Meetings of the Psychoanalytic Association of New York

February 28, 1977. THE ANALYST AND TRANSIENCE. Norman Atkins, M.D.

Defining transience as the sense of the inevitability of personal death and the nonexistence of the self, Dr. Atkins discussed the analyst's difficulty in facing and dealing with ubiquitous derivatives of the fear and denial of death. This contrasts with the ability to generally listen to and analyze patients' anxieties and conflicts pertaining to ideas of annihilation, the cessation of relationships to others, and the unprepared-for finiteness of life. Countertransference tensions in dealing with patients such as the aged, the dying, or regressed individuals with psychosomatic complaints, who struggle with primitive or unneutralized aggression, have been noted in the literature. The unavailability of denial and isolation as defenses contrasts the analyst's approach to that of other physicians. This decreased defense combined with increased sensitivity and empathy inevitably results in cumulative traumatic strains in such analytic work.

Analytic patients regularly have recurrent concerns with the subjects of time, death, and transience, especially after midlife. Dr. Atkins made reference to some clinical vignettes and to several of Freud's classical papers in which aspects of this set of problems were illustrated. In addition, he emphasized certain other features of development and of the structure of the analytic situation which tended to focus attention on the rigidity and meaningfulness of the time dimension. However, he felt that a total acceptance of the idea of one's transience was never fully possible. The problem is further complicated by the difficulty in separating realistic anxiety about age-specific, normative crises about time and death from neurotic fears derived from instinctual conflicts. After noting the import of such difficulties on analytic practice, Dr. Atkins expressed the conviction that these problems could be productively explored in every analysis.