REVIEW DIVISION DIVISION A QUARTERLY PSYCHOANALYTIC FORUM
NO.4 SUMMER 2012
A QUARTERLY PSYCHOANALYTIC FORUM
NO.12 SUMMER 2015
“I DIDN’T MEAN TO BE” BENSON | Salah
WHEN REALITY INTRUDES
LIVING ON THE BORDER
BONANNO | Abbasi
HEGEMAN | Ainslie
FRIED | Grotstein
R E S E A R C H M
ACHIRO | MARKETING PERSONALITY
SUMMERS | ANALYTIC DYAD
P E R F O R M A N C E
Feel Good Gene
BENVENUTO | DYING FOR A SIGNIFIER
AXELROD | VALUE OF “PROGRESS”
SEIDEN | TRACKS IN THE SNOW
STUKENBERG | LISTENING & RATING
SINCLAIR | DADA DAS UNBEHAGEN
READY | WHAT FADES
AN INTERVIEW WITH GROTSTEIN
GERSON | AMY HERZOG
P O E T R Y
David LICHTENSTEIN, Editor
In an op-ed piece in the New York Times Sunday Review, “The Feel-Good Gene” (March 6, 2015), Richard A. Friedman wrote about the discovery that some people have a genetic variation that tends to immunize them from anxious feelings.1 The genetic variation leads to the production of a higher than average level of a certain neurotrans1. I am grateful to Will Braun, psychoanalyst, for initiating a discussion of this topic and Richard Friedman’s op-ed piece on the Google Group unbehagen-salon@.
mitter with the Pinchonesque name of anandamide (ananda being the Sanskrit word for bliss). The “bliss chemical” is a natural and endogenous relative of cannabis, the psychoactive ingredient in marijuana. When our bodies produce this chemical we are more blissful and less anxious, and some people are genetically predisposed to produce it more frequently than others. Friedman suggests that since this genetic variation allows a certain subset of
the population to be less anxious, anxiety itself should be considered primarily a chemically mediated event, that is, “a mental state that has no psychological origin or meaning” (Friedman, 2015). If anxiety is the relative lack of the bliss factor, then why look for subjective causes? As Friedman put it, “some people are prone to be less anxious simply because they won the genetic sweepstakes and randomly got a genetic mutation that has nothing at all to
Official publication of Division of Psychoanalysis (39) of the American Psychological Association
BOOK REVIEWS 4
Henry M. Seiden CONTRIBUTING EDITORS
Shelley Galasso Bonanno The Rupture of Serenity: External Intrusions on
CHAIR, PUBLICATIONS COMMITTEE
Lyric Sexology Vol. 1 by Trish Salah
the Therapeutic Relationship by Aisha Abbasi The Fight to Save Juarez: Life in the Heart of Mexico’s Drug War by Ricardo Ainslie
Ricardo Ainslie, Steven David Axelrod, Christina Biedermann, Chris Bonovitz, Steven Botticelli, Ghislaine Boulanger, Muriel Dimen, William Fried [REMINISCENCE], Patricia Gherovici, Peter Goldberg, Adrienne Harris, Elliott Jurist, Jane Kupersmidt, William MacGillivray, Paola Mieli, Donald Moss, Ronald Naso, Donna Orange, Robert Prince, Allan Schore, Henry M. Seiden [ON POETRY], Robert Stolorow, Nina Thomas, Usha Tummala, Jamieson Webster, Lynne Zeavin ASSOCIATE EDITORS
Loren Dent, Kerri Chladnicek
An Interview with Dr. James Grotstein
Mac Walton PHOTOGRAPHY BY
Gina De Naia
Listening to Audiotapes of Psychoanalytic Sessions and Rating Them: A Clinician Engages in Process Research
Tim Maul DESIGN BY
Hannah Alderfer, HHA design, NYC
What Fades in the Rearview Mirror
Das Unbehagen of Duchamp, Dada, and Psychoanalysis
The Conflict of Power in the Analytic Dyad
Steven D. Axelrod
The Value of “Progress” in Psychoanalysis
Dying for a Signifier
Subscription rates: $25.00 per year (four issues). Individual Copies: $7.50. Email requests: divisionreview@optonline. com or mail requests: Editor, Division/Review 80 University Place #5, New York, NY 10003 Letters to the Editor and all Submission Inquiries email the Editor: firstname.lastname@example.org or send to Editor, Division/Review 80 University Place #5, New York, NY 10003
A Case for Amy: Sociopathic Rage in the Era of the Marketing Personality PERFORMANCE
The Great God Pan by Amy Herzog: The “Play” of Memory ON POETRY
Henry M. Seiden
Tracks in the Snow: A Poem of the Sung Dynasty LETTERS
DIVISION | REVIEW a quarterly psychoanalytic forum published by the Division of Psychoanalysis (39) of the American Psychological Association, 2615 Amesbury Road, Winston-Salem, NC 27103.
The Division 39 Wikipedia Task Force; Marilyn Charles; Bruce Reis;
Advertising: Please direct all inquiries regarding advertising, professional notices, and announcements to email@example.com © Division Of Psychoanalysis (39) of the American Psychological Association. All rights reserved. Nothing in this publication may be reproduced without the permission of the publisher. DIVISION | REVIEW accepts unsolicited manuscripts. They should be submitted by email to the editor: firstname.lastname@example.org, prepared according to the APA publication manual and no longer than 2500 words DIVISION | REVIEW can be read online at divisionreview.com
DIVISION | R E V I E W
Feel Good Gene from page 1 do with strength of character.” Of course, it is true that 80% of the population lost the sweepstakes, are more prone to anxious states, and are therefore “genetically disadvantaged” regarding bliss. “What we really need is a drug that can boost anandamide—our bliss molecule—for those who are genetically disadvantaged” (Friedman, 2015). There’s hope for the 80%. Actually, Friedman’s assumption that psychoanalysts view anxiety as having the sort of psychological origin or meaning that can be explained and resolved through psychotherapy is a misreading. That 80% of the population is susceptible to anxious states, and that the other 20% only suffer from them somewhat less by virtue of their brain chemistry, is entirely understandable in psychoanalytic terms. The psychological origins of anxiety are not discrete life events that can be worked
out in therapy, but inherent characteristics of our civilized social being. We are all more or less anxious beings insofar as we live in cultures with established structures, laws, and taboos. There is no culture without permission and prohibition, and thus without both bliss and loss. Anxiety is the signal that guides us on the path between bliss and inevitable loss. Indeed, it is the inescapability of loss that launches us as cultural beings and propels us in the very pursuits that sustain our cultural life. Without anxiety we could not become articulate and effective as cultural beings. Ananda, pure bliss or perfect happiness, may be a spiritual point of reference, a mythic ideal, but it is neither an actual condition of life nor the goal of psychoanalytic treatment. Anxiety is a fulcrum of psychoanalytic treatment and an experience that the analyst learns to pay attention to. However, that attention is not directed at eliminating anxiety and replacing it with bliss, but instead at seeing where the anxiety is pointing, at
recognizing what signal it is sending, since it is by coming to read those signals that the patient benefits from analysis. It is true that coming to read the signals of anxiety means that one may be less disturbed or blocked by the experience of those signals. In this sense psychoanalytic treatment may appear to be directed at reducing anxiety. But a more accurate picture is that it is directed at coming to know how to use anxiety, to get along with it, and to be less stymied by it. That a person may appear to be less anxious as a result of successful analysis is merely a by-product of knowing how to read it. If Richard Friedman is correct and the bliss pills are on the way, we will ultimately see to what extent people choose to engineer good feelings, or whether they continue to see a benefit in listening to their anxious ones. z
gestures that are recorded via a hybrid of the photographic print and hand-rendered picture. Her works on paper and occasional readings involve the repetition of phrases (I USED TO THINK THAT IF I LOOKED AT A FORM IT WAS ABSOLUTE) that may recall enforced learnings or time-killing punishments doled out to unfortunate elementary school students in the past. DeNaia’s developing art occupies a cool center in a maelstrom of Instagram overkill
and feverish selfies, a ubiquitous social phenomena whose effects on our recollective processes and in how we mediate encounters with all things new have only begun to be studied. In systematically extending an action of dubious value into a series, Gina DeNaia breaks some rules of what comprises the photogenic and in doing so reinvents the wheel as a way of moving forward. www. ginadenaia.com. z Tim Maul Image Editor
REFERENCE Friedman, R. A. (2015, March 6). The feel-good gene. New York Times Sunday Review, p.S1.
On the Photography of Gina De Naia Working in San Francisco in the mid1960s, Bruce Nauman galvanized the international art world of that transitional moment with a visually arresting body of sculpture, objects, videotaped studio activities, and photography, leaping to the front of the class, from a New York perspective, out of nowhere. The impact of Nauman’s Eleven Color Photographs (1966) upon art (less so staid “photography”) is enormous, and in so-called conceptual and behaviorist/phenomenological body art of the early 1970s, the still or moving image functioned as a performative “real-time” space essential to framing the humorous (William Wegman’s videos, burlesquing Nauman) and the provocative (Hannah Wilke’s glam-feminism). Gina DeNaia’s recent photography, videos, drawings, and painted works derive both from Nauman and a generational enchantment with handheld imaging technologies that evolved photography into a habitual act. Central to DeNaia’s developing art is a form of self-portraiture reliant not on appropriative characterization(s) but the execution and clinical documentation of tasks, some of which appear mildly transgressive in a juvenile manner. In a series of truncated portraits, DeNaia does not apply makeup but “paints” her lips with her thumbs using red acrylic, resulting in a beguiling, if not bloody, “mess.” She also “plays” with, and therefore “wastes” matches, a huge childhood no-no. Again using her fingers as digits, she counts, making prelinguistic numerical
DIVISION | R E V I E W
“I Didn’t Mean to Be” I continue to want to learn more about transgender people’s development and experience. I feel a great willingness to learn, so far primarily through reading, listening, Lyric Sexology Vol. 1 By Trish Salah New York: Roof Books, 137pp., $15.95, 2014 and supporting those who are dealing with life before, during, and after transitions, coming to realize its implications socially, psychologically, biologically. I have never seriously considered changing sex, but I’ve wondered what it would be like to be a woman or another gender. I value in myself plenty of characteristics and qualities socially coded as feminine. My interest may also be fueled by the amorphous attractions and identifications of a bisexual orientation and a sexualized ambivalence between reality and fantasy in sexuality, along with my uncertainty about their place. How normal am I? What difference does it make? Who am I? Not this, not that, neither continuous nor unfamiliar. A transgendered identity might be an impulse, a potential, a dream, in any of us (Cate Blanchett seemed closest to getting it right as Bob Dylan in I’m Not There), but to deliberately bend gender or commit to a change of sex has radical, uncontrollable ramifications in lived experience. From such a platform of rampant naiveté, I’m writing here about Trish Salah’s new book of poetry, a glistening, grueling, challenging, and potentially liberating exploration of meanings, identifications, experiences, associations, ordeals, revelations, and questions associated with trans experiences—others’ and her own. Whether I comment on her work with adequate savvy, skills, and sensitivity will remain an open question, at least for me, but I urge it on any other interested reader as a great effort and achievement on a present reality many find difficult or imponderable. What a gift! Let me know when someone writes such a poetry book on climate change! Faithful to a title more than demonstrative of Salah’s clarity, wisdom, and perspicacity, suggestive of unlimited scope and detail, of academic scientism and romantic folly, imbued with cunning, coyness, and civility in this usage, Lyrical Sexology Vol. 1 treads as wide a road as writable, addressing a readership of trans people but willing to breathe life and realism into others’ readings of trans experience. The poetry is mannered even while it is earnest, difficult yet direct, aslant as well as weaving, erudite and earthy, bawdy, true. (Is “Vol. 1” here an oblique nod to Dylan’s lyrical, mischievous, cut-up recycling of mis-self-representing autobiography
as history in Chronicles Volume 1? Only Salah’s press agent knows for sure.) Salah courts chaos and breaks rules by applying other rules throughout the book, refusing to settle for any binary boundedness. Seemingly typographical errors, naïve misspellings, disabled sentences, and unidentified specific references stand on pages rife with rhetorical panache, self-evident scholarship, and brazenly or viciously aggressive provocations. The polymorphous perversity of the writing insinuates itself into a cis reader’s willingness to learn and/ or identify within this sliding precinct of esoteric yet lived and lively, loving and desiring precedents, promoting a testy carnival of interpretative axes. Lyrical this writing is, subjective, interpellating beauty, expressive and lush, yet it engages persistently in periods and persons of distant lands and diverse values, inviting observation and identification, collusion and mystification, in the reader. Betimes and impulsively too, it attacks, it argues, it postulates, it recalls, it questions itself as much as any other. Mr. Jones may not know what’s happening here (Dylan answered one interviewer’s question in 1965, “Queen Jane is a man”), and Salah doesn’t say whether she does either, but she does drag words and associational attention to witness psychologically and viscerally sense intimate experiences variously interrogated for their revelations of trans living across time, in lives of known persons who questioned their authorized genders, effected surgical transitions, and/or found themselves against the grain of established gender norms. Unpredictably playing out poetic trysts with Tiresias, Lili Elbe, Janice Raymond and Caroline Cossey (aka Tula), Michael Dillon, Julian Robinson, Magnus Hirschfield, kari edwards, and many others sent me to raid online resources in further research. Daniel Paul Schreber, judge and iconoclast, wo/ man and book, well-known in his posterity to psychoanalysis, is treated to an especially elaborate series of exhumations across twelve pages in a suite called Schrebergarden. The patient, as you will recall, succumbed (repeatedly?) to dementia praecox after he observed his desire to experience sexual union as a woman. He wondered if a hypnotist had victimized him, inserting this idea into him via rays. (Don’t worry, Sigmund Freud didn’t do it. He only read Schreber’s book, and history is linear. Isn’t it?) While Freud famously interpreted Schreber’s memoirs as documents of suppressed homosexual desire underlying a conflict that precipitated madness, 4
DIVISION | R E V I E W
Schreber’s passion might also reflect late-onset gender dysphoria, unmanageable in a man of his position and neurological vulnerability within the staunchly patriarchal culture that had affirmed his eminent authority following a childhood subject (by legend or in fact) to his enterprising father’s experiments in optimal child development and eradicating wildness and rebellion (e.g., baths of ice water at three months and mechanical appliances to prohibit adolescent masturbation and to train dinner table posture). Salah doesn’t systemize an argument but follows Schreber’s example, and Gertrude Stein’s, including everything and beginning again and again. Sample stanzas from these thirteen poems (two of which are numbered “VII”) afford a glimpse of the range of Salah’s own manners, in a lyrical, textual, mirroring interface with Schreber’s: Words do not go away chirping away, or judge The cause. What is the cause? “The doctors can only speculate,” She explained. + A beautiful feeling fucked free of judgment. “Fuck my sex out.” “Fuck the god out.” “Fuck my brains out.” A judge cannot be a judge in/of her body. “What a delightful feeling to be without one’s sex one’s judge, I meant, one’s submission.” + Animated chatter, trill and vault like summer languor and this prison is an illusion really, the world’s all rock and wasted and the prettiness I make the only consolation among the spectral mechanos of my murderers. + We are a literal proliferation. Our view is the mirror’s retrospective shatter. Our view is the continually created, Himself. + How can a moral person planted in the order of the world
Become the cause of its dissolution? Even afflicted by hallucinations and illusions, The malice and interferences of her protectors, her doctors? + Even if some “might retain me on the masculine side” Do not be deceived by my girlish trickets and sensual gait, I retain my sense of manly honour. + Unmanning at the end of that century’s end mad becoming impossible speech, an impossible position, a sex that was not one, so sure mad becoming unmanning, a bellowing miracle, a cold wind blowing through a body’s hollow with becoming becoming becoming deposits in nerves, on nerves’ kin, as nerves speech, sinuous sensuous miracle, the jolt of
illness at the root of genderqueerness and transsexuality, proposing a mind-set “to open the question of transsexuality to its otherness…by considering it as a signified that, like femininity and masculinity, requires further interpretation regarding its multiple significations.…Transsexuality reveals psychoanalysis’s ambiguous investment in normative sexuality while problematizing its disavowal of the heterogeneity of the drive,” haunted by its own unconscious “resistance to internal difference and inevitable recourse to fetishistic understandings of transexuality” (p.28). (Happily, Gozlan thus spells that word more than one way!) Such resistance and recourse are taken by Gozlan as evidence of cultural and institutional trauma.
the possible—but that is suffering as much as pleasure and entails also law and lack” (ibid., p.1). Her engagement of actual and imagined trans experience across a bounty of historical sources provides no comprehensive, systematic overview, but breeds within a field of relations a welter of promises, frustrations, and realizations, blisteringly contradictory and irreconcilable. As she draws in this book on figures she may have treated more historically in a doctoral dissertation, this book, as she says, “does affective work, and politically motivated and strategic dis-identificatory work, but it is also about allowing those archives to pose questions of this moment, these subjects we’ve become—are becoming” (ibid., p.2). She responds here to the mistakes
Transphobia thus translates as pathologization, rendering our healing racket a systemic straitjacket, riddling the work itself with throbbing shocks that may terrify, disarm, and demean its clientele. In a 2012 interview with Matthew Hall, Salah invoked a transgender writing for trans people, one that would hope not to prepare “a remedy for non-trans (cissexual) lives,” but “to reimagine the social, articulate experiences of living lives that are marginalized or erased, contending with criminalization, or lack of healthcare” (Hall & Salah, 2012, p.1). Recent research indicates an especially high risk of homelessness, mental illness, and suicide among trans people, prominently including adolescents, which it associates with their subjection to betrayal, bigotry, neglect, and ignorance. Salah says her “own poetics is one of dispersed and multiple identification and desires, of barred and deferred subjectivities, and that does have its relationship to jouissance, the generative and open economy of
and assumptions and harms in society’s responsivity to transsexuality and trans-identified people by evoking with this writing the ways one might with trans experience read through a text. Although questioning whether cissexual people will take any true interest in what’s on trans people’s minds, she doesn’t close the door on that. As a reader, I feel that to understand this book is to join in its questioning. To take on that commitment to understand may comprise at least a contemplative stage of gender reorganization. Reading, sensing the prosodic rhythms and tonal inflections, I identify, even a little, sotto voce, with the voice behind the words, as if it were speaking. Resonating with the voice, its depth and immediacy, I identify, even a little, with the body behind the voice. Feeling that voicing compelled through that body, I further feel identity with a mind that must be behind both body and voice. Knowing, even a little, some of its workings, I feel implicated in the history of that mind, its situations across time. Finding
Unmanning, Freud in reading wondering to himself to you, here almost exactly a century later “whether there is more delusion in my theory than I should like to admit…[or] more truth in Schreber’s delusion than…people are as yet prepared to believe” + Unmanning, can reading a book change your sex? Margaret Mead made me gay, they say, but Freud defended himself manfully from all that unmanning, luder, shit, he was no He was not going to become writing his spinning his theory his unconscious his sex Unmanning, no he would not be Not a woman in another man’s arms Not a prostitute, a whore for some foreign God, Not luder, shit, prostitute, homosexual jew or woman becoming Not a jew, homosexual shit, prostitute becoming homosexual, not a Delusion. Just this, writing “the cross sexed wish, a symptom of the patients’ repressed homosexuality, harbinger of their savior fantasies, paranoia” A century of that, thank you doctor. Couldn’t you just have slept with Sandor yourself? In DIVISION/Review, no. 7 (Spring 2013), Oren Gozlan countered a neo-Freudian perpetuation of the presumption of
DIVISION | R E V I E W
myself feeling fraught, ambivalent, keyed up within that situation, I suspect something of this history of betrayals and lies that threaten to undermine the integrity of that mind that somehow works that voice through that body. Struggling there, I can sense and admire a problematically assertive and beseeching integrity inhering in that fragmented, dissolute, explosive, idealistic multiplicity of figure—implicitly, a person, mission, identity, politics. Writing a self-consciously politicized poetry, “directly confronting the question of social erasure and cultural marginalization” (Page/Odofemi, M., 2014), Salah positions her exchange primarily toward a literate, searching trans culture being born, while permitting others not just to eavesdrop but to submit to a fuller evocation of trans experience, including its internal confusions and societal debasement. As she says, her book does work with narratives, figures, and discourses that are messy, sexually violent, and sometimes toxic in their representation of trans lives. Some of those very ambiguous and problematic discourses, figures, and narratives are drawn from trans people’s self-representations, some come from the transphobia, racism, misogyny, ableism, erotophobia and racism of the broader culture…implicating the reader in eugenic rhetorics written across both historical and contemporary discourses on trans (and) gender. Doing this kind of work does feel like a risk, and an important one to take.
