The Precipitating Factor in Psychoanalysis

    There are events that look as of no big significance, yet they are followed by major changes that eventually prove that those insignificant events were quite significant in a different way. This  is familiar both in individual cases as in political and social cases. They precipitate  change in unexpected way. Changes in those cases are understood only retroactively. They reveal that the sudden  is only so because change was taking unexpected and unnoticeable course.

    I will give two examples from my clinical practice which stand out  in my memory as exemplary to what the word precipitation suggests. To do that it is important to mention that after Lacan published his paper on the “Mirror Stage” the understanding of narcissism had to radically leave the Libido theory behind. I gradually and unintentionally (for a while) recognized a difference between the two types of patients'  associations that relate to who is talking to me. There was the I patient and the me patient. The I talks as the subject of the analysis, and whatever he mentioned came from that person who is lying on my couch, not someone talking to me about him: {She was nice and kind}. The me patient talked to me about himself as the object of the analysis {I felt that she is nice and kind}. The subtle difference is the difference between talking (I am), and talking- about (me says), which directly or indirectly told me about his me. 

    The first patient- Mr. P. was an I patient. At the time he was in analysis it was common to use the psychoanalytic stages of development (Oral, Anal, Phallic) as an additional element in the diagnosis of patients. Mr. P. was an anal character (person) where ‘everything in his life’ was tidy, and his religion (a middle eastern religion) was the only source of rules in his believes and life. One day on the train which he used daily to commute to work he had a dispute with another commuter that resulted in some physical struggle which was immediately stopped by the other passengers. Just using the diagnosis of anality for a second, I would say that: something undesirable skipped the psychological sphincter of Mr. P., and the tidy I had to deal with the untidy nature of !!!!!me. The event was not so aggravating, but it was a psychical straw that broke the back of Mr. P’s rigidity.  The change started with doubting everything about what he thought of himself  and evolved to reveal to him a "me" that was a secret he kept, particularly-since childhood- from his mother.  Analysis of the ‘me’ was the rout to sort of cure, which was limiting a milder anal character to himself and let others live outside his expectations.

The second case was of a typical Egyptian young woman (Twenty-two years old) who was expected to be a me person (the object of anything she talked about, to the degree of not having a speaking I at all (if there was one). She was expected to speak as middle class, well brought up daughter and future wife, and stop being argumentative and a person with an identity. She was expected to speak as upper class well brought up girl, and stop being argumentative. The mother who came with her for the first interview mentioned marriage and the suitability of her daughter for a good match since she is getting a little older than her relatives and friends. The daughter was obvious in her ’childishness’, which was- to me- an undeclared strong mutual dependency  between mother and daughter. So, it was a complicated me kind of patient: the me that mother does not approve of is the me that preserve the interdependency between the two. The me that the patient was keen to acquire and, able to be, was the one the upper class 'Dallo-a' (an Egyptian term of a spoiled brat) is not suppose to have. The analysis was stopped when the patient, after few weeks of getting worse, was not allowed to come to her sessions by orders from her mother. 

Unexpectedly, I got a call from  her brother few weeks later informing me that she was hospitalized for a couple of weeks and she and the rest of the family (except the mother) wanted her back in therapy. I found out that what precipitated her breakdown was her cousin and a friend getting engaged and were supposed to get married soon. He explained the decision to pursue therapy was that after several "bizarre" fights with her mother in which she mentioned things she became aware of in her therapy the mother thought that I am not good for her daughter. The patient became incoherent, and sleepless and had a tendency to be physically violent. Hospitalization was recommended. After two weeks she wanted to go back to therapy and -as the brother mentioned- she was much more mature and serious about her future than anyone even thought that she has ever considered those matters.  The precipitating factor  was seeing with her own eyes what her mother did not want her to see. What she saw was that she was the one who is the main person in any marriage arrangement even if it is a traditional marriage. The precipitating factor was maturity as a requirement for separating from mother's symbiotic attachment to her daughter.

The link between the precipitating factor and the sudden change is a gradual unconscious change to undesirable ways of life, or thinking. What this means is that the precipitating factor is merely a trigger of change that is already ready to be declared but is not. The important factor here for analysts is the gradual but consistent process of interpretation and avoiding the scattered interpretations that do not lead to a definable target. With Mr. P. the  definable target was gradually bring to focus rigidity as a me that is translated in dealing with others as an I. Interpretations only -interpretations- could reveal to the patient the distinction between I and me, because an interpretation shows the patient difference between what is said and what is meant. This point is seldom touched in training, because in the history of the unconscious we were trained to think of it to be hidden and not part of the obvious, while it is always there in front of our eyes and ears. It just has to be brought out of its embeddedness in the obvious.  as an example: Mr. P. was quite concerned and worried about his son's 'Lesse  Fair' attitude regarding spending (twenty dollars a week). I intercepted his concerns as what about the future. This shift in emphasis brough about his anxieties about his son's idealization of him and his anal restrictions. In other words, interpretation is making the implicit explicit and that kind of change would eventually lead to the a precipitating factor of change.  

Interpretation leads to creating a gap between I and me. This gap is where the work of precipitating the cure takes place. When Mr. P. realized that there is an me that he is denying its existence this awareness released several other restrictions he was imposing on himself, like religion and its rituals. 

There is more say at this juncture but I wand to write about is how this model of understanding is also applicable to sociopolitical phenomena. I home to write something about it.