PERSONAL VIEW

Christmas Crackers on the NHS

Mary Brownescombe Heller

SUMMARY The therapist's holiday breaks always resonate with meaning for the patient;none more so than Christmas. Using the meaning of the Christmas break, set in the contextof redecorating work taking place in the department - with its inevitable disruptiveconsequences - I attempt to explore and understand the symbolic significance of suchholidays to the patient. In particular, to look at the more primitive, infantile psychicmechanisms that are employed to defend against the pain of separation and the loss of thetherapist as a maternal holding environment.

The setting is the psychology department. The scene a week before Christmas. Onceagain, the heating is off. It always happens when we get heavy rain. Apparently it floodsinto the basement and shuts down the old boiler. We have been lent some calor gas heatersby District Works.

Mr D, arriving early for the group, says: `I don't know whether you want to warm uswith that thing ... or poison us all with the fumes!' He intends me to think that this is a joke.

We have the decorator in. He has been told the job must be finished before Christmas.Under the new NHS contracting arrangements, better value for money and a precursor tothe internal market, one man is expected to complete two rooms every day ... moving theheavy filing cabinets, the bookcases overflowing with journals, the steel cupboards, thedesks. Scraping; making good; papering; painting - ceilings, walls, doors and skirtings. Wehave all been impressed with Joe even if he has spilled quite a bit of paint on the carpets inhis brave efforts to keep up to schedule. (It seems that there were not enough dustsheets.)Joe has given us his private address - he needs the work. He recently bought a street houseand his wife is expecting their first baby shortly.

Christmas is, after all, about a couple and a baby. The Christmas story tells of a couplewandering the streets; looking for a home where a baby can be born. They are turned fromevery door. No one wants to give them house room. As the story has it, the external worldis dark and frozen. A chill wind blows, whipping snow in their faces. It is deep midwinter.The birth takes place in a dank and cheerless stable, straw and dung for a bed, only animalsfor company.

The traditional Christmas card pictures an idealised image of a mother and baby - withfather in attendance - worshipped by animals and wise men alike. The parental couple andtheir adored infant are bathed in celestial light. Every year we are presented with the rebirthof a baby who is to save the world.

From another perspective, there is a couple and the product of their intercourse. At thevery sight of them, normal, ordinary people bar their doors, turn their backs,

Mary B Heller MSc AFBPsS DCP is Top Grade Psychologist in Psychotherapy for ClevelandCounselling and Psychology Agency and is currently completing the Tavistock Qualification in AdultPsychotherapy. Address for correspondence: Woodlands Road Clinic, Middlesbrough, Cleveland, TS13BL.

British Journal of Psychotherapy, Vol 9(2), 1992© The author

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freeze them out - push them out of sight and out of mind. The couple and their baby havearoused the most intense envy and hatred. They have become persecutory. No depressiveposition concern here but the very acme of paranoid-schizoid functioning.

In this state, the Christmas break signifies being pushed out into the cold; excludedfrom the couple and their intercourse; displaced by another baby; deprived and starving ina land of plenty.

In the bleak mid-winterFrosty wind made moan,Earth stood hard as iron,Water like a stone;Snow had fallen, snow on snow,Snow on snow,In the bleak mid-winter,Long ago.

Christina Rossetti (1830-1894)

In the internal world, mother's body has been turned to ice.The telephone rings in my room - the second time this week. A colleague knocks on

my door even though the `Engaged' sign hangs in place. There is something about thedisorganised state of the department this Christmas that is contagious. It infects thinking.

Finding myself in a state of not thinking with my patient, I feel alarmed. I wish thewalls were thicker, the door and window soundproofed. I need the organised structure ofthe department, our unwritten rules about therapeutic privacy, to contain me. I begin towonder whether my sense of insecurity is conveying itself to my patient. I interpretanxieties and anger about the therapist me who has not provided a sufficiently secure andprivate place for the work; make a reconstruction about a mother who did not protect ababy sufficiently from intrusions; comment on the patient's experience of being pushedinto too early independence and link this with the functioning Christmas holiday. It allseems a bit intellectual.

The reality of the state of this building resonates with so many unconscious phantasiesin this patient - in every patient - in me too. And how am I to contain my anger at all thesedisruptions?

The decorating will not be done in time, of course. It is an institutional delusion thatcontracts one person to do the work of two. It is a regression to the infantile omnipotenceof the self-created baby. The annihilation of the couple. Isn't this why the Ceaucescucouple were put to death at Christmas? Judged in haste and found guilty before a nationand the watching world. Monsters they were described as, yet brought into power by aregime which they reflected, and it them. Even so, I thought their last few minutesdignified. It is so easy to switch from blind idealisation to murderous hatred when you feela parental authority has let you down. Perhaps it is simplest to deny the reality of a couplealtogether.

Mr A tells me of a doctor friend who is spending Christmas in the Canary Islands withher husband. He says he feels sorry for her poor patients. I suggest he feels left out of mylife and curious as to what I will be doing with my husband this Christmas. `But MrsHeller', he says indignantly, `I didn't even know you had a husband!'

Mr B reflects on his fantasies about my home life at Christmas. He imagines me in alarge house full of dark, heavy furniture. He sees me on my own with two daughters.

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He laughs and says that he doesn't want any male members living in the household. Isimply say yes. I wonder to myself whether this is not more than a denial of a threepersonoedipal situation; whether it isn't a fantasy at a part-object level in which male membersmust be kept out of mother's body.

Parthenogenesis - virgin birth - is a denial of the father and the sexual mother. TheVirgin Mary carries the Christchild in her womb, unsullied by the entry of male membersinto her household. In this way, she remains a pure and idealised love-object. Yet theunderlying hostility to an idealised mother prevents the baby taking her into himself as asustaining resource, during times of need.

Even so, hate that is split off, and based on feelings of hopelessness, has to gosomewhere. Is it in the frosty wind that moans; the earth turned hard and unyielding asiron; the Christmas holly with its berries red as blood, its thorns sharp as a witchmother'snails?

My group too, push away their feelings about Christmas. The mechanisms of denial,splitting and projection, typical of the paranoid-schizoid position, are perhaps at their mostobvious in group therapy. When I put it to them that they are being nice to me about theChristmas break - that they find it painful to experience a sense of missing - that they areavoiding what they might really be feeling - they look at me blankly.

Oh no - of course you must have a holiday!I won't miss the group. It will be a relief not to have to come for two weeks.I love Christmas. In fact, I'm crackers about it!(Belligerently) This is what you always say - where's your evidence.

How disconcerting it is for the baby when the breast he demands is withdrawn. It isdifficult then to hold on to a good mother; the baby's hatred is pushed into the mother in hismind and leads her to become bad - poisonous - like the oil heater mother in the grouproom. This type of persecutory anxiety is the hallmark of the paranoid-schizoid position. Itinvolves a feared re-introjection of an internal, retaliatory persecutor and produces terribleanxieties about being destroyed from within (Klein 1946). Healthy splitting in early infantdevelopment is about keeping these two mothers well apart in the baby's mind - until amore mature state of being able to tolerate ambivalence is achieved.

In the next session, the talk in the group is about standing in queues during theChristmas shopping rush. One of the participants has come in late, delayed by such aqueue, and tells the group of a near panic attack. The others comment:

I hate queues. I never stand in them!Christmas is a dreadful time ... you never get what you want.You should have gone back when there was no one else there.

I say that they are feeling panicky about the Christmas break; that they would like tohave me all to themselves, but instead they feel they have to queue up and wait for myattention - not just today, here in this group therapy, but during the two weeks when I willbe on holiday.

Again, these thoughts are promptly dismissed by the group. Later, however, they talksympathetically about the silent member of the group; saying that she would feel happier ifshe could see me on her own.

I am reassured by Bion's drily humourous comments in Experiences in Groups (1961).He says that when he begins an interpretation to his group, he is convinced of its

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truth, but by the time he has finished speaking, he feels he has committed some kind ofgaffe. I frequently feel like this in the group.

This Christmas, there is no question of the present state of my room, my department -the background environment that I provide - being under my control. I suspect this leads meto be readily experienced in the minds of my patients as a damaged object; certainly, as onewhich fails to sufficiently hold and protect.

Mr B told me he didn't mind the state of the corridor - the dustsheets ... the paintcans. Itwas tripping over and falling down that he was worried about. And so he is - having beendropped from his mother's mind as a baby, when she developed a brain tumour and diedwithin a few years of his birth. With all the commotion outside; the fumes; my roomstripped ready for painting; I note my headache and a sense of despair about my capacity tohold him securely in my mind. My countertransference in identification with his dyingmother.

Using the symbolic meaning of story material from an opera by Ravel - DasZauberwort (The Magic Word) - Melanie Klein (1929) comments on an early infantilestage of development - the stage of maximum sadism - in which attacks in phantasy aremade on mother's body and its contents; which include father's penis and a multitude ofbabies. This is seen to be the earliest anxiety situation and is imbued with a special,dangerous intensity because of the small child's desire to attack the parents' union.

The forthcoming Christmas break and fears about how she might be contained, leadMrs C to preoccupy herself with anxieties about my cupboard - a symbolic representationof mother's body. She notices that the door to my tall cupboard is slightly ajar and becomesanxious. She tells me of a recurring fantasy in which she imagines herself hiding inside thiscupboard - sometimes on her own, sometimes with her older sister. She says I will think hersilly to have such thoughts; this is why she has not mentioned them before. When thecupboard door is closed she feels she can be safe inside it. Open, it feels insecure. Someonemight come in. She doesn't like the building being in such a mess. She wonders who usesmy room when I am away on holiday. When she comes back after a break, she says, sheknows immediately whether anything has been moved. It annoys her to think that someoneelse might use my room, touch my things, poke about. It makes it difficult for her to comeback. She feels inexplicably guilty about having such thoughts and feelings.

When Mrs C's brother was born, to a mother who had only ever wanted a boy, Mrs Cand her sister became surplus to requirements. Mrs C would like to spend Christmas safeinside mother's body - in this way she could defend herself against unbearable feelings todo with being separate, excluded and alone. But then, a penis might come poking in - and isit this, or is it Mrs B's jealous rage towards the couple and their new baby, that has somessed up mother's insides that it no longer provides a safe, containing space? Howdifficult it would be for Mrs C to come back if, in her unconscious phantasy, she fears shehas left the attacked and damaged remains of mother's insides, father's penis and theproducts of their intercourse, there in the cupboard, during the Christmas break. What wasonce experienced as a safe container, will have become a terrifying Pandora's Box - full offragmented, increasingly hostile objects - all set to get back into her and destroy her insides.

The group begin their penultimate session before Christmas by talking about burglaries.One of the participants says that she was burgled this last weekend. Another tells the grouphe has already been burgled twice. Another, that he has been burgled three times.

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I expect there will be a lot more burglaries - what with Christmas coming up. (There is generalagreement with this statement).There's never a policeman around when you want one, is there?No. And if you do find one, he's sure to be bent!

(A discussion follows, detailing the ineptitude of the police and their easy corruptibility.The group finally relents somewhat, and finds one or two examples of trustworthy, honestpolicemen.)

I comment that the group is not sure who is doing the stealing and who is beingdishonest. There seems to be one version in which they feel that a bent policeman fatherand I are stealing away two of their sessions over Christmas. In another version they arelooking for an honest, trustworthy policeman father who can keep their aggressive feelingsabout the Christmas break under control - in case all their feelings of deprivation and rageget out of control and end up as criminal acts.

This produces a long, increasingly heavy silence. Eventually, the dominant member ofthe group talks about how he had so very nearly acted out an impulse to murder his wifeone Christmas - when she told him she was leaving him for another man. He is in tears ashe tells the group this. The impulse to murder his wife was fuelled by memories of amother who abandoned him and his father, not long before Christmas, pregnant with someother man's child. In this session he carries and gives substance to the murderoustransference feelings in the group about the genital, parental couple who go off with eachother, leaving the group baby at the mercy of a `bent' superego. This corrupt anduntrustworthy superego is a burglar. The stealing represents a perverse way of dealing withloss, deprivation and despair - it functions as an antidepressant.

The fear, hatred and ensuing remorse that can be aroused by the thought of the parentalcouple in intercourse has been successfully averted.

Before the break, Mr A notices a small stick hanging on a peg in my room. It is ascaled down replica of a shillelagh (an Irish cudgel) given to me years ago by a patient. Ithas been hanging there for so long that I no longer see it. I had forgotten to remove it inreadiness for the repainting. He comments on it; goes over and touches it; holds it brieflyin his hand. Mr A, who has problems with boundaries, needs to hold on to something hard,in case he falls inside mother and is lost forever during the Christmas break. The stick isthe nipple that gives form to the breast; it is the penis that separates and structures themind.

The disorganised state of the building this Christmas, equated with fears about the madstate of my mind - the tumour in mother's mind - leads Mr B to talk of his memories ofpotholing in the Pennines. The narrow passages; the cavernous rock chambers; a tunnel hecrawled through; an explosion, far off, its repercussion felt through his whole body; hishead torch, reflecting back from a pool of water, frightened him - put him in mind of ablack hole and falling into infinity.

For Mr B, the potholing, anal quality of these memories, suggests that there is no safeplace in which to spend Christmas. Not mother's mind, or her breast, or her womb.Certainly not these dark, subterranean passages. He knows that some dreadful, explosiveevent has happened, which is kept far away from him in his internal world. He can feel itin his body but not his mind. To feel it in his mind would be to risk disintegration. There isno experience of even a two person relationship in this material; no containing mother'smind in reverie - Mr B's psychic projections are beamed straight back at him, deprived ofmeaning. This is his experience of the tumour in his mother's mind.

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In the last week before Christmas, the group are talking about Christmas cards. Theyoungest member says he hates those cards with sloppy messages - he would never sendone of those. Then he has an alarming memory. It is of his parents standing together in thekitchen washing up and he - as a small boy - seeing a knife. There was the thought that hecould stick it into them. He could have killed his parents. The oldest group member beginsto cry. She remembers that when she was pregnant with her first child, she had the impulseto stick a knife into her stomach. She was so horrified at the thought, she had a panic attackand had to be put on tranquillisers. She has never told anyone this before.

I talk of murderous feelings being stirred up in everyone. I say that these are to do withthe break and what I will be doing over Christmas; feelings that are aroused to do with theexperience of being excluded by a parental couple; feelings of terrible jealousy to do withthe babies that might be born to this couple - the Christmas couple. The group do notcomment on what I have said, but talk of their plans for this Christmas in a spirit ofsubdued optimism.

When I say it is time to end, the dominant member of the group says:

Well ... despite what we have said about Christmas, I hope you have a good one!

This is echoed by the rest of the group.After the group has gone, I reflect on the fact that the redecorating is almost complete.

When we return in the New Year it will be done. Order will be restored. I feel a sense ofhope - a feeling that seemed to be in the group.

Christmas is, after all, a symbolic enactment of love, rebirth and, most of all, hope.

References

Bion, W.R. (1961) Experiences in Groups. London: Tavistock Publications.Klein, M. (1929) Infantile anxiety situations reflected in a work of art and in the creative

impulse. In International Journal of Psycho-Analysis 10, pp. 436-443.Klein, M. (1946) Notes on some schizoid mechanisms. In International Journal of Psycho

Analysis 27, pp. 99-110.