Correspondence: Gabi Bonwitt, M.A., 11 Balfour Street, Tel Aviv, Israel. e-mail: Gabib_10@hotmail.com

¹Gabi Bonwitt, M.A., Clinical psychologist, psychoanalyst, Israeli Psychoanalytic Society.

Abstract

This paper will explore the difficulties of treating people in an environment that is intraumatic—where trauma never ends. These circumstances evoke the massive use of primitive defence mechanisms that makes it difficult to work through the horror. I will examine the ongoing relationship between life and death and the clinical meaning of walking the line between them while maintaining it. In the heart of this approach is the paradoxical statement that in order to live you have to maintain the feeling of death. The therapeutic position is not necessarily interpretive but more of holding the infinitive unbearable and enigmatic meaning of death. Questions of setting are raised, especially around meeting a patient outside the therapeutic setting, for instance at the grave.

A. went back into therapy after her daughter's violent death. I remember her screams and the helplessness I felt when I called her after hearing the news of the death. "Tell me, what do I do?" she shrieked. There was not much room for thinking, and the words I heard myself utter turned out to be the very essence of treating A. "We'll try to find that seam between life and death, walk that line, and try to keep it from unravelling." This paper will examine the ongoing relationship between life and death and the clinical meaning of walking the line between them while maintaining it. I shall relate to three circles—the social circle, the clinical circle, and the personal one. It is my psychoanalytical view that individuals' mental manners are the result of the relationship between their subjectivity and their environment. Therefore, in my view, the relatedness between these three circles is inevitable. Walking among these circles will present the opportunity to address existing paradoxes and to understand them as they are held and maintained by the therapist, within each analytical time unit. The paradox of life and death will be examined with the help of my cases.

An Israeli analyst, I live in a bleeding country, where fear of loss and loss itself are significant components of our selves and our work. This paper will discuss people who have lost loved ones, people who are constantly touched by death from within and without and for whom death is a pivotal axis of their mental life. These individuals are not post-traumatic. Rather they are people for whom trauma is a steady companion. Ours is an intraumatic society, a term coined by David Grossman (2004) to describe a society in constant traumatization: one where life and trauma are in constant identity and cohesion, a situation that inhibits processing the trauma. This ongoing identity and cohesion are the grounds on which the trauma is violently recalled and relived, especially through distortion and flattening out of the memory. When life is an ongoing trauma, individuals are occupied with emotional survival and have difficulties absorbing the trauma and processing it.

Trauma is a Greek word meaning a penetrating injury to the skin, resulting in the breaking of the skin (Laplanche and Pontalis, 1973). Freud undergoes change in his theoretical development of trauma. He moves from an emphasis on childhood trauma, trauma that is of external origin and is related for the most part to temptation, to emphasizing trauma caused by a present event, associated with early fantasies related to arousal of drives. Thus, classical psychoanalysis refers to internal trauma, one that takes place within, among various mental aspects, and discussion of external trauma is limited. Grotstein (1990) refers to an event that can be neither contained nor resisted. This mental event leads to mental disintegration, which in turn leads to mental death. When Bruno Bettelheim (1960, cited in Tarantelli, 2003) mentions "walking skeletons" he is referring to Holocaust survivors who died a mental death, perhaps like the people described by Primo Levi in If This is Man (1958). The experience is one of an inner explosion of sorts, where the emotional foundation collapses and there is no self to handle the event. In addition, external reality overtakes internal reality so that the psychotic event—in which internal reality overtakes external reality—is actually overturned. Therefore, people in trauma are mistakenly diagnosed at times as being psychotic. The result is a chaotic experience in which the boundaries between both realities—internal and external—become blurred, and the self ceases to exist as a distinct entity. Trauma is related to processes of internalization, yet it is an experience that took place during an act of violence that "penetrated" and took over consciousness from within, and is intraumatic. Therefore, it lives on as an ongoing traumatic experience that cannot be absorbed, and hence cannot be considered to have been internalized and become a part of the self.

As mentioned, A. went back into therapy after her daughter had been killed in an act of violence. I called her after I learned of her daughter's death and when I heard her screaming I recalled the horrible nausea I felt when I was informed that my mother had been killed in a road accident. The nausea was an attempt at throwing the news up and out, not letting it sink in, not letting it turn into a part of what I am. For a while, my body's protest and my soul's scream took over.

