Category Archives: Group Analysis

Observations Upon Group Therapy, Dr Paul Dane’s comments and introduction of a new method – MJA, July 1949

27 Saturday Feb 2021

Posted by in 1940s, Group Analysis, Group Analytic Therapy in Australia, War Neurosis, WW2

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And so, on the quest to find how psychoanalysis threaded its way through Australian life and culture, I have been perusing the Medical Journal of Australia in the State Library of Victoria. One year, two volumes at a time, of monthly reports and newsletters. It is close reading material, but worth the time and effort.

Apart from medical reports and photographs that only medical practitioners can understand, there are articles about history, Australian settlement, and anything that any doctor found interesting and decided to write about. They are an eclectic bunch, these medical men. And of course, women. Paediatricians, oncologists, physicians, and all specialties. What made a good ‘medical man’; how medical men were members of a club, participants in a vocation, specialists, separate and apart from the rest of the world, at once akin to God, but like ordinary mortals, trying to work out how to best serve their profession.

I have began to have my favourites. EP Dark’s articles on socialised medicine during the 1940s caused more than a modicum of consternation, often from, no less, Dr Paul Dane from Melbourne. Dane was a staunch believer in the right of medical men to set their fees, and work, without interference, or regulation, from government.

Dane has found his place in the Australian psychoanalytic hall of fame for his earnest work establishing the Melbourne Institute of Psychoanalysis. But his contributions to the understanding of war trauma is not yet recognized as much as it should be. His lovely, compassionate article on War Neuroses published in the International Journal of Psychoanalysis in 1927 is surely an account that draws on his own experience of illness, and relief at being evacuated from the field of war. His image of the rocking motion of the train carrying the wounded soldier to safety after the desecration of battle – the babe’s relief when mother cradles him in her arms, rocking and crooning, summons the memories of most, after some deeply traumatic and humiliating experience. Dane’s years treating war shock patients at the Fifth Australian General Hospital in St Kilda Road in Melbourne, had their dividends in his work to establish psychoanalysis as a clinical discipline.

Dane’s contribution to beginnings of group analysis in Australia is also noteworthy. Such work was probably not long enough for he died in 1950, a little over a year after he published an article entitled ‘Observations of Group Therapy’ in the Medical Journal of Australia ( July 25 1949). Written after a tour of inspection in Washington, Dane recorded his experiences of four groups of psychotic and borderline patients at St Elizabeth’s Hospital over seven months. The work had developed in response to need – as large number of war traumatized patients sought help. Dr JH Pratt of Boston and Dr Moreno of New York were named as pioneers.

Group therapy had emerged in the interwar years, Dane wrote… at least that what we had been told. But sick people had long been treated in groups, he went on to say – in the temples of Diana in Ancient Greece. And so too were members of the Christian faith. Even so the discipline was new; practice was still being established and, he noted, the ideas about groups were extending to family treatments.

Dane went onto discuss small and large groups, the interplay of interpersonal dynamics and instinctual forces, the frequency of treatment sessions, and the management of the group conductor – one or two.

‘The therapist is of course the most important member of the group’, Dane wrote. It is not essential that this person be a psychiatrist, he continued, but should have a sound training in psychoanalysis – ‘he should be analytically orientated and, better still, have undergone a personal analysis. I do not think it is possible for anyone, however skilfull a psychiatrist he may be, who has not become analytically minded to understand the complex interplay of forces that occur in an individual analysis as well as in group analysis. Repression, transference, identification, are among the chief mental mechanisms that must be understood, that must be observed and interpreted, only a person analytically trained is fully competent for these tasks’. Dane was a long time supporter of the medical professional’s claim upon psychoanalysis, at least in mid-twentieth century Australia.

