Michael Balint

Balint was born in Budapest on 3 December 1896, the son of a practising physician. Against his father's wishes he changed his name from Bergsmann to Bálint. He also converted from Judaism to Unitarian Christianity. In the First World War he served at the front, first in Russia and then in the Dolomites, and in 1918 he completed his medical studies in Budapest. Alice Székely-Kovács, later Alice Balint, suggested that he read Freud. He also began attending the lectures of Ferenczi, who held a professorship of psychoanalysis in Budapest from 1919.

Around 1920 Balint and Alice, now married, moved to Berlin. There he worked in Otto Warburg's biochemical laboratory on a doctorate in biochemistry, while also working half-time at the Berlin Psychoanalytic Institute. Both began their analytic training in Berlin, in analysis with Hanns Sachs from 1921. The couple were dissatisfied with that analysis. In 1924 they returned to Budapest, where Ferenczi took both of them into analysis. Their son John was born after the return.

His years with Ferenczi shaped all of Balint's later work. He was Ferenczi's pupil and his successor as head of the Budapest institute. After Ferenczi's death in 1933 he became his literary executor and transcribed and translated the Clinical Diary of Ferenczi's last years. He also watched at close range Ferenczi's late attempt to meet every need of a single patient. Balint later called this attempt the "grand experiment", and in The Basic Fault he made it the cautionary case for how an analyst should respond to regression (The Basic Fault²).

In Budapest Balint took a leading part in Hungarian psychoanalysis. In 1935 he became director of the Budapest Psychoanalytic Institute. He worked closely with Alice Balint and with Imre Hermann. In 1937 he described the three of them as a group following Ferenczi, each supporting their shared view from a different field: comparative pedagogy, the study of primates and sexual theory (Frühe Entwicklungsstadien des Ichs: Primäre Objektliebe³).

Two papers of this period made his name internationally. In August 1934, at the International Psychoanalytical Congress in Lucerne, he read a paper on the final goal of psychoanalytic treatment, published the following year (Das Endziel der psychoanalytischen Behandlung⁴). In May 1937 he gave a report on the earliest stages of the ego at the Four Countries Conference in Budapest. There he set the Budapest view against the views of London and Vienna (Frühe Entwicklungsstadien des Ichs³).

In early 1939, as Jewish analysts were being advised to leave Hungary, Balint emigrated to England with the help of John Rickman. He settled in Manchester, where he became clinical director of a child guidance clinic. That year he and Alice wrote a joint paper asking whether transference is the patient's work alone or whether the analyst's behaviour also shapes it. Alice died in Manchester a few months after they arrived, leaving Balint with their son.

In 1944 he remarried; the marriage soon broke down, though the divorce came only in 1952. In the same year his parents, about to be arrested by the Nazis in Hungary, took their own lives. Also in 1944 Balint moved from Manchester to London and joined the Tavistock Clinic. There he learned about group work from W. R. Bion, and he took a Master of Science degree in psychology.

In 1949 Balint met Enid Eichholz, who had founded the Family Discussion Bureau, a casework service for couples, and whom he later married. Sources differ on the year of the marriage. From 1950 he ran a research and training seminar at the Tavistock, in which general practitioners met weekly with psychoanalysts to discuss cases from their own practices. He reported on it in The Doctor, His Patient and the Illness in 1957 (The Doctor, His Patient and the Illness¹). With Enid Balint he also wrote Psychotherapeutic Techniques in Medicine (1961).

Two books on regression followed: Thrills and Regressions⁵ in 1959 and The Basic Fault in 1968. In 1968 he also became president of the British Psychoanalytical Society. He died in London on 31 December 1970.

The new beginning. Balint's paper for the Lucerne congress asked whether clinical experience alone could define the point towards which an analysis tends, without appeal to a philosophical or moral ideal of health. He started from re-analyses and difficult cases, and from an observation: in deep analyses the final months bring almost no new unconscious material, yet that is when patients actually get well. Measured against this, he judged two kinds of definition of the goal of treatment and found both lacking.