In her article about catastrophic psychic trauma, Tarantelli (2003) claims that vomiting is a defence mechanism of primitive quality, aimed at protecting our body and soul from toxic substances. These toxic substances are of the type our self is not able to ingest, and thus present a most basic threat to the self. This is one of the physiological manifestations of denial and of the indigestible split. Bion (Symington and Symington, 1996) calls them the beta elements that cannot become an integral part of our selves using the alpha function. Death is the object that is being expulsed by the very primal fear that ingesting it will annihilate us too.

I remember A.'s daughter's funeral. All is black against a gray sky. A. is being led by her sister and a friend, not walking on the ground. Rather, her body is being carried in such a way that it would collapse without support. I am behind her, as if understanding that from now on my role will be, among others, to stand behind her and make sure she does not fall. I do not see her face. Later on A. tells me that she was not at the funeral. Her soul was in a dark black corridor devoid of life and death, with only a feeling of having ceased to exist, of rage, an attack of sorts on the bitter, incomprehensible reality of her daughter's death. I will later address the question of why I crossed the boundaries of the therapeutic setting and ventured into the cemetery to attend the funeral.

In the initial period following her daughter's death, A. would come over looking gray, barely carrying herself, collapsing into the armchair and repeating, over and over, her wish to die. Her life is over. Every capillary in her body carries the death experience in a way that leaves room for nothing else. She is busy with one thing only—planning her own death. She fantasizes about driving and falling asleep at the wheel, then getting into an accident and being killed. If anyone tries to bring her back to life she bursts out in rage. She then retreats into herself and figures out her end. I worried about her. She poisoned and wasted her body with cigarettes and coffee, in a kind of self-destruction, as if holding on to her daughter's body, preventing it from being buried.

In Beyond the pleasure principle, Freud (1920) refers to the death instinct and indicates a relationship between death and violence. According to Freud, the death impulse is an inner entity whose main function is disintegration and destruction. Originally, the death impulse aims inward, but at times it is rerouted to the outside and then turns into the motivation behind aggression, domineering, and destruction. The relationship that Freud found between death and violence is an interesting one. One way of understanding this relationship is that the inner violence, to which Freud attributes the ability to dismantle, kills our selves, and thus kills our consciousness. Perhaps this happens in the very same way that the death of a child violently enters our consciousness and threatens to overtake our self and annihilate it.

To a certain extent, A. had internalized the violent act that had killed her daughter and had reconstructed it in her wish to die in a car accident. In Freud's terms, we could say that because of its violent nature, her daughter's death united with the death instinct and activated it. The expression of this activation was her wish to die in a car accident.

In certain ways, we may be able to draw analogies from the inner world and apply them to social processes. Violence also works against consciousness on the social level, and death has become an inseparable part of life in our social space. Every minute ticking by is accompanied by death—in our anxiety for our children, at work, in the news, and in our dreams at night. At times we may feel that death has lost its meaning. The worship of death is a black hole (Hawking, 1989) that swallows up any possible emotional meaning, a black hole in which we manage to exist paradoxically—seemingly recognizing its presence but actually denying its emotional significance by using ritual and pre-formulated utterances.

Meaning is created before ritual. Ritual is the space that maintains meaning. Ceremonies of mourning uphold the meaning of the meeting between life and death. A ritual that has shed its meaning turns obsessive and false. Furthermore, a ritual that has shed its meaning turns into a sort of barrier that does not allow touching upon the emotional meaning from which the ritual is derived.

I believe that one of the reasons for the split between death rituals and their meaning is that death occurred under violent circumstances. The extremely difficult bond that exists here between death and violence creates denials, projections, and splits that do not allow us to look at death and turn it into an inseparable part of what we are. Primitive defence mechanisms replace the search for meaning, as they also replace observation and holding. Using the same mechanisms creates the splits between the ritual and its meaning.

In Thoughts on otherness, boundaries, and dialogue, Shmuel Erlich (2001) says that "the other is a separate and defined entity, located in the subject or the other who are different and separate of the other, while in psychoanalysis the other is found in both entities—the different other and the unconscious ego" (pp. 19–22). Psychoanalytical observation confronts us with the other within us, which is the unconscious aspect of our selves that partially carries a fair number of violent aspects which we find difficult to accept as inseparable from us. Our self is not complete as long as it does not accord space to the existence of the other, especially when this other wears the black garments of violent death. In this sense, death is the hated other. As I said, the intraumatic underpinnings of ongoing violence do not allow internalization and memory, and therefore we cannot see the violent part within us, as part of the processing of trauma. Varvin (Silverman, 2004) claims that destructive reality, combined with dehumanization, creates a split between a good, ideal part and a bad, violent part that we cannot own. Varvin further explains the relationship between a violent environment and an inner reality that cannot contain the violent aspect of reality, and therefore uses split and denial.