When Reality Intrudes Aisha Abbasi’s reflections on external intrusions, including events in the analyst’s life, on the therapeutic process represents a valuable contribution to the field of psychoThe Rupture of Serenity: External Intrusions on the Therapeutic Relationship By Aisha Abbasi London: Karnac, 192pp., $37.95, 2014 analysis and psychoanalytic psychotherapy. Abbasi’s sensitive exploration of external intrusions, from the waiting room, to machines, to personal events in the analyst’s own life, allows the reader to think more fully about the multilayered effects of these events on our own lives as well as on the lives of our patients, and how they may contribute not only to a disruption, but ultimately to the deepening of the treatment. I am reminded of an endearing quote by Henry Stack Sullivan, the famous interpersonal psychoanalyst, who eloquently stated, “We are all much more simply human than
We are at a trial, and our exes and our rivals and our friends Are indistinguishable. We know this from Tiresias. The economy of glances, drives, Itthey, are plural, lurid. Hands on thighs, eyes slide off of inside to out. We are border routines within “a departure from an unchosen place.” I hate that she is gone from here, and make her up. Is there any way to do this that is not ultraviolent? Obviously not. It takes all my sex to do so (again) and so There is blood, bone, blur of consciousness, cum. (a few words, hairs, a precious object). Heart of gold. An assistant professor of women’s and gender studies at the University of Winnipeg and winner of the latest prestigious Lambda Literary Award for Transgender Fiction, Salah is coeditor of the upcoming fourth issue of TSQ: Transgender Studies Quarterly from Duke University Press. She also hosted “Writing Trans Genres: Emergent Literatures and Criticism,” a conference at the University of Winnipeg in 2014 that, according to its website, “brought together writers, performers, critics, and community members to celebrate
and theorize an emerging body of literature by transgender, transsexual, two spirit, and genderqueer writers.” Such facts represent functions, not identity. While the contested issues within Lyric Sexology Vol. I may be being, becoming, and identity, situated in a contested dynamic of doer and done to, desire and abjection, Salah’s business is, partly, to make no assumptions, even regarding herself, despite numerous implicit and explicit references to potential understandings, while still providing not only goals and focus adjustments but also lively entertainments in a variety of genres. If some readers will inevitably refer any phrase back to the theme of trans life, as if it were to be defined and known as such, the text moves on, trumps its own order, returns us to experience, risking distraction and derogation all the way. I’m no spoiler. I won’t tell you how it ends. You needn’t remember a thing. A thing will. Don’t remember what I’ve come to. REFERENCES Gozlan, O. (2013). Transsexuality as a state of mind. DIVISION/Review, no. 7 (Spring), pp.26-28. Hall, M., and Salah, T. (2012). Genderqueer and trans poetics: An interview with Trish Salah. Cordite Poetry Review, http://cordite.org.au/interviews/genderqueerand-trans-poetics-matt-hall-interviews-trish-salah/ Page/Odofemi, M. (2014). Trans women’s lit? An interview with Trish Salah and Casey Plett. Canadian Women in the Literary Arts. http://cwila.com/trans-womens-lit-aninterview-with-trish-salah-and-casey-plett/ (unpaginated). Salah, T. (2014). Lyric sexology vol. 1. New York, NY: Roof. (2014). Writing Trans Genres, http://www.writingtransgenres.com/conference-description/
Shelley Galasso BONANNO
otherwise.” And so it can be said for both the patient and the analyst. As Abbasi notes in the introduction to her book, “This book was written as a life is lived; in bits and pieces, over time, its chaotic colours spilling onto the pages” (p.xv). Abbasi’s writing encourages readers to reflect not only on her therapeutic work, but also on their own. Analysis is a profoundly intense, deeply intimate relationship. Abbasi bravely addresses not only the analysis of her patients but her own analysis. And thus, reading Abbasi’s book, I was fondly reminded of my relationship with my own analyst, a cocreated relationship filled with enactments and rich transference and countertransference material. Despite Abbasi’s rigorous and extensive training as a psychiatrist, psychoanalyst, and a training and supervising analyst, she has an effortless way of revealing herself that is free of jargon and accessible to both the seasoned clinician and/or the curious patient. 6
DIVISION | R E V I E W
Her book engages and successfully bridges the gap between the often disparate worlds of the patient and analyst. Abbasi expresses gratitude for her patients, who bring to us “a gift of communication whatever the form” (p.65), and emphasizes that our patients often teach us valuable lessons by challenging us to “think deeper and reach higher” (p.93). Her tolerance for action on the part of her patients, allowing patients “to express in actions what they can initially not express in words,” is described in multiple clinical vignettes. Her ability to add to the text through these richly clinical illustrated vignettes reminds us of the value of storytelling, in stories of our patients as well as our own, as well as the narrative the patient and the analyst create together. Abbasi’s exploration of the impact of her personal life experiences as well as more direct external events on the therapeutic relationship such as world events—including 9/11—waiting room dramas between patients, revelations about the analyst—including Abbasi’s own
infertility struggles—and the richly detailed chapter about one patient’s tape recording of the analytic sessions are fascinating. Her discussion of the relevant psychoanalytic literature at the conclusion of each chapter supplements the clinical examples. Abbasi reminds us that analysis is a “discovery and rediscovery,” and highlights the value of writing about our clinical experiences. On p.149 she captures this beautifully by noting “all of us who are analytic writers continue to function not only as writers, but also as analysts as we write about our work.” Her sensitivity to exploring both her own responses and her patients’ deepens our own awareness and propels us to reflect deeper. Reflecting on the value of all communication and the analyst’s reactions to various forms of communication, she notes: “If, however
accepting and safe setting with an analyst who tolerated not only my own strong transference feelings but his own, often anxiety-producing, countertransference responses. As a psychotherapist, I know firsthand that self-disclosure and acknowledgment of countertransference feelings have not always been ideas synonymous with proper psychoanalytic psychotherapy and psychoanalysis. Abbasi’s description of her analytic sessions reveals how she does not allow conventional prohibition to become a barrier to her work. She feels comfortable exploring and considering the important and unavoidable, both spoken and unspoken, mutual impact that the transferences of both the patient and the analyst have on the therapeutic relationship. She speaks openly and in detail about her infertility struggles, her older child being transgen-
great deal through action what they cannot express in words” (p.88). Throughout the book, Abbasi repeatedly demonstrates how meeting our patients where they are at, and allowing ourselves to sit with our own uncertainty, unfolds into emotional growth and a deepening of the analysis. Noting that “different analysts have different degrees of tolerance for acting on the part of the patients,” she nonetheless notes the strong value of action and concludes, “All action, however—if it can ultimately be viewed through the analytic lens—can be a valuable source of information, and sometimes our only one” (p.88). Abbasi’s vivid descriptions of how she meets patients where they are and allows them to express themselves through both verbal and nonverbal communication helps the reader learn about her patient’s struggles as
the form of communication my patient has adopted is not particularly dangerous—but is unusual or jarring for me and makes me anxious—I work in trying to understand my own reactions so that I can better tolerate what the patient is doing to, and with, me” (p.65). In such a setting, “rich and effective analytic work can be done.” Abbasi’s exploration of transferencecountertransference dynamics, including those related to her own personal history and life events, allows the reader to explore specific ways in which various events affect their own therapeutic work and might directly and indirectly play a significant role in the co-construction of the therapeutic relationship. Abbasi’s words warmly remind me of my own analysis, an analysis conducted in an
dered, and ethnic/religious differences before and after 9/11. As analysts and therapists, we know that enactments and ruptures are unavoidable and necessary, albeit at times a difficult aspect of treatment. Through her detailed clinical descriptions, Abbasi helps the reader understand that ruptures are not obstacles to be avoided, but rather growth experiences to be embraced. Her curiosity and poignant descriptions of her own feelings are powerful, and the courage with which Abbasi reveals herself is moving. It allows us to explore and accept how our own personal experiences can make it difficult for us to always be at our “analytic best” (p.53). As so eloquently noted by Abbasi, it is often necessary for patients “to express a
well as her own, and reveals her compassion and unconditional acceptance of her patients. I believe it is here where Abbasi’s work shines. Abbasi not only acknowledges the strength of the therapeutic relationship but poignantly acknowledges the role our patients play in our professional and personal lives, as well as recognizing the impact that the external world has on our work. The juxtaposition of rupture and serenity, two seemingly contrary ideas, allows the reader to sit with the ambivalence the title suggests. And while one of the tasks of our patients is to work through their often idealized transference of us, in the end, as so eloquently narrated to us by Abbasi throughout The Rupture of Serenity, “we are all much more simply human than otherwise.” z
DIVISION | R E V I E W
Living on the Border This book is the product of a unique methodology—Ainslie’s “psychoanalytic ethnography” shows us both the personalities of those caught up in, and the social forces The Fight to Save Juarez: Life in the Heart of Mexico’s Drug War By Ricardo Ainslie Austin: University of Texas Press, 282pp., $25.00, 2013 behind, the “drug wars,” one of the most tragic and important social problems confronting both the United States and Mexico. The main value for psychoanalysts is in his keenly humanistic perspective, bringing to life these problems, as seen and experienced by his interviewees. The “War on Drugs” is behind such issues and problems as the recent increased immigration from Central America through Mexico; the gigantic increase in the US prison system, with over a million and a half people incarcerated for drug offenses, mostly cases of possession and use; and the waning of the middle class in Mexico and the United States. Ainslie’s thoughtful, detailed description of how the drug cartels came to wield such political power over the last two decades in Mexico gives us the background to these and many social issues. As a versatile anthropologist, professor, and maker of movies, as well as a psychoanalyst, Ainslie is able to integrate many individual points of view with a blow-by-blow account of how events unfolded over time. The Fight to Save Juarez gives a human face to the disintegration of civil society in one city just over the border from the United States. Using his psychoanalytic insight, Ainslie is able to capture the points of view of people from all rungs of the social ladder. He tops it off with a comprehensive analysis of the social structural features that have made Mexico, like so many other emerging nations, so vulnerable to the failure of centralized authority needed to provide the secure framework that economic development requires. Illegal drug consumption and trade inside the borders of the United States bear the responsibility for the rise of the cartels and the devastation they have brought to Mexico. Ainslie provides descriptive details of the devastation caused by Mexico becoming the primary path through which cocaine and heroin had to pass to get to the United States. By the 1990s, the city of Juarez (across the border from El Paso, Texas) had become home to
the most important drug cartel in the country. Between the wars among the cartels from different regions and the ongoing maintenance of discipline from within, there were an average of six to seven “executions” by drug dealers a day in Juarez alone during the years 2008–2012. When the rule of the cartels was finally brought under control, the death rate declined to only 700 per year in this city of 1.3 million. Given its lax gun control, the United States bears considerable responsibility for this slaughter, as well as for being the prime demand source for illegal drugs, because most of the hi-tech assault weapons which the cartels used, and still use, to overpower the Mexican criminal justice system, and even the national army, are supplied through illegal gun traffic from the border states of Texas, Arizona, and New Mexico.
This is well-known. But Ainslie is rare in showing in vivid and personal terms both the individual and social structural consequences of the drug wars in two ways: (1) he writes from a subjective intensity that shows his care and involvement with the city of Juarez and its people, especially through his relationships with his friends and “informants”; and (2) he weaves in the details of personal lives of the more than 56 key players he interviewed during the course of writing the book. These interviewees included mayors, municipal police, generals of the Mexican national army brought in to attempt to keep the peace when the corrupt and ineffective municipal police force had visibly failed, grieving relatives of the kidnapped, tortured, and murdered, members of the president’s security cabinet, and the mistress of a cartel leader. Through their eyes he shows us the dilemmas people face; for example, what does an honest politician do with a municipal system riddled with influence from the cartels? How is it possible to avoid collusion with corrupt influences without an adequate tax base or political support? 8
DIVISION | R E V I E W
Ainslie’s description of the details of this devastation is powerful. It would be useful to speculate on what made Juarez, and, more generally, Mexico, susceptible to such horrors. As I see matters, much of the devastation was set in motion by the North American Free Trade Agreement (NAFTA). Most Americans are oblivious to the terrible changes wrought to both the US and the Mexican economy by NAFTA. Since it was launched in 1994, for complex reasons related to globalization, it has drained the United States of thousands of well-paying jobs and negatively affected the US economy. In both Mexico and the United States, lower-wage jobs have displaced union jobs with security and benefits, decimating the middle class in both countries. (The TransPacific Pact, known as the TPP, the evil twin of NAFTA, is about to be considered by Congress and will have similar but far more sweeping devastating consequences on all sides of the Pacific Rim.) But the impact on Mexico has been far more destructive: the income of millions of farm laborers there is now one-third of what it was before NAFTA, leading to extreme, widespread rural poverty and starvation. Government policies regarding labor laws and the subsidy of important crops like corn shifted. In addition, more than two million jobs have been lost in the urban sector, where poorly paid temporary employment has displaced real job growth. This trend parallels the swing to “contract” or temporary employees in the United States, where real jobs with health insurance and retirement benefits are more and more scarce. Wages have shrunk in both the United States and Mexico too for the educated, who would have been the basis for a middle class. Mexico lost 15% of its white-collar jobs in the first six years of NAFTA. It is no accident that this time period corresponds to the rise of the power of the drug cartels, with a shift in the whole economy away from legitimate taxable production of goods and services, and toward unregulated, untaxed, and often illegal informal trade based on cash and street sales. This type of economy offers security neither to a government tax base, nor to workers, who have no benefits or reliable future, and certainly not to investors, who seek stability and predictability. In the decade before NAFTA, the stage was set for the shift to dehumanizing
low-wage jobs in Mexico. US corporations set up shop just over the border in order to manufacture as cheaply as possible, and succeeded in shifting the workforce to temporary employment without real benefits or security. These sweatshops attracted young women, aged 16–19, who were fired as soon as they married or became of age to become pregnant, in order for the factories to avoid having to pay the maternity leave required by labor laws. These factory owners used manipulative tactics to keep the young girls working for low wages: by providing cheap entertainment and distractions such as birthday parties and beauty contests for naïve girls with little education, factory owners for US corporations kept wages low and benefits nonexistent. At the same time, the factory girls were the target of a terrible backlash from their own society: a wave of at least 370 murders of vulnerable, temporary female workers, most in
their teens, took place from 1993 to 2005. Social scientists have blamed many different factors, such as their departure from traditional gender roles or religious values; they were perceived as taking away jobs from men. But surely the devaluation of these young women by the maquiladora system, and the successful shift to temporary employment without real benefits or security, contributed to their becoming targets for this violence (Iglesias Prieto, 1997). Media focus has been on the horrifying details of the violence the cartels use to control a terrified populace. Out of our need to believe in a just society, we try to persuade ourselves that there is a normal life where executions do not take place, and we ask, what makes people become so violent that they torture for pleasure or kill without compunction? We could think of the influence of intergenerational trauma—Mexico, like many Latin American countries in which power is decentralized, has a violent history. But perhaps even more immediate, the US corporations that brought in the maquiladoras have demonstrated such indifference to human rights, to the basics of life, that they paved the way for the sicarios, the assassins who carry out the orders of the cartel leaders. This provides one answer to the question that should concern us as
psychoanalysts: what makes people who have lived in peace for decades, supporting the public order, turn to such violence? The Fight to Save Juarez puts a human face on those whose lives revolve around the economy of drug transportation (almost all of the “product” is manufactured and consumed outside the country). There are obvious signs of society-wide trauma buried in Ainslie’s interviews. One such sign is that cartel operatives expect to die young, living fast and high, according to Ainslie. This “expectation of a foreshortened future” is one of the significant indicators of trauma that connect the economic downturn brought about by NAFTA with the damage done to the generation of young people now reaching adulthood. Ainslie’s chapter on “los Nini” illustrates the society-wide problem of the children who grow up having no care after they come home from school, drop out of a bad school early, and emerge into an econo-
my with no real jobs. American readers will be familiar with these problems from the other side of the border—in the television series Breaking Bad we were introduced to the narcocorridas, the popular songs that celebrate the casual brutality and dehumanizing power of the cartel leaders and operatives, and the sometimes extreme youth of the child assassins who have no ideals and no choices but those of the drug world. But the hunger and poverty are worse and the numbers are greater in Mexico, which has been subjugated to the drug-consuming appetites of the norteamericanos. Ainslie points out that the majority of those who are “executed” by opposing drug dealers are under 25 years old. A second sign of the trauma to and disintegration of traditional social structures is provided by the woman described in the chapter “The Mistress,” who does not aspire 9
DIVISION | R E V I E W
to marriage—she wants to be a mistress, considering it to be a more honest relationship, and one in which she can have more freedom. She knows she is sharing her man not just with a wife, but with several other women. When he is killed (she is still under 30), she discovers at his funeral that he has 12 children, only four from his marriage. As Ainslie portrays her life and aspirations: “Her life already exceeded what most from her background could have hoped for” (p.66). If “Elena” is typical of the intelligent, ambitious young women of her generation, the powerful social values of religion and family that have held this society together, for better or for worse, are changing radically. Perhaps the most prescient analysis in the book lies in the description of the pervasive and intricate collusion of the drug industry with the police hierarchy, not just in Juarez but throughout Mexico. This has long been the case to some extent, but the de-
struction of public faith in the police became complete with revelations about the volume of money passing through the drug system and into the hands of the police. The story of the recent “kidnapping” of students in Iguala demonstrates the degree of interpenetration between the two structures, and the resulting lack of public trust in government and criminal justice institutions. When the mayor of Juarez called in 5,000 soldiers from the national army in February 2008, it was a sign of his desperation in the face of the ineffectiveness and corruption of the police, but it was also the signal for the Juarez cartel to attack him and his government even more viciously. Ricardo Ainslie is well-known as a maker of anthropological movies on topics of social justice. The movie No Dancin’ in Anson: An American Story of Race and Social Change and further studies of communities in conflict and transformation capture important social realities. The main value for psychoanalysts in The Fight to Save Juarez is Ainslie’s keenly humanistic perspective seen through the eyes of his interviewees. He brings to life a view of Mexico that we are generally blind to. z REFERENCE Iglesias Prieto, N. (1997). Beautiful flowers of the maquiladora: Life histories of women workers in Tijuana. Austin: University of Texas Press.
An Interview with Dr. James Grotstein Sadly, Jim Grotstein died on May 30, 2015. Because he was alive when I wrote this essay, I used the present tense for general statements about him. I have decided to let that stand. After completing the article, I sent it to Jim. Here is what he wrote in return: Dear Bill, Thank you so very much for the biography. You certainly put a lot of effort into it. I admire that. On the whole, it seems to be me, albeit elevated in stature. Thank you very much for what you've done for me and to me. I have no corrections to make. Where is it going to appear? —Warmly,
On July 27, 2013, at 6:30 am, I drove the 95 miles from Santa Barbara, California, where I was staying with friends, to the home of Dr. James Grotstein, in Los Angeles. Jim was standing on the edge of the driveway, a short distance from the door of his house, waiting, as I made the turn. His smile was welcoming and expectant. He leaned, but not heavily, on the aluminum bars of a walker. I knew he’d been having some fairly serious health problems, and hence the prosthesis. He told me he called it “Johnny,” and his cane “Abel.” A third object to which he’d given a fanciful name was his antique Jaguar XKE, introduced as Nigel Bruce, after the English actor who, through many Hollywood Sherlock Holmes films, played Dr. Watson, as a comic foil to Basil Rathbone’s suave, unflappable Holmes. I followed Jim across his threshold; he moved with alacrity despite the encumbrance, and its seeming to rely on him rather than the obverse put me immediately in mind of the complex permutations of projective identification. He was soon to add to these by broaching his concept of projective transidentification, but I am getting ahead of my story. On seeing and greeting Jim’s gracious wife, Susan, who straightaway invited me to a bountiful breakfast at their table, I regretted the earlier stop I had made at a coffee shop. Over fruit, yogurt, coffee, rugelach, and several smaller tasty enhancements, we talked politics, travel, religion, culture, and family. I’d driven through Montecito on my way south. Sue and Jim said they love to go there because the landscape reminds them of Provence. It was casual and unhurried, like a visit to old friends. Jim told me how honored he felt that I’d come all the way from New York to interview him. Clearly, however, the homage was entirely mine. I am not sure how much
credence I give to Jim’s protestations of his own relative insignificance as a psychoanalytic figure, but I am bound by the canons of journalistic integrity to report on the frequency of his self-depreciatory remarks. Doubtless, he doth protest too much, and his dismissal of his stature and achievements must be juxtaposed with his oft-expressed disappointment at the failure of the psychoanalytic community in this country to read, review, and acknowledge his works to the degree they deserve. I asked him why he thought this was so. He attributed it to the absence of a “following,” his not having founded a school or attracted disciples. He did allow, however, that he has received appreciative mail from analysts in South Korea, Spain, and other foreign countries.
