Division Review No. 31 Spring 2024

DIVISION A QUARTERLY PSYCHOANALYTIC FORUM

NO.31 SPRING 2024

REMINISCENCE A MAN FOR ALL SEASONS | DRUCK

ROUNDTA BL E

DISABILITY, NEURODIVERGENCE & PSYCHOANALYSIS

DIS/ABLING PSYCHOANALYSIS | CROSBY MOURNING PERSON | VARGHESE DOUBLE SLITS, DOUBLE BINDS | MORSA INTERVIEW WITH VALERIE SINASON | CROSBY WHERE WE STAND WITH AUTISM | SMITH

SPECIAL SEC TION LAPLANCHEAN DIALOGUES WITH (second dialogue) HÉLÈNE TESSIER | BATISTA-THOMAS BEN STEPHENS

PH OTOG R A PH Y

Official publication of Society for Psychoanalysis and Psychoanalytic Psychology, Division 39, American Psychological Association

EDITOR

Loren Dent GUEST EDITOR

Jay Crosby

CONTENTS

SENIOR EDITORS

Steven David Axelrod, J. Todd Dean, William Fried, William MacGillivray, Marian Margulies, Bettina Mathes, Manya Steinkoler CONTRIBUTING EDITORS

Gemma Marangoni Ainslie, Ricardo Ainslie, Christina Biedermann, Chris Bonovitz, Steven Botticelli, Ghislaine Boulanger, Patricia Gherovici, Peter Goldberg, Adrienne Harris, Elliott Jurist, Jane Kupersmidt, Paola Mieli, Donald Moss, Ronald Naso, Donna Orange, Robert Prince, Allan Schore, Robert Stolorow, Nina Thomas, Usha Tummala, Jamieson Webster, Lynne Zeavin

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Andrew Druck

A Man for All Seasons by Andrew Druck

ROUNDTABLE: DISABILITY, NEURODIVERGENCE AND PSYCHOANALYSIS

BOOK REVIEW EDITOR

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Jay Crosby

Anna Fishzon

Dis/abling Psychoanalysis

FOUNDING EDITOR

David Lichtenstein

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Ricky Varghese

Mourning Person

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Ben Morsa

Double Slits, Double Binds

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Jay Crosby

An Interview with Valerie Sinason

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Brian E. Smith

Where We Stand With Autism

PHOTOGRAPHY BY

Ben Stephens DESIGN BY

Hannah Alderfer, HHA design, NYC 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.

SPECIAL SECTION: 22

Bryan Batista-Thomas

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Laplanchean Dialogues with Hélène Tessier interviewer

Second Dialogue

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Notes on Contributors

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ISSN 2166-3653

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Photography by Ben Stephens https://www.benstephensphotography.com 3

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A Man for All Seasons

Andrew B. DRUCK

Dr. Richard Lasky died on April 10, 2023, a short time after his 80th birthday, following a long illness. He was a charismatic, brilliant psychologist and psychoanalyst who made major contributions to psychoanalytic institutes and to psychoanalytic thinking. Richie, as everyone called him, was a big man, a natty dresser, a force of nature. He was easy to talk to, knew much about many subjects, and spoke about them all with insight, clarity, well-earned authority, and respect for his listeners. A close friend recalls that, “I always enjoyed and was inspired by Richie’s way of listening, his wisdom, his humor.

Our discussions would go from clinical matters to politics, and then to travel destinations”.

Richie was a dominant intellectual presence in any group. He was a generous, loving mensch, a wonderful and loyal friend, a wise colleague and a beloved husband, brother, and uncle.

Richie often told the story of how, when he was in the army, if you weren’t busy, they would find something for you to do. To avoid that, he spent his time in the library, which was not the hub of military life. He read Freud’s Interpretation of Dreams, and became hooked on psychoanalysis. Richie went to college at LIU after completing his military service. He was hungry to learn as much as he could, so he kept asking his instructors for a chance to do research. They put him touch with Dr. Frederick Baekland, a leading sleep and dream 2 researcher, with whom he worked for several years. This resulted in four joint research publications, and he began graduate school as a published author, (Richie published thirty papers, reviews, and presentations along with two books and one edited book, over his long career).

Richie married Judy, his life-long partner, a week before both started graduate school in 1968. They celebrated with a brief city honeymoon, then took two and a half months after their first year of school to tour Europe.

Judy recalls that, when they were in Spain, Richie was uneasy. When she asked why, he told her that, while in the army and on leave, he’d been traveling through Spain and seen crowds gathered in public spaces. He’d thought it was a festival and gone out to join. It turned out to be a political demonstration and he, along with many others, was arrested. The army got him released, but he was put on a “do not allow to enter” list by both Spain and Portugal.

During this vacation, he entered but was very careful about obeying all of the rules, including not parking illegally when he was in Spain.

Richie received his Ph.D. at NYU in 1971 in the community psychology program, where he also took clinical courses. He wrote his doctoral thesis on New York City policemen, going on patrol with several of them for six months to gather data. He interned at Postgraduate Center for Mental Health, where he learned

group therapy, a subject he taught for several years. While in graduate school, he worked at the Village Project, a drop-in center for homeless and drug addicted adolescents. He received his analytic training at 3 NYU Postdoc, graduating in 1974, and obtained a certificate in analytic group therapy from Postgraduate Center in 1975.

Richie then moved to C.W. Post, where he taught courses on Freud, in what was a behaviorally-oriented program. The courses were extremely popular, to the consternation of the behaviorist powers-that-be in the program.

They didn’t renew his contract, but waited to take this action until the summer months, when students were not there to protest. From that point on, he went into private practice. He taught and supervised for many years at NYU Postdoctoral Program, IPTAR, and seven or eight other training programs.

In his practice, he saw a patient with multiple personality, and published a paper on the topic. A publisher, who had read the paper, approached him and invited him to write a book. In 1982, at the age of 40, Richie brought together his psychoanalytic interests and his studies of police to write “Evaluating Criminal Responsibility in Multiple Personality and Related Dissociative Disorders: A Psychoanalytic Perspective” (Charles C. Thomas, 1982). I remember vividly the celebration for the publication: about forty guests in the Lasky living room drinking champagne and listening to a string quartet play music that Richie and Judy loved.

Richie had become a sought-after supervisor and analyst at NYU Postdoc and IPTAR. In 1986, he suffered a sudden major heart attack and had to take time off from his practice. Being Richie, he used this experience to become one of the first analysts to write about the impact of an analyst’s illness on his patients.

This resulted in three papers, including “Catastrophic illness in 4 the analyst and the analyst’s emotional reactions to it” (IJP, 1990) and “Superego conflicts in the analyst who has suffered a catastrophic illness” (IJP, 1992). These were pioneering efforts and Richie was soon in demand for supervision by analysts who were ill.

Truly a Renaissance man, Richie was an avid reader with a wide range of creative interests. He never dabbled; when he was interested in something, he became expert at it. At some point in the 1980’s, Judy wrote a chapter on midlife change for an edited book. Richie read it and thought: if not now, when? He had always been interested in music and was able to enroll in Julliard to study composition for several years. He was talented at it and his knowledge of composition only enriched his appreciation of music. The couple made regular trips to Tanglewood, the Glimmerglass festival, the Brooklyn Academy of Music, and the Santa Fe opera. Among his 4

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favorite composers were Samuel Barber, George Crumb, and Olivier Messiaen. When Richie was in his fifties, he began to study photography at the International Center for Photography. Here, too, he was gifted. He spent years both taking pictures and editing them. His photos inaugurated IPTAR’s “Arts and Society” series with a show in 2015 entitled “Richard Lasky: Fine Art Photography.” When Richie learned something, he was extremely generous about sharing his knowledge. Friends have spoken of his spending afternoons with them, patiently helping them learn how to use a camera and edit photos. He was also generous with his photos. One photo, I think of a cow giving birth, graces homes in New York, New Jersey, and Westchester.

Richie was interested in tribal art: African art, oceanic art, and, later on, Southwest Indian pottery. When he and Judy were on the first of their many trips to New Mexico, Richie saw a piece of pottery that he liked. He asked its price and, when he was told how expensive it was, he asked why. This was his introduction to Southwest Indian pottery. He returned home and started reading…and then reading more. Richie became an expert on this genre, amassing a large collection of books and, as the years went by, an extensive collection of art. The Lasky living room, and Richie’s office, were filled with it.

Richie loved animals. He had two large dogs, Attila (a giant schnauzer) and Samson (a doberman), several finches, and many beloved cats. What was most visible (and audible), however, was his large parrot, Paco, and the two Rosellas, who dominated the home office waiting room of this very classical Freudian analyst.

Paco was big, loud, and beautiful. He was a fixture in the suite until the Laskys got Attila, their first dog. Attila would bark from the back room and Paco would imitate his bark. Soon the waiting room sounded like a jungle, and Richie and Judy, reluctantly, parted with the birds.

The couple bought a country home in Sheffield during this period, a beautiful, cozy house, painted white with black trim, on a quiet road adjacent to a large field punctuated by rows of haystacks in the summer. They went there virtually every weekend for 26 years and were generous in lending it to their friends. Owning a country house means owning a car, and I was privileged to spend time on the phone with Richie several times a week as he waited in his car for 6 the alternate side of the street no-parking time to expire. After they sold the house, Richie and Judy were able to satisfy their love of travel, going to Alaska, Hawaii, and Morocco; eventually, Richie was able to fulfill his dream and visit Israel.

Richie was active at both NYU Postdoc and IPTAR. He was President of the Psychoanalytic Society of the NYU Postdoctoral Program from 1982-1984. For approximately two decades, he was an important member of sever-

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al IPTAR governing boards where his brilliant, wise, creative, and forceful opinions were highly valued. He was able to grasp the essence of an issue quickly. In addition, however, he was not one to suffer fools gladly. He argued eloquently and passionately for high standards and for a classical point of view.

Richie was father of the IPTAR clinic. At a time when candidates were looking for training cases, Richie worked on founding a clinic that would provide high quality, longterm, treatment to the community while also furnishing candidates with training cases. To everyone’s surprise, he was able to get grants that financed the clinic for a number of years. Others participated in the clinic and directed it, but his initial contribution got it off the ground and was indispensable.

After 9/11, looking for a way to contribute to society, Richie and Judy became involved with Doctors of the World (now Healthright), an organization that provided services to people seeking asylum. They interviewed applicants to provide them with documentation of the trauma and mental abuse they had suffered, which would support their applications. This work was pro bono.

Unsurprisingly, some of these people needed psychotherapy. They were referred to a city agency but, when funding to this agency was cut, Richie came to Brett Gorkin, who was then Director of the IPTAR Clinic, with a proposal: could the IPTAR clinic act as a referral source?

At that time, there were no resources geared towards psychotherapy with asylum seekers.

The clinic board was receptive, and researched it for several months. One of their concerns was that the therapists treating traumatized patients would themselves become vicariously traumatized. In collaboration with the clinic,

Richie, addressed this problem by running process groups and also supervising the therapists.

He conducted these groups for several years.

Brett Gorkin directed the asylum program and Richie worked with the therapists. As Brett told me, “Richie quietly did many things that were progressive and caring. He was always there if you looked closely”.

Richie conducted psychotherapy research with Bert Freedman and Marvin Hurvich.

They had obtained permission to analyze tapes of psychoanalytic sessions which were judged by outside raters, in terms of the session arc and movement towards organization and disorganization. After Bert died, Richie continued this research with Anthony Mazella and Jonathan Eger for many years.

Richie was an extremely popular teacher and supervisor at both IPTAR and NYU Postdoc, and a Fellow (training and supervising analyst) at IPTAR, (Postdoc does not have the position of training analyst). He never “phoned it in” when he taught; he prepared his syllabus with thought and re-read all the material (and there was always much of it) every time he taught the class. He was a 8 master teacher, a classical Freudian analyst who taught and supervised from this point of view with depth, clarity, and analytic wisdom, laced with his sense of humor. He influenced and mentored several generations of analytic candidates. In 1993 he published a brilliant and influential book, Dynamics of Development and the Therapeutic Process (Aronson) that provided a clear outline of classical theory and technique. He also edited a festschrift “Symbolization and Desymbolization: Essays in Honor of Norbert Freedman (Other Press) in 2003.

Richie was loved and respected by his students, supervisees, patients, and colleagues.

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He was thoughtful, funny, and knowledgeable.

You could (and I did!) ask him about anything, including obscure psychoanalytic concepts, and receive an informed and insightful opinion. When someone asked me a question I couldn’t answer in a class I was teaching, I would call Richie, leave a message, and get an erudite reply within the hour. Richie, Marvin Hurvich, and I met monthly for several years reading each others’ draft papers. The papers were always improved after Richie’s comments were applied. Richie was like a sabra plant; seemingly tough on the outside but soft, empathic and loving, with a fount of wisdom on the inside, a twinkle in his eye, and a dry sense of humor. He was generous with his time and his thinking.

One of his extraordinary traits was a notable lack of envy; he was genuinely happy when his friends had successes and he always had your back when you were in difficulty. He was a loyal and great friend.

I cannot end this profile without saying something about Judy. Richie and Judy were married for a little less than fifty-five years. They shared everything— love of art and music, generous hosting in New York and Sheffield, contributions to psychoanalytic organizations. They balanced and complemented each other. Judy was the love of Richie’s life. In his last months of life, he would spontaneously exclaim that Judy was an angel who was keeping him alive.

As always, he was right: Judy cared for him and was with him until the very end. Richie died as he lived: with courage, grace, perspective, and love. May his memory serve as a blessing.

I want to thank Judy for spending a good deal of time during this difficult period sharing with me details about Richie and their life together.

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Dis/abling Psychoanalysis

Jay CROSBY

If there was a country called disabled, Then I am one of its citizens.

I came there at age 8. I tried to leave.

Was encouraged by doctors to leave.

I tried to surgically remove myself from disabled country but found myself, in the end, staying and living there.

If there was a country called disabled, I would always have to remind myself that I came from there.

I often want to forget.

I would have to remember…to remember.

excerpts from “Disabled Country”

In “Disabled Country,” the oft-cited poem by author and playwright Neil Marcus, the reader is presented with a landscape of disability. It is one whose borders are marked and delineated, defining a psychic, bodily, social, and physical space. The author imagines a country with an implied history and sovereign citizenship, yet he also presents a kind of ambivalent nationalism. He was encouraged to flee his country—under the likely presumption it was somehow unfit for living—and cross over the border into the assumed land of normality. However, Marcus writes about remaining and responding to the psychic and social demands that urge him to forget his difference and give in to the normalizing currents of reality.