A few months after therapy began I went to a Buddhist retreat in Wales. In the rolling verdant countryside I found myself thinking often of A., of the closeness I feel toward her and of my worry about her death wish. The retreat was led by an elderly teacher whose speech and method of guiding us into meditation impressed me. All at once I decided to ask for an appointment and to share my feelings with him. His first reaction was "It is not only guilt feelings." I concurred and he continued, "By her wanting to die in a car accident, she actually identifies herself with the violent act which killed her daughter." I was amazed at the psychoanalytical thinking of the Buddhist teacher. He became thoughtful and then turned to me and asked, "Did you consider speaking with her about reincarnation?" I looked at him, surprised. How could I discuss reincarnation with a person who did not believe in it? He looked at me and said, "Considering and believing are not the same thing." Thus ended the meeting. The next time I met with A., I decided to tell her about the meeting with the teacher; after all, I had carried her to the retreat with me, so we had both been present in the meeting with the teacher. A. burst out crying when she heard my story and told me hers: Some time after her daughter was killed, A. met a pregnant friend. The friend told her that she had been contemplating calling the baby after A.'s daughter. She gave birth a few months later and A. came to visit her at the hospital. Again the friend voiced her thoughts regarding the name, when the friend's phone rang, and a male voice, the voice of a stranger, asked to speak to a woman whose name was that of A.'s daughter. A. and her friend were both shaken by this coincidence and right then and there the friend decided to name the girl after A.'s daughter. This was an important turning point in the therapy. It was the first time that both she and I realized that life and death are not separate, split entities, but rather two entities who live side by side in a coexistence of sorts. In Buddhist philosophy, the concept of reincarnation as a private example of transformation is a central value. Transformation means that matter and spirit are two entities that constantly evolve and change shape. They do not disappear and they have no beginning or end. Thus, the meeting between life and death is a good example for transformation. Beyond the metaphysical meaning, this event gave A. the first opportunity to hold on to her dead daughter in an emotional zone where there was life.

Sometime later I met the Israeli psychoanalyst Ra'anan Kulka, and told him the story of the name. Ra'anan was disappointed by the fact that the baby was named for A.'s daughter. "A.'s daughter is now in a state of superposition," he said. "She is no longer in a given place, she is now nowhere and everywhere all at the same time, and therefore it is wrong to bring her back to a given place." In attempting to explain superposition, Ra'anan said, "Superposition is something we can define neither with our spirit nor with words, because its very being is a potential manifested in the very void it makes." In other words, only a voiding of the self enables us to observe it as it is. The closest way to describe such a situation is by thinking of anti-narcissism, that is, the total opposite of the narcissistic experience that—due to distress and suffering—places the self in the center. This enabled placing life and death not as polar opposites but as being able to be connected into something that is one.

A few months later, A. invited me to a ceremony awarding scholarships in memory of her daughter. The last part of the evening was a memorial to A.'s daughter and included a film about her. Everyone in the audience cried. It was a chilling experience, with several dozen people who did not know the girl mourning her death as if they had known her, as if there had been a place in their soul that had waited for her. A sudden intimate relation was thus formed between the girl and people who had not known her. It was a gift that the recipients of the scholarships received from her and from her death. Superposition gained meaning—in life and in therapy. Her absence made her present and again life and death were bound by a knot that was not to be unravelled.

S., who had been my patient many years ago, lost her mother when she was five. No one ever told her that her mother had died. It was only when she was in school, and the children used to tease her and say that her mother was "behind the trees" (the euphemism for the local cemetery), that she found out. When she was 16, her brother and sister were killed in a terrorist attack. All those around her perceived the way in which she coped with that loss as brave. In fact, she had completely detached herself from the pain of losing her siblings, and remembers the rage she felt at the funeral toward all those who exhibited any expression of pain over the loss.

When she was in the army, S. was invited on the eve of Independence Day to the president's residence as an exemplary soldier. The presidential ceremony was to take place at the very same time that the memorial for her brother and sister had been scheduled. S. did not know where to go—should she go to the ceremony at the presidential residence as an expression of life or attend the memorial as an expression of death? Her despair led her to a suicide attempt and she was hospitalized in a psychiatric ward, where she was later diagnosed as suffering from a bipolar disorder. In her manic state she would imagine her brother and sister in every helicopter she saw flying by, and she recognized her mother in a Bedouin vendor in the local market. In her depressive state she described herself as a walking memorial candle.

