A Note on the Feeling of Confusion in Analysis

This communication is in the nature of a short supplement to Bertram D. Lewin's paper, The Nature of Reality, the Meaning of Nothing, With an Addendum on Concentration.1 Lewin noted that when the word 'confusion' was used as an analytic association it frequently referred to the female genital. In other patients, and particularly in phobists, a momentary feeling of confusion over an otherwise simple interpretation frequently leads to latent thoughts concerning the female genital and especially the denial of the implication of castration.

For a considerable period in her analysis, a middle-aged agoraphobic woman reacted to any interpretation or clarification with a feeling of confusion. Statements by the analyst evoked such responses as 'I'm confused', 'I can't see it', 'It doesn't make any sense', or, on occasion, an agreement followed by associations indicating complete misunderstanding. Yet this patient was well above average in intelligence, had a high degree of conceptual thinking, and a reasonably sophisticated understanding of analysis. It became increasingly evident that he responses were unrelated to the manifest content of the interpretations. Otherwise, she was a coöperative patient and the level of conscious resistance was generally low.

Significant historically was the fact that she was the only girl among six brothers, some older and some younger. The brothers were her only playmates until she began to go to school and, because of the relative isolation of her home, her afterschool activities continued to be with them for many years. From an early age she felt she was different from everyone else and that the rest of the family considered her incompetent, inferior, weak, and helpless. In fact she was a good student and, because she was a tomboy, could hold her own with her brothers. She recovered memories of becoming aware of the difference between the sexes when she attributed their imagined derogation to the fact that she was a girl. Coinciden