At some moment between the end of breakfast and our repairing to Jim’s study for the interview proper, he said, almost as an aside, or throwaway line, “I’m just a poor man’s Bion.” The statement threw me; it reflected insecurity and vulnerability for which I was unprepared. I hope to demonstrate the irony— doubtless unintended—of Jim’s assumption in the ensuing paragraphs: while it is true that Grotstein has built a significant part of his career explicating Bion’s work, he has done so with a clear and incisively critical eye. Further, he has made many original contributions to psychoanalytic theory and practice that owe less to Bion and Melanie Klein than to his own exploration, elaboration, and creativity. More than these, however, in his teaching and synthesizing of the intricate strands of psychoanalytic thought from a wide range of traditions and perspectives, he has few, if any, equals. Where Bion was a reserved, taciturn Englishman, given to enigmatic, elliptical, and ambiguous utterances, Grotstein is a warm, generous, effusive American Jew whose greatest pleasure, nay obsession, is to teach, to clarify, to explain, to convey. He wants you to understand and will not stop talking until you do. Not that he lacks a profound respect for the ineffable. Far from it, for he, like his mentor, is a mystic for whom “[t]he unconscious [Bion’s “O”], either is God or as close as we’ll ever get to it.” I think Grotstein accepts that there is much (perhaps too much) that we 10
DIVISION | R E V I E W
cannot know, but unlike Bion, he does not set about deliberately to render things more obscure than they are or need to be. In all probability, Jim would reproach me for holding such an opinion. He has often described how Bion used a discursive method intended to divert attention from himself as a source of knowledge in order to provoke his listener to seek his own knowledge. We are familiar with the intentions of Zen koans and the assertion that “[l]a reponse est la malheur de la question,” but there are also many things that can be taught and learned more directly without damage to the minds of either teacher or student, and Grotstein is a master of this approach. Thus, using the caveat that is the title of Grotstein’s book on technique, “…But at the Same Time and On Another Level…,” perhaps Bion was a poor man’s Grotstein. There is a supreme irony and pervasive tension in the phenomenon of this fundamentally gregarious, warmhearted man’s project to justify the ways of Bion (an aloof,
remote, Delphic personage) to (psychoanalytic) (wo)man.1 Minimalist and gnomic in his pronouncements, Bion evokes maximal explication and clarification from Grotstein. The precedents are Paul to Jesus, the Aaron of Schoenberg’s opera to his brother, Moses. In a magisterial stroke of the creative imagination, Schoenberg rendered only Aaron capable of singing, and of using his song to interpret the thought of Moses, who at first cannot speak and then is unable to sing, instead using sprechstimme, an updated version of operatic recitative, to express the ineffable nature of God. Grotstein mentioned that Bion felt he had died while serving as a British tank 1. The last part of this sentence is a clumsy paraphrase of Milton’s stated purpose in writing Paradise Lost, “To justify the ways of God to Man.”
Jim chose his study over his consulting room, located in a separate structure, for our interview. No sooner had we settled into our respective seats than I realized that I was about to commit a colossal error. On my three or four previous meetings with him, I’d formed the impression that his voice was robust and his enunciation clear. As a result, I did not bring with me the hearing aids that I sometimes use in my office when listening to patients whose depression, shyness, or other impediment reduces their speaking volume below my gradually diminishing threshold. Jim’s voice had lost sufficient resonance that, without my enhancements, I was able to apprehend only about two-thirds of what he said, the gaps varying among crucial, highly
had to be changed: she asked whether I would mind driving with Jim to a nearby restaurant where they ate often. I readily agreed, helped Jim into my car, and followed his directions to the place. The staff there knew him well and were very solicitous, seating us at a convenient table and providing attentive service. Over lunch, we continued the interview, and I continued to hear very imperfectly. After lunch, I drove him home, took a few minutes to make my good-byes to the Grotsteins, got back into my car, and drove off, faithfully heeding the pitiless voice of my GPS as it led me, by a series of tortuous routes, into the heart of a central California traffic snarl. The long delays afforded ample opportunity for brutal self-reproach and denunciation. I had time to reflect on my dereliction, its causes and consequences. There was also time to try to recall and piece together some of the things Jim had told me. He expressed regret at not having had more time with Bion. His analysis with him lasted six years, interrupted when Bion’s health took a turn for the worse and he was no longer able to see
blow, he resolved to acquire the training and education in the Kleinian system that would allow him to recover his sense of professional competence and its attendant self-esteem. Thus, though his analysis with Bion was of great clinical importance, it also served as the training analytic component of his sea change into a Kleinian. He told me that he regretted having been unable to visit and live in London for a sufficient period to obtain this training at its source, but also felt the distance from the inevitable politics and cultus of the institute had been an asset. Though he’d not been Bion’s colleague and student in London, his advantage over those who had was that he’d been Bion’s analysand and thus able to experience, firsthand, his technique and analytic style. Further, unlike the contemporary Kleinians of London whom he admired and, to some degree, envied, he’d been thoroughly schooled in classical psychoanalysis and the contributions of Fairbairn, prior to his Kleinian training. Jim was critical of the ever increasing popularization of Bion’s ideas by self-styled disciples who “memorize, quote, idealize,
significant, important, and inessential to my understanding. Further, I did not deploy the tiny tape recorder I’d brought with me. The reason was a certain sense of shame, the explanation for which I shall defer until I have the time for some serious self-analysis, or perhaps indefinitely. So I sat this way for about two hours, vainly straining for the words and phrases that systematically and seemingly perversely eluded me. From time to time I’d ask a question, but without any confidence that it was relevant to the content and flow of Jim’s discourse. If these handicaps made me appear stupid or demented, James Grotstein was too thorough a gentleman and sensitive human being to call my attention to it. At a little past noon, Sue came by and explained that her plan to serve us lunch
patients. This had been Jim’s third analysis. His first analyst was Robert Jokl, a classical Freudian; his second was Ivan McGuire, whose approach was Fairbairnian; and his fourth, due to Bion’s departure, was Albert Mason, a British Kleinian who had emigrated to the West Coast. Jim alluded to the event that caused him to enter analysis with Bion as well as to alter his entire analytic perspective radically. It was his response to hearing Betty Joseph (1971) present a paper about a patient who had a rubber fetish. He became seriously depressed, convinced that he was fraudulent and knew nothing about psychoanalysis. Joseph’s approach, her knowledge and skill, were so impressive to him that his own seemed insignificant in comparison. Under the impetus of this
and lionize him but don’t understand him.” Ironically, despite his apparent indifference and even hostility to it, Bion, both in life and posthumously, has acquired the sort of “following” that Jim feels is lacking in his own career. I was reminded of Milton’s lines, “Fame is the spur that the clear spirit doth raise / (That last infirmity of Noble mind)” (Milton, 1638, quoted in Harrison, 1959, p.422), and thought, too, of how Jim had remarked that “[b]eing a psychoanalyst is lonely because you are not really in a relationship with your patients so you need friends and there are not enough of them.” Apropos this observation, he added that “Bion was amazed that analysts in the US converse with their patients.” He also avowed that he deeply values his friendship with Thomas Ogden.
commander in France in 1918. In fact, he was the sole survivor of a savagely destructive engagement with the enemy. Such an experience may have so decimated Bion’s sense of his connection to life that the tone, syntax, and tenor of his utterance appeared to come from the grave. It fell to Jim to resuscitate this dead voice.
DIVISION | R E V I E W
Arriving back at my friends’ home in Santa Barbara, I tried to take stock of the circumstances my various lapses had created. When I’d asked Jim whether he’d ever been interviewed before, he said he had, by a Jungian journal, but his offhanded reference to the event clearly suggested that he accorded it little importance. Curious, I clicked on the Grotstein entry in PEP Web and found an interview published in the journal Fort Da in 2008, by a psychologist named Maureen Franey, formerly a supervisee of Jim’s. So far as I could determine, it covered much of the ground that I was able to recall, however incompletely, that Jim and I had covered, and a good deal more. It was, in fact, a very informative, incisive, sensitive, and comprehensive interview conducted by someone who knew Jim a lot better than I; more relevantly, she was able to hear him quite distinctly. I would urge anyone interested in having an intimate glimpse of James Grotstein as an analyst and a human being to read it. Where, however, did that discovery leave me? Among my few options, the most honorable would probably have been to call Jim, confess, apologize, and either abandon the project altogether or ask him to meet with me a second time, for which I would be careful to prepare. The latter would have made more sense had I not discovered the Franey interview. Though I might have tried to explore different or divergent aspects of Jim’s experience, the similarities I’d been able to detect between his responses to Franey and their fainter echoes in my interview suggested that the determinants of Jim’s discourse were strong and consistent; the likelihood of my diverting his stream of associations in new directions was not great. It is of interest in this connection that I asked Jim, a while before going to Los Angeles, whether there was any particular approach to the interview that he might prefer in terms both of content and format. He replied that his preference was to follow the fundamental rule, allowing his associations their freedom, the way he does when he lectures. That is, he does not follow a prepared script. In this, he accords with Bion:
Of Jim’s spontaneity and of Bion’s I think it accurate to say that, like good jazz, it is well rehearsed. But the passage also underscores another essential difference between Grotstein and Bion: Jim needs company. His energy is potentiated by the presence of others; Bion, even in a room full of people hanging on his every word, always seemed inherently alone. I ruled out the notion of a second interview, and considered what else I might do. Referring to psychoanalytic sessions, Jim differentiates between the text, the patient’s verbalizations, and the holding function, all the nonverbal operations by which the analyst provides a secure environment for the patient’s exploration of his mind. The predicament that resulted from my failure to bring my hearing aids was roughly equivalent to that of an analysand who, unable to apprehend the text, must place an inordinate degree of his hope for the session on the analyst’s willingness and ability to hold him. Another way to put this is that since the lyrics were difficult for me to understand, I had to rely much more on the melody. Fortunately, Jim Grotstein’s willingness to hold and contain is almost reflexive, and he is a consummate melodist. Another uncanny element of my visit was that immediately afterward, I was scheduled to attend the APA annual convention in Hawaii to present a paper about the film Gods and Monsters in which a young man comes to interview an older man named Jimmy, who is ill and cared for by a formidable woman who loves and dotes on him and disapproves of his impetuousness. That enterprise, like mine, founders on the interviewer’s blunders. Jim’s wife, Susan, is his formidable woman. The spoken and unspoken rapport between them is so strong as to be almost palpable, and a very significant dimension of it is their humor. They kid each other with the most admirable ingenuity and affection.
Bion once said, as he was being introduced to a large audience at a Franz Alexander lectureship, “I can hardly wait to hear what it is I have to say.” He wasn’t joking because he never read from notes. I have a muse, and when in a public forum I feel better. When I’m sitting at my computer screen, I feel all alone. There is no one resounding; I need company. (Grotstein, in Franey & Grotstein, 2008, p.5)
The way in which I decided to resolve my dilemma was to write an essay about it in which I would describe the experience with Jim as accurately as I could, conceiving it as a necessarily odd and incomplete account, yet including as much as I was able to recall of what he shared with me. In reparation for the inadequacy of my performance, however, I also resolved to append a brief review of the first of the two volumes of
DIVISION | R E V I E W
Jim’s comprehensive work on psychoanalytic technique, “…But at the Same Time and On Another Level…” (2009). Among the things Jim said that I did hear were that Bion, like him (and, incidentally, me), had majored in (“read” in British universities) English literature as an undergraduate, and regarded it as the best preparation for a career as a psychoanalyst. He added that he could not understand why Bion had gone on to study medicine. In contrast, Jim had been very enthusiastic about his medical studies and given up traditional doctoring to become a psychiatrist and then a psychoanalyst only with the greatest reluctance and sense of loss. Soon after we greeted each other, Jim asked me to
tell him what was going on in psychoanalysis in New York. Consistent with the other ways in which I was to disappoint him, some overt and some covert, I replied that I have no particular knowledge of the state of psychoanalytic affairs in New York, because of my place at the fringe rather than near the center of that community. I had nothing to add but the rather banal observation that relational ideas seem increasingly prevalent among the analysts of my acquaintance. Here, Jim made the first of several references to his concept of “projective transidentification,” which posits that the projection is not into the other, but rather the image of the other in the mind of the person doing the projecting. He emphasized this repeatedly, underscoring that it diverged from the relational idea that the other is the direct recipient of the projection. Grotstein loves ideas: he is profoundly gratified and excited by thought, the life of the mind, and philosophy, with a special interest in the pre-Socratics, Kant, Hegel, and Nietzsche. He is an unabashed mystic and has explored Kabbala in addition to Asian mysticism. He accepts and advances Bion’s idea of truth or ultimate reality as the
irreducible entity that is the ultimate ground of all experience, believes that the Freudian drives should be regarded as subordinate to this, and that ultimate reality is essentially unknowable except indirectly and in small doses. Further, he disagrees strenuously with Freud’s view of the unconscious as a repository of untamed and dangerous impulses, preferring to see it as the source and locus of all creativity. He therefore feels on good terms with it. In this, he also diverges radically from Melanie Klein’s jaundiced perspective. Indeed, it would not misrepresent Grotstein’s position to say that his view of human nature is basically optimistic; that is, he sees the mind as a creative, constructive kind of initiative that, given facilitative op-
portunities, will develop and grow in desirable directions. He does not so much dismiss the more sinister inclinations that are such prominent aspects of Freud’s and Klein’s theories as subordinate them to the realm of defense, and to the role of players in the larger drama of the person’s evolving relation to his own psychospiritual potential. These proclivities may have some roots in aspects of Grotstein’s childhood. For example, he mentioned that his mother became a Christian Scientist around the time of her pregnancy with him. Her father had been a rabbi and she retained her Jewish faith even while practicing Christian Science, finding no necessary contradiction in doing so. His family were not observant Jews, though they were very clear about their cultural heritage and conveyed this to Jim. He recalled being surprised when an aunt who had remained orthodox refused to attend his bar mitzvah reception because his mother did not keep a kosher home. I had attended a handful of earlier conferences at which Jim presented papers that were predominantly theoretical, with occasional interpolations of clinical material, but it was not until the fall of 2008 that I was
able to observe Jim Grotstein, the clinician, at work. He was invited to the Institute for Psychoanalytic Training and Research (IPTAR) both to speak and to supervise an ongoing treatment case conducted by an experienced analyst in front of an audience. The analyst provided some background and then gave a verbatim account of a recent session. Jim intervened frequently, demonstrating his method of listening to the linkages from one association to the next, so as to educe “the [patient’s] maximum unconscious anxiety before the defense against it.” The Kleinian rationale for this procedure is that the patient will experience it as empathic because it addresses his helplessness at the time the anxiety began. Grotstein calls this process “the parsing of associations.” It resonated instantly with my recollections of the interpretive method of an Argentinian Kleinian analyst with whom I had studied in the early 1970s, who quoted Klein on the necessity to find “the point of urgency” in each moment of the session. Unaccustomed to the stichomythic style of authentic Kleinians, both the presenter and members of the audience seemed frustrated by Jim’s approach to supervision, though there was a general grudging admiration of his ability to follow the thread of the patient’s unconscious fantasy through myriad transmutations. To me, it seemed a virtuoso performance, but when Jim alluded to it during our interview, he said he thought it had not gone over well. I protested that many of those present had much appreciated his performance. Had it occurred to me, I might have added that 31 years earlier, Bion had met with levels of disapproval and rejection from IPTAR audiences that made their response to Jim seem positively congenial.
Jim Grotstein is a prolific writer, having published 12 books and more than 250 articles. “…But at the Same Time and On Another Level…,” his two-volume treatise on psychoanalytic technique, was published in 2008. He asked me whether I’d read this work; I was ashamed to say I hadn’t. He asserted that few people in the United States had and that the book had never been adequately reviewed. Again, I consulted PEP Web for references to any reviews of the book and discovered that the same psychologist whose interview of Grotstein had been published in Fort Da had also 13
DIVISION | R E V I E W
published what appeared, from its length, to be a substantial review (Franey, 2011). I have no reason to assume either that Jim was disingenuous or unappreciative, only that he may have wished for another interview and additional reviews. The book’s title is unwieldy but informative. It refers to the essential difference and transition from psychotherapy to psychoanalysis, as well as from whole to part-object relationships, and finally from intersubjective to intrapsychic experience. Here is Jim’s elucidation of the ideas involved: Thus in any analytic session, the analysand may be discussing his father, mother, wife, husband, boss, and so on, with great emotion. The analyst must listen carefully to what the analysand seems to be consciously feeling and carefully survey these affects, inquire into them and even comment on them. Then, once the analyst begins to detect a pattern to the associations, he may then seamlessly end the “psychotherapy” and initiate the analysis with: “…but at the same time and on another level I believe that your mother, about whom you have those deep feelings, may also be a way of talking about a mother-me.” (Grotstein, 2009, pp.2122, emphasis in the original) Implicit in this passage is Grotstein’s delineation of the distinction between Kleinian/Bionian analysis and that of the classical and relational schools widely practiced in the United States. The former he characterizes as “the fundamental technique for psychoanalytic treatment” (Grotstein, 2009, p.3, emphasis in the original) because of its emphasis on unconscious phantasy, omnipotence, and agency. For this reason, he considers it best suited to deal with pre-Oedipal, part-object relations, in contrast to the American schools (including ego, relational, interpersonal, and self psychologies). Building his case for this opinion, he undertakes an incisive review of the approaches in question. His descriptions of them are accurate, his assessment of them fair, and his command of their contributions, positions, and interrelations authoritative. This broad survey of the field creates a context for Grotstein’s elucidation of Kleinian/Bionian technique. In truth, however, this volume is not so much a primer of technique as a study of the theory of technique. That is, it is a close examination of all aspects of theory—and especially Kleinian theory—that bear on the question of how best to conduct an analysis, but does not, for the most part, provide examples of the method. This is left for the second volume,
which is primarily an annotated collection of clinical illustrations. Because both volumes, but especially the first, introduce and use complex and often arcane ideas, the reader benefits immeasurably from Grotstein’s tireless repetition of his ideas, each time in a different and uniquely illuminating context, the process akin to the gradual emergence of a holographic image. An anecdote Jim told me about how during his analysis with Bion, he asked him to repeat an interpretation and Bion replied that he would not, because the moment had passed and therefore become irrelevant, highlights the divergence of their sensibilities. Jim’s native inclination, as I have maintained earlier, is to be prodigal with his knowledge; Bion’s was to choke his back.
defending them systematically with lucid and tenacious arguments. His professional credo is reflected in all of his writings; he assumes full responsibility for it, inviting criticism and comment from his readers. Not infrequently, an analyst whose work has been published or presented is described as “very human.” The comment is often made when the analyst discloses an instance in which she breached the treatment frame under circumstances regarded as special, such as extending the session beyond the allotted time to allow the patient to finish speaking about a particularly distressing event, or disclosing something of the analyst’s personal experience that paralleled a situation in the patient’s life. These moments are sometimes discovered to be
I have two criticisms of Jim Grotstein’s book, neither of which detracts much from its overall excellence. The first is that his attempts to demystify Bion’s thought sometimes fail as a result of what appears, at times, to be a compulsion to show off his own erudition. The second is that Jim seems constitutionally unable to jettison or discard any concept once he has cathected it; rather than suffer the pain of renunciation, he prefers to work the less valued of his ideas into some distal nook or cranny of his theoretical structure.
enactments that, when analyzed, may prove useful to the treatment. More often, however, they are not analyzed, and their effect on the treatment can be shown to be deleterious. It is precisely for the latter actions that some observers reserve the term “human” as an expression of their admiration. My contention is that humanity does not inhere in behavior that may appear kind and sensitive on the surface while being disruptive and counterproductive in its unconscious consequences. What does qualify as human is epitomized in the work and character of James Grotstein, whose transparency is a function of a disposition to share his working method in molecular detail, exposing each linked procedure to degrees of scrutiny that most speakers and authors in our field rarely risk. Complementary to this unconstrained access to his work, he has published and made available a selection of biographical material and personal anecdotes that contribute to an understanding of
James Grotstein’s contributions to theory and technique are of unquestionable value. Nevertheless, there is another quality he embodies that is sufficiently rare among his colleagues to deserve our special attention. I am referring to his courage in taking explicit positions about so many of the key components of psychoanalysis, and
DIVISION | R E V I E W
how a psychoanalytic career evolves over the course of a lifetime. These disclosures contain little that would stimulate a scopophilic appetite but much that might inspire and enlighten anyone contemplating or engaged in a career as an analyst. Grotstein is a consummate professional. He has devoted his entire life to his absorbing passion, to put his skills, knowledge, and person at the service of the work of being a psychoanalyst. He has struggled and suffered with competing ideas, theories, methods, and allegiances throughout his life, and though his analytic identity is that of a Kleinian/Bionian, the precipitate of myriad other approaches informs and enriches his work. Unlike other advocates of particular systems, Grotstein evinces respect and esteem for ways of thinking about the mind that are widely divergent from his own. Further, he keeps open channels of dialogue with analysts of all persuasions and is easily able to learn from them. An octogenarian, he continues to be as avid a learner as he has been all his life, a fact reflected in the variety and exponential richness of his erudition. This focus on Jim’s unique accessibility must inevitably return us to his unremitting struggles with experiences, memories, and the specter of Wilfred Bion. His writings and other communications convey that Bion was a towering and troubling presence in his life, one that has goaded him into the position of advocate, apologist, critic, explicator, and even adversary. That Jim has always presented this relationship in all of its irresolution and disquiet is no slight evidence of his uncompromising honesty with himself and with those of us who read his writings. I have said that, for Jim, the source and ground of all human motivation is an ultimate reality that cannot be known directly and that this entity (called “O” by Bion) is identical with truth. W. B. Yeats, a few weeks before he died, wrote in a letter to Elizabeth Pelham, “Man can embody truth but he cannot know it” (quoted in en.wikiquote.org/ wiki/William_Butler_Yeats ). Jim Grotstein comes as close to that embodiment as any person I have ever met. z REFERENCES Franey, M. (2011). Book Review: “…But at the same time and on another level…” Psychoanalytic theory and technique in the Kleinian/Bionian mode (Volume 1) and “…But at the same time and on another level…” Clinical applications in the Kleinian/Bionian mode (Volume 2) by James S. Grotstein, M.D. Fort Da, 17, 73–82. Franey, M., & Grotstein, J. (2008). Conversations with clinicians: Who is the writer who writes the books? Fort Da, 14, 87–116. Grotstein, J. (2009). “…But at the same time and on another level…” Psychoanalytic theory and technique in the Kleinian/ Bionian mode (Vol. 1). London: Karnak. Harrison, G. B., ed. (1959). “Lycidas,” by John Milton. In Major British Writers, (Vol. I). New York: Burlingame, Hartcourt Brace and World Inc. Joseph, B. (1971). A clinical contribution to the analysis of a perversion. International Journal of Psycho-Analysis, 52, 441–449.