The etiology of the bipolar disorder is beyond the scope of this paper. However, the desperate separation between life and death that collapsed on the eve of that Independence Day was an expression that, in retrospect, turned out to be an impossible attempt to "organize" S.'s emotional world. Her denial of death when she was in the manic state and the emotional death she felt in the depression that left no room for her desire to keep on living created a deep abyss in her soul, and she collapsed into it each time this illusion of denial did not hold up.

In his lyrical introduction to the Hebrew translation of Playing and Reality (1995), Ra'anan Kulka tells that Winnicott jotted notes for an autobiography he never wrote. In these notes he quotes a poem (Little Gidding) by T. S. Eliot from the Four Quartets (1944): What we call the beginning is often the end
And to make and end is to make a beginning
The end is where we start from.... (p. 5)

Masud Khan (in Clancier and Kalmanovitch, 1987), Winnicott's student, believed that, throughout his life, Winnicott carried a paradox that blazed within him—that life and death, or rather living and dying, are woven of the very same fabric. Elsewhere in The Four Quartets, T. S. Eliot (1944) says: Words move, music moves
Only in time; but that which is only living
Can only die (p. 7)

Dana Amir (2005) presented her view on T. S. Eliot lines: "There is no life without something of death, and there is no death without something of life. Therefore, those who 'just live,' only know life from the life side and not the death side can do nothing but 'just die.'" This central motif becomes necessary when we treat people in whom everything that used to live became persecuted and in danger of annihilation following the loss of a beloved person. In other words, by understanding this paradox, any attempt to "take away" the death experience from the people, an experience with which they are bound and which is bound in them, would necessarily mean also robbing them of life. The very black hole that opens in the soul of people who have lost their beloved becomes an inseparable part of what they are and constitutes an initial condition for their option to live in the emotional sense of living.

Back to A. The understanding that her only chance of living is by allowing unconditional space for the death within her raises serious questions regarding the role of the therapist in what we call "the work of grief." This is a multi-stage process, at the end of which the person "returns" to life. At some point A. is invited to a professional conference overseas. She is undecided, she does not want to travel because, since her daughter's death, she has nothing of her own. However, she has the ability to contribute to the success of the conference, and is interested in doing so. A. cannot stand people relating the overseas trip to "her improvement." As far as these people are concerned, the less death they see in her daily managing of herself, the better. She is furious, and says that instead of being with what she is, they respond to their own difficulty to contain their own helplessness, fears of death and personal and collective guilt feelings. I understand that I should not encourage her to go, and instead of encouraging her I offer to hold on to her death, right here, until she returns. As if I had told her that I would care for her daughter and watch over her until she came back from the conference.

As I mentioned, therapy, too, contains rituals that are derived from their emotional significance. The therapeutic setting, and its various components are not arbitrary, and among other functions it is meant to hold the emotional significance of the actual encounter of therapist and patient. In treating A., the meaning of the ritual was derived from the maintenance and holding of the seam between life and death—a delicate seam, vulnerable to raveling, one that would always require some kind of holding. In this case, the ritual creates a space that is permanently located both physically and temporally and frees us of the need to reinvent the wheel weekly, constructing a setting that will hold and maintain this seam space. The space also exists when our meeting is canceled, as if the room is there even when she does not come. By now, two and a half years after the calamity, when A. is asked whether therapy does her good, she smiles and does not answer. The parameters of the therapeutic meeting are not necessarily related to the question of whether therapy does her good or whether she's improving. This is the ritual that contains within it the meaning of the paradoxical connection between life and death. Kasher (2002), the Israeli philosopher who lost a son a few years ago, maintains that the flavor of one's life is related to joy and happiness, and that a life of pain and sorrow can also be imbued with meaning. For A., life has lost all flavor; but the meaning of life can be built within the context or perhaps within the space created on that seam between life and death. The flavor of life has to do with a no-longer-existing desire, passion, and libido, all of which have been swallowed by the black hole of death. However, it is inaccurate to believe that the libido has vanished completely. Grieving people have been known to embark on something new such as studies or a new occupation. One way of reconciling the contradiction between the death of the libido and the new beginning could be by relating their libido and passion to be the fulfilment of their dead child's passions. Thus, the passion is not theirs, rather they are the desire's executors. At the same time, the new occupation does not have a common history with the child, opening a new space that is also a transitional space where the mourner's self on the one hand, and the dead child's self on the other, simultaneously exist and do not exist.

