Bipolar disorder – a disturbance of the Ego-Self axis / Tamar Kron, Ph.D

This article is focused on the concept of the ego-self axis, Erich Neumann’s singular contribution to analytical psychology. In contrast to the Jungian depiction of the ego-self relationship as that of a higher integrative power to an inferior one, Neumann views the ego as an offshoot of the self, a filiale immanent to experience. The process of filialsierung exists from the start, as does the process of individuation, where ego and self draw closer together for the purpose of centroversion.

Neumann presents the ego-self relationship as an expression of dialogic centeredness and wholeness, a reciprocal relationship, both outward and inward. Thus, to the psychic state of nur- welt with nur- ego (mere-world and mere-ego) – he adds a relationship describable as tertium non datur– the third is not given.

Whereas Jung views the self as the central organizing archetype that guides the psyche, and the ego as a complex that is not at the center of personality but at the center of consciousness, Neumann coins the term ego-self axis to describe ego and self as a dialogical unit that evolves around an axis.  As Jung’s pupil, Neumann too ascribes primary importance to the polarity of ego consciousness and the archetypal unconscious, but Neumann draws attention to the dialogical nature of the ego-self axis while Jung describes it as a hierarchical one-way relationship.

The description of centroversion in stages represents Neumann’s theory of the ego-self axis: in the first stage the ego is a complex and like all complexes it is rooted in the archetype. In the second stage, however, centroversion brings about the centering of ego-consciousness, that is, the ego is no longer a complex but a reality plane of consciousness in and of itself. In the third stage the ego recognizes its place as a filiale and satellite of the self. This is the insight the conscious ego arrives at, its relative place as the “son of the self”. But being connected with the self, the ego, like the self, is located on the self-ego axis, as part of the self-field that is capable of synchronizing the regulation of inner and outer in a freer way than the field of the limited archetypal structure as such.

In the first part of the article I present the development of the ego-self axis. The second part is a delineation of the clinical implications of the disturbances of the ego-self axis. In the third part I present the bipolar disorder as a disturbance of the Ego-Self axis. This will be followed by a case presentation.

Development of Ego- Self  axis

In his last book "The child"[1], published after his death, Neumann delineates the psychological development of the Human infant as the development of the Ego-Self axis

Neumann starts his description of the development of the child by distinguishing between two births of the human infant and proposing two embryonic phases. Following  Portman's concept of "Social womb" [2] Neumann postulates a second, post-uterine, post-natal embryonic stage. Even though the child's ego and consciousness begin to grow, this phase is dominated by the primal relationship with the mother.

There are two opposing inborn tendencies: one is to adapt to the human society, to the collectivity, and the other is what Neumann calls "Automorphism" – an important concept in Neumann's developmental theory.  Automorphism is the need of the individual to fulfill his/her specific constitutional nature and realize his/her potentialities – within the collectivity.

Neumann describes the development of the ego and consciousness as "born",'so to say, from the unconscious. The basic assumption of the development of the personality is that the total personality and its directing center – the Self, exist before the ego and consciousness develop. In this connection Neumann presents the concept of Centroversion which he defines as the "psychic function of the totality"' which in the first half of life leads to the formation of the Ego – the center of consciousness, whose role is to represent the interests of the total personality and to ensure its physical and psychological survival.

In the post-natal embryonic pre-ego stage the baby is merged with its mother, and the nature of this state is predominantly transpersonal or archetypal. That is, the personal mother functions and is experienced primarily according to collective, transpersonal traits and images. In Neumann's words: "The bond of dual union is a specific situation in which a not-yet individualised being in the pre-ego stage is joined with a transpersonally, archetypally functioning being in a unified field."[3]

In this stage the so-important automorphic development – the development of the unique individual potentials – is taking place and is completely connected with the reality of the personal mother who is also the archetypal mother. The baby is still contained within its mother, even though its body is already outside the mother's body. The same with the child's ego and consciousness  – it is still contained in the unconscious. The reality that the infant experiences is that of the primary unitary reality. The unity on which the child's existence depends consists in a biopsychic identity between child and mother. There is no differentiation between its own body and the mother's and the child's ego world experience is experience of the mother. In this primal relationship both mother and child live in an archetypally determined unitary reality.