The "classical" definitions were Freud's: making the unconscious conscious, lifting the infantile amnesia, overcoming the resistances. Balint found them neither necessary nor sufficient. The "romantic" definitions he found too general or too narrow. They included the full reliving of the Oedipal relation proposed by Ferenczi and Otto Rank, Rank's abreaction of the birth trauma, and Wilhelm Reich's orgastic potency.

Against both, Balint described a new beginning, which he had first presented at Wiesbaden in 1932. Near the end of treatment, patients revive long-abandoned infantile wishes and seek to have them gratified, timidly at first and then with an addictive passion. Mishandled, this turns into insatiable demands. If patient and analyst persevere, it gives way to a realistic relation to the object.

Drawing on Ferenczi's theory of the erotic sense of reality, Balint argued that every drive is bound to an object from the first and has a passive aim, to be loved and satisfied. On this view autoerotism and narcissism are detours imposed by frustration. The anal-sadistic and phallic phases are products of uncomprehending upbringing rather than normal stages. He pressed this point against the stress on constitution in the analysis of his day, taking Melanie Klein's The Psycho-Analysis of Children as his example. He closed with the motto "less sadism and more love" (Das Endziel der psychoanalytischen Behandlung⁴).

Primary love against primary narcissism. The 1937 Budapest report took up the clash between the London and Vienna schools over the earliest stages of mental life. The London school, as Joan Riviere presented it, explained the child's greed and hostility by an innate oral sadism rooted in the death drive. Robert Waelder's Viennese critique rightly disputed London's evidence but left the same phenomena unexplained.

Balint reported that patients deep in analysis come to want small, primitive gratifications, such as a kind word or being touched. Refused, these wishes bring despair, hatred and fear of retaliation. Granted, they bring an addiction-like bliss that collapses at the first frustration. Met at the right time and in the right measure, they produce no more than a quiet sense of well-being. He linked this with Hermann's work on the infant's instinct to cling and with Alice Balint's account of the mother–child unity.

From this material he drew the concept of primary object love. It is an early phase that cannot be skipped and is tied to no erogenous zone, and its aim is passive: to be loved and gratified without giving anything in return. Both London and Vienna, he argued, held to the hypothesis of primary narcissism, and he named it as the source of their confusion of tongues. Primary narcissism was for him a negative concept, reached by extrapolation and defined by "not yet", and it had never been observed clinically. He warned that the logically simplest state need not be the original one, as biology had learned with the amoeba, and offered primary object love as a working hypothesis (Frühe Entwicklungsstadien des Ichs³).

His 1952 collection gathered these papers with later ones written in Britain, together with a paper by Alice Balint. In it, narcissism, autoerotism, sadism and hate appear as secondary formations: consequences of the frustration of primary love, and defences against it. Adult genital love fuses genital satisfaction with tenderness and with regard for the partner as a person. On technique, the book treats the analytic situation as a relationship between two people, in which the analyst's behaviour and personality help shape the transference, and it deals with countertransference and the termination of analysis (Primary Love and Psycho-Analytic Technique⁶).

Ocnophils and philobats. In Thrills and Regressions Balint started from the pleasures of the funfair and of risky sports. A thrill, he wrote, has three elements: awareness of a real external danger, deliberate exposure to it, and a confident hope of returning safely. From people's opposite responses to such situations he derived two attitudes. For the ocnophil, objects are safe and the spaces between them are horrid and empty, so the ocnophil clings. For the philobat, open spaces are friendly and objects are unpredictable hazards, so the philobat relies on their own skills and keeps a distance. Each attitude, he argued, rests on an illusion.

Behind both he now placed primary love, conceived as a harmonious mix-up of the individual and the environment, more like a world of substances such as water or air than of bounded things. Firm objects emerge only when frustration and separation destroy this harmony, and the two attitudes are secondary reactions to that loss. Here he revised his earlier view: clinging to the analyst now seemed to him a defence against the fear of being dropped, not an expression of primary love.

He also criticised the technique of his time as biased towards ocnophilia. Interpreting everything as transference, he argued, makes the analyst an object always offered to be clung to. The patient may end up with an "efficient shell" that equips them for life but narrows what they can feel. The book closes with a chapter by Enid Balint (Thrills and Regressions⁵).

