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Interview with Riccardo Lombardi, MD

Interviewed by Patricia Marra, MFT

This year’s Visiting Professor is Riccardo Lombardi, M.D., a psychiatrist, child and adolescent psychoanalyst, and a Training and Supervising Analyst at the Italian Psychoanalytic Society (SPI) in Rome, where he works in private practice. 

Dr. Lombardi approaches psychoanalytic thinking as an “open work” constantly evolving — something to examine and question. Central to his clinical thinking is the Body-Mind connection (and disconnection) that he locates at the core of primitive mental states and as the foundation for developing the capacity to think. 

The conversation that follows occurred by email between Riccardo Lombardi and Patricia Marra, from their respective cities of Rome and San Francisco, in early August 2016.

 

PM:

Let’s start with your own development in psychoanalysis.  How did you get interested in psychoanalysis and where and with whom did you study and do your training?

RL:

I became acquainted with psychoanalysis through my courses in clinical psychology while studying medicine. In the beginning, I studied medicine to become a surgeon like my father.  I did work with him in private clinics, and then I frequented the surgery departments at the Catholic University in Rome. I shifted to Psychiatry because I was fascinated by the irrational and the illogical, as an area to explore through scientific instruments.

I grew up as a child immersed in anthropology — in the south of Italy — where magic has an important role and illnesses are connected to the Evil Eye's influences.  During my residence in Psychiatry at the Catholic University, I was mainly impressed by the teaching of Matte Blanco and Salomon Resnik. Matte Blanco's approach met my interest in exploring the dark and confused areas of the mind with a rational laser precision. His reading of Freud was exciting because he emphasized the continuous contradictions of the Freudian text as an expression of his effort to translate a multidimensional reality that is beyond Aristotelian logic. I never loved math, so I was unable to follow Matte Blanco in that way, but I was always fascinated by philosophical questions when I was in high school, so I was greatly interested in Matte Blanco’s thinking.  Salomon Resnik was fascinating for his ability to reason through jumps, in an associative way, and to find a meaningful consistency in the chaotic communication of psychotic patients.

Both of these teachers stressed, in my perception, the determinant role of happening and surprise. Thinking is always connected with a nascent state.  I perhaps found realized and also creatively amplified in their teachings the curiosity — also with its creative sadistic component — that had pushed me towards surgery. It was clear for me from the beginning that psychosis is at the core of psychoanalysis and that madness can be analyzable as a crucial chance of confrontation between the rational and irrational. And, of course, we need pharmacology, too, with these patients, but it’s only psychoanalysis that can catalyze a meaningful development or a stable recovery.

After having worked in supervision with children and adolescents, my first adult patient was a psychotic woman. Meeting Armando Ferrari — a Training Analyst at the Psychoanalytic Society of San Paulo, Brazil — was crucial since he supervised my work with psychotic patients, teaching me to take very seriously every communication of the psychotic patient. He had just arrived in Rome from Brazil where he had received Bion's teaching. Ferrari stressed, perhaps provocatively, that I will never learn psychoanalysis from my analysts or from my supervisors, since only my psychotic patients are able to teach psychoanalysis.

After these experiences, I entered the IPA institute in Rome.  I must confess that after the inspiring teachings of Resnik, Matte Blanco, and Ferrari, I found Italian psychoanalysis mostly intellectual and quite far from the clinical problems of the psychotic areas. The Italian Society is a very difficult environment for those who are not interested in a political career. As I wrote in a paper published in the Italian journal Rivista di Psicoanalisi, psychoanalytic institutions are characterized by the dynamics of power, envy, and rivalry, which unfortunately obscures the true object of psychoanalysis.

PM:

Let’s take up Ferrari’s pronouncement that you will never learn psychoanalysis from your analysts or supervisors, and that only your psychotic patients are able to teach you psychoanalysis.  This reminds me of Bion’s concept of “Transformations in Hallucinosis” — and Civitarese’s elaboration of it — where the analyst must become part of the psychosis to understand what is emotionally occurring.

RL:

In psychoanalysis, we need to use a simple language.  Bion had an unusual ability to construct abstractions, remaining consistently attached to the concreteness of his clinical experiences, but he also wanted to reduce psychoanalytic theories to a very few main concepts. It's very different from what often happens with post-Bionians, who use Bion’s statements as new theories and risk losing contact with clinical reality.

Psychotic patients can be our teachers because they are more in contact with their unconscious: for this reason they are for us what Virgil was for Dante in the discovery of the deepest levels. The analyst is generally more familiar with the most superficial areas of the mind, while his psychotic patients are more familiar with the deepest levels. This difference is the basis for a potential enriching exchange of experiences for both parts of the analytic relationship.

In the analysis of psychosis, the analyst must be able to observe and to communicate to his patient what he observes.  This is not obvious because very often analysts follow their emotional reactions and imaginations instead of observation and communication. We need discipline to follow the psychotic patient's communications, paying attention to their specific languages to translate the patient's private language in a transitional language where analyst and analysand can understand each other. We need first of all the activation of the system Perception-Consciousness to contain the explosivity of psychosis, as an a expression of a reverie, that is cognitive, but not less than emotional.