The infant's fusion experience with the mother dominates over states of separateness during the first year of life. This means, for example, that the infant's needs and its mother's fulfilling them are not two distinct experiences, but are experienced rather by both as part of a whole.[4] This experience of union, of totality between mother and child, represents the archetypal constellations which evoke in both mother and child the archetype of the self.

Here Neumann presents an important idea about the development of the Ego-Self axis in the context of mother-baby relationship, that implies the dialogical character of the Self-Ego unit. In the embryonic phase the mother is also the child's Self. Although the child has an emerging  body-Self which is based on body sensations , the mother in the primal relationship not only plays the role of the child's Self but actually is that Self.

The primal relationship of the participation mystic experience is characterized by loving attention and attentiveness of the mother to the needs of the child. Neumann calls this characteristics of the mother-as-self – the Eros character of the Self.  For Neumann this Eros aspect is the essential element of the relationship. Positive Eros connectedness between self and ego cannot occur within the child's psyche by itself, since ego and self are not yet formed and differentiated. Only in so far as the mother positively incarnates the self for her child through this Eros aspect of the primal relationship can the developing ego consciousness experience its connection to a nourishing and sustaining center of totality. With the passage of time and the child's growing perception of its mother in her personal reality, the latent self- imago in the child grows increasingly separate from the mother's self and becomes the child's self. This will happen at the end of the post-natal embryonic phase- at the end of the first year of life outside the womb.

The self of the child then grows and relates reciprocally with its developing ego in accordance with the experience of the mother-child connection in the primal relationship. This means that the character of the Ego-Self axis depends on the primal relationship. In this connection Neumann brings to the fore the I-Thou relationship as the basic, most important relationship between the Ego and the Self, the psyche and the world, and the psyche and God. Neumann writes: "The structure of the adult Self always implies an I-Thou relationship…. The Self has an Eros character which determines a man's entire development and which may be described as individuation, as relation and as a change of relation. Thus, pardoxically, the Self is that which is most our own, but at the same time it takes the form of a "Thou". ..This paradoxical twofold nature of the Self is manifested in early childhood; as the child's own the Self it is the body-Self, as "Thou" it is the mother. "[5]

Neumann further elaborates on the Self as Thou for the Ego and the Ego as thou for the Self.  He writes: "Not only the security of the ego and of its feeling of Self, but also the ability of the ego to make contact with the Self and the unconscious depends on the positive contact provided by the primal relationship. For the unconscious also confronts the ego and consciousness as a Thou."[6]  In other words, he writes here about the reciprocal relationship of the Ego and the Self on the Self-Ego axis as a dialogical unit.

Clinical implications of disturbances of the Ego-Self axis

The Ego-Self axis, the relationship between the developing ego and the total Self is of crucial importance for the development and sound functioning of the psyche.  The positive development of this axis depends on the primal relationship with the mother and the constellation of the Good Great mother with her divine child. Neumann mentions security and stability of the Ego as the basic attitude needed for the stability of the Ego-Self axis, which he calls "the spinal cord of individual autmorphism". The positive primal relationship will bring an attitude of confidence of the Ego towards the world, and towards the Self. A secure and confident Ego can trust the Self and find in the Ego-Self relationship sources of self-confidence , positive self –evaluation and trust in human beings. The Ego which splits off from the Self , or never developed into the Ego-Self axis, Neumann calls "mere-Ego" (Nur-Ego). This will be an insecure ego, which is impelled by anxiety to cling to itself, and becomes rigid and constricted.