We collectively find ourselves at a time where the idea of a “normal reality” is simultaneously a privilege and process that is hard to bear. Borders and homelands are painfully and violently at stake. Refugees are desperate to find safe haven, fleeing from increasingly inhospitable conditions pin their countries of origin. Difference is often vilified and threatened, and we face a litany of crises—climate, genocide, violence, famine, lack of resources —with little sense that anyone has the capacity to intervene effectively. With notions of democracy, equality, and freedom that are ever fragile and under attack, it is easy to become inured to the point of exhaustion and just accept all of this as increasingly normal.

Within American psychoanalysis, there has been a spate of recent crises of borders and fault lines in some presumed battles around the scope and limits of our discipline.

What is psychic? What is social? Who is included and excluded as the object of psychoanalytic study? And who is authorized to ask these questions and define this scope? There are fractures and factions that emerge in our professional associations, where conflicts take on an eerie doubling to what is happening socially and politically around us. At the center

of this is the question of what constitutes the core ethical framework and direction for psychoanalytic practice and inquiry.

There has been some preliminary, although important, work done in recent years to address aporias and blind spots of psychoanalytic inquiry regarding gender, sexuality, race, and class and to understand the damage done by insidiously normalizing tendencies presented under the guise of theory, treatment, and cure. Whereas fifty to sixty years ago, queerness was seen as psychopathology, people of color, particularly African-Americans, were considered by some to be unanalyzable (Holmes et al., 2023).

The American psychoanalytic establishment kept strict control over medical dominance of the profession; we have recently seen the rise of the Holmes Commission, a surge of vital and creative writing on queer and trans experience from a psychoanalytic perspective, and a burgeoning interest in community psychoanalysis, representing attempts to open the field and to question its prejudices and preoccupations. However, true to psychoanalytic form, these changes have come slowly— perhaps unacceptably slow —with significant resistances and defensive counterresistances.

Despite these attempts to open the purview of psychoanalytic thought and practice to those previously marginalized or excluded, analysts have been slow to enter disability country.

The majority of contemporary clinical writing in psychoanalytic journals hews closely to the normative setup of abled-bodied analyst and patient exploring the patient’s afflicted mind in the context of a private setting, with alterations in this setup ascribed to the realms of “psychodynamic therapies” or “applied psychoanalysis.”

Furthermore, while there is an established although mixed history of the psychoanalytic understanding of autism, there is hardly a robust history of psychoanalytic writing on physical disability, nor cognitive or intellectual disability, in which psychoanalysts have treated by “mostly 6

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vacillating between indifference and disdain or unthinking derogation,” (Herzog, 2019, p. 136).

Given that psychoanalysis is one of the most sophisticated bodies of thought and practice to address human development, mindedness, trauma, affect and the fate of the body on the mind, it is vexing and troubling that analysts have avoided a sustained engagement with disabled persons and disabling conditions in both thinking and practice.

It is important to acknowledge that disability is a broad umbrella term that refers to a range of physical, sensory, cognitive, and psychic-emotional differences or impairments. As British sociologist Tom Shakespeare writes, “It is dangerous to generalize about disabled people because impairment comes in so many forms, and because each person reacts differently to their own experience of impairment.

The extent to which disability is a problem depends on the complex interplay between the individual’s impairment and their personal resources for dealing with it, and the wider context of the social and physical environment in which they live,” (Shakespeare, 2007, p. 53).

To wit, the areas of critical disability studies, crip theory, and the neurodivergence movement, among others, provide modes of analysis that aim to reveal how social structures are implicated in the production of disabled life and subjectivity, often in a harmful and limiting way. These areas illustrate how disability “is not an object but a social process” (Davis, 1995, p. 24) and offer a vital perspective on the social and historical contingency of that which the biological and mind sciences consider to be strictly individual phenomena. There have unfortunately been few meaningful intersections coming from the side of psychoanalysis with critical disability studies to date, and clinical training and psychoanalytic treatment remain, on the whole, elitist and exclusionary.

This legacy of inaccessibility and exclusion can, at least in part, be tied to Freud.

Despite his radical reformulation of human

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subjectivity and his position as an expositor of human psychology amidst a period of extraordinary social and historical upheaval, Freud sometimes veered toward a conservative perspective. In one of his final papers, “Analysis Terminable and Interminable,” he states, “The ego, if we are to make a pact with it, must be a normal one. However, a normal ego of this sort is, like normality in general, an ideal fiction.

The abnormal ego, which is unserviceable for our purposes, is unfortunately no fiction.” (Freud, 1937, p. 235, my emphasis added). Freud, in this essay, is speaking to the extraordinary demands that the task of analysis presents to both patient and analyst alike and presumably refers to the necessity of a “normal ego” as a bulwark against so-called difficult patients and failed analytic treatments given the precarity of his still nascent psychoanalytic movement.

However it is a deeply curious and suspect notion to tie it to a social construct—despite referring to it as “an ideal fiction”—without explaining why abnormality is “unserviceable” with the psychoanalytic method.

Indeed, generations of analysts and analytic movements have adopted this position in relation to normality, downplaying the psychic impact of pressures inflicted on individuals through social and historical contingencies, and in certain cases being part of the social order involved in enforcing normality.

One need only look to the areas of ego psychology that stress adaptation to social norms as an analytic goal rather than the opposite: society accommodating a range of its subjects, or more to the point, analysis accommodating to a range of analysands.

With this stated, it is also vital to note that the history of psychoanalytic innovation has repeatedly involved challenging the idea that the so-called “abnormal ego” is unserviceable. From Klein to Winnicott to Bion, from the Tavistock tradition to Chestnut Lodge and Austen Riggs, and from Karen Horney and Harry Stack Sullivan to the contemporary relational tradition, psychoanalysis has benefitted from challenging its own limitations when clinicians take risks to think

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and work differently. In the current context, a more sustained engagement with disability and critical disability studies can help us acknowledge neurodivergence, autism, intellectual disability, physical disability and major psychiatric conditions with the same openness that we aspire to with gender, sexuality, race and class. The idea is to highlight how we are all thrown into the world in different ways, occupying life worlds and our bodies in historically contingent, singular, and precarious ways, and to further acknowledge the manner by which social forces impact and structure psychic and relational life.

REFERENCES: Davis, L. J. (1995). Enforcing normalcy: Disability, deafness, and the body. Verso.

Freud, S. (1937). Analysis terminable and interminable.

Herzog, D. (2019). Psychoanalysis Confronts Cognitive Disability. Psychoanalysis and History, 21(2), 135-146.

Holmes Commission on Racism in American Psychoanalysis (2023). Final Report. https:apsa.org/aboutapsa/holmes-commission/ Shakespeare, Tom (2007) Disability, normality and difference, In Psychological Challenges in Obstetrics and Gynaecology: the clinical management, edited J.Cockburn and ME Pawson, London: Springer Verlag.

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Mourning Person

Ricky VARGHESE

…how to mourn a missing body, a body that has gone missing even to itself, spirited away, a body whose wounds will disappear without a trace, like Sade’s Justine, forever young and beautiful, intact and virginal–a continually unwritten surface, unscarred despite an infinity of mutilations?

Comay, 2011 I recently revisited this stunning passage from Rebecca Comay’s Mourning Sickness: Hegel and the French Revolution after a particularly challenging session with my psychoanalyst. In the session, I was thinking about the body, my body in particular, and the identity of being disabled. In returning to this passage, it appeared as though I was searching for something—a feeling, a sensation, perhaps, an affect—with respect to how I, at a very personal and subjective level, experienced my disability. I felt as though my body had gone missing; more specifically, it felt as though it had gone missing to myself. When, then, does a body —a disabled body—become a person? Is it when the fantasy of the perfect able-bodied figuration can be mourned? Comay’s passage concerns Antigone mourning the death of her brother Polynices.

The tragic Greek heroine recognized that the

only ethical thing to do is to bury and mourn her brother, despite the aggressive injunction against it. She saw in this act of mourning—an act that could cost her her own life—an opportunity to recognize the body of her brother as a person who deserved to be mourned, a person deserving of grief. In my case, who does (or, has to do) the work of mourning, which ultimately might be the work of recognizing the other as a person? Does it fall on myself or on those others around me in the world who perceive my bodily difference? Or both? Is this work of mourning able-bodied-ness an ethical act, perhaps the ethical act par excellence, of recognizing the personhood implicit in the otherness that disability represents within the normative world?

When I refer to my body as having gone missing to myself, I want to be clear that what I am suggesting is not that disability inherently causes the subject to go missing, or absent, or evacuated from the scene of being a figure in the world. I am fully aware of my body and its complicated presence in the world and the reality it has had to become accustomed to. I know that when I walk down the street I am encountered with looks, gazes, and stares. I know that my disability inspires curiosity in others; I also know it inspires feelings of surprise, shock, 8

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desire, maybe even revulsion or disgust. I take a certain amount of pleasure in seeing disgust for what it truly might be, as the queer theorist Tim Dean put it, as [representing] not simply a reaction against pleasure but an unacknowledged form of pleasure in itself: the ego-enhancing pleasure of feeling superior to the objects of one’s regard” (Dean, 2014), which in this case would be me and my disability.

Though I do not identify as a woman, in such moments I also find an uncanny resonance in that poignant line from writer Anne Michaels’s novel The Winter Vault which goes like this: “How much of a woman’s body belongs to herself, how much the clay of a man’s gaze” (Michaels, 2009). This is what I was attempting to approach—this feeling that my body appears “unscarred despite an infinity of mutilations,” that it is a surface that, at times, does not feel as though it belongs to me, but to everyone else in how they choose to perceive, or interact with, it. How does one become a person in such an instance? To be sure, becoming a person here does not mean that one “overcomes” their bodily difference or resists its reality as experienced through living in a world designed by systemic and structural forms of ableism.

Rather becoming a person—subjectification, in

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the truest sense—in this context might require the body to be seen for what it is or what it can be, not so much by others, not least by others alone, but, most immediately, by the one who occupies it. The missing body, the body missing to itself, needs to be found by the person inhabiting it; it has to be mourned by its own person.

A First Mutilation—“…a shameful nakedness…”

I was born with a rather rare congenital condition called cystic hygroma. It is also known as lymphangioma, which, in relatively lay terms, refers to a build-up of fluid in the lymph nodes around my neck and chin area. I had my first corrective surgery for it when I was barely a month old and my seventh and last surgery when I was sixteen. At the age of eighteen, shortly before I was to leave for university, I was told I could have one last—it was always this same promise, “one last”—intensive surgery to make a set of significant “corrections.” I still recall the maxillofacial surgeon saying to my parents as though I wasn’t in the same room as all of them, “It won’t be perfect…but we can bring him as close to that as possible…” My parents were keen on getting this seemingly final procedure done. I wasn’t. All my prior surgeries had taken months of pre-operative preparation and it took still even more months to recover afterwards. This last one would be no less involved and intrusive. In fact, it promised to be the most tedious experience I would have had in my young life till then, involving a yearlong pre-operative period of preparation that included extensive dental and orthodontic work, followed by a long surgical procedure requiring the transplanting of bone material from my hip to my jaw, after which the required post-op recovery time would be, at minimum, six to eight months, most of which would involve significant amounts of bed rest.

Much to my parents’ grave disappointment, I refused to undergo this final operation.

Having turned eighteen, I could exercise my rights as a newly initiated adult and refuse care if I so wished. I refused it for a variety of different reasons. On the one hand, I had no time to put myself through yet another long and incredibly painful set of procedures which would then yield only the slightest modicum of so-called “improvement.” I was eager to leave home, go to university, and get my life started. I find myself holding on to the belief that, oftentimes, time is just a stand-in for desire. When someone says, “I have no time for this…or that…,” perhaps what they mean is that they have no desire for it. In a literal sense, I couldn’t afford the time.

It would mean that I would have to sacrifice, at the very least, a year, perhaps even much longer, of my post-secondary schooling. Still further, it would mean I would have to continue my life at home with my parents from whom, in some sense, I was desperately trying to get away and become more independent.

There was a second, perhaps more significant, reason why I refused to undergo this final treatment plan. I had stopped feeling ashamed of my difference. Or rather, I was able to separate my sense of self as it related to my disability from how my parents experienced it. I “had become individuated from them,” as my analyst described it to me years later. I no longer wanted to live under the shadow of the doubt that they held regarding my marked difference and how it could exist or survive in the world beyond them, in a world that did not necessarily include them. The possibility of leaving home was an attempt on my part to necessarily mourn, and thereby let go of, a past or former sense of myself, one that had always been bound up to and mediated by my parents and how they related to my embodiment. Leaving was not about wanting to leave my body behind, but about taking it with me on what lay ahead of me.

Growing up I was acutely aware of how my parents, both collectively and individually, related to my disability. Collectively, it seemed as though there was a sense of ambivalence or uncertainty they felt toward it. They didn’t know, as my father once put it to me, “how to deal with it”—as though it was something that needed to be dealt with. Individually their respective responses to my disability suggested more to me about them than having had anything to do with me per se. My mother, being professionally trained as a nurse, took on the role of my very own personal nurse. Generally calculated in how she dispensed off affection to her children, she approached mothering me in a coldly technical and clinical sense by charging herself with the role of being my primary caretaker. Having a tumultuous relationship with my father and his extended family, I also became her chief weapon, or rather she weaponized me against them. When I was eleven, I recall her telling me this: “Your grandmother… your father’s mother…when you were born had suggested that I give you up…I thought, how dare she suggest such a thing…you’re my child!”

When I recalled this disclosure in a session with my analyst, I remember saying. “….how dare she tell me…her child…something so hurtful?!

What was she trying to do by telling me this?!”

In hindsight, I have a sense of what my mother was trying to do—she was attempting to create an alliance between her and I against my father and his family by appearing as though she was not only confiding in me an intimate bit of information regarding the early part of my life, but also casting herself in the role of being my most steadfast protector. This would ensure, in her estimation perhaps, that I would always be her willing ally against those who did not want anything to do with either her or me. I was, or rather I became, as I recalled to my analyst, “mommy’s little helper…”

It was easy for me to ally with my mother against my father—an inversion of the Oedipal narrative, with my father being on the outside 9

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of the bond I shared with my mother. This came quite easily to me because, while my mother tried to possess me through her forcing an alliance between us from very early on, my father’s relationship to me, as mediated by his experience of my disability, was one of him wanting to disavow me. He had never entirely been comfortable with my disability. He did not know how to “deal with it,” with how he could have had an “imperfect child” as he put it. Forty-three years later, I feel he still does not know how to “deal with it.” The deep-seated nature of his discomfort regarding my disability can be evidenced in the anxiety that informed a statement he made to me when I was eight: “You know…we were never going to have your brother…we were concerned that he would turn out like you…”

Some parents say such things to their children without even knowing, perhaps, how cruel they are being; or, maybe, my father did. I distinctly recall how matter-of-fact he was when he said this to me; how matter-of-fact he was when he announced that my brother’s existence had depended on how my parents felt about taking the risk of having another child. My disability represented that risk; I represented that risk . The statement in itself, its cruelty, may have been uttered in a manner so matter-of-fact. Its implicit anxiety—regarding my disability, regarding how I “turned out,” regarding how they feared how my brother would “turn out”—was anything but a matter of fact. My father was, in fact, very afraid that another offspring of his would “turn out” like me.