Dane continued, exploring the ideas about shared experience, and the differences, advantages and disadvantages of group therapy in relation to individual therapy. And whether there was danger in this method. Group therapy is not intended to replace individual therapy, he continues. ‘ Ít is a supplement or an aid to such therapy; and both can be conducted simultaneously. ‘We do not yet know its limitations or possibilities, but it is a form of therapy that has come to stay’, he concluded. ‘It should form part of the treatment in all institutions and clinics that deal with psychosis and neurosis’.

There is much more to this article – a contribution to the beginnings of Group Analytic Therapy in Australia. After Dane’s passing Dr Frank Graham took up the mantle, diverting from Dane’s interest in returned soldiers to develop and teach group analytic therapy on broader, analytic principles, in Melbourne. The Australian Association of Group Psychotherapy, an outcome of this work, is continuing.

References

Paul G Dane, Observations upon Group Therapy, The Medical Journal of Australia, 23 July 1949.

Some thoughts on W R Bion, psychoanalysis, shell shock, and the Great War.

11 Thursday Feb 2016

Posted by in Group Analysis, War Neurosis

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This is a summary of a paper delivered to the Australian Association of Group Psychotherapists Annual General Meeting on 14 November 2015.

 

Introduction

The tragic losses on the battlefields of the Great War and the resulting psychological injuries to millions has had long term consequences for families down generations in Europe, Britain and the former Dominions. The Great War has also led to major professional and scientific advances and re-thinking including development of psychoanalysis from the treatment of trauma by doctors in the field and afterwards. During the last decade scholars have mined W R Bion’s autobiographical work as a basis for his contribution to psychoanalytical theory with his, focussing on his experience as a tank commander in the Great War. Terms such as nameless dread, attacks on linking, and ideas about the splintering of the mind emerged from the idioms of war in an attempt to put language to horrific experiences in the field. (Jacobus 2005; Torney 2009; Roper 2009). While this paper follows these developments I suggest that W R Bion’s book, ‘Experiences in Groups’ based on his work at Northfield is has its origins in his military training and experience in the Tank Corps under the command of General John Frederick Charles (‘Boney) Fuller.

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During the first months of the war a quarter of a million were killed and the war had stalled in France where it remained for the next two to three years. By December 1914 A third of the British Expeditionary Force had been evacuated from France, many with shell shock, the result of being ‘blown up’, by a shell or other incendiary device. The symptoms: paralysis, loss of senses, headaches, nervous tremors and nightmares where it seemed the patient relived his traumatic experiences were likened to ‘Hysteria’ by medically trained psychologist Charles Myers.( Myers 1915).

By mid 1916, in letters home from the Somme and the Battle of Pozieres soldiers wrote of conditions worse than the hell they had ever imagined. In letters published in the Australian press in 1916 soldiers observed how shell shock victims were ruined for battle, if not for the remainder of their lives. They wrote of the noise, the din, carnage and losses. Even so fear of the censor’s pen held them back. In his 1919 Memoir Bion wrote of the fear of finding himself walking on corpses of fallen soldiers – a ploy, perhaps, to protect his mother from the realities of the warfield. For Bion, a member of an elite group, the tank command of especially chosen officers, the difficulty of holding himself together in these conditions is expressed in his account of watching, for hours, a clod of earth held by the green shoot of a plant dangling above him – as if an infant holding himself together by focussing on a light or an object. His complete emotional collapse, and an event to which he returned again and again, for the remainder of his life, came with the death of his batman, Sweeting, who, as he lay dying from horrific injuries beside him, called to Bion to write to his mother. Bion, unable to cope, told him to ‘shut up’ and turned away. Indeed, Roper notes, letters home made light of the horrific conditions even as these acted to contain soldier trauma ( Roper 2009). No doubt there were many others who turned away. Too.