When the primal relationship is insecure and a defective development has weakened or disturbed the ego-Self axis, the result is a disorder not only of the development of ego and consciousness, but also of the relationship between ego and Self. When the mother is persecutory, or neglects the infant and the primal union is not constellated properly, or when the infant is abandoned or traumatized , the Ego-Self axis will not develop or will be defected. Neumann differentiates between two possible consequences of such a sad state. The first option is apathy, an egoless state of decline. The child gives up, or dissociates. Such a state was described by Bowlby[7] , in his writings on attachment and loss. Bowlby related to the personal dimension in his description of the impact of the disturbed attachment to the mother. Neumann relates also to the personal dimension but goes beyond it to the Ego-Self axis.

The second option is the establishment of what he calls "Distress-ego" or "Emergency ego". Without the shelter of the primal relationship an emergency negative ego emerges prematurely. Not being able to rely on the other it awakens too soon and is driven prematurely to independence by the situation. This is particularly so when the trauma happens early in the child’s life, and is chronically sustained. Rather than feel helpless and unsafe the emergency-ego is consumed with aggression and rage. This emergency-ego is disconnected from the Self, it is a "mere-ego" which helps the child to survive hardships and traumas, but if it continues to be active, it has an impact on  every aspect of the child’s behavior. A rigid emergency-ego is associated with almost all psychopathology. Unfortunately the emergency-ego does not allow oneself to feel or connect with others, and the child is left in  a state of isolation and rage, The connection to the Self and to the world and other human beings is impaired.

Another result of the disturbed Ego-Self axis is the fragmentation of the personality. Neumann describes the fragmentation as the failure of the  totality function of the Self to exert its normal compensatory action. One consequence of this situation is that dreams often lose their compensatory, totality oriented character.  We see this in dreams of psychotic patients, and also in states of trauma. The dreams are concrete and describe the trauma, over and over again, without change. In a research on dreams of people living near the Gaza strip under the incessant attacks of rockets we collected dreams from 3 groups of inhabitants of that area: young (age 14-18), middle (age 19-40) and older (over 40). We found  that the young  boys and girls are the most vulnerable to the traumatic situation, and many of their dreams consisted of  concrete visions of the rockets attack.[8]

 

The Bi-polar disorder  as a disturbance of the Ego-Self axis.

Carl Gustav Jung wrote his landmark paper On Manic Mood Disorder in 1903.[9]  This paper was the first to distinguish between manic-depression involving psychotic states, and that which does not involve psychosis. Jung’s distinction is today referred to in the DSM-IV as that between ‘bipolar I’ (involving psychotic episodes) and ‘bipolar II’ (without psychosis). In this paper Jung introduces the non-psychotic version of the illness with the introductory statement, “I would like to publish a number of cases whose peculiarity consists in chronic hypomanic behavior” where “it is not a question of real mania at all but of a hypomanic state which cannot be regarded as psychotic”.[10]

Since the publication of this paper there have appeared just a few references to manic depressive disorder from a Jungian perspective. In 1987,  Luigi Zoya wrote on the alterations on the Puer-Senex axis as alterations of manic-depressive moods.[11] In the same year  Jole Cappiello McCurdy published a paper entitled, ‘Manic-Depressive Psychosis – A Perspective: Binswanger, Jung, Neumann, and the Myth of Dionysus’.[12] In the following I will refer to McCurdy's writing on Neumann's perspective and present a clinical case.

McCurdy’s central thesis is that the disorder is at root not affective, but rather a dysfunction in the ego’s relationship with the self. McCurdy

gives Neumann the credit of allowing for a psycho-dynamic approach to mental disorders which are otherwise labelled as hereditary or constitutional, and, therefore, not accessible to psychological analysis. The concept of the ego-self  axis, she writes, stresses the intrapsychic connection. The Eros bond which characterizes the relationship between mother and child is the basis not only for interpersonal relationship, but also for the intrapsychic relationship between the different functions of the psyche.