The basic fault. Balint's last book begins from moments when interpretations stop working as interpretations. They are heard as attacks or seductions, and a patient who is not understood sinks into emptiness rather than anger. He distinguished three areas of the mind. The Oedipal area is triangular, organised by conflict and reached by ordinary adult language. The area of the basic fault is strictly two-person. It holds a deficiency rather than a conflict, a fault in the geological sense, born of a marked lack of fit between the infant's needs and the care available. In the area of creation there is no external object at all.

He weighed three responses to regression. Classical technique depends on a careful choice of patients. The consistent interpretation of the Kleinian school risks making the analyst all-knowing and the patient weak. The management associated with Donald Winnicott risks an endless spiral of demands.

The heart of the book is the distinction between two forms of regression. Benign regression aims at recognition, takes place in a trusting atmosphere and ends in a new beginning. Malignant regression aims at gratification and drifts towards addiction-like states. Which form appears depends on the analyst's response as well as on the patient. Balint argued that Freud had generalised from malignant cases and Ferenczi from benign ones.

In the area of the basic fault, he advised, the analyst should avoid becoming an omnipotent object. Instead the analyst should let the patient use them as a primary substance is used, the way water carries a swimmer. Interpretation should be sparing during the regression, and Acting out accepted as communication. The fault cannot be analysed away: at best it heals with a scar, and successful treatment includes mourning for the original defect (The Basic Fault²).

The doctor as a drug. The Doctor, His Patient and the Illness argued that the drug most often prescribed in general practice is the doctor in person, a drug whose dosage and side effects nobody knew. Balint described how, at an early "unorganised" stage, a patient offers the doctor a series of illnesses, and the doctor's responses help decide which one becomes "organised". Against the habit of pursuing a physical diagnosis through one examination after another, he called for an "overall diagnosis" that takes in the patient's personality and relationships.

The book also named several patterns in medical practice. The "apostolic function" is the doctor's urge to convert patients to the doctor's own idea of how to behave when ill. In the "collusion of anonymity", responsibility is diluted among specialists until no one carries it. The "mutual investment company" is the shared experience that builds up between a family doctor and their patients over the years. The seminars aimed not to turn practitioners into psychotherapists but at a limited though considerable change in the doctor's personality (The Doctor, His Patient and the Illness¹).

Balint's influence runs along two lines, one within psychoanalysis and one in medicine. Within psychoanalysis, Primary Love and Psycho-Analytic Technique is a principal statement of the Budapest school's contribution to object-relations theory. Its view of the analytic situation as a two-person relationship prepared his own later work on regression (Primary Love and Psycho-Analytic Technique⁶). Margaret Mahler's idea of a dual unity of mother and child has been traced in part to Balint, alongside Therese Benedek. His reading of the Freud–Ferenczi controversy through benign and malignant regression gave Ferenczi's late technical experiments a framework within which they could be weighed rather than dismissed (The Basic Fault²). The Basic Fault has been translated into Hebrew, published by Am Oved in 2006.

In medicine, The Doctor, His Patient and the Illness established the case-discussion method later known as Balint groups. It became a classic of patient-centred medicine and of medical education (The Doctor, His Patient and the Illness¹). After his death a Balint Society was formed to carry on the seminars with general practitioners. A psychoanalytic institute in Hamburg also bears his name.

In German his main early papers are "Das Endziel der psychoanalytischen Behandlung", read at Lucerne in 1934 and published in 1935 (Das Endziel der psychoanalytischen Behandlung⁴), and "Frühe Entwicklungsstadien des Ichs: Primäre Objektliebe", given in Budapest in 1937 (Frühe Entwicklungsstadien des Ichs³).

In English, Primary Love and Psycho-Analytic Technique (London, 1952) collects his papers from 1930 onwards (Primary Love and Psycho-Analytic Technique⁶). The Doctor, His Patient and the Illness appeared in 1957 (The Doctor, His Patient and the Illness¹), and Thrills and Regressions, his third book, in 1959 (Thrills and Regressions⁵). Psychotherapeutic Techniques in Medicine, written with Enid Balint, followed in 1961. His last book was The Basic Fault: Therapeutic Aspects of Regression (London, 1968) (The Basic Fault²).