As Freud remarked in 1918, shell shock by many other names – war neuroses, neurasthenia, war shock – ‘helped put psychoanalysis on the map among medical men hitherto sceptical of its claims’. In the early months of the war diagnoses and treatment of shell shock followed physical definitions and treatment. By 1916 doctors were integrating psychological principles into diagnoses and treatment. In his 1917 work, War-shock, the psycho-neuroses in war: psychology and treatment, psychoanalyst and medical officer to the neurological department in Malta, David Eder observed shell shock to be rare amongst the seriously wounded, as if, he said, ‘the energy taken to deal with it left none to spare for the creation of phantasies'(Eder 1917). In a survey of one-hundred cases Eder noted that shell shock did not differentiate between classes nor between experienced soldiers and new recruits. Careful to differentiate the neurological, physical effects of being blown up from the psychological and asserted argued that shell shock occurred when presence of psychological factors over neurological in diagnosis and treatment. Eder asserted that the experience of war shock with its associations with mental collapse and insanity, was not the province of the weak minded, nor genetically disadvantaged, but resulted from unbearable and consistent terror. Work undertaken by W H R Rivers at Craiglockhart, immortalized by authors Siegfried Sassoon and Pat Barker, followed similar principles. On the German side similar work occurred. In 1918, also at the Fifth Psychoanalytical Congress in Budapest, Sandor Ferenczi’s paper on the treatment of war shock was well received and, according to Judit Meszaros, helped pave the way for his presidency of the International Psychoanalytical Society ( Meszaros 2014). By 1920 psychological interpretations and treatment of shell shock was was widely accepted. Further it was understood that part of the symptomatology of shell shock, was a manifestation of unconscious conflicts. ( Roper 2016, p. 43). In 1920 the Australian Medical Congress devoted an entire section, some eight papers, to neurology and psychotherapy many focusing upon the treatment of war shock.
An invisible wound of war, the effects of shell shock such as long term inability to hold work, marital conflict, family violence – were transmitted down generations. One outcome for Australians, was the emergence of formal psychoanalysis, borne of doctors attempts to understand patients suffering the condition in the post war years. Roy Coupland Winn and John Springthorpe who had enlisted as Medical Officers, returned with experience with shell shock patients the field hospitals. By 1933 after a training analysis in England Winn established the first psychoanalytic practice in Sydney and for the next three decades was a key figure in the establishment of the Melbourne and Sydney Psychoanalytical Societies. Winn’s Melbourne colleague Paul Dane developed his interest in psychoanalysis after working with shell shock patients in Melbourne. He enlisted as as a Medical Officer in 1916 but was invalided home within the year after a serious attack of dysentery and colitis. During the 1920s he went to London where he underwent analysis with Joan Riviere.
While scholars have stressed the place of Bion’s personal trauma in his later work, Bion’s experience in the Tank Corps a remains relatively neglected. Mary Jacobus has pointed out the failure of the containing function of tanks – called various ‘Mother’, ‘Little Willie’ and ‘Big Willie’, highlighting, as Bion did, their danger, noise and at worst, Bion’s experience of them as death traps (Jacobus 2005). He entered the tank Corps, Bion explains, because it was interesting and the secrecy surrounding appealed to him. Headed by Major General John Frederick Charles Fuller, ‘Boney’ Fuller, the Tank Corps was developed in order to break the stalemate and battlefield slaughter extant since late 1914. The Corps was the instrument of the younger generation designed to break the deadlock in France (Freedman 2013). Tanks were the secret weapon, designed to cover ground and defences more efficiently than an army platoon. In his account of the Corps. Drawn from the elite: its members were highly experienced soldiers (Fuller 1920) It members were the veritable ‘best and brightest’, experienced and, like Bion, with potential to lead. Freedman explains that Commanding General ‘Boney’ Fuller, based much of his work on that of le Bon’s theory of crowd behaviour. This stressed the ‘mindlessness’ of crowd behaviour. Freedman explains that Fuller, instead, described a military crowd dominated by a spirit which is the product of the thoughts of each individual concentrated on one idea. It was an organised crowd, contained through training and a common purpose. Nonetheless it was a crowd and could turn when stressed. (Freedman 2013 p. 130).