Transsexuality and the Art of Transitioning
The Brain, the Mind and the Self
The Legacy of Sandor Ferenczi
By Oren Gozlan
By Arnold Goldberg
Edited by Adrienne Harris, Steven Kuchuck
A Lacanian approach
A psychoanalytic road map
From ghost to ancestor
Get 20% off with code IRK71 at www.routledgementalhealth.com
Contemporary Psychoanalytic Perspectives
A Rumor of Empathy
Contributions to Clinical Practice
Resistance, narrative and recovery in psychoanalysis and psychotherapy
Edited by Milton Kramer, Myron L Glucksman
Edited by Alessandra Lemma, Paul E. Lynch
By Lou Agosta
Routledge... think about it www.routledgementalhealth.com 15
DIVISION | R E V I E W
Listening to Audiotapes of Psychoanalytic Sessions and Rating Them: A Clinician Engages in Process Research Karl STUKENBERG
Listening to hours, rating them, and then discussing the ratings and the process of the therapy is a terribly rich process that mirrors other clinical processes, such as supervision, but is also radically different from these processes. I think that while the listening that I do as a researcher is similar to the listening that I do as a clinician, there are unique components to the research listening that help to improve my therapeutic functioning. These include a subjective sense that analysis is a worthwhile endeavor, and the ability to more accurately label, evaluate, and describe what it is that I am doing in any given clinical hour. Finally, I think that there are advantages to not having the person doing the treating be in the room as the work is heard and discussed. The first component of the research process is listening to the work of other analysts. This is not something that I have had the experience of doing except in the context of this research, aside from my own analysis and seeing a few brief role-playing sessions of analyses. I have to admit to a certain privileging of the analytic hour—I think of it as a sacred space and expect there to be qualitative differences between it and psychotherapy. I think that carries over to listening in on the work of my peers. I feel privileged to be allowed into the analytic hour, and appreciate the analysand’s willingness to let me be privy to their thoughts and lives. While I have watched videotapes of my own psychotherapy while I was in training and now videotapes of my supervisees, I have rarely heard the work of seasoned clinicians. I have wondered if there would be a qualitative difference between the seasoned clinician and the novice, and also between psychoanalysis and psychotherapy. There are significant differences between listening to analyses and tapes of other clinical work. The analytic silence is something that distinguishes the work. Analysands talk longer and seem to be interrupted less, and there is, at least for stretches, periods when they are deeply immersed in their material. That said, analysts are a chatty group, much chattier than I would have thought—and chattier than my own analyst was (or than I experienced him as being). And the things that analysts say range all over the place—they do not simply offer clarifications and interpretations, but engage in the entire range of the therapeutic repertoire. They also have personal styles. Some focus almost exclusively on the transference as manifested in the here and now. Some engage their patient’s material
and lives much more broadly. Even in the work of those who are most focused on transference and the here and now, there is a great deal of talk about the stuff of life— riding in the taxi on the way to the session, relationships with significant others in the person’s life, the fee and the parameters of treatment, and so forth. What seems to me to be consistent across analyses is a tone—we don’t have a scale for it, and I don’t know that we can rate it. It is a certain kind of meta sound that I look for in the therapy hours of the beginning trainees that I supervise. It has less to do with the particulars of what is being talked about and more with the sense that the back and forth, the prosody, the leading of the patient, the following of the therapist, sounds right. I think it has to do with a sense that the analysand should, given reasonable ego strength, feel safe, supported, and heard, and that the therapeutic or analytic space is an open place that they can play within. I think the prosody is poorer in those cases that are approaching or at an impasse, but that then becomes a research question if we can figure out how to quantify what I am talking about. But the basic idea is that analyses that are going well sound like good therapeutic work; even if the rhythm involves more analysand airtime than other therapies, there is still a kind of call and response that occurs. In fact, there is more back and forth than I expected, but a good therapeutic atmosphere predominates, and if anything a somewhat richer one than I am used to in other therapeutic interactions. I attribute that partially to the level of comfort/familiarity between the analysand and analyst, which derives, at least in part, from having learned more about the rhythms they can expect of each other based on more frequent contact and contact across a longer period of time. Learning the Analytic Process Scales (APS) has been good for my clinical practice because I have had to figure out what it is that analysands are doing at a particular moment, to rate them, and more to the point, to rate what analysts are doing. The first thing I have learned is that what we do is a bit of this and a bit of that. A single analytic intervention may be rated 3.0 (out of 4) on clarification, 4.0 on interpretation, 2.0 on support, and 3.0 on encourages elaboration. And it might range all over the map on how useful an intervention it is—anywhere from 0 to 4. A supportive comment may be just what is needed in this moment; an interpretation may have been too distant and off-putting. 16
DIVISION | R E V I E W
The language that we use to talk about analytic technique is an abstract one; it can be applied to what we do, but not cleanly. In fact, we are engaged in a conversation—informed by technical considerations, but underneath it all, it is a linguistic interaction, with all the mess that this implies. It is sloppier than we would like to think when we are reading papers and discussing them, and when we are presenting case material that has been “edited for clarity.” The position of being a member of an audience is another way that listening to the research experience is different than any other kind of listening I have done. By the time we hear the analysis, it is a done deal. The work has been terminated and the analyst has decided to donate the recording to our collection. Even when the analysand mentions the researchers—all of the analysands know the work is being taped and the taping becomes grist for the analytic mill—we are an idea, not actual people the way a supervisor might be (though some analysands fantasize that our input will affect the analytic process because they imagine that we are listening to the tapes between sessions and interacting with their analysts about the material). In addition to the lack of interaction with the analysand, with one exception, the analyst is not present. We are able to talk about the work quite frankly. Not to impress, not to present, but to try to accurately characterize—as accurately as we are able, for good or ill—what is occurring at this moment in the analysis. We don’t have to worry about hurting someone’s feelings or managing our desire to do so, nor of stroking their ego. We don’t have to think about the larger context of telling others how to do this work, or of learning how to do it; we are listening from an oddly empirical/analytic position and then can engage in conversations about that. I actually think that, being free of the considerations noted above, we are able to inhabit a particular kind of analytically neutral position. Oh, we pull for the analysands—we want things to go one way or the other, but we don’t have to frame a response or worry about the impact of our formulations. They don’t bear on the outcome of the work. That said, I think that we listen compassionately. We want to know, as best we are able, what is occurring in the mind of the analyst and in the mind of the analysand. Even in those cases where there is an impasse, my experience of the group is that we are thinking, “There, but for the grace of God, go I.” We are empathic both with the analyst,
who is caught up in something that, as far as we can tell, is not understood, and with the analysand, who continues to struggle in whatever way with the analyst. Recently, we presented some case material, and some audience members—we privately referred to them as hawks—were quite critical of the analyst. What they didn’t know was that the analysis had an objectively very good outcome, and that some of what they were criticizing we had come to see as essential to the analytic process. So we have learned to listen to the work with a more open mind. We are not, though, an audience of one. One of the fascinating things about this is the different aspects of the work that each of us pick up on. While we may agree (or not) on the “red thread”—the main theme—there are subthemes that others may find that I have not heard at all. One of the frustrating things for me as a supervisee is when the supervisor hears a theme and pronounces it the one that should be followed. I find in the research listening that many themes are being developed, and that whatever is interpreted highlights some of them, but leads to the masking of others. With a tape, it is possible to listen twice. I am frequently better able to hear some material the second time through. On a case we listened to this week I went back and listened to some very early hours. The initial presentation of the patient was so odd—I was trying to figure out just how psychotic he was, and from that listening position I missed some key “objective” pieces of information that would have indicated that he was actually functioning at a much higher level in most of his life than I had thought. The emphasis on differences between what members of the research group pick up from sessions might obscure a more important part of the work. The quality of our conversations about the analytic process is very high. We are thinking and reflecting on the work in sophisticated and novel ways. We reference other research, but also theoretical perspectives and particular papers. And it is a confidence builder to be able to engage in a conversation, to appreciate with other clinicians the intensity of the transference and to arrive at what is generally a relatively consensual understanding of what is taking place within a given hour. Finally, the research helps me to feel more comfortable with my own intuitive approach to connecting with analysands, more comfortable even than supervision does. The supervision hour is, of course, not an analytic hour. It is a conversation about an analytic hour, one that I report as accurately as I am able, but it ultimately is filtered by how I have heard and interpreted what happened in the analytic hour. It also is one in which I feel a need to justify what I have said or how I have
intervened—and not one in which I feel as much freedom as I might to imagine myself into the psychoanalytic space. In our research discussions of the analytic work, on the other hand, we all have a shared text—and recording—of an analytic hour. While I was not the analyst, I form analytic interventions in my head as the hour moves along. The similarities and differences between what I formulate and what the actual analyst produces are informative, as are the group discussions of the range of options that would have been available and the impact of the chosen intervention. I think that in my own personal (training) analysis there were moments of intuitive connection with my analyst, and with his intuition about what was occurring within me. I also think there was a parallel process occurring between the patients
supervision—I am able to hear it without a certain investment and can connect with it, oddly, more directly. Hearing the recorded analyses as a model for my own analytic work is facilitated, I think, in part by listening to the work of someone who is not in the room and that, in turn, allows for a different kind of listening. In an hour where I am the analyst, I have my own associations available to me. This enriches but also limits my ability to evaluate the accuracy of what I am interpreting to the client. When listening to a case, not having the associational networks of the patient or therapist available helps us better evaluate how effective a particular intervention is. Does the intervention deepen the treatment? Or does it confuse the patient? This is never as clear, whether in the analytic or the research seat, as
I was treating and the process in my own analysis. It was eerie to then use the interpretations that he would offer later in my functioning as an analyst—but the latency was very short. Listening to tapes of sessions feels more like accessing this source of support for my interventions. It is closer to the lived experience of an analytic process— it more closely mirrors it, because it is, after all, exactly that. I feel a sense of analytic kinship in the presence of the recorded analytic pair. And I feel that this pair becomes a model—not the only model, because none of the cases that we listen to embody a perfect analysis, but a model for how analysis should be done (and sometimes for how it should not be done). Both of these inform the work that I am currently doing almost as vividly as being in my own analytic process. Perhaps it is easier to hear the work of others than it is to hear my own work in
we would like it to be, but there is something about the researcher’s listening stance that facilitates this process. This, in turn, helps my treatment, because it teaches me to let go of my associations as I listen to the response of the analysand to my intervention. What is the quality of the response? How disruptive was it? Did it move things forward? This pulls me a bit out of the analytic reverie, but also keeps me from becoming too locked in (I hope) to my own interpretation of events. I have found this research to be directly helpful to my clinical functioning. It is not sterile, distant, and focused on results, but warm, immediate, and clinically lively and relevant. The analyst/analysand pairs serve as models, and the process of rating, discussing the rating, and discussing the case and thinking about what is taking place clinically is a much more clinically relevant task than I imagined when I first began this work. z
DIVISION | R E V I E W
What Fades in the Rearview Mirror
It is difficult to end any human relationship by mutual design. Life intercedes—relationships end abruptly or with prolonged false stops and starts that require decoding. Sometimes unresolved memories of abandonment or other emotional pain reprint on the fabric of the present, making a simple good-bye impossible. If we are lucky enough we can have sufficient time
responsibility is it to inform clients or patients of a loss, and how are impending, unexpected losses addressed within the therapeutic process? How do we help someone through an ending that has instigated a re-enactment? Considerations of ethics and best practices are involved. There is also a need to revise protocols in order to address some of the contingencies of modern life.
When I would ask Barbara if we could please stop talking about the book and the group, she would say yes, but the request had no lasting effect. The next week, as soon as we sat down, Barbara would begin talking about the same two topics, interspersed with random childhood and young adult memories. Sometimes Barbara talked for 40 minutes. She wouldn’t stop until I in-
and space to prepare for a perfect theoretical closure. On the other hand, what makes a resolution successful may not always be immediately apparent. Ferenczi believed that “a complete analysis entails an infinite period of time” (Ferraro & Garella, 2009), which might embrace the fact that patients, and we ourselves, are often working through multiple layers of losses. This essay will focus on a confusing termination I had with a former analyst, which I will use to explore the dilemma of disappearances in our profession, and the process of unexpected terminations. Whose
My previous analyst and I ended our work together in a slow, disintegrating manner. I had been asking for months if she (I’ll call her Barbara) could please stop dominating sessions. Each week Barbara told stories based on two themes. One story was about a neurobiology book she was reading on the topic of love. The second story was about a neuropsychology study group she had joined. I had been a member of that same study group as a graduate student, but had chosen not to continue once the group moderator switched from “in person” to Skype sessions.