How do we determine the meaning of life when there is no desire? What is the daily life of one who lost desire, wish, and self? What will brighten the life of a person whose existence centers on mourning?

In order to understand how meaning was constructed for A., let us turn and observe the change she underwent. While she had the death experience and lost all will in her life, something happened to A. that seems paradoxical at first sight: The quality of her work improved and her relationships with those around her became fuller and more intimate. Lacking desires that tend to screen inner and outer reality, she has a sharper, fuller view both of her inner world and of the reality around. In this way she is able to capture the moment and experience the psychological moment that we screen at times with our passions and expectations. This is another option of explaining the choice of the meaning of life while wholly or partially relinquishing the flavor of life. The flavor of life is related to the pleasure principle. It is motivated by instincts and urges; conversely, meaning is derived from observing the world—both inside and out. Clearly, although instincts can be part of this observation, this is not mandatory. A. finds this experience troubling and painful—the fact that something in her emotional being has become fuller is "driving her mad" as she feels betrayal of her daughter whose death enabled her to experience the moment so fully. When she feels guilty and betraying, I tell her, "now that your daughter is no longer alive she is within you like a baby, and you own not only her death but all the life that was in her."

L., a woman of 36 who lost her husband to cancer, tells of how her father used to forbid her to enter into conflict with her mother. He would say, "If you fight with your mother she and I will have to get divorced." When she failed and got into a fight, he would tell her to leave and would stop talking to her. When her husband was alive, he mediated between them, thus maintaining a relationship with the father and taking care of L. This week she "failed" again and her father demanded that she leave the house. She did. He called her the next day and asked her to forgive him, and for the first time in her life L. was not willing to forgive, saying, "I've already lost my husband, what else could happen?" In saying this, she expressed that she was no longer willing to be the container for her father's narcissism. Her ability to stand up to her father's threat has increased. This is another example of the way in which the death experience changes the very essence of the texture of relationships between inner and outer reality. To a large extent, the death of a near person poses the most significant threat to the self. The realization of such a threat significantly diminishes the power of other threats.

In Mourning and melancholia, Freud (1917) distinguishes between normal mourning and pathological mourning. Freud claims that melancholia is created from narcissistic expressions of anger and ambivalence toward the dead person, and these are turned inward, preventing separation from the deceased and returning to life. According to Freud, melancholia splits the ego in two—one part identifies with the dead object and the other part attacks it. In this way, the object is kept alive and becomes itself, but the object's shadow rests on the ego. This process, which combines identification and projection, created a melancholia that does not allow the use of Freud's term, "to kill the dead." If so, separation is the condition for returning to life. In cases of the loss of a child, killing the dead is tantamount to killing the self, especially because an identification is formed between the two.

In a 2002 article, Ogden explains mourning and melancholia. Using the terminology of object-relation theory, he writes that in a denial of separateness, in the sense that "the object is me and I am the object," denying the experience of loss is taking place. The conclusion he then reaches is that melancholy is the disease of those suffering narcissistic injuries, especially due to the huge difficulty of carrying the pain involved in accepting the death of the beloved object. It is my opinion that Freud did not accurately differentiate between various types of mourning. Grieving the death of a beloved child is essentially different from mourning the death of a parent, if only because the death of a child contradicts biological logic that parents die before children. Grief over the death of a child never ends and becomes an emotional center from which the parent's meaning of existence is derived. Therefore, I do not think that this type of mourning, even if it lasts for many years, can be seen as having pathological qualities in the way Freud sees in his distinction between mourning and melancholia.

However, we could also say that a narcissistic unity is created within bereaved parents between their child and themselves. This may be the only emotional possibility open to them for bearing the pain and preserving their living child within them, perhaps in much the same way that a mother carries her fetus in her womb. This is an existential act that has no pathological qualities but, instead, an attempt to continue existing in a life that carries infinite pain. It is interesting that Freud wrote his Mourning and melancholia when his children were being drafted and sent off to the Russian front during World War I. Erri De Luca's God's mountain (2001) describes the world through the eyes of a 13-year-old boy. He writes that when we long for something, it is not that something is missing, it is actually a presence, a visitation. If so, is it a presence when we think of something we miss? According to De Luca, it is, and we should welcome this presence as such. De Luca questions the process that makes it possible to make the transition from a real, physical presence of a person who had been alive to a presence of a different type, one that is not physical but whose emotional and mental existence are clear. In other words, how does the lack of something turn into an existing entity?