Serving in the Tank Corps was a pivotal experience for Bion. It influenced his work and his contemplation of leadership and the group in the book, Experiences in Groups. Bion’s analysis of group behaviour addressed the nature of unconscious stressors within the group and the group’s response. Where Fuller stressed leadership and containment of the group through careful and rigorous discipline, Bion took up the latent, unconscious aspects of group behaviour – the reasons why a group might fail. Critical of Freud’s idea that the group seeks a leader to look up to Bion explores the notion of the leaderless group and whether it is possible for such a group to function maturely, without regression. In his discussion of the mental activities of groups Bion recognizes the existence of ‘two groups’ existing within the one entity – the ‘work group’ which tries to retain focus on the task at hand but is constantly perturbed by influences that come from other group mental phenomena ( Bion 1961) and the ‘basic assumption’ group variously dependency, where the group gathers around a leader and appoints a ‘dummy’ that has to he taught; the pairing group: the idea, that two members will produce ‘a new leader figure who will assume full responsibility for the group’s security. The wish, in unconscious phantasy, is that the pair will produce a Messiah, a Saviour, either in the form of a person or an organising idea around which they can cohere’.(Lawrence, Bain and Gould 1996). Fight/Flight suggests there is an enemy to contend with. ‘The
unconscious assumption of the group is that they are met for action which is to preserve itself by fighting someone or something or by taking night from these. The individual is less important than the preservation of the group. Understandably [culture] is profoundly anti-intellectual and will decry as introspective any behaviour which attempts to reach self knowledge through self study’ ( Lawrence, Bain and Gould 1996). Each position, unconsciously held, acts against the group task undermining discipline from without.

War is a difficult subject to address coherently. Two classic texts read today Clauswitz’s ‘On War’published in 1832 and the work of the Chinese sage Sun Tzu’s The Art of War, sets out the conditions under which war is declared and fought, methods and goals. Freedman’s work on strategy during the Great War shows how officials, generals and strategists drew upon myriad disciplines in their undertakings, not least being group theory. It is to wonder how much the group activity of war was, and can be,disrupted by unconscious assumptions with the resulting stalemate in the Great war. Bion’s work on groups deserves further attention in this light.

REFERENCES:

Bion, W H R, (1919) War Memoir 1917-1919, London, Karnac.

(1961), Experiences in groups and other papers, London, Tavistock.

(1975), A memoir of the future, London, Karnac.

(1982), The Long Weekend 1897-1919, London, Karnac.

(1989), All My Sins Remembered : Another Part of a Life and The Other Side of
Genius: Family, London, Karnac.
Eder, Montague David (1917), War-shock, the psycho-neuroses in war: psychology and treatment, London, Heinemann.

Freedman, Lawrence (2013), Strategy: A History, Oxford, Oxford University Press.

Fuller, J F C ( 1920), Tanks in the Great War 1914-1918, New York, E P Dutton and Co.

Harris Williams, Meg (1985), The Tiger and “O”, Free Associations http://human-nature.com/free-associations/MegH-WTiger&O.html accessed 2 February 2016

Jacobus Mary,( 2005), The Poetics of Psychoanalysis: In the Wake of Klein, Oxford University Press.

Lawrence, W Gordon, Bain, A and Gould, Laurence ( 1996), The fifth basic assumption
Free Associations Volume 6, Part 1, (No. 37): 2855, http://www.acsa.net.au/articles/thefifthbasicassumption.pdf, accessed 10 02 16.
Myers, Charles (1915), ‘A Contribution to the study of shell shock’, The Lancet Vol. 185, February 13, 1915 pp. 316-320.

Roper, Michael, (2009), The Secret Battle: Emotional Survival in the Great War, Manchester, Manchester University Press.

Souter, Kay ( 2009), ‘The war memoirs: Some origins of the thought of W R Bion’, International Journal of Psychoanalysis, Vol.90, Issue 4, pp 795-808.