terrupted with: “There’s something I wanted to explore today.” I realize that my degree of patience and politeness may be more excessive than the average client; however, my tolerance was in direct proportion to my respect for Barbara. Her behavior was out of character. Prior to these unsettling interactions, Barbara had been a focused, perceptive, and sensitive psychotherapist. My original motivation for seeing her had been to address attachment issues, stemming from growing up with an emotionally absent mother. I credit Barbara with helping me to grow a
DIVISION | R E V I E W
mind, including working through current situations wherein I re-enacted unhealthy patterns. I worked with her throughout graduate school, through an internship at an acute psychiatric hospital, and through the completion of my dissertation. I did formal analysis with her for eighteen months wherein I came to depend on Barbara’s timely and pointed interpretations. I suppose in retrospect there were foreshadowing moments of what was to come. At one point, Barbara and I argued over a bill. Her accounting system seemed illogical, which I told her. She was clearly angry, and even slightly paranoid, as if I was trying to cheat her. I was puzzled by the intensity of her reaction, since I had been consistently conscientious about money matters over the years. At the time of our disagreement, I wondered if I was being unreasonable. The same self-doubt descended when Barbara referred several times to my dog, who had been dead for three years, as if he was still alive. She liked to revisit the story of how the rescue dog and I had cautiously bonded a few months after I had been bitten in the face by a friend’s Australian shepherd. The story had been a metaphor, like a cracked cicada shell, from which our later work had taken wing. I wondered if I had run away from some illusion that Barbara was intentionally circling me back to uncover. Instead, we occupied the emptiness of the outgrown metaphor together. The final six months of sessions with Barbara were particularly untenable. I felt disconnected and often left her office dissatisfied. When I addressed what I found unsettling, Barbara was defensive: pushing the focus back on my internal issues, assuring me that our relationship was not problematic. I asked if it were possible to change how we worked together, such as allowing more space at the beginning of the session, or taking measured pauses. Barbara deflected the focus back to my childhood and an accompanying lack of trust. Grasping, I told Barbara that perhaps I needed a new therapist. She said that was a good idea, but offered no referrals. I ended up choosing a male analyst, esteemed in the community, someone whom I also held in high regard. He had been Barbara’s mentor. We first addressed and worked through the jagged closure with Barbara. Fast-forward two years to last October, when I was sitting one afternoon by the front window of a coffeehouse with a therapist friend. Barbara and her husband walked by. Barbara stopped to linger outside the window, staring at a planter of red geraniums. I was uncomfortable. I noticed that she seemed older; she had let her hair go white. My friend was talking about a
movie she had recently viewed, but I wasn’t really listening. When Barbara finally walked away, I told my friend why I had been distracted. I explained the years of work with Barbara and my reaction to a perceived abandonment. The friend, who also knew Barbara, paused, then said, “I’m not surprised that was difficult for you. She’s losing her mind.” The friend explained that Barbara had closed her practice during the past year due to the onset of dementia. The friend said, “It’s amazing how long she was able to hide it.” My initial reaction was anger. I had invested months of energy and emotion trying to grasp why Barbara and I had become so misattuned. Was it something I had done, somewhere I had become stuck? It would never have occurred to me to consider that Barbara’s sharp mind—she was in her early sixties—would abandon its own orbit. It began to make sense why she dominated the therapy sessions to stay engaged and in control. She likely wasn’t aware of what was happening. Once I realized that Barbara was struggling with dementia, I could access other octaves of emotion. I wish I had known sooner, so that it would have been a less chaotic transition, and I could have more easily cherished the places where her mind has given mine its retrofitted foundation. There are other issues. When I told my new analyst the story about Barbara’s dementia, he was quiet at first. Then he said that he had gone to visit her a few months after hearing my story and the stories of other members of the psychoanalytic community. “It was difficult to accept that it was happening to her,” he said. “I was shocked. It was quite tragic.” He described how Barbara had reached the point where she could no longer sustain her practice. Things devolved quickly. She gave up her office. The psychoanalytic community here is relatively small but vibrant. I was curious why it took two years to find out about Barbara. It made me wonder if there is so much public shame and fear around dementia that we can’t have an open dialogue. What are our ethical obligations as therapists in disclosing vulnerabilities that may impact the quality of our work as well as our clients’ psyches? My analyst apologized to me when I brought the subject of Barbara up again a second time, as my anger waned and was replaced by deep sadness. He questioned his own omission in not sharing the knowledge of Barbara’s illness with me or with others who might have been negatively impacted. In addition, he had not initiated Barbara’s evaluation and review by appropriate peers in the psychoanalytic 19
DIVISION | R E V I E W
community. He described having requested such a review of another analyst in the past, who turned out to be of quite sound mind. Our minds and our bodies are essential instruments of our work. We promise, in a sense, that patients can borrow our minds, and that we have the capacity to hold clients in mind. We help clients think in the midst of emotional turmoil. We brave the subtle and sometimes precarious work of tending the gates of the unconscious. What happens when those same gates fall open in us? Dementia, especially in its early stages, is relatively invisible. What do we do as psychotherapists and analysts if our main tools fail us? If my analyst had passed away rather than losing her mental capacity, I could easily have found public access to her obituary, or a memorial announcement. I also wonder why someone in the community, such as her husband, who was also in health and human services, didn’t help her compose a letter to clients and former clients to help them with closure. What comes to mind is a poem, “A Ritual to Read to Each Other” by William Stafford, particularly these two final lines: “the signals we give—yes or no, or maybe—should be clear: the darkness around us is deep.” Since I was no longer Barbara’s client when she stopped practicing (a year later), she had no obligation to inform me of her office closure. Nor did my analyst have an obligation to tell me about her condition. And yet, that information would have been immensely useful. Otherwise, I had no way to understand what seemed like a live re-enactment of early maternal abandonment. On the other hand, because I had developed a sufficient amount of insight and resilience during years of sessions with Barbara, I was able to easily make the transition to another therapist. Our dissolution was not traumatic enough to require months of sessions to repair the loss. I moved on. Perhaps Barbara and I had already come to the end of our work together, but we had not yet made a conscious articulation of that fact. I can stand back now and consider the irony of holding what Barbara lent me of her mind, inside of my mind, which enfolds and expands and attests to her fine clinical skills. It is, in a way, an infinite process. In any case, I have been able to let Barbara go with honor and respect. I hold, like a mental talisman, the words she often quoted from her beloved Sullivan: “more human than otherwise.” z REFERENCES Ferraro, F., & Garella, A. (2009). Endings: On termination in psychoanalysis (Vol. 10). Amsterdam: Rodopi. Stafford, W. (1953). A ritual to read to each other. Retrieved from http://www.williamstafford.org/spoems/ pages/ritual.html
Das Unbehagen of Duchamp, Dada, and Psychoanalysis In 1917, Marcel Duchamp submitted a urinal to the first annual exhibition of the Society of Independent Artists here in New York under the pseudonym R. Mutt. Duchamp was one of the founding members of this organization, along with Walter Arensberg, Katherine Dreier, Man Ray, and Joseph Stella. This society was founded with the intention of providing a platform for individual artists to showcase their work, whether new, experienced, experimental, or avant-garde, and was dedicated to advancing the ideas of independent artists, free of juries, prizes, or ranking of any kind. As long as one paid the entry fee of six dollars, one’s work would be shown. The first annual exhibition included over 2,000 works of art. The catalog was organized and the exhibition hung in alphabetical order by the artists’ last names to ensure equal treatment. Yet shortly before the opening, the society refused to show Mutt’s (Duchamp’s) Fountain. Apparently the Society of Independent Artists was not as open to new ideas of art as one would have liked to believe. Once Duchamp proved this, he soon resigned from his position as a director. A similar event occurred in France before Duchamp moved to New York in 1915. In fact, the Society of Independent Artists was modeled after the French Société des Artistes Indépendants, who in 1912 held their twenty-eighth exhibition. Duchamp submitted Nude Descending a Staircase (No. 2), to be hung with the cubist work. Although the cubists were the innovative movement of their time, they developed a strict set of rules for themselves, and while Nude contained the fragmentation, synthesis, and muted colors associated with cubism, the movement in the piece was said to be of futurist influence. Duchamp, however, has often stated that he was not aware of the futurist movement at that time. Cubist images were to be static/fixed. Even the title was under attack, being too literary. Duchamp’s brothers, Jacques Villon and Raymond DuchampVillon, were sent to break the news to Duchamp, who quickly proceeded to pack up his painting and take it home in a cab. This same work became the most talked-about piece of the Armory Show the following year. The International Exhibition of Modern Art, organized by the Association of American Painters and Sculptors in 1913 and henceforth known as the Armory Show, was the first largescale exhibition of modern art in America. Images we find iconic today shocked and appalled audiences at the time. Teddy
Roosevelt declared, “This is not art!” (Roosevelt, 1913), while the media likened them to cartoons and child’s play. Duchamp’s Nude was quickly satirized as The Rude Descending a Staircase (Rush Hour in the Subway) by J. F. Griswold of the New York Evening Sun (Blythe & Powers, 2006, p.41). Viewers were outraged, as they had never seen art of this kind and did not understand how to relate to it. It was called un-American: an attack on cultural mores and religious values. And although the Armory Show included many pieces by well-established and more traditional artists, including Mary Cassatt, Edward Hopper, and James Whistler, the shock and outrage that ensued from works such as Duchamp’s Nude and Matisse’s Luxury has forever linked the signifier Armory with the avant-garde, pushing and questioning the boundaries of art as espoused by institutions. Gabrielle Buffet writes of this time, “All of us, young intellectuals of that period, were filled with a violent disgust at the old, narrow security; we were all conscious of the progressive decline of reason and its experience, and alert to the call of another reason, another logic which demanded a different experience and different symbols” (Buffet, 1949, p.255). The year 1913 was significant in the history of psychoanalysis as well. By this time, Freud and Jung had run the course of their passionate collaboration, which ended with Jung’s formal resignation from his position as president of the International Psychoanalytical Association (IPA) in 1914. In the years before World War I, psychoanalysis had begun to secure itself in Europe and North America, with societies established in Vienna (1908), Berlin and Zurich (1910), New York and Munich (1911), and London and Budapest (1913). In 1909, Sigmund Freud made his historic venture to the United States to give a series of lectures at Clark University on invitation from G. Stanley Hall. Accompanied by Jung and Sandor Ferenczi, this trip marked Freud’s first and only visit to America. The three men spent several days sightseeing in New York with fellow psychoanalysts, A. A. Brill and Ernst Jones, before traveling to Clark University, where Freud gave a series of lectures detailing the rise and growth of psychoanalysis. In Geopsychoanalysis (1981), Jacques Derrida delineates the impact sociopolitical culture and geography had on psychoanalysis as it took root in different countries throughout the world. As World War I was imminent, many began to flee their homelands. For many artists and 20
DIVISION | R E V I E W
intellectuals, the war produced a collapse of confidence in the rhetoric and principles of the culture of rationality that had prevailed across Europe up to that point. The birth of mechanized warfare, with its massive death tolls, coupled with the totalitarian politics of the time, produced a sense of the fragility of civilization. In his essay “Thoughts for the Times on War and Death,” Freud discusses the disorientation of modern man, expressing disillusionment with the civilized world, namely, the state, and acknowledging the altered attitude toward death that this, and every war, forces upon its people. “The individual who is not himself a combatant—and so is a cog in the gigantic machine of war—feels bewildered in his orientation, and inhibited in his powers and activities” (Freud, 1915/1957, p.275). Dada was born in this crisis of disillusionment, its collaborators’ wartime experiences greatly influencing their collective body of work. Dada presented a skepticism of society’s accepted values and consensus worldview, while embracing new ways of thinking and utilizing new materials and methods, including collage, montage, assemblage, ready-mades, performance, and chance. Quickly shattering certain conceptions about the nature of art, including the appropriate mode of creating, viewing, and experiencing artwork, Dada valued cacophony, dreams, and the violation of syntax as techniques for freeing the unconscious from the domination of reason and tradition. The Dadaists felt that up to this point art had served civilization—their antiart would challenge it. Their radical rethinking of art making was fundamentally a collective achievement born of a moment of moral and intellectual crisis. The Dadaists made use of new media that allowed for contact between persons across long distances—letters, postcards, journals, magazines—that not only provided important means of sharing but were also incorporated into new forms of artwork. These correspondences between artists and writers in different cities across the globe traced the movement of ideas that transformed art and intellectual thought as it had been known. The aims of the Dada movement were often supranational, emerging amid the racially tinged nationalistic discourse of World War I. A central tenant of Dadaism was antinationalism, fashioning itself as a network with centers in Zurich, Berlin, Hannover, Cologne, New York, and Paris; a web of connections linking its various contributors, serving as a conduit of ideas and
images. Dada promoted a global identity, and even though Europe and North America contained the city centers of the movement, Dada was as far-reaching as Japan. Buffet describes the atmosphere of the time as being heavily charged as a result of the unusual gathering together of individuals of all nationalities, each with unique talents. “It also turned out to be an exceptionally favorable climate for the development of a certain revolutionary spirit in the domain of the arts and letters which, later on, became crystallized in Europe under the name of Dada” (Buffet, 1938, p.13). At present, in the psychoanalytic community, a diverse group of psychoanalysts,
group of peers, a series of lateral relationships have been created among those who wish to revitalize the field of psychoanalysis. Free from hierarchical structure and authorizing bodies, the key is to maintain this position, a position akin to the analytic position, and not be swept up in the wellworn cycle of the avant-garde becoming the next institution. DU considers questions around the event of its own inception, institutional structures, psychoanalytic formation, case presentation, maintenence of the analytic position, and what that would mean for a collective of this sort: a group attempting to exist without leaders. This year the
philosophers, and graduate students have come together across “national lines” to meet under the signifier Das Unbehagen. Most universities and psychoanalytic institutes in New York City are represented. The inaugural year included meeting with Otto Kernberg and Lewis Aron to discuss psychoanalytic training and development, clinical study days with David Bell and Alain Vanier, and discussions with Simon Critchley and Guy Le Gaufey, among others. Peer supervision, study, and working groups have formed. Individuals are coming together to facilitate lectures, conferences, and publications. Now in its third year, Das Unbehagen (DU) continues to develop as a platform to support independent professionals interested in the study and practice of psychoanalysis, free from the constraints of judge and jury. As a
first of a series of experimental clinical case presentations was held. For “Without History,” three prominent psychoanalysts—Muriel Dimon, Patricia Gherovici, and David Lichtenstein—were given process notes of a case without being provided with the analysand’s history and were asked to interpret the information however they saw fit. The result was an engaging discussion between panelists and audience members that continued well after the event. Continuing in this vein of maintaining inquisitive dialogue, Gherovici and Jamieson Webster are planning a conference called “Acephalic Communities: Unbehagen and Unbelonging,” to be held in Philadephia—the home of the largest Duchamp collection in the world—while Lichtenstein is organizing a series of conversations entitled “Institute/No Institute,” 21
DIVISION | R E V I E W
to begin in the fall. Also concerned with systems and societal constructs outside of the field of psychoanalysis, “Civilization and Its Blisscontents: On Violence and Psychoanalysis,” a conference on violence in all of its forms but most notably those inherent in systematization, including medicalization and diagnosis, systemic racism, privilige, and class structure, facilitated by Manya Steinkoler and myself, was held at Fordham University this spring. Psychoanalysis was once called “the knowledge that disturbed the peace of the world.” What happened? Even as early as the time of the surrealists, psychoanalysis was seen by some as yet another method of compartmentalization and categorization. When did free association, begin to be co-opted as a means of organization and normalization? When did the focus shift away from the desire to enable the subject to speak with no intention set upon what the outcome should be? The Dadaists moved away from formal organization and conventional structure by embracing chance, dreams, free association, and automatic writing. Duchamp remained autonomous while playing a key role in several artistic movements over the course of his development. In this vein, DU has the potential to be a vehicle of support for the individual who desires to forge one’s own path, whether that path be completely comprised of independent study or utilizing resources to supplement formal training. Practitioners are welcome from every theoretical orientation and may remain a part of any institution they wish. What is encouraged is self-direction, the building of bridges, and fostering of working relationships. As the introduction to modern art forever changed our culture, the way we perceive beauty and push the limits of creativity and innovation, I ask the same of psychoanalysts today: tread your own path, and as Alain Badiou (2000) so eloquently states, “Persevere in the interruption.” z REFERENCES Badiou, A. (2000). Ethics: An essay on the understanding of evil. New York: Verso. Blythe, S. & Powers, E. (2006). Looking at Dada. New York: The Museum of Modern Art. Buffet, G. (1938) “Arthur Craven and American Dada,” Transition, Paris, no. 27. Reprinted in Motherwell, R. (1951). The Dada painters and poets: An anthology. 13-17. 2nd ed. Cambridge: The Belknap Press of Harvard University Press. Buffet, G. (1949). “Some memories of pre-Dada: Picabia and Duchamp.” Reprinted in Motherwell, R. (1951). The Dada painters and poets: An anthology. 255-267. 2nd ed. Cambridge: The Belknap Press of Harvard University Press. Derrida, J. (1981). “Geopsychoanalysis...and the rest of the world.” In Psychoanalysis of Race. 65-90. Christopher Lane [ed.] (1998). New York: Columbia University Press. Freud, S. (1915). “Thoughts for the times on war and death.” In J. Strachey [Ed. and Trans.] (1957), Standard edition (Vol. 14, pp.273–300). London: Hogarth Press. Roosevelt, T. (1913). “A layman’s views of an art exhibition,” Outlook, no. 103, Reprinted in Roderick Nash (Ed.) (1970). The Call of the Wild (1900–1916), 718–720. New York: George Braziller.
The Conflict of Power in the Analytic Dyad In recent years the development of agency has become an increasing focus of analytic therapy across theoretical perspectives. The common experience of seeing the patient unable to take a psychologically active role in making change despite insight into unconscious patterns has frustrated clinicians and undoubtedly given impetus to the introduction of agency as a primary therapeutic goal. Less discussed are the concrete clinical implications that may follow from conceptualizing therapeutic action as agency. This is all the more important given the fact that the means by which we attempt to achieve this goal are the same as those deployed when understanding was regarded as the only tool of analytic change. Very few analysts still believe that making repressed material conscious is sufficient, but a gap remains between this awareness and clinical technique. The hallmark of analytic therapy has always been interpretation, but if the analytic process consists in the patient’s receipt of the analyst’s interpretations, the patient is in a consistently passive position, and one wonders how agency can develop under such conditions. Or, to put the point in the reverse: how is the patient to become agentic from the passive position of absorbing the analyst’s interpretations, no matter how accurate they may be? To be sure, some contemporary analysts include the role of the relationship in therapeutic action, rather than confining therapeutic movement solely to the interpretive process. However, the problem persists, because the provision of a relationship can promote passivity to the same degree as a sole focus on interpretation. When the emphasis is on what the therapist does to or for the patient, the conflict between therapeutic intervention and the goal of agency is present. So, the dilemma becomes: how can the analytic relationship, with its focus on depth understanding and relating, facilitate the development of the capacity to take ownership over one’s life? Jessica Benjamin (2004) has addressed this problem most directly by advocating a role for the patient to be “knower” and “doer” as well as “known” and “done to.” Benjamin’s solution is a model of analysis in which each party is able to be on both sides of the binary, both “knower” and “known,” “doer” and “done to.” By experiencing both poles of the binary, the patient is not consigned to a single position, whether passive or active, but is able to move between the two. Psychic ownership for Benjamin involves the ability to assume both positions of the binary.
Benjamin’s transformation of the analytic field into a space in which the patient experiences both sides of the binary is a step forward, because it provides a role, at least in theory, in which the patient is active. Nonetheless, the process is an alternation of “doer” and “done to,” and neither may involve an active role for the patient. No one would argue that “being done to” is an agentic position, but it is less obvious that being the “doer” can lack agency. As I have elaborated elsewhere, the Nike slogan “Just Do It” implores thoughtless and affectless
agency means that the analytic space must at some point be opened to the play of possibilities. At that point the therapeutic space becomes what Winnicott (1971) called potential space, an openness unstructured by interpretation or therapeutic provision. In this unstructured space, both sides of the binary can be given their due, and even more tellingly, the patient is not locked into the options of the binary. In the free play of potential space, possible ways of being and relating that transcend the binary are facilitated and become possible.
activity (Summers, 2013). To make a move of whatever type without self-reflection or thought for the consequences is not agency, but in a very real sense, mindless activity that is psychologically passive. Agency is the use of one’s capacities to make a free choice. Impulsive or frenetic activity tends to lack psychological action, so such behavior is not agentic and is not the goal of analysis; it is not blind behavioral action to which we aspire, but informed action based on the exploration of thought and feeling. I emphasize the psychological passivity of mindless activity because being a “doer” or being “done to” does not define what we mean by agency, and therefore adopting both positions at different times is not the determinative factor in agency. Because agency is freedom, it is the freedom to adopt the active or passive positions based on the exploration of each that defines agency. This point has determinative clinical implications. The fact that free choice among enacted positions is the key to
It is this space of experimentation with conflicting options that provides the best opportunity for the patient to create a third alternative of her own making from the elements of each side of the binary. Ownership of one’s psyche and taking control of one’s life mean the ability to transcend the binary, rather than living on its split-off poles. The ability to transcend the givens of any situation constitutes the very nature of agency. Negatively stated, it is the refusal to be confined to the givens of any particular situation that defines the sense of agency toward which analytic therapy directs itself. Psychological power rests in neither behavioral activity nor passivity, but in the ability to choose which position is most self-enhancing and effective in any given situation. That is why Benjamin is right that agency embraces the ability to assume both passive and active positions, but we must be sure to recognize that it is the ability to choose each state or create some amalgam from the two that is the key to therapeutic action, not simply the enactment of each side.
DIVISION | R E V I E W
Ultimately, power resides in the ability to create one’s own way of being from the givens of any particular situation. The analytic relationship can be used for that purpose if it is constructed as a space in which new possibilities can be created, what Winnicott (1971) called bounded formlessness. Such a space requires the analyst to relinquish her position not only as interpreter of the patient’s speech and behavior, but also as the one who provides for the patient in any sense. The therapeutic posture is fundamentally transformed from the provision of the patient’s needs, whether for understanding, the provision of functions, or a type of relationship. Any such role is abandoned in favor of an openness in which the analytic pair can explore possibilities that transcend the binary. The analyst’s role is that of facilitator of the patient’s efforts to find a new way of being or relating. What emerges is likely to be unforeseen by both patient and analyst. The therapist follows the patient’s lead to see what in the patient’s thoughts, feelings, and associations can be an element out of which a new way can be created. The analyst may see potential in the patient’s material, but she can only stoke it as the spark from which a fire can be built. The patient’s power comes from the analyst’s willingness to relinquish her position as the one who knows or provides. The analyst gives up power because if the analyst is the only mem-
ber of the dyad who uses power, the patient is reduced to the position of desubjectified passivity. The analyst’s surrender of his power is not a position of passivity, but an active relinquishing in order to provide the openness in which new ways of being can be created and articulated. As Ghent (1990) famously put it long ago, the analyst surrenders but does not submit. The difference is that surrender is agentic, a freely chosen state to do what is judged to be best at the moment, whereas submission is a capitulation, an enforced passivity in which the self collapses, even if temporarily, from external pressure. Thus, the way out of patient passivity toward psychic empowerment is paved by the analyst’s willingness to surrender his privileged position in favor of becoming a facilitator of new psychic possibilities in the open space created in the analytic relationship. To give one brief illustration, consider the patient who is masochistically compliant. The issue is not that the patient needs to adopt the sadistic position of the other who controls her so that she can move between the masochistic and sadistic positions. Both are pathological states in which the other is split and desubjectified. Pathological compliance is pathological because the patient is driven to comply and feels no freedom to do otherwise. In a word, agency is lacking. Compliance is not always a pathological phenom-
The Value of “Progress” in Psychoanalysis Anxieties about the “erosion of our profession” (Eisold, 2007) have become widespread in the past 10–15 years. While economic factors have certainly affected our sense of well-being, Paul Stepansky’s 2009 cri de coeur Psychoanalysis at the Margins convincingly argued that psychoanalysis’s internecine battles have contributed to our marginalization. I believe we have entered a period of serious reflection, with efforts to rethink some of our core values and concepts. I want to focus here on the idea of “progress” as foundational to our attempts to reshape our identity and self-image. Splits and rivalries have been part of psychoanalysis since its inception. Some of the factors that have continued to fuel our divisiveness include identification with our rivalrous forbears, wishes for theoretical certainty in the face of difficult and ambiguous work, conflicted relationships to authority, and the inclination for more introverted and cerebral personality types to affiliate through ideas. Hopefully, by continuing to be curious about the
underpinnings of our schisms, we will be able to better see our profession in perspective, and ultimately to better explain our unique value to the public. Beginning to acknowledge the price we’ve paid for our splits and antagonisms has paved the way to better recognize the more integrative and progressive trends in our field. In this essay, I want to highlight some of these trends—in theory and technique, training, research, and applied psychoanalysis—and to explain why we should embrace the idea of progress itself. THEORY AND TECHNIQUE When we discuss the advancement of psychoanalysis, we usually speak in terms of theory. We are typically attracted to the profession by the fact that it offers a theory of mind and mental functioning. Like Freud, who embarked on a quest for a grand, unified theory of mental functioning, analysts tend to be theoretical and conceptual creatures. Thus, our controversies and antagonisms are typically fought out on the level 23
DIVISION | R E V I E W
enon; it is pathological only because it is the only thing the patient can do. The patient lacks the freedom to say “no,” to be in conflict with the other. If the analyst is always the “knower,” the analytic relationship is in danger of repeating the patient’s lifelong pattern of accommodating the one who knows. At some point in the analytic process the patient will need to develop the capacity to determine when to go along with and when to oppose the analyst. The analytic space, if opened to the play of possibilities, to experimentation with when to confront conflict and when to accommodate the other, can provide the opportunity for choosing compliance or confrontation, depending on which relational option fits the exigencies of the moment. And that requires a therapist who gives the space over to the patient’s experimental possibilities and thereby relinquishes her therapeutic power to the free play of the patient’s imagination. z REFERENCES Benjamin, J. (2004). Beyond doer and done to: An intersubjective view of thirdness. The Psychoanalytic Quarterly, 73(1), 5–46. Ghent, E. (1990). Masochism, submission, surrender: Masochism as a perversion of surrender. Contemporary Psychoanalysis, 26, 108–136. Summers, F. (2013). Psychoanalysis in the age of Nikeism. Presidential Address, Spring Meeting, Division of Psychoanalysis, April 25, 2013, Boston, MA. Winnicott, D. W. (1971). Playing and reality. New York: International Universities Press.