My mother was killed in a road accident. I came to her home a few hours after she died, opened the door and entered. With a movement that had been familiar to me all my life, I went into the kitchen and opened the fridge. The fridge was full of food she had cooked and prepared for the Sabbath. I took a plate and tasted. "Mother's here," I tell myself, "she'll be right back, she just went out on some errands." Her presence is so strong—her smells, the way she left her shoes by the bed, the folds on the bedspread, everything is so present. Over the next days, we eat the food she left us, it's just enough for the shiva, the prescribed seven days of Jewish mourning. She gradually disappears. Her smell vanishes, the house begins to fill with a thin layer of dust, and there is matter under it. The spirit has taken off, it is no longer here. At the same time, her presence within me has not ended but gained additional qualities, some of which appeared only after she died.

L. is 36 years old and has been in therapy with me for two years. As mentioned, she came after her husband died of an agonizing cancer. Toward the end of the year of mourning, L. finds herself enlarging photographs of her husband and hanging them all over. I tell her, "You're afraid to forget him, afraid to forget how he looked. Fear makes you leave photos everywhere, so that if you happen to forget, they will remind you of him. But now he's already melting within you in a way that you are within him and he is within you, except that at times that just doesn't feel like it's enough and you want more." L. has different ways for preserving her husband's memory, for example in her conversations with her children she uses words he used to use. In one of our meetings L. tells me that she had decided to paint her apartment, the first time since her husband's death. At night she dreams that she is being interrogated by the Israeli intelligence service for treason. The interrogator is the heroine of "Matrix." Those who saw the film and remember it most likely noticed that this heroine lacks all signs of humanness, is asexual and shows neither feelings nor desire. L. does not give up on life, and this leads to a feeling of betrayal. Painting the apartment, the flower-arranging course she started, all these feel as betrayal of her dead husband. This feeling of guilt does not hold the existential paradox, which is that life does not obliterate death just as death does not obliterate life.

A. has kept her daughter's answering machine. Her voice lives on there but A. never listens to it. Sometimes she wears perfumes that her daughter wore. She is now pondering the issue of a computer. It's old and becoming redundant. Her grandson, the son of her other daughter, had used it, but he no longer does. But how can she throw away something that was her daughter's? A. feels this to be an intolerable betrayal and turns the daughter's room into a black hole that cannot be filled.

The physical presence of our dead moves farther away, vanishing into infinity. Their smell disappears, at times their shape becomes blurry. The memory of their touch is no longer sharp, their physical existence through our sense is less and less viable. Concomitantly, another process takes place, where something within them integrates with what we are. The dead person begins to exist in each and every one of our cells, losing his or her separateness as an independent physical entity in our memories too. A. says that her daughter has returned to the womb, where, tiny and vulnerable, she watches carefully over her. I understand that the pain is the sign of her daughter's life within her, is not metaphorical and does not represent anything. She is her daughter and she is therefore unwilling to relinquish the pain. I tell her, "the pain is branded into you and you are branded into it, just as you and your daughter are branded together. She's like a baby in the womb, the pain is your daughter and that's why you can't give it up."

Her daughter's grave is a place that deeply moves A. She visits the grave every Friday and meets the "regulars," all the bereaved people for whom that area of the cemetery has become an inseparable part of their lives. On the second anniversary of A.'s daughter's death, I meet A. by the graveside. The geographical proximity of her grave to my mother's is also the emotional closeness. With a great deal of pride she shows me the new tree she planted. The tree gets its sustenance through the roots it sends through her daughter's grave. The grave is a growth of natural flora, and there is a bench next to it where we are seated. There, by the grave, integration is clearly expressed. It is there that A., the plants she planted, and her daughter's grave for a moment come together and merge into a unified entity. There is an understandable debate as to whether going to the grave breaks the boundaries of the setting and creates a therapeutic culture of acting out; it could also be claimed, with no small justification, that going to the grave is the concrete satisfying of needs. This indicates relinquishing the therapeutic space as a place where physical reality turns into symbolic reality.

