Bruno Bettelheim, psychic regressions and...

BRUNO BETTELHEIM, PSYCHIC REGRESSIONS AND THE “LIFE WORLD” OF FREEDOM
According to the new psychological theory broadly outlined by the Russian psychologist Fyodor Vasilyuk, the psychic life of a person passes, simultaneously or consecutively, in four “life worlds” respectively organized on the principles of pleasure (or, more precisely, the principle of primary processes, which may be perceived as pleasure), reality (and activity demanded by the principle of reality), values and creativity (resp. freedom).
In our paper “Bruno Bettelheim and the dialectical psychotherapy” sent to the Usenet newsgroups sci.psychology.psychotherapy.moderated and sci.psychology.theory on 14.09.00, and also in some other papers of ours, we have made an attempt to re-interpret the psychotherapy of B.Bettelheim from this standpoint. Our main concern was to prove, with respect to the life worlds of pleasure, reality and values, that B.Bettelheim ingeniously uses the “lower” life worlds to achieve good results in the “higher” ones.
In the present paper we try to show that the case is rather different with respect to the world of freedom.
In the Orthogenic School, as B.Bettelheim called his psychiatric clinic for schizophrenic, and later also autistic, children, one of the main therapeutic principles is “offering the child as much gratification as possible, particularly at first”.
Naturally it demands much freedom for the patients: anything is permitted which has no “outright destructive consequences”.
B.Bettelheim relates many instances of such allowances, some of which seem truly amazing.
When she entered the clinic, an 8-years old schizophrenic girl Mary masturbated freely and often, undoubtedly with intent to provoke. This masturbation was taken as a matter of course.
Later on this same Mary enjoyed many other freedoms including the freedom to become dirty and the freedom to come to her favorite nurse ten times nightly and wake her up.
When the patient at long last acquires more self-control and becomes more socialized, some limitations of freedom can be introduced but only with extreme mildness. For example, if a child destroys dishes and glass in the dining-room, such behavior is ignored for the new-comers, but the child who has already sufficiently improved is stopped, or, if he persists, sent from the dining-room, naturally with his full fare, to eat by himself.
Such superabundant satisfactions of the children bear rewarding fruit. It has been compellingly proved by independent observers that the patients considered incurable by other doctors improved beyond all expectation and as a rule were completely cured.
But the price of these successes is also high: years of unremitting care and attention of the therapeutic staff and regular periods of regression of the patients, often prolonged and severe, before the final recovery.
Let us dwell on the regression of the aforementioned Mary, which continued for several months on end. She could not brook the slightest frustration even when it was unavoidable. She expected the nurses to divine all her wishes and fulfill them immediately. Later she became unable to express her real desires, and even if she could say what she wanted and it was given her, it was never what she actually craved.
“Obviously,- writes B.Bettelheim,- we had disappointed her”. She often fell into outbursts of despair and cried: “Do something for me! You never do anything for me! I hate you!”
After several months of her breakdown a gradual improvement took place. During the period of improvement the screaming of Mary changed slowly from a deadly repetition of “I’m dying” or “I hate all of you” to more specific and realistic complaints. She clearly craved for outside help and frequently demanded: “you’d better settle me down” or “take me to Dr B (Bettelheim)”.
The treatment of Mary had a happy end, as is usual in the psychotherapy of B.Bettelheim, but the problem of regressions in the therapy remains unsufficiently solved.
Naturally B.Bettelheim puts questions to himself on the causes of these regressions and how to deal with them rightly.
In particular with respect to Mary he writes: “...she was overwhelmed by pleasant experiences with undesirable results”.
It is probably quite right, but were it so simple, the remedy could be easily found. If the patient receives too much gratification and that is all, let us limit it, and limit also her freedom to search for gratification.
But B.Bettelheim prefers rather to avoid such maneuvers.
During Mary’s regression the gratificatory tenor of the therapy and the liberal attitude to her freedom remained unchanged. E.g.: “Whenever Mary began venting her frustration or hostility, the counselors (nurses) did their best to satisfy her demands and make her more comfortable”.
We believe that one has weighty grounds to persist in the ways of gratification despite regressions, which grounds B.Bettelheim did not formulate exactly.