Steven D. AXELROD
of theory. In the past few decades, though, explicit integrative attempts and innovative ideas have helped better contain theoretical splits and antagonisms, contributing to progress in our field. In recently reviewing a series of papers from prominent interpersonalists from the 1950s and 1960s onward (Axelrod, 2015), I was struck by how the ideas of these “dissenters” were ultimately absorbed more broadly to good effect. The contributors to the original roundtables had championed the mutative effects of a warm, supportive, authentic relationship between analyst and patient in opposition to the cold scientism of contemporary American ego psychology. While in some ways simplistic and dogmatic in its presentation 50–60 years ago, the core idea has carried the day and our field is the better for it. In our field, new theoretical discoveries typically emerge in opposition to the mainstream and are enshrined in “schools” that make totalistic claims similar to the theories they seek to supplant. But over time, in a
kind of dialectical process (D. Lichtenstein, personal communication, December 8, 2014), the different theories interpenetrate and lead to a more broadly accepted version of the “dissident” theories. This is evident in contemporary efforts to incorporate Kohutian and relational innovations into the more traditional approach. Psychoanalysis has a tradition of leaders (e.g., Loewald, Sandler, Kernberg) who contribute at the interface of the major theoretical traditions, and thus provide integrative force to our profession. Others, like Wallerstein and Pine, have made explicit attempts to further theoretical integration. Wallerstein (2002) argued that the common ground of psychoanalysis is to be found in experience-near clinical theory, while diversity is to be found in experience-distant general theories or metapsychologies. He called our general theories “scientific metaphors” that reflect the happenstance of training and personality differences rather than any verifiable truth. In his integrative 2011 paper “Beyond Pluralism: Psychoanalysis and the Workings of Mind,” Fred Pine argued that important developments in psychoanalysis over the past century, while giving rise to “conflicting theories and sect-like groupings,” can best be understood as “filling in gaps that Freud specifically excluded or failed to develop fully.” In words that helped inspire this essay, Pine stated: Psychoanalysis does itself a disservice, in the public eye and in the eyes of those in neighboring academic and scientific fields, when it allows itself to be seen either as locked into the theories that Freud formulated from seventy to one hundred and ten years ago, or as a splintered field with varying sets of contradictory ideas, each with adherents that contradict one another’s views. This is not only a mistake conceptually, a misreading based on historical and group processes that shall be described, but also an unnecessary and grave error in terms of our professional identity and public image. (2011, p.824) Like Wallerstein, Pine has emphasized the disjunction between psychoanalytic theorizing and the everyday work with patients—the practicing psychoanalyst makes use of what seems to fit in the moment regardless of his espoused metatheory. I believe that the real progress in psychoanalytic theory is taking place at this more pragmatic, clinical level. The more we face the diversity and difficulty of day-to-day psychoanalytic work, the more differences in metapsychology recede into the background as helpful belief systems
rather than causes for disparagement and exclusion. The more we focus on effectiveness in actual clinical work, the more we can see that the different metatheories are valuable primarily in providing tools for listening, understanding, and intervening at different times with different patients. Psychoanalytic work from 50 to 100 years ago could seem schematic, overly
understanding of how the inner world develops. Fonagy and other attachment theorists have challenged the psychoanalytic mainstream to incorporate phenomena related to threat, fear, safety, affect regulation, and early relationship patterns, giving the working psychoanalyst more tools for listening to and responding to patients.
certain, and distant from the patient, with the analyst focused on fitting the patient into the procrustean bed of his or her theories. Now, our different theories offer us tools to stay with the patient’s experience, think (and feel) more open-mindedly about what he or she is saying and doing, and intervene in a more genuine and related fashion. The growth in the psychoanalytic study of mind that Pine so compellingly described is intertwined with an increased range and receptivity of the analyst’s listening, which I believe has led to increased therapeutic effectiveness. Progress in psychoanalytic theory has occurred through innovation at the boundaries of psychoanalysis and other disciplines. Our growth as a field is measured in part by the extent to which new ideas can influence psychoanalysis through a kind of semipermeable membrane of our profession’s boundaries. For example, Fonagy’s work on mentalizing has been described as “the most generative new concept in psychoanalysis [over the past two decades]” (Gazillo, Gordon, & Waldron, 2015). Fonagy has woven together the attachment work of John Bowlby with Joseph Sandler’s careful thinking about internal representation to expand our
Innovation has also occurred at the interface of psychoanalysis with brain science. The founding of neuropsychoanalysis as a formal domain some 20 years ago brought together two perspectives that had appeared not only divergent but antagonistic. Work in this area has provided confirmation for some core psychoanalytic ideas (the unconscious, drives, attachment, dream processes, etc.) and has the potential to reshape some of our clinical concepts and techniques (Axelrod, 2012).
DIVISION | R E V I E W
RESEARCH Leaders in our field have argued for a more robust research agenda as the key to our future (Eagle and Wolitzky, 1989; Kernberg, 2002; Waldron, 2010; Fonagy, 2013). The need for research is in part a pragmatic one—we live in a world that is built on and values scientific discovery, and we need to demonstrate that our theories and treatments have scientific validity. But beyond proving our legitimacy to the wider world, I think a broad program of empirical research plays an important part in fostering our integrity and maturity as a profession. The capacity to change some of our ideas and methods as a result of empirical findings is the mark of a more mature, less insular and defensive profession.
Wallerstein’s outcome study from the Menninger Clinic (Wallerstein, 1986) is a good illustration of how research can have a broad impact on psychoanalysis. The results of that study helped alter previous assumptions and certainties about the differential effects of psychoanalysis and psychoanalytic psychotherapy, and have helped reshape clinical practice. We continue to debate and investigate the questions Wallerstein raised over 30 years ago. Are the mechanisms of psychoanalysis and psychoanalytic psychotherapy significantly different? Do patients benefit differentially from the two treatments, and can we identify who benefits more from one than the other? Does psychoanalysis (or higher-dose psychotherapy) yield more durable long-term effects than lower-dose psychotherapy? Our integrity as an organized profession rests on our ability to confront an issue such
as the differential impact of psychotherapy and psychoanalysis head on, and to be willing to learn and change our views on it. This issue is a complicated one, and like anything in our field, challenging to investigate, but as we continue to refine our research we demonstrate true open-mindedness and integrity. Beyond investigating whether our treatments work and under what circumstances, we are using increasingly sophisticated tools to explore the complex interaction between patient and therapist and how change takes place in clinical work (Gazillo et al., 2015). Learning about what therapist traits and activities are most effective is actually a high-stakes effort—it has the potential to improve our clinical work but also to threaten our narcissism. We are at a critical juncture where we can either continue
to put our heads in the sand, insisting that the patient-analyst dyad is too complex to study empirically, or we can incorporate what we are learning from our fine-grained analysis of the treatment process into our training and continuing education. TRAINING Our experience of being a profession in crisis derives in good measure from the relative scarcity of psychoanalytic candidates over the past twenty years. But the falloff in candidates has also helped force a rethinking of the entire training process, and I want to consider some of these trends in psychoanalytic education and training. Settlement of the GAPPP v. APsaA (American Psychoanalytic Association) lawsuit in the early 1990s broke medicine’s hegemony over psychoanalytic training in the United States. The opening of the ad-
missions process in psychoanalytic institutes has significantly expanded the talent pool for our profession. The William Alanson White Institute recently accepted the invitation to join APsaA, and further invitations are in the works. Continuing efforts to integrate our training programs and professional associations should reduce the schisms that have prevented the broad collegial contact that is essential for innovation. APsaA institutes are expanding and enriching their curricula to reflect more theoretical diversity and pay more attention to psychotherapy, which constitutes the lion’s share of most analysts’ practices. APsaA’s efforts to fundamentally change the Training Analyst (TA) system has brought howls of protest and has deeply divided 25
DIVISION | R E V I E W
the organization. The problem of concentration of power in the cadre of training analysts must be addressed for organized psychoanalysis to become better aligned with contemporary organizations that are increasingly characterized by open systems, distributed power, and less hierarchy. Hopefully, changing the TA system will reduce the constraining influences of fear, insularity, and malignant group dynamics on the developing mind of the psychoanalyst. The creation of outside accrediting and certifying groups such as the Accreditation Council for Psychoanalytic Education (ACPE) and the American Board of Professional Psychology (ABPP) for psychoanalysis represents further attempts to confront the self-interest and concentration of power that has distorted our education and training system. ACPE has developed a set of standards agreed to by groups with different theoretical points of view and different institutional interests, and provides an invaluable source of feedback for our training programs (L. Aron, personal communication, January 19, 2015). ACPE and ABPP represent progress away from potential abuse of power toward professionalization and systems of accountability. This appears to be a time of ferment for psychoanalytic education and training. There are now models other than the traditional freestanding institute. Whether based on the evolution from institute to center or more explicitly university-based, I believe we are moving toward a vision of psychoanalytic education that balances a “trade school” focus on building clinical skills with a mission to advance, apply, and more widely disseminate psychoanalytic knowledge. APPLIED PSYCHOANALYSIS Applied psychoanalysis in the traditional sense—the “use of insights gained from clinical psychoanalysis to enlarge and deepen the understanding of various aspects of human nature, culture and society” (Moore and Fine, 1990, p.27, quoted in Esman, 1998)—began with some of Freud’s greatest contributions. However, Esman has taken issue with our use of the term, in part because it implies that clinical psychoanalysis is more truly psychoanalytic than its “applications.” He quotes Freud in “The Question of Lay Analysis” (1926/1959): As a “depth psychology,” a theory of the mental unconscious, [psychoanalysis] can become indispensable to all the sciences which are concerned with the evolution of human civilisation . . . the use of analysis for the treatment of the neuroses is only one of its applications; the future will perhaps show that it is not the most important one. (p.248)
If we accept Esman’s argument that clinical psychoanalysis (and psychoanalytic psychotherapy) be considered an application of psychoanalytic concepts to the clinical situation, then the range of psychoanalytic contributions to the understanding of social problems, trauma and disaster, cultural developments, intergroup conflict, organizational dynamics, economics, and finance, as well as history, biography, art, literature, and music, will stand side by side with clinical psychoanalysis. Progress vis-à-vis applied psychoanalysis depends on mitigating our bias that the clinical practitioner is the pre-eminent psychoanalytic professional. Indeed, clinicians do not have a monopoly on “psychoanalytic mindedness,” which is rather widely distributed among practitioners of applied psychoanalysis. In advocating a “big tent” approach to all the applications of psychoanalysis, I am not just urging inclusiveness for its own sake. Rather, I believe that valuing the full range of our applications is essential to maintaining our profession as an “open system.” Our progress depends on this openness, our ability to be influenced, and to influence, other disciplines and systems of knowledge. These “dialogues of influence” make us feel more relevant and engaged and extend our impact beyond the consulting room.1 IN CONCLUSION This essay is based on my belief that we can identify areas of progress in the psychoanalytic professions,2 and that the idea of “progress” provides a unifying principle for our field at a critical time in its evolution. The idea of progress is useful in both an inward-facing and outward-facing sense. Internally, recognition of how our field progresses can give us an increased sense of confidence and helps build an overarching commonality (we can all contribute in our own ways). Externally, it better aligns us with other professions and intellectual pursuits—we are not “stuck in the past” but contributing to general betterment. Objections to the value of progress could come from a few quarters. To the traditionalist, identification with progress could connote a distancing from what has made psychoanalysis both unique and powerful. Progress, moving toward the future, implies a different worldview than the timelessness of the unconscious, a core tenet of psychoanalysis. To some, the idea of 1. A more comprehensive effort in this regard could be useful in fostering awareness of opportunities for engagement and in helping us better appreciate our richness and vitality. Some of the applications that interest me are described in the DIVISION/Review blog at www.divisionreview.com. I encourage you to add to the conversation by describing some of the applications you are working on or are familiar with. 2. “Psychoanalytic professions” (plural) conveys the open systems, pluralism, and breadth of applications that is aspirational for our field.
progress might suggest a kind of acceptance of the same cultural trends that our field uses psychoanalytic concepts to critique. From a postmodern perspective, the idea of progress may well be suspect. Progress could be identified with the kind of rationality and linearity that postmodernism has called into question. Indeed, the idea of progress risks being a chimera, one that ignores or leaves behind the dispossessed. However, I believe there is more agreement now than 20 years ago that rejecting modernity and celebrating the primitive is not a solution to our problems. The idea of progress does not equate to blind boosterism—it needs to be carefully and skeptically thought through. Others might object to claiming progress when the economics of our profession are so problematic. How can we talk about progress when the patient base for psychoanalytic treatment is so dramatically shrinking, and when we are threatened by the popularity of short-term, behavioral, evidence-based treatments? I do not mean to minimize these concerns; indeed, I share them. But I also think these challenges are forcing some constructive changes in our field; put more bluntly, nothing concentrates the mind like the prospect of a hanging. We need to balance the grieving for unmet expectations with the hope inspired by the progressive contributions within our field and related areas. Bemoaning our fate and the lack of appreciation for what we offer can be part of a withdrawal into a sense of misunderstood specialness. In our insularity we may convey that psychoanalysis is a matter of belief, a quasi-religious way of life. I think this is a narrow, defensive way of viewing ourselves that is not particularly appealing to the rest of the world. Is the idea of progress simply a matter of belief? How do we know we are making progress? I believe that evidence of progress rests on three broad principles. First is the tendency toward open systems in the psychoanalytic professions. This means more openness to influences from outside psychoanalysis, more engagement with allied fields, and more inclusion of people from different backgrounds. The analogy to open-source software—software that can be freely used, changed, and shared in modified or unmodified form by anyone—is worth consideration. Second is the principle of accountability. Progress depends on the open-minded evaluation of our treatments and applications in different situations, and the willingness to make modifications accordingly. Whether we aspire to scientific status based on the falsifiability of our ideas, a clear-eyed view of our strengths and weaknesses is essential to our field’s integrity. Our willingness to be accountable is essential to being credible as a system of thought and action, not just a belief system or a way of life. Finally, progress across the different domains 26
DIVISION | R E V I E W
of our field rests on the principle of integration. The growth of the psychoanalytic professions depends on the primacy of forces that bind together and tend toward the creation and maintenance of ever greater unities; in other words, the primacy of the life instincts over the divisiveness of the death instinct. In this essay I have tried to show that “progress” can be both a unifying theme and a kind of stance we can take toward our profession, our own work, and our nonpsychoanalytic interlocutors. For five key areas where we can take action to foster progress, please see the related blog post (where you can respond) at www.divisionreview.com. While working on this essay, I have been reflecting on the professional bonds I have formed with psychologists and psychoanalysts in recent years. Some of these colleagues think very much as I do in terms of psychoanalytic theory, and our nods of agreement when we speak to each other are a source of comfort. But just as often these bonds are formed with people who take very different approaches to their guiding theories and practice. These are colleagues who are passionate about something innovative they are doing or a project they are committed to that will bring about change in education, research, or service. It is the bonds formed with people who are contributing to the field that have left the strongest impression, and these bonds of love for our profession provide the foundation for our progress. z REFERENCES Axelrod, S. D. (2012). A summarized interview with Nancy McWilliams. DIVISION/Review, no. 6 (Fall), 36–37. Axelrod, S. D. (In press). Some observations on progress in psychoanalysis. Panel discussion (R. J. Prince, moderator), “What’s effective in psychoanalytic psychotherapy: A historical reprise.” American Journal of Psychoanalysis. Eagle, M. N., & Wolitzky, D. L. (1989). The idea of progress in psychoanalysis. Psychoanalysis and Contemporary Thought, 12, 27–72. Eisold, K. (2007). The erosion of our profession. Psychoanalytic Psychology, 24, 1–9. Esman, A. H. (1998). What is “applied” in applied psychoanalysis? International Journal of Psychoanalysis, 79, 741–752. Fonagy, P. (2013). There is room for even more doublethink: The perilous status of psychoanalytic research. Psychoanalytic Dialogues, 23, 116–122. Freud, S. (1959). The question of lay analysis. In J. Strachey (Ed. and Trans.), Standard edition (Vol. 20, pp.179–258). London: Hogarth Press. (Original work published 1926) Gazillo, F., Gordon, R. M., & Waldron, S. (Eds.). (2015). Draft tools section 6 of the PDM 2. Kernberg, O. F. (2002). Presidential address. International Journal of Psychoanalysis, 83, 197–203. Moore, B. & Fine, B. (Eds.) (1990). Psychoanalytic terms and concepts. New Haven, CT: Yale University. Press. Pine, F. (2011). Beyond pluralism: Psychoanalysis and the workings of mind. Psychoanalytic Quarterly, 80, 823–856. Stepansky, P. (2009). Psychoanalysis at the margins. New York: Other Press. Waldron, S. (2010). Thoughts on enhancing the position of psychoanalysis in our communities (Unpublished manuscript). Wallerstein, R. S. (2002). The trajectory of psychoanalysis: A prognostication. International Journal of Psychoanalysis, 83, 1247–1267. Wallerstein, R. S. (1986). Forty-two lives in treatment: A study of psychoanalysis and psychotherapy. New York: Guilford. ACKNOWLEDGMENTS The author thanks the following for their interest and ideas: Lew Aron, Andy Druck, Ken Feiner, Jo Lang, David Lichtenstein, Nancy McWilliams, Ron Naso, Larry Rosenberg, and Woody Waldron
Dying for a Signifier Text presented at the international conference “Ethnic and Religious Conflicts in the World: The Contribution of Psychoanalysis,” October 17, 2014, Italian Chamber of Deputies, Rome.
Between 1954 and 1962, France was caught up in opposing Algeria’s successful war of independence. What one of France’s prime ministers (before the rise of de Gaulle), Guy Mollet, said in parliament to justify the fact that Algeria belonged to France and, therefore, to justify the ruthless repression against the insurrection particularly struck me. He said that Algeria was essentially a French invention. This was true. The French created Algeria as a political entity. This, however, did not prevent a strong national sentiment from taking shape among Algerians, one that culminated in a bloody war of liberation. In 1994 we witnessed one of the most shocking genocides of the 20th century: between half a million to one million people died in Rwanda, victims of a civil war that killed mostly civilians in just three months. This holocaust resulted from the conflict between two ethnic groups, the Hutu and the Tutsi. But who exactly were these Hutu and Tutsi, and what was the source of such a reciprocal and deadly hatred? In fact, there is no clear meaning to being Hutu or Tutsi. Both groups speak the same native tongue, Rwanda-Rundi, which is part of the Bantu subbranch of languages. Nobody knows exactly what produced this lethal difference between Hutu and Tutsi, although a few theories have been elaborated, the most reliable of which affirm that the difference was created by German and Belgian colonists. It seems that the Belgian colonial power designated people as Tutsi or Hutu on the basis of cattle ownership and of differences in their physical stature! Yet this arbitrary designation caused millions of deaths, refugees, destruction, and ruin. Another striking example is the patriotism fuelled by the Ba’ath party in Iraq for 35 years starting in 1968. Iraq was created by the British and French in 1920. They inscribed within a single state Sunnis, Shiites, and Kurds—all mutually hostile. This postcolonial construction is now disintegrating (and perhaps Western politicians should finally acknowledge it). Yet how many people have died in the name of this invented state called Iraq! Some 250,000 Iraqis apparently died in the war against Iran (1980–88). They died for a country formed by European diplomats. I am somewhat familiar with Ukraine, having taught there for some years now. A few years ago, before the recent dramatic conflict with Russia, I could never
have imagined that conflict to assume the political proportions it has now taken on. All Ukrainians speak Russian, and all the Russians who live in Ukraine understand Ukrainian. I’ve seen working close together Ukrainian mother tongues and Russian ones without any sort of problem for either party. I know many Ukrainian natives who side with Putin’s politics and many Russian natives who side with Poroshenko’s government. Is this contrast between Ukrainians and Russians, then, a recent invention?
These are all examples of something that psychoanalysis has highlighted from the very start: signifiers dominate the life of human beings, as they do that of society itself. Signifier, a linguistic term invented by Ferdinand de Saussure, was subsequently adopted by Jacques Lacan and by others, anthropologists, philosophers, and analysts. What distinguishes a signifier from other types of symbols is the fact that a signifier marks only an opposition; it is a purely “differential” entity that has no specific meaning in and of itself. Applied to political life, we could say that Iraq, for example, is a signifier insofar as it distinguishes itself from—and in many cases opposes—other contiguous entities that call themselves Iran, Jordan, Syria, and so forth. So, “feeling like an Iraqi patriot” has a possible meaning only because there exists a difference between the Iraq signifier and the other national signifiers that we have mentioned. An analogous discourse could be made for the Hutu and Tutsi of Rwanda. These differences have led to frightening wars between these “signifiers.” Some think instead that wars are fed by the arms industry. But this widespread conception obstructs the reality: that the arms industry thrives because nations demand weapons. And they demand weapons because human beings’ basic aggressive drive (which Freud—challenging even Albert Einstein—always recognized as an irreducible, ineradicable human feature) is structured by signifiers. For Saussure signifiers are arbitrary: they don’t resemble their meanings, but rather the meanings are the effects of signifiers.