By its very nature, death cannot be defined positively; therefore, it is clearly difficult to turn it into a symbolic entity. The only way to define death is by it being the negation of all that symbolizes life. A parent grieving over a child's death cannot symbolize death or construct a structure with metaphoric qualities within it. In the relationship with death, there is no separation between mental and physical. Bion called this the proto-mental system, and later used the term beta elements (Symington and Symington, 1996). A metaphoric presence that relates only to the mental aspect is nothing but a partial presence. The cemetery is the place where mental and physical meet. When A. refers to our meeting at the cemetery, she says, "You care for me and love me and hold me, because when you come to this temple, my daughter's temple, you give her space in a way no one else does." It is because of this way of thinking that I found it right to leave the therapeutic setting on occasion and be present at those places where I thought there is no substitute for my physical presence. It is quite possible that later in therapy a Winnicott-style transitional space will be established where we will be able to have the same encounter in the therapeutic setting, while maintaining its emotional meanings.

A growing number of articles have appeared over the last few years describing how the therapist's illness or other traumatic events entered analysis or therapy and became a central factor, impacting treatment (Hoffman, 2000). The writers were primarily concerned with the influence of the various aspects of the therapist's illness, the therapist's ability to be present during the therapeutic hour, and the patient's reactions to the overt or covert knowledge of the therapist's illness. These articles devote fewer words to the human encounter of the therapist's pain with the patient's pains. When I came back to work after my mother's death, some patients who knew the circumstances of her death felt very guilty that I must deal with their everyday pains while confronted with the magnitude of my own pain. I, in turn, thought how comforting it was to have the opportunity given to me, after the rage and within the pain, to be partner to their pain and through it to combine the experience of death with that of life, for myself as well. Pain—physical and emotional—is a clear sign of life, from the moment of birth and for the rest of our lives. In Life within death: Towards a metapsychology of catastrophic psychic trauma, Tarantelli (2003) claims that there is one way to survive catastrophic trauma and it is to forever live the pain that is the clear expression of the self experiencing the trauma.

There are places where our pain merges with our patients' pain, mixes, and turns into a single entity. Quite possibly, there is no other way to remain within them. A. lost her mother when she was ten. In one of our sessions, I relate to her mother's death and say, "Your mother died when you were eight." A. corrects me and says, "My mother died when I was ten." And I realize that my mother left home when I was eight. My pain and her pain were branded into each other.

At such a moment, while dwelling within the pain, psychological processes cannot always be defined and delineated. At times the use of process definition in therapy aims at distancing and stretching a definitional fence between the experience and the therapist. This does not contradict the importance of theoretization through which accumulated knowledge and learning are created. However, as I have stated, that which enhances and develops could at times hold back and hinder. The attempt to define the moment leads to moving away from it and losing it.

In The gay science, Nietzsche goes as far as to say that "without doubt, all our actions are, in a manner basic and unmatched, personal and totally private. However, when we translate them into our consciousness, they no longer seem that way. Thus, all that has been made conscious (i.e., using words for communication) becomes shallow, superficial, and relatively silly." Nietzsche explains that using a word to relate an experience or event flattens it out in a way that falsifies and distorts it.

Pontalis (2000) states, if so, the necessary condition for creating a concept is forgetting. Forgetting that which is private, unique, and different. I say "table" and forget this table. I say "he's obsessive" and forget the person talking to me; I say "identification with father" and I've said nothing; I say "love" and I think I've been delivered from extreme love or from merciless hatred. Can we really manage without the ammunition and the baggage that concepts give us? We can at least try to sneak away from them, not give in to their authority in order to open to what cannot be fathomed. However, surely some manufacturer will show up who will find a way to conceptualize even the unfathomable. (pp. 19–20)

In 1915, Bialik, the Israeli poet wrote in his wonderful essay Exposure and concealment in language, "it is clear. Language—in all its manifestation—does not at all lead us into the inner section, into the total essence of matters. Rather it sets a partition in front of them. Outside the lingual partition, behind its curtain, the human spirit, denuded of its verbal shell, does nothing but perpetually wonder. There are no words.... If, nonetheless, a person does speak and his mind is somewhat set at ease, it is only because of his great fear to remain for a moment together with the same dark void, the 'nothingness,' face to face without separation" (pp. 162–165). And in How does analysis cure?, Kohut (1984) says that the observer needs a helpful theory, but that theory must be helper, not master.

