Vamık D. Volkan, M.D., DLFAPA, FACPsa.

Vamık D. Volkan
Lecture at the Dutch Psychoanalytic Society, May 17, 2000.
Unconscious fantasy is, of course, one of the central elements of psychoanalytic theory and practice. In 1908's “On the Sexual Theories of Children”, Freud delineated two types of unconscious fantasies: “unconscious phantasies have been unconscious all along and have been formed in the unconscious; or – as is more often the case – they were once conscious phantasies, day-dreams, and have since been purposely forgotten and have become unconscious through ‘repression’” (p.161). For a child’s perception and “interpretation” of a childhood trauma to become an unconscious fantasy, they must be repressed, then further influenced and distorted by primary process thinking. When this process occurs, it exerts, as unconscious “mental content”, an interminable psychodynamic effect on subsequent perception, behavior, thinking, responses to reality, and adaptive or maladaptive compromise formations (Arlow, 1969; Indebitzin and Levy, 1990; Volkan and Ast, 1997). Thus, a little boy who witnesses a primal scene - and is traumatized by it -will not remember the event as an adult. But, in accord with the specific unconscious fantasy connected to watching his parents’ love-making which tells him that one will be hurt during sexual intercourse -he may exhibit difficulty in his own adult love-making.
Once the “story line” of an unconscious fantasy is put into words during psychoanalytic work, as we know, it closely resembles a conscious fantasy or a daydream that serves a variety of typical aims:  satisfying aggressive or sexual tensions; seeking satisfaction of various wishes; restoring self-esteem; creating relationships with and identification between “good” self- and object-images; and supporting rebellion against or submission to superego precursors (“bad” self- and object-images), or to the formed superego itself. Unconscious fantasies, when reactivated and enmeshed in present mental conflicts, can be a primary source of anxiety; at the same time, however, they can also function as defense mechanisms against anxiety - as we will see in the brief case study presented later in this paper.
“Actualization” of either kind of unconscious fantasy occurs when the child’s external-world experiences interfere with the usual confinement of the fantasy only or mostly to the psychological realm. Consider a little girl at the time she is developing unconscious oedipal sexual fantasies for her father:  such unconscious fantasies, in a routine developmental process, stay within the psychological realm; using them to satisfy infantile sexual desires, to enhance self-esteem, to create “bad” competitor-mother images, and so on simply remains as a set of psychological processes subject to modification as the child ascends the developmental ladder. If this little girl is sexually molested during her oedipal phase by her father, or by his substitute, however, her unconscious oedipal fantasy becomes “actualized”: There will be a strong link between the unconscious fantasy and reality; the little girl’s unconscious fantasy will exist in both the psychological and experiential realms. This paper focuses on the technical issues surrounding the therapeutic regression of patients who come to treatment with “actualized” unconscious fantasies.
There are those who are not in favor of introducing the concept of “actualized” unconscious fantasies. The reasoning behind this position is that classical psychoanalytic technique considers only the realm of “psychic reality”; classical psychoanalysis would therefore render unnecessary any concept that addresses difficulties in keeping mental “content” restricted to the psychic realm. Nevertheless, we note in practice that the reactivation of certain unconscious fantasies within the transference-countertransference axis complicates that classical picture of analysis by creating specific problems that cannot be successfully negotiated without reference to the world beyond the analyzand’s “psychic reality." In cases involving what I call “actualized” fantasies, the analyst’s interpretation alone is not enough to complete a working-through process that will resolve the unconscious fantasy’s pathogenic influences on the patient; a modification of classical technique is required.  