I’d like to tell a personal anecdote. After a presentation on a book on Jacques Lacan, a young man approached me with the following question: “What disturbs me in Lacan is the fact that he always talks about signifiers, never about true emotions.” An objection raised a thousand times before. My answer was more or less as follows. Psychoanalysis obviously starts from the emotions, love and hate in particular. 27
DIVISION | R E V I E W
However, the analyst tries to reconstruct those signifiers that trigger love, hate, and other affects. Let us take the Israeli-Palestinian conflict. For decades it has fed a series of wars and conflicts, generating strong feelings of love and hate on both sides. But the point is that it would be in the interest of these two peoples to live in peace, to cooperate economically, in the same way as in Europe France and Germany, for example, have been cooperating for 70 years, after having been at war for centuries. We can’t even say that in Palestine there is a conflict between two religions, considering that many Israelis and many Palestinians are nonbelievers. Their endless fighting damages deeply both nations, which don’t even possess any oil resources. No political or economic rationale can explain such an explosive conflict for the entire Middle East. Psychoanalysis suggests that signifiers drive both Israelis and Palestinians. On the one hand, the signifier thread of IsraelJudaism-Shoah-Zionism-Western values, and on the other, of Palestine-ArabnessIslamism-Eastern values. The important thing is not to deal directly with emotions— some of which even lead to heroism and glory—but with the signifiers that trigger these emotions. End of my brief speech. The young man seemed impressed. The point is that this reply would not have convinced my many friends who know psychoanalysis very well, and who are sometimes Lacanian, because they claim to be Marxist. When there’s a conflict in the world, their comment is usually: “Economic problems are always at the core of every conflict. Social inequality, poverty, and so no.” Yet they have to admit that the Israeli-Palestinian conflict cannot be explained by any economic contradiction. It is obvious that preparing for and making war is always more expensive than not carrying out war, especially in economic terms. Just think that (according to the SIPRI database on military expenses worldwide) the United States and Russia both spend 4.4% of their gross national product (GNP) to keep their military power, while Israel and the United Arab Emirates spend 6.2% and 6.9% of their GNP, respectively, on their armed forces. A vast amount of money that could go to improving living conditions in these countries. I don’t want to diminish economic reasons in explaining the political conflicts of the past and today, but these economic contradictions always interlink with the extraordinary, I would say lethal, power of signifiers. The often bloody sudden conflicts between ethnic and religious groups that
had coexisted for many years or centuries without the slightest problem illustrates precisely what psychoanalysis, since Freud, has always tried to shed light on: that political life, like individual life, is dominated by the logic of signifiers. Even if Freud didn’t call them signifiers, instead talking about Vorstellungen, representations. I even wonder if part of the present Ukrainian crisis is not explained by the fact that the word “Ukraine” in Russian means “edge.” When a state is identified as an edge, this image ends up generating a split into two, because either you’re on one side of the edge, or you’re on the other.
Psychoanalysis has always challenged “identitarianism” or “communitarianism”—the idea, in other words, that there is such a thing as predefined cultural identities and that the culture we belong to is our second nature, as Arnold Gehlen said. This idea of cultural belonging as a second nature is very widespread today, even among intellectuals. Psychoanalysis does not believe in cultural identities, just as it does not believe in sexual ones. Psychoanalysis describes identifications, not identities. Freud effectively sought to show that sexual identity is not determined at birth, but is something that is constructed through tribulations and can even lead to transsexualism, transgender, homosexuality, and so on. As Simone de Beauvoir said in reference to women (The Second Sex, 1949), one is not born a man or a woman, but becomes one. In the same way, we don’t have cultural or national identities; one is not born an Italian, but one becomes one after a, I would say, narcissistic identification. Identification is always an alienation: I take a signifier that has been imposed upon me by the Other, with a capital “O”—let’s say by the social network I live in—and make it my own, in the sense that I inscribe myself within this signifier. To the point of sacrificing my life for it. By this I don’t mean that all identifications are bad, or lead to fanaticism and war. Identifications are also the basis of the most sublime causes. It is notable that in many languages the same word, “cause,” means both what causes effects, and the ideal that pushes us to action in our life. “My cause” infuses lifeblood and enthusiasm into a life that might otherwise be tedious and dull. “My cause” is the cause of both sublime acts and dreadful cruelty. In short, identifications are inevitable. We are all “alienated” beings. But then, how to distinguish between good and bad identifications? What distinguishes the idealism of a cause from fanaticism and sectarianism? Is psychoanalysis capable of supplying an answer, even if only theoretical, to this question?
In clinical practice the analyst actually does operate in such a way as to separate a subject from a dominating signifier—separated, I would say, through a strategy that resembles humor. Through analysis, the subject is separated from a signifier with which he or she identifies, even if unconsciously. The problem in political conflicts, on the other hand, is that their actors consciously identify with the signifiers dominating them. They enthusiastically submit to these often deadly signifiers. Unfortunately, you cannot make a whole people, or even a considerable part of it, lie on the couch. Is psychoanalysis, then, perhaps of some use to better understand conflicts, but not to solve them? I suspect that over a century psychoanalysis has carried out a political function, even though unwittingly. I suspect that psychoanalysis does politics, but unconsciously. For example, some wonder at the fact that analytical practice takes off only in countries with a complete democracy, those with full freedom of expression and universal suffrage, with political parties in authentic—not fake—competition. For example, psychoanalytic practice is diffused in Japan, but not in China. Yet China is no less capitalist than Japan. Maybe the difference derives from the fact that in China political pluralism is absent. Are full freedom of expression and democracy through nonmanipulated elections a condition for the development of the psychoanalytic practice in a particular country? Or is it the other way around? Thus, does a country move toward a pluralist democracy—what some refer to with contempt as “formal democracy”—also because the spread of analytic practice ends up influencing that country’s civil society as a whole, its Kultur, as Freud would have said? Let’s take a country like Argentina, where analytic practice is very widespread. Can we say that this practice has helped Argentina to emerge from a dictatorship and head toward full democracy? Perhaps impossible to answer definitively, but at least it is a good question. Is the fact that the despotic Argentinian military junta of the 1970s and 1980s persecuted so many analysts only because they were analysts not the sign that dictatorships rightly consider psychoanalysis a mine that could destroy them? I realize that for many of us, political democracy—in other words, full freedom of expression and free elections—doesn’t signify much. There is a certain widespread disdain—by both the left and the right—for this “capitalist” democracy. And yet I believe that in some way both psychoanalysis and democracy—even if “capitalist”—are linked to each other. Analysts and their patients are only a small minority in a country, but a minority that tends to develop a contagious virus. In 28
DIVISION | R E V I E W
its own way, psychoanalysis is viral, to use an expression common today. Is there a loop between analytical practice and democracy, in the sense that democracy supplies the terrain on which psychoanalysis blooms, while the psychoanalytical flower nourishes and fertilizes the terrain of democracy? Is psychoanalysis the earthworm of democracy? In effect, the repercussions of psychoanalysis go far beyond the person in analysis, but concern her spouse, children, parents, colleagues, and so forth. Some challenge this hypothesis, which should, however, be taken seriously. Now, democracy and freedom of expression may not extinguish conflicts, but they can contain them within the limits of bloodlessness. Civil wars are rare in democratic countries. Even if the earlier bloody Irish revolt in Northern Ireland, and the Ukrainian conflict later, may instead be exceptions that do not conform to the rule. However, democracy, which feeds on conflicts, identifications, and alienations like any other social regime, can shift conflicts to the level of representation, and hence, I would say, of irony. Democracy is a great dramatic theater where love and hate, identifications and persecutions, lose their hyperdestructive dimension and take on the structure of a “stage show.” French philosopher Guy Debord said that modern society is a show society, société du spectacle. But thanks to this huge theatralization of conflicts, we no longer fight each other with cannon fire within our own nations, except in Donetsk. Even if low blows are the daily bread in a democracy. This is where we can perhaps catch an analogy between democratic method and psychoanalytic method: both shift conflicts from a crude experience—neurotic and psychotic symptoms in subjective life, wars in the political world—to the register that generates a good part of these conflicts, the register of signifiers or representations. Because of psychoanalysis and democracy, the actual struggle loses its violent element thanks to its symbolic inscription; it tends to be reduced to what D. H. Winnicott called “playing,” that is, it is symbolized into representations. This is why analytical practice, though so focused on individual conflicts and stories, is probably a social training ground for solving democratically social conflicts. z
A Case for Amy: Sociopathic Rage in the Era of the Marketing Personality Richard ACHIRO
Warning: This article contains plot spoilers for the film Gone Girl. Erich Fromm, the psychoanalyst and social philosopher, presciently identified a character structure that by 2014 has become ubiquitous within Western society: the marketing personality. This is the person who lives his life feeling more like a commodity to be bought or sold than a living animal with initiative and vitality derived from a sense of subjective reality. Nowhere is this more apparent than on our Facebook profiles, Snapchat feeds, and Instagram photos, which act as self-generated attempts at packaging ourselves to look alive, enviable, and, most importantly, worth something. For Amy (Rosamund Pike) in the film Gone Girl (2014), the commodification comes not in the form of a social networking platform, but in the comparatively quaint premise of a children’s book series written by her well-intentioned yet narcissistically inclined parents. The book series’ titular character, Amazing Amy, is like Amy the real girl, only not. In short, Amazing Amy is perfect (read: perfectly marketable). She also represents the pseudoperson Amy’s parents needed her to be in order for them to feel good about themselves. In this way, the books are the metaphorical translation of Amy from an authentic human into a commodity, meant solely for consumption and the gratification of others’ needs. It’s no wonder that Amy, like so many of us, comes to see her felt needs and longings as nuisances to be suppressed in favor of taking on the carefully adapted personas most likely to attract the attention and purchasing power of those around her. Amy’s hyperattentiveness to the desires of others takes on an almost superpower quality. When she meets her eventual husband, Nick (Ben Affleck), it takes but one quick, flirty exchange for her to deduce what package to put herself in to attract him. For Nick, she will be the woman who pals around with the guys, who is never a “shrew,” and, most of all, who simply lets him be (the birthright she was never afforded). In exchange, she could at least count on his love and would never have to fear him leaving her. But the thing about our most deep-seated internal longings is that they can never really be completely extinguished. Amy’s hope that something real inside of her can be truly appreciated is rekindled when, on their impromptu first date, Nick takes her to the back alley of a sugar factory. The sugar permeating the air creates a wondrous snow-globe moment for the pair, who lean
in to kiss—but before they do, Nick brushes away some of the sugar on her lips as if in an attempt to get to the real Amy through the saccharin artifice that she’s worked so hard to construct. Therein lies a glimmer of hope that maybe Nick wants Amy. Not Amazing Amy. Just Amy. For the rest of us: not the liked selfie with the perfect lighting, nice arm candy, and good hair, but the one that shows us disheveled and, for once, actually enjoying something in the moment. But the selfie, being a selfie, is always an appeal for approval from the outside: an outside that inevitably disappoints. And who could be expected to gracefully endure a blow from the outside on which you’ve based your whole identity? Somewhere around the four-year mark of their marriage, Nick cheats. He breaks their tacit commodity-consumer contract in favor of a younger, presumably more amazing Amy. Betrayal—not only at the hands of her husband, but also those of her parents, who had promised her a substantial legacy fund based on the profits of the Amazing Amy books, but who ultimately ask to keep that money to save their troubled publishing company. So, it would seem that only Amazing Amy had worth after all. Real Amy was gone. When Amy fakes her own murder in an attempt to frame Nick, it is a concrete acting-out of a felt experience; that of her true self being killed off repeatedly by those she loves the most. This is a woman who, given a specific set of formative experiences in a specific cultural milieu, never gained the capacity to believe that life could be anything other than an exercise in self-sacrifice. Likewise, Amy’s subsequent framing of an ex-boyfriend for her kidnap and rape speaks directly to the emotional experience of being perpetually controlled by some overpowering force. A force that is primarily a psychological relic from her childhood experiences, but that gets repeatedly played out interpersonally because, to believe in her own suffering, she needs to see it and have it be seen in objective reality. Subjectivity, after all, is almost a moot point in the era of the marketing personality. Validation for our very existence is increasingly sought based on the objective activity of a fan following that communicates through “likes” or a high viewer count on our latest YouTube video. Aspiring for celebrity status, even through a meagerly viewed blog, is perhaps our best attempt to feel real by knowing someone is watching. Amy’s subjective, internal experience is so lost on her that she is impelled to resort to literally forcing a foreign object into herself, 29
DIVISION | R E V I E W
as if by rape, in order to prove to herself and others that her experience of being intruded upon is real. Amy may go to the concrete extreme by using a high-end bottle of wine to sodomize herself, but we’re all grasping for something fancy to fill the void. The consumer-centric ideal passed on unwittingly by our parents and lovers promises worth through material gain but ultimately thrashes our nature and leaves us feeling dreadfully empty. Ultimately, Amy, in all of her sociopathic rage, slits the throat of her alleged raper—the ex-boyfriend who comes to represent the exploitative oppressor who she could never seem to escape. What Amy sadly never grasps is that the oppressor lives in her psyche—it is the little voice who tells her that she is not, nor could she ever be, real. In an interesting turn, the highly scrutinized and media-exploited experience of being Amy’s suspected murderer results in Nick coming to intimately understand Amy as a person: one who only exists to fulfill others’ fantasies and who is made up of projections from the outside rather than an inner vitality. In this way, somewhat paradoxically, Amy’s true internal experience is finally felt and understood by someone she loves. To the befuddlement of the Gone Girl audience, Nick stays married to Amy after her ceremonious return to their paparazzi-littered home in a dress soaked in her victim’s blood. But of course they would stay together. Albeit a subjective experience consumed by hate and dread, Nick and Amy still shared something intensely real together. Nothing in life, especially in the modern marketing life, is quite so precious. Commodification of the human experience is a debilitating and life-threatening cultural disease. The rage buried within us for being taught to mute our realness finds release in Amy’s acts of destruction. But it is important to note that Amy is both victim and aggressor and that there is an expansive distance between destructive fantasy and destruction committed. Diminishing the possibility of the latter relies on accepting the former as real within us; even homicidal rage is a fundamentally human trait. Feeling into the subjective veracity of our own hatred alleviates us from the urge of acting it out recklessly with those around us. If it is real to us, we do not have to make it real to everyone else in the way our marketing culture would have us believe. The best hope for all of us Amys is that we find the courage to look inside of ourselves and live in fulfillment of our true nature, which is beautifully imperfect and inspirationally idiosyncratic. z
The Great God Pan by Amy Herzog: The “Play” of Memory I think that Amy Herzog is one of our most gifted contemporary playwrights. I first became aware of her when I saw 4000 Miles, which captures a profound attachment between a grandmother and grandson, crackling with intergenerational dynamics. With that evening’s recommendation, I went to see The Great God Pan. Not only did I think it was a beautifully crafted play, but I thought that this is a text that captures the ambiguities of memory, the repetitions of trauma, the merging of individual dynamics in cocreated and knotted relationship patterns, and even embeds a psychotherapeutic re-enactment as part of its drama. The uncanny way that Herzog captures the fundamental clinical issues that one deals with as a couple’s and family therapist made me feel that she had been a fly on the wall of my office, as well as a synapse in my brain for the last 30 years. Section VIII of Division 39, Couples and Family Therapy and Psychoanalysis, had benefited from two earlier, stellar readings by the Red Well Theater Group of Washington DC, and I felt that Pan would be an excellent candidate for a staged reading as well. Directed by Robert Schulte, who has a career in theater, Red Well is composed of avocational actors, therapists with a specialty in group treatment. They describe their work as follows: Philosophically, we approach theater and group therapy as healing arts, more similar than different. Both traditions share an ability to illuminate the contextual complexity of human relatedness through the emergent interplay of the past, present, and imagined future. … Our dialogical model of learning (Stiers, 1998) combines the American community theater tradition whereby a performance is created by, with, and for a particular group of people with the ancient Athenian ideal of a public forum in which all are welcome to bear witness and openly share deeply felt experiences. (Dluhy and Schulte, 2013, p.58) I moderated a discussion of The Great God Pan, followed by a conversation hour, led by Joyce Lowenstein, Susan Shimmerlik, and Debbie Wolotzin. Though Red Well’s customary approach is largely experiential, our discussion included therapeutic and theoretical perspectives. The discussion was unusually vibrant. What is so gripping about The Great God Pan? The drama begins with Jaime, the 30-something protagonist receiving a surprise
visit from a childhood friend, Frank, who gently queries Jaime about the possibility of his (the friend’s) father sexually abusing Jaime when they were young boys. From this encounter on, we plunge down a rabbit hole of interlocking dynamics, revealing some of Jaime’s sexual difficulties in the relationship with his girlfriend, a relationship inflamed by her intrusiveness. We wonder whether Jaime’s parents negligently left him at the home of Frank’s father, in which the abuse may have occurred. Concomitantly, we witness current examples of psychological misattunement, and
Joelle, we feel the press of Paige’s own issues with weight control, of depression, of her desperate dependence on rules and procedure as a life raft in a stormy and frighteningly unreliable subjective world. I think there are fascinating correspondences between stage drama and couples and family therapy. I wrote a paper on this interface a decade ago (Gerson, 2001). They are both a powerful compression of the enacted and the real. Couples and families arrive with a drama in process. Burke (1945) created a concept of “dramatism” that included five terms: “what was done
we learn about past instances of parental obliviousness, reflective of casual and self-absorbed parenting. In the end, does it matter whether the abuse occurred? As audience, we feel bound in a familiar Gordion knot of narrative versus archaeological truth, and I think we can only remove ourselves from its stricture by entertaining both realities (Davies, 1996). Pan presents us with a veritable maze of complexity, eschewing any effort by the couple (Jaime and Paige) to tell a linear, concerete story of their disconnection. We enter and exit this maze in a kind of reverie of unknowing, which is a state of consciousness familiar to us analytically, dense with meaning as well as anxiety. Even more familiar is Herzog’s portrayal of Paige as therapist for a young patient with an eating disorder, Joelle. It is one of the most masterfully insinuating portrayals of countertransference I’ve been privileged to see. In her engagement with
(act), when or where it was done (scene), who did it (agent), how he did it (agency), and why (purpose)” (p.xvii). An imbalance in the “ratio” of these components generates drama. In drama we begin with act and scene. Consider the opening of Death of a Salesman:
DIVISION | R E V I E W
From the right, Willy Loman, the Salesman, enters, carrying two large samples cases. …He is past sixty years of age, dressed quietly. Even as he crosses the stage to the doorway of the house, his exhaustion is apparent. …Linda, his wife, has stirred in her bed at the right. … More often jovial, she has developed an iron repression of her exceptions to Willy’s behavior. Linda, hearing Willy outside the bedroom, calls with some trepidation: “Willy!” Willy: It’s all right. I came back. (Miller, 1949, p.12)
Willy Loman’s decline is riveting for us before we know much of anything about him. So it is when a couple or family enters our office. There is a story in action: she has betrayed him; he doesn’t want to have children. The therapeutic context of individual therapy is quite the opposite. There we begin with intention and character: “I feel my life lacks meaning; I can’t sustain a relationship.” The power of psychoanalytic therapy is that it provides an arena in which the ordinary pragmatics of daily living—action and its parameters—become symbolized. I think it is undeniable that the context for a therapeutic conversation matters greatly. As Uta Hagen (1996) noted, “You don’t tell an event as if it’s happening—that’s sentimentality or melodrama; you tell it in terms of who you’re telling it to.” I think that individual therapy is consonant with the dialogic narrative model, but that couples and family therapy is best served by drama. What couples therapy and drama share is not only a kind of “make-believe,” but also the intricate and recursive play between the real and the imaginary. A couple performs a relationship in both senses of the word: partners re-enact a relationship that has a consistent shape independent of treatment, and they also “show” a particular face of that relationship to their therapist. How many of us who work with couples go into our waiting room to witness a dyad in harmonious and
of representation of the author’s own life experience and psychology, resonated in the work. There was a striking moment in our discussion. The group asked Yovar Moghimi, the Red Well actor who played Jaime, what it was like to inhabit the role of Jaime. Yovar noted that in every rehearsal and in the live reading, he was particularly moved by the moment in which he rec-
actual biographical event in Amy Herzog’s life—one of several she identifies as a childhood memory “tinged with fear” (Herzog, 2012). She says that in writing the play, “The image of a woman falling from a vine into a creek became central” (Herzog, 2012, p.iv). What is transmitted between the playwright’s internal focus and an actor’s entry into a subjectively imagined role? How did
they join affectively in giving this moment dominance? Toward the end of the discussion Deborah Wolotzin read the poem that the name of the play is taken from, “A Musical Instrument” by Elizabeth Barrett Browning. Browning’s poem is about the destruction that is necessary to create and how the “true gods” recognize the loss involved in creation. What better testimony to the cycle of destruction/deconstruction and rebirth and creation that we are privileged to participate in as psychoanalysts and couples therapists. z
collaborative conversation, who, when seated in our office, go straight to battle? One husband voiced this discrepancy in extremis, when he said, “In here [my office] it’s sacred; out there [waiting room] it’s profane.” Of course, floating through any discussion of artistic production is the question
ollects the vulnerability of his babysitter, Polly, as she plunged into a deep water hole while swinging from a rope. The group felt that this moment captured vulnerability, trauma, and potential loss. Notably, this memory is somewhat incidental to the driving narrative of the play, but it represents an 31
DIVISION | R E V I E W
REFERENCES Burke, K. (1945). The grammar of motives. New York: Prentice Hall. Davies, J. M. (1996). Dissociation, repression and reality testing in the countertransference: The controversy over memory and false memory in the psychoanalytic treatment of adult survivors of childhood sexual abuse. Psychoanalytic Dialogues, 6, 189–218. Gerson, M. J. (2001). The drama of couples therapy. Journal of Psychotherapy Integration, 11(3), 333–347. Dluhy, M., & Schulte, R. (2013). A playful approach to group therapy training. Group, 37(1), 57–75. Hagen, U. (1996, April). Panel discussion on Mrs. Klein. Presented at the annual meeting of Division 39 (APA), New York. Herzog, A. (2012). 4000 miles. New York: Samuel French. Herzog, A. (2012). The great god pan. Hanover, NH: www. InAnHourBooks.com (an imprint of Smith and Kraus, Inc.). Miller, A. (1949). Death of a salesman. New York: Viking Press. Stiers, M. (1998). Toward a dialogical learning community: The National Group Psychotherapy Institute (Unpublished doctoral dissertation). Washington School of Psychiatry, Washington DC.