PM:

Could you please elaborate on that last sentence:  “We need first of all the activation of the system Perception-Consciousness to contain the explosivity of psychosis, as an a expression of a reverie, that is cognitive, but not less than emotional”?  It seems to refer to a lot of things, especially the link between the body and the mind.

RL:

Yes, Patricia, you're right that I stress the role of the link between Body and Mind as the most primitive area where the mind is organized. Perception (the mind) seems simple but it is not so elementary If we consider the parallel need to contain the sensorial chaotic storms (the body) that can accompany some perceptions.

I stress the role of the perception as an expression of a never-ending nascent state arising from the Body-Mind link and the key role of reality.  There are things that our difficult patients know better than we do, even in their disorganized states. So, they need our respect. I am impressed by the enormous amount of perverse patients we find in the  psychoanalytic literature. Is the patient really perverse (a very moralistic perspective!), or does he become perverse when he doesn't meet the analyst's theoretical expectations? In my view, the analyst's reverie allows us to organize the patient's knowledge that is just present inside him. So, severely disturbed patients can be reinforced in their authority and self-esteem. The analyst's authority derives from his stronger emotional containment, not by his knowledge. 

PM:

This leads to the body being the place that provides limits to — that contains — the infinity of psychotic thinking – bringing Matte Blanco into the picture.  Would you say something about how Matte Blanco contributes to this idea of the Body-Mind and psychotic thinking?

RL:

Matte Blanco, himself, didn't focus specifically on the Body-Mind, but on the connection between infinite sets and the Freudian unconscious. He was inspired by Melanie Klein's description of children's intense affects for describing the role of infinite affects. His reformulations of Freud and Klein permitted him to resume and reformulate mental functioning — said very concisely — in the oscillation between the two opposites of reason/divisibility and affective life/indivisibility. Both are essential to mental life.  I used some of his hypotheses, as well as Bion’s, to arrange a clinical focus on the Body-Mind, Space-Time, and Infinity in my first book in English, Formless Infinity. Clinical Explorations of Matte Blanco and Bion, published in 2015 by Routledge, The New Library of Psychoanalysis.

Differently from Matte Blanco, Armando Ferrari — after having studied in an intersubjective way the role of the analytic relationship — focused specifically on the Body-Mind, formulating the hypothesis of the eclipse the body. He retranslated Bion's proposal “no emotion, no thinking” — in the sense that it is possible to think only in the presence of emotions —to the more radical statement “no body, no thinking,” which considers the sensorial perception as the starting point of mental functioning.

The analysand who disowns his or her body — and who disowns the need to think and act recognizing the demands of the body through the mediation of the mind — dies analytically. This is Ferrari. I used various formulations of Bion, Matte Blanco, and Ferrari for arriving at a better understanding of what happens with very disturbed patients.  In my forthcoming book, Body-Mind Dissociation in Psychoanalysis: Development after Bion, to be published this year as part of the Routledge Relational Series, I am able, more specifically than in my first book, to present my clinical view on the Body-Mind.

I hope it can be enough for answering your question.  But, please, pay attention, the body in itself cannot contain anything because only the mind can have a containing function: it is the perception of the body that can offer a point of reference to the mind for emerging from the dark and formless Infinity of the unrepressed unconscious.  Bion stressed the role of thinking: the psychotic patient risks being drawn into the chaos if he doesn't start to think. In my experience with psychotic patients, I saw that the recognition of the body and bodily experiences has a powerful organizing role for establishing the first realistic spacio-temporal parameters that are the roots of thinking and for emerging from psychotic breakdowns and schizofreniform diseases.  I now have the project of writing a more specific book on psychosis and the body.

PM:

Going back to your earlier statement, “The analyst's authority derives from his or her stronger emotional containment, not by his or her knowledge” — I understand “emotional containment” to be the emotional and psychological work the analyst does in response to what the patient brings in.  Are you privileging this internal work of the analyst over what the analyst actually says to his or her patient?

RL:

No, absolutely not.  The belly is the belly, the head is the head: We need both. Our task is a development: body, affect, thinking. And each element is not less important than the other. Analysis is a work in progress and the cognitive working though is not less important than the emotional working through. What patients say and what we say is determinant because this exchange designs a horizon of exploration.

There is certain tendency to pre-establish the parameters of psychoanalysis in what psychoanalytic theories say and to obey them: in such a way we confuse the history of psychoanalysis  — which is good to know, of course, but also good to forget — with psychoanalysis itself — which is a process of discovery.

I presume it's important to get what our patients teach us and try to make public our clinical experiences. From the confrontation among clinical experiences, it can be possible to open new perspectives and possibilities to our science. Without development, there is no future for psychoanalysis!

PM:

Riccardo, this seems like a good place to stop — or perhaps pause — until your upcoming visit to San Francisco this November.  Grazie mille for taking the time to introduce yourself and your fascinating thinking.

 

 

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