Many individuals with childhood experiences of sexual assault(s), overt sexual or aggressive stimulations by parents or siblings, bodily injuries, surgeries, near-death experiences, severe object losses, or exposure to massive destruction (e.g., earthquake or war) are prone to developing “actualized” unconscious fantasies. In fact, Bergmann (1982), Kogan (1998, 2000), and Volkan, Ast, and Greer (in press) have illustrated that a child may also develop “actualized” (Bergmann and Kogan use the term “concretized”) unconscious fantasies as a result of identifying with parents or other relatives - or, indeed, with the large group (i.e., ethnic group) with which he or she is associated - who have sustained massive traumatic experiences, such as surviving the Holocaust. If such a person enters into psychoanalysis as an adult, and if the “story line” of his or her fantasy becomes available to him or her, that individual will have difficulty differentiating where his or her (now conscious) fantasy ends and where reality begins. For this person, then, keeping the transference neurosis limited to the psychological realm will be difficult. Such an individual’s therapeutic regression will need to take him or her to the point at which the unconscious fantasy became “actualized” in order for the process of “therapeutic regression followed by therapeutic progression” to be successful. It is as if the patient must “go back” to the time at which the mental “content” and the external reality originally converged in order to re-establish the difference between what belongs to an unconscious fantasy and what belongs to the external world.
Generally speaking, the psychological significance of various actions has not been carefully studied in psychoanalysis (though there are, of course, exceptions - see, for example, van Waning [DATE]). In order to serve our patients most effectively, we need to understand the nature and functions of actions as a crucial part of working through “actualized” unconscious fantasies in treatment. We need, as well, to differentiate these actions from those of a different nature and function, such as those best categorized as “acting out”:  Remembering through actions in order to maintain repression, rather than remembering in words, with accompanying affect. There are, as well, actions that are part of the transference neurosis which occur in almost every analytic process. Actions pertaining to unconscious fantasies which are contained only or mostly in the psychic realm, however, are categorically different from what concerns us here. I will focus here a moment on the case of “Gitta”, a woman who came to analysis with “actualized” unconscious fantasies. In her late twenties when she began her analysis with Dr. Gabriele Ast (Munich, Germany; I functioned as a consultant for Gitta’s treatment), Gitta was extremely traumatized by having been born with a life-threateningly defective body. Beginning in infancy and lasting until she was 19 years old, she endured 40 surgical interventions. Though, when she started analysis, her physical appearance was for all practical purposes normal, she reported that, as a child, she had looked like a “monster.”
When she was born, Gitta was literally leaking from her mouth; her saliva had to be wiped out often in order to keep her alive, a task that her mother performed throughout Gitta’s early years of life, as well as later, when Gitta had to remain immobilized, sometimes for months, after some of her surgeries. As an infant, Gitta had been tube-fed, requiring a “hole” to be made in her body. And, throughout her childhood, the various surgical procedures and additional periods of tube feeding required countless additional openings to be made in her young body. One of her main unconscious fantasies, then, when its story line could be put into words during her treatment, read something like this: “My body is full of holes; it leaks. As long as fluid comes out of my body, I am alive.” Some of her adult behavior indirectly expressed this unconscious fantasy. For example, she wore sanitary napkins literally every day. As long as fluids (menstrual blood, urine, feces) passed (or seemed to be passing) from her to the outside world, it seemed, she could maintain her sense of identity. Thus, when she sat on a toilet, she took an hour or so to defecate, prolonging that moment. She also avoided swimming in a nearby lake; later in analysis, it became apparent that she was afraid that the lake water would enter into her body through its “holes” and would contaminate her own fluids. Her leaking fantasy, among its other meanings, was also a protection against regressing to a symbiotic existence (her fluids and lake water merging) with the representation of her mother.