Tracks in the Snow: A Poem of the Sung Dynasty I have my Mandarin-speaking colleague, Peter Lin, to thank for a lovely image from classical Chinese poetry. The poem (written during the Sung dynasty, that is, around ad 1100) advises that in our life on earth we’re like wild geese that land for a moment on the snow, and then leaving only their footprints fly away… The poem is in the form of a letter from the poet, Su Tung P’o, to his brother, Su Che. It recalls a journey the brothers took together and reports on what the poet finds now at a temple they had visited on that trip. It remembers Min Ch’e, the old monk. (The poem has many contemporary translations. Here’s an attempt by Peter Lin and me.)
“Remembering Min Ch’e: A Letter to His Brother Su Che” What is our life on earth? A flock of migrating geese Rest for a moment on the snow, Leave the print of their claws And fly away, some East, some West. The old monk is no more. There is a new gravestone for him. On the broken wall of his hut You can’t find the poems we wrote Or anything to show we’d ever been there. Do you recall the steep winding slopes, The road long? I’m tired now And my limping donkey Has been braying all the way. These lines compare interestingly to those of a familiar Western romantic meditation, one most of us learned in school, Percy Bysshe Shelley’s sonnet “Ozymandias,” first published in 1818.
“Ozymandias” I met a traveller from an antique land Who said: “Two vast and trunkless legs of stone Stand in the desert. Near them, on the sand, Half sunk, a shattered visage lies, whose frown, And wrinkled lip, and sneer of cold command, Tell that its sculptor well those passions read Which yet survive, stamped on these lifeless things, The hand that mocked them and the heart that fed: And on the pedestal these words appear: ‘My name is Ozymandias, king of kings: Look on my works, ye Mighty, and despair!’ Nothing beside remains. Round the decay Of that colossal wreck, boundless and bare The lone and level sands stretch far away.” 32
Henry M. SEIDEN
It’s interesting how much the two poems have in common— tonally different though they are and arising as they do in such different cultural contexts: the traveler’s report on the past’s decay; the desert sands, the snow; the monument perishable despite being made of stone; the vanity of the attempt at enduring art, much less enduring dominion. The Chinese poem is humble, small in its human perspective— one pictures a classical landscape painting (Su Tung P’o was a much esteemed painter as well as a poet): the high mountains, the deep gorges, the tiny travelers on a path by the river. Interestingly, the poem was the product of a grand and proud civilization. The Sung dynasty, which was the immediate predecessor of the Mongol dynasty of Kublai Khan, saw the invention of printing as well as gunpowder, good economic times and military success, a population boom, a thriving literacy, a stable government, a scholarly bureaucratic class, and a 300-year cultural hegemony. The romantic poem was written, it could be argued, at a similar proud high point in Western civilization and during a similar cultural and imperial hegemony. This is broad-brush comparison; I’m aware that historians may quibble. And yet both moments in human history could be thought of as inviting their subjects to an inflated self-regard, a self-importance, partly justified, but in psychological terms grandiose, illusional, and self-convincing. Long before we relied on psychologists, we relied on poets to address and puncture such posturing. There are differences, of course. “Ozymandias” is likely to be read as a political indictment. Like most of us, I suspect, I was taught to read it this way. There’s a triumph at the comeuppance of the tyrant. How self-deluding the pretensions of dictators! But then, how self-deluding too is the notion of an “American century”—as if our “century” could last forever. (Among other grave threats, climate change is upon us; the image of “lone and level sands” is cautionary.) The Chinese poem is more intimate and more personal. It reflects a sad recognition rather than a triumphant one. What we will leave behind is fleeting; our own disappearance is inevitable. This, of course, is a Buddhist view—but a useful corrective even for non-Buddhists. Kohut’s familiar notion of the vertical split, so useful in our clinical psychoanalytic work, has a similar lesson in it. Readers will know that he recommends helping our narcissistically inflated patients put the two sides of themselves into contact by empathically acknowledging both the prideful ambition and the emptiness that drives it. What would this mean for those of us a little less narcissistic? (And probably one can’t be human and certainly not American without being just a little narcissistic.) Not that we must give up our pride and our pleasure in our accomplishments. Rather, it would mean that we hold in consciousness at the same time the ancient Buddhist perspective: we are homeless travelers, we know not where we go—and what we will leave behind will be but haphazard marks on the impermanent surface of this world. z
With my thanks to Peter Lin, PhD, Professor of Psychology at St. Joseph’s College, Brooklyn, NY.
DIVISION | R E V I E W
Letters THE DIVISION 39 WIKIPEDIA TASK FORCE WANTS YOUR HELP Although the growth of Wikipedia as an important source of information has proven to be a mixed bag, there is little indication that its role as a destination for those seeking information will diminish anytime soon. According to the New York Times, Wikipedia was ranked fifth among all websites as of February 2014, “with 18 billion page views and nearly 500 million unique visitors a month.” As the New York Times also indicates, some medical professionals are increasingly thinking of Wikipedia as a source for educating the lay public, and as a training tool to help medical students build jargon-free communication skills. However, the drawback of Wikipedia’s open platform is that accuracy problems can lead to poor quality control and misinformation. These issues have motivated some medical schools to offer college credit to edit Wikipedia pages for accuracy and legibility in order to improve the quality of information that is pertinent to their discipline.
The following letter was submitted to the New York Times on May 13, 2015. TO THE EDITOR: RE: “REPORT FINDS COLLABORATION WITH TORTURE” (NYT, MAY 1) For the past ten years, the Division of Psychoanalysis has differed with our parent organization, the American Psychological Association, on key elements regarding ethics, most notably psychologists’ participation in interrogations. James Risen’s book and recent New York Times article provide evidence that our concerns were justified. We are frankly appalled at APA’s reaction of dismissal and denial to Risen’s May 1 article, as seen in its press release referring to “recirculated allegations” and “public misunderstanding.” Newly surfaced email evidence appears to link APA with the CIA, starting around 2003, in support of their interrogation
MAKE PSYCHOANALYSIS UNDERSTANDABLE TO THE PUBLIC Other health professions are similarly taking notice of the ways Wikipedia might be used to build relational bridges to the public. In view of this situation, a task force for psychoanalysis and psychoanalytic psychology on Wikipedia was created by the past president of the Division of Psychoanalysis (Division 39) of the American Psychological Association, Frank Summers, and is being cochaired by Lewis Aron and Ari Pizer. The broad aim of the task force is to inform interested graduate students and early career professionals about the importance of Wikipedia as a source of information on psychoanalysis and psychoanalytic psychology. It will also provide assistance to keep entries relating to these topics accurate, up to date, and at the highest levels. The hope is that this will stimulate and enable a wide network of participants who can then openly and democratically work together or separately to edit all relevant Wikipedia entries, including all theoretical orientations, subdisciplines, and specialties.
LEARN TO EDIT WIKIPEDIA In the short term, the task force will be responsible for organizing a meeting open to all interested members at the next Division 39 Spring Meeting in San Francisco. We will discuss the importance of this project and outline the basics of how to edit and contribute to Wikipedia. In the long term, the task force may consider expanding its role to include the establishment of the following: (1) a workshop that would meet regularly in order to give participants the basic skills necessary to contribute to Wikipedia; (2) a network of experts in various areas so that anyone editing a Wikipedia article would have access to expert consultants who could look over the text or answer questions about content; and (3) a liaison who would connect editors with the appropriate expert consultants.
program, including contact with Mitchell and Jessen, the two purported architects of interrogation techniques widely considered torture. In 2005, APA worked closely with those in the military and DOD on the PENS Task Force to ensure the presence of psychologists in detainee interrogations, showing little concern that psychologists were implicated in military interrogation abuses and no regard for the fact that the conditions of detainee confinement constituted cruel, inhuman and degrading treatment. Ten years ago APA should have stated outright that participation in such activities is unethical. APA still has not done so today, to the detriment of our profession and our relationship with the public. Instead, in 2014 APA quietly withdrew the 2005 PENS Task Force report from APA Policy without denouncing it or examining its mistakes. When APA refused to redress this ethical problem, APA members themselves generated and passed a referendum which disallows psychologists working in settings where persons are held outside of, or in violation of, international law or the US Constitution (where appropriate) unless working for detainees or third parties protecting human rights. It remains unenforced and ignored by
APA. APA has yet to call for the removal of psychologists from such situations. Further, while APA was writing inadequate resolutions denouncing torture there is mounting evidence, cited by Risen, that some in APA colluded with government agencies to provide a justification for torture. We applaud APA for appointing an independent reviewer regarding Risen’s accusations, but the Division of Psychoanalysis talked long ago with APA leadership about what we saw as the horrific work of Mitchell and Jessen as cited by Risen. We remain deeply concerned about this longstanding pattern of evasion on this crucial issue. We ask that APA make the uncensored and unfiltered report of the independent reviewer public as soon as it is received and repeat our request that APA implement the referendum passed by the membership. The American Psychological Association is our professional home. We hope the Association’s response to the upcoming report of the independent reviewer will exemplify the integrity and accountability integral to the code of ethics of psychologists. z
DIVISION | R E V I E W
JOIN US AS AN EXPERT CONSULTANT It is important to note that although the task force will function under the auspices of Division 39, the division will not provide oversight or attempt to control any of the activity it helps to stimulate in accordance with the spirit and regulations of Wikipedia. For more information about the project, please email Ari Pizer (email@example.com). We look forward to hearing from you! z
Marilyn Charles President, Division 39 (Psychoanalysis) of the American Psychological Association
A LETTER FROM RIYADH Bruce Reis New York was cold when I left, but the sun was bright and warm when I stepped off my plane at the Riyadh airport, and while it was early morning according to my body, it was already late afternoon there. After a night’s sleep I couldn’t tell whether I was hungry or not, and despite the sleep, I wasn’t quite rested. The disorientation was immediate, somatic, and psychological and it would last my entire stay in Saudi Arabia. One does not just decide to go to Saudi Arabia; one must be invited. Official government permission had been granted following the offer to speak as the only psychoanalyst at a conference on the treatment of affective disorders. Still, a mountain of paperwork was needed before I could get the necessary visa: photos, declarations of citizenship, and a strict and explicit agreement regarding how long I was planning to stay and where I would travel within the kingdom. Among the papers I was to sign was an acknowledgment that should I be caught trafficking in either narcotics or pornography, the Saudis would reserve the right to execute me. As a psychoanalyst, though, I was importing ideas, a different sort of contraband; and my thoughts turned to Freud’s reputed remarks upon coming to America: “We are bringing them the plague, and they don’t even know it.” Psychoanalysis is not something the Saudis know much about. Their culture is not generally open to nontraditional ways of thinking, and psychoanalysis is solidly not in the Arab tradition. What I was entering was a hybrid psychiatric subculture dominated by international pharmaceutical companies and the use of traditional faith healers. A bizarre mixture of the very latest Western scientific attitudes and centuries-old religiously inspired tradition holds sway there. Thus, CBT, because of its claims to scientific legitimacy, has caught on recently in the kingdom, and it’s not uncommon to have verses from the Koran mixed in with manualized treatments seeking to correct cognitions. Yet what I knew about the Saudis is that beyond their veneer of strict cultural rectitude lay a remarkable openness. I counted on this feature of their culture, having learned a great deal about it from a Saudi psychoanalytic candidate who attended his course work at an American psychoanalytic institute and his supervision with me via Skype. The auditorium where the other speakers at the conference and I gave our presentations was vast and brand-new. Women sat on one side of a chest-high wall that divided the room, all of them in black, full-length chadors from head to toe, many with their faces covered so that only their eyes were
visible behind a mesh veil. The men sat together on the other side of the divider, most dressed in a traditional thawb, long white robes, and a red-and-white checked kaffiyeh, or head scarf. I had presented professionally throughout North and South America and in Europe, but I’d never seen anything like this before. In this modern, state-of-the-art hall with sophisticated sound system, lighting, and ample refreshments, the gathered professionals (psychiatrists, social workers, psychologists, medical doctors) maintained ancient customs of propriety by only interacting with colleagues of the same gender, all of them veiled to varying degrees. I suffered through several presentations of the sort one might expect. Drug company–sponsored pharmaceutical trials, PowerPoint slides, an industrialized approach to care, the language of which focused not on people but on symptoms and products. There was nothing particularly Saudi about these; indeed, they were remarkably generic. Then, a Saudi psychiatrist presented. He was dressed in Western suit and tie, which was unusual in this group. A good deal of his talk expectedly had to do with the affective disorders and their psychiatric management, but then he dropped in a few paragraphs about how he felt that psychiatrists shouldn’t agree to use psychiatric hospitalization to aid political disappearances. He spoke as if everyone in the audience was well familiar with the practice, and he raised the question of whether the psychiatric profession really wants to be mixed up in all of that. Then he concluded his talk by
DIVISION | R E V I E W
going back to the topic of affective disorders. There were no questions or comments from the audience about what he’d said, but neither was a there any palpable sense of tension. What had just happened? Over my three days at the conference I gave three different presentations. Two were workshops for clinicians on analytic technique; one was a keynote speech. Knowing what appealed to the Saudis, I presented the results of recent scientific studies that raised significant doubts as to whether SSRI medication was any more therapeutically effective than a placebo in the treatment of depression. I reviewed the scientific literature on effectiveness of short-term manualized treatments versus psychodynamic psychotherapy and the effectiveness of psychodynamic psychotherapy as compared with psychoanalysis, letting them know that all these approaches are about as effective in addressing depressive states, but that long-term analytic approaches treat more than just the individual’s state, and their long-term outcomes positively reflect this difference. Several therapists approached me afterward wanting to know more. It had caught their attention that psychoanalysis may offer more robust and longer-lasting benefits than either medication or short-term cognitive treatments. I had brought several books with me for the purpose of leaving with colleagues who showed an interest, and they were enthusiastically received. The traditional banquets at night were full of joviality. Hospitality to guests is im-
portant to the Saudis and was on display. More striking than anything to me was the simultaneous observance of strict codes of conduct and their utter disregard. Perhaps the most perverse example of this was my learning that underneath their black headto-toe coverings many of the women were dressed in the latest couture fashions from Europe—Chanel, Fendi, Prada. The symbolism was arresting as religious tradition met great wealth to create simultaneous aspirations in multiple conflicting directions. Some of these same women who had been covered at the conference social-
ized freely without their head coverings at the outdoor BBQ restaurant where we dined one night. When I asked my hosts as discretely as I was able why the women needed to be covered at one event and not at another, the question was politely deferred. These experiences squared with my experiences supervising the clinical work of the Saudi candidate I had been meeting with via Skype. While the Saudis have a strict moral code of behavior that is most certainly followed, it is also true that what happens in private very much stays in private. Thus, I’ve learned that alcohol
IPA 49th Congress IPSO 23rd Conference
World Trade Center, MA, USA 22–25 July 2015
Changing World The shape and use of psychoanalytical tools today
Registration is now open www.ipa.org.uk/congress
DIVISION | R E V I E W
and drug use is frequent, as are same-sex relationships and marital affairs, and that clinical cases provide a unique insight into a culture, for they provide a record of what happens on the ground, in everyday life. I don’t know whether the Saudis were as disrupted by my presence there as I was by participating as a psychoanalyst in a culture devoid of any references to psychoanalysis. In my fantasies my colleagues are reading the books I left with them, discussing the nature of the unconscious, perhaps adding their own unique view to the conception. z
DIVISION | R E V I E W
NON-PROFIT ORG. U.S. POSTAGE PAID Washington, D.C. Permit No. 6348
American Psychological Assoc. 750 First Street, NE Washington D.C. 20002-4242 Forwarding Services Requested
NOTES ON CONTRIBUTORS
Frank Summers practices psychoanalysis and psychoanalytic psychotherapy in Chicago, is clinical professor at the Feinberg School of Medicine, Northwestern University, a supervising and training analyst at the Chicago Institute for Psychoanalysis, and a faculty member of the Chicago Center for Psychoanalysis. His book, The Psychoanalytic Vision (2013), received the 2014 Gradiva Award Bruce Reis is a Clinical Assistant Professor in the New York University Postdoctoral Program in Psychotherapy and Psychoanalysis, and a visiting faculty member at several psychoanalytic institutes in the United States. In addition to practicing in Manhattan, Dr. Reis lectures internationally, and serves on the editorial boards of numerous psychoanalytic journals. He is a member of the Boston Change Process Study Group.
Trisha Ready is a writer and a Clinical Therapist at Fairfax Hospital in Kirkland, WA. Her essay, “How Listening to Music and Fighting with Susan Sontag Helped Me Cope with Chemo” appeared this year in The Stranger (Seattle). Karl William Stukenberg is Chair and Associate Professor at the School of Psychology, Xavier University, Cincinatti. His research interests include Psychological Testing, Psychotherapy Process and Outcome, and Group Psychotherapy. Elizabeth Hegeman is a Professor at John Jay College of Criminal Justice-CUNY. After fieldwork on the process of urbanization in Latin America and Puerto Rico, she trained as a psychoanalyst. She is currently researching and theorizing about culture-bound syndromes of mental illness.
Shelley Galasso Bonanno, is a psychoanalytic psychotherapist in private practice in the metropolitan Detroit area. Her poem “The Time Machine” about the depth and importance of the transference experience, was published in the Fall 2010 issue of The American Psychoanalyst. William Fried is a photographer and a clinical psychologist and psychoanalyst in private practice in Manhattan. For 27 years, he served as Associate Director of Psychiatry Residency Training at Maimonides Medical Center. Dr. Fried is a member and on the faculty of the Institute for Psychoanalytic Training and Research and an editor (Reminiscence) at D/R. Henry Seiden is a poet and a psychologist, a regular contributor to this review, and editor of the On Poetry column. Dr. Seiden also maintains a private practice in Queens, NY. Steven D. Axelrod practices psychotherapy and psychoanalysis as well as organizational consultation in New York City. He is editor of Research for D/R. Mary-Joan Gerson is Adjunct Clinical Professor, Consultant in Psychoanalysis, and Director of the Advanced Specialization in Couple and Family Therapy at the New York University Postdoctoral Program in Psychotherapy and Psychoanalysis. She maintains a private practice in New York City. 36
DIVISION | R E V I E W
Steve Benson is a poet and psychologist and practices both in Downeast Maine. He is also active in his local peace and justice group, food co-op, zendo, and Waldorf school. Sergio Benvenuto is a researcher in psychology and philosophy at the National Research Council (CNR) in Rome, Italy, and a psychoanalyst, president of ISAP (Institute for Advanced Studies in Psychoanalysis). His books include La gelosia (Bologna: Il Mulino, 2011). Richard P. Achiro is a Registered Psychological Assistant who practices individual and couples therapy in Los Angeles. Dr. Achiro completed his training at the Wright Institute Los Angeles. Vanessa Sinclair is a psychoanalyst in private practice in New York. She is an active participant in Unbehagen: A Free Association for Psychoanalysis.