The Pain in the Patient's Knee

We know very little about pain either.

—Sigmund Freud, Inhibitions, Symptoms, and Anxiety

Pain cannot be absent from the personality.

—Wilfred Bion, The Elements of Psycho-Analysis

Between Therapy and Hermeneutics

What is the place of a psychoanalysis that exists “between” therapy (considered both as a theory and a practice, but also as a theory of practice) and hermeneutics, or the theory of interpretation and understanding? How do we understand psychoanalytic “understanding” itself, as a mental process that involves both the analyst and the analysand in the analytic encounter? I want to approach these related questions by way of the writing of the British psychoanalyst Wilfred Bion (1897–1979). Bion is best known outside the psychoanalytic profession as a pioneer of the so-called leaderless group and a theorist of group process [see Bion, Experiences in Groups]. But his collected theoretical and clinical oeuvre represents—especially in its “epistemological” period during the early 1960s, from Learning from Experience (1962) to Transformations (1965)—the most systematic, original, and philosophical revision of psychoanalytic theory since Melanie Klein’s controversial development of Freudian ideas during the middle decades of this century.¹ Consequently, Bion’s influence pervades, and in some cases underpins, the rethinking of psychoanalytic theory and practice that characterizes British object relations in the wake of Klein. In particular, it gives contemporary post-Kleinian analysis its distinctive focus on (not) learning, (non)meaning, and (un)knowing, with an accompanying emphasis on the destruction of the links that make thought possible, as well as on the importance of being able to learn from experience and being able to bear not knowing. In other words, it brings to the fore difficulties associated specifically with questions involving interpretation and understanding in an analytic context.

Bion’s writing is noted for its paradoxical combination of directness and difficulty, and for its emphasis on primitive emotional states and experiences, on the one hand, and epistemology and consciousness, on the other. Rigorous in its clinical focus, it also makes frequent reference to philosophy, mathematics, and other branches of contemporary science. André Green, in the context of the new impetus that Bion gave to orthodox Kleinianism by linking it back to Freud, suggests that his particular contribution lay in realizing that the unconscious phantasies and archaic anxieties emphasized by Klein coincided with thought processes. Finding in Bion “an author who could measure up to Lacan,” Green saw the two as engaged in the common project of “reformulating psychoanalytic theory within a contemporary epistemological framework.” But for Green, “Lacan made the error of excessive abstraction, whereas Bion, with his constant reference to affect and the process of transformation, is the more authentically intellectual” [10–11].² Although Bion’s writing is read wherever the theory and practice of British object relations psychoanalysis is seriously taught and studied, for the most part it remains surprisingly unknown within the academy. This is especially the case in America—even when it comes to literary critics and theorists with an interest in the “authentically intellectual,” who are often, by contrast, steeped in Lacan and well versed in recent Continental psychoanalytic writing. If only for this reason, but also because Bion’s work is particularly relevant to issues involving the relation between therapy and hermeneutics, I want to focus on the culminating book of Bion’s “epistemological” period during the early 1960s, Transformations—so called because of Bion’s analogy between the psychoanalyst’s representation of the experience of the analytic encounter and the artist’s transformation of the experience of what he sees.

Bion’s writing, although terse and at times humorous, makes considerable demands on the reader, particularly on the capacity of the mind to entertain a new thought or consider it from a radically new perspective. He places pressure on thinking (including his own), as well as attempting to communicate the seeming incomprehensibility or hallucinatory dimensions of psychotic thought processes (which are often continuous with normal thought processes). In what follows, I will address both the kind of communication made by Bion himself—which is subject to its own interpretive difficulties and obscurities—and the relation between therapy...