October 20, 2021 “Autoimmunity as a Response to Analytic Change” with Nancy Winters, MD, FIPA, ABPsa

“The danger of death does not become acute until it is clear to every beholder that a resounding success is at hand.” Bion, 1991 As Bion reminds us, growth and change in a successful psychoanalysis are likely to be experienced unconsciously as a catastrophe. This ‘catastrophic change’ can result in dysregulation and chaos at every level of a person’s existence. In this presentation, a case illustration will be used to explore a catastrophic response in the body, an autoimmune illness. In other words, the immune system’s rebellion against the self. Surprisingly, an examination of autoimmunity at a cellular level reveals self-destruction to be an innate capacity, even tendency, lending support to Freud’s death instinct. Yet our existential capacity for self-destruction is also necessary for tearing down and building new structures, both physically and psychically. This understanding of the immune system’s capacity for destruction and rebuilding has even more meaning in the time of COVID-19. We will discuss how the analyst can work with catastrophic change and the tenuous balance between life and death instincts towards new levels of organization and vitality.