According to the psychological theory of F.Vasilyuk, there are conflicts and fights between the regulating principles of the life worlds, and notably between the principles of pleasure and reality.
We believe that the principle of pleasure in the patients of B.Bettelheim was severely repressed in their previous lives, and the need to reactivate it arose, even by the price of regressions into the world of pleasure.
But certainly as much as unharmfully possible to preserve, or even to newly introduce, from the principle of reality must be preserved and re-introduced.
Mary was never left alone, and the nurses continued to help her in realistic, not autistic, gratifications and activities towards them.
When a patient of B.Bettelheim manifests ambivalent behavior, his freedom to be ambivalent is not suppressed by negative reinforcements, but realistic gratifications are always present in sight to give him possibilities to grasp them.
When B.Bettelheim’s patient, the autistic girl Laurie, regressed severely, B.Bettelheim had weighty grounds to suppose that her regression had been triggered off by the ambivalence of the girl towards her teacher. Nevertheless, when the state of Laurie improved, the presence of this teacher was re-introduced in order to permit Laurie to learn to relate to her teacher in a more realistic way.
Still the question remains: can anything be done to mitigate regressions of schizophrenic and autistic patients or, better, to avoid them entirely without losing the gratificatory tenor of the therapy?
Ways to achieve it do in fact exist.
When the severe regression of the aforementioned Laurie began, B.Bettelheim, seeing that his usual laissez-faire attitude, which, we should mention, is regularly connected with much small, secure and easy everyday routine gratification of the patients, does not help, he commanded an active interference.
The nurse who permanently cared for the girl began to manifest maximum approach and attention to her. For the following days she held Laurie in her hands and cuddled her during all the day and for the most part of the night.
At first Laurie showed displeasure at such closeness and wanted to isolate herself, but later she accepted the new closeness. This active approach, which rather interfered with Laurie’s “freedom of privacy” (one of the major rights of patients, according to B.Bettelheim) led to the beginning of the improvement of the girl.
Still more interferences with the antigratificatory drives of schizophrenic patients are effectively carried out by the Swiss psychotherapist M. Sechehaye and the Russian psychotherapist V. Loseva.
M. Sechehaye often chooses herself what gratification must be administered to the patient and in what ways. Such an approach seems to help against regressions but demands much prudence.
Once M. Sechehaye told the nurse in the presence of her patient Renee: “Give Renee a bath whenever she wants it; it will please her!” These words were followed by agitation and self-destructive behavior of the girl. Later, when Renee grew entirely well, she explained to the psychotherapist the nature of the mistake. It appears that M. Sechehaye should have taken the responsibility of the bath on herself and said to Renee: “Mama orders Renee to take a bath”. Gratification by orders from the “omnipotent Mother”, as the psychotherapist appears to the regressive forces of the patient’s subconsciousness, is easier for the patient to sustain than gratification by her own initiative.
And the Russian psychotherapist Vera Loseva, having evaluated in many psychoanalytic sessions the actual behavior, attitude and the former history of her schizophrenic out-patient clients, also gives them clear orders for activities directed to gratification. The patients of V. Loseva never regress.
Both M.Sechehaye and V. Loseva pay much attention to the, always present, gratificatory drives of their patients, yet they do not rely only on their spontaneous carrying out but help insistently to their patients.
Activity directed to gratification is potentially very conflict-laden for schizophrenics, and possibly also for many other persons considered and considering themselves more “normal”. The cause is probably in the simultaneous influences of the principles of pleasure and reality, which act in the contrary directions. Therefore helping patients in such activity, especially to counteract their regressions, seems to be a very important task.
Was not such a direct help of the therapeutic staff just what Mary incessantly and fruitlessly asked for in her regressive plight? And could not such limitation of the freedom of patients lend more versatility to the therapeutic guidance of them?
Regressive exacerbations similar to those taking place in the psychotherapy of B. Bettelheim do occur elsewhere too.
A. Burton writes:
“There can really be no basic change in the schizophrenic situation without surmounting such upheavals”.
And outside the clinical field there is also a possibility of regressions, which, according to R. Firestone, “are more likely to have been activated originally by positive movement towards individuation than by negative occurrences”.
Therefore our considerations may be of some interest for wider domains of psychotherapy and psychic correction.