacks on the breast (Klein) and on the mental apparatus (Bion). These latter attacks effect, in particular, analytic thinking and awareness of thoughts and feelings.

There thus develops a hatred of twoness and the linking function necessary to form a coherent whole. Aside from the splitting and scattering effect brought about by these attacks, what develops is a denial of self worth and object value, in favor of an omnipotent sense of superiority or megalomania. One of the significant manifestations arising from this hostility is the development of a kind of superficial concept of the world, in which real knowledge derived from any depth, including the unconscious, is denied.

What is particularly noted with such patients is their attempt to keep all explanations on a most superficial level, where emotions of unconscious origin are explained on the basis of present-day reality. In attempting to hide infantile anxiety in external reality in this manner, the