When my brother was born, my father’s fears were put to rest. The truth is that the chances of my brother having cystic hygroma were miniscule, if anything at all. Cystic hygroma, as I mentioned earlier, is incredibly rare.

It isn’t a genetic condition; at best, it could be described as a malformation in the lymphatic system, a “birth defect” as it was put to me growing up—I will return to this notion of my hygroma being a “birth defect” later—and so, I am the only one in my entire extended family on both sides who was born with the condition.

In fact, truth be told, I have never met another person with cystic hygroma. That’s how rare it is. I remember telling my analyst once, “…it’s as though I won some sort of existential lottery…”

And yet, it was a cause for concern for my parents and especially my father. After my brother was born, my disability became all the more magnified. The lines were drawn so firmly in my familial system. My father now had himself an able-bodied child—a son—he could claim as his own without discomfort and I became my “mother’s child.”

So much of these early years of my life were shaped by the overwhelming weight of this shame that I felt I had to shoulder—a shame that wasn’t even mine, but one that I felt I nonetheless internalized quite deeply. I recall an incident—one that I experienced as profoundly violent, while also being deeply

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formative—from when I was nine that reveals just how burdensome this sense of shame was.

My father had picked my brother and I up from school. He parked the car close to our home.

As we were walking to the house, we noticed a group of children on the other side of the street had stopped and started pointing and laughing at me. I could see my father beginning to seethe and get angry. Rather than usher us along quickly into the house, he stopped us in our tracks and looking directly at the group, he pushed me toward them, while holding on to my shirt collar and yelled at them, “Here! Go ahead and laugh! Laugh at him!” I recalled this incident in analysis once and described feeling startled at what had taken place. I remembered not feeling safe; but even further than that, I recall feeling so utterly exposed like I had something to hide, to be ashamed of. Despite being fully clothed, I felt so strangely naked. It would only be years later in a graduate school seminar on the work of Emmanuel Levinas that I would come across a series of passages that could best describe what I felt in that instance. In his short treatise De l’évasion, Levinas suggested this: Shame arises each time we are unable to make others forget our basic nudity.

It is related to everything we would like to hide and that we cannot bury or cover up.

The timid man who is all arms and legs is ultimately incapable of covering the nakedness of his physical presence with his moral person…[In] shameful nakedness, what is thus in question is not only the body’s nakedness…[For] what is the meaning of shameful nakedness? It is this that one seeks to hide from others, but also from oneself…[What] appears in shame is thus precisely the fact of being riveted to oneself, the radical impossibility of fleeing oneself to hide from oneself, the unalterably binding presence of the I to itself (du moi à soi-même). Nakedness is shameful when it is the sheer visibility (patence) of our being, of its ultimate intimacy.

And the nakedness of our body is not that of a material thing, antit hesis of spirit, but the nakedness of our total being in all its fullness and solidity, of its most brutal expression of which we could not fail to take note…[It] is therefore our intimacy, that is, our presence to ourselves, that is shameful. It reveals not our nothingness but rather the totality of our existence. Nakedness is the need to excuse one’s existence. Shame is, in the last analysis, an existence that seeks excuses. (Levinas, 1982) Something about the fullness of my body as represented through my disability—its presence in the world as a kind of bodily inscription that I carry with me everywhere I went— became apparent to me in that moment. I felt exposed by my father. It felt as though I was exposed to the elements; interpellated, as such, by the laughter of others. I introjected

my father’s shame, which shaped his anger, and felt my disability laid bare for others, felt it as a kind of exposure, a nudity or a “shameful nakedness” that I could not escape or resist. It felt like there was no escape —not so much from who I was or from my disability, but from the lens through which my father viewed me, or the script he had already started to write in his mind about my life. Perhaps, in refusing that “one last” surgical procedure that would “bring” me as close to perfect as was possible, I was trying to map out an escape route for myself. I wanted to escape, but not without my body. I wanted to track down that body that had gone missing to itself, recuperate it from the stories that others told themselves about it, and leave with it, making of it a person and no longer making excuses for myself.

A Second Mutilation—“..to be an exception…”

The figure of the supercrip elides bodily integrity; it transcribes over the story of disability a narrative of overcoming it. It assumes that the crip body can exist beyond its perceived or real limitations. It overrides the script of ableism with its own ableism. It makes exceptions out of bodies consigned to the margins of the social landscape. The disabled body is then expected to outperform its own limitations; the onus falls on the body to excel, rather than reorganizing or reconstituting the systems that serve to restrain or limit the body. There is something biopolitical in nature, in the Agambenian sense of the term, about this state of exception. The sovereign state is replaced by the sovereign figure/ individual of the supercrip. Biopolitics becomes atomized here to the level of the individual who is supposed to be in-charge of their own destiny.

There is a totalitarian, even absolutist, sensibility attached to this experience of being a figure that is assumed to be able to surpass what disables it. This became particularly evident in how my parents began to treat me as yet another kind of exception.

I was homeschooled till the age of eight.

My parents had the means to hire a private teacher for me and so they did. They feared that being sent to school would mean that I would be exposed to an inordinate amount of bullying from my peers because of my disability.

Ironically enough, they were concerned about the emotional impact this would have on me. I say, ironically enough, because I don’t think they assessed how not being sent to school might have its own impact, let alone the very impact they themselves had on my self-perception or my self-image.

It was my homeschool teacher who persuaded my parents to send me to school. He thought it would be important for me to socialize with children my age, that I needed to be exposed to the world, not cloistered away from it.

My parents were ambivalent about the suggestion. They were too anxious about what they felt 10

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would be the consequences. I recall it requiring some convincing on the part of my teacher to encourage them to let me go to school. He had picked up on the sense that I had a strong aptitude for learning and suggested to my parents that I be tested for giftedness. This is what finally allowed my parents to relent. I recall having to do a series of tests which in the end yielded the result that my teacher had intuited and that my parents were hoping for. Something happened in how they viewed me—a transformation of their image of me felt as though it took place overnight. Suddenly I was no longer the “sick child” who needed their care, but the “smart child” who needed their support. The child they were ashamed of, overly protective of and anxious about, was institutionally deemed “gifted.”

Another mutilation on how I was perceived—it allowed them to “get over” my disability or “deal with it.” In their view, my intelligence would be my salvation—my way out, my escape route.

At first it did feel as though I had finally found that way out from the juggernaut of shame that presented itself to me. I was going to be exceptional, or rather I was going to be an exception. I was sent to school and began to excel at it. It appeared as though school came easily to me and, in a manner of speaking, it did. I enjoyed learning, being challenged, reading ahead of my peers. It also felt, in those early years, that this new-found sense of myself served as a kind of advantage I had over my brother. My parents, especially my mother in her possessiveness of me, would never cease to find an opportunity to compare my brother to me—“…why can’t you be as good at school as your brother?,” her refrain would go directed at him. My brother, the able-bodied sibling, was cast as the athletic, more physical one between the two of us. I was cast as the more studious of the two. This characterization was its own sort of harmful script. Another instance where my body would go missing to itself. When before my exceptional nature was attributed to my bodily difference, my disability, now my state of exception was attributed to my intelligence and what it promised to offer me, an alternate narrative, a body that could do other things, studious, smart things.

An Infinity of Mutilations—“… misrecognition…”

“I feel like I am at a crossroads right now…I guess I am trying to locate the person that I am…trying to see if I can recognize who he has become…,” I recently proclaimed to my analyst in that particularly difficult session that I opened this essay with. I am not in the habit of referring to myself in the third person, but somehow it felt, or rather feels, apt. It feels appropriate especially in light of how disembodied some of the experiences I outlined above have felt to me; a body that has gone missing to itself, a body that is unsure of how or what to mourn in this scene of having gone missing.

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The session was difficult because I was trying to contemplate this sense of being at a crossroads. The precise crossroads that I was thinking through in analysis was one at the intersection of academia and private practice.

The young studious child had over the course of his schooling acquired five post-secondary degrees, which included two undergraduate degrees, two master’s degrees, and a PhD. I trained in both theory and practice. I was a social worker by training professionally, but I was also interested in philosophy, literature, film, and critical theory, the so-called liberal arts. My doctoral work, which I completed in 2014, was followed by me setting up my private practice as a psychotherapist. Three years into my clinical work, in 2017, I decided to train to become a psychoanalyst at the Toronto Institute of Psychoanalysis. I completed my training in the summer of 2022. All along, I had maintained a foot in the door to the academy as well. I am heavily invested in writing and teaching and harbor fantasies of being both an academic and a clinician. “Why can’t I have both…?” I asked my analyst rhetorically, not expecting an easy answer to my query. I know well how stretched and over-extended I feel most days between both worlds. I know how difficult it is to secure a tenure-stream position in the academy and yet the desire which informs this fantasy structure persists.

“People in my life keep asking me—‘Why academia?’” I said to my analyst. She repeats their query, “Why academia?” I respond, “…but why not?” I elaborate on this. I tell her that beneath that question—“…why are you so invested in becoming an academic?”—I hear the echo of an age-old disavowal of me that assumed that I won’t be able to make it, that I should just accept my “stock in life.” I tell my analyst that “I had drunk the Kool-Aid of my own intelligence…I feel like what I am going through is not so much a crisis of faith…but, a crisis in identity…” What would it mean to leave the academy, school as such, once a safe haven, a cloister unto itself, and devote my life to being clinician. The following exchange ensued: Me: All my life, I feel like I have been trying to prove people wrong…

My analyst: Wrong about what?

Me: I don’t think my parents expected much from me…they were just grateful, I guess, that I survived…everything I achieved or continue to achieve feels like icing…nothing is treated as just “normal”… as I say it now, I don’t even know if I am invested in that word “normal”…it’s such a horrible, punishing word…

My analyst: And yet…

Me: And yet…everything I do has been made to feel exceptional, outstanding, spectacular…

My analyst: And you came to believe this as well?

Me: Yep…it’s the Kool-Aid…when someone asks me, why do you keep trying your hand at succeeding in the academy…I just want to prove them wrong…I hear in that question something else…I know that that’s about me and how I see myself… always wanting to prove others wrong… always wanting to excel…be other…be otherwise than what I feel they expect of me… which I feel, often, is very little or nothing at all…I feel like I am always having to deal with misrecognition…

My analyst: And I suppose, if you keep doing things out of a fear of being misrecognized…if you keep doing things because you want to prove others wrong about yourself, it gets confusing as to what you may be doing that you actually want to do for yourself… and…on that note…we are at time.

The all-too-popular Nietzschean aphorism suggests that what doesn’t kill you makes you stronger. I can’t attest to the veracity of that statement, but there is a certain truth to what my analyst suggested to me. Proving others wrong isn’t a mark of resilience; at some point, what you want for yourself becomes indistinguishable from what you feel others want for you. Take for instance the marker of the “birth defect.” My parents were always uncomfortable with the idea that I was disabled. From their perspective, it meant I wasn’t, or wouldn’t be, able to achieve certain things in my life.

For them, it signified both a lack and a loss of something – ability or able-bodied subjectivity.

My intelligence gave them a “way out” of this conundrum that my disability represented for them. What they felt I “lost” through my cystic hygroma, I “gained” in how they began to invest so heavily in the idea of having a gifted child.

And so, they refused the label of me being disabled and would describe my hygroma to others as a birth defect.

I internalized this as well. Well into my early twenties, I, too, would correct anyone who categorized me as having a disability. I would explain that my hygroma was a birth defect, parroting what my parents suggested about it. This characterization, aside from being medically inaccurate (because cystic hygroma isn’t a condition that occurs as a result of “simply” being born), is informed by an ableist rhetoric that refuses to perceive the body as it is. It was a kind of psychic exhaustion that allowed me to eventually land at the identity of being disabled. Years of having to explain my hygroma to others, having to correct others’ perception of and fantasies about it, left me feeling anything but resilient. My body doesn’t exist in the world in isolation from it. I realized that my disability, like my “giftedness,” forms a relationship with the world around me.

These identities are structured by the function that expectations serve to play in how a body is imagined to exist in the world. Freud was right in suggesting that the ego is “first and foremost a 11

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body-ego” (Freud, 1923). For the visibly disabled subject, the ego is felt perhaps first and foremost at the level of the body.

The body is something that I can’t take for granted. No matter what I did or achieved in my life, I would first and foremost be a body precisely because of my disability and that is a sense of myself that I can’t take for granted. This matter of sense is important here to tarry with.

Jamieson Webster becomes instructive when she suggests: “We need the body of sense, the touching of body and sense; this can only take place at the limit, which is the meaning of extension, of a not-being-able to know itself there where it encounters something beyond itself.

Sense as feeling, against sense as meaning, happens at the place where we make contact with the other” (Webster, 2018). The otherness, in my case, is not merely concerning how my parents related to me as other; the other in question, perhaps the only other that matters here, is the way in which I perceived my own self, the other that I had become to myself.

Misrecognition is psychically exhausting.

But, so is misrecognizing oneself. At a certain point, I realized that the more radical gesture would be to own up to and claim the body I occupied, allow it to breathe, allow it to become a person in all its fullness. If as Levinas suggested, “shame is…the fact of being riveted to oneself, the radical impossibility of fleeing oneself to hide from oneself,” then being unashamed might be about allowing oneself to be rivetted to one’s body, the radical possibility of returning to oneself after having hidden oneself for so long. I want to steer away from a liberal reading of this, as being a sign of liberatory existence or a mark of resilience. Instead, it comes out of a scene of, to repeat myself, psychic exhaustion with ableism. I want to add, as well, as a coda that in writing what I have here it might appear as though I am casting my parents in a less-than-generous light. That was never my intention. I understand them as profoundly complex persons unto themselves capable, as we all are, of both love and cruelty and every feeling in between. Instead by taking account of both them and myself, what I wanted to approach was a sense of my body as being as much a part of my person, as are the psychic wounds, both visible and invisible, that it tenuously carries.

The missing body is no more missing to itself; it is a body among a host of other bodies that surround it.