As I described before – when there is a stable and vital connection of the Ego with the Self- its source and the ground of its being – the results for the person include high levels of self confidence and realistic self-esteem, which allows the positive relationships with others and with the world. The absence of the ego-self axis or its disturbance, however, is marked by an inability to make those connections, a situation that can lead to an ego vulnerable to depression and to many symptomatic attempts to compensate for the resulting state of rootlessness.

The more severely damaged the Ego-Self   axis is, the more there is potential for severe pathology. Undue displacement of the Ego-Self axis in the direction of the self, Neumann believed, could lead to the disintegration of the personality due to a psychotic absorption and destruction of ego by the overwhelming power of the unconscious.  But another kind of pathological development is possible if the ego becomes split off from its connecting axis with the self.

In this situation the ego retains its essential identity, but, being more or less cut off from the self, manifests the accentuated rootlessness found in the phenomenology of manic-depressive psychotic states. In these cases there is a loss of true orderliness of the world, with its rules of temporal sequence and natural cause and effect.

Moreover, we can hypothesize that the transcendent function, as an expression of the connection between the unconscious and the conscious, between the self and the ego, is paralyzed or blocked. Therefore, in manic-depressive states, the ability to form symbols is lost.

As a consequence of the rupture of the Ego-Self axis , the Self cannot actualize itself through the ego: it cannot fulfil its directive function or produce symbols or a synthesis through human consciousness. The ego remains suspended between two opposites of the totality, between its dark and luminous sides, oscillating between the two poles of depression and elation.

Following Neumann's description of the development of the Ego-Self axis, McCurdy suggests that the bipolar disturbance is rooted in the primal relationship where the mother was unable to take on herself to be the Self for the baby and to fulfill the function of the unifying totality for the emerging Ego. The child and his/her Ego are then subject to wild swings between the opposites, experiencing a disordered and unstable inner and outer worlds, with the resultant mood swings.

McCurdy presents the mythological biography and behavior of the god Dionysus as – in her words – " an archetypal version of the failed primal relationship", with the resultant swings between the opposites and inability to find a center. Description of  the aspects of Dionysus—his appearances and disappearances, his wanderings, his oppositions and contradictions—is almost  a phenomenological description of manic-depressive psychosis. The origins and meanings of the mythh enhance our understanding of the illness and its psychodynamics.

Dionysus was born twice: Once prematurely and traumatically when Semele his mortal mother was burned by Zeus' fire, and the second time from his father's leg. He was given to different nurses to nurse him, while all the time he was persecuted by the jealous Hera.

Dionysus's loss of mother is critical to the development of the myth.

Semele, the mother he never knew, is at the center of Dionysus's life, of his desire for revenge, of his deep frustrations, and of his sorrow. The myth tells of his almost obsessive relationships with women—with nurses, and the Maenads, whose main function is to nurse the god. Women who are mothers and nurses appear again and again in the stories about Dionysus. On the one hand, Dionysus seeks revenge against the women in his life; on the other, again and again he looks to reconcile and merge with them in ecstasy.

Separated from his mother even before his birth, Dionysus never experienced the primal relationship, the Eros contact which enables creating relationships between Ego and Self, and with the world.  Dionysus's birth, then, can be seen as symbolizing the rupture of the Ego-Self axis, and his dual and paradoxical nature is the consequence of this rupture.  His obsession with women, with mothers and nurses, can then be seen as a frantic attempt to repair the break, to experience the primal relationship he never had. He is the god who appears and disappears, who comes and goes, who gives both intense joy and terrible suffering.

In his absence there is depression, and when he arrives he awakens joy and excitement which culminates in death and dismemberment. He is the god of artistic creation – and of fragmentation and madness.

During his apparent absence, he is in the depths of the sea or in the underworld; but, no matter how remote, when he emerges, his presence is felt immediately and overwhelmingly. His arrival creates among the women waiting for him frenzy, passion, music, dance, unbelievable noise.

But when he leaves and disappears , this energy of mania turns into the emptiness of depression. The creative energy can also be blind and turn, suddenly, without awareness, into destructive power. The lack of awareness is similar to the absolute denial of the manic patient, as is the energy turned to violence.

