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Bion was interested in psychoanalytic approaches to psychotic patients throughout his career. This is difficult work because, “the medium of the analysand’s transformation lies in the sphere of action, that of the analyst in the sphere of thought and its verbal representations” (Bion 1965, V, 248). The domain of hallucinosis may be represented in the model by O. Making contact with psychotic patients within the domain of their hallucinosis presented the greatest challenge, both conceptually and practically. Being with the psychotic patient constitutes an O shared by patient and analyst (Bion 1965, V, 169-170), and transformations in hallucinosis denotes both the specific work of transforming observations made in contact within this shared O, and the general circumstance of processes of transformations occurring in states of hallucinosis. It may be helpful to think of it as transformations within hallucinosis. Bion offers an example demonstrating that observing from T(K) and observing through transformations in hallucinosis produce vastly different interpretations of the clinical situation shared patient and analyst. His psychotic patient found that Bion’s words: “flew over his head and could be detected in what to me were patterns on a cushion . ... [By contrast,] he was able, in a state of hallucinosis, to see that the patterns were really my words travelling through his eyes , to him. Furthermore, the ‘meaning’, which could not be grasped outside the conditions of the hallucinosis, was perfectly clear in a state of hallucinosis. The ‘meaning’ of a statement in hallucinosis is not, however, the same as its meaning in the domain of rational thought” (Bion 1970, 251; italics added). The first italicized phrase indicates how Bion, and presumably every analyst would perceive, or ‘interpret’ the object on the couch: it is a cushion with patterns on it, the result, T(β), of the analyst’s transformations in K, T(K), from looking at it. Without describing how he observed transformations in hallucinosis, Bion gives the result, T(β), transformed into his thoughts, T(K): “the patterns were really my words travelling through his eyes, to him”. These two observed results could not be more different, and the difference is vital to appreciating psychotic states. Bion clarifies that the “meaning”, which he puts in quotations, has to do with “sense impressions in this domain [that] do not have meaning; they provide pleasure or pain” (Bion 1970, p. 251). Bion states as a general precept that analysts must listen with trained analytic “intuition” (Bion 1965, V, p.243; 1970 p.246) in order to apperceive the total situation and effect transformations into ideas such as “the patterns were really my words travelling through his eyes, to him”. Analysts must observe and intuit the “meaning” that is “perfectly clear in a state of hallucinosis”, and therefore trained intuition is a core element of analytic observation and transformation of the observed. The kernel of the problem lies with how the analyst may observe transformations in hallucinosis. The issue goes beyond purely technical questions, and takes up the state of mind and state of being of an analyst when working to observe transformations in hallucinosis. In terms of the model, the analyst aims to be in a state devoid of T(K), that is, to abandon memory, desire, explanation, and thinking as maximally as possible while observing. Describing this state of mind directly is impossible, because description is a function of T(K). In “Attention and Interpretation”, Bion attempted to evoke qualities of this observational state with descriptors including, “becoming O ... he must be it ... real ... be at one with ... become at one
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