REFERENCES Comay, R. (2011). Mourning sickness: Hegel and the French revolution. Stanford University Press.

Dean, T. (2014). Stumped. In Tim Dean, Steven Ruszczycky & David Squires (Eds.), Porn archive (pp. 420-440). Duke University Press.

Freud. S. (1923). The ego and the id. In James Strachey (Ed.), The standard edition of the complete psychological works of Sigmund Freud, volume XIX (1923-1925) (pp. 1-66). Vintage.

Levinas, E. (1982). De l’évasion [On escape]. Stanford University Press.

Michaels, A. (2009). The winter vault. McClelland & Stewart.

Webster, J. (2018). Conversion disorder. Columbia University Press.

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Double Slits, Double Binds

“I think I am autistic.” How could an analyst respond to this sort of statement from a patient? On the one hand, analysis is a practice of critical reflection on any statement a person might make about themselves.

An analyst might consider: “why are they saying this to me now?” On the other hand, the analyst may feel discomfort or a lack of familiarity with what it means to be autistic.

And while an analyst does well to respect the patient’s statement, they would be remiss not to consider the context in which it is said.

Assessing adults to determine whether an autism diagnosis is indicated is a fraught process. Assessment is a less common intervention than therapy—less familiar to the public. It is also a costly process that carries all of the barriers endemic to mental health in the United States. The assessment of autism has also largely focused on assessing children. There are clearer processes for assessing autism in children than in adolescents and adults. Autism assessment is also a specialized skill and there just are not sufficient provid-

Ben MORSA

ers to respond to the patient’s statement that opened this paper. And if they could, the patient may be part of one or more groups that may be under identified in autism assessment practices. For so many reasons, an assessment may not reflect the truth of the patient.

Enter self-diagnosis. Self-diagnosis generally refers to the practice of identifying with the diagnosis of autism or, more broadly, the experiences of autistic people. Sensory sensitivity, differences in social communication, executive functioning challenges, deep interests, and a need for the familiar and predictable are the experiences that bridge self and clinical diagnosis of autism. Autism is a disabling condition—whether one locates this in the autistic individual or adopts a social model of disability that attends to the ways society is built in ways that limit or devalue autistic functioning.

The functional impairments an autistic person experiences may qualify them for limited and scarce services and accommodations.

Enter the assessor, whose task is to use (contentiously) agreed-upon diagnostic no12

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sologies and assessment tools to determine whether the patient will receive a diagnosis and associated services. The reality is that the patient’s statement, “I am autistic” is important to hear because they are linking to a category that may qualify them for scarce, and perhaps life changing, support. But analysis is not the apparatus to answer this question.

That falls to assessment. And with the growing number of patients wondering about their own autism, analysis may find value in becoming more curious about assessment.

Enter psychoanalysis, a practice that does not rest on the most obvious solutions or explanations but encourages deeper inquiry to learn something new. Assessment may lead to a diagnosis of autism and even offer an explanation to the patient for what this says about their functioning. Psychoanalysis can hold space for the patient’s consideration of ‘autism’, how it does or does not define them, and the tangled epistemological, ontological, and existential questions autism diagnosis evokes. Put another way, because analysis en-

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courages the patient to take responsibility for what they say about themselves, it is uniquely positioned to meet the self-diagnosing patient. Analysis can help the patient to understand the context of their identification as autistic, how they relate to the diagnosis, and why it might mean something different to them than it does to the DSM 5 (American Psychiatric Association, 2013). Patients are more than their diagnosis. This paper aims to offer a framework for this dialogue or, at least, render its importance.

To accomplish this, I will introduce the agential realist framework of Karen Barad (2007). This framework will help us to delve into the complexity of a diagnostic / identity category like autism and better understand the opportunities and limitations of psychological assessment. Barad (2007) introduces a process of diffraction as a practice that encounters something new in the interaction of the material and the social. Assessment negotiates the interface between material systems and diagnostic categories. Still an agential-realist perspective, challenges the idea that a psychological assessment reflects the ‘truth’ of the patient. As I will elaborate later, assessment of autism quickly entangles in questions of identity and epistemic authority to define identity.

My study of Barad’s (2007) work leads me to believe that it may be more valuable to become curious about how the interactions between the material objects of the assessment, the assessor, and the subject matter.

This would allow us to complicate narrow, reflexive, interpretations of assessment data and notice patterns of interference and diffraction that emerge when we construct apparatuses in attempts to know what is there. This feels familiar to the practice of psychoanalysis, which respects the fraught nature of speaking the truth, especially about oneself or others.

Diffracting analysis and psychological assessment is both an application and a deepening of Barad’s framework that helps us to understand the burgeoning ecology of self-diagnosis and self-definition that is autism.

Agential Realism, Apparatuses, And Material-Discursive Interactions Barad (2007) is a leading theorist in science studies and her work offers a refreshing critique of materialism and post-structuralism. While her focus is on science / social discourse more generally, I feel her tools are useful in this paper’s argument for interaction between psychoanalysis and psychological assessment. Barad (2007) takes on a false binary of the division between scientific / material and social / discursive under the heading of agential-realism. She accomplishes this via critique of the idea of “separateness”—especially the separation between observer / observed, measurement / measured,

etc. She argues that separateness is neither an inherent feature of the world, nor a linguistic fiction. This enables an interaction between material and discursive practices and a critical understanding of measurement apparatuses and the boundaries they make. Barad acknowledges post-structural thinkers like Foucault and Butler for exposing the fiction of a separate (and therefore neutral) objective knowledge—perhaps especially of the body, gender, and sexuality. Of course, there is extant critique (feminist, queer, postcolonial, critical race, disability, class, e.g.) that skewers the well-worn fantasy of an objective science that can be divorced from the sociocultural context in which it is produced and practiced.

Science can not only observe the natural but exerts power through its authority to define what is natural. The conduit of this power is the performance of scientific practices. In assessment, the power to define a patient is performed through conducting an assessment, reviewing the data, preparing the final report, and delivering feedback—including the answer to the question, “am I autistic?”

If autism assessment is so fraught with challenges to arrive at a true diagnosis, then is it any wonder that people and communities would make self-diagnosis a social phenomenon?

Barad (2007) picks up from here to review how post-structuralist thinkers challenge the idea that a social category (like diagnosis) reflects the truth of the person. She adds, though she is not the first to do so (e.g. see Sedgwick, 2003), that post-structuralism can tend toward a paranoid position. It is always eager to reveal how the emperor of science, or any established discipline, wears no clothes and expose the underlying, and socially constructed, conditions of identity and oppression. With respect to autism self/clinical diagnosis, a post-structuralist perspective would rightly critique the problems of autism diagnosis, some of which I introduced in this paper. If autism assessment is so fraught with challenges to arrive at a true diagnosis, then is it any wonder that people and communities would make self-diagnosis a social phenomenon? In recent trainings I have offered, questions inevitably arise about the rapid spread of self-diagnosis and this is often linked to social media, TikTok, and misinformation.

Whether a patient is “truly” autistic or is caught 13

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up in a collective delusion (unlikely, IMO) of self-diagnosis is less interesting to me than the context in which they make the statement. Let us return to Barad to better understand the importance of context and interaction.

Barad (2007) notes that although positivist science and post-structuralism seem at odds, they share a reflexive bias. They share the common fallacy that categories reflect the truth of something—for positivist science, approved instruments reflect the truth of what is measured and for post-structuralists, identity categories reflect a socially constructed truth.

For Barad, both of these fail to account for doings and practices that matter. A patient who says they are autistic may come to learn this through interactions with other autistic people, interactions with social media, interaction with a tattered mental health system where clinical assessment is unreachable for many, and all the horrors of contemporary life. An analyst would be right to consider all of this and to wonder about self-diagnosis as defense, including a defense against those very horrors.

But is that all there is?

To complicate interactions between observer / observed, Barad focuses on boundary making practices, measurement apparatuses, and sensory registers often excluded by the optic bias of science and the paranoid eye of poststructuralism. For her, “posthumanism marks the practice of accounting for the boundary-making practices by which the “human” and its others are differentially delineated and defined (Barad, 2007, p.136).” Assessment certainly participates in the boundary-making practices of diagnosis, accommodation, and neurodivergent identification. Similarly, psychoanalysis participates in the boundary-making practices of subjectivity and who counts as an agential subject—even as it contests these possibilities for anyone.

I do not read Barad (2007) as cancelling science any more than she is cancelling post-structuralism. Instead, she proposes we move past looking for apparatuses that reflect truth and toward diffraction. Put another way, we need not discard the material nor the social, psychodynamic and contextual.

Instead, we can become curious about how interactions between both reveal surprising insights about the material and the social. In this next section, I will review her concept of diffraction and then propose a diffraction of psychoanalytic and assessment apparatuses, so that we might better understand the many interactions that shape the patient’s statement, “I am autistic.”

Reflection And Diffraction Barad (2007) also identifies a common, reflexive, bias in both material and social-discursive perspectives. Each of these, seemingly incongruent, discourses rely on reflexivity— either of the experimenter measuring an ob-

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served phenomenon, or of a theorist that asserts social categories reflect reality. It is easy to identify a reflexive bias in the practice of psychological assessment. Classical psychometric theory relies on the assumption that standardized tasks and activities reveal information about underlying constructs in the patient’s thinking and functioning. Common assessment constructs include intelligence, the various executive functions, theory of mind, social cognition, expressive language, autism, gender, and others. These constructs are not equivalent to scientific constructs like displacement, length, velocity, temperature, concentration, and gravitational force. The latter are much more reliable to measure than the fuzzy and socially embedded constructs in psychological assessment. This means that scores and normative data in psychological assessment amplify the reflexive complications that Barad critiques. There is a higher threshold to trust that they represent something real.

To demonstrate this, I will now review Barad’s (2007) concept of diffraction. But to do so, I must also introduce the reader to the famed double-slit experiment. The double slit experiment, and its variations, offer surprising insights about measurement and complex objects of study. An electron is matter, substance. Yet when one fires electrons through a double-slit apparatus, a diffraction pattern emerges. We might expect the electrons to move directly through the slits—landing directly opposite them. Instead, they form an interference pattern as they diffract through the slits. This is strange because waves behave this way—and electrons are particles after all.

Or so we used to think. I encourage the reader to seek out one of the many video demonstrations of this, which help to stoke the imagination. What is important here is that the double slit experiment, and this pattern of diffraction and interference, led to the surprising insight that matter behaves both like a particle and a wave. We thought we were measuring something real but, in fact, could only see a partial truth.

Barad (2007) relies on the double slit experiment to offer ‘diffraction’ as an alternative methodology to ‘reflection.’ Diffraction as methodology is an example of observing something we did not expect. This methodology has the advantage of focusing on the interactions between the material and the social. Of course, rather than using diffraction to draw lines, we might do better to be curious about which tools, positionings, and contexts draw which lines and how. Barad terms this focus on interactions between materiality and social discourse ‘agential-realism’ and applies this methodology through discussion of the apparatus.

Apparatus Barad’s (2007) agential-realist definition of ‘apparatus’ offers several tools for thinking

about assessment and psychoanalytic work with autism. She defines several characteristics of apparatuses. They are material discursive practices rather than mere things. In analysis, the couch or telehealth matter. An assessment is more than just an inert tool of observation. Apparatuses are less these things, but more how they are configured and located in the world. Is the couch narrow or wide, short or long? What bodies find comfort there? Does the patient need to walk up stairs to access it? What price must they pay to lay on the couch? There is much more here but note for now the key themes of interaction, mutual influence, open-system, dynamism, and contingency. Each of these introduces problems in a classical and antiseptic practice of either psychological assessment or psychoanalysis. These problems are also affordances and opportunities for meaningful reconfiguration of self, other, human, and world.

Let us consider two apparatuses of autism assessment: the Autism Diagnostic Observation Schedule—Second Edition

If psychological assessment and clinical diagnosis affirm self-diagnosis, then what was the cause of the autism? Was the cause a motivation to seek assessment first stoked by selfdiagnosis? Would selfdiagnosis be a cause?

(ADOS-2, Lord et al., 2012) and the Monteiro Interview Guidelines for the Diagnosis of Autism Spectrum—Second Edition (MIGDAS-2, Monteiro & Stegall, 2018). Clinicians may have heard that the ADOS-2 is the “gold standard” of autism assessment, but when I completed training with an author of the ADOS-2, she clearly stated it is not a “gold standard” and the ADOS-2 should not be the deciding factor in determining whether to diagnose a patient as autistic and this assessment’s manual offers the same guidance (Lord et al., 2012). Her humble statement affirms that the ADOS2 apparatus does not fully reflect the reality of the patient’s autism, or lack thereof. The assessment manual also advises against using the ADOS-2 as a litmus test for autism.

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More context about these assessments would be informative. The ADOS-2 (Lord et al., 2012) is a series of modules, chosen based on the patient’s age and expressive language ability. They can look very different, but they have a common purpose—to create a structured but, hopefully, naturalistic experience where the patient can reveal their autism. Autism is defined as a series of atypicalities and the degree of atypicality for each corresponds to a number. The numbers are compiled into an algorithm and a cutoff score determined. The idea is to observe the patient without them being too aware they are being observed. The observer risks influencing what they observe in their interactions with the patient. This makes administration challenging and, for some assessors, deeply uncomfortable.

Perhaps analysts reading about this register discomfort too. An analyst would rightly question, “how is the patient’s narrative taken into account?” In a strict sense, it is not. The MIGDAS-2 (Monteiro & Stegall, 2018) has a different structure. It is open form, lacks the psychometric qualities of the ADOS-2, and is based on narrative theory. It presents questions or activities to the patient that invite them to share about their interests, their sensitivities, their emotional and relational experiences, and their use of language. It catalogues differences, rather than atypicalities. It invites the patient to knowingly show themselves, rather than subtly inducing them to perform autism. Analysis may do something similar. I review these tests to highlight various problems—if the patient has no voice and is surveilled for their strangeness, how will this impact them? If the patient can simply say all the reasons they feel they are autistic, can we truly believe them? If neither assessment is a true “gold standard” then how do we solve the problem of knowing whether the patient is autistic? Furthermore, how do we learn what it means for them to be autistic?

Let us engage an exercise to reflect on these problems. Is the patient autistic when they begin reflecting on this question in analysis? Are they autistic when they self-diagnose? If psychological assessment and clinical diagnosis affirm self-diagnosis, then what was the cause of the autism? Was the cause a motivation to seek assessment first stoked by self-diagnosis? Would self-diagnosis be a cause? Would the feedback session after an assessment be the effect—or a new and true cause, true because it would then be backed by the scientific authority of the psychologist? At which point in this process would a person truly be autistic?

