“Repeating, Remembering, and Working Through”

Freud’s essay “Repeating, Remembering and Working Through,” in my opinion, is the most crucial one he ever wrote. Thus it comes as no surprise to me that Rudolph Binion has chosen to explore this essay in some depth. The concept of repeating versus remembering is the primary thought every analyst carries as we listen to our patients’ efforts at self-defeat.

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In the broadest sense, repetition compulsions are exceedingly common and very difficult to fix. Long ago, I started out as a young psychologist from SUNY Stony Brook trained in behavior modification. I soon realized that no matter how I endeavored to use these techniques on my patients, their symptoms would persist or change form. This prompted me to enter psychoanalytic training in the hope that I could take the patient further in treatment. I quickly learned that nearly every symptom, misperception, weak or grandiose self-image, and out-of-balance affect seems to repeat continually.

Rudolph Binion approaches this dilemma with a theoretical interest in its genesis. He reviews Freud’s ever-changing positions on the matter by talking about neurotic predispositions, early childhood trauma, childhood fantasy, and finally adult trauma, which Binion calls “episodic traumatic reliving.” It seems that seeking out the root of repetition compulsions and arguing about whether it stems from infancy or later life largely misses the point.

It is clear to any practicing analyst that we are faced with patients with repetitive hysterical symptoms, repeating conversion symptoms, chronically poor interpersonal choices, and self-destructive behavioral habits. These symptoms are carried by the self. Virtually every level of the patient’s self perpetuates these repetition compulsions. Let us say we are treating a patient with narcissism. The perceptual system of the narcissist produces hunger and a feeling of great emptiness, which no doubt stems from early childhood deprivation. They will possess an unconscious self-image filled with shame and anger. Their affective equipment will be an overflowing pool of anger. They will be grandiose and hypercompetitive. All these things will work out of view. These will repeat endlessly, much to the dismay and the exhaustion of patient and doctor. As the psychoanalyst Masud Khan once said, it is an exceedingly “long wait for the cure.”

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Over the years, we will learn of his psychic structure and then engage in the arduous task of change, which will include changing perceptions, affects, images, and behaviors. There is no easy way around this process. Freud called all neurosis “sticky,” and he was quite right. We will find the genesis of this reluctance to change in predispositions to infant and adult trauma.

I commend Rudolph Binion for having the courage to enter the dark world of repetition compulsions, though I can see he prefers the phrase “episodic traumatic reliving.” He has attempted to root out the theoretical meaning of this problem. Do patients have neurotic predispositions? Do they have early childhood experiences which form neurosis? Do they make things worse with childhood fantasy? Do they suffer adult trauma? The answer is yes in each case. And then they show up at our door.

The key theoretical position given to us by Freud is that early experience influences later experience. This is really all we need to know. I recall a symposium I attended when in graduate school when researchers were visiting our campus from Stanford. They were comparative psychologists working with animals, particularly an experiment with newborn kittens. For the first two weeks of life the kittens were put in an environment with controlled light. The newborn kittens never saw vertical lines throughout this crucial phase of their development. Then they were let loose into normal environs and proceeded to “compulsively” bump into chair and table legs, and they never gained an ability to see vertical lines. I asked if they thought the kittens would ever learn to see verticality and they said no.

However, psychoanalysts are not as cavalier as these animal researchers, for we treat human beings. Our patients come to us with early childhood deprivations that set up inevitable repetitions. They are as blind as the kittens, but their

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blindness relates to things like love, pride, joy, satisfaction, safety, and peace. Our job is to be like a Buddhist priest and practice patience and fortitude. The cure for the repetition compulsion is a long one, but the patient needs and deserves our presence on their long way home.

Like the amazing final scene in the award-winning film The Hurt Locker, Dr. Binion brings up the common idea that patients will seek out and reenter traumatic scenes in order to master them. This is a large subject that deserves more space than I have here. It is sufficient to say that the many patients have no other language than that of trauma and must seek it out in order to live. They may not be trying to master anything at all, but merely to live in the only way they know how.

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