Renovating her apartment during the second year of her analysis, a process that took a little over nine months, became a crucial part of Gitta’s therapy. The apartment represented her leaking body:  as she modified its internal structures, repaired its leaking windows, and made it beautiful, she also restructured her mental image of her body and separated what belonged to her “memory” and past feeling states from what was real now. Significantly, her action incorporated her analyst’s image as well: Rather than buying the necessary equipment or material for her work all at once or in substantial installments, Gitta habitually brought to her sessions a small brush, or a small amount of paint, or some other small item for the renovation, that she had bought on the way to the analyst’s office. Dr. Ast -who herself enjoys woodworking- would then talk with Gitta about what the patient planned to do at her apartment next, instead of interpreting away the meaning of the patient’s action. After the function of repairing her apartment/body image took its course, then the interpretation of the function could be made explicit. In fact, though, doing so was rather unnecessary; by the time Gitta finished renovating, she herself already knew the meaning of her activities. It was the function of her activities that had to be protected until it could serve its purpose. After months of work on the apartment, Gitta could differentiate internally what belonged to her own mental image of her body from what belonged to the physical existence of the apartment.
Handling patient actions related to “actualized” unconscious fantasies requires the analyst to accept the analyzand’s action as a kind of “therapeutic play” involving both the image of the patient and the corresponding image of the analyst. The need to revisit the convergence point of reality and fantasy within the therapeutic space creates a tendency in the analyzand -and/or a countertransference inclination in the analyst- to intrude into that space. But intrusion into the therapeutic space will foil the process of differentiation; it is essential that, as in Gitta’s treatment, the analyst allows the function of such “play”/action to take its course. Interpretation needs to be secondary and should come after the separation of what belongs to the mental realm and what belongs to the external reality is confirmed.
In fact, the analyst’s premature and/or overly vigorous interpretation of what the patient is trying to do will interfere with the therapeutic process. In the analyzand’s mental representation, the analyst’s image initially functions as a transitional object (Winnicott, 1953); as the patient differentiates unconscious fantasy from reality, he or she also evolves the image of the analyst from a transitional object to a differentiated and nurturing “new” (Leowald, 1960) object. The actions that help the patient to free himself or herself  from the pathogenic influence of “actualized” unconscious fantasy and give rise to reality testing, creativity, and sublimation can, in fact, be called “transitional activities” (Volkan and Itzkowitz, 1984). The sort of therapeutic “play” that I am recommending evolves a story that represents a return to the point at which the patient’s fantasy and reality became linked and then differentiates what belongs to the mental realm from what belongs to the present external world. A truly therapeutic process for an analyzand with actualized unconscious fantasies can be achieved once that differentiation is solidly established.
1- Arlow, J. (1969.) Unconscious Fantasy and Disturbances of Conscious Experience. Psychoanalytic Quarterly, 381-27.
2- Bergmann, M.V. (1982.) Thoughts on Super-ego Pathology of Survivors and Their Children. In Generations of the Holocaust, (Eds.), M.S. Bergmann, and M.E. Jucovy,
pp.287-311. New York: Basic Books.
3- Freud, S. (1908.) On the Sexual Theories of Children. Standard Edition, 9:205-226. London: Hogarth Press, 1959.
4- Inderbitzin, L.B., and Levy, S.T. (1990.) Unconscious Fantasy: A Reconsideration of the Concept. Journal of the American Psychoanalytic Association, 38:113-130.
5- Kogan, I. (1998.) Der Stumme Schrei der Kinder-Die zweite Generation der Holocaust Opfer (The Cry of Mute Children – The Second Generation of the Holocaust).
Frankfurt: S. Fischer.
6- Leowald, (1960.) On the Therapeutic of Psychoanalysis. Journal of the Psychoanalytic Association, 41:16-33.
7-  van Waning, A.(xxxx) Volkan, V.D., and Ast, G. (1997.) Sibling in the Unconscious. Madison, CT: International Universities Press.
8- Volkan, V.D., and Itzkowitz, N. (1984.) The Immortal Atatürk: A Psychobiography. Chicago: The Chicago University Press.
9- Volkan, V.D., Ast, G., and Greer, W. (in press.) The Third Reich in the Unconscious.
Copyright © Vamık D. Volkan and Özler Aykan 2007.
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Last modified on: Apr 20, 2016