This is where I believe psychoanalysis has something to offer. The concepts of self, self-definition, and truth are always contested.

Simultaneously it values the reflective dialogue and project of meaning-making found in the

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dance of free-association and interpretation.

At its best, psychoanalysis holds the reality of constructs and categories in critical suspension. This is not to deny the reality of autistic disability, but, rather, to interrogate the idea that this is something any other person can define. It offers a space for an autistic person to be curious about themselves as such. In the conclusion of this paper, I will discuss how this psychoanalytic affordance helps us to understand the burgeoning ecology of self-diagnosis and self-definition that is neurodiversity.

Double slits and double binds. In one set of interactions, psychoanalysis is ill-equipped to address certain material realities of autistic life. Here, assessment is a different apparatus.

Its situation in a field of scientific and diagnostic authority allows it to make the boundary between human and autistic and interact with the material reality of an autistic person in ways psychoanalysis cannot. In contrast, although assessment may offer more material affordances for clinical practice, it is prone to its own habits of mind and imperfect boundary making practices. Autism assessment enacts specific boundary-making practices around subjectivity and, in my view, has much to gain in diffraction with psychoanalysis. Specifically, an analyst can be with a patient while they negotiate these interactions and support them to deepen their awareness of the context in which they (or an assessor) state the patient is autistic.

A Burgeoning Ecology It is no accident that clinical signifiers regularly compose definitions of autism and serve as the primary objects in conversations about neurodiversity. Clinical constructs, and their check-listed symptoms, serve a gatekeeping function for social services and disability classification. The construction of these diagnoses matters because it differentially impacts the material wellbeing of neurodivergent people. Because diagnostic systems also apportion money and compulsory participation in capitalist labor markets, they call upon designated professionals (primarily psychologists) to enact the authority of defining who meets diagnostic criteria and who is functionally impaired enough to receive support. Psychologists use the practice of assessment to render individuals in the eyes of social systems that matter. Assessors are in a position to do this, analysts are not. This is what assessment can offer analysis.

In this diffraction, analysis can also offer something to assessment. The phrase, “I am autistic” makes (or should make, IMO) the analyst curious. Intrapsychic splits, repression, projection, the holding environment, the attachment system, and the relational field all complicate the idea that there is an ‘I’ to be or a subject who could truthfully say, “I am autistic.” It piques analytic curiosity. At best, the analyst approach-

es the patient’s claim with a spirit of curiosity and an openness to the patient’s associations to autism—neither rejected nor accepted outright but held in an open tension.

This tension might reveal diffracting dynamics that accentuate the complexity of the statement “I am autistic.” Trauma, depression, family dynamics, flows of (mis)information, the trials of life, and garden variety identifications and defenses all seem relevant contextual factors that analysts are well-positioned to consider. Each may, or may not, drive the patient to say they are autistic. Perhaps more importantly, analytic apparatuses may help the patient understand what it means for them to be autistic in deeper and more contextual ways than the DSM-5. Assessment will weigh in on the patient’s statement—but largely in terms of gathering evidence for functional impairment—a breakdown of the interaction between individual and environment. And the conclusion may have a direct material impact on the patient as well as epistemological and ontological implications for their experience of knowing (or not knowing) their being.

the idea that there is an ‘I’ to be or a subject who could truthfully say, “I am autistic.” It piques analytic curiosity.

At best, the analyst approaches the patient’s claim with a spirit of curiosity

Psychoanalysis has the potential to hold space for the fact that autism—like any category—is in suspension. Changing perspectives of what autism is, critiques of the autism status quo (applied behavioral analysis, and the pathology model of autism), the errors of assessment tools (and assessors), a lack of consensus on the assessment process for adolescents and adults, the financial barriers to accessing quality assessment, and the systemic barriers that constipate the pipeline to train more assessors all speak to the material reality that if objective diagnosis (and therefore assignation of autism as signifier of identity) were possible, few would be able to access it.

In closing, I want to return to the assertion that self-diagnosis is a kind of fad or collective defense. I mention this because some version of this statement / question inevitably appears in trainings and supervision I lead.

Typically, people code the burgeoning ecol15

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ogy of self-diagnosis and self-representation of autism in social media as collective defense against the trauma of COVID, youthful refusal to grow up, or a delusional defense transmitted through social media- like a virus or a dangerous refusal to wear a mask. This context is certainly relevant to consider, but to say it reflects a reality that the patient’s statement is not true may be misguided.

Consider the adolescent who does not turn work in on time, refuses to attend school, and has taken to always wearing noise-cancelling headphones. Is this merely an example of how “kids these days” refuse the responsibility and hardship of growing up? Then again, can we blame them? The world we are leaving them is burning, their innocence has been stolen, and we feel helpless to repair that. I take for granted that analysts would recognize the dangers of responding to the patient’s statement with the reply, “no you are not,” perhaps especially an adolescent patient, particularly if followed by adult rejoinders to pull themselves up by their bootstraps.

The statement, “I am autistic” is a kind of constitutive negation. When a patient identifies themselves as an autistic subject, this identification also rests on a negation—they are not neurotypical, they are not functioning in the world, they are not supported, they are not normal, they are not what is expected of them, they are not understood. Conversely, when an autism diagnosis is assigned to them, they may not know what this says about them. In a first session with a patient, I said I was just getting to know them and asked them to tell me about themselves.

They replied by saying they had been diagnosed with autism, c-PTSD, and alexithymia. They received these diagnoses in a formal assessment and added that despite feeling they were true, they had little idea of what this meant to them.

For various reasons we chose not to work together. In this situation, I often offer psychoeducation about the therapeutic alliance and its central role in the outcome of a treatment—oftentimes more than any specific orientation or brand of therapy. They said this was hopeful and disheartening. Hopeful because it meant they could decide. Disheartening because only they could decide. Is this not a truth patients encounter in analysis?

REFERENCES American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi. org/10.1176/appi.books.9780890425596 Barad, K. (2007). Meeting the universe halfway: Quantum physics and the entanglement of matter and meaning (2nd Edition). Duke University Press. DOI https://doi. org/10.1215/9780822388128.

Lord, C., Rutter, M, DiLavore, P., Risi, S., Gotham, K, Bishop, S. (2012). Autism Diagnostic Observation Schedule Manual (2nd Edition) [ADOS-2 Manual]. Western Psychological Services.

Monteiro, M. J. & Stegall, S. (2018). Monteiro Interview Guidelines for Diagnosing the Autism Spectrum, Second Edition: A Sensory-Based Approach [MIGDAS-2 Manual]. Western Psychological Services.

Sedgwick, E., K. (2003). Touching Feeling: Affect, Pedagogy, Performativity. Duke University Press. DOI https://doi. org/10.1215/9780822384786.

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An Interview with Valerie Sinason

Jay Crosby: Thank you for speaking today. By way of introduction, I’ll say that I’m interested in the relationship between psychoanalysis and disability both for personal reasons—I grew up with a father with a chronic physical disability and have a son diagnosed with a rare developmental disability—but also for political reasons, in order to further understand and address the elitism and ableism that continue to permeate and limit our field. I’m wondering if you can speak to how you came to develop your work and how you’ve negotiated this problem of ableism in psychoanalysis.

Valerie Sinason: There are some key issues that you’re raising, one of which is that most of the work done on intellectual disability has been done by people who, like you and me, have someone they love in their family with an intellectual disability, which makes sense. But it was shocking to me when I realized that the second group that cares intellectually, clinically, and theoretically is made up

Jay CROSBY

of those that, for whatever reason, have had a complicated minority experience themselves.

At the Tavistock clinic, where for over 20 years I either led or co-led what was first called “the subnormality workshop,” then “the mental handicap workshop,” then “the intellectual disability workshop,” there were the first group, then immigrants that knew what it felt like to not be the wanted color, gender, accent, or class. The only exception to that—was pointed, out for example, by my excellent co-chair for several years in the adult department at the Tavistock, John Stokes—were brilliant upper-class white people who had felt at odds being brilliant, or upper class-, because therapy professions are mainly middle class.

It is easy for a middle class professional to end up thinking that there’s middle class, lower middle class, working class, the traumatized, the dispossessed—but can tend to forget that there’s upper class and aristocracy.

And, in fact, the first time I ever assessed an 16

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upper-class patient with a severe disability, I went into a kind of subordinate mode that I was quite fascinated by. He was speaking with these upper-class manners and accent and I was temporarily unable to believe he was disabled. So I got a very embarrassing personal lesson about social class and therapy. We are only now in the UK paying attention to the traumas of boarding school and separation.

When we first started getting ethnic questionnaires asking, “How many people in your workshop are this background or that background,” I answered that it would be a sign that the status of disability had changed when we don’t have far more minorities represented than any other workshop in the building.

JC: Disability can be so aversive to people.

VS: Disability is a terrifying subject, especially intellectual disability—I think it is part of the Darwinian legacy. If we had some extra thinking power that made us different than other animals, it was unbearable to get near someone whose thinking would not be

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on the level of the rest of their peer group.

There’s a feeling of contagiousness getting near it. It’s a reality that people don’t want to face in their own life, so they don’t want to think of someone else having to live like that.

But it’s Mother Nature. Let’s say that 10% of babies in lucky countries will have some sort of cognitive difference. But if you go to traumatized and poor countries, the percentage will be infinitely higher, because outside of the small group of middle-class or upper-class families where something out of the blue happens, the biggest disability worldwide is mild intellectual disability. And the shock is that it’s nearly all for political reasons in that group. Whilst profound disability related to genetics is spread evenly and in relatively small numbers across all social classes, mild disability is a symptom of trauma. There’s a small number for whom something organic has caused it, but the majority are breathing in toxic environments at the age when the brain is developing. And therefore, given that most therapists have a civil service mentality—go very slowly, carefully, don’t rush in, take our time, do not intrude—the shadow side of that is a fearfulness of reality.

JC: How did you bring psychoanalysis to bear in your work with intellectual disability?

VS: Psychoanalysis lives inside me with whatever I do. Well, I did a Kleinian child training with an independent group analyst, and then an adult psychoanalytic training with a Freudian one. I’m very “mixed race” over my training—child and adult. I couldn’t do without projective identification from Klein, or the power of counter-transference, in disability trauma work, but I think that British Kleinians working with adults, until the last few decades, have been damaging over the status of external reality, and that the delay before sexual abuse was seen as reality—and not an Oedipal fantasy—is still impacting generationally. And somehow, within the independent group, the past Freudian work on abuse was just forgotten. So I think that as disability in itself can be experienced as a trauma and as people with disability are more vulnerable to abuse a psychoanalytically- informed, trauma- informed way of working is crucial.

I have my own apologies to make-both over the time it took me to recognize reality and over my class bias in disability work.

Anne Alvarez, a brilliant Kleinian child psychotherapist, was my favorite supervisor.

When I qualified, I went straight to her by choice. We both joined the Tavistock as consultant psychotherapists at the same time— her with the autism workshop and me with the mental handicap workshop. And it used to impact on me that the work of the autism workshop gained extra support due to the fact that autism was middle-class in terms of the brave parents who were showing that

their child had not had the right treatment and needed something. And from my sort of working-class background, I was concerned about autism only if it went with being learning disabled as well. I thought, “Typical -people caring only about autism when it is middle class.” And that was very arrogant and snobbish of me—reverse snobbery. It was almost half a century ago!

Now I’m much more aware that it’s far more than 10% of any school class with a problem. I’m very grateful to the whole neurodiversity movement for making us aware of things that I never had any training in. I never knew about things like sensory processing disorders. So, I think we do need to properly take on board that everybody is a universe of their own, and whilst we might share a common language, it’s going to have a different meaning for everybody until we’ve interrogated it.

This led me to another Freudian realization: that you have to have curiosity for others. You have to ask a question. Whereas in adult analytic training, certainly in the U.K., you didn’t use to ask questions, with disability it mattered that you did. When we asked questions of people with severe and profound disability, we got answers that changed our lives. For example, for 16 years Baroness Professor Sheila Hollins and I ran a weekly group for men with severe intellectual disabilities and sexual problems. The men were all always talking about “sections”—they only met each other in the group once a week for an hour and a half, and every week it would be all, “My section’s coming up.” And one week Sheila asked, after over a year of weekly therapy, “Do you know, you all often talk about being on a section? What’s a section?”

And one of the men said, “It means nobody wants to sit next to me because I smell.”

It makes me feel like crying, remembering it all these years later. So, it’s not just middle-class autism that masks. There’s a way every human being masks, and it’s called “politeness” or “courtesy to the other.” But none of us really know how well we know the people we think we know, if we haven’t asked and heard them. So there’s something about really actively and deeply listening to somebody.

One of my most painful examples of this was a girl in a special unit who had come from an abuse background into a lovely foster home, and was doing really well at school until it came to the end-of-term party and she was offered lemonade. She picked up the glass bottle, smashed it, and it went everywhere. Everyone was terrified. It turned out that she was a victim of organized abuse, and in the abuse, semen was called lemonade.

What she was saying was, “I thought it was different here.”

Since 80% of everyone disabled I worked with turned out to have been abused—which is average, we now know 30 years later—I 17

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started to become very aware of the assumption that words mean the same thing to everyone, when in fact meaning is dependent upon the experience someone has had. For example, what did a bedroom mean? How could someone sleep in a bedroom if that’s where they’d been hurt? What did a table mean if you’d been beaten over a table? What were the different objects that had different meanings in your mind? Because I’ve always loved words, it’s always been the words and the linguistic meaning I’ve gone for. Each of us as a therapist brings something so totally different than anybody else, whatever our training has been.

When you work with severe disability and trauma—because they normally go together— everything you’ve been and known is useful.

My maternal grandmother, who lived with us until she died, was illiterate. And that was always the reason given for what she could and couldn’t do. It was only after my mother died that I was allowed to realize internally that she had a mild intellectual disability through trauma. That was not speakable before. So in my second edition of Mental Handicap and the Human Condition, I put my own bit of blindness in, because I’ve always loved Bowlby’s paper, “On Knowing What You’re Not Supposed to Know and Feeling What You’re Not Supposed to Feel.”

The more you work with trauma, the more you realize how everyone dissociates, which is my other main area of work.

My father became a professor of “mental handicap having had to leave school at 14 after the army. When they wanted teachers, he got himself a further education, taught “backward children,” then became a head, and then a professor. He was the first head teacher of a school for disabled children to force his staff to give up the cane, because he saw this as assault very early on. He’s the reason disabled children in England go to school. Until him, they went to hospital because they were “ineducable,” and it was his book, No Child is Ineducable, that transformed things politically. He was the most utterly wonderful, wise, and lovely man.

In 1979, Neville Symington—an Australian analyst—got interested in a man with a mild disability who was unusually referred to him, who could speak well and read to an eight-year-old level. So Neville started a workshop, and four or five analysts at the Tavistock joined, because they loved Neville. I was a trainee child therapist, and the workshop had been going a few months, and I thought, “If I join, am I being Oedipal? “And then, “If I don’t join, I’m also being Oedipal, so I might as well join.” And I found that I knew the work—I’d lived it. That man who Neville treated was just like my Nan, even though I wasn’t naming that then. The moment I joined I felt I’d come home. And Dad was so pleased I had gone into the same area.

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But once Neville went to Australia the group stopped, and John Stokes and I built it up again. And we found that the international analytic history was very like what happened at the Tavistock—that a single analyst would, by fluke, get a referral, realize, “My goodness, this person can make use of a talking treatment brilliantly,” write a paper on it, it would get noticed, and then they’d never do another piece of disability work again. I stayed for 20 years running or co-running it, and only leaving the Tavistock to set up my own clinic for dissociative studies.

Eventually, following in my family’s footsteps, I came to realize that my job was to go where people had not been given meaning.

JC: Psychoanalysts ideally engage in a form of listening that is predicated upon an openness of being to an other—one that offers safety and to allows the patient to open to painful parts of him or herself. And yet, we have so many ideas around the complexity of clinical listening and clinical process and the position of the analyst in relation to the patient, that leads some analysts and analytic traditions to lose sight of the humility necessary to good analytic work. Given your experiences, I’m wondering about your perspective on the utility of psychoanalytic thinking and training in relation to the hermeneutics of humility.

VS: I think that the hierarchy in analytic training , hopefully mainly in the past has been so severe and powerful that it hasn’t aided that kind of humility which is engendered through working in a rough school or in the back ward of a psychiatric hospital. I think there is a way that when analysis is embedded in a prestigious place or a certain class, and not made available, it doesn’t help itself. But I think you have to go through whatever the training is in order to be able to undo it or tweak it—to know what has been precious and mutative for you, and what has been damaging. I was lucky with both the two main analysts I chose, who compensated for where the actual training structure did not help me.

For example, I was working with a woman with dissociative identity disorder, who was quite brilliant in her main personality. And there was a silence after she said something, and I was thinking—or rather, I thought I was thinking. And after a moment the patient said, “Okay, you’ve gone again, Valerie. Where are you? And don’t give me that analytic crap that you’re thinking that you’re in a couple, and I don’t like you being in a couple, and I’m intruding. You’re stuck, you idiot, aren’t you?” And I was utterly gobsmacked. I realized I was stuck, and she told me exactly why I was stuck, and it was devastating. I’ve always said one patient like that can save you years of analysis. They know you better than almost anybody. In a way, that was a very good illustration. Like lemonade, I would never have thought of

that. I could have come with all sorts of theoretical formulations and interpretations in mind, but she had the answer when she was listened to.

Another thought I have about analytic training is rather controversial. I think there is a dissociative listening that many analysts are trained in, which is comfortable, that can be sunk into, thought about. “And I wonder if…” “And could it be that…?” And actually, that’s dissociating from the emotional impact of the other.

There’s a small group of us that have been doing this work for 40 years, and we know our equivalent colleagues all around Europe and the world. We’ve all been saying the same things, all meeting the same subtle responses, “Oh, you work with disabled people! You must be so patient!” Meaning, “What a failure you are if you want to work with people like that.” My father used to talk about the E-stream teachers being given the E-stream. He said, “You want the A-stream teachers for the E-stream! You’ve got to have the best for the people that have suffered the most.” But that’s not what happens. Analytic culture is not kinder, is not more understanding than other aspects of culture, which is rather disappointing.

I think, in a way, we feel our mental health is on the line when we apply for analytic training. It’s as if to be rejected is to be told, “You’re mentally ill.” And then, the thrill at being accepted leads to an idealization of the institution in a way that makes it harder to see all the problems involved. Pearl King, my beautiful supervisor for my work with dissociative patients , once said that the time you have most power as an analyst is the year after you’ve qualified, you’ve gotten rid of your supervision, and you feel free. And when you’ve retired. And she said, “Silence is traumatizing.” Most training is on the joys of silence and the 365 flavors of silence. Not with trauma. Not with disability. Not with dissociation. With those, silence is persecution. When the absent object is the present persecutory one, it’s not helpful to work through it by being that. Not for people that have gone through more hell than we could ever imagine.

JC: What you’re saying, broadly, makes me think about Bruno Bettelheim and the move that he did in the 1940s taking seemingly psychotic or autistic children out of the hospitals and offering them a beautiful home on the Midway in the south side of Chicago, serving meals on ornate china and painting elaborate murals throughout the building.

This was part of a remarkable paradigm shift in terms of treating disabled people in a more human way and seeing symbolic expression in behaviors that others wanted to shut down.

But then I also find myself thinking about the destructive legacy of Bettelheim in terms of 18

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the theory of the refrigerator mother and the subsequent biological and neurological turn in terms of conceptualizing most disability in terms of brains and genes. This pendulum can be dizzying, yet I hear a sensitive movement in what you’re saying about the etiology of disability in terms of trauma, disavowal, marginalization, and not being given a voice.

VS: You’re right, we go from one to the other, and it’s hard to stay holistic. Everybody has a bit of everything, and each generation will have to privilege the bit that was missed out by the last. You go ‘round in different circles until they’ve all been put together. But at some level, we have to ask, “Can we go back to being human, please?” I love the Sylvia Plath poem, “The Applicant”—Are you our sort of person? Do you have a crutch? Do you have a rubber leg? And if not, well, how can we find a place for you?

And we haven’t even started. One thing I did have to humbly learn was that, despite amazing changes in emotional capacity and functioning among people with intellectual disabilities in therapy—even with profound multiple disabilities—IQ did not change. I had to learn that through my own research, because I never believed IQ was something static. Not that it necessarily matters, but it was important to realize. The patients’ free association, their stories, their narratives, their verbal language, all showed change. So we’ve been able to show that talking treatment works, but not in ways measured by IQ. JC: That’s a remarkable finding, particularly since IQ can have such a dominant influence on the provision of services and in determining what level of education one has access to.

VS: Yes, and most people with intellectual disabilities don’t ever get that chance, although a few are lucky with this part of their environment. Just to have one person, one teacher—you don’t expect all the teachers in your school will be nice to you or like you, but you need one. In some cases, it could make all the difference. Being able to say, “I love you,” and realize someone liked to hear that from you, when you felt they all hated you. Also, a greater awareness of ableism is needed. Like with a child who’s fallen over, gotten their scratch, and scratches it more to make their war wound more impressive, a lot of people with a disability will add on what I call “the secondary handicap.” If you’re going to be looked at for looking or sounding different, you might as well exaggerate yourself to mock the people looking at you. They think they’ve seen you, but you know you can do them one better. To be safe enough to give that up then means you’re just a bit different, which can be much more painful. Like getting a B instead of a B-plus can be harder than getting a C or a D. It’s asking a lot of someone to dare to be themselves.

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Where We Stand With Autism An action so often understands how to disguise itself as a passive experience.

—Freud For some decades now, speakers on autism have observed a surge in diagnoses that some have called an epidemic. Once thought of as among the rarest and most severe of clinical problems, affecting no more than one-tofour out of ten thousand, estimates of prevalence in some places have reached as high as one out of forty-four children, with increases looking asymptotic. Autism has commanded attention, and deserves it, not least because no other diagnostic form has undergone such staggering change in perceived quantity and quality—from almost non-existent to seemingly everywhere, from gravest pathology to a wide array of phenomena. It seems as if we are trying to work something out.

Epidemiologists, to whom we ordinarily might turn in such a situation, insist that they have little to offer. They are clear that their methods do not and cannot answer a question some pose, even as others object to its premises: whether the growth in autism diagnoses reflects true change, or is only a function of altered practices and social conditions. The conditions they identify are: more numerous and more liberal diagnostic definitions, diagnostic substitution

Brian E. SMITH

by autism for other diagnoses like intellectual disability, increased awareness of autism among professional and lay people, and advocacy to diagnose as early as possible. The most this line of work can conclude is that the changes better cover the involved population, even as it can’t quite shed a suspicion some have that the language of autism has come to describe people who, for lack of a better way to put it, might not be autistic. But it cannot tell us whether there are more autistic people than there used to be, or even whether—to put it a bit existentially— there is more autism than there used to be.

Without helpful understanding, many fall back on intuition, and autism affords expression of a common one: that trends in mental illness or their diagnosis express shared or cultural psychological preoccupations. Over time these intuitions have tracked trends in the appearance of things like depression, attention-deficit / hyperactivity disorder, obsessive character, multiple personality and dissociative identity disorders, and now autism spectrum diagnoses. Other problems preoccupy other times and places. Here the thought is that something in the culture has been making us more autistic, and the intuition seeks to link shifts in diagnosis to seeming autistic phenomena and concurrent cultural trends. The need for links can feel so

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great that some who cannot tolerate uncertainty cobble together whatever they can find, and insist on its value even when discredited.

Meanwhile the phenomena have long since burst past the conceptual apparatus seeking to meet them, manifesting with such diversity that even the most circumspect generalization can feel misplaced, even dangerous.

Thus the wisdom in the familiar autism rights aphorism, “If you’ve met one person with autism, you’ve met one person with autism.” In this field, great caution is good counsel. There is no overestimating the value of what is often felt to be at stake in conversations about autism; no overstating the strength of conviction, the pressure to believe and be believed; and too often, no mistaking the impulses toward retaliation. People get fundamentalist at autism.

Since so much is at stake, any step risks harm. For my part, I acknowledge the perhaps inevitable harm this writing may cause. I apologize for this harm. I hope you will simply discard whatever you find unhelpful. I will be happy if, by sharing what I think I see, I can shed even a little light on a situation that is so clearly unclear. Perhaps it is too much to hope that this brief communication might contribute in some way to the dignity and satisfaction of people with autism and those who love them.

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Overlapping the same decades as the changes in autism, psychoanalysis famously declined in the West, its power largely assumed by organic psychiatry and behavioral psychology. One form this took was replacing what little was said about autism—as in Margaret Mahler’s theory of normal early autism, and the so-called refrigerator mother theory—with beliefs in biogenic autism, that is, that autism is an expression of organic factors. Mahler, in a relatively early part of her career, crafted a theory of normal infantile autism as the earliest phase in her program of separation-and-individuation, a phase characterized by “lack of awareness of a mothering agent.” She later recanted. The refrigerator mother theory is a popular way of referring to a formulation of psychogenic autism that emerged in the decades after Leo Kanner, in his foundational work on autism, claimed to perceive emotional coldness in the parents, particularly the mothers of the autistic children he observed. The theory reduces etiology to a consequence of the supposed coldness, and was, in my view, part of a larger trend, still with us, that literalizes the psychoanalytic emphasis on childhood and reduces it to a crude psychogenesis that always links clinical problems to deficits in parenting.

Some theories are less brutal and less prone to caricature than the so-called refrigerator mother theory. For one, a long tradition of workers, largely European, have emphasized that they treat only psychogenic autism or its psychological facets, leaving to organic origin whatever space it occupies. Indeed, many contemporary psychoanalysts seem to feel little conflict in recognizing as organic the origins of the autism of people they treat, while others simply keep etiology and treatment separate enough to offer their help without getting drawn into questions of origin.

The point is not the origin, but rather that psychogenic theories were once more viable, perhaps even hegemonic, and have largely been replaced by organic accounts.

The implication, often unstated, is that progress has been made—we once were foolish, or dogmatic, or cruel, but now we understand things better and behave with more compassion. This seems to be true, but it is also not the point. The point is that the possibilities for thinking, talking, and belief have changed.

In seemingly sensible conversations, people have a hard time appearing or even feeling reasonable in voicing a psychogenic autism.

Thinking and talking about autism are now structured this way.

Or put another way, autism is now one of the only ways left to reliably do something that used to be central to psychoanalysis: being scandalous. It is hard to be scandalous with the things psychoanalysis used to be scandalous about—things like incest, atheism, toileting, psychological explanations for evil.

Around none of them can a psychoanalyst stir scandal as reliably as uttering something felt to communicate a parent’s even unwitting hand in their child’s autism. In many settings, to wonder such a thing is a thought-crime. It is preferable and less seemingly unreasonable to wonder if a vaccine or an unknown environmental toxin is somehow involved. No doubt the shift from clinical psychoanalysis to organic psychiatry and behavioral psychology expresses changes in the possibilities for belief about a great many things, in and out of the domains traditional to psychiatry and psychology. Across the board—the story goes—it is relatively more difficult than it used to be to seem or feel reasonable in voicing a psychogenic theory of anything. Often this is because psychogenesis is felt to imply blame, and the theory seems cruel.

This may be the main reason why our interest in working on the theory of psychogenesis has so atrophied—because many have decided that it must mean trauma, by which they usually mean abuse or neglect, even indifference, and usually picture a blameworthy party. If we can’t imagine a person or entity actively or passively harming someone—by commission or omission—we have trouble imagining a psychological origin to a psychological problem. This has impoverished our theories of pathogenesis, and has left us, when we want to try to explain something for which such a personified trauma does not seem to fit, with little recourse but to fall back on innateness, which fast becomes biogenesis; we then look for organic correlates of psychological phenomena and believe in them as holding truth when we find them.

All the while we carry an at least latent—often enough manifest—moral memory of the harm that some theories of psychogenesis have caused. Taken together we have in effect become phobic of psychogenesis. It might be helpful to remember that psychoanalysis used to know how to think psychogenesis without recourse to blame or its disavowal, or even necessarily to an external precipitant.

Naturally such an idea would be a little like internal psychological conflict in its relative independence from outside factors. And yet we might still notice a pathogenic moment, which would be more like a psychological accident—something that is nobody’s fault, but still happened, causing injury, with consequences.

After all, the history of the disillusion with psychoanalysis is nothing if not a reckoning of who to blame and why. Psychoanalysts so clearly have on their minds the blood on their hands: of women, people of color, queers, the poor, the differently abled, non-physicians, patients unhelped or frankly harmed by dogmatic treatments. There are others. Autistic people and those who love them lay claim to special status in this group 20

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on account of the great change in the appearance of quantity and quality of autism in recent decades. This point cannot be overemphasized—that out of fields in which autism shares so much with other things, it stands unique because nothing else has undergone change quite like it. This uniqueness calls for special understanding.

The context for that uniqueness is shifting zeal—for a time, a lot of people believed that psychoanalysis could do anything. Some still do. And then, for a time, a lot of people believed psychoanalysis wasn’t good for much at all. Some still do. From this perspective, the famous decline of psychoanalysis might have been a welcome relief from the tyrannies of unrelenting zeal. And because the so-called refrigerator mother long has been shorthand for the worst excesses of that zeal, an uncompromising biologism persists for many as a cherished corrective of the damage that zeal did and safeguard against repeated error.

In fact, the fruits of biologism (indeed, of any essentialism) go further: it can be reassuring when we have doubts about ourselves; it shields us from blame; it is relatively easy to understand, and therefore to use in building consensus; and, perhaps most importantly, it is a bedrock of claims for safety, dignity, rights, and justice. Because claims of innateness pull on our sympathy, we use them to fend each other off—interpersonally, politically, clinically, even intrapsychically. And yet, however important these claims may be from the perspective of safety, they may be failing to tell us enough about what else we might be doing to ourselves and each other when we believe and disbelieve things. After all, belief is countertransference too.

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Many authorities on autism describe its essence as a difference or disorder of belief, and of a specific kind of belief at that—the belief that other people believe things. They often state this using the familiar psychological constructs of theory of mind, mentalization, and metacognition. By this they are describing their own picture of an autistic person’s sense of the inside of another person, specifically that person’s mind. Perhaps importantly, there are four minds in this scenario: (1) the authority imagining (2) the autist knowing less about (3) someone’s mind than (4) another person whom the authority considers normal knows about that mind.

Clearly this involves at least two stereotypes: the autist and the normal.

Whatever our ideas of the essence of autism, if there is any, there can be little doubt that sometime in the last quarter of the twentieth century, the uses of those ideas shifted dramatically among a very large group—at least the West, possibly the species. In my view, the shift involved unconscious psychological group work. This is a logic fa-

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miliar from theories of group processes, as in group therapy, in which a group’s use of ideas—and in particular a dramatic change in those uses—expresses underlying unconscious group motivation. From this perspective the great shifts in autism were not passive—something that happened to us, like an earthquake—but rather something we did to each other and ourselves, out of complicated conscious and unconscious motivations. The fuller thought is that unconscious group motivations contributed to the constitution of (a perception of ) a critical mass of autism in shared awareness. Our task would then be to try to understand what these motivations were and why we chose autism to serve them.

Over time, as so many expressed their doubts about psychoanalysis, some gravitated toward the weakest spot, the place where psychoanalysis most feels its shame and least its courage. They perceived that because of the moral record, it is at autism where psychoanalysts least feel—or least voice—the skepticism necessary for their work. It turns out that the context and the phenomena fit together: the former, disillusion and its consequence, impoverishment of belief; the latter, a social form communicating that people do not believe things. They fit so well that they seem mutually reinforcing. And so we might see the autistic theory of mind as neither difference nor disorder, but rather as identification with this social fact, the fact that certain people do not believe things. There can be little doubt that at least psychoanalysts believe much less, and much less intensely than they used to—that they thinned out the courage of their convictions because they are ashamed of themselves.

Of course expressions of suffering are always invitations for care, and in such exchanges both parties get a chance to grow. If what happened with autism is such an invitation, then it is, in my view, at least twofold.

First, the ordinary one that some psychoanalysts have always received and responded to, at times well and at times poorly: to provide analytic therapy to suffering autistic people and those who love them, which analysts go on doing every day. And then a second invitation, perhaps subtler than the first, but whose consequence could be more farreaching: that psychoanalysts dust themselves off and feel something of their old strength, picking up, among other projects, work on the theory of psychogenesis without any necessary reference to the two dominant narratives, biogenesis and blame. This latter interest would call on psychoanalysis to remember itself and its value, which is to say, to surmount its shame. The hope would be the same as with any reparative effort that does not merely become depressive.

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Laplanchean Dialogues with Hélène Tessier November 1, 2022 - January 3, 2023 2ND DIALOGUE *Editor’s note: the first dialogues were included in the Winter DIVISION/Review (Issue #30).

Bryan Batista-Thomas: Which parts of Laplanche’s theory are lost in translation?

Hélène Tessier: I’m a little bit taken aback by this question. Something is effectively lost in translation, but it would be interesting for Laplanche translators to answer it. I have not read Laplanche in other languages aside from French. Laplanche was very aware of what is always lost in translation. His whole metapsychology revolves around this affirmation.

Furthermore, he closely monitored Freud’s German-to-French translation, discussed it with the other translators of his team, and wrote about the decisions that had to be taken while translating—decisions that were never entirely satisfactory. For further developments on the translation of Freud by Laplanche, I would refer you to the collective book Translating Freud.

In the translation of Laplanche’s works, there are, of course, things that are lost. I will try to identify some of them. As preliminary comments, I would say that the choices made in translation depend partly on who translates.

One always translates from one’s formation, interpretations, theories, and, eventually, ideologies. There is also the lexicon of a language. For example, the word “indice,” in French, which is essential in Laplanche’s description of the sexual unconscious, is translated as “index” in English. It makes a huge difference because the term “index” also exists in French–and is to be also found in Laplanche’s theorizing–but means something different than “indice” and can hardly be combined into an expression like “pulsion d’indice” [index drive], which is an earlier formulation of the concept of source-object.

The idea of what is lost in translation is at the basis of Laplanche’s theory of the formation of the sexual unconscious. He developed it extensively in a few papers, including “A Brief Treatise on the Unconscious” in Between Seduction and Inspiration: Man. As you can see, your question touched on a fundamental issue, not only for the practice of translation but for the process of becoming human.

BBT:What about the translation of après-coup?

HT:For après coup, even the French translation loses something from the German.

Laplanche tackled this issue in his translation.

Après coup is not Laplanche’s translation, it’s Lacan’s. Lacan was the one who was interested in this Freudian concept, a concept which is not that prominent in Freud. Before talking

about the concept of après-coup, let us say that Laplanche criticized the English translation of Nachträglichkeit, given by Strachey, which is “deferred action.” He argued that it was a translation enhancing a solipsist perspective, reducing it to a well-known psychological effect of the delay between an event and its psychological repercussions. Deferred action would then be something that happens in time one and has its effects in time two: this is a psychological temporality. This is true for everything and may be more so for traumatic experiences. In the solipsist view of deferred action, the timeline goes like this: past—present—future.

Though Laplanche uses the French translation après-coup, he also underlines that it may lead to another solipsist understanding of the concept, the retroactive effect. In this understanding, which he called “bombe à retardement” [timed detonation], an event of the past is re-interpreted through future circumstances, something similar to re-writing history, which involves a Heideggerian bend. He thinks that this view of après-coup is also solipsist. In this retroactive effect view, the timeline goes past—future—present.

We can refer to the anecdote Laplanche likes to tell—I think it comes from Freud— about the man who says: I cannot believe I was suckling my nounou’s breast! Had I known at the time, I would have enjoyed it more!

For Laplanche, the “deferred action” and the “retroactive effect” perspectives are unsatisfactory because they don’t involve the other. This is why Laplanche proposed that in English, we use the word “afterwardness.” Laplanche’s view of après-coup is dialectic: it involves the other from the start. It is the temporality of the message, which has to originate in the other, and is the temporality of translation. The message implies two moments: moment one, a message coming from the other—in other words, something that makes a sign, which is addressed, which is received by the individual (the infant), and moment two, its eventual translation. For more precision, let us refer to the conclusion of Après-coup: Problématiques VI. Après-coup is not something intrapersonal but instead interpersonal. It is not played out within one individual in the successive stages of his/her/their life but in the simultaneous presence of an adult and a child (Laplanche, House & Thurston, 2017, 156).

The temporality of translation sheds a different light on the time, which Laplanche calls the temps-auto, which is the main time for the formation of infantile sexuality, in other words, auto-erotic sexuality. This time, “auto” is the time when the external message coming from the other becomes an exciting internal other: it is a temporality that is essential to the process of fantasmatization, which is the trademark of infantile sexuality.

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BBT: Are there other words or notions with translational issues?

HT: We can say a few words about other problematic translations of Freud in English, which open the way to a specific Englishspeaking reading of Freud—for example, the word repression. Repression may be the correct translation for Verdrängung in English. But in French, the word chosen is refoulement. As you can see, a different line of interpretation opens if you speak about repression, which has a more general social meaning, and refoulement, which is more directly related to physics. We may say that a society is repressive, that there is police repression, or that religion or morals lead to the repression of certain acts. At the same time, refoulement is much more a term of physics. In French, the image that comes with refoulement is pressure: “refoulement des eaux, ou des égouts.”

BBT: Is “of a sewer”?

HT: Yes, sewer. When you are in a city with too much rain or the water does not flow where it must go, it comes back into the houses and basements. This, in French, is called refoulement d’égout. That is refoulement: it is about water or liquid in physics. If you put a barrage to stop the water, and if it does not work and the water floods, that’s refoulement. However, in French psychoanalytic circles, refoulement gets very technical. The word refoulement is still very common: commonly used in French for trivial things, like if a sink is blocked.

In Freud’s work in German, Verdrängung also has the same connotation, the same physical/physicalist image. Laplanche mentions that Freud was quite influenced by physicalist imagery for the circulation of energy in the physics of his time. Repression in English has no connotation that relates to physics. You can see how different it becomes to read “repression” instead of refoulement (or Verdrängung).

In French, the image of something blocked and may flow again comes easily. This image of le retour du refoulé, the “return of the repressed,” becomes handy in French psychoanalysis. It evokes, among other things, blocked water flowing again. It looks very poetic in English, “the return of the repressed,” but it doesn’t mean much. In French, le retour du refoulé, is evocative of a physical phenomena.

Another word would be “obsessional neurosis.” Laplanche objected to Strachey’s and French translations of Zwangsneurose by obsessional neurosis. Laplanche’s translation was névrose de contrainte. A contrainte (Zwang) is something that has a hold on you. In a way, it implies the other, a sense of externality. Even if a contrainte is a self-imposed contrainte, it still conveys the idea of being forced to do something or to think something. An obsession has this quality: it feels beyond your control.

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Another word we can discuss is the translation of Seele, which became “mind” in English—you can see the possible rapprochement with philosophy of mind in the US—and psyche in French, which has a technical and disconnected quality. Laplanche rejected both these words and chose a neologism, an adjective derived from the noun “soul” or “animique.” To translate Seele as mind puts one in the filiation of philosophy of mind, which is very influential in English-speaking circles.

BBT: Why did Laplanche choose animique instead of psychique?

HT: Seele is the German word for âme in French. In English, mind and mental refer easily to “mental” or “mentalization.” In French, using psychique instead of mental is already different, but using animique—which is an adjective for âme, though not used in current French—instead of psychique takes one away from a technical term: it refers to processes which are in the realms of ideas, images etc. In his translation of Freud, Laplanche uses “animique” for “seelisch” and “psychical,” when Freud himself uses psychical or psychic—for example, “Appareil de l’âme” for “psychic apparatus.”

Another example is the expression “psychic reality,” a central concept of Laplanche’s work, that he differentiates from psychological reality. This instance is a translation of Freud using the word “psychical” in German. We will come back to this. I don’t know if the English translation of Laplanche says apparatus of the soul.

They should because that’s what he writes. In Laplanche’s book Translating Freud, he and the other members of the translation team explain their lexical choices.

The neologism may be why Laplanche’s translation of Freud in French is not so wellliked. Psychoanalysts feel more comfortable with the more fluent Freudian French. They rarely use “animique” or “Appareil de l’âme.” But it would be interesting to ask ourselves, why is there this resistance?

BBT: There is a theological bend to it.

HT: Yes, that may be why people resist it. But in German, no. It is a historical word in philosophy, for example, in Aristotle. It may be the same in French or English, but I do not know. Âme refers to the realms of ideas, the one we share with animals of what is not material.

According to Laplanche, what happened with the word psychic, especially in French psychique, is that the reference became a technical term.

People use it in all sorts of circumstances but without thinking about it.

BBT: In talking about translation in this way, there’s a way in which we are metaphorically speaking about Laplanche’s Translational Model of Repression. I am now going to make a fairly large pivot: I understand there’s a whole historical context of Laplanche being pushed out of mainstream psychoanalysis in France.

HT: Yes and no. We can say that it was the opposite, at least concerning the IPA,

but maybe not within French psychoanalytic circles, which, according to what I know, the relations within psychoanalytical schools were complex. On this topic, you may want to read Francis Martens’s new book, Lacan pris au mot: Les fureurs de Bonneval ou Laplanche maudit par son maître.

Concerning the IPA, it was Lacan who was pushed out of the IPA for a set of reasons.

Laplanche and others, like Jean-Bertrand Pontalis, founded the APF (French Psychoanalytic Association): they wanted to remain in the IPA. BBT: I was referring to his theory.

HT: I will answer based on what I know and have observed, not from France but Canada.

In France, I usually work more closely with analysts close to Laplanche’s work. According to what I know, his theory was never mainstream in French psychoanalysis. He was well-considered when developing the Vocabulaire de la psychanalyse [The Language of Psychoanalysis] and the Problématiques. However, when, in 1987, he published New Foundations for Psychoanalysis and developed his own theory, he became less popular than others, like Pontalis or André Green. His criticism of Freudian concepts like the Oedipus and Castration complexes, and more generally of mythosymbolism, when used as defining primary content of sexuality, have been, I believe, a source of irritation. In addition, there was also his critical discussion of recognized authors, like Winnicott, and, in general, of dominating trends that, according to Laplanche, were definitely leading to a desexualization of psychoanalysis.

On the issue of sexuality, I think that Laplanche’s thought represents the only possible way out for psychoanalysis. On the one hand, he rejected the classical definition of sexuality in psychoanalysis, its normative view on the differences between the sexes and the composition of the family but, on the other hand, without joining other critics of the same issues in overlooking the central role of infantile sexuality in psychoanalysis. He came up with another way of conceptualizing sexuality and its formation in psychoanalysis. He did so by building from a Freudian definition of infantile sexuality: a sexuality that is perverse and polymorphous. To the difference of Freud, he underlined that this sexuality originates in fantasy, is not linked to the difference of the sexes, and has no reproductive aim. He parted from Freud’s “temptation of biology,” so to speak, and from Freud’s use of phylogenesis and mythosymbolic tools to account for the formation and content of human sexuality. He also made clear that in psychoanalysis, the focus on sexuality requires a focus on infantile sexuality, which invades everything, including adult sexuality.

Laplanche affirms, for example, that there is nothing sexual in Oedipus. Quite the opposite, he describes it as anti-sexual. It is a tool, among others—maybe less popular than it used to be in 1960—at the disposal of the ego to 24

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bind the excitement linked to the attack of the sexual death drive.

Another part of the criticism of Laplanche’s work, mainly in France, revolves around the scientific nature of his metapsychology, his requirement or argument for the necessity of scientific truth, coherence, and a systematic integration of all parts of this metapsychology, including when it accounts for the action of clinical psychoanalysis.

On a more general level, we still have to say that everybody respects Laplanche’s work: nobody would have said that Laplanche did not know Freud or psychoanalysis. He was sometimes accused of not being clinical enough.

Some said he was not doing enough clinical practice and was too much of a theoretician.

On the level of clinical practice, I cannot say.

However, on being clinically useful, I totally disagree. Laplanche’s metapsychology goes hand in hand with the practice of psychoanalysis. It is a way to account for the clinical action of psychoanalysis.

In some French circles, Laplanche is described as a repentant Lacanian, a pale copy of Lacan’s original theorizing. I disagree with this statement: the two are on two opposite epistemological planets and belong to different philosophical traditions.

BBT: What do you mean by “a systematic integration of his metapsychology” that would have led to a criticism of his work?

HT: In Vie et mort en psychanalyse [Life and Death in Psychoanalysis] and in the first five Problématiques, Laplanche was considered a critical reader of Freud, which indeed he was.

Though he started early on to emphasize the original definition of some concepts, his writings were still very much a discussion with Freud. From New Foundations for Psychoanalysis, Laplanche formulated a theory: the General Theory of Seduction. Even though most of the pillars of the theory were developed in previous books, in New Foundations for Psychoanalysis, Laplanche assumed the consequences of presenting a systematized theory, which, in some circles, was seen as a provocation. If it was not a provocation, it was certainly a rejection of the postmodern and deconstructivist epistemological trends. Freud also, but at a different point in time, when it was less polemical, presented a theoretical system: more precisely, he formulated two systematized models: the first topographical model and the second structural model.

French psychoanalytic circles are close to philosophical circles. Since the 1970’s, philosophical circles have moved towards postmodern deconstructionism. These trends imply a contestation, or at least a de-consideration of the idea of scientific truth. In elaborating on his theory, Laplanche keeps in line with the rationalist tradition (see Rationalism and Emancipation in Psychoanalysis: The Work of Jean Laplanche), strongly anchored in humanism.

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In that respect, he situated himself in an antipostmodern epistemological endeavor, which he openly affirms. The systematic approach to theorizing and the definition of metapsychology has a science that should try to tell truths about its object as part of this affirmation.

In psychoanalysis, the unconscious is often described as impossible to account for scientifically. This objective is seen as a counter-productive pursuit since the nature of the unconscious would be to express itself in a poetic, associative, ethereal form. Laplanche disagrees with such a position. For him, clinical practice has to keep away from the theory: the analyst should work: listening with free-floating attention, concentrate on the associative/dissociative method of psychoanalysis, accepting the refusement [refusal], which goes along with an attitude of respect for his/her/their unconscious. However, analytic theory and metapsychology have different purposes: they aim to account for psychoanalysis’s mode of action and the formation of the human soul and its possible transformations. This is, for him, a scientific objective.

BBT: How do you understand the interest in his work now in North America?

HT: It certainly has to do with the increased availability of the translated Laplanche’s work, especially in English. For a few years, there was a real acceleration of the translation in English. The fact that Laplanche is dead may also make it easier to approach his work. Direct discussions with him are no longer possible: his theory may be presented as closer than it is to other theories that proceed from a different epistemological inspiration. So, this interest can also dilute Laplanche’s specificity and radical difference from other psychoanalytic theories.

This being said, I will highlight why I think Laplanche’s work is of great interest to contemporary psychoanalysis. I just discussed most of this above in a different context, but it is worth insisting on. Laplanche’s metapsychology is fundamentally nonsexist, and his definition of sexuality is non-normative, to the difference of most psychoanalytic theories. It has a nonnormative view of the family, with no reference to abstract concepts such as “the Maternal,” “the Paternal,” “the Feminine,” “the Masculine,” etc. His definition of the Fundamental Anthropological Situation is as simple and as nonnormative as possible: an infant with no unconscious in the presence of an adult—or an older child—who has one. There is no mention of family structures, family ties, gender, or differences between the sexes.

The same with his definition of infantile sexuality. As I said, in Laplanche’s definition, infantile sexuality has its roots in fantasy, is polymorphous and perverse—that is to say, essentially, masochistic and sadistic—and has no links to reproduction and the difference of the sexes.

Maybe this is why some theorists of Cultural studies, Film Studies, and Gender

Studies, like Teresa De Laurentiis and Judith Butler, took an interest in Laplanche’s work. I do not know enough to comment on their uses of Laplanche’s work. Still, from what I read, it seemed related to a different epistemology, closer to a Neofoucauldian inspiration.

It is worth repeating that the other great interest of Laplanche’s work for contemporary psychoanalysis is his way of re-affirming the centrality of infantile sexuality in psychoanalysis. In so doing, he enhances the specificity of psychoanalysis, its method, and its clinical stance. Even if his work moves away from Freud’s theory in many aspects, Laplanche considers that the sexual unconscious remains the center of interest of clinical psychoanalysis, which constitutes a unique way to access its derivatives.

BBT: I will make another pivot: do you think there are holes or incongruencies in Laplanche’s work?

HT: Laplanche’s development of the enclave [unconscious enclave], which I referred to earlier, raises questions for me. He states that this enclave contains messages that encounter a radical failure of translation and messages waiting for translation. Let’s leave the part about messages awaiting translation and concentrate on messages that face a radical failure of translation. We must ask ourselves what messages we face with this radical failure. What makes them untranslatable? Among other messages on which we will come back, Laplanche mentions messages that are barely messages, messages where the translation is the message itself, and messages of unbound violence, totally invaded by the sexual unconscious. This raises three issues: What makes a message translatable or untranslatable? Second, is a message invaded by the sexual unconscious still a message? Thirdly, is a message of unbound violence “sexual”?

If we follow Laplanche’s reasoning about translation, what renders translation an option is the internal imbalance of a message; in other words, its compromised nature is caused by unconscious fantasies1. If the message is invaded by the sexual unconscious (meaning fantasies), yes, it could become untranslatable. But the opposite would also be true; a message deprived of unconscious fantasies would also be nontranslatable or uncompromised. Laplanche does not go into the uncompromised. He sorts of postulates that it’s compromised; I think this can be questioned. I am inclined to think that messages encountering radical failure of translation are of the latter type, in other words, totally uncompromised. Especially since, as Laplanche writes, the unconscious enclave is not sexual: topically, it is in a different location than the topographical system constituted by the sexual unconscious and the Ego. As Laplanche writes, they express unbound violence and this, according to me would have more to do with self-preservation, a negative self-preservation, if you will, but still self-preservation, especially 25

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considering, let’s say, the clinical implications of these messages, which have to do with violence.

We then deal with life and death, not of the ego, but of the individual.

The other aspect of my questions revolves around Laplanche’s affirmation that these messages are barely messages. I agree: what he means, I think, is that they only conserve the material element of the message, which is the address. They still “make a sign.” But I suggest that instead of messages, we call them “signal,” a term borrowed from semiotics. A signal cannot be translated because it cannot be interpreted; nothing is lost in translation. It calls for obedience, not translation.

The purpose of Laplanche in developing the idea of an unconscious enclave was to propose a unified model of the human soul and to account for fully protected psychotic breakdown. It is a worthwhile objective that goes along with the requirement of systematization that he put as a standard for his theory. One of the important theoretical consequences of this model, and here, as you can see, I am not expressing dissent with Laplanche’s idea but elaborating on them, is we have to remember that the unconscious enclave, not being translatable, does not undergo repression and for that reason, do not contribute, neither to the formation of the sexual unconscious and to the formation of the ego. They stay as external messages, covered, as Laplanche writes, by a thin layer of consciousness. For this part, the individual was governed by something coming from the outside, reluctant to be integrated into an auto-historicization in a story about oneself.

BBT: Shall we stop here? Analysis is always incomplete and open to further elaboration. Thank you for your time, Hélène.

HT: My pleasure.

REFERENCES Laplanche, J., & Mehlman, J. (1976). Life and Death in Psychoanalysis. John Hopkins U.P. Laplanche, J., & Pontalis, J.-B. (1988). The Language of Psychoanalysis. Karnac Books and the Institute of Psycho-analysis.

Laplanche, J. (2011). Freud and the Sexual. The Unconscious in Translation.

Laplanche, J., & Mehlman, J. (2015). Between Seduction and Inspiration: Man. The Unconscious in Translation.

Laplanche, J., & House, J. (2016). New Foundations for Psychoanalysis. The Unconscious in Translation.

Laplanche, J., House, J., & Thurston, L. (2017). Après-coup: Problématiques VI. The Unconscious in Translation.

Laplanche, J., & Thurston, L. (2020). The Unfinished Copernican Revolution: Selected Works, 1967-1992. The Unconscious in Translation.

Martens, F. (2022). Lacan pris au mot: Les fureurs de bonneval ou Laplanche maudit par son Maître. Hermann.

Ornston, D. G. (1993). Translating Freud. Yale University Press.

Tessier, H. (2012). “Métapsychologie, Épistémologie et éthique de la clinique psychanalytique, Psicologia im estudo.” Vol 17, no 3 Jul. Set. 2012, pp 373-381.

Tessier, H. (2020). Rationalism and Emancipation in Psychoanalysis: The Work of Jean Laplanche. The Unconscious in Translation.

Endnotes 1. This is in Laplanche’s theory. We have to underline that it is in accordance with translational theory in semiotics: a translation is never without a residue, except for signs which bear their own codes of translation (a stop sign, for example).

NOTES ON CONTRIBUTORS

NOTES ON CONTRIBUTORS

Jay Crosby, Ph.D. is a clinical psychologist and psychoanalyst in private practice in New York. He is on the faculty at the Columbia University Center for Psychoanalytic Training and Research where he trained as a psychoanalyst, and is a Clinical Assistant Professor in Psychiatry at NYU School of Medicine. He has written, published, and presented papers on a range of topics including early psychosis, the psychodynamics of overstimulation, and messianism and object use. He has a Ph.D. from the Derner Institute at Adelphi University, received additional clinical training from the Melanie Klein Trust and has an A.M. in the History of Religions from the University of Chicago.

Andrew B. Druck, PhD., ABPP, is a Fellow (Training and Supervising Analyst), past President, former Dean of Training, and Faculty member at the Institute for Psychoanalytic Training and Research (IPTAR). He is a Clinical Assistant Professor of Psychology, Faculty member and Supervising Analyst at the New York University Postdoctoral Program in Psychotherapy and Psychoanalysis. He is the author of Four Therapeutic Approaches to the Borderline Patient.

Benjamin Morsa, PsyD is a clinical psychologist and psychoanalytic practitioner in Oakland, CA. He founded the group practice Tide Pools, a psychological corporation, a generalist practice that specializes in psychoanalytic work with gender diverse and neurodivergent patients. He offers psychotherapy, psychological assessment, consultation, and training. His clinical and scholarly interests include interdisciplinary approaches to psychoanalysis, the Rorschach, forensic educational assessment, autism, neurodevelopmental differences, gender, sex and sexuality, mycology, and the philosophy of science. He has taught graduate and postgraduate students at psychodynamic and psychoanalytic programs in the Bay. He is also a musician and all-around polymath.

Dr Valerie Sinason, is a poet, writer, child and adolescent psychoanalytic psychotherapist (retired), Bowlby Centre attachmentbased psychotherapist (retd) and adult psychoanalyst . She has specialised in trauma and disability for over forty years within the public sector at the Tavistock Clinic, St George’s’ Hospital Medical School and schools for disturbed children and has edited, co-edited or written twenty five books, 264 papers, reviews and chapters, and lectures nationally and internationally. Founder and now Patron for the Clinic for Dissociative Studies UK, President of the Institute for Psychotherapy and Disability, she is a Fellow and current board member of the ISSTD and received their 2017 Lifetime Achievement Award , the British Psychoanalytic Council’s Innovation Excellence Award, 2022 and the Swedish life membership of POMS. She is an honorary consultant psychotherapist at the Cape Town Child Guidance Clinic. Her first novel is The Orpheus Project (2022), Sphinx books.

Brian E. Smith, Ph.D., J.D. is a general and addictions psychologist and psychoanalyst in private practice in New York City. He is Assistant Clinical Professor of Medical Psychology at Columbia University College of Physicians and Surgeons, and is President of the Division on Addictions of the New York State Psychological Association. He has taught and supervised trainees at a number of hospitals, graduate schools, and law schools.

A graduate of the Columbia University Center for Psychoanalytic Training & Research, where he is on the faculty, he holds a Ph.D. in clinical psychology from The Derner Institute at Adelphi University, and a law degree from Yale.

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Hélène Tessier, LL.M., D.E.A., Ph.D. is a psychoanalyst, a member of the Canadian Psychoanalytic Society and the International Psychoanalytic Association, and a lawyer member of the Quebec Bar. She is a Full Professor in the School of Conflict Studies in the Faculty of Human Sciences and Philosophy at Saint Paul University (Ottawa).

She is the Vice-President of the Scientific Council of La Fondation Jean Laplanche/ Nouveaux Fondements pour la psychanalyse and the author of publications on Laplanche’s work and their epistemological and ethical implications.

Bryan Batista-Thomas, LCSW, MA, is a psychoanalytic candidate at IPTAR and a graduate of Performance Studies from NYU Tisch School of the Arts, where he focused on the queerness of temporality, the performativity of epistemology, and oral traditions. He is currently preparing a manuscript provisionally entitled Readings of Jean Laplanche in Process: Conversations Amplifying Differences (forthcoming Routledge 2024). Bryan works full-time in private practice.

Ricky Varghese, is a psychoanalyst and writer based in Toronto. He writes about sex and death,queer porn and art,memory and memoir, and Judaism and Kerala—not always in that order. He has edited Raw: PrEP, Pedagogy, and the Politics of Barebacking (University of Regina Press, 2019) and the forthcoming Little Deaths: Politics and Psychoanalysis in the Age of Pandemics (University of Regina Press, 2025). Presently, he is also completing two monographs: The Look Back: Mourning, Melancholia, and the Madness of Loss is a study linking the experience of melancholia in the works of Sigmund Freud and Walter Benjamin, while Leave-taking: Sex, Death, Ethics is an exploration of the relationship between suicidality, late capitalism, and the death drive. His writings have appeared in publications such as the Los Angeles Review of Books, the LARB Quarterly, Porn Studies, Drain Magazine, and the Gay and Lesbian Quarterly, to name a few