When I try to formulate and conceptualize my own therapeutic viewpoint for myself—both my general viewpoint and specifically with A.—I use a concept that I will refer to temporarily as unfolding. Unfolding is the Buddhist description of a flower at the moment it opens toward the light and the rising sun. This concept is deeply related both to observing the complexity of the psychological moment and to basic optimistic assumptions of life, just as within the flower there is the knowledge that when it opens its petals toward the sun it chooses life. Opening to the sources of life is made possible in the therapeutic space in which the therapist holds the moment, with all its complexities, and especially with the paradoxes that exist within it by its very being. Just as there is sadness in happiness, just as there is retreat in advancement, so too, in all states of separateness there is also the unbounded melting, and in all of life death is also present. The contrasting entities are not separated from each other but rather are part of one essence, an essence all-encompassing and harmonious with the contradictions within it. Life and death seemingly contradict each other's existence, but one cannot exist without the other, thus creating one single wholeness. It was thus I could promise A. that we would not, for a moment, give up on the death that is within her, because we understand, deep down inside ourselves, that relinquishing death is tantamount to relinquishing life. When A.'s friends ask her when she plans to give up wearing dark clothes and begin applying makeup, she is furious, and I tell her, "you can't give up black because giving up black is like giving up all the other colors." It is clear that in every mental moment in A.'s life, death is alive. Ignoring death is equal to ignoring the life within her. As far as I am concerned, the main question is not the difference in the various weltanschauungs of the various schools of psychoanalysis, but the distinction between the perspective or the theoretical position and the therapeutic presence, from which the therapists' emotional positions are derived at any given moment. This is to say that at times, the theoretical position stands between the therapist and the necessary therapeutic presence, thus turning from a source of support to a hindrance. The therapeutic position is useful for the therapy when it is derived from the emotional position and presence and not, as may happen, that the theoretical position forces itself on the therapeutic presence and creates alienation and obstacles.

At any given moment in my work with A., L., or my other patients, basic assumptions of several schools of psychoanalysis exist. We will turn back for a moment to the dialogue between us, the one I mentioned earlier regarding the conference A. was invited to attend. The dialogue contains the Klienian tension between the two positions which is, in effect, the tension between depressive pain and violent suffering with schizo-paranoid qualities. Kohutian relations of self-object are there in the sense that I echoed her self to her by holding her life that had been drained out of her after her daughter's death, thus turning us into one entity. There is the projective identification that requires using Bion's processes of containment, so that the intersubjective aspect integrates my mother's death in a road accident. In this sense, she is in my hands and I am in hers, and the shared pain lives between us. I cannot establish a hierarchy that will determine which basic assumption is more important and more prevalent, nor do I want to do so. All the various observations that originate in the unfolding process exist simultaneously, moving in the same space, at times with momentary harmony and at others through conflict and paradox.

If so, the therapeutic presence is the therapist's ability to be with the therapeutic moments with all of its complexities and contradictions, with hope and scare, and with the most basic paradox created in the encounter of life and death. The boundary between that presence and a narcissistic presence that glorifies the therapist's self, for example, in an interpretation that creates esteem or adoration, is a thin, delicate border. During the last few years, I've been finding myself less excited by a brilliant interpretation, because, at times, it deters from the independent presences in the therapeutic moment. This could be similar to Ghent's article (1990) on surrender and submission, where he makes a distinction between analysts who emphasize information, namely, perceive insight as the reason for cure, and analysts who emphasize transformation or the experience cure that is followed by insight.

We must recall that human nature seeks harmony and seeks merging into a single entity, one in which there are no contradictions. The pain, anxiety, and occasional rage that are related to the encounter with disharmony are at the very heart of holding and containing. In The matrix of the mind, Ogden (1990, pp. 208–209) discusses the potential space in which the encounter between opposites takes place. He calls this a dialectic process. He points to the existential fact that nothing has meaning without its opposite. Our subjectivity is meaningless if there is no other present, there is no meaning to consciousness if no unconsciousness exists, and therefore every dictionary must include at least two words. As Ogden says, meaning grows from differences. Meaning is not possible in a completely homogeneous field, as there will be no terms there that could be applied to anything beyond itself. This paradoxical is expressed in the poem of the Vietnamese Buddhist monk Thich Nhat Hann:¹

I Am Everyone I am the fly that rolls and changes its shape over the river and I am the bird who with the approach of spring comes at the time ripe to swallow the fly.
I am the frog slowly swimming in the pond and I am the snake, silently slithering to swallow the frog.
I am the child in Uganda, all skin and bones, my legs thin bamboo stalks and I am also the arms dealer who sells Uganda its weapons of destruction.
Please call me by my true names so that I may hear the sounds of my cries and my laughter together, turning them into one.