Wine, intoxication and ecstasy, which are always associated with Dionysian rites, can be seen as means of attempts to recreate a totality experience. From a clinical point of view, we can then better understand the association of manic-depression with drug and alcohol abuse.

Understanding the manic-depressive patient in the light of these perspectives has various clinical implications. For example, external stressing factors are generally present prior to the manifestation of the depressive, and even manic, symptoms. Although these stressing factors are not considered causative, their importance could be understood in terms of further decompensating an unstable balance. The stressing factor calls for a new adjustment of the Ego-Self   axis, for a new orientation and direction. Naturally, these tasks will be extremely difficult, if not impossible, for an unstable Ego-Self axis.

Presentation of a clinical case

I would like to present to you a specific disorder –Bi-polar disorder, from the perspective of the defective primal relationship which results in disturbed Ego-Self axis.

Daniel, 28 years old, is diagnosed as Schizoaffective with manic episodes and drug addict.  For the last 2 years he has been treated in a drug addicts'  rehabilitation center, and stopped using drugs since a year ago.

Daniel is handsome , intelligent, and a "charmer". He grew up in a multi-problem family, one of 5 children to a violent and abusive father and a neglecting mother. He describes himself as a lonely child, who grew up without parenting. He was beaten by his father, and has no memories of his mother comforting him, cooking for him or supplying any kind of physical and emotional care.

At elementary school Daniel joined "bad" kids, and quite early started to be "problematic", smoking cigarettes, being violent and rebellious. Since early adolescence his relations with girls have been purely sexual with no real intimacy. He started using "light" drugs at the age of 14, and was involved in "light" delinquencies.

At the age of 20 Daniel suffered his first manic episode, was hospitalized and treated with medication. A short time after he was discharged, he started using heavy drugs, which "helped me not to fall into depression and kill myself" (in his words). Two years later he suffered his second manic episode, but succeeded in hiding his condition from friends and relatives, continued using drugs and in one of the violent fights he was involved in, Daniel killed a friend. He was diagnosed as psychotic and was hospitalized by court order for 6 years.

After his discharge Daniel started treatment in a drug rehab center, and during two years' treatment he succeeded to get off drugs.

Daniel lives in a flat with two flat-mates who are treated in the same rehab center, and takes part in a rehab program. He takes "light" anti-psychotic medication, participates in group meetings and meets his therapist twice-a-week.

The focus of therapy during the first months was on the reasons for Daniel's drug addiction and violence. Daniel blamed mainly his physically abusive father, while the neglecting and indifferent mother was   described as the father's victim. The therapist had the advantage of taking part also in the group sessions, and could discuss with Daniel the way he was keeping group members at a distance and as a result feeling lonely.

Daniel's transference to the therapist at that time was ambivalent, trying to get closer on one hand and keeping distant and behaving in a sort of unnatural and non- spontaneous manner on the other. In a sort of projective identification the therapist felt that he has to keep the distance between them. Together with Daniel, he focused on the abusive father as the main factor in his disturbance.

Working with Daniel on his shadow brought Daniel to the verge of deep depression. "Who would accept a man with a monster living inside him?" he asked. The narcissistic defenses weakened and Daniel confronted his psychosis, drug addiction and violence. He could keep abstaining from drugs with the help of medication and the presence of the therapist who could now give Daniel his empathy and understanding.

At that time the therapist ended his supervision with his first supervisor, and came to me for supervision. I conceptualized Daniel's case differently, and suggested that he suffers from defected Ego-Self axis as a result of the failure of the primal union. Father's abusive behavior was surely an important factor, but with mother's neglect and indifference the primal relationship was seriously impaired. With this in mind the therapist could open with Daniel, slowly and cautiously, the issue of the neglecting mother who victimized her son.

In supervision we worked on the therapist's attitude to Daniel. The more he felt confident and opened to his patient – the more Daniel trusted him and could speak openly about his sexual perversions and addiction to sex. Daniel never had an intimate relationship with a woman. He was sexually attracted to transvestites and transgender prostitutes, but also to older women with motherly traits. He designated himself as a "sex maniac", meaning that he is preoccupied with sexual thoughts and phantasies. He told the therapist an erotic dream about his mother which recurred a few times. With the therapist's acceptance of his sexual phantasies and acts without judging, and the interpretations of their meaning as distorted expressions of longings for the absent mother, the grip of the possession by the complex lessened. Daniel expressed his wish to be able to be in an intimate "normal" relationship with a woman, and asked the therapist to help him.

But after the sudden death of his father, he started to insist that he will leave the flat he lives in (as part of his rehabilitation program), and move to his mother's house. This wish was connected to the phantasy that living with his mother will, as he said, "make me normal".  Daniel's mother was not enthusiastic about this idea, and he accepted reluctantly the objection of the therapist and the rehabilitation center's director to his plan. In wake of these events, a long and painful work on the need to give up the phantasy of the good-but-victimized mother could now begin, with the inevitable depression following. The support of the rehabilitation program and the 3-times- a week sessions with the therapist helped Daniel through depression, without him regressing to mania and the use of drugs.

Supported by his therapist, Daniel started academic studies in political sciences and sociology. His academic achievements and the ability to adjust to "normal people's environment" heal his wounded self-image, and enhance his ego's creative potentials. Much therapeutic work is still to be done, but Daniel's defected ego-self axis is in the process of repair.

 

Concluding comments

The Ego according to Neumann, is not a complex, but a partner in the ego-self axis. . The Ego has a creative potential, and can develop in the inner direction as much as in the outer direction. For Neumann the real world, is also legitimate for depth psychology.  The world around us is challenging the Ego and its communication and relationship potential.

Our main task as analysts and therapists is helping the patient widening his consciousness and fulfilling his potential to be creative. We have to treat the images our patients bring with much consideration and caution, and not to degrade them as projections only. Otherwise we constrict the patient into a narrow perspective that blocks creativity. The important point here is that creativity is not only the domain of the collective unconscious – it is not less the domain of the Ego, when and if the Ego is connected to the Self on the Ego-Self axis.

We also have to remember that our responsibility as therapists is to have the deepest understanding that our meeting is in the ego-self axis itself.  The healing is in the meeting, in the dialogical relationship of Ego and Self both in the inner world and in the outer world, between the patient and the therapist.

 

 

[1] Neumann, e. The Child: Structure and Dynamics of the Nascent Personality. Translated by R. Mannheim. Karnak Books, 1988

[2] Neumann met Adolf  Portmann, a Swiss zoologist  in Eranos and found much in common with Portmann's ideas which integrated anthropology, philosophy and zoology.

[3] Neumann, e. The Child: Structure and Dynamics of the Nascent Personality. P.40

[4] In that description Neumann is very close to Winnicott's description of the first months after birth as "primary maternal pre-occupation" and the baby's omnipotent "creation" of the breast.

[5] Ibid. p. 13

[6] Ibid.  p.45

[7] Bowlby J. (1969). Attachment and loss. New York: Basic Books.

[8] Kron, T., Hareven, O. & Goldzweig G. (2015). Dream Dome: Do dreams shield the psyche in times of continuous stress? Dreaming, vol.25(2), 160-172

 

[9] Jung, C.G. On manic mood disorder. In: Jung, C., Collected Works of C. G. Jung, Vol. 1. 2nd. ed., Princeton University Press, 1970. 260 p. (p. 109-134).

[10] Ibid p.1

[11] Zoja, L. ‘Analytical psychology and the Metapsychology of feeling’: Journal of Analytical Psychology, Vol 32 (1),  Jan 1987 (p.50-51)

[12]  McCurdy, J. C. (1987). Manic-Depressive Psychosis – A Perspective: Binswanger, Jung, Neumann, and the Myth of Dionysus. International Journal of Analytical psychology, Vol.